Your ever-present challenge: Keeping the immunization level high

August 1, 2006

Nationally, immunization levels are higher than ever, but new challenges mean no rest for the pediatric community. Consider these tips on maintaining immunization coverage-to help you preserve and extend essential protection for children in your care.

MS. ASCH-GOODKIN is a contributing editor for Contemporary Pediatrics. She has nothing to disclose in regard to affiliations with, orfinancial interests in, any organization that may have an interest in any part of this article.

You and your colleagues in pediatrics have every reason to be proud of your success in immunizing children against infectious disease. Coverage rates are at a historic high, and the Healthy People 2010 goal of reaching 80% of children 19 to 35 months old with the routine immunization series was surpassed by 2004. In fact, that percentage continues to rise. But new developments, listed in "In 2006, challenges to immunization coverage gather steam," complicate the task of immunization-and that means this is no time for complacency! Those developments make achieving and maintaining a high coverage level a continuing challenge; the recommendations that follow can help you meet it.

Where to begin?

So the starting point for reaching and maintaining the highest possible levels of immunization coverage is assessment. You can assess immunization status in any of a number of ways:

AFIX (Assessment, Feedback, Incentive, and Exchange) is a quality improvement strategy developed by the National Immunization Program (NIP) to improve immunization coverage levels. AFIX starts with assessment-the systematic collection of immunization data from patient charts. Those data are used in the feedback process to help diagnose potential problems relating to delivery of services and office policies, so that areas for improvement can be targeted. The incentive and exchange phases of AFIX include methods to encourage provider participation and mutual support, recognize successful solutions, and promote the exchange of results and ideas.

The immunization program of your local health department can arrange an AFIX contact and set up an assessment appointment. Assessment involves a site visit, which can be combined with a Vaccines for Children (VFC) site visit. The assessors input immunization data from a sample of your patient records into the CoCasa software just described. The software generates a report on the coverage rate for specific immunizations, series, and age groups. The report can pinpoint missed opportunities, the drop-off rate, and children who start their series late. Assessors then meet with physicians and staff to report results, identify problem areas, diagnose problems in the delivery of services, assist in developing a reminder-recall system, provide information on best practices, and help the practice tap into the health department's immunization registry. Want to learn more about AFIX? Visit