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Table 1; Vaccination Coverage Levels Among Children Aged 19-35 Months,
by Selected Vaccines, 1998
Bexar
Texas County
%/ %/0
DTP/DT
3 doses
4 doses
Poliovirus
3 doses
96
84
91
MCV
1 dose
Combined Series
4DTP/3Polio/1MCV
93
78
88
92 90
81
75
Data on individual vaccines show that
US 1998 levels for each vaccine are all
above 90%, except for the fourth dose of
DTP (DTP4) (84%) (Table 1). In Texas
only the third dose of DTP (DTP3) and
MCV meet the 90% goal. Since 1996 the
DTP3 vaccination coverage level in
Texas has always been at or above the
90% goal (CDC 1996, CDC 1997). As
seen in Table 1, the underimmunization
problem lies with DTP4 vaccine required
at 15 through 18 months; almost one-
quarter of Texas children fail to receive
this fourth dose. This failure with the
DTP4 is consistent across the four Texas
areas assessed and is in line with the
literature on primary reasons for low
coverage levels.
Texas Immunization Survey
Conducted in 1994, 1996, and 1998, the
Texas Immunization Survey (TIS) is a.
population-based statewide survey
designed to assess vaccination coverage
levels among Texas children 3 through
24 months of age. The Texas Department
of Health commissioned these surveys
to obtain coverage status not only on
children younger than 19 months, but on
important subpopulations not included
by the NIS [Medicaid, Special Supple-
mental Program for Women, Infants,
and Children (WIC)]. The TIS conducted
in 1994 was an in-person survey and in
1996 and 1998, a random digit dial
telephone survey. Survey protocols and
instruments were modeled after the NIS.
To determine a child's immunization
history, interviewers asked for dates of
each vaccine including DTP, OPV/IPV,
and MCV For parents without their
child's shot record, interviewers asked
about each vaccine, whether the child
had received the vaccine, how many
doses, and at what age. A proportion of
immunization histories were verified
against providers' records.
The vaccination coverage levels for
children 3 through 24 months in 1994,
1996 and 1998 were 62%, 68%, and 66%
percent, respectively. Examination of the
levels by race/ethnicity indicate that,
compared with White and Hispanic
children, African American children have
lower coverage levels for all three years.
Coverage levels in African American
children have steadily risen, from 47% in
1994 to 63% in 1998. Levels among
White and Hispanic children reached a
peak in 1996 at 70% and 68%, but both
dropped slightly in 1998 (66%).
Privately insured children are usually
more completely vaccinated than
Medicaid or uninsured children (Table 2).
However, there are no consistent trends
over time. In 1994 and 1996, children
receiving WIC services had higher
vaccination coverage levels than children
not enrolled in WIC. However in 1998,
the level among WIC children dipped
below that of non-WIC children. In 1994
children receiving Aid to Families with
Continued
United
States
0
Dallas
County
0
El Paso
County
0
City of
Houston
0
96
83
93
92
80
92
76
88
87
73
93
81
91
89
79
87
65
76
87
61
Page 2
June 19, 2000
DPN
