News about immunization: Coverage levels up, flu shots lag for children with asthma-and much more

Childhood immunization, pediatric medicine's first line of defense against disease, is in good shape. The picture is complex, and most of the news is good. Significant developments include:

Coverage level. The 2005 coverage statistics for children between 19 and 35 months old are in, and they show coverage with vaccines on the Center for Disease Control and Prevention's recommended schedule continues at a record high. Nationally, coverage with the recommended 4:3:1:3:3:1 series (four diphtheria-pertussis-tetanus, three polio, one measles-mumps-rubella, three Haemophilus influenzae (Hib), three hepatitis B, and one varicella) is 76%-still short of the 80% Healthy People 2010 goal, but getting close. There is considerable state-to-state variability (from 90.7% in Massachusetts to 62.9% in neighboring Vermont) and differences among urban locales (from 84.5% in Jefferson County, Ala., to 58.8% in Clark County, Nev.). Coverage for the full series of pneumococcal conjugate vaccine (PCV7) was surprisingly high, given that shortages have occurred: 50% for the four-dose series and 80% for three doses. The best news? Racial and ethnic disparities in coverage have disappeared.

Track record of the conjugate pneumococcal vaccine. When PCV7 was added to the recommended schedule, researchers hoped the vaccine would have a substantial impact on the prevalence of ear infection in young children-the ailment that accounts for the largest number of pediatric visits. According to a report published in the September issue of Pediatrics, that wish has come true: Since introduction of the vaccine in 2000, pediatric visits for ear infection by children younger than 2 years have dropped by 20%-or, 246 fewer outpatient visits for every 1,000 children younger than 2 years. That's a substantial savings in health-care costs-and in children's misery.

Tdap for new moms. The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has voted to back the so-called cocoon approach to protecting infants from pertussis. ACIP has voted to recommend that all new mothers, including adolescents, be vaccinated with the new formulation of the tetanus-diphtheria-pertussis vaccine for adults before they leave the hospital. The ACIP approach differs slightly from that of the AAP, which is pushing for Tdap vaccination at the 11- to 12-year-old wellness visit for all teenagers. As that recommendation takes hold, fewer and fewer females will enter their childbearing years unvaccinated.