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The Problems, Barriers, and Recommendations

The National Vaccine Advisory Committee; Donald A. Henderson, MD, MPH; Frances J. Dunston, MD; David S. Fedson, MD; Vincent A. Fulginiti, MD; Robert John Gerety, MD; Fernando A. Guerra, MD; Kay Johnson; Edgar K. Marcuse, MD; Don P. Metzgar, PhD; Ronald J. Saldarini, PhD; Parker A. Small, Jr, MD; Gene H. Stollerman, MD; Thomas M. Vernon, MD; Catherine Wilfert, MD

JAMA. 1991;266(11):1547-1552.

Abstract
The nation has experienced a marked increase in measles cases during 1989 and 1990. Almost one half of all cases have occurred in unvaccinated preschool children, mostly minorities. The principal cause for the epidemic is failure to provide vaccine to vulnerable children on schedule. Major reasons for the low vaccine coverage exist within the health care system itself, which creates barriers to obtaining immunization and fails to take advantage of many opportunities to provide vaccines to children. Ideally, immunizations should be given as part of a comprehensive child health care program. However, immunization cannot await the development of such an ideal system. Essential changes can and should be made now. Specific recommendations include improved availability of immunization; improved management of immunization services; improved capacity to measure childhood immunization status; implementation of the two-dose measles vaccine strategy; and laboratory, epidemiologic, and operational studies to further define the determinants of decreased vaccine coverage and to develop new combinations of vaccines that can be administered earlier in life. The measles epidemic may be a warning flag of problems with our system of primary health care.

(JAMA. 1991;266:1547-1552)

Author Affiliations
(Chair), The Johns Hopkins University, Baltimore, Md; New Jersey Department of Health, Trenton; University of Virginia Medical Center, Charlottesville; Tulane University, New Orleans, La; Biogen Inc, Cambridge, Mass; San Antonio (Tex) Metropolitan Health District; Children's Defense Fund, Washington, DC; University of Washington, Seattle; Connaught Laboratories Ltd, Willowdale, Ontario; Lederle-Praxis Biologicals, Wayne, NJ; University of Florida, Gainesville; Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Mass; Colorado Department of Health, Denver; Duke University Medical Center, Durham, NC.

Footnotes
Reprint requests to National Vaccine Program Office, Parklawn Bldg, Room 13A-53, 5600 Fishers Ln, Rockville, MD 20857 (Dr Kenneth J. Bart).

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