CDC shifts focus on vaccination data


CDCWASHINGTON -- Federal health officials have decided to forgo gathering detailed data on whether children in 22 big cities are receiving recommended immunizations and instead will survey teenagers, who are the target of several new vaccines.

The decision is drawing protests from local health officials, who say the soon-to-be-lost information is essential to their efforts to make sure that infants and toddlers, many from poor families, are protected against childhood infections.

"Unfortunately, we are going backward here," said Jeffrey Duchin, chief of the communicable-disease section of Seattle's health department. "At a time when we need more information, we are getting less about what is happening in little kids."


That view was echoed by Baltimore Health Commissioner Joshua Sharfstein, who said that without the data "it will become a guessing game" to figure out which children are being missed.

Officials at the Centers for Disease Control and Prevention who made the decision said they are reluctantly choosing between two worthy goals.

"It was really a very, very difficult decision. But we think we have to have information about adolescents because it is such a growth area," said Lance Rodewald, director of the CDC immunization services division.

Historically, most vaccines have been administered to infants and young children and only few to adolescents and teenagers, but that is changing. Under recently approved guidelines, pre-teenage girls should receive the new human papilloma virus, or HPV, vaccine; college freshmen should have the meningococcal meningitis vaccine; and most teenagers should receive boosters for tetanus, diphtheria, and pertussis, as well as the chickenpox vaccine if they did not receive it as children.

Each year, the CDC contracts a polling company to get data on vaccination rates in various age, demographic, and income groups nationwide. While urban children are part of the National Immunization Survey, too few are sampled in any one place to provide accurate city-specific numbers.

To remedy that, since 1994 the CDC has spent money to "oversample" 22 cities that had historically low immunization rates or were the sites of a series of measles outbreaks between 1989 and 1991. The appearance of measles is evidence that the level of vaccination coverage in young children is too low.

Those cities, which include Boston, Baltimore, Detroit, Los Angeles, Miami, and New Orleans, will no longer receive enough data each year to tell them how they are doing. Six cities will still get the information through a special grant, however. Those cities are Chicago, Houston, New York, Philadelphia, San Antonio, and the District of Columbia.

Data on vaccination rates are of more than academic interest.

In a letter to CDC director Julie Gerberding, Sharfstein said Baltimore had increased immunization in toddlers from 65 percent in 2001 to 83 percent in 2004.

"Without the survey, Baltimore will lose the best way to measure our continued progress and will have trouble quickly recognizing declining immunization levels," he wrote.