Abstract
OBJECTIVES: In 1989 and 1990 the United States experienced a measles epidemic with more than 18,000 and 27,000 reported cases, respectively. Nearly half of all persons with measles were unvaccinated preschool children under 5 years of age. We sought to identify potential sites for vaccine delivery. METHODS. Preschool children with measles were surveyed in five inner cities with measles outbreaks in 1989 to 1990 to assess the children's use of health care services and federal assistance programs before contracting measles. RESULTS. Of 972 case children surveyed, 618 (64%) were eligible for measles vaccination at measles onset. Of those, 93% had previously visited a health care provider (private physician, public clinic, hospital emergency department, or hospital outpatient department) and 65% were enrolled in a federal assistance program (AFDC, WIC, or food stamps). Based on parent-reported reasons for health care visits, in Dallas and New York City, health care providers of 24% of 172 children may have missed at least one opportunity to administer measles vaccine. CONCLUSIONS. Many potential opportunities exist to raise the vaccination coverage of unvaccinated preschool children. These opportunities depend on (1) health care providers taking advantage of all opportunities to vaccinate, and (2) immunization services being linked to federal assistance programs.
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Selected References
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- Atkinson W. L., Orenstein W. A., Krugman S. The resurgence of measles in the United States, 1989-1990. Annu Rev Med. 1992;43:451–463. doi: 10.1146/annurev.me.43.020192.002315. [DOI] [PubMed] [Google Scholar]
- Cutts F. T., Orenstein W. A., Bernier R. H. Causes of low preschool immunization coverage in the United States. Annu Rev Public Health. 1992;13:385–398. doi: 10.1146/annurev.pu.13.050192.002125. [DOI] [PubMed] [Google Scholar]
- Gindler J. S., Cutts F. T., Barnett-Antinori M. E., Zell E. R., Swint E. B., Hadler S. C., Rullán J. V. Successes and failures in vaccine delivery: evaluation of the immunization delivery system in Puerto Rico. Pediatrics. 1993 Feb;91(2):315–320. [PubMed] [Google Scholar]
- Hayward R. A., Bernard A. M., Freeman H. E., Corey C. R. Regular source of ambulatory care and access to health services. Am J Public Health. 1991 Apr;81(4):434–438. doi: 10.2105/ajph.81.4.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hutchins S. S., Escolan J., Markowitz L. E., Hawkins C., Kimbler A., Morgan R. A., Preblud S. R., Orenstein W. A. Measles outbreak among unvaccinated preschool-aged children: opportunities missed by health care providers to administer measles vaccine. Pediatrics. 1989 Mar;83(3):369–374. [PubMed] [Google Scholar]
- Orenstein W. A., Atkinson W., Mason D., Bernier R. H. Barriers to vaccinating preschool children. J Health Care Poor Underserved. 1990 Winter;1(3):315–330. doi: 10.1353/hpu.2010.0324. [DOI] [PubMed] [Google Scholar]
- Treviño F. M., Moyer M. E., Valdez R. B., Stroup-Benham C. A. Health insurance coverage and utilization of health services by Mexican Americans, mainland Puerto Ricans, and Cuban Americans. JAMA. 1991 Jan 9;265(2):233–237. doi: 10.1001/jama.1991.03460020087034. [DOI] [PubMed] [Google Scholar]