Philadelphia has among the highest vaccination rates in the nation, often topping all other big cities and most states. For Hib, a deadly disease that has reappeared for the first time in years, the most recent National Immunization Survey estimates the city's vaccine coverage at 96.3 percent - the best in the country, period.
Philadelphia does more than the rest of Pennsylvania and New Jersey to ensure that children get vaccinated.
Every day, for example, armed with records showing missed immunizations, Velazco-Miranda and other outreach workers for a community organization contracted by the city Department of Public Health visit 10, 20, 30 homes around the city. They carry no vaccine, and have no enforcement authority.
They can, however, help with the hurdles - no transportation, no money, no medical records, no English - that prevent children from getting immunized. And they are on a mission.
"We don't stop. No water, no lunch break, no nothing. We keep going until we are finished," said Betzabe Toledo, who insisted she was not exaggerating about the day that she and Velazco-Miranda knocked on 65 doors. Half were not home, so they had to go back.
Vaccines are one of the great success stories of public health, along with clean drinking water and good nutrition. Once invented, however, they still had to make it into children, particularly poor children.
As recently as the early 1990s, up to half of infants and preschoolers in some neighborhoods here and elsewhere still were not getting immunized on time. Measles infected more than 1,200 children in Philadelphia in 1991; eight died in the epidemic.
