It Takes a Village:
Childhood Immunization Is Ongoing Priority

Every Child by Two. Shots for Tots. All Kids Count. Together for Tots. Baby Track. Head Start Sibling Immunization Drive. These are just some of the program titles in the array of local, State, and Federal efforts targeting the immunization of infants and children.

Such public health efforts are essential for several reasons:

• A new cohort of children is born every year, and they all need immunizations.
• Many children have been missed because of problems ranging from overlooked opportunities by health care providers to inadequate services for needy families to poor record keeping. For example, some of today's preteenagers were not targeted by infant immunization efforts when the chickenpox vaccine was made available in March 1995. Now, these children need immunization (see box in Focus, "It's Never Too Late . . . To Immunize for Chickenpox").
• Recommendations may be revised from time to time, as is the case for the poliovirus vaccine policy.

Although progress in improving immunization rates has been significant, about 1 million children under age 2 are not fully immunized. One Healthy People 2000 immunization objective is to increase basic immunization levels for children under age 2 to at least 90 percent from 1985's baseline of 64 percent; at the midcourse review, the halfway mark had not been achieved.

As reported in Progress Review: Immunization and Infectious Diseases, efforts to achieve the objective include targeting specific populations and linking immunization services to other important services for children. Indeed, linkage and interagency cooperation have become key elements, as reflected in the coordinated public outreach effort known as the Children's Health Care Initiative (CHCI), for which HHS Secretary Shalala serves as the national spokesperson. The Health Care Financing Administration (HCFA) and Health Resources and Services Administration (HRSA) are the co-lead agencies for CHCI. Other participating agencies include the Administration on Children and Families (ACF), which promotes immunization as an integral component of the healthy and safe development of young children in child care; the Agency for Health Care Policy and Research, which is investigating the impact of managed care on services provided to children; and CDC, which has a number of child-related programs.

The CHCI builds on existing programs, including President Clinton's Children's Immunization Initiative, to improve immunization services for needy families; reduce vaccine costs for lower income and uninsured families; increase community outreach, participation, and partnerships; and enhance vaccines and vaccine use. Specific immunization programs feature community-based and collaborative activities. For example:

• CDC provided a community guide in its kit for this year's National Infant Immunization Week. With the theme of "Don't Wait-Vaccinate," the kit contained many suggestions for activities that public and private organizations could cosponsor.
• Immunization information and vaccine schedules are available in English at (800)232-2522, in Spanish at (800)232-0233, and on CDC's home page (http://www.cdc.gov/).
• CDC and HCFA are providing technical assistance to immunization projects and State Medicaid programs.
• ACF's Child Care Bureau and HRSA's Maternal and Child Health Bureau sponsor the Healthy Child Care America Campaign and help communities follow the Blueprint for Action. Immunization strategies encompass training, technical assistance, information dissemination, and collaboration.
• The Guardian Angel project, a co-operative effort with the Arkansas Department of Health, the City of Little Rock, and various organizations, such as Rotary International, emphasizes taking the vaccines to children, especially in underserved areas. The project has enlisted more than 50 child care facilities, including Child Development Centers, Head Start programs, and pediatric treatment centers, in identifying children who are due or behind with immunizations. Vaccinations are later administered on site. The result is vastly increased immunization rates.
• Through CDC's National Immunization Outreach Program:
  • McDonald's printed immunization information on tray liners;
  • Rotary Club members in New Jersey distributed immunization flyers and t-shirts;
  • Kmart, in cooperation with Procter & Gamble, provided diaper coupons to clients whose children were up to date on immunizations; and
  • Country singer Bonnie Raitt promoted infant immunization during her national tour.

Similar success is being reported throughout the country as communities adopt the "It Takes a Village" concept in improving children's immunization rates.

*The Advisory Committee on Immunization Practices (ACIP) announced in January the most substantive change in policy since the introduction of oral poliovirus vaccine (OPV) in 1961, with three options now recommended: sequential vaccination with inactivated polio-virus vaccine (IPV) followed by OPV, OPV alone, or IPV alone. For overall public health benefit, ACIP recommends a sequential vac-cination schedule of two doses of IPV followed by two doses of OPV for routine childhood vaccination.

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