LOW IMMUNIZATION RATES AMONG SOME CITY CHILDREN RAISE CONCERN Despite widespread access to medical care, only about half of Baltimore's inner-city children are fully vaccinated by the time they reach age 2, according to a School of Public Health study published in the July issue of _Pediatrics_. The survey of immunization coverage and preventive health care for inner-city preschool children in Baltimore was begun in response to an outbreak of measles in Baltimore and other urban areas in 1989 and 1990. The outbreak was attributed to low rates of immunization. Principal investigator Bernard Guyer, professor and chair of maternal and child health in the School of Public Health, said the results of the study indicate the need for a more responsive primary health care system. By age 3 months, almost 80 percent of the children surveyed had made age-appropriate health visits, and 75 percent had made similar visits between the ages of 12 and 17 months. Yet the study found only 53 percent of the children had received a measles-mumps-rubella vaccination, and 39 percent had received the third in a series of four diphtheria-tetanus-polio shots needed for complete immunological coverage. Overall, the immunization rate for 2-year-olds in Baltimore's inner city was 54 percent. The low rates occurred even though the majority of the children were taken for preventive health care, their treatment is covered by Medicaid and their providers receive free vaccine from public agencies. Similar low levels of coverage have been observed for low-income children in inner-city areas of Philadelphia and Los Angeles. Dr. Guyer called for a cooperative effort -- including changes in how immunizations are administered -- between city and state health departments, advocacy groups, providers and parents to improve the nation's childhood immunization rates. Some changes have already been made. Earlier this year, the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommended that doctors begin giving children the measles-mumps-rubella vaccine at 12 months, instead of 15. "This is important because we found that 18 percent of children made a preventive health visit during this early period, but did not return in time for their immunization," Dr. Guyer said. Researchers based their findings on a random sample of 557 2-year-old children living in the inner city of Baltimore. Data were collected from the children's medical records and through interviews with parents and health care providers.
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