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Executive Summary Oregon's Benchmark goal and the national Healthy People 2010 goal for immunizations are consistent -- achieve a 90% immunization coverage rate for two-year-old children. The classic up-to-date (UTD) rate for the childhood series of four doses of diphtheria, tetanus and pertussis, three doses of polio and one dose of measles, mumps and rubella (4:3:1), remains below the national average, and below our state and national goals. To help realize our goals, Oregon-specific data is needed to identify pockets of under-immunization, health practices of the under-immunized and barriers that parents and providers face in getting children immunized.In 1996, Oregon conducted a birth certificate follow-back survey of parents of children 19-35 months of age to collect demographic data, immunization histories, health practices, and reported barriers to receiving immunizations. Completed surveys were received, immunization histories verified, and birth certificate data compiled on 2,452 children (80% response rate). In this survey the immunization rate among Oregon children 19-35 months old was 81% for the basic 4:3:1 series. The immunization rate did not change significantly when three doses of Haemophilis influenzae type B (Hib) were added to the series. Immunization rates for single antigens were better: 90% percent of children had three doses of OPV, three doses of DTP (four are recommended), one dose of MMR, three doses of Hib and three doses of hepatitis B. Immunization rates were age-dependent, that is as children got older, the rate of full immunization improved. Only 52% of the children had completed the 4:3:1 series by 18 months of age compared to 78% who completed the series by 24 months of age and 83% who completed the series by 30 months of age. Immunization rates among African American children (71%) and American Indian children (75%) were significantly lower than rates among Asian children (82%), Hispanic children (82%) and White children (81%). The children who were under-immunized were a heterogenous group, distinguished by the degree of immunization. Eighty-one percent (81%) of the children were Fully immunized with 8 shots; 15.5% were Almost immunized with 5-7 immunizations, 2.1% were Poorly immunized with 1-4 immunizations and 1.4% were Unimmunized with no immunizations. Nearly half of underimmunized children were missing just one immunization (48%) and among parents of the children missing one immunization, 85% believed their child was up-to-date. Children Poorly immunized, who are more susceptible to vaccine preventable diseases, were more likely to start their immunizations at a later age, more likely to come from a family of lower socioeconomic status, more likely to seek immunizations outside of their primary care, and more likely to have a parent report a barrier to receiving immunizations. The most commonly reported barriers were provider and parent scheduling conflicts, financial cost and child sickness. Multiple strategies are needed to address the challenges faced by the Poorly immunized children. And finally, as new vaccines become available for other childhood diseases, it is important that Oregon address the barriers faced by families and providers in order to maintain high immunization levels for the basic 4:3:1 series, which will lay the foundation to improve the acceptance of newer vaccines. Recommendations
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