Immunization status of children on school entry: area analysis and recommendations 1991

The objective of the study was to examine the immunization status of children entering school as of September 1990 in two selected school districts in the Pittsburgh area. Immunization levels were determined by review of the students' school health/immunization records using AAP recommendations for age-appropriate vaccines for these children at the onset of the study. A telephone survey of parents was then conducted. Reasons for lack of adequate immunizations and demographic data were examined in the survey. Two hundred eighty-one records were reviewed. Only 122 (43%) of children were fully immunized (FI) according to the recommendations used. From the total, 237 (84%) families were successfully contacted by telephone; 109 (46%) children from this subset were FI. Both districts were similar for immunization status and demographic data. Seventy-one percent of the children were missing DTP, 48% HIB, and 44% OPV. All children had at least one MMR. The mean age of the children was 5.4 years (SD = 0.35). Potential missed opportunities for immunization were identified. Ninety-six percent (n = 237) of students not fully immunized (NFI) had seen a physician at least once within the past year and 65% within the past six months. Parental lack of knowledge for the need for vaccines was the reason most often identified by parents (58%) for their child's missing vaccine(s). A significant number of children in this study were found to be lacking recommended immunizations for age at entry to school despite a recent physician visit. Although many were still within the recommended age range for receiving needed immunizations, a large number of their parents stated that they did not know further vaccines were needed. Contrary to previous reports, cost, access, illness, and mobility were not identified by parents as reasons for missing vaccines in their children. Future efforts targeting immunization must emphasize better education of parents and physicians.