STATE AIMS TO IMPROVE IMMUNIZATION RECORD

Missouri health officials hope a new strategic plan will give the state's immunization program a shot in the arm.

The state tied for last in immunization of young children in a recent report from the Centers for Disease Control and Prevention. The Missouri Department of Health wants to improve that record.

A national survey showed 64 percent of the children in the state were adequately immunized. The state's survey of public health clinics put the figure at 61 percent.

"That told us we not only have a problem with the public health clinics, but with all providers," said Anita Vonderahe, a health educator for the Missouri Department of Health's Bureau of Immunization.

State health officials developed a "priority map," showing which of the state's 114 counties should receive the most intense efforts to improve immunization.

In Southeast Missouri, Cape Girardeau, Scott, New Madrid, Pemiscot, Dunklin, Butler and St. Francois counties are all higher priority counties for immunization improvement.

The city of St. Louis and St. Louis County are also considered high priority.

A county ranked as first priority has more than 300 births per year, and an immunization rate of less than 70 percent, Vonderahe said.

Charlotte Craig, director of the Cape Girardeau County Public Health Center, estimates that about 77 percent of the children her staff see are "adequately immunized" by age 2.

That's "probably pretty indicative" of the immunization rate at private providers, Craig said, adding health department staff immunize 400 to 500 children a month.

"Of course, our goal is to have 100 percent immunization. I would think we'd have to be up in the 90th percentiles before we could consider (childhood immunization) a medium priority," she said.

Public health departments offer childhood immunizations -- including oral polio vaccine, DTP (diphtheria, tetanus and pertussis), MMR (measles, mumps and rubella), bacterial meningitis and Hepatitis B -- at no charge.

The state is taking several steps to increase the number of children immunized, Vonderahe said.

"The first is trying to get our statewide immunization computer tracking system up and running," she said. "It helps you find the kids. They don't get lost in the system."

It's difficult to keep track of immunization records for children whose families move from county to county or from private providers to the public health center, Vonderahe said.

"It helps with the record-keeping. The kids may go to the doctor's office for their first vaccination and to the public health center for number two, and sometimes the records don't cross-match," she said.

The state is also working to coordinate the Women, Infants and Children program with its immunization program. The federally-funded program for low-income families supplies food vouchers to pregnant women and young children, as well as nutrition education and well-baby checkups.

"When people come in and apply for WIC, many are asked to bring in their children's immunization records," Craig said.

Women can bring their children in for immunizations on subsequent WIC visits or to any of the center's immunization clinics, she said.

"WIC is a great portal of entry for medical care for a lot of reasons, but particularly for immunizations," Craig said.

Vonderahe agreed. "There's a large number of the same kind of client, and they're coming in on a regular basis," she said. "The trouble is they're coming in, but in some public health centers, they're not being referred for the other services, like immunizations. WIC is the largest captive audience of the 0 to 2 year-olds that we're trying to get immunized. Combining the two kind of helps make it a little simpler for people."

The health department has also started assessing public health clinics' immunization levels and giving staff feedback on what they're doing right and where there is room for improvement, Vonderahe said.

In some cases, simple steps like screening children who come in for other services for immunizations can go a long way toward improving immunization levels, she said.

The state is also getting ready for a public education campaign to hammer home the message, "Be Wise, Immunize," Vonderahe said.

Public health providers need to look for ways around the barriers that prevent childhood immunizations, she said. Some clinics, private and public, won't allow babies to receive immunizations until after they've had their well-baby checkups.

There's no reason those two steps can't be combined in one visit, she said, especially for parents who have to take a day off -- at the risk of losing pay or even their jobs -- for every visit.

Legislation pending before the Missouri General Assembly should help improve the state's immunization level, Vonderahe said. The Children's Immunization Reform Act would allow parents to designate another adult to take their children in for immunizations.

Craig said she was "absolutely delighted" that the bill's authors included provisions to allow another adult to bring the child in for immunizations.

"That's been a major barrier, having to have the parent there. I can't tell you how many times Grandma or Grandpa have called, and we've had to tell them, don't even waste the visit," she said.

Another provision in the bill would require insurance providers to cover the costs of immunizations for children ages 3 and under, without requiring deductibles, co-payments or co-insurance.

There was a time when the state had "a great grip" on immunizations and disease prevention, Craig said.

"We're dealing with parents in a population that don't remember these diseases," she said, adding she remembers childhood friends who contracted polio. As vaccines for polio and other childhood diseases like whooping cough (pertussis) were developed, "the threat kind of got lost. It wasn't a real disease or a real killer or a real crippler anymore."

The county health center offers nine eight-hour immunization clinics monthly, including some with extended hours so parents can bring children in after work. For more information, call the center at 335-7846.