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Mexico more effective than U.S. at immunizing children

Vaccination News Home Page

http://www2.ocregister.com/ocrweb/ocr/article.do?id=17384&section=NEWS&year=2002&month=12&day=22

Sunday, December 22, 2002

Mexico more effective than U.S. at immunizing children
Mexico's paternalistic approach has led to a 96% vaccination rate for children ages 1 to 4, compared with 79% of American 2-year-olds.


Houston Chronicle

MONTERREY, MEXICO – If parents here are late getting their child inoculated, a public-health nurse will come to their home, pull down the youngster's pants and give the vaccination right there in the living room.

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If the parents are away at work, the nurse does not wait for them to come home and give permission. Shots are given anyway, and the paperwork is left with the baby sitter.

In Monterrey, like Houston, an industrial city of more than a million with large pockets of underclass, the government divides its poor neighborhoods into sections of about four square blocks each, then puts a nurse in charge of supervising parents in each area to ensure all of the children are vaccinated on time.

It is a paternalistic approach almost impossible to imagine in the United States - where privacy rights and other freedoms are highly valued and immunizations are increasingly feared - but it has proved remarkably effective: Mexico has a 96 percent vaccination rate for children ages 1 to 4, compared with an immunization rate of 79 percent for 2-year-olds in the United States.

The disparity is even greater between Monterrey and Houston, which has one of the most stubbornly low vaccination rates in the United States. In Monterrey, 98 percent of the children ages 1 to 4 are fully immunized, a higher percentage than reached by any U.S. city. In Houston, barely 71 percent of 2-year-olds are caught up on their shots.

Mexico's immunization success is something Americans - particularly Texans - can cheer. Epidemics of preventable disease used to go back and forth between the two countries. That no longer happens, thanks mostly to the remarkable but unheralded improvements in Mexico and other countries in the region.

"One of the main reasons there is no longer measles in the United States is because we no longer have measles in Latin America and the Caribbean," said Dr. Ciro de Quadros, the recently retired director of immunizations for the Pan American Health Organization. Mexico, he said, has done a "remarkable" job of vaccinating its children in the past decade.

Conventional wisdom says it is harder to develop a public-health system in a poor country. But Quadros notes that a wealthy country like the United States has problems of its own.

"In the United States, there are so many obstacles to vaccinations," said Quadros, a native of Brazil. "People have so many forms to fill out, and there are so many more lobbies - anti-vaccine, anti-technology, anti-everything."

The differences in culture and outlook between Mexico and the United States make it difficult to compare the two systems of administering vaccinations. But there are similarities, particularly between two cities that share so much trade and human traffic.

Both Houston and Monterrey suffered from a terrible resurgence of measles more than a decade ago, and leaders in both places promised to respond by bolstering vaccine programs to ensure such an epidemic never happened again. The goal - on both sides of the border - was a 100 percent vaccination rate.

But while Monterrey and Mexico as a whole have come close to keeping that promise, the improvement in Houston's vaccination program has not been so great. Vaccinations are clearly up from the winter of 1988-89, when 10 children died from measles in Houston and organizers of the Houston Livestock Show and Rodeo distributed letters warning that participants may have been exposed to the disease and risked taking it to other parts of the country.

Public and private groups responded by forming a number of programs, such as mobile health clinics, which are designed to better reach the most needy areas of Houston. But Houston still has no coordinated vaccine registry, which officials say is necessary to reach the people effectively.

And the effectiveness of the patchwork services now offered by so many different organizations is hampered by a lack of any central vision for running an immunization program, critics say.

"There's no real local leadership on the immunization issue," said Barbara Best, with the Children's Defense Fund.

While no one predicts another measles resurgence, officials in Houston and the rest of Texas have already started to worry about a return of pertussis, also known as whooping cough.

Mexico, by contrast, has a sharply focused vision. After the measles pandemic reached Mexico in 1990 and killed 5,899 babies, the Mexican government established a central authority to oversee the national vaccination campaign, known as the National Immunization Program.

Immunization campaigns are run three times a year, done with great fanfare. In addition, uniformed brigades of nurses keep careful watch over vaccination rates, neighborhood by neighborhood.

U.S. health officials, who have seen the unsparing force of a Mexican immunization campaign, tend to remember it with both awe and dread.

 

The public-health nurses of Monterrey begin tracking babies before they are born.

The nurse in charge of immunizations in a particular neighborhood keeps a census of the area, including maps detailing where women of child-bearing age live.

Babies are given their first immunizations - against polio and tuberculosis - in the hospital right after birth. They also receive a government-issued National Vaccination Record, on which the vaccines they receive throughout their lives will be tallied. The vaccine record must be presented in order to enter school, to get passports or other identification papers and even to get some jobs and loans. Losing the record is not usually a problem, because the same information is recorded with the federal government and can be replaced.

 

 

 



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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.