Effort to Ensure Infant Vaccinations Urged : Health: A report calls for all children to be immunized by age 2. Today, fewer than 70% of 2-year-olds in the nation are protected.

Citing the distressingly low rate of infant immunizations in this country, the Institute of Medicine urged the public health community Tuesday to adopt innovative measures to ensure that all children receive their vaccinations by the age of 2.

A report issued by a special panel of the institute, part of the National Academy of Sciences, recommended greater collaboration among physicians, families and public health officials to achieve comprehensive immunizations. It encouraged pediatricians, for example, to administer as many vaccinations as possible during a single office visit.

“By the age of 2, all children are supposed to have received nearly their full set of immunizations, but fewer than 70% of 2-year-olds in this country have,” said Lorraine V. Klerman, chairwoman of the department of maternal and child health at the University of Alabama. Klerman chaired the institute panel studying the issue.

A childhood immunization initiative introduced by President Clinton last year designates 1996 as the target date for achieving comprehensive immunization of 2-year-olds. During the last five years, numerous outbreaks of vaccine-preventable diseases--such as measles--have focused attention on low immunization rates among preschoolers.

Vaccines are available for virtually all major common childhood illnesses except chicken pox. The Food and Drug Administration is expected to license a chicken pox vaccine by the end of the year.

More than 95% of American children are fully immunized by the time they enter school, a figure that “is in sharp contrast to the unacceptably low immunization rates” for those aged 2 or younger, the report noted. Public schools typically require immunization upon entry, accounting for the higher rates.

Although the rates are especially low among minority preschool children, incomplete immunization is “a widespread problem” for all socioeconomic levels, the report said. Statistics for 1992, for example, show that more than 70% of 2-year-olds who were not protected against measles were white, and a similar proportion were not living in poverty.

Various barriers contribute to under-immunization, the panel said. Chief among them is the health care system itself, which often emphasizes acute care over preventive care.

Other factors include lack of education, limited access to health care, personal and cultural characteristics that make families unaware of the risk and severity of illness, and the failure of health care providers to adequately monitor patients’ immunization status.

The responsibility for achieving full immunization must be shared by public health officials, health care providers, families and communities, the report said.

The panel urged physicians to become more aggressive in ensuring that youngsters receive the necessary shots.

It recommended that they maintain accurate records and regard all visits as opportunities to screen, educate and vaccinate eligible children.

“A newborn child’s first immunization appointment can be made in the hospital before the mother and child are discharged,” the report said.