Immunization coverage and its relationship to preventive health care visits among inner-city children in Baltimore

B. Guyer, N. Hughart, E. Holt, A. Ross, B. Stanton, V. Keane, N. Bonner, D. M. Dwyer, J. S. Cwi

Research output: Contribution to journalArticlepeer-review


Objective. To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization. Design and methods. We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers. Main outcome measures. Age-appropriate immunizations and preventive health care visits. Results. By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age. Conclusions. Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.

Original languageEnglish (US)
Pages (from-to)53-58
Number of pages6
Issue number1
StatePublished - 1994


  • immunization coverage
  • measles
  • preschool children
  • primary health care
  • vaccination

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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