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Change and Complexity in the National Immunization System
Pages 54-70

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From page 54...
... and national increases in immunization coverage levels. Nevertheless, as discussed in Chapter 1, significant problems remain, including disparities in coverage levels for children, low adult coverage rates and ethnic disparities in adult immunization rates, and concerns about the quality of measurement tools and programmatic efforts.
From page 55...
... the immunization schedule, (2) the nature of infectious disease, and (3)
From page 56...
... . · In 1999, inactivated poliovirus vaccine (IPV)
From page 57...
... Nature of Infectious Disease The national immunization system is also affected by the changing nature of infectious disease. Pathogens, like human populations, undergo genetic evolution.
From page 58...
... CVaccines likely to be recommended for universal use (including VFC coverage for childhood vaccines)
From page 59...
... population demographics, affecting susceptibility to infectious diseases and placing increased demands on the national immunization effort. For example, immigrants accounted for 35 percent (7,930)
From page 60...
... Finding 2-1. The rate of change in the immunization schedule, the nature of infectious disease, and population demographics increased dramatically in the l 990s and is likely to accelerate in the future.
From page 61...
... INCREASING COMPLEXITY In addition to the challenges resulting from scientific advances and changes in the environment, the national immunization effort must adapt to the increasing complexity of the financing, service delivery, and public health information systems. Many vulnerable populations now receive vaccines from private health care providers, as the well-insured have long done.
From page 62...
... The rise of managed care has caused public health services, such as immunizations, to be increasingly privatized and funded through capitated arrangements, which makes it difficult to document immunization services. For example, the number of Americans that receive health care services from health maintenance organizations (HMOs)
From page 63...
... Yet the enrollment growth among Medicaid beneficiaries in capitated plans that do not bill for individual services has reduced public agencies' ability to monitor service delivery for vulnerable populations. Record scattering and patient movement both on and off Medicaid and between health plans (known as "cycling")
From page 64...
... Private agencies include individual providers, managed care organizations, health plans, and insurers. Each of these organizations has some responsibility for the immunization process, but no single entity has a universal role that allows it to establish data standards, criteria for record keeping, or performance guidelines, or to make cost allocation decisions.
From page 65...
... State and local public health agencies are taking on health system management roles and developing tools that can help them work with and through managed care to improve practices, reduce missed opportunities, and ensure timely immunization coverage. At the same time, however, public health agencies at all levels of government must remain prepared to combat disease epidemics and provide vaccines when necessary to underserved groups.
From page 66...
... The increasing complexity of the immunization schedule necessitates intensive surveillance and records management for young children, especiallyfor vulnerable populations who may not have a regular source of health care and are therefore at greatest risk of low immunization coverage. This complexity is likely to increase during periods of reform and realignment within the health care delivery system; thus, greater oversight and monitoring are required to ensure that disparities in immunization coverage rates do not grow.
From page 67...
... show disparities of 7 to 8.6 percentage points between the immunization coverage levels for nonHispanic white children and Hispanic and non-Hispanic black children for the 4:3:1:3 series, and lesser disparities for individual vaccine coverage rates among these groups (CDC, 2000e)
From page 69...
... Disparities in Adult Coverage Levels While the generally low adult immunization coverage levels are disconcerting, disparities in the immunization rates among ethnic populations represent an even more serious situation. In 1997, 66 percent of white adults aged 65 and over received an influenza vaccination, compared with 45 percent of black and 53 percent of Hispanic adults in the same age group (National Center for Health Statistics, 1997~.
From page 70...
... For example, although rubella has been virtually eliminated within the U.S.-born population, rubella outbreaks have occurred sporadically among Hispanic populations in the last 5 years as a result of immigration from countries where rubella vaccine is not part of the childhood immunization schedule (information provided by CDC)


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