A Shot In Time


September 22, 1990|By Sara Engram | Sara Engram,from the evening sun

CITY OFFICIALS hope there will be a lot of screaming children in Baltimore this weekend. The wails are inevitable, since medical wizardry has yet to eliminate the sting of needles, or the cringes they inspire in children and adults alike.

Even so, a few tears can save a lot of pain and discomfort down the road -- not to mentionBy Sara Engram health-care dollars. Wisely, Mayor Schmoke, in conjunction with the city and state health departments, Johns Hopkins School of Hygiene and Public Health and the federal Centers for Disease Control, has orchestrated a four-day Shots for Tots campaign that runs through Monday.

Parents can take their children to any of 16 health centers around the city for free immunizations and consultation on medical histories and immunization schedules for each child. The effort is designed to reach children between the ages of 15 months and 5 years, who often don't get timely immunizations.

Maryland, like other states, requires children entering school to have had vaccinations against common childhood diseases. Unfortunately, many of them don't get immunized until they are ready for school. That leaves a worrisome gap, since pre-school children are susceptible to diseases like mumps, measles or rubella -- and can be even more vulnerable to dangerous complications than older children are.

During the past decade, international efforts to immunize children have saved thousands of lives in poor countries around the globe. Childhood immunization levels in the Third World have risen from as low as 2 percent to more than 50 percent.

Ironically, this country has been moving in the opposite direction. A federal emphasis on childhood immunization during the 1970s dissipated during the Reagan administration; as a result, immunization rates of 2-year-olds in the United States have dropped from about 80 percent to around 50 percent. That's no better than Third World countries and, to make it worse, our movement is in the wrong direction.

So it's not surprising that the United States has seen a sharp rise in diseases that can easily be prevented. Last year there were 18,000 cases of measles in the United States, with 50 deaths. Currently, reported cases of measles are running ahead of last year's rate.

Measles, mumps and other diseases were once virtually a rite of childhood. Thanks to vaccines, they are now relatively rare. That may be one reason we underestimate the importance of immunizations.

But the number of deaths from measles alone -- not to mention the higher risk pre-school children run of developing pneumonia and other bacterial complications -- is reason enough for campaigns like Shots for Tots.

Low immunization rates aren't necessarily an issue of the lack of funds. Poor families and those without insurance have access to free immunizations at public health clinics like those involved in Shots for Tots. But many of them don't know it or can't get to the clinics during the hours they are open.

Other barriers -- easily surmountable -- also contribute to the poor immunization rate, according to Dr. Bernard Guyer, chairman of the Department of Maternal and Child Health at the Hopkins School of Hygiene and Public Health.

One is a simple lack of awareness of the importance of preventive medical care. Another factor is poor training of clinic personnel. In many cases clinic workers interpret guidelines too strictly -- deciding, for instance, not to immunize a child who has a runny nose but no fever, even though a vaccination would be recommended under those conditions.

We need to learn more about these subtle obstacles to immunization in order to clear the way toward more sensible health care. The need is evident in the story of the 18-year-old mother who appeared at a hospital emergency room recently with her two children, 18 months old and 31 months old. All three were sick with measles.

The mother developed complications and was hospitalized for five days. The children also had long illnesses, and medical bills exceeded $8,000 -- all easily preventable by a shot in time.


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