U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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  Quality of IHS Health Care

Performance Measures

Health Topic: Childhood Immunizations
If a child is not vaccinated and is exposed to a disease germ, the child's body may not be strong enough to fight the disease. Before vaccines, many children died from diseases that vaccines now prevent such as measles and polio.

Immunizing individual children helps to protect the health of a community. People who are not immunized include those who are too young to be vaccinated (e.g., children less than a year old cannot receive the measles vaccine but can be infected by the measles virus), those who cannot be vaccinated for medical reasons (e.g., children with leukemia or a contraindication to a vaccine), and those who cannot make an adequate response to vaccination. Immunization also slows down or stops disease outbreaks.

Routine immunizations are a cost-effective public health measure that significantly improves the health of children. To lower your chances of getting a childhood disease, you should have your child immunized as described below.

Who should get this immunization?
Children between the ages of 19 to 35 months should be immunized. Some vaccines may only be given after the age of 1 year (e.g., measles). Some vaccines are best if given after 42 days of age, ask your doctor for a vaccine schedule and discuss when to begin vaccinations.

Why are childhood vaccines important?
Routine immunizations are a cost-effective public health measure that significantly improves the health of children. Vaccines help prevent infectious disease in the people who receive them and protect those who come into contact with unvaccinated individuals.

What is the GPRA measure?
The GPRA measure is the percentage of IHS AI/AN children ages 19 to 35 months of age who have received the 4:3:1:3:3:1:4 combination. The combination is all of the immunizations listed below.

  • 4 doses of DTaP (Diphtheria, Pertussis, and Acellular Pertussis)
  • 3 doses of IPV (Polio)
  • 1 dose of MMR (Measles, Mumps, and Rubella)
  • 3 doses of Hepatitis B
  • 3 Hib (Haemophilus influenzae type B)
  • 1 dose of Varicella
  • 4 doses of Pneumococcal

How is IHS doing?
The United States long-term goal is for at least 80% of children 19 to 35 months of age to receive the recommended individual immunizations (4:3:1:3:3:1:4 immunization combination) by the year 2020 (Healthy People 2020). IHS is close to achieving this goal. The IHS 2012 goal was to achieve the rate of 77.8% for the proportion of American Indian/Alaska Native children ages 19-35 months who have received the recommended immunizations (4:3:1:3:3:1:4 combination). IHS did not meet this goal by reaching 76.8%. The bars on the graph below show that IHS has decreased the rate of childhood immunizations from 78% in 2006 to 76.8% in 2012. However, beginning in 2010 the immunization combination was changed from 4:3:1:3:3 to 4:3:1:3:3:1, refusals was removed from the rates, and beginning in 2011 the immunization combination changed from 4:3:1:3:3:1 to 4:3:1:3:3:1:4. So, the 2006-2009 rates cannot be compared with the 2010 rates and the 2010 rates cannot be compared with the 2011-2012 rates. Beginning in 2013, the recommended immunizations will include 3 or 4 HiB vacinations (4:3:1:3or4:3:1:4 combination)

Percentage of IHS AI/AN Patients  Aged 19-35 Months with 4:3:1:3:3:1:4 Combination  (IHS 2013 goal is to establish a baseline for patients aged 19-35 months with the 4:3:1:3or4:3:1:4 combination)  NOTE: A higher score is better

View a table of this chart's data.

Year Percent
2006 78
2007 78
2008 78
2009 79
2010 79
2011 75.9
2012 76.8
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To see how IHS is doing on this measure at the Area (regional) levels, click here.