Pediatric Annals

editorial 

Improving Immunization Rates: Practical Tips

Stanford T Shulman, MD

Abstract

Immunizations save lives, reduce morbidity, and protect society. Almost universally, pediatricians have firmly embraced our critical role in supporting and implementing national recommendations for immunization practices. All of you in your offices know that this isn't nearly as easy as some of our physician colleagues might think. In fact, it is a complex task that, if anything, has become increasingly complicated over time.

This issue of Pediatrie Annals contains a series of articles related to the theme of enhancing immunization rates among children, with emphasis on practical issues including coding; development of state, community, or office-based registries; and office logistics such as refrigerators, Vaccine Information Statements, and others.

Progress in vaccinology includes increased numbers of safe and effective vaccines that prevent morbidity and mortality. And the number keeps growing: that's the very good news. Just a few days before I wrote these words, news reports were full of stories about the Food and Drug Administration's approval of the first human papillomavirus (HPV) vaccine, a vaccine with the potential to prevent a very large proportion of cervical carcinoma as well as genital warts. We will be writing more about this in future issues. Of course there are hurdles to overcome before this vaccine fulfills its potential, including cost, societal issues, and logistics.…

Immunizations save lives, reduce morbidity, and protect society. Almost universally, pediatricians have firmly embraced our critical role in supporting and implementing national recommendations for immunization practices. All of you in your offices know that this isn't nearly as easy as some of our physician colleagues might think. In fact, it is a complex task that, if anything, has become increasingly complicated over time.

This issue of Pediatrie Annals contains a series of articles related to the theme of enhancing immunization rates among children, with emphasis on practical issues including coding; development of state, community, or office-based registries; and office logistics such as refrigerators, Vaccine Information Statements, and others.

Progress in vaccinology includes increased numbers of safe and effective vaccines that prevent morbidity and mortality. And the number keeps growing: that's the very good news. Just a few days before I wrote these words, news reports were full of stories about the Food and Drug Administration's approval of the first human papillomavirus (HPV) vaccine, a vaccine with the potential to prevent a very large proportion of cervical carcinoma as well as genital warts. We will be writing more about this in future issues. Of course there are hurdles to overcome before this vaccine fulfills its potential, including cost, societal issues, and logistics.

The somewhat bad news is that, as the number of vaccines grows, the immunization schedule becomes increasingly complicated, as you know only too well. This, of course, is balanced by the direct and indirect benefits to our patients and society. Combination vaccines will play an increasing role over time and should help alleviate crowding of the schedule. We can only speculate (and smile) about how our predecessors in pediatrics from 50 or more years ago would have marveled at our phenomenal ability now to prevent the host of diseases that we do. So we must continue not to get bogged down by the sometimes tiresome specifics and logistics and keep our eyes on the prize: the protection of our patients and society from serious, even life-threatening illnesses.

Christopher Rizzo has guest edited this issue and has contributed to several articles. He emphasizes that improving immunization rates in office settings is the most cost-effective strategy for a community, and he has organized the issue to focus on practical aspects of vaccine delivery. Steven Kairys and colleagues describe the structure and the encouraging experience of the New Jersey Improving Preventive Services Project, a joint effort of the American Academy of Pediatrics New Jersey chapter and the New Jersey Department of Health vaccine program. Richard Tuck provides detailed and useful coding and reimbursement tips for immunizations, and Kari Veraas reviews the nursing and staff issues relevant to vaccine administration, including those related to schedule, patient screening, vaccine information statements, and storage.

Unresolved issues surely remain, and they must be worked out to maximize the benefit of vaccines for our children. A system in which the pediatrician must take a financial loss - that is, cannot be reimbursed at least his or her cost of a vaccine - will not be sustainable and is inherently unfair. This has to be rectified by discussion (and action) among manufacturers, our professional societies and governmental agencies.

Immunization stamps are plentiful, and the recent celebration of the 100th year of Rotary International has added to the numbers. The large souvenir sheet from Nevis in the Caribbean shows two polio victims and a child receiving oral polio vaccine. The same theme is evident on the stamps from Kenya and Belgium, also portraying the administration of oral polio vaccine. The stamp from the Marshall Islands, a US protectorate, celebrates the (almost but not quite complete) victory over polio, chiefly spearheaded by the outstanding efforts of Rotary International worldwide.

10.3928/0090-4481-20060701-01

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