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This report is devoted to analyze the effect that compulsory vaccination has on the compliance of the population, compared with the results obtained by massive campaigns for optional vaccinations. The implementation of a specific software for the management of individual schedules helps to reach a substantial complete coverage of the individuals for the first ones, while improving but incomplete results regard the vaccines against pertussis and measles-mumps-rubella, optional in Italy. The optimization of data management at the local health unit level improves the quality and the satisfaction of the work performed by the personnel, but has a limited effect on the already nearly complete coverage for the compulsory immunizations. The mounting percentage of children immunized with optional vaccines can be explained both by the massive campaigns of information conducted in recent years and by the better tracking of individual immunization schedules.
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PMID:Compliance to compulsory vaccination: strategies and results. 749 70

Attention to local uptake of childhood immunisation is fundamental to the achievement of national targets. The aim of this investigation was to discover whether local interventions by the immunisation coordinator in a district health authority improved uptake. The immunisation coordinator and a public health nurse determined the immunisation uptake in their locality. They made inquiries, and responded to general practitioners and health visitors who asked them to help encourage persistent non-attenders to consent to immunisation. All interventions intended to encourage parents to consent to immunisation (such as telephone calls, letters, and home visits), and their outcomes, were monitored. The uptake of immunisation was remeasured after one year. Ninety-three children were identified whose parents had not responded to repeated invitations for immunisation. Eleven cases were lost to follow up: the families of 10 children had moved out of the area, and one child had died. The remaining 82 children could be divided into two groups: one group, of 49 children, was due for primary vaccination (diphtheria, tetanus, pertussis, and polio, and measles, mumps, and rubella), and a second group, of 33 children, was due for the preschool (diphtheria, tetanus, and polio) booster. Fifty-eight of the 82 children were vaccinated as a result of the intervention. All but two general practices achieved the 90% target for uptake. The review showed that the locality as a whole achieved greater vaccine coverage. The biggest improvement was in the preschool booster uptake, which rose from 87% to 90%.
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PMID:The immunisation coordinator: improving uptake of childhood immunisation. 752 Aug 3

Despite the availability of many effective vaccines, some vaccine-preventable diseases still cause significant morbidity and mortality. Increased prevention should be attainable through proper education about the efficacy and safety of vaccines, improved immunization rates, and adherence to recommended vaccination guidelines from the Advisory Committee on Immunization Practices. Childhood immunization should include a complete diphtheria, tetanus, and pertussis series and a measles, mumps, and rubella series. Booster doses for tetanus should be given every 10 years throughout life.
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PMID:Vaccination update. Diphtheria, tetanus, pertussis, mumps, rubella, measles. 756 14

Urban, poor, preschool children are noted for having low immunization rates. To determine factors related to completion of immunization, vaccine records of 479 3-year-old children from an inner-city pediatric clinic were reviewed. Complete immunization was defined as four diphtheria-tetanus-pertussis doses, three oral polio vaccine doses, one measles-mumps-rubella dose, and one Haemophilus influenzae type b vaccine dose. Seventy percent of our patients were up-to-date by 2 years of age. The administration of all age-appropriate vaccines at a single visit for patients 15 months and older, the establishment of a continuous primary-care relationship, earlier age at first immunization, and lower birth weight were significantly associated with higher immunization levels in our study.
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PMID:Factors associated with improved immunization rates for urban minority preschool children. 758 18

An estimated 8 million infants and 2 million children and adults may die from tetanus during the 1990s despite efforts by the World Health Organization (WHO) to eliminate it by 1995. Vaccination to prevent postabortal and maternal tetanus has been neglected. The immunization of preschool children and of pregnant women has omitted adolescent girls, who are therefore at risk. Data collected on 1101 cases of maternal tetanus in developing countries between 1958 and 1990 indicated that 27% were attributed to postabortal and 67% to postpartum sepsis. In southeastern Nigeria where abortion rates are high, a high proportion of girls were also seronegative for tetanus antibodies. Many unvaccinated pregnant women cite the lack of money for obtaining vaccination when obtaining prenatal services. The WHO is promoting vaccination of women of reproductive age by screening their tetanus toxoid status, but adolescents are poorly covered because they are not regular attenders. Expressly targeting girls would be feasible, as it would require 5 injections providing protection for life. Even 4 injections may protect for 20 years if delivered at the end of primary school. Thus a school health service delivering tetanus vaccination may improve the vaccination of adolescent girls. This could be combined with distribution of vitamin A and antihelminthics whereby the response to the vaccine could be improved significantly. In addition, it has also been suggested that a late dose of an acellular pertussis vaccine and a second dose of measles vaccine given in adolescence would reduce the pool of susceptible girls, just as girls have been targeted for rubella vaccination. Implementation of tetanus vaccination would require local schools vaccination days, immunization cards, high potency primary vaccination, and tetanus boosters free of charge with a system to monitor antibody responses.
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PMID:Protecting adolescent girls against tetanus. 754 4

We describe a new method for active post-marketing surveillance of vaccine safety based on patient records. We studied the association between diphtheria/tetanus/pertussis (DTP) vaccination and febrile convulsion, and between measles/mumps/rubella (MMR) vaccination and febrile convulsion and idiopathic thrombocytopenic purpura (ITP) in five district health authorities in England by linking vaccination records with computerised hospital admission records. We found an increased relative incidence for convulsions 0-3 days after DTP vaccination. The effect was limited to the third dose of vaccine for which the attributable risk (all ages) was 1 in 12,500 doses. Completion of vaccination by 4 months instead of 10 months after the change in the UK to an accelerated immunisation schedule may have resulted in a 4-fold decrease in febrile convulsions attributable to DTP vaccine. 67% of admissions for a convulsion 6-11 days after MMR vaccination were attributable to the measles component of the vaccine (risk 1 in 3000 doses). An excess of admissions for a convulsion 15-35 days after MMR vaccination was found only for vaccines containing the Urabe mumps strain (1 in 2600 Urabe doses). There was a causal association between MMR vaccination and ITP resulting in admission 15-35 days subsequently; there was no evidence of a mumps strain-specific effect. The estimated absolute risk of 1 in 24,000 doses was 5 times that calculated from cases passively reported by clinicians. This finding emphasises the need for active surveillance of adverse events. The record linkage method that we used is an effective way to identify vaccine-attributable adverse events.
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PMID:A new method for active surveillance of adverse events from diphtheria/tetanus/pertussis and measles/mumps/rubella vaccines. 1684 86

A recent analysis demonstrated a change in incidence approaching 100% for diseases against which we routinely immunize in the United States. At present, measles, mumps, rubella, invasive Haemophilus disease, poliomyelitis, diphtheria and tetanus are well-controlled but not eliminated. Diseases that now pose special problems include pertussis, hepatitis A and B and varicella. The incidence of pertussis surged in 1994, possibly in part because of waning immunity in the immunized population. Acellular pertussis vaccines are available for booster doses in children but are not now recommended for adults. Licensure of acellular pertussis vaccines for primary immunization of infants is eagerly awaited. Recombinant hepatitis B vaccine has been licensed for more than 10 years but there has been little change in disease incidence in the United States. Routine immunization of infants is now recommended but concerns exist about cost and persistence of immunity into adolescence. Inactivated hepatitis A vaccines appear to be highly effective in preventing clinical hepatitis and controlling epidemics. Potential target populations include military personnel, day-care attendees and travelers. Hepatitis A vaccine may be recommended for all children after approval by the United States Food and Drug Administration and if a combination vaccine becomes available. A live, attenuated varicella vaccine developed in 1974 and unlicensed in the United States is safe and highly effective in preventing varicella in healthy and immunocompromised populations. It also appears to reduce subsequent development of herpes zoster. Vaccines against pneumococci (conjugate vaccine), respiratory syncytial virus, rotavirus, tuberculosis and human immunodeficiency virus are needed. Research and technology to develop these vaccines must be developed, and efficient delivery mechanisms must be created and implemented.
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PMID:Present and future challenges of immunizations on the health of our patients. 763 35

In patients who have fibrodysplasia ossificans progressiva, routine childhood diphtheria-tetanus-pertussis immunizations administered by intramuscular injection caused a significant risk of permanent heterotopic ossification at the site of injection (p < 10(-8)), whereas measles-mumps-rubella immunizations administered by subcutaneous injection posed no significant risk. Intramuscular injections should be avoided, if possible, once a diagnosis of fibrodysplasia ossificans progressiva has been established.
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PMID:Permanent heterotopic ossification at the injection site after diphtheria-tetanus-pertussis immunizations in children who have fibrodysplasia ossificans progressiva. 775 3

Since 1986, 150 to 180 general practitioners, internists and pediatricians in private practises have reported morbidity data to the Swiss Federal Office of Public Health within the Sentinella network. Data on a certain number of infectious diseases, some noninfectious diseases and other reasons for consultation are collected through this reporting system. The number of participating physicians corresponded to 2.3 to 3.1% of all family practitioners for each of the three specialties. They also covered approximately 2.7% of the total annual number of consultations in Switzerland. In 1992/93, all cantons and all half-cantons except Nidwalden and the two half-cantons of Appenzell were represented by at least one physician who reported during 75% or more of the total reporting period. When compared to other countries, the network density of the Swiss Sentinel network is high. Since 1986, several infectious diseases have been continuously monitored by the Sentinella system (measles, mumps, rubella, influenza). Surveillance of pertussis, which was started in 1991, will be continued for several years. According to these data, an annual pertussis incidence rate of 60 out of 100,000 population and 100 out of 100,000 population was estimated in 1991/92 and 1992/93, resp. More than 55% of cases were children aged between one and eight years. Of these children, 70.4% were reported to be vaccinated, and 62.6% had a well-documented vaccination status (based on a vaccination certificate). In 95.6% of these cases, at least three vaccine doses were given.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The Sentinella reporting system in Switzerland exemplified by pertussis monitoring from 1991 to 1993. Sentinel Work Group]. 778 75

The Childhood Immunization Initiative (CII) was initiated to increase vaccination coverage among 2-year-old children. The 1996 objective is to have at least 90% coverage for four of the five critical vaccines routinely recommended for children (i.e., one dose of measles-mumps-rubella vaccine [MMR] and at least three doses each of diphtheria and tetanus toxoids and pertussis vaccine [DTP], oral poliovirus vaccine, and Haemophilus influenzae type b vaccine [Hib]), and at least 70% coverage for three doses of hepatitis B vaccine (Hep B) (1). These objectives are an interim step toward the year 2000 goal of at least 90% coverage for the recommended series of vaccinations and are being monitored on an ongoing basis. This report presents national estimates of vaccination coverage among 2-year-old children derived from provisional data from the National Health Interview Survey (NHIS) for the first quarter of 1994 and compares these with the last two quarters of 1993.
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PMID:Vaccination coverage of 2-year-old children--United States, January-March, 1994. 786 81


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