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Standards for Pediatric Immunization Practices

Roger H. Bernier, PhD, MPH; Vance J. Dietz, MD, MPH & TM; Alacia E. Lyons, RN, MA; Harry L. McKnight; John H. Mullen, MA; Dennis J. O'Mara; Kay Bender, RN, MS; Claire V. Broome, MD; Ann H. Cary, PhD; Vito M. Caserta, MD; Kathleen A. Fessler, RN; Fernando A. Guerra, MD; Elin A. Gursky, ScD; Vince L. Hutchins, MD; Samuel E. Katz, MD; Janet C. Lenart, ARNP, MN, MPH; Darryl Leong, MD, MPH; John C. Lewin, MD; Edgar K. Marcuse, MD, MPH; Mavis L. McGuire; Freda Mitchem; Edward A. Mortimer Jr, MD; Karen L. Mountain, MBA, MSN, RN; Paul W. Nannis; Richard P. Nelson, MD; Audrey H. Nora, MD, MPH; Christine H. Nye; Tom Schlenker, MD; James E. Strain, MD; David Stevens, MD; Phyllis E. Stubbs, MD; F. Edgar Thompson, MD; Ronald C. Van Buren, MD; Vance Dietz, MD, MPH; Kenneth J. Bart, MD, MPH; Roger Bernier, PhD, MPH; Walter A. Orenstein, MD
JAMA. 1993;269(14):1817-1822. doi:10.1001/jama.1993.03500140069038.
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THE RESURGENCE of measles in the United States between 1989 and 1991 was associated with 55622 reported cases,1,2 11251 hospitalizations, and over 42 000 hospital days (unpublished data, Centers for Disease Control and Prevention, 1992) and 166 suspected deaths from measles.3 The main cause of the epidemic was failure to vaccinate children at the recommended ages, 12 to 15 months.4

For editorial comment, see p 1844.

While 97% to 98% of children are vaccinated by or shortly after school entry with four doses of diphtheria and tetanus toxoids and pertussis vaccine, three doses of oral poliovirus vaccine, and one dose of measles, mumps, rubella vaccine, series-complete immunization levels among preschool children are considerably lower. Recent surveys of school entrants in nine cities that measured immunization status as of the second birthday documented that only 52% to 71% had been vaccinated against measles.5 Series-complete immunization levels ranged


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