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Swaziland is a kingdom with 800,000 inhabitants bordering on Mozambique and South Africa with about 50% of the population under 15 years of age. The experience of a nurse in a small clinic in the course of several years is recounted. Swaziland ranks 3rd in the world in alcohol abuse which often leads to wounds requiring suturing. Penicillin is given prophylactically with a paracetamol preparation for analgesia. As a rule, every injured person will get a .5 ml tetanus injection for prophylaxis. The most serious conditions of polyclinic patients are hepatitis, bilharzia, diarrhea, pellagra, pneumonia, and malnutrition. A great number of patients have sexually transmitted diseases, and the rate of AIDS infection is not known. According to 1 study 60-80% of the population in reproductive age will die of AIDS in the course of a 5-year period. The majority of people are impervious to counseling about their sexual behavior in spite of educational programs on the radio, in schools, and in work places. Condoms are not popular, since they are not considered manly. Pregnant women receive iron and multivitamin tablets in the course of pregnancy. Many pregnant women are anemic, and 70% give birth at home, the rest in a hospital or clinic. During delivery they get no analgesia, and there are few complications. The average weight of the newborn is 3.5 kg, although none of the women are under 150 cm. A little after birth all children are vaccinated with bacillus Calmette-Guerin (BCG) and polio, later with diphtheria-pertussis-tetanus (DPT) and measles.
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PMID:[Nursing under a different sky. Swaziland]. 146 29

Outbreaks of vaccine preventable infections have focused attention on 'missed opportunities' for immunizing children. The immunization status of 520 consecutive children attending Casualty during a 10 day period was studied. Only 70% of children had received their diphtheria, tetanus, pertussis (DTP) and poliomyelitis immunization at the appropriate time, 13% had completed the schedule later than recommended and 17% had immunizations overdue by 4 weeks or more. For measles (mumps/rubella) vaccine (MM or MMR) 75% were up to date, 10% were given late and 15% were overdue. A subset of 171 families was interviewed to evaluate factors affecting compliance. Families possessing a Social Security 'Health Care Card', whose father was unemployed, who spoke poor English or who had lived in Australia for 5 years or less were significantly more likely (P < 0.02) to be inadequately immunized. There were 84 children whose immunization was overdue and who were well enough to be immunized. The parents of 70 (83%) of these 84 said that they would agree to 'on the spot' immunization if it were available; 14 (17%) parents refused, the commonest reason for refusal being that the parents felt that the child was too sick at the time to be immunized.
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PMID:Immunization status of casualty attenders: risk factors for non-compliance and attitudes to 'on the spot' immunization. 146 42

The effect of prior injections on the pattern and severity of paralytic poliomyelitis has been examined by a retrospective analysis of case notes from an outpatient pediatric clinic in South India. Of 262 children with acute polio, 176 had received unnecessary injections < 48 h before paralysis and 12 had received diphtheria-pertussis-tetanus or provocative injections. Two children injected in the right arm had paralysis in that limb only. Children with no injections (controls) had an equal chance of paralysis (0.73) in each left and right leg. Children with injections in the right or left gluteus or in both had a 19% greater chance of paralysis in the injected leg(s), whereas uninjected legs had a 31% lower chance of paralysis. Injected leg muscles were weaker than those of control children. Legs of control children were stronger than those with one leg injected and much stronger than those with both injected. More than 96% of the children had at least one leg paralysed. Age and vaccine status did not affect the results of injections. After injections there was greater likelihood of death or lack of recovery of muscle strength. About three-quarters of the children had received unnecessary injections; of these 60% had more severe paralysis and a non-paralytic attack became paralytic in 40%. If oral medicines for fevers and diarrhoea replaced unnecessary injections, the prevalence and severity of paralytic polio would be reduced.
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PMID:Unnecessary injections and paralytic poliomyelitis in India. 147 30

During the 1970s and the early 1980s, immunization practices in the United States were unchanged. Immunization against pertussis, tetanus, diphtheria, measles, mumps, rubella, and polio were routinely administered to children. Infections with these organisms declined dramatically. Nonetheless, research was vigorous, culminating in the 1980s in new vaccines and changes in immunization strategies and practices. This presentation will focus on these changes: universal hepatitis B immunization; two-dose schedule for the measles, mumps, rubella (MMR) vaccine, Hemophilus influenza type B vaccine for infants, acellular pertussis vaccine as booster immunizations, the inactivated polio vaccine, and the yet-to-be-licensed live varicella vaccine.
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PMID:Immunization update. 149 Jun 20

In 1987 the nutritional status of Zambian children under 5 years of age was studied in 3 regions around Kamoto Hospital with the objective of exploring the prevalence if malnutrition and contributing factors such as maternal education and immunization status. Jumbe was within easy reach of the hospital with a relatively high standard of living. Masumba and Kakumbi were different areas in one region with their own health center further away from the hospital. Chibembe was isolated without good roads. The nutritional status of 1-5 year old children was measured by the Mid Upper Arm Circumference (MUAC). A questionnaire with 22 questions queried mothers about education, breast feeding, meals, water supply, and sanitation. A total of 1251 children were observed, 1222 under age 5, and 29 a little older. 40% of mothers had no education and 54% had some primary education (15.2% passed grade 4, 7.3% reached grade 6, and 18.2% finished grade 7). Less than 5% attended secondary school, and only 1% of mothers finished it. In Chibembe almost 50% of mothers had no education, secondary school education was the lowest of the regions, while in Jumbe was the highest. Immunizations included Bacillus Calmette-Guerin (BCG) at birth, diphtheria-tetanus-pertussis (DTP I, II, III, and a booster), oral polio vaccine (OPV) I, II, III, and a booster, and measles. The Chibembe region has the highest number of incomplete immunizations. In the Jumbe region unknown immunization presumably contributed to a higher number of older children. The nutritional status of children was the lowest in Chibembe region with a 10.8% rate of malnutrition and the lowest rate of maternal education. In Masumba/Kakumbi malnutrition was the lowest with 5.6%, while maternal education and complete immunization were the highest. The nutritional status of the completely immunized children was better. MUAC should be routinely employed for children under 5 years of age.
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PMID:Immunisation and nutritional status of under-fives in rural Zambia. 150 11

A repeat vaccination coverage survey has been conducted in the Edendale/Vulindlela district of KwaZulu. The survey data were processed using the Coverage Survey Analysis System (COSAS) developed by the World Health Organisation (WHO) through its Expanded Programme on Immunisation (EPI). A modified random cluster sampling method was used to select 281 children between the ages of 12 and 23 months. Of the children surveyed, 83% were in possession of Road-to-Health cards (RTHCs). The best estimate of overall coverage for doses up to and including the second doses of polio and diphtheria, pertussis and tetanus (DPT) was 85% or higher, but estimates for polio 3 and measles, at 72% and 67% respectively, remain suboptimal. Stratification of coverage into urban, peri-urban and rural categories revealed that the major contribution to the fall-off in coverage, after the second dose of polio and DPT, came from children in the peri-urban category with estimates of 52% for polio 3 and 38% for measles. The fact that coverage in the peri-urban population for doses up to and including polio 2 was 78% or higher indicated that the peri-urban influence responsible for this drop-out effect occurred between the approximate ages of 5 and 8 months. This identified populations in informal peri-urban settlements as a priority group for urgent intervention and further study. The estimation of missed opportunities at visits when vaccinations are normally given, found in this survey to occur in 17% of children, was a useful feature of COSAS and provided a basis for a specific intervention.
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PMID:The use of COSAS in the analysis of vaccination coverage in urban, peri-urban and rural populations in the Edendale/Vulindlela district of KwaZulu. 150 23

Although injections administered during the incubation period of wild poliovirus infection have been associated with an increased risk of paralytic poliomyelitis, quantitative estimates of the risk have not been established. During a poliomyelitis outbreak investigation in Oman, vaccination records were reviewed for 70 children aged 5-24 months with poliomyelitis and from 692 matched control children. A significantly higher proportion of cases received a DTP (diphtheria and tetanus toxoids and pertussis vaccine) injection within 30 days before paralysis onset than did controls (42.9% vs. 28.3%; odds ratio, 2.4; 95% confidence interval, 1.3-4.2). The proportion of poliomyelitis cases that may have been provoked by DTP injections was 35% for children 5-11 months old. This study confirms that injections are an important cause of provocative poliomyelitis. Although the benefits of DTP vaccination should outweigh the risk of subsequent paralysis, these data stress the importance of avoiding unnecessary injections during outbreaks of wild poliovirus infection.
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PMID:Attributable risk of DTP (diphtheria and tetanus toxoids and pertussis vaccine) injection in provoking paralytic poliomyelitis during a large outbreak in Oman. 153 50

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

The immunogenicity and safety of a new Haemophilus influenzae type b conjugate vaccine, PRP-T, was studied in 107 infants from the Oxford district. The vaccine was given concurrently with diphtheria, pertussis, tetanus, and polio vaccines at 2, 3, and 4 months of age. Symptoms after immunisation were recorded by a parent. Sera were obtained before the first immunisation and at 5 months of age and the antibodies were measured by both radioimmunoassay and enzyme linked immunosorbent assay (ELISA). No serious adverse reactions were observed and there was no increase in the incidence of expected minor side effects. By radioimmunoassay, the geometric mean titre of serum anticapsular antibody increased from 0.09 micrograms/ml before immunisation to 5.01 micrograms/ml after three immunisations. Ninety eight per cent of children had antibody concentrations consistent with protection (greater than or equal to 0.15 micrograms/ml). IgG antibody concentrations measured by ELISA correlated well with total antibody concentrations measured by radioimmunoassay (r = 0.864). These results provide encouragement that routine immunisation against H influenzae type b at 2, 3, and 4 months of age, could prevent most cases of disease in children in the UK.
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PMID:Immunogenicity and safety of PRP-T conjugate vaccine given according to the British accelerated immunisation schedule. 158 Jun 74

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


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