Measles immunization of 2-year-olds in a rural southern state
S. Feldman, M. Andrew, J. Gilbert, B. Bracken and F. E. Thompson
Department of Pediatrics, University of Mississippi Medical Center, Jackson 39216.
OBJECTIVE--To assess the measles vaccine coverage of 2-year-old children
living in Mississippi during the national measles epidemic of 1989 and
1990. DESIGN--Survey of 2-year-olds randomly selected from the 1987 birth
cohort. The status of measles-mumps-rubella (MMR) vaccination was
determined by medical record reviews and family contacts. SETTING--A
predominantly rural state in the southeastern United States with a large
black minority population (35%) and a low per capital income ($9827 to
$12,899). Approximately 80% of MMR immunizations are given by public health
service nurses working in nine health districts. SUBJECTS--A total of 2450
preschool-aged children representing 6% of the 1987 birth cohort (n =
41,279). Three hundred forty-one children were considered ineligible,
leaving 2109 in the final sample. MAIN OUTCOME MEASURES--Confirmed
vaccination by the age of 2 years. Rates of immunization were calculated
for the entire state, its health districts, and subgroups based on
population density, per capita income, type of clinic visited, and race.
RESULTS--The statewide immunization rate was 87% (95% confidence interval,
86% to 88%). Among the nine health districts, rates varied from 79% to 97%
(median, 88%). They were similar for white and black children in each
health district and within the state as a whole. The level of vaccine
coverage was significantly higher in districts with lower population
densities (89% vs 85%, P = .02) and in those with higher per capita incomes
(89% vs 86%, P = .03). There were four minor outbreaks of measles during
1989 and 1990; half of the cases occurred in unimmunized children too young
to receive the MMR vaccine. CONCLUSION--A high rate of measles immunization
is attainable among 2-year-olds living in a rural state with a large black
minority population and limited economic resources.
