Immunization Schedules – a Question of Responsibility

A recent article in The Wall Street Journal examined the alarming neglect in immunizations among adult populations in the U.S., the story’s central concern focusing on the potential for more widespread and unnecessary infection rates and on the surprising reemergence of illnesses such as whooping cough as a result of that neglect.  Given the busy nature of our lives, it is easy to understand how something as seemingly benign as an immunization schedule can be overlooked.

But a parallel concern is also found in the question of who is responsible for the upkeep of immunization schedules.  

I put this question to Diane Peterson, Associate Director for Immunization Projects at the Immunization Action Coalition in St. Paul, Minnesota.  “The question of responsibility is difficult.  Doctors are often confused because the CDC’s recommendations change.  Age-based recommendations are easier to manage than risk-based ones.  It is not at all like going into a Toyota dealership and getting service based on a particular model.”

The Toyota dealership analogy gives shape to the core issue: there are no centralized immunization databases attached to specific patients.  If you are stopped for a traffic violation, there is a centralized database available to the police for any prior violations that may exist on your record.  If you are delinquent often enough when paying bills, that delinquency is processed in a centralized record and can reappear should you need available credit in the future.  You and your relevant file numbers are attached to various records elsewhere in your life.

But there are no centralized data records available for your health history – and if you wind up unconscious in an emergency room, this history should be able to speak for you. 

Additionally, as Americans are mobile – moving from job to job, state to state, and doctor to doctor – medical records and immunization schedules are routinely not passed along, and patients are asked to provide these answers from memory. 

When was the last time you had a tetanus shot, or a measles booster?  Should there not be a database for this historical information?

“Automated immunization registries have been in the works for more than 10 years,” said Ms. Peterson.  “Mobility has made it difficult for parents to remember their children’s vaccinations, and doctors have to rely on the recollections of these parents.   The automated system will likely not be extended to adults because there are simply too many adults.  With children, we can start clean from birth records – and schedule and record the administration of the various immunizations accordingly.”

The current administration of immunization schedules is surprisingly sparse.  The Centers for Disease Control put together recommendations and schedules that are published in medical journals – an action that assumes that the select journals are being read by general practitioners of all disciplines.  Immunization Action Coalition publishes laminated recommendation schedules – based on the CDC’s latest data – and distributes them to doctors nationwide.  But in the end it is an admittedly flawed process.

Ms. Peterson recommends keeping a hardcopy record in your wallet, and she says there is no harm in over-vaccinating.  “If you’re in doubt, go ahead and vaccinate.”