Low Immunization Rates Research Articles

Population-based study of measles and measles immunization in human immunodeficiency virus-infected children.

This study reports the course of measles and results of measles immunization in a cohort of human immunodeficiency virus-infected children. Six cases of measles were identified. All had typical clinical manifestations, 5 of 6 developed pneumonia and 3 of 6 died. A measles intervention program consisting of serologic screening and active immunization (measles-mumps-rubella (MMR)) was instituted in 1990. Among 127 children with data available for analysis (mean age, 6.7 years), only 35% had documentation of prior immunization with MMR. Among 80 children who had preimmunization measles serology reported, 56% were measles antibody-negative and 40% were antibody-positive; following intervention 36% remained measles antibody-negative. Six children lost measles antibody over time. MMR nonresponders had lower CD4 lymphocyte counts (303 +/- 394) compared with responders (865 +/- 677; P = 0.0058). Measles is a potentially fatal illness in human immunodeficiency virus-infected children. Prevention strategies are limited by low rates of age-appropriate MMR immunization, poor antibody responses to MMR in older human immunodeficiency virus-infected children and seroreversion.

Immunization Opportunities Missed Among Urban Poor Children

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)

A NEW LOOK AT MEASLES

Since the measles vaccine was licensed in the United States in 1963, the number of measles cases has declined by 98%. Nevertheless, measles has not been eliminated as had been hoped, and, in fact, has started to increase in incidence. The increase in the number of cases has been accompanied by a change in measles epidemiology; the highest attack rate now occurs in preschool-age children and in older school-age and college students. The latter is the basis for the adoption of a two-dose measles immunization schedule by the ACIP and AAP. In preschool-age children, however, the problem is more disturbing and reflects low rates of immunization, particularly among inner-city populations. A major public health effort must be directed to achieve and maintain high vaccination rates if measles elimination is to be accomplished. Otherwise, measles outbreaks, with their accompanying morbidity and mortality, will continue to occur.

Measles Vaccination

Recently, outbreaks of measles have occurred across the United States among infants and young children with low rates of immunization, and among schoolage and college students with high rates of immunization. Because of these outbreaks, the Committee on Infectious Diseases of the American Academy of Pediatrics has changed its recommendations for measles vaccination. New recommendations for routine vaccination are two doses of MMR, one at 15 months and one at age 11 or 12, when a child enters middle school. For infants and children considered to be at increased risk, three doses are recommended: the first at 12 months, the second at 15 months and the third at 11 or 12 years. With school outbreaks, revaccination is recommended for all students, siblings of students and school personnel born on or after January 1, 1957, who did not receive two doses of MMR after 12 months of age. Primary care providers have the opportunity to be on the front lines for the education of the public, the implementation of the recommendations and the ultimate eradication of the disease.

Measles Vaccine

Administration of measles vaccine has sharply reduced the occurrence of measles. However, "mini epidemics" occurring at increasing intervals through 1989 brought about the need for a routine two-dose schedule of measles vaccination. The prevention of preschool cases and school-based cases are two major goals of this new schedule. A two-dose schedule will address the latter goal, however, it will not affect the more difficult problem of measles among preschoolers, a group with lower immunization rates than school-age children. The use of Edmonston-Zagreb measles vaccine in developing countries offers the promise of reducing worldwide disease rates in young infants in the future. However, the major goal in the United States and other developed countries is to increase levels of measles immunity.

Low immunisation rates: Fact or fiction?

The uptake rate for primary immunisation against diphtheria in 1987 in the east part of Riverside District Health Authority was 61% for children aged two. A retrospective survey was undertaken of the immunisation records of all children aged two recorded on the Child Health System as not fully immunised: 46% had been immunised; 18.1% had moved out of the district; 15.6% of the children could not be traced; in 13.6% of records, there was no reference to immunisation; and only 2.5% of children were definitely not immunised. Large numbers of omissions were found in the data held on the Child Health System. The reasons for this are discussed and recommendations made for improving the quality of the data held.

Pertussis immunization in eight-month-old children in North Carolina.

Between 1984 and 1987 reported pertussis cases in North Carolina increased threefold. Pertussis immunization rates were examined for those years in three one-year cohorts drawn from a random selection of North Carolina birth records. The percentage of children immunized with three DTPs at eight months of age was 58.1, 58.6, and 56.7 for the three cohorts. Only 20.5 percent of 117 reported pertussis cases in children 9-36 months of age during the last 10 years were adequately immunized. The low pertussis immunization rate may have contributed to the recent increase in pertussis cases in North Carolina.

The epidemiology of a measles outbreak on a remote offshore island near Taiwan.

In September-October 1985, a measles outbreak occurred among elementary school students on a small offshore island near Taiwan. The outbreak began with nosocomial transmission of measles in a hospital emergency room on the main island of Taiwan. Four distinct generations of transmission occurred among elementary school children an their household contacts. Elementary school children were susceptible to measles because they were born after the last major outbreak, but before measles vaccine was locally available. Low immunization rates and low vaccine efficacy contributed to the spread of measles among preschool-age household contacts.

PRACTICE AWARENESS OF CONTRAINDICATIONS TO PERTUSSIS VACCINE (V): A SURVEY OF 403 PEDIATRICIANS (P)

The debate over the liability for pertussis-related neurologic complications prompted the following survey. The survey was undertaken to evaluate the awareness of contraindications and examine recent physician attitudes towards the use of the V. A questionnaire (Q) was mailed to 924 P. In the Q the P were asked whether they would/or would not administer the V in each of 27 clinical situations. The situations included contraindications given by the Red Book (RB) of the Committee on Infectious Diseases (American Academy of Pediatrics) and other clinical situations. The Q was completed by 403 P (44%) of whom 192 were child neurologists. Results: All of the responders differed with the recommendations of the RB. Unexpectedly, the results show that some P would have given the V even when contraindicated by the RB, and a number of clinical situations (prematurity 14%, allergies 17%, cystic fibrosis 18%, family history of seizures 21%, cerebral palsy 26% and sibling with adverse reaction to V 51% ) were erroneously interpreted as contraindications. If P non-compliance with established guidelines is as prevalent as our survey suggests, lower immunization rates, increased incidence of pertussis, increased V related complications and increased number of vaccine related litigations will not be unexpected.

The protein-energy malnourished child in a Nigerian teaching hospital.

Over a 5 year period January 1972 to December 1976 a total of 4624 patients were admitted to the pediatric wards of the University College Hospital Ibadan Nigeria. 203 of these patients were suffering from Protein Energy Malnutrition (PEM) 146 with kwashiorkor 33 with marasmic-kwashiorkor and 24 with marasmus. PEM patients have significantly lower electrolyte values than healthy Nigerian children. Their packed cell volumes were within the lower limits of normal values for health Nigerian children and a low immunization rate for communicable diseases was also observed. 28.3% gave a history of measles attack while 19.4% had chronic diarrhea during the period immediately before presentation with PEM. Hypothermia hypoglycemia and sepsis were not adequately documented on these patients an indication that they were less rigorously looked for than they ought to have been and are presumed to have contributed to the high mortality rate of 28%. Improved management of these patients while on the ward should include use of a low reading thermometer for detection of hypothermia use of dextrostix for quick bedside blood sugar estimation monitoring of packed cell volume or haemoglobin levels to watch for anemias and thorough screening for infection in addition to chest radiographs and tuberculin tests. Urine stool and blood cultures were incompletely carried out on the children in this study. (authors modified)

The Knowledge, Attitude and Practices Regarding HBV Infection of Married Women in the Reproductive Age Group living in Different Districts of Bangladesh

The present study was conducted to know the knowledge, attitude and practices of 300 married women in the reproductive age group living in different districts of Bangladesh, regarding HBV infection. Only 20% of the women were found aware of the mode of transmission of HBV. However, 50% of the women were having the misconceptions regarding mode of transmission of HBV. 4% of women, 30% of children up to 5 years and 15% of children above 5 years were fully immunized with hepatitis B vaccine. 80% of children up to 5 years and 75% of children above 5 years were fully immunized as per universal immunization programme. Hence, the results of the study clearly indicated the low immunization rate with vaccine against HBV under universal immunization programme and this further potentiated the need to grow public awareness about vaccination against Hepatitis B by focusing the beneficial effect of early immunization through public electronic media. Key words: KAP; HBV; Immunization; Perinatal transmission DOI: 10.3329/medtoday.v22i1.5602 Medicine Today Vol.22(1) 2010. 29-31

Post-secondary Students’ Perception of Flu Immunization

During the H1N1 pandemic, young adults and college students were noted to be susceptible to influenza. Despite the guidelines for post-secondary education issued by the Center for Disease Control and despite informative campaigns implemented by all institutions, young adults still show low immunization rates. This study aims to examine post-secondary students’ perspectives on influenza immunization. A short online questionnaire was designed. The questionnaire included questions about the participants’ age, gender and program of study. Participants were asked if they have recently received the vaccine or if they chose not to, and what were their reasons/views on flu immunization. The study received ethical clearance by St Lawrence College’s (SLC) Research Ethics Board and the online questionnaire was administered via a mass email to all SLC students across the three campuses. Of the 186 participants, 78% were females and 69% were between 18-24 years. 19% of participants reported to receive the vaccination on campus, 38% were vaccinated off-campus, while 43% did not receive the vaccine. The most commonly reported reasons for vaccination among students were being a program requirement (74%) and believing vaccine makes illness milder if they ever contracted the flu (11%). 37% of the non-vaccinating participants perceive the vaccine as unnecessary, while 12% believed that flu vaccine can make them ill. We conclude a significant percentage of students remain unvaccinated and may not view the flu vaccine as important. Misconceptions concerning the flu vaccine exist and providing more clear and accurate information may enhance flu immunization efficiency among students.