The immunization Programme was started in India in 1978 with the objective of reducing the mortality due to vaccine preventable diseases. Immunization coverage levels in infants and pregnant women have increased substantially over the last decade. Immunization coverage levels of 69 to 82% with various vaccines were reported in 1989-90. There is however, a wide disparity in the coverage levels in states and in the districts. While the priority to remains to increase immunization coverage levels, surveillance of vaccine preventable diseases is receiving high priority to identify weak pockets for intensification of immunization services and to document impact. Besides completeness of reporting., emphasis of the surveillance system in many areas has shifted to obtaining information on cases as early as possible to allow epidemiological investigations and effective follow-up action. The achievements in a large number of districts show that the goal of universal immunization, while difficult and challenging, is attainable.

Immunization coverage assessment of 327 children in Himachal pradesh revealed that 66.7%, 42.2% and 50.6% children were fully immunized in urban, rural and tribal areas respectively. The coverage by all vaccines was well above the national average. Drop out rates were more in the rural areas followed by tribal and urban areas. The main reason for drop outs in immunization was parents’ preoccupation with their work. However in the opinion of the health workers, fear of side reactions and illness of the child were the main reasons for the poor response.

A study conducted in an urban and rural area of Delhi to assess immunization coverage of children revealed that the number of fully immunized and partially immunized children was higher in the urban than in the rural area, but all vaccines, except BCG, in both areas fell short of the target of 85% coverage as laid down by the Universal immunization programme, knowledge of mothers about immunization was but one third of mother in both areas did not know about the requirement of 3 does of DTP. Health staff was the most important sources of information in both areas (66.5%in urban and 66.7% in rural area) followed by radio of T.V in the urban and person-to-person contact in the rural area. The most important reasons for failure of immunization in both areas were illness of the child and family problem. Therefore the need for imparting health education in both areas through health workers by personal contact and by mass media is strongly recommended to achieve the target of 85% immunization coverage.

The role of immunization in reducing childhood mortality cannot be over-emphasised, yet many opportunities for immunization are missed when children and pregnant women visit a health facility. Reducing missed opportunities is the cheapest way to increase immunization coverage. The present study discusses the extent of the problem of missed opportunities for immunization in children and pregnant women and the factors contributing to the problem, in spatiality and community outreach clinics of Christian Medical College & Hospital, Ludhiana. Recommendations are made regarding ways and means of reducing missed opportunities.

Three thousand six hundred and twenty four mothers selected from100 villages randomly chosen from 60 UIP districts were interviewed. Mothers of fully immunized children were better educated, of a higher social class and were willing to actively seek immunization than mothers of partially and non-immunized children. The source of information was generally a health facility. The strategy of outreach services would benefit the poor and ill-informed mothers to have their children fully immunized.