The effect of epidemic measles on immunization rates

Abstract

Objective: To evaluate whether immunization against a vaccine-preventable disease is sought to avoid the naturally occurring disease itself, we hypothesized that the rate of "on-time" measles immunization would increase during an epidemic of that disease. If such an effect occurred, we wondered whether it would have an impact on on-time administration of other recommended immunizations.

Design: Retrospective evaluation of immunization rates of children at their second birthday with the use of computerized health records of children entering kindergarten in an 8-year interval spanning the onset of epidemic measles in Chicago, Ill, in 1989 and 1990.

Setting: Children entering Chicago public schools.

Main outcome measures: Rates of receipt of measles-containing vaccine (MCV), 1 to 4 doses of a diptheria toxoid-tetanus toxoid-pertussis (DTP) or diphtheria toxoid-tetanus toxoid (DT) vaccine, 1 to 3 doses of oral or inactivated polio vaccine (OPV/IPV), and the full series of these vaccines (4:3:1) that are required to be "up-to-date" by the second birthday.

Results: The rate of on-time MCV receipt increased from 56% to 58% in the years prior to 70% during the epidemic (1989 and 1990). A similar increase did not occur to DTP/DT 4 or OPV/IPV 3. Moreover, among older children delayed in MCV receipt, evidence of catch-up immunization also occurred during the epidemic years; similar catch-up for delayed DTP/DT 4 or OPV/IPV 3 immunization did not occur.

Conclusions: Dramatic increases in one-time and catch-up MCV receipt occurred during the Chicago measles epidemic of 1989 and 1990. The lack of similar increases in DTP/DT 4 and OPV/IPV 3 suggests MCV receipt was not associated with receipt of other recommended immunizations during that time.