Uptake Of Measles Vaccine Research Articles

Retraction: Improving measles vaccine uptake rates in Nigeria: An RCT evaluating the impact of incentive sizes and reminder calls on vaccine uptake.

Retraction: Improving measles vaccine uptake rates in Nigeria: An RCT evaluating the impact of incentive sizes and reminder calls on vaccine uptake.

Improving measles vaccine uptake rates in Nigeria: An RCT evaluating the impact of incentive sizes and reminder calls on vaccine uptake.

To assess the impact of increasing incentive size and reminder calls on the measles vaccine uptake rate. Randomized controlled trial, randomized at individual level, stratified by clinic. Nigeria. 1088 caregivers with children aged nine months or older; had received at least one previous conditional cash transfer (CCT) at a program clinic, had received their Penta-3 immunization but had not yet received their measles immunization, and the caregiver had provided a phone number. Nine clinics were randomized to two models; caregivers in Model 1 received a default of 2000 Nigerian Naira (NGN) for completing the measles vaccine, and those in Model 2 received by 3000 NGN. Caregivers from the respective clinics were then randomized to one of the four arms: 1) control (baseline amount of 2000 NGN or 3000 NGN), 2) baseline amount plus a reminder call, 3) baseline amount plus 1000 NGN and a reminder call, and 4) baseline amount plus 3000 NGN and a reminder call. Receipt of measles vaccine as reported on a child health card. Overall, there was no clear trend that increasing the incentive amount resulted in an increase in vaccine uptake rates. In Model 1 households, an additional 1000 NGN and 3000 NGN resulted in a 6.4 percentage point (95% CI: -2.3-15, p-value = 0.15) and 11.8 percentage point (95% CI: 3.9-19.6, p-value = 0.003) increase in the probability of completing the measles vaccines, respectively. This increase, however, was only significant for the 3000 NGN increase. On the other hand, in Model 2 households, increasing the incentive by 1000 NGN and 3000 NGN increased the probability by 3.3 (95% CI: -3.8-10.4, p-value = 0.36) and 3.3 (95% CI: -3.7-10.4, p-value = 0.35) percentage points. These increases were not statistically significant. Adding reminder calls to CCTs increased the probability of completing the measles vaccine; caregivers who received reminder calls plus CCTs were 5.1 percentage points more likely to get their children vaccinated (95% CI: 0.50-9.8, p-value = 0.03) compared to those who received CCTs and did not receive a reminder call. These results were largely driven by caregivers who went to clinics in Model 1. A combination of increasing incentive amounts and reminder calls modestly improves measles immunization rates. However, this program also shows that there is substantial regional heterogeneity in response to both incentives and calls. While one possible conclusion is that a larger incentive and phone reminders are more likely to work in higher income and higher baseline coverage settings, the study is not designed to evaluate this claim. Rather, policymakers could consider experimenting with a similar low-cost calling study as part of the design of other cash transfer programs to identify whether adding reminder phone calls could increase the impact of the program.

Determinants of low uptake of vaccination against influenza, measles, and hepatitis B among healthcare professionals in Greece: a multicenter cross-sectional study

ABSTRACT Vaccination is recommended for healthcare professionals (HCPs) to protect them against vaccine-preventable diseases (VPDs); however, uptake rates are low. This study aimed to evaluate HCPs’ influenza, hepatitis B, and measles vaccine uptake in all healthcare levels in Crete, Greece. We conducted a questionnaire–based, cross-sectional multicenter study in 2018, including HCPs employed at 18 primary care centers and 3 hospitals. Overall, 2,246 HCPs responded (57.2% of the target population). The influenza vaccine uptake rate was 36.1% (810/2,246), with the annual vaccination rate at 14.8% (332/2,246) over the previous 5 years. Concurrently, the hepatitis B 3-dose vaccine uptake rate was 60.3% (1,316/2,181). Among the participating HCPs, 70.7% (1,457/2,061) had measles immunity due to previous illness (959/2,061, 46.5%), a 2-dose vaccination scheme (461/2,061, 22.4%), or serological confirmation (37/2,061, 1.8%). Vaccine uptake rates differed between groups depending on age, profession, and workplace setting. Logistic regression analysis revealed that risk factors for no influenza vaccine uptake during the previous season were younger age (≤45 years; odds ratio [OR] 1.35, 95% confidence interval [CI]: 1.08–1.66), profession other than physician (OR 2.94, 95%CI: 2.09–4.12), and working in hospitals (OR 1.39, 95%CI 1.02–1.89). Older age (>45 years) was an independent risk factor for not receiving a measles (OR 26.74, 95%CI: 17.41–41.06) or hepatitis B vaccine (OR 1.36, 95%CI 1.09–1.7). Working in primary care was an independent risk factor for not getting a hepatitis B vaccine (OR 1.52, 95%CI: 1.15–2.1). Our findings indicate that individualized and targeted interventions should be implemented to increase vaccine uptake among HCPs.

Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine

Background and ObjectivesEurope has experienced a major resurgence of measles in recent years, despite the availability and free access to a safe, effective, and affordable vaccination measles, mumps and rubella vaccine (MMR). The main driver for this is suboptimal vaccine coverage. Parental attitudes and beliefs toward measles vaccination are of paramount importance in influencing vaccine coverage. The three objectives of this study are to synthesize and critically assess parental attitudes and beliefs toward MMR uptake, to develop strategies and policy recommendations to effectively improve MMR vaccine uptake accordingly, and ultimately to identify areas for further research.MethodsA systematic review was conducted using primary studies from PubMed, Medline, Embase, and Scopus published between 2011 and April 2019. Inclusion criteria comprised primary studies in English conducted in Europe and studying parental attitudes and behavior regarding MMR uptake. Data were extracted using an inductive grounded theory approach.ResultsIn all, 20 high-quality studies were identified. Vaccine hesitancy or refusal were mainly due to concerns about vaccine safety, effectiveness, perception of measles risk and burden, mistrust in experts, and accessibility. Factors for MMR uptake included a sense of responsibility toward child and community health, peer judgement, trust in experts and vaccine, and measles severity. Anthroposophical and Gypsy, Roma, and Traveler populations presented unique barriers such as accessibility.ConclusionA multi-interventional, evidence-based approach is vital to improve confidence, competence, and convenience of measles vaccination uptake. Healthcare professionals need an understanding of individual contextual attitudes and barriers to MMR uptake to tailor effective communication. Effective surveillance is needed to identify under-vaccinated populations for vaccination outreach programs to improve accessibility and uptake.

Measles Virus Infection and Immunity in a Suboptimal Vaccination Coverage Setting.

Despite efforts to improve surveillance and vaccination coverage, measles virus (MeV) continues to cause outbreaks also in high-income countries. As the reference laboratory of the Veneto Region, Italy, we analyzed changes in population immunity, described measles outbreaks, investigated MeV genetic diversity, and evaluated cross-protection of measles vaccination against MeV epidemic strains. Like most European areas, the Veneto Region has suboptimal measles vaccination coverage and is facing a growing public mistrust of vaccination. A progressive decline of measles vaccine uptake was observed during the last decade in the Veneto Region, leading to immunity gaps in children and young adults. Measles outbreaks were caused by the same MeV genotype B3, D4, and D8 strains that were circulating in other European countries. Eleven cases of measles were observed in immunized subjects. These cases were not associated with particular MeV genotypes nor with mutations in epitopes recognized by neutralizing antibodies. Accordingly, sera from fully vaccinated subjects cross-neutralized epidemic MeV strains, including the genotypes B3, D4, and D8, with the same high efficiency demonstrated against the vaccine strain. In fully vaccinated subjects, high MeV IgG antibody titers persisted up to 30 years following vaccination. These results support the use of the current measles-containing vaccines and strategies to strengthen vaccination.

Is maternal HIV infection a risk factor for delayed or missed infant measles vaccination in western Kenya?

ABSTRACTMeasles is a highly infectious virus and one of the leading causes of childhood morbidity and mortality in areas with low immunization rates. Despite the introduction of the measles vaccine preventing about 20 million deaths between 2000 and 2016, there still is a low uptake of the vaccine, especially in low-income countries. Maternal HIV positive status is identified as one of the factors inhibiting the uptake of the measles vaccine in some settings. Using data from a Health and Demographic surveillance system (HDSS), and a Longitudinal Bio-behavioural Survey (LBBS), we assessed the effect of a mother’s HIV status on a child’s overall uptake of measles vaccine and timeliness in western Kenya. The findings did not show association between a mother’s HIV status and a child’s receipt of measles vaccine (OR = 0.84, 95% CI: 0.65, 1.08). However, higher socio-economic status (SES) was a positive factor for receipt of timely measles vaccine (OR = 1.34, 95% CI: 1.03, 1.75) for middle, (OR = 1.43, 95% CI: 1.10, 1.86) upper middle, and (OR = 1.51, 95% CI: 1.15, 1.98) higher quintiles as compared to the lower. Consequently, it is imperative to incorporate interventions that target low SES children and those that improve economic status.

Measles Vaccination is Best for Children: The Argument for Relying on Herd Immunity Fails.

This article examines an argument which may negatively influence measles vaccination uptake. According to the argument, an individual child in a highly vaccinated society may be better off by being non-vaccinated; the child does not risk vaccine adverse effects and is protected against measles through herd immunity. Firstly, the conclusion of the argument is challenged by showing that herd immunity's protection is unreliable and inferior to vaccination. Secondly, the logic of the argument is challenged by showing that the argument is inherently self-defeating and therefore logically inconsistent. In practice the argument cannot be used to protect children against measles. Measles vaccination is undoubtedly best for children, even in highly vaccinated societies. Only if a medical contraindication to vaccination exists should vaccination be waived in favour of reliance on herd immunity. This places obligations on those who stand in care relationships with the child: parents, healthcare providers, and the state.

Assessment of Vitamin A supplementation coverage and associated barriers in Sokoto State, Nigeria

Aim: The aim of this study is to evaluate the Vitamin A supplement (VAS) and measles vaccination coverage in a district of Sokoto State, Nigeria. Objectives: To determine the VAS and measles coverage in the district among children aged 6 months to 59 months and factors associated with nonuptake/poor uptake from provider's perspective. Methodology: Mothers of children aged 6–59 months or their caretakers were interviewed for data on demography, socioeconomic status of the family, knowledge of Vitamin A, and receiving VASs and measles vaccination. Reasons for not receiving supplement and measles vaccine were sought from mothers and health care workers. Results: A total of 900 children were enrolled from 20 clusters, of which 61.6% of children had received at least 1 dose of VAS in the past 12 months. Only 41.6% of the children received the two annual recommended doses of VAS. The measles vaccine coverage was 42.1%. After multivariate regression analysis, fathers' education (none or Islamic), mother's education (none or Islamic), mothers' occupation (manual, homemaker), and the child being female gender were found to be predictors of poor uptake of VAS. Fathers' disapproval was the most common barrier to uptake of both measles vaccine (64.8%) and VAS (69%) from both mothers' and health care workers' perspective. Conclusion: This study showed poor coverage of both VAS and measles vaccination among children in Gwadabawa district and fathers' disapproval was the major reason for poor uptake

Utilization of essential immunization services among children under five years old in Kacheliba Division, Pokot County, Kenya

Background: Immunization contributes significantly to the achievement of millennium development goal number 4 and is one of the eight elements of primary health care. Effective utilization of immunization services is associated with improved child health outcomes. WHO targets immunization coverage of 90% for urban areas and 80% for rural areas. Most rural areas in remote counties of Kenya fall short of this target precipitating high mortality rates from immunisable diseases. Objectives: The main objective is to determine the utilization of immunization services by children under five in Kacheliba Division. The specific objectives were to determine the level of utilization of immunization services and economic and socio-cultural factors influencing utilization of immunization services. Methods: This was descriptive cross-sectional study involving use of quantitative techniques carried out in Kacheliba division, Pokot North District, Kenya. Kacheliba division, which has 4 locations, was selected through purposive sampling. In every location, a household that met inclusion criteria was selected by systematic sampling (every Kth household). The guardian or mother was interviewed and household’s demographic, socioeconomic and immunization status of children recorded in a structured questionnaire. Children’ immunization cards or booklets and BCG scar mark were scrutinized as well as the mother’s or guardian’s verbal verification. All the 8 health facilities in Kacheliba division were visited and their cold chain facilities assessed. Quantitative data was analyzed using stata version 12 special edition. Results: The study covered 381 children in 164 household. There were 178 boys and 203 girls with a mean age of 28.3 months. 41.7% of children were fully immunized with 59.8% measles vaccine uptake. Except for the level of education and age, respondents’ socioeconomic and cultural factors were not significantly associated with vaccine uptake. Conclusion: The proportion of fully immunized children was far below the WHO’s target of 80%. Demographic and socioeconomic factors were not significant predictors of immunization services uptake except age and education level. Therefore, it is recommended that educational and flexible frequent outreach programs on immunization services should be carried out among the Kacheliba residents to improve utilization of immunization services.

Consequences of incomplete measles vaccine uptake in healthcare workers during an outbreak in North East England

Two cases of measles-infected healthcare workers are described, plus the case of a third who was excluded from work for an extended period of time due to non-immunity, during an outbreak in North East England. There is clearly a need for further effort to ensure that healthcare workers are protected against measles. Vaccine uptake may be increased by establishing a one-off measles immunization programme in conjunction with systematic pre-employment screening. Such programmes could be strengthened through incentivized or mandatory vaccination. Staff and policymakers at all levels should work together to prevent hospital-acquired measles infection.

The Interplay of Public Intervention and Private Choices in Determining the Outcome of Vaccination Programmes

After a long period of stagnation, traditionally explained by the voluntary nature of the programme, a considerable increase in routine measles vaccine uptake has been recently observed in Italy after a set of public interventions aiming to promote MMR immunization, whilst retaining its voluntary aspect. To account for this take-off in coverage we propose a simple SIR transmission model with vaccination choice, where, unlike similar works, vaccinating behaviour spreads not only through the diffusion of “private” information spontaneously circulating among parents of children to be vaccinated, which we call imitation, but also through public information communicated by the public health authorities. We show that public intervention has a stabilising role which is able to reduce the strength of imitation-induced oscillations, to allow disease elimination, and to even make the disease-free equilibrium where everyone is vaccinated globally attractive. The available Italian data are used to evaluate the main behavioural parameters, showing that the proposed model seems to provide a much more plausible behavioural explanation of the observed take-off of uptake of vaccine against measles than models based on pure imitation alone.

Paternal education status significantly influences infants’ measles vaccination uptake, independent of maternal education status

BackgroundDespite increased funding of measles vaccination programs by national governments and international aid agencies, structural factors encumber attainment of childhood measles immunisation to levels which may guarantee herd immunity. One of such factors is parental education status. Research on the links between parental education and vaccination has typically focused on the influence of maternal education status. This study aims to demonstrate the independent influence of paternal education status on measles immunisation.MethodsComparable nationally representative survey data were obtained from six countries with the highest numbers of children missing the measles vaccine in 2008. Logistic regression analysis was applied to examine the influence of paternal education on uptake of the first dose of measles vaccination, independent of maternal education, whilst controlling for confounding factors such as respondent’s age, urban/rural residence, province/state of residence, religion, wealth and occupation.ResultsThe results of the analysis show that even if a mother is illiterate, having a father with an education of Secondary (high school) schooling and above is statistically significant and positively correlated with the likelihood of a child being vaccinated for measles, in the six countries analysed. Paternal education of secondary or higher level was significantly and independently correlated with measles immunisation uptake after controlling for all potential confounders.ConclusionsThe influence of paternal education status on measles immunisation uptake was investigated and found to be statistically significant in six nations with the biggest gaps in measles immunisation coverage in 2008. This study underscores the imperative of utilising both maternal and paternal education as screening variables to identify children at risk of missing measles vaccination prospectively.

Opportunities to increase pertussis and measles vaccine uptake

Opportunities to increase pertussis and measles vaccine uptake

Determinants of apparent rural-urban differentials in measles vaccination uptake in Indonesia

Regional differences in vaccination uptake are common in both developed and developing countries, and are often linked to the availability of healthcare services and socioeconomic factors. In 2007, 0.9 million eligible Indonesian children missed measles vaccination, and 19 456 cases of measles were documented among Indonesian children. The authors investigated rural-urban differentials in measles vaccination coverage among young Indonesian children, and sought to identify key factors influencing the probability of a child receiving the first dose of measles vaccination in Indonesia. Data used in the analyses were sourced from the nationally representative Indonesia Demographic and Health Survey 2007. The influence of location of residence, household wealth, maternal and paternal education, total children ever born and use of skilled birth attendants on measles vaccination coverage was investigated using bivariate analysis and chi-square tests. The independent effects of these variables were established using binomial logistic regression analysis. Indonesia's 2007 first-dose measles national vaccination coverage was, at 72.8%, lower than the 2008 global first-dose measles vaccination average coverage of 82%. Bivariate analysis revealed that the first-dose measles vaccination coverage in rural areas of Indonesia was 68.5%, compared with 80.1% in urban regions (p < 0.001). The apparent significance of rural residence in impairing vaccination coverage was marginal after controlling for the sex of the child, maternal age, maternal and paternal education, wealth, and access to skilled health workers. Apart from sustainable initiatives to increase measles vaccination coverage globally, it is important to close the rural-urban gap in Indonesia's measles vaccination uptake. Addressing critical determinants of inferior measles vaccination coverage in Indonesia's rural regions will facilitate major improvements in Indonesia's child health trends. This article suggests initiatives for addressing three of such determinants in Indonesia's rural areas: poverty, parental education and access to skilled health workers.

Correlates of first dose of measles vaccination delivery and uptake in Indonesia

Objective To determine health systems-related, familial, and cultural factors which influence the delivery and uptake of measles vaccination in Indonesia. Methods Logistic regression analysis of data collected during the 2007 Indonesian Demographic and Health Survey was undertaken by the authors to investigate these factors. The 2007 Indonesian Demographic and Health Survey dataset is a nationally representative, randomly sampled survey containing 15 065 children aged between 9 and 59 months. Results 72.8% of children had received the measles vaccine. Vaccination coverage was similar for males and females; however, coverage was higher amongst urban children, 80.1%, compared to 68.5% in rural areas. The key findings of the regression analysis were congruent with the results of previous research targeting vaccination coverage. After controlling for all other factors, maternal age, maternal education, wealth, the use of a skilled birth attendant, and postnatal check-ups were positively and significantly ( P< 0.01) correlated with measles vaccination. The number of children per household was negatively correlated ( P<0.01). Conclusions In order to enhance measles vaccination coverage in Indonesia, delivery to, and uptake by, rural and low socio-economic populations require substantial improvements. Mass health education and health systems improvements are also required.

Measles, Mumps and Rubella: A Brief Guide

Practice NursingVol. 22, No. 2 Immunization & VaccinationMeasles, Mumps and Rubella: A Brief GuideGail BeckettGail BeckettSearch for more papers by this authorGail BeckettPublished Online:29 Sep 2013https://doi.org/10.12968/pnur.2011.22.2.78AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferencesAnon (2010) Retraction—Ileallymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. http://press.thelancet.com/wakefieldretraction.pdf (accessed 25 January 2011) Google ScholarBlake H (2010) Man disabled by MMR vaccine awarded £90,000 after 13-year fight. The Telegraph 30 August. http://tinyurl.com/2e8uwt3 (accessed 23 January 2011) Google ScholarBoseley S (2010) Andrew Wakefield struck off register by General Medical Council. The Guardian 24 May. http://tinyurl.com/35chvkg (accessed 23 January 2011) Google ScholarBurgess DC, Burgess MA, Leask J (2006) The MMR vaccination and autism controversy in United Kingdom 1998–2005: Inevitable community outrage or a failure of risk communication? Vaccine 24(18): 3921–8 Crossref, Google ScholarCenters for Disease Control and Prevention (2009) Measles mortality reduction and regional global measles elimination. http://tinyurl.com/63zypqy (accessed 23 January 2011) Google ScholarClinical Knowledge Service (2010) Measles. www.cks.nhs.uk/measles# (accessed 23 January 2011) Google ScholarCotton R (2009) MMR vaccination: Consent, controversies and challenges. British Journal of School Nursing 4(6): 298–301 Link, Google ScholarDepartment of Health (2010a) Measles. In: The Green Book, chapter 21. www.dh.gov.uk/green book (accessed 23 January 2011) Google ScholarDepartment of Health (2010b) Mumps. In: The Green Book, chapter 23. www.dh.gov.uk/green book (accessed 23 January 2011) Google ScholarDepartment of Health (2010c) Rubella. In: The Green Book, chapter 28. www.dh.gov.uk/green book (accessed 23 January 2011) Google ScholarHealth Protection Agency (2011a) Measles: epidemiological data: notifications (confirmed cases) 1995–2010 by qtr. http://tinyurl.com/5rnl9n4 (accessed 23 January 2011) Google ScholarHealth Protection Agency (2011b) Mumps: epidemiological data: notifications (confirmed cases) 1995–2010 by qtr. http://tinyurl.com/5rbll83 (accessed 23 January 2011) Google ScholarHealth Protection Agency (2011c) Rubella: epidemiological data: notifications (confirmed cases) 1995–2010 by qtr. http://tinyurl.com/6facxfm (accessed 23 January 2011) Google ScholarLaskari HP, El-Bashir H (2010) Immunisations among school leavers: is there a place for measles-mumps-rubella vaccine? Eurosurveillance 15(17) Google ScholarLernout T, Kissling E, Hutse V, De Schrijver K, Top G (2009) An outbreak of measles in orthodox jewish communities in Antwerp, Belgium, 2007-2008: different reasons for accumulation of susceptibles. Eurosurveillance 14(2) Crossref, Google ScholarLopalco PL, Martin R (2010) Measles still spreads in Europe: who is responsible for the failure to vaccinate? Eurosurveillance 15(17): 3–4 Crossref, Google ScholarWakefield A, Murch S, Anthony Aet al. (1998) Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 351(9103): 637–41 Crossref, Google ScholarWilliams CJ, Leibowitz LD, Levene J, Nair P (2010) Measles, mumps and rubella (MMR) vaccine uptake in hospital healthcare worker contacts following suspected mumps infection. Journal of Hospital Infection 76(1): 91–2 Crossref, Google ScholarWorld Health Organization (2010) Measles and rubella: Next steps towards eliminating measles and rubella in Europe. http://tinyurl.com/66gr87a (accessed 23 January 2011) Google Scholar FiguresReferencesRelatedDetails 1 February 2011Volume 22Issue 2ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Received 16 January 2011 Accepted 23 January 2011 Published online 29 September 2013 Published in print 1 February 2011 Information© MA Education LimitedKeywordsMeaslesmumpsrubellaMMR vaccineimmunizationinfectious diseasepublic healthPDF download

Subacute sclerosing panencephalitis: an update

Subacute sclerosing panencephalitis (SSPE) is a chronic encephalitis occurring after infection with measles virus. The prevalence of the disease varies depending on uptake of measles vaccination, with the virus disproportionally affecting regions with low vaccination rates. The physiopathology of the disease is not fully understood; however, there is evidence that it involves factors that favour humoral over cellular immune response against the virus. As a result, the virus is able to infect the neurons and to survive in a latent form for years. The clinical manifestations occur, on average, 6 years after measles virus infection. The onset of SSPE is insidious, and psychiatric manifestations are prominent. Subsequently, myoclonic seizures usually lead to a final stage of akinetic mutism. The diagnosis is clinical, supported by periodic complexes on electroencephalography, brain imaging suggestive of demyelination, and immunological evidence of measles infection. Management of the disease includes seizure control and avoidance of secondary complications associated with the progressive disability. Trials of treatment with interferon, ribavirin, and isoprinosine using different methodologies have reported beneficial results. However, the disease shows relentless progression; only 5% of individuals with SSPE undergo spontaneous remission, with the remaining 95% dying within 5 years of diagnosis.

Mass immunisation campaign in a Roma settled community created an opportunity to estimate its size and measles vaccination uptake, Poland, 2009

During a mass immunisation campaign following an outbreak of measles in a Roma community settled in the town of Pulawy, Poland, we performed an estimation of the size of this Roma population and an assessment of its vaccination uptake. We obtained a list of Roma residing in Pulawy from the local municipality and estimated using a simple capture-recapture formula that Pulawy had 377 Roma residents (43% under 20 years old), which was 27% more than the 295 registered at the municipality. During the vaccination campaign, demographic information was recorded that could be linked to information from the municipality list as well as to prior immunisation status. Among the people whose data were recorded during the vaccination campaign, 14% were not registered at the primary healthcare centres, and were therefore deprived of access to healthcare. Among 102 screened subjects under the age of 20 years, 51% were vaccinated according to schedule. Vaccine uptake for the first dose of measles-containing vaccine was 56% (54/96) and for the second dose 37% (18/49). The present study indicates the need to get a better demographic overview of Roma communities living in Poland and to understand the barriers limiting their access to healthcare and social services. Organisation of catch-up immunisations of this vulnerable population is necessary.

Measles in Vietnamese refugee children in Hong Kong.

From September 1991-January 1992, there was a measles epidemic in an established refugee camp for 7000 Vietnamese 'Boat People' living in Hong Kong. This 16 week outbreak occurred against a backdrop of poor uptake of measles vaccination and overcrowded living conditions. Two hundred and sixty-two children were affected (155 boys, 107 girls); 235 children (89.7 %) were < 2 years old, age range 5-39 months. Children age 6-11 months had the highest crude attack rate (AR) of 54.3%. The highest age specific crude AR was 83.8% in children aged 14 months. Measles complications affected 234 (89.3%) children. Sixty-six children (25.2%) were admitted to hospital. There were two deaths from pneumonia, giving a case fatality rate of 0.76%. Measles control in refugee camps continues to be a public health challenge.

Randomised controlled trial of the use of a modified postal reminder card on the uptake of measles vaccination

OBJECTIVETo determine whether rewording postal reminder cards according to the “health belief model”, a theory about preventive health behaviour, would help to improve measles vaccination rates.DESIGNA randomised controlled trial, with...