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Family physicians can play a key role in reversing the resurgence of vaccine-preventable illnesses by making sure that patients are fully immunized. Childhood immunization schedules have recently changed. A second dose of measles, mumps and rubella (MMR) vaccine should be given at age four to six years. It has been recommended that hepatitis B vaccine be administered routinely to all infants in the United States. Both hepatitis B vaccine and hepatitis B immunoglobulin should be given to offspring of hepatitis B carriers. Haemophilus b conjugate vaccine (HbCV) should be administered to all infants, beginning at two months of age. Vaccines can be safely administered to patients with mild illnesses, allergic rhinitis, low-grade fever or penicillin allergy, as well as to those taking antibiotics. If indicated, several vaccines, such as diphtheria, tetanus and pertussis, oral poliovirus, HbCV and MMR, can be given simultaneously.
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PMID:Childhood immunizations: a practical approach for clinicians. 155 51

Increasing numbers of immigrants from the former Soviet Union are settling in the United States each year, making it imperative for clinicians to know how to find and interpret immigrant children's immunization records. Records show that these children have usually received immunizations against tetanus, diphtheria, pertussis, poliomyelitis, measles, mumps and tuberculosis (BCG). They are occasionally vaccinated against influenza, smallpox and tularemia, but never against rubella, hepatitis B or H. influenzae meningitis. The Soviet immunization schedule differs significantly from the U.S. schedule only in BCG vaccine and polio immunization. Contrary to widespread belief in the United States, BCG vaccination does not necessarily render a child's tuberculin skin test positive, and it certainly does not confer total immunity to tuberculosis. MMR vaccination is essential for all Soviet immigrant children. A single update of all the other immunizations may be a wise approach when handling Soviet children's immunizations.
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PMID:Clinical management of immigrants' immunization histories: a focus on Soviet health records and BCG. 157 76

We studied the immunization of hepatitis B vaccine integrated with of EPI. 180 children (0-9 months of age) from three towns of Shunde County were randomly divided in to three groups (two trial groups and one control group). Which were vaccinated by three different immunization schedule. The serum antibodies to different vaccines were measured before and after immunization. The results show that the seroconversion rate and GMT of each EPI vaccine are conformed with the expected EPI indexes. The seroconversion rate of anti-HBs antibody is found no significantly different among the three groups. The titres of pertussis agglutinating and three types polio neutralizing antibody is higher in trial groups than that in the control group. We conclude that the immunization of hepatitis B vaccine can be integrated into the EPI schedule. And third dose of hepatitis B vaccine can be simultaneously given with measles vaccine.
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PMID:[Immunization of hepatitis B vaccine integrated with expanded program on immunization schedule in children]. 158 48

A community health professor analyzed 1986-1989 data on selected primary health care (PHC) services (immunizations, prenatal care, and delivery) to examine the progress of PHC interventions in the rural Odukpani local government area (LGA) in Cross River State, Nigeria. Coverage for the diphtheria-pertussis-tetanus (DPT) and oral poliovirus (OPV) vaccines increased steadily over time (DPT-1 and DPT-2 18-32%; DPT-3 3-28%; OPV-1 18-35%; OPV-2 8-32%; and OPV-3 3-28%). On the other hand, measles and bacille Calmette-Guerin (BCG) vaccine coverage fell (42-28% and 49-31%, respectively). Tetanus toxoid coverage was 13% in 1986 and fell to 12% in 1987 and increased above original levels in 1988 (17%). Odukpani LGA vaccine coverage figures were below national coverage figures. The proportion of all 15-49 year old women using antenatal services fluctuated around 20% during this period, but the percent increase in utilization of antenatal services increased from 0-14%. Overall, the proportion of health worker (HW) attended deliveries increased (e.g., 56-69% during 1988-1989) while the proportion of traditional birth attended (TBA) deliveries decreased (e.g., 45-31% during 1988-1989). On the other hand, in 1986-1987, TBA deliveries rose (39-47%) while HW attended deliveries fell (62-53%). Traditional birth attendants did receive training to reduce maternal and child mortality. There was a real possibility of underreporting in this LGA. These results do indicate, however, that the PHC system has effected at least modest increases in specific interventions. This pilot approach can serve as a practical means to monitor implementation of PHC efforts.
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PMID:The use of selected interventions in monitoring primary health care implementation in rural Nigeria. 158 61

Low immunization rates among US preschool children suggest a need for improved immunization practices. Immunization and encounter records were reviewed to ascertain immunization rates and missed opportunities for vaccine administration among 515 preschool children who were active patients at a hospital-based primary care center serving lower socioeconomic status families in Rochester, NY. The point prevalence at a mean age of 4.4 years for lack of one or more recommended immunizations was 27%; 7% were missing measles-mumps-rubella, 18% were missing Haemophilus influenzae type b, 8% were missing two or more diphtheria-tetanus-pertussis, and 4% were missing two or more oral poliovirus immunizations. A visit was counted as a missed opportunity if an immunization was due but not given. Over the period from birth through age 36 months, 422 (82%) of children missed at least one immunization opportunity. For these 422 children, there was a mean of 7.2 missed opportunities per child. Although 64% of missed opportunities occurred at an acute illness visit, 36% occurred at well-child, administrative, follow-up, or chronic illness visits. Review of 200 medical records randomly selected from all opportunities at acute illness visits found no contraindication in 63% (50% nonfebrile infectious disease, 13% minor noninfectious problems). Findings for random samples of 100 missed diphtheria-tetanus-pertussis opportunities for children aged 2 to 6 months and 100 missed measles-mumps-rubella opportunities for children 15 to 24 months were similar to findings for the sample of all acute illness visits. Emergency department visits, where immunization records were not readily available, accounted for 18% of missed opportunities.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Immunization opportunities missed among urban poor children. 812 12

On June 13, 1991, President George Bush announced in a White House ceremony a local planning effort to break down barriers and provide better access to immunization in six representative localities "to solve the problem of late immunization." (children need to be immunized appropriately by their second birthday, not just in time for school.). The community "Immunization Action Plans" (IAP) are one of several Federal, State, and local responses to an outbreak of measles that produced 27,600 cases and 89 deaths in 1990. The community effort and subsequent early childhood immunization plans around the country are also part of a much broader effort initiated by Secretary Sullivan as a Healthy People Year 2000 goal to increase immunization levels to at least 90 percent for the nation's children by their second birthday. These efforts also respond to 13 recommendations for improving immunization availability made by the National Vaccine Advisory Committee in January 1991. The recommendations focused on improvements in the management of immunization delivery and in methods for measuring immunization status, increasing appropriate consumer demand, and other prevention needs. Although measles prompted the action, the immunization initiative is aimed also at eight other communicable childhood diseases--diphtheria, tetanus, pertussis or whooping cough, poliomyelitis, mumps, rubella, and Haemophilus influenza type b that causes bacterial meningitis, and hepatitis B. Details are described of the immunization action plans developed by Dallas, TX; Maricopa County (Phoenix), AZ; South Dakota; Detroit, MI; San Diego, CA; and Philadelphia, PA, to ensure that children are fully immunized not just by the time they enter school but by age 2 years. The six were chosen by the Centers for Disease Control as representative of many without adequate childhood immunization coverage.
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PMID:Six areas lead national early immunization drive. 159 33

The international community has launched the Children's Vaccine Initiative, which has created the most ambitious grouping of public and private sector interests ever to tackle a global health issue. Developed by WHO, UNICEF, UNDP, the World Bank, and the Rockefeller Foundation, the initiative is the result of decisions taken at the World Summit for Children, held in New York in September 1990. During that meeting, world leaders requested greater resources for the development of new or better vaccines. The Children's Vaccine Initiative, says WHO Director-General Dr. Hiroshi Nakajima, will not only yield specific benefits in improving vaccines, it will also establish a process of collaboration between the public and private sectors, which will have far-reaching benefits in other areas. The new initiative comes on the heels of another international effort, the successful Expanded Program on Immunization, which in 1990 achieved its goal of immunizing 80% of the world's children against 6 major childhood diseases: poliomyelitis, measles, tuberculosis, diphtheria, pertussis, and tetanus. The new initiative will strive to develop vaccines against a wider spectrum of viral, bacterial, and parasitic diseases which cause mortality in children. These diseases include rotavirus infection, hepatitis A and E, dengue, Japanese encephalitis, acute respiratory diseases, meningococcal meningitis, diarrheal diseases, pneumococcal pneumonia, and malaria. The new initiative will also seek to improve existing vaccines, making them easier to administer and less painful and costly.
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PMID:New children's vaccine initiative launched. 160 Apr 43

Vaccination is one of the most effective health promotion activities, but specific targets have been difficult and costly to achieve, and have frequently fallen short of the desired aims, leaving some vulnerable groups unprotected. Policy in the UK has differed for the childhood diseases and in some cases, for example diphtheria and poliomyelitis, has been successful in almost eliminating the disease. In other cases, such as that of pertussis, there has been public opposition, and for other diseases, for example, measles, sufficient numbers of the susceptible population have only recently been reached. Although the World Health Organization target of 90% uptake for the childhood diseases has been reached for all except pertussis, the figures conceal lower uptake rates in some areas, particularly the inner cities. The introduction of target payments to general practitioners appears to have had some effect in increasing uptake rates, particularly in some inner city areas, although the change in immunization schedules may also have had an impact. Target payments fail to take account of the difficulties faced by inner city GPs and, in effect, favour those who need to make least effort, since, in some areas, high uptake rates may already have been achieved before targets were introduced. It is suggested that there is a case for special local development programmes in inner city areas which will provide help with improving record keeping and recall systems for immunization. An alternative policy, which might be more difficult to implement, would be to have targets which could be set at different levels in different areas so that uptake rates could be progressively improved.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Immunization in the UK: policy review and future economic options. 162 11

From 1989 through 1991, in the United States, the incidence of reported measles increased sixfold to ninefold over the median annual incidence (1.3 per 100,000 population) reported from 1981 through 1988. In 1990, the peak of the resurgence, the incidence of measles among children aged less than 5 years was 15-fold higher than the median 1981-1988 incidence (4.8 per 100,000) (1). During 1991, approximately 9500 cases were reported (Figure 1), including 4662 cases among children aged less than 5 years (CDC, unpublished data). The measles epidemic is a consequence primarily of the failure to vaccinate preschool-aged children at appropriate ages (2); among children aged 16-59 months who developed measles during this resurgence, only 15% had received measles vaccine as recommended (CDC, unpublished data). This report compares the number of public clinic vaccinations* (i.e., all measles-containing vaccines [MCV], diphtheria-tetanus-pertussis vaccine [DTP], and oral polio vaccine [OPV]) for 1988 with that for 1989-1991 in response to the measles resurgence.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Public-sector vaccination efforts in response to the resurgence of measles among preschool-aged children--United States, 1989-1991. 163 Apr 30

A National Serum Bank was established to store sera obtained during the National Seroepidemiological Survey performed in Mexico in 1987. More than 70,000 serum samples were obtained from subjects of either sex 1-99 years of age in each of the 32 states of the country. The current collection of sera includes 28,704 male samples and 40,629 female samples. This paper describes the procedures for handling serum samples, including reception registry, storage and distribution to several laboratories for detection of measles, rubella, poliomyelitis, AIDS, diphtheria, pertussis, tetanus, brucella, salmonella, amoeba, toxoplasma, American trypanosomiasis and cysticercus. Determinations of total cholesterol were also made in order to describe its distribution and to identify the prevalence of hypercholesterolemia.
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PMID:[The National Serum Bank]. 163 28


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