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Report Urges Improved Vaccinations

Updated:
WASHINGTON (AP) — Vaccinations of America's toddlers may be at a record high, but the immunization system is under critical strain and the country risks disease outbreaks if it isn't strengthened, a new report says.

Some 11,000 babies are born each day who need shots, thousands of unvaccinated inner-city children remain at risk of epidemics — plus there are millions of unimmunized adults, the Institute of Medicine warned Thursday.

The institute called on federal and state governments to invest $1.5 billion over the next five years to improve inoculations, about $175 million more per year than is now spent. It's not just to buy vaccines, but to shore up the public health infrastructure to ensure the most at-risk people aren't missed.

``We're worried about children falling through the cracks,'' said report co-author Dr. David Smith, president of Texas Tech University Health Sciences Center. ``It's very alarming.''

But children aren't the only ones at risk. Up to 70,000 adults die annually from vaccine-preventable illnesses, mostly flu but also diseases ranging from pneumonia to hepatitis B, the report said.

The Senate Appropriations Committee asked the IOM, a branch of the National Academy of Sciences that advises Congress, to investigate vaccinations.

The report ``raises troubling questions,'' said Sen. Jack Reed, D-R.I. Reed and nine other senators wrote the committee to urge that next year's federal vaccine budget, scheduled for a Senate vote in the next few weeks, include an additional $85 million.

Vaccines are one of medicine's biggest successes, dramatically slashing disease over the last century. Today, a record 80 percent of toddlers — the most vulnerable age group — have received the most critical vaccinations.

Still, 300 American children die each year of diseases vaccines could have prevented, the IOM said. Far more are at risk if an outbreak occurs.

Of the 20 percent of uninoculated American toddlers, most are poor, inner-city children, said Dr. Bernard Guyer of Johns Hopkins University, who chaired the IOM committee.

For example, less than half of children in East Los Angeles are properly immunized, vs. three-fourths of all Los Angeles children, the report said. Worse, a Chicago study found just 36 percent of black children — and 29 percent of black children in public housing — were properly immunized, compared with 59 percent of all Chicago children.

These unvaccinated pockets are a reservoir for future epidemics, just like the measles outbreak that sickened 43,000 Americans and killed 100 in the early 1990s, the report warned.

Immunization rates measure just the most critical, longest-used vaccines. While the number of new childhood vaccines is expected to triple within 25 years, cash-strapped health systems already are having a hard time adding newer shots, the report said. Only 43 percent of children have been vaccinated against chickenpox, two years after the Centers for Disease Control and Prevention recommended it.

Plus, only a quarter of adults at risk of influenza complications get a yearly flu shot, and only 13 percent of lung disease patients get a pneumonia vaccine, Smith said. ``This is atrocious.''

Lots of problems contribute to these gaps, the report said: Health programs inadequately track vaccine recipients so health programs don't even know who to target. Families changing doctors for insurance reasons — either private insurers, managed care or Medicaid — can miss vaccines.

Federal grants supporting state immunization programs have been cut in half in recent years, the report said. Some states compensated by investing their own money, while others severely slashed immunization efforts. The IOM recommended that CDC change vaccine funding to ensure the worst states get more money — but that each be required to invest state revenues, too.

Also, the IOM urged Congress to allot $50 million to buy vaccines for underinsured adults.
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