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Immunization coverage and its relationship to preventive health care visits among inner-city children in Baltimore
1Department of Maternal and Child Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205.
Insights
Many young infants are underimmunized despite regular preventive visits. On-time DTP1 vaccination significantly improves overall immunization status by 24 months, highlighting critical early intervention needs.
Area of Science:
- Pediatrics
- Public Health
- Immunization
Background:
- Childhood immunization is crucial for public health.
- Assessing preventive healthcare access and immunization coverage in urban populations is vital for policy development.
Purpose of the Study:
- To provide empirical data on immunization coverage and preventive healthcare receipt among inner-city children.
- To inform policymakers on strategies to enhance childhood immunization rates.
Main Methods:
- A random sample of 557 2-year-old children in inner-city Baltimore was surveyed.
- Preventive healthcare visits and immunization status were obtained via medical record audits.
Main Results:
- By 7 months, less than 40% of children had age-appropriate preventive visits.
- Immunization rates at 24 months included DTP1 (71%), DTP3 (39%), and MMR (53%).
- On-time DTP1 vaccination doubled the likelihood of being up-to-date by 24 months.
Conclusions:
- The primary healthcare system's performance, particularly in the first 6 months, needs improvement.
- Many infants remain underimmunized despite regular visits and insurance.
- Routine 12-month measles-mumps-rubella (MMR) vaccination initiation is recommended for high-risk populations.
Objective:
To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization.
Design And Methods:
We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers.
Main Outcome Measures:
Age-appropriate immunizations and preventive health care visits.
Results:
By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age.
Conclusions:
Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.