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Arkansas ranks low when compared to other states regarding child immunization rates, but just how low is hard to determine from statistics compiled by the Centers for Disease Control.

According to the CDC’s latest National Immunization Survey, which covers July 2006 through June 2007, 76.3 percent of Arkansas children ages 19-35 months have received all of the doses they need of five vaccines: four doses of diphtheria, tetanus and pertussis; three doses of polio; one dose of measles, mumps and rubella; three doses of Haemophilus influenzae type b; and three doses of hepatitis B. That ranks the state 43rd in the nation, compared to 45th in 2006 and 49th in 2005.

But according to Phil Smith, a CDC mathematical statistician who helped design the survey, Arkansans made up only about 200-250 of the 30,000 people sampled nationwide. While the current national average of 80.4 percent has a plus or minus ratio of only 0.9 percent, Arkansas’ is plus or minus 6.3 percent.

The small sampling has helped caused the state’s percentage to swing wildly in recent years – 76.5 percent in 2003; 82.4 percent in 2004; 67.8 percent in 2005 (when the survey had a plus or minus ratio of nine points in Arkansas); and 74.9 percent in 2006. But what has remained consistent is that, at least recently, Arkansas has remained in a familiar place in national health rankings – in the 40s. According to Smith, any state in the bottom 15 could trade places with any other state in the bottom 15, and the same holds true for those in the top 15.

The survey indicates that most Arkansas children are being immunized, but some simply aren’t receiving the recommended doses of all the vaccines by the time they have reached 35 months. Almost 90 percent have received the one recommended dose of the measles-mumps-rubella vaccine, and even higher percentages have received the three hepatitis B shots and the three doses of the Haemophilus influenzae type b vaccine.

For most children, the gaps will be closed when they enter public school or a childcare facility – when they are required by law to be immunized unless they receive a philosophical exemption.

Why don’t some children get immunized? Socioeconomic factors, such as the state’s higher poverty and teen birth rates contribute to the problem, but individual parental choices also play a major role. Many parents aren’t educated about the need for vaccines or simply forget to have their children immunized.

Bryan Burke, MD, a pediatrician who finished his residency in 1982 and is now associate professor of neonatology and general pediatrics at the University of Arkansas for Medical Sciences, said parents are expressing concerns that vaccines cause autism, a belief that is growing in popularity even though scientific studies have found no such link. Because the incidence of many childhood infectious diseases have been greatly reduced by vaccines, Burke said they no longer seem as threatening and therefore parents are concluding that immunizing their children is not worth the perceived risks. However, he said he usually can allay parents’ fears if he has a chance to counsel them.

Meanwhile, the state’s rate of philosophical exemptions has been rising since a 2003 state law made them easier to obtain. According to a 2007 study conducted by the Arkansas Center for Health Improvement, UAMS and others, any parent who requests a philosophical exemption is almost certain to receive one as long as they complete the paperwork. The number of exemptions increased from 529 during the 2001-02 school year to 1,145 in 2004-05. Nonmedical exemptions accounted for almost all of them in the third and fourth years included in the report.

Parents are only part of the reason some children aren’t immunized. Burke said pediatricians miss too many immunization opportunities when children visit their offices for other reasons. He said society has failed to make health insurance available to many Americans, forcing them to rely on emergency rooms as their primary care providers and depriving their children of a medical home.

Martha Phillips, MD, MPH, assistant professor of epidemiology at the UAMS College of Public Health, said the healthcare system needs to do a better job of removing barriers to immunization and of educating parents about the need for their children to be fully immunized. “Parents are not by and large negligent. That’s a very small percentage of people – a very, very small percentage of people,” she said. “Parents want the best for their children. They want their children to grow up to be happy and healthy and productive.”

Jim Phillips, MD, Arkansas Department of Health branch chief for infectious disease, and Karen Fowler, interim section chief for immunizations, said the state is trying to increase rates by educating Arkansans and providers at the grassroots level that vaccines are available for all uninsured and underinsured children. The vaccines are free, and although providers can tack on administrative fees, ultimately no family that wants to immunize their child at a county health department will be denied because of inability to pay. The state sends new parents its “Happy Birthday Baby Book,” which includes information about immunizations. A web-based system used by 500 facilities lets providers know their patients’ immunization records.

While Arkansas has ranked near the bottom in recent surveys, Massachusetts consistently ranks at or near the top. A high-income, dense, urban state obviously has advantages over a lower-income, rural state such as Arkansas, but according to Donna Rheaume, a spokesperson for the Massachusetts Department of Health, the state also has made a concerted effort to increase immunizations. It purchases recommended vaccines and distributes them to providers for use in all children, regardless of insurance. The state in 2007 distributed more than 3.6 million vaccine doses for children and high-risk adults, a program that cost $100 million in state and federal funds but will save almost $600 million in potential health costs and $1.9 billion in overall societal costs. The state assesses the immunization status of children in daycares and schools, and it visits providers in high-risk areas to assess rates and vaccine storage.

No one will have to educate Burke about vaccines’ safety and effectiveness. Since beginning his practice, he has seen the number of children suffering from a variety of potentially serious infectious diseases plummet thanks to immunizations. Meanwhile, none of his patients has ever suffered a serious side effect. “If it is not right to give immunizations to children, then I am unclear that anything that I do is right,” he said. “Once you get past food, clothing and shelter, there is no medical intervention I know of that is more important or gives you more benefit for the money that you spend than immunizations.”



August 2008

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