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The objective of the Childhood Immunization Initiative (CII) is to protect all children in the United States by their second birthday against nine vaccine-preventable diseases. Specific objectives for 1994 were to increase coverage levels to at least 85% for the third dose of diphtheria and tetanus toxoids and pertussis vaccine (DTP3) and the first dose of measles, mumps, and rubella vaccine (MMR1); 75% for the third doses of oral poliovirus vaccine (OPV3) and Haemophilus influenzae type b vaccine (Hib3); and 30% for the third dose of hepatitis B vaccine (HepB3) (1). To determine whether county health departments in Kansas had achieved the national vaccination objectives, in 1993 staff from the Kansas Department of Health and Environment (KDHE) began assessing vaccination coverage rates for children aged 2 years served by county health departments in that state. This report presents the results of the first vaccination coverage assessments of all 105 county health departments in Kansas during November 1993-November 1994.
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PMID:Vaccination coverage surveys in county health departments--Kansas, 1993-1994. 788 21

In August 1991, the Institute of Medicine released a report entitled Adverse Effects of Pertussis and Rubella Vaccines, which examined, among others, the relation between immunization with whole-cell diphtheria-tetanus-pertussis (DTP) vaccine and both acute encephalopathy and chronic neurological damage. The committee reviewed information from a wide range of both professional and lay sources and found that the evidence is consistent with a possible causal relation between DTP vaccine and acute encephalopathy, although it is insufficient to establish causality. The range of excess risk of acute encephalopathy following DTP immunization is consistent with that estimated from the National Childhood Encephalopathy Study: 0.0 to 10.5 cases per million immunizations. The committee concluded that the evidence is insufficient to indicate either the presence or absence of a causal relationship between DTP vaccine and permanent neurological damage. The evaluative methods used by the committee are briefly described and the evidence underlying its conclusions presented.
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PMID:Acute encephalopathy and chronic neurological damage after pertussis vaccine. 790 66

The use of vaccines to prevent infectious diseases is a hallmark of modern preventive medicine and public health. During this century, improvements in immunization practices have dramatically reduced the number of reported cases of potentially serious diseases such as diphtheria, measles, mumps, pertussis, poliomyelitis, rubella, and tetanus. Yet, despite such reductions, outbreaks of vaccine-preventable diseases continue to occur. Recent outbreaks of measles and pertussis, particularly in underimmunized and unimmunized children, raise concern regarding the effectiveness of existing childhood immunization practices. Such concern is stimulating action from policymakers, physicians, and public health professionals to improve childhood immunization programs in this country. This article discusses one of these programs, the Vaccines for Children (VFC) program, which is part of a new federal initiative to improve childhood immunization levels. Enlisting the support and participation of private physicians is crucial to the success of this national immunization strategy.
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PMID:Childhood immunizations and the Vaccines for Children program. 795 61

One hundred-twenty-six pediatricians were questioned about their attitudes concerning the practice of immunization, their feelings about the new vaccines (measles, mumps, german measles, hepatitis b) and about the pertussis vaccine. 80% of them reported that indications and contraindications were still unclear: Down's syndrome and atopic eczema are still thought to be real contraindications--despite the mass of papers suggesting that they are not so--, moreover 95% of the participants persists into the unnecessary evaluation of the antibody title following hepatitis b immunization. We conclude that it would be wise to periodically diffuse to pediatricians update recommendations about the extended immunization program, especially in our region, were still an high number of children are not properly immunized.
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PMID:[The attitude and vaccination practice of a sample of Campania pediatricians]. 797 59

Scientific evidence documenting the effectiveness of immunization delivery methods was summarized using the generic approach developed by the Community Health Practice Guidelines Working Group. The delivery methods examined were those for the adult and childhood vaccines of influenza, pneumococcal infection, hepatitis B, measles-mumps-rubella and diphtheria-pertussis-tetanus-polio. Based on a critical appraisal of 54 eligible comparative studies, the effects of different interventions were obtained and pooled effects were calculated for delivery methods oriented to the client, the provider and the system. The results indicate those interventions found to be most effective for each vaccine. This review of the scientific evidence of the effectiveness of immunization delivery methods provides a base for policy development and assists in the planning of resource allocation.
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PMID:Evaluation of the effectiveness of immunization delivery methods. 798 55

The association between parents in Liverpool consenting to their children being invited for primary immunisations and five sociodemographic factors, namely sex, position of child in the family, family type, migration into Liverpool since birth, and local deprivation was examined. Rates of consent to invitation were over 97% for each antigen except pertussis, which had a consent rate of 83%. Consent to invitation for pertussis vaccine was least likely to have been given for boys, children with older siblings, those recorded as living with a single parent, and those in the most deprived areas. Local deprivation also had an effect on consent to the measles, mumps, and rubella vaccine. Migration into Liverpool had a significant effect on consent to invitation for all antigens except pertussis. The child's sex, family type, and local deprivation had no effect on consent to diphtheria, tetanus, and polio immunisations. Maximising pertussis vaccine uptake will require more attention to be paid to those parents who have been identified as being less likely to give consent. It is particularly important that consistent and clear advice about immunisations is made available to parents with two or more children, lone parents, and those living in materially deprived areas. Our findings challenge some of the assumptions underlying the principles of 'first parent visiting', at least so far as pertussis is concerned.
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PMID:Primary immunisations in Liverpool. I: Who withholds consent? 818 76

The association between completion of primary dipht eria, tetanus and pertussis, measles, mumps, and rubella and polio immunisation courses in Liverpool and five sociodemographic factors, namely the child's sex, position in the family, family type, migration into Liverpool since birth, and local deprivation was examined. Only 68% of children were fully immunised by their second birthday. The immunisation rate for pertussis was 74%, compared with 85-89% for the other antigens. Children who had older siblings, were recorded as living with one parent, had moved into Liverpool or who lived in areas of high deprivation were less likely to complete the full set of antigens and individual courses. Boys were significantly less likely than girls to be fully immunised against pertussis. Differences in the completion of pertussis immunisation associated with the child's sex and with local deprivation were a direct reflection of differences in rates of parental consent. Parental consent did not wholly account for significantly lower rates among children with older siblings, those living with a lone parent, and those who had moved into Liverpool, however. This may reflect the practical difficulties of attending immunisation clinics. To achieve immunisation targets, a more flexible and targeted approach is required of health professionals. This may include the careful targeting of efforts to increase consent and the improvement of access to immunisations by providing domiciliary services or by opportunistic immunisation of infants when they are in contact with primary and community health care services.
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PMID:Primary immunisations in Liverpool. II: Is there a gap between consent and completion? 818 76

A 1992 retrospective survey by the Kansas Department of Health and Environment (KDHE) of children entering school in Kansas indicated that 52% were completely vaccinated by 24 months of age (i.e., received four doses of diphtheria and tetanus toxoids and pertussis vaccine [DTP], three doses of poliomyelitis vaccine, and one dose of measles-mumps-rubella vaccine [MMR]). In response to this low vaccination coverage rate, the KDHE set a goal for 1995 of completely vaccinating 90% of children by age 24 months. A major new initiative--Operation Immunize (OI)--undertaken to accomplish this goal consisted of three statewide vaccination campaigns on weekends during 1993-1994. This report summarizes the results of an assessment of the short-term impact of OI on children who remained undervaccinated following the first campaign.
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PMID:Assessment of undervaccinated children following a mass vaccination campaign--Kansas, 1993. 804 53

The primary goal of the Childhood Immunization Initiative (CII) is to increase, by 1996, vaccination levels for 2-year-old children to at least 90% for the most critical doses in the vaccination series (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 to at least 70% for three or more doses of hepatitis B (Hep B) vaccine (1). This report presents estimates, based on the National Health Interview Survey (NHIS), of the annual national vaccination coverage levels for children aged 19-35 months (median: 27 months) for 1993, compares estimates for 1993 with those for 1992, and compares estimates for the first 6 months of 1993 with third and fourth quarter 1993 estimates.
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PMID:Vaccination coverage of 2-year-old children--United States, 1993. 809 Jan 58

Vaccination coverage levels among 2-year-old children for each of three routinely recommended vaccines--diphtheria and tetanus toxoids and pertussis (DTP), oral poliovirus (OPV), and measles-mumps-rubella (MMR)--are lower than the national Childhood Immunization Initiative (CII) goal of 90% coverage for these vaccines (1.2). During 1991-1992, CDC awarded contracts to four universities (in Philadelphia, Los Angeles, Baltimore, and Rochester, New York) to conduct evaluations to identify causes of undervaccination, characterize and quantify missed opportunities (MOs) to vaccinate, and assess their programmatic importance. The evaluations targeted high-risk racial/ethnic minority children in inner-city settings in the four urban sites. This report summarizes selected findings* from these studies.
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PMID:Impact of missed opportunities to vaccinate preschool-aged children on vaccination coverage levels--selected U.S. sites, 1991-1992. 809 Jan 59


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