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Felicity T. Cutts, MD; Elizabeth R. Zell, MStat; Dean Mason; Roger H. Bernier, PhD; Eugene F. Dini; Walter A. Orenstein, MD

JAMA. 1992;267(14):1952-1955.

Abstract
The United States has achieved over 97% immunization of children by school age and has reduced the incidence of vaccine-preventable diseases by more than 90% since the prevaccination era. However, children often do not receive immunizations at the recommended age, and in densely populated urban areas this delay in immunization has led to epidemics of measles. Correctable deficiencies of the immunization delivery system have been identified in these areas. To respond to needs, the public health infrastructure must be strengthened, and active participation from the private sector must be obtained, both in delivery of immunizations and in assessment of performance. Appropriate action must be stimulated by the provision of timely information on immunization coverage and on indicators of program performance at the local level.

(JAMA. 1992;267:1952-1955)

Author Affiliations
From the Immunization Division, Centers for Disease Control (Drs Cutts, Bernier, and Orenstein, Ms Zell, and Mr Mason), and the Immunization Program, Georgia State Department of Human Resources (Mr Dini), Atlanta, Dr Cutts is now with the Communicable Disease Epidemiology Unit, School of Hygiene and Tropical Medicine, London, England.

Footnotes
Reprint requests to Technical Information Services (E06), National Center for Prevention Services, Centers for Disease Control, 1600 Clifton Rd, Atlanta, GA 30333 (Ms Zell).

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