Measles Immunization of 2-Year-Olds in a Rural Southern State

Objective. —To assess the measles vaccine coverage of 2-year-old children living in Mississippi during the national measles epidemic of 1989 and 1990. Design. —Survey of 2-year-olds randomly selected from the 1987 birth cohort. The status of measles-mumps-rubella (MMR) vaccination was determined by medical record reviews and family contacts. Setting. —A predominantly rural state in the southeastern United States with a large black minority population (35%) and a low per capita income ($9827 to $12899). Approximately 80% of MMR immunizations are given by public health service nurses working in nine health districts. Subjects. —A total of 2450 preschool-aged children representing 6% of the 1987 birth cohort (n=41 279). Three hundred forty-one children were considered ineligible, leaving 2109 in the final sample. Main Outcome Measures. —Confirmed vaccination by the age of 2 years. Rates of immunization were calculated for the entire state, its health districts, and subgroups based on population density, per capita income, type of clinic visited, and race. Results. —The statewide immunization rate was 87% (95% confidence interval, 86% to 88%). Among the nine health districts, rates varied from 79% to 97% (median, 88%). They were similar for white and black children in each health district and within the state as a whole. The level of vaccine coverage was significantly higher in districts with lower population densities (89% vs 85%, P =.02) and in those with higher per capita incomes (89% vs 86%, P =.03). There were four minor outbreaks of measles during 1989 and 1990; half of the cases occurred in unimmunized children too young to receive the MMR vaccine. Conclusion. —A high rate of measles immunization is attainable among 2-year-olds living in a rural state with a large black minority population and limited economic resources. ( JAMA . 1994;271:1417-1420)