Keiki immunizations down 10 percent

By Robbie Dingeman
Advertiser Health Writer

The loss of health insurance in tough economic times has contributed to a nearly 10 percent drop in infant immunizations in Hawai'i during the past three years.

Kiona Nena, 2 1/2 years old, waits patiently in the arms of her mother, Mary Ann, as Kaiser Honolulu Clinic nurse Billie Mullally prepares to administer one of five immunizations. Hawai'i ranks near the bottom in immunizations nationwide. Bruce Asato • The Honolulu Advertiser

The decline pushed Hawai'i down the list of states in a study on immunizations with the battery of common childhood shots — from 19th in the nation to 47th.

The economy can take its toll when a family member loses a job and insurance coverage and begins to skip doctors' visits, said Dr. Paul Effler, state epidemiologist.

It's a situation in which Mary Ann Nena of Kapahulu found herself falling behind on shots for her 2-year-old daughter, Kiona. "We moved to and from Kona and back. We didn't have insurance for awhile," said Nena.

She said not having coverage was the only reason she fell behind on Kiona's immunizations, and when she took her child to Kaiser Permanente's Honolulu Clinic last week she found Kiona needed five shots that day and must return for more in a few weeks.

Kiona took the shots calmly, only tearing up on the last one as licensed practical nurse Billie Mullally talked her gently through each needle prick.

Nena, who also has three sons, ages 15, 13 and 6, said she is getting all her children up to date on their immunizations, and believes vaccinations help keep her family healthy. So when she got a new job and health insurance, she started getting her children back on track. "It's for the kids' sake; it's for their good," she said.

State health officials recently called together doctors, community organizations, health insurance executives and others to try to figure out why immunizations have dropped since 1999 and to search for solutions to the problem.

Effler noted that a recent survey indicated parents who fall behind on getting their children immunized are likely to be younger mothers, those who have recently moved, and those with larger families. Income and education are factors, the survey indicated.

Families with little or no health insurance can often get vaccinations for free, Effler said. But when there is a gap in coverage because of a switch in jobs or when a job is lost many skip all doctor visits until insurance is restored.

Kay An said she was happy to find she didn't have to postpone shots at Kaiser last week after delaying one shot for her 2-year-old-son, Eugene, because of a lag in coverage. "Even though we didn't have insurance, they were still willing to serve us," An said through an interpreter.

Effler said he's not as concerned about Hawai'i's plunge in the state rankings as he is disturbed that one in four babies isn't getting immunized on time.

Nationwide, the Centers for Disease Control and Prevention identifies Rhode Island with the highest rate of immunizations for children younger than 3, at 81.7 percent. New Mexico is at the bottom with 63.2 percent.

Eugene An, 2 1/2, awaits his shots with his mom and dad, Kay and Byeong Nam An, in a Kaiser Honolulu Clinic waiting room. Bruce Asato • The Honolulu Advertiser

Hawai'i comes in at 72.8 percent, compared to the national average of 77.2 percent. In 1999, the rate in Hawai'i was 81.6 percent.

State Health Department director Bruce Anderson said he is unhappy with the overall decline. "We can't afford to lower our guard," Anderson said.

Most children are caught up on shots by the time they enter school because those immunizations are required for entry, said pediatrician Dr. Galen Chock, who heads the immunization committee for the Hawai'i chapter of the American Academy of Pediatrics.

Chock recommends that parents keep in touch with their physicians in annual visits to make sure vaccinations are updated for all family members.

In addition to economics, Effler said negative national publicity about possible side effects from vaccines may be another reason for the decline.

Effler and Chock said reports of a possible link between autism and the vaccine for measles/mumps/rubella, or MMR, may have caused some parents to delay that shot for their children.

"I don't think it's that common, but I do think there's some concern about side effects of vaccine," said Effler.

The CDC supports the vaccine as safe, saying "carefully performed scientific studies have found no relationship between MMR vaccine and autism."

Doctors, nurses and community organizations agree that there is likely no one simple solution to getting families to get all their shots on time. "We need to partner with the community," Effler said, to make sure that parents realize that timely vaccination helps prevent illnesses that can have serious complications in some cases.

Chock said that patients and doctors might respond to some kind of incentive or bonus provided to them for keeping infant immunizations up to date. Doctors want to do the right thing, but "they lose money on vaccinations," Chock said.

Offering incentives will work better than trying to scare parents into taking their children in for shots, he said. And some incentive paid to the office might help cover the cost of the paperwork and staff expenses that go with doing vaccinations.

The Hawaii Medical Service Association's Cliff Cisco said the health insurance organization would like to work with others in the community to increase the immunization rate.

Cisco, senior vice president of HMSA, said children are scheduled to get 15 shots by age 2. He suspects that part of the decline is people's general attitude about shots. "That's a lot of needles in their baby. If you're a parent and you yourself are averse to needles, it's understandable."

Cisco said his organization is "willing to look at anything" to help change the trend.

State Health Department officials met recently with top health care providers and community leaders at Washington Place to discuss strategies for reversing the decline, and tracking the cause.

Effler said the state Health Department plans to use a $300,000 federal grant toward a public education/media campaign for immunization awareness. The state plans to continue to meet and talk with community organizations to help set priorities about how money should be spent and programs shaped, he said.

Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.

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