| Simultaneous administration of vaccines Administering more than
one injection in a visit, is often perceived by parents and practitioners as cruel or
undesirable for the infant. Failure to practice simultaneous administration is most
evident in the comparison of the data on the fourth DTaP (69 percent) and the first
measles, mumps and rubella vaccine (87 percent) which should be administered in the same
visit. There are no contraindications for simultaneous immunization, even up to five
injections in a visit, and the probability of a timely return for further immunizations is
low. Simultaneous immunization is the recommended standard of care. The complexity and
frequent changes in the infant immunization schedule makes simultaneous administration a
significant factor in a successful program. HDHHS programs have always practiced
simultaneous administration. HDHHS nurses encourage parental consent for simultaneous
administration through education.
Utilization of the accelerated schedule.
If an infant is behind on immunizations at six or twelve months, they are unlikely to
be up-to-date at 24 months. HDHHS will provide additional information to local physicians
on the accelerated schedule this Spring in efforts to improve immunization rates and
protect pre-school children.
Lack of an immunization registry.
There has been significant progress in the past several years with immunization
registries in various state and local health departments. The registry would list each
child and all the pertinent information regarding their immunization status so that the
reliance on a parent to keep track of a paper record is reduced and the immunization
history is consolidated. The registry provides the practitioner an automatic assessment of
the immunization coverage for their practice. The registry often has an automated feature
which sends out reminder/recall cards to parents for the next or past due immunization
visit. Texas Children's Hospital has taken the lead in developing an immunization registry
for Houston and Harris County. The registry will begin field testing in a HDHHS health
center this summer.
Universal coverage
Universal coverage is a significant feature in the success of Massachusetts' excellent
immunization |
| coverage levels. Universal coverage means that the state pays for the
vaccines for all children and is not eligibility based. Parents can seek immunizations at
any immunization venue and administration fees are waived for those who cannot pay. It is
unlikely that this option will be available in Texas. HDHHS has encouraged the Texas
Department of Health to reimburse all providers who immunize Medicaid patients as opposed
to only contract providers. Nationally and locally, there is a small but vocal, well
organized anti-immunization movement.
This movement is associated with fear of government health programs and the potential
for vaccine side-effects.
As of the Spring of 1998, all Harris County Medicaid patients were enrolled in one of
six health maintenance organizations. The impact this transition of care has had on
immunization rates is yet to be determined. Optimally, primary care physicians will be
aggressive on behalf of their patients to ensure proper immunization.
HDHHS has two venues for infant immunizations: direct delivery at health centers and
mobile sites and Vaccine for Children (VFC) where private physicians are provided with
vaccine by HDHHS for their low income patients. There are approximately 400 private
physicians enrolled in VFC. The total doses administered through these two programs have
increased each year.
|
HDHHS Vaccine Dosage Administration
|
| Year |
Direct
Admin |
VFC Doses |
Total |
| 1991 |
358,730 |
74,998 |
433,728 |
| 1992 |
374,340 |
94,048 |
468,388 |
| 1993 |
411,244 |
154,135 |
565,379 |
| 1994 |
334,591 |
261,968 |
596,559 |
| 1995 |
408,359 |
251,383 |
659,742 |
| 1996 |
420,881 |
268,894 |
689,775 |
| 1997 |
391,697 |
318,958 |
710,655 |
| 1998 |
349,974 |
393,932 |
743,906 |
|
In 1993, the transition between direct doses administered by HDHHS and VFC doses began to
shift. In 1998, the VFC program overtook the direct delivery program. HDHHS offers
immunizations for free or $1 ($3 effective in May) at our 44 sites. Immunization services
are available from 8 AM to 5 PM weekdays, evenings and Saturdays. Immunizations are al |
|