Texas should increase immunization of Texas toddlers, senior citizens, and others at high risk.
BackgroundThe threat of whooping cough, which claimed 9,000 American lives in 1923 alone, had nearly vanished in the U.S. by the mid-seventies due to regular and near-universal vaccinations. Since then, the disease has made a partial comeback, with thousands of new cases and 10 deaths in 1994--deaths that could have been prevented with vaccination.[1]
The case of whooping cough illustrates both the efficacy of widespread vaccination and the threat posed by disease in its absence. Other diseases provide equally compelling testimony for vaccination. For instance, after the measles vaccine was licensed in 1963, the number of cases reported in the U. S. dropped from more than 400,000 a year to just 312 in 1993.[2] According to the Journal of the American Medical Association, childhood and adult immunization saves $21 in future costs for every dollar spent on the vaccine against measles, mumps, and rubella.[3]
Immunization of the young
Under the Texas Department of Health's "Shots Across Texas" program, Texas has greatly improved its immunization rates for children under 2 years of age, but many Texas children are still exposed to disease unnecessarily. A 1995 Centers for Disease Control and Prevention (CDC) survey revealed that just 71 percent of Texas' youngest children were immunized, placing the state at 39th in the nation.A 1993 CDC survey had placed Texas last in the nation. Houston ranked last among the nation's cities for childhood immunizations; by August 1995, the city's immunization rate had more than doubled to 64 percent. Nationwide, only 75 percent of the toddler group is fully immunized.[4]
CDC recommends that all American children receive a complex vaccination schedule from birth to the teen years, involving vaccines against hepatitis B, diphtheria, tetanus, pertussis, haemophilus influenzae type b, polio, measles, mumps, rubella, and chickenpox. The complexity of this vaccination schedule contributes to low compliance rates. The DPT series (for diphtheria, tetanus, and pertussis) alone covers a period of five years; CDC has found that many parents and providers simply forget to arrange for the later doses in this series.[5]
The Texas Department of Health (TDH) reports that the older the child, the less likely he or she is to be up to date on immunizations. A 1994 TDH survey found that 83 percent of children from three to four months old were immunized; for children from 16 months to 24 months of age, the vaccination rate fell to only 37.1 percent.[6]
Immunization of adults
Pneumonia and influenza kill nearly 53,000 Americans each year, according to a 1995 Government Accounting Office (GAO) report. The U.S. Department of Health and Human Services (HHS) reports that influenza is responsible for more than 150,000 hospitalizations annually, with Medicare costs of between $750 million and $1 billion even in a non-epidemic year, and some $12 billion in direct and indirect costs to consumers.[7]
CDC and medical experts recommend annual vaccinations against influenza and one-time pneumonia vaccinations for vulnerable groups including the elderly and others at high risk, such as persons with cardiovascular disease. Vaccination rates for these diseases are lamentably low; GAO estimates vaccination rates were about 23 percent for pneumonia and 51 percent for influenza in 1993.[8]
Efforts to increase immunization
According to the American Medical Association, vaccination tracking and reminder systems significantly increase immunization rates.[9] TDH is piloting a statewide tracking system that has received the Smithsonian Institution's award as the year's most outstanding innovation in medical information technology. This system will allow doctors to enter a child's name and birth date and instantly receive the child's immunization record.
Texas also is hosting a federal project aimed at increasing vaccination. The U.S. Health Care Financing Administration (HCFA) is planning a two-year pilot program in seven southern states, including Texas, to determine the cost-effectiveness of immunization campaigns. HCFA has included El Paso and Waller counties and two areas of Houston in its demonstration sites, and is planning to use media outlets and doctor and patient contacts to promote increased awareness of the need for immunization.[10]
Recommendation
The General Appropriations Act, via rider, should direct the Texas Department of Health (TDH) to report on current and future plans to increase immunization of Texans.
TDH should be required to work with the Texas Medical Association and report to the Health and Human Services Interim Committee before September 1, 1998.
Fiscal Impact
Higher costs for immunization should be more than offset by savings in hospital and other medical services related to illnesses that can be prevented by immunization but the savings cannot be estimated at this time.
Footnotes[1] Jeff Doan, "Rise in Whooping Cough Turns Focus to Adults," Associated Press report, Springfield, Massachusetts, February 5, 1996.
[2] "Pediatrics (Varicella) Chickenpox Added to U.S. Child Vaccination List," Vaccine Weekly (January 29, 1996).
[3] "Childhood Immunization Registries: A National Review of Public Health," Journal of the American Medical Association (December 13, 1995), p. 1793.
[4] Ruth Sorelle, "A Successful Shot in the Arm: Houston Climbs Out of Last Place for Immunization Rates," The Houston Chronicle (August 26, 1995), p. 1.
[5] "Public Health: National Immunization Goal Hinges on Delivering Final Doses of DTP, Hepatitis B," BNA Health Care Daily (March 4, 1996).
[6] Diane M. Simpson, Ph.D., M.D., and Lucina Suarez, M.S., "The immunization status of Texas children aged 3 to 24 months: results of the 1994 Texas Immunization Survey," Texas Medicine (March 1996), p. 61.
[7] United States Government Accounting Office, Immunization: HHS Could Do More to Increase Vaccination Among Older Adults (Washington, D.C., June 1995), p. 11.
[8] Immunization: HHS Could Do More to Increase Vaccination Among Older Adults, p. 20.
[9] "Childhood Immunization Registries: A National Review of Public Health."
[10] Interview with Mike Keenan, Texas Department of Health, Austin, Texas, September 3, 1996.
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