Infant care in Hasbro is excellent, as demonstrated in percent of patients up-to-date for all vaccinations by age 35 months.  DTP was 84% for 1999, HIB was 94%, HBV was 93%, MMR was 93%, Polio was 82%, and the total was 82%.  Varicella even increased in coverage percentage from 56% to 74% in one year. However, adolescent vaccination coverage is strikingly in need of improvement.  Reasons may vary. Adolescents currently enrolled may not have received complete care as infants in a different state where free vaccines are not available, or where infant care was not as accessible.  However, upon reaching Hasbro these adolescents were not able to catch up on required vaccines for reasons for which we can only speculate because the nature of this study does not go that far. 

Adolescents may tend to visit the doctor less for checkups than infants for obvious reasons ’Äì they and their parents may worry less because they are much stronger than they were as infants.  Adolescents may only visit during acute or emergency situations causing preventative vaccination to most likely be the last thing on a doctor, patient or parent’Äôs mind.  However, it is clear that adolescent care must be improved.  Lack of immunization is an indication of lack of health care, whether on the part of the system’Äôs or patient’Äôs negligence, lack of access, or any number of reasons.

Rhode Island offers free vaccines because they are state purchased.  Our study population, all welfare recipient, RIte Care members can be vaccinated for free.  Thus the price of the vaccines themselves is not the barrier to vaccination. However, undervaccination still exists and is possibly a direct public health issue to the community.  It is also a reflection that certain members of the population are not reached by the health care system, perhaps are neglected or missed.  Why?  It is most likely a combination of many of these other issues, including access.  Vaccination during acute visits if patients are not visiting the physician regularly may increase vaccination levels. 

Physicians/hospitals need to keep vaccination track records more persistently, more on the forefront.  If patient information systems were designed to alert caregivers when a vaccination is approaching (perhaps computer systems that flash a vaccine or its impending date when a patient’Äôs name is entered into the system, or a hard copy notice in the front of a record) or past due, caregivers could be reminded of the importance at each visit to keep a child on track.  Educating the general population on the importance of vaccination, improving neonatal care, improving preventative care not just for young children but for adolescents, changing attitudes that cause parents to hesitate on the importance of vaccination ’Äì these are some general areas that can then be broken down into specific strategies in order to improve vaccination coverage, especially in a population that can access the vaccines themselves for free, removing one of the barriers most of the population has.

Despite the tremendous impact of vaccinations on the level of these diseases in the United States, there are still some communities who are under-vaccinated.  It is in these populations that outbreaks of vaccine-preventable disease, such as measles, continue to occur and account for significant morbidity or mortality.  Hepatitis B is no different. The American Academy of Pediatrics has deemed routine vaccination of Hepatitis B beneficial and necessary.   There has been substantial progress in fully vaccinating children against Hepatits B, but greater efforts are needed to ensure that all infants receive 3 doses of hepatitis B vaccine.  In a Chicago study in 1998 of children (19 to 35 mo), only 10% of the high-risk and 2% of public housing  community compared to 14% city-wide had completed HBV series.  It is clear from this urban study that children in public housing remain at increased risk for vaccine-preventable disease.  Factors that have been associated with higher immunization levels for urban minority preschool children include:

• establishment of a continuous primary-care relationship
  earlier age at first immunization
  lower birth weight
   

 There is emerging data that in populations with very high rates of chronic HBV infection, new chronic hepatitis B virus infections can be eliminated by immunizing the children.  In 1983-87 the statewide prevalence of HbsAg among Alaska Natives was 3.1% (around 756) and after a comprehensive hepatitis B vaccination program a study in 1999 found only 2 infections.   Comprehensive programs which vaccinate all children in birth in all areas (including rural and underserved) and with the addition of catch-up vaccination for those not vaccinated as infants could rapidly eliminate this cause of chronic liver disease and cancer.  However, the cost of catch-up vaccinations may not be affordable in all settings.  Increasing the familiarity with hepatitis B vaccine, greater attention to follow-up and the ability to offer the vaccine for reduced cost may increase immunization coverage.

 Things to keep in mind with our study:

• assessment of records of vaccination coverage kept at Hospitals is useful to monitor that facility and evaluate missed opportunities- yet this assessment doesn’Äôt provide info on children not at this facility and those with the fewest care visits’Ķ
• actual vaccination coverage may have been underestimated.

This web site was developed by undergraduate students at Brown University as a project for a course in vaccine development (Bio 160). An effort has been made to present information on the prevalent opinions available at this time.  References to published articles and acknowledgements of other sources are cited in the text.  The authors of this web site are not certified medical professionals.  Biomedical research and clinical medicine are constantly evolving fields, thus it is possible that significant advances in research and treatments will come into existence following posting of this web site.