Kansas is falling behind in immunizing children, ranking among the worst states in protecting youths from a host of vaccine-preventable diseases.

The state’s low standing in immunization coverage has stunned public health advocates, who are scrambling to come up with ways to improve the situation.

“We are in the bottom. That’s dismal, it’s really disturbing,” said Sue Bowden, director of the immunization program for the Kansas Department of Health and Environment. “We need to use the fact that we are in the bottom to garner the will to change the way we do business and change the system and process.”

Kansas’ ranking

The standard measurement for vaccination coverage is how many children between 19 months and 35 months old have received a combined vaccination series called 4-3-1-3-3. This includes doses for diphtheria, pertussis, tetanus, polio, measles, mumps, rubella, haemophilus influenza type B and hepatitis B.

In that category, the coverage rate in Kansas was 66.8 percent, tying the state with Louisiana for 45th in the nation, according to a survey for 2002 by the Centers for Disease Control and Prevention.

The only states with lower rates were Montana, Oklahoma, New Mexico and Colorado. The state with the highest immunization percentage was Massachusetts at 86.2 percent; the national average was 74.8 percent.

Kansas’ rate has fallen from 73 percent in 2001.

During the 1990s, after a push during the administration of Gov. Joan Finney, Kansas’ coverage rate was briefly more than 80 percent, according to former KDHE Secretary Bob Harder.

Harder said that back then the state embarked on “Operation Immunize,” spending a lot of time educating the public and getting the vaccines out to children.

Now, Harder said, “I think it’s unfortunate that we have fallen in ranking in comparison to other states. In terms of thinking about health care costs, the matter of getting timely immunizations seems invaluable.”

Tyler Larison, 7, of Olathe, braces for his flu shot from nurse Elaine Houston at the Lawrence-Douglas County Health Department as his mother, Lori Larison, watches. Larison brought her family to Lawrence to get their shots from Houston, a family friend. Kansas, once a leader in childhood immunizations, now ranks near the bottom of the 50 states.

Why the drop?

Bowden said many factors might be contributing to the decline, such as recent shortages of certain vaccines and flat spending by federal and state governments for immunization programs. Parents’ concerns about some vaccines’ connection to autism also may be playing a role.

But, she said, those factors would have also affected other states, so they can’t be used as excuses.

Kansas also has lagged behind in setting up a statewide immunization registry to help parents and health care providers keep track of the vaccinations children need.

A statewide registry was started in 1993, but the system was technologically flawed, expensive and finally disbanded, so KDHE is revamping the whole system, Bowden said.

Health officials also say some people aren’t having their children vaccinated because they are complacent about vaccines since many of the diseases they prevent have been nearly erased.

Complacency

Nationwide, immunization efforts have cut the number of vaccine-preventable diseases by more than 99 percent, according to health officials.

“Because those diseases haven’t been around, people haven’t seen what whooping cough is like or complications from measles. They were pretty horrific,” said Barbara Schnitker, director of nurses for the Lawrence-Douglas County Health Department.

Added Bowden: “Many people are more afraid of the side effects than the disease they prevent.”

Some groups have tied chemical preservatives in vaccines to serious illnesses in children, though many health officials deny there is a link.

¢Centers for Disease Control and Prevention: Estimated Vaccination Coverage¢2003 Childhood & Adolescent Immunization Schedule¢Make a vaccination schedule for your child (birth to 5 years)¢Kansas Department of Health and Environment Immunization Program¢General Vaccine Information¢ Letter: Vaccine safety (10-16-03)¢ Letter: Vaccine safety (8-1-03)

In Douglas County, Schnitker said, it is difficult to determine whether there has been a drop-off in childhood vaccinations, because the health department keeps records on total immunizations, which include flu shots and shots given for travel purposes.

In 2000, total immunizations were 14,032; in 2001, 16,466; and in 2002, 13,348. In a 2001 survey by KDHE, Douglas County ranked in the middle of counties in vaccination coverage.

‘Herd immunity’

Schnitker said she thought the health department did a good job keeping track of vaccinations and kept a “tickler” file to remind clients when the next series of vaccinations are needed.

Bowden said another factor that may be leading to lower vaccination rates is that some parents believe in the “herd immunity”: “If most of the population is immunized, my child is not in that much danger.”

But, she said, the diseases still exist and can be a danger.

“We still have whooping cough, pertussis, and that is devastating for kids who haven’t been immunized. We still have mumps, and mumps can cause deafness,” she said.

Bowden said state officials were forming a group to study what was being done in more successful states on vaccinations, to determine what would be appropriate for Kansas. The Kansas Public Health Assn. has requested more funding for immunizations.

“Every percentage that we are away from 100 percent means that there is a child that is at an unnecessary risk,” Bowden said.