Pediatric Annals


Immunizations: The Greatest Good

Stanford T Shulman, MD


Pediatricians must advocate for children at the national, state, and local levels.


Pediatricians must advocate for children at the national, state, and local levels.

No medical or public health intervention except sewer systems and clean water supplies has saved more lives and prevented more suffering than routine immunizations. Dr. Lawrence D. Frenkel guest-edited this issue and the next issue of Pediatric Annals, both full of informative articles on immunization topics. These include in this issue an excellent review of combination vaccines and updates related to pertussis, rotavirus and influenza vaccines.

A recent study noted that each year about 2.1 million US children ages 19 to 35 months are undervaccinated.1 For each year between 1995 and 2001 , researchers collected a nationally representative probability sample of children in this age group and assessed their vaccination histories from medical providers. They found that 37% of children were undervaccinated and that 0.3% had received no immunization. It was estimated that annually approximately 17,000 US children are unvaccinated.

The characteristics of the unvaccinated and undervaccinated populations are strikingly different. The undervaccinated tended to be black, to live in the inner city, to be at or near the poverty level, and to have a young mother who was not married and didn't have a college degree. In very sharp contrast, the unvaccinated children tended to be white, to have a married mother with a college degree, to live in a household with more than $75,000 per year income, and to have parents who expressed concerns about vaccine safety.

In absolute numbers these 17,000 children live predominantly in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan. Therefore, many of us practice in areas with high incidence rates or high absolute numbers of these children whose (usually educated) parents have opted to place them at significant risk for preventable infections. Documented consequences of this situation have included substantially higher attack rates of vaccine - preventable diseases such as measles, pertussis, tetanus, and polio - among the unvaccinated.

This is a huge challenge for all of us who practice in an area with large numbers or high rates of completely unvaccinated children. The problem has been well-defined. The solutions are not going to be easy, but it is our responsibility to continue to advocate for children at the national, state, and local levels. One thought is to publicize effusively (but within HIPPA guidelines) cases of vaccinepreventable diseases that occur.

Three stamps illustrate this column this month. Edward Jenner ( 1 749- 1 823), a London-trained country doctor, is credited with developing the successful vaccination against smallpox using live material from people with cowpox, establishing the concept of an attenuated viral infection that leads to protection against a more virulent infection. He is portrayed on the stamp from The Gambia vaccinating his first subject, young James Phipps on May 14, 1796. The other two stamps honor the two rivals who developed the polio vaccines - Albert Sabin shown on the blue Brazilian stamp and Jonas SaIk on the green stamp from Dominica.


1. Smith PJ, Chu SY, Barker LE. Children who have received no vaccines: who are they and where do they live? Pediatrics. 2004;! 14(1):187-195.


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