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The "Morbidity and Mortality Weekly Report" ("MMWR") Series is prepared by the Centers for Disease Control and Prevention (CDC). Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly "MMWR" are provisional, based on weekly reports to CDC by state health departments. This issue of "Morbidity and Mortality Weekly Report" includes the following reports: (1) Lead Poisoning in Pregnant Women Who Used Ayurvedic Medications from India--New York City, 2011-2012 (Paromita Hore, Munerah Ahmed, Jacqueline Ehrlich, Celia Ng, Lourdes Steffen, Slavenka Sedlar, Phyllis Curry-Johnson, Nathan Graber, Deborah Nagin, Nancy Clark, Robert Saper, and Marissa Scalia Sucosky); (2) Vaccination Coverage Among Children in Kindergarten--United States, 2011-12 School Year (Stacie M. Greby, Karen G. Wooten, Cynthia L. Knighton, Bob Avey, and Shannon Stokley); and (3) Tattoo-Associated Nontuberculous Mycobacterial Skin Infections--Multiple States, 2011-2012 (Brenden Bedard, Byron Kennedy, Vincent Escuyer, Kara Mitchell, Jeffrey S. Duchin, Paul Pottinger, Stanley Hurst, Ken Sharp, Timothy Wickham, Sarah Jackson, Wendy Bamberg, Pamela LeBlanc, Linda M. Katz, Taranisia MacCannell, Judith Noble-Wang, Heather O'Connell, Alexander Kallen, Bette Jensen, Duc B. Nguyen, and Michael H. Kinzer). QuickStats are also included. Individual reports contain figures, tables and references.

The "Morbidity and Mortality Weekly Report" ("MMWR") Series is prepared by the Centers for Disease Control and Prevention (CDC). Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly "MMWR" are provisional, based on weekly reports to CDC by state health departments. This issue of "Morbidity and Mortality Weekly Report" includes the following reports: (1) Physical Activity Levels of High School Students--United States, 2010 (Janet E. Fulton, Dianna D. Carroll, Deborah A. Galuska, Sarah M. Lee, Danice K. Eaton, Nancy D. Brener, and MinKyoung Song); (2) Beverage Consumption Among High School Students--United States, 2010 (Nancy D. Brener, Caitlin Merlo, Danice Eaton, Laura Kann, Sohyun Park, and Heidi M. Blanck); and (3) Place of Influenza Vaccination Among Adults--United States, 2010-11 Influenza Season (Erin D. Kennedy, Tammy A. Santibanez, Leah N. Bryan, Pascale M. Wortley, Gary L. Euler, James A. Singleton, Carolyn B. Bridges, Cindy W. Weinbaum, Lisa M. Koonin). Also included are: (1) Notes from the Field; (2) Announcement; (3) Errata: Vol. 60, No. 21; and (4) QuickStats. Individual reports contain tables and references.

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. Lead article of this issue is "What is a Child Care Health Consultant and Why are They Important in ECE Settings?." Other topics include: How to Speak to Vaccine Fears; Take a Child's Temperature; Active Commuting and Your Health; Spider Bites; Children with Hemophilia in Child Care Settings; 20 Healthy New Year's Resolutions for Children; and Health and Safety Resources. (Individual articles contain references.)

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about programs and goals of public education in Alabama. This issue contains the following articles: (1) Race to the Top; (2) H1N1 Update; (3) Students + Parents + Educators = Alabama Success; (4) Making Middle Grades Work: A Closer Look; and (5) New Teacher Education and Certification Web site Saves Time and Provides Vital Information to Teachers. Regular features include: (1) Good News in Alabama Schools; (2) Awards, Opportunities, and Professional Development; (3) Calendar; and (4) Teacher of the Month.

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. The lead article of this issue is "H1N1 Influenza (Swine Flu): Guidance for Child Care Programs." Other topics include: Immunizations for Flu Season; Helping Toddlers Learn Self Control; What to Eat and Drink When You Stay Home Because of the Flu; What is H1N1 (Swine Flu) and How to Prevent It?; Helping Children to Accept New Siblings; Preventing the Flu; and Health and Safety Resources. (Individual articles contain references.)

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. The lead article of this issue is "How to Reduce the Risk of Expulsion from Child Care Programs." Other topics include Flu; Infant Development of Head, Neck and Shoulders (Tummy-Time); Carbohydrate Intake in Children; Phthalates; Temperament and Regularity; Smoke-Free Cars and Asthma Prevention; and Emergency Response Procedures for Missing Children.

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. Lead article of this issue is Responding to Head Injuries in Child Care Programs. Other topics include Preschool Fitness; Sleeping Babies in Car Seats; Caregivers and MRSA Infections; Emergency/Disaster Preparedness in Child Care; Child Care Self-Assessment; and Response to Life-Threatening Allergic Reactions. [NOTE: Volume Number on document is misprinted. See 2007 issues (ED501793, ED501821, ED501823, ED401824, ED501828) and other 2008 issues (ED501825, ED501829). ERIC Title information has been corrected.]

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. Lead article of this issue is "Act Now--Get the Word Out about Paid Family Leave!" Other topics include: Flu Immunization; Infant Feeding; Heart Health Care; Toxic Cleaning Products; Uncontrollable Crying; Objective Observation; and Secondhand Smoke.

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of this newsletter are to promote and support a healthy and safe environment for all children in child care reflecting California's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. This issue contains these articles: (1) Pandemic Flu and Child Care Programs (Bobbie Rose); (2) Constipation in Young Children (Bobbie Rose); (3) What to Expect from a Preemie in the First Year (Vickie Leonard); (4) Dietary Fiber and Young Children (Bobbie Rose); (5) Safety and Effectiveness of Cough and Cold Medicine in Children (A. Rahman Zamani); (6) Nutrition and Activity for Young Children: Raising Physically Fit and Well Nourished Children (Bobbie Rose); (7) Children with Spina Bifida in Child Care Settings: Part II (Vickie Leonard); (8) Important Legal Settlement Involving Diabetes Care in California K-12 Public Schools (9) Ear Infections Can Affect Language Development (A. Rahman Zamani and Tahereh Garakan); and (10) Seasonal Flu Vaccine. A list of additional health and safety resources is included.

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of this newsletter are to promote and support a healthy and safe environment for all children in child care reflecting California's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. This issue contains these articles: (1) You Hold the Wisdom--Use It; (2) Orientation Plan for New Staff; (3) Relationship-Based Care; (4) Reducing the Risk of Infectious Disease: Vaccination for Adults; (5) Safe Transportation of Your Child with Disabilities; (6) Bullying: A Common Public Health Problem; (7) Guidelines for Physical Activity for Young Children; (8) What Is a Regional Immunization Registry?; and (9) Identifying Children with Undiagnosed Special Needs. A list of additional health and safety resources is included.

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of this newsletter are to promote and support a healthy and safe environment for all children in child care reflecting California's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. This issue contains these articles: (1) Help with Blue Immunization Cards (Bobbie Rose); (2) Getting Health Information for a Child (Judy Calder); (3) Introducing Solid Foods to Infants (Vickie Leonard); (4) Feeding Styles of Parents and Caregivers (Bobbie Rose); (5) Bad Breath: An Embarrassing Problem (A. Rahman Zamani); (6) Exposure to Communicable Disease; (7) Suspected Illness or Communicable Disease Exclusion Form; (8) Transitioning Children with Special Needs in Educational Systems (Tahereh Garakanai); (9) Immunization: What Family Child Care Providers Need to Do; and (10) Choosing Safe and Appropriate Toys (Vickie Leonard). A list of additional health and safety resources is included. (Individual articles contain references.)

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. Lead article of this issue is Supportive Referrals for Developmental Issues. Other topics include Domestic Violence; Breastfeeding; Caring for Pregnant Caregivers; Oral Health Care; Unimmunized Children in Child Care Settings; and Color Vision Deficiency. [Additional support provided by Healthy Child Care California and First 5 California (formerly the California Children and Families Commission.)]

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. Lead article of this issue is New Recommendations for the Influenza Vaccine (Eileen Walsh). Other topics include Non-Bleach Sanitizing; Creating Learning Environments; Proper Lifting/Carrying; Type 2 Diabetes Prevention; Nutrition; and School Readiness. Pullout section includes information on Childhood High Blood Pressure; Toilet Learning; and Managing Childhood Allergies. [Additional support provided by Healthy Child Care California and First 5 California (formerly the California Children and Families Commission.)]

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. The lead article of this issue is Antibacterial Soaps: Benefit or Bad Idea? (Eva Guralnick). Other topics include Post-Vaccination Chicken Pox; Immunization; Toddler Environments; Hand Washing; Drowning Prevention; Oral Health Care; and Behavior Issues. Pullout section includes information on Computer Risks; Insect Repellent; Environments for the Physically Challenged; and Medication Administration. (Individual articles contain references.) [Additional support provided by Healthy Child Care California and First 5 California (formerly the California Children and Families Commission.)]

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. The lead article of this issue is Vaccine Safety is Reaffirmed (Eva Guralnick). Other topics include Splinter Removal; Toilet Learning; Violence in Children's Lives; Television Viewing; Childhood Lead Poisoning; and Tuberculosis Screening. Pullout section includes information on Obesity; Thumb/Finger/Pacifier Sucking; Childhood Diabetes; and Behavior Issues. (Individual articles contain references.) [Additional support provided by Healthy Child Care California and First 5 California (formerly the California Children and Families Commission.)]

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. The lead article of this issue is Promoting Complex Learning in the Play Yard (Jane P. Perry). Other topics include Infants and Milk; Music in Child Care; Immunization; Raccoons and Safety. Pullout section includes information on Over-the-Counter Drugs; Infant Intelligence; and Food Allergy treatment. (Individual articles contain references.) [Additional support provided by Healthy Child Care California and the California Children and Families Commission.]

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. The lead article of this issue is What Caregivers Can Do to Help Children Understand Death (Judy Calder). Other topics include Car Seat Use; Encouraging Exploration/Creativity; Food-Borne Disease; Pertussis; and UV Rays. Pullout section includes information on Microwave Ovens; Head Lice; Seizures; and Immunization. (Individual articles contain references.) [Additional support provided by Healthy Child Care California and the California Children and Families Commission.]

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all children in child care reflecting the state's diversity; to recreate linkages and promote collaboration among health and safety and child care professionals; and to be guided by the most up-to-date knowledge of the best practices and concepts of health, wellness and safety. Information provided in the newsletter is intended to supplement, not replace, medical advice. Regular features include columns on resources or current information related to infant/toddler care, school-age child care, public health, staff health, nutrition, inclusion, diversity, health consultancy, product information, pending legislation, available resources, and "Ask the Nurse," a Question-Answer column. Lead article of this issue is Does Time in Child Care Affect Children's Behavior (Abbey Alkon). Other topics include Getting Ready for Flu Season; Feeding Young Children in Group Settings; Kitchen and Fire Safety; Immunization and Oral Health Care. Pullout section includes information on Vaccines; Gastric Tubes in the Child Care Setting; Behavior Concerns; and Childhood Depression. [Additional support provided by Healthy Child Care California and First 5 California (formerly the California Children and Families Commission.)]

This special theme issue of the journal "The Advocate," offers articles on early interventions for preschoolers with special needs, including three articles in Spanish. Contents include: "Providing An Orientation for Life" (Galen D. Kirkland); "AFC Fights Cuts in Education at 'Speak Out' Rally" (Nadine Renazile); "Testimony of AFC, 12/9/94, before the NYC Early Intervention Interagency Coordination Council" (Sharon Hammer); "Early Intervention for Children Living in Temporary Housing" (Alexandra Michalos); "Early Intervention: A Brief Parent Guide Regarding the Development of Individual Family Service Plans" (Sharon Hammer); "Intake"; "Tips for Parents/Consejos parra Padres" (Janice Silber); "Physical Exams & Immunization Requirements for New Students" (Valerie Pekar); "The Impartial Hearing Process/La Vista Imparcial" (Joan Harrington); "Asistencia Tecnica (Technical Assistance)"; "A Victory for Preschool Children with Disabilities" (Ellen Gallagher Holmes); "The Family Perspective on Head Start Inclusion" (Diane Bonelli); "A Historical View on Inclusion"; "Least Restrictive Environment Update" (Diana Autin); "The Least Restrictive Environment for Peter" (Janice Silber); "The National Council on Disability Holds Hearings in New York City"; "What Services and/or Programs Are You Entitled to from Your Committee on Preschool Special Education?" (Sharon Hammer and Ellen Gallagher Holmes); and "Testimony by AFC, 11/16/94, to: NYS Association of Counties Regarding Preschool Programs for Children with Disabilities" (Ellen Gallagher Holmes). (SW)

Goal One of the six national education goals now embodied in the Goals 2000: Educate America Act states that "By the year 2000, all children in America will start school ready to learn." One of the objectives formulated to meet this goal asserts that "Children will receive the nutrition and health care needed to arrive at school with healthy minds and bodies." This digest summarizes government and private efforts to fulfill this objective. Federal programs which serve preschoolers' health and nutrition needs include Project Head Start; Medicaid; and the Supplemental Food Program for Women, Infants, and Children. Examples of state-funded programs include the establishment of service centers in Kentucky and Hawaii, and support provided by nutritionists to citizens in Mississippi. Efforts to serve preschoolers' health and nutrition in health care settings include immunizations programs; a campaign to educate parents about the connection between their children's health and education; low-cost health care services provided by community health centers; and recommendations concerning children's health and nutrition offered by several commissions and organizations. Preschoolers' health and nutrition is fostered in the preschool setting by serving nutritious food in preschools, teaching children about cooking, establishing nutrition data systems, and establishing health and nutrition guidelines to be applied to child care facilities. Community initiatives include efforts to teach Mexican-American parents about their children's food requirements, establishing data systems to track families with preschool children, and instructing health care professionals about culturally appropriate ways to work with American Indian families. (BC)

Difficulties faced by homeless children include depression, low self-esteem, lack of sleep and nutrition, and feelings of shame and embarrassment. Challenges faced by schools in providing education to homeless children include: (1) keeping children in one school despite frequent family moves; (2) ensuring that children's health records are obtained; (3) providing quiet times for children to do homework; and (4) providing transportation. The education of homeless children was addressed by the McKinney Act of 1987, which called for access to free education for every homeless child. Amendments to the act passed in 1990 mandated that states address issues of transportation, immunization and residency requirements, and school and health records. Measures that schools can take to help homeless children succeed in their education include: (1) coordinating social services; (2) providing counseling; (3) providing a place for children between the closing of school and the opening of the shelter; and (4) using computerized tracking systems to coordinate homeless children's records. Several communities have tried comprehensive approaches to educating homeless children. These approaches include transitional schools for homeless children, which children attend before being mainstreamed into regular schools, and case management approaches, in which a case manager coordinates school staff, counselors, shelter workers, and health care and family support services in order to meet homeless children's basic needs. (BC)

This report describes the health status of children and adults in developed and developing countries. Worldwide, life expectancy at birth rose from 47 to 67 years between the 1950s and late 1980s. However, more than 300 million people live in countries where life expectancy is below 50 years of age and 1 of every 10 newborns dies before age 1. In developing countries, UNICEF has led an effort to improve child survival through education, inoculation campaigns, anti-malaria and nutrition programs, and programs that promote oral rehydration therapy and breastfeeding. However, malnutrition has limited the gains in child health. Improved adult health in developed countries reflects lifestyle changes and improved medical technology. In developing countries, unsanitary conditions and the effects of childhood illnesses may perpetuate adult health problems. Urbanization brings new health hazards, and AIDS threatens further health gains, especially in sub-Saharan Africa where 10 million children may be orphaned by the disease by the year 2000. Achieving the goal of good health at low cost, as China and Sri Lanka have, requires strong political and social commitment, especially to improving women's education and ensuring equal access to health care. Lists of 71 references and 32 suggested readings are provided. (Author/BC)

Articles collected in this issue of UNICEF News deal with different aspects of the theme of communication in development programs. Specifically, topics covered include (1) communication as a total process and the role of communication in overcoming obstacles to social change; (2) a village education and resource center, in Bangladesh, committed to principles of self-reliance and voluntary participation; (3) facts about communication media; (4) problems in communicating health information in the Caribbean; (5) contrasting elements of one-way and two-way communication campaigns in Pakistan; (6) communication efforts in Brazil's national breast-feeding campaign; (7) facilitating communication through use of photographs made by illiterate village women in Tanzania; (8) village handpump caretakers in India; (9) the effect of a communication workshop in the Philippines on mothers' acceptance of vaccinations; (11) rural East African people's visual literacy; (12) development education activities; and (13) an update on UNICEF activities. (RH)

Focused on early childhood development, this "UNICEF Intercom" asserts that developmental programs should aim to give children a fair chance at growth beyond survival. First presented are moral, scientific, social equity, economic, population, and programatic arguments for looking beyond the fundamental objective of saving young lives. Supplemental articles concerning Vietnam, China, rural Africa, and other countries, recount recent UNICEF efforts in this field, enumerate types of child development approaches, examine the importance of educating parents, analyze CHILD-to-child programs, and look at how children are cared for in some countries while their mothers are at work. Additional materials concern the opening of the International Child Development Center in Florence, Italy, a field visit to Bangladesh after the floods, immunization in the Dominican Republic, statistics concerning relationships between national health and wealth, medical education, communication and visual literacy in Kathmandu (Nepal), development education, new publications, fund-raising with Spider-Man, and a special event marking United Nations Day in Barbados. (RH)

Contents of this double journal issue concern immunization and primary health care of children. The issue decribes vaccine storage and sterilization techniques, giving particular emphasis to the role of the cold chain, i.e., the maintenance of a specific temperature range to assure potency of vaccines as they are moved from a national storage center to regional storage centers, peripheral immunization centers, clinics, and mobile teams. The first section of the issue discusses immunization and primary health care, vaccines, organization of vaccination, community participation, training of personnel, evaluation of immunization programs, and accelerating the implementation of immunization programs. The section on storage and sterilization techniques focuses on reasons for the cold chain, management of vaccine supplies, needed facilities and their use, monitoring the cold chain, and training persons responsible for maintaining the cold chain. An appendix briefly discusses the activities of a resarch unit known as the GRET/GERES (Groupe de Recherches et d'Echanges Technologiques/Groupe Energies Renouvelables) renewable energies unit, which is concerned with the use of renewable energies and the reduction of the technical and economic burden of energy on health organizations. (RH)

The Pan American Health Organization's Revolving Fund for Access to Vaccines (the Revolving Fund) is a shared pool of funds for the procurement of vaccines, syringes, and cold-chain equipment for the Member States of the Organization. With a view to evaluating the results obtained during the Revolving Fund's operation and analyzing its contributions to achievements in immunization, a review was conducted of historical documents and grey literature related to the Fund's history and current processes, as well as data from platforms fed by countries' annual reports, with reference to growth indicators, burden of vaccine-preventable diseases, introduction of new vaccines in the Region of the Americas, and lessons learned. In its 43 years of operation, the Revolving Fund has grown and contributed to the introduction of new vaccines, and the Region has made rapid progress in the field of immunization. However, several countries and territories in the Region have not yet introduced certain vaccines due to their high cost and the economic impact of sustainably administering them. The requirement to obtain the lowest possible price and to set a uniform price for all participating Member States has been instrumental in the Revolving Fund's contribution to the vaccination goals of national immunization programs, and for timely planning of demand, accompanied by technical advice. An interprogrammatic approach and the planning of auxiliary inputs are key to the success of the programs. Pandemic preparedness, regional vaccine production, and the protection of national budgets for sustainable procurement of high-cost vaccines are current and future challenges. [ABSTRACT FROM AUTHOR]

Objective. To establish a ranking of national immunization programs in Latin America that compares the various realities, identifies challenges and unachieved goals, and encourages countries to search for strategies to overcome the obstacles they face. Methods. Ten countries with the most innovative national vaccination schedules (NVCs) were selected. Information published on official websites of ministries of health, the World Health Organization (WHO), the Pan American Health Organization (PAHO), and the United Nations Children's Fund (UNICEF) were used, as well as interviews with experts from each country. A ranking was constructed, based on domains linked to the 2019 NVC (vaccinations given at different life stages, influenza vaccination, and vaccination in special situations); vaccination coverage in 2018; and programmatic aspects. Results. The general ranking is led by Chile and Panama, due to vaccination in the first and second year of life. They are followed by Argentina, Uruguay, and Costa Rica, which stand out for vaccination of other groups, influenza vaccination, and programmatic aspects. Brazil, Colombia, and Mexico have more delays in their NVCs, as well as programmatic gaps and lower vaccination coverages. Finally, Paraguay and Peru have similar deficiencies and bigger information gaps. However, when the domains are analyzed individually, the ranking changes and the same pattern is not repeated. Conclusions. This is the first ranking of national immunization programs in Latin America that highlights strengths and weaknesses in each country. The periodicity of this exercise will be key when comparing the evolution and positioning of these programs over time. [ABSTRACT FROM AUTHOR]

As Seth Berkley leaves Gavi, the Vaccine Alliance, the epidemiologist reflects on its growth and challenges ahead.

Objectives. To more accurately determine coverage and timeliness of the second dose of measles-mumps-rubella vaccine (MMR2), while identifying factors associated with low MMR2 vaccination uptake among children in Saint Lucia. Methods. A survey was conducted in October - November 2015 targeting children born in 2004 - 2009. At 86 preschools and primary schools, two children from each grade were randomly selected, yielding an effective sample of 836 children. Health records were reviewed to assess vaccination coverage and timeliness. Parents and/or guardians and principals of all 86 schools were interviewed regarding knowledge, attitudes, and practices related to vaccination. Results. Of 767 children included, 75% were vaccinated with MMR2 (n = 572); 46.7% were vaccinated in a timely manner, i.e., by 5 years of age. Cohorts born in 2004, 2005, and 2008 reported the lowest proportion. 'Mothers as caregivers' was positively associated with timely MMR2 vaccination. Although 97% of principals surveyed considered vaccination important, 48.8% were not aware of national legislation requiring complete vaccination prior to school entry. Survey results concurred with the low MMR2 administrative coverage rates reported by Saint Lucia, much lower than the recommended 95%. Conclusions. Based on the results of this survey, Saint Lucia's national immunization program has lowered the age of MMR2 to 18 months in 2016, increased advocacy with schools to enforce the school-entry law, and is working to vaccinate the cohorts of children who have not received timely MMR2. [ABSTRACT FROM AUTHOR]

Objective. To measure the effectiveness of pneumococcal conjugated vaccine (PCV13) against Community Acquired Pneumonia (CAP) and invasive pneumococcal disease, 2 years after the vaccine (2+1) was included into the National Immunization Program of Argentina, and to describe variables associated with bacterial pneumonia and hospitalization. Methods. This was a prospective, population-based surveillance study of CAP incidence (ambulatory and hospitalized) among children less than 5 years of age in the Department of Concordia (Entre Rios, Argentina) from April 2014 -- March 2016. The diagnosis of probable bacterial pneumonia (PBP) was determined following the standardized WHO protocol. Incidence during the post-vaccine introduction period was compared with the results from a previous study that used similar methodology for the pre-PCV13 introduction period from 2002 -- 2005. Results. During the study period, 330 patients had a clinical diagnosis of CAP, of which 92 were PBP (6 with pleural effusion). S. pneumoniae was not isolated from any sample. No factors associated with PBP were found in multivariable analysis. The decrease in PBP and pleural effusion was significant in relation to the previous study: 63% (P < 0.0001) and 80.9% (P < 0.003), respectively. PCV13 uptake was 97.3% for the 1st dose and 84.8% for the booster dose. Conclusions. PCV13 was effective to reduce incidence of consolidated pneumonia and pleural effusion, among children less than 5 years of age in Concordia, Argentina. Vaccination is a very effective public health strategy for reducing vaccine preventable diseases, with impact on burden of disease and hospitalization. [ABSTRACT FROM AUTHOR]

Objectives. Three highly effective vaccines are available to prevent human papillomavirus (HPV) infection, and they have been introduced in many countries around the world. This article describes advances and challenges in introducing HPV vaccines in the Expanded Program of Immunization (EPI) of countries in Latin America and the Caribbean (LAC). Methods. We reviewed national and regional sources of information to identify LAC countries with and without universal HPV vaccination, along with the year of introduction, type of HPV vaccine, vaccination scheme, age groups targeted, and coverage level reached. Incidence rates of cervical cancer were compared across countries with and without an HPV vaccination program, in order to identify inequities in access to HPV vaccines. Results. So far, 10 LAC countries have supplied data on their vaccination policies and vaccination coverage rates to the Pan America Health Organization. The majority of those 10 started their vaccination programs using quadrivalent vaccine. Only Chile, Ecuador, and Mexico started their programs using a two-dose scheme. However, by the end of 2016, most of the other countries had switched from a three-dose to a two-dose scheme. Different age groups are targeted in the various programs. Some countries vaccinate one-year birth cohorts, while others vaccinate multiple-year birth cohorts. By the end of 2014, coverage with at least two doses ranged from a low of 2% to a high of 86%. With the exception of Venezuela, the LAC countries with the largest populations introduced universal HPV vaccination between 2010 and 2014. Despite the progress that has occurred in some LAC countries, there are still 10 LAC nations with cervical cancer rates above the LAC average (21.2 cases per 100 000) that have not introduced an HPV vaccine in their EPI. Conclusions. With several key adjustments, HPV vaccination programs across Latin America and the Caribbean could be substantially strengthened. Ongoing monitoring of HPV infection outcomes is needed in order to assess the impact of different vaccination policies. [ABSTRACT FROM AUTHOR]

This report covers the background and evolution of Vaccination Week in the Americas (VWA), an initiative that started as a coordinated response to a 2002 measles outbreak in Colombia and Venezuela, and evolved into the model for other regions and World Immunization Week (WIW). VWA focuses on the work of national immunization programs, with special efforts to reach the unreached. This paper offers examples of how countries have leveraged VWA to implement a diverse array of vaccination activities, strengthening overall health services by integrating with other preventive health interventions, and bolstering "Pan-Americanism" and health diplomacy. The opportunities offered by this global initiative were clearly demonstrated in April 2016 when the successful global switch from the trivalent oral polio vaccine to the bivalent vaccine was synchronized with WIW. Going forward, VWA and WIW can help close the gaps in access to immunization and other health services, contributing to achieve universal health coverage. [ABSTRACT FROM AUTHOR]

Objectives. To summarize and critically evaluate the evidence on the impact and effectiveness of meningococcal vaccination programs around the world in order to inform decisionmaking in Latin America and the Caribbean. Methods. A review of the literature was conducted following several components of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed Central® was searched for papers published in any language from January 1999 - March 2017. Results. In all, 32 studies were included, most of which evaluated the meningococcal C conjugate vaccine. Fourteen studies measured effectiveness and 30 measured impact. The effectiveness of polysaccharide vaccines was 65% - 83.7% (different age groups), while the effectiveness of the conjugate vaccines was 66% - 100%. Incidence decline of laboratory-confirmed meningococcal disease for the conjugate vaccine ranged from 77% - 100% among different ages groups. The only study that evaluated the protein subunit vaccine reported a vaccine effectiveness of 82.9%. Conclusions. The studies reviewed show impact and effectiveness of both polysaccharide vaccines and conjugate vaccines on vaccine-serogroup meningococcal disease. The conjugate vaccines, however, show higher impact and effectiveness with longer-lasting protection over the polysaccharide vaccines. Given the variance in potential use of a meningococcal vaccine, epidemiological surveillance systems should be strengthened to inform national decisions. [ABSTRACT FROM AUTHOR]

Maternal and neonatal immunization (MNI) is a core component of the new immunization model in the Americas, which transitioned from immunization of children to that of the entire family. Immunization during pregnancy protects the mother and the fetus by providing the neonate with maternal antibodies against disease. It has the potential to impact early childhood morbidity and mortality, and thus MNI has gained visibility and priority on the global health agenda. The Region of the Americas is a leader in MNI, as seen by its elimination of congenital rubella syndrome in 2015 and the progress made toward neonatal tetanus elimination. In the Americas, 31 countries currently target pregnant women for influenza vaccination; and 21 countries--over 90% of the Region's birth cohort--have nationwide newborn hepatitis B vaccination. This paper describes the status of MNI in the Americas and identifies gaps in the evidence, obstacles to optimal implementation, and opportunities for future improvements. Catalysts for MNI in the Region have been political commitment, endorsement by scientific societies, an established "culture of vaccination," widespread access to antenatal care, and context-specific communications; however, universal and equitable access for pregnant women and their newborns continues to be a formidable challenge, and additional vaccine safety and effectiveness evidence is needed. Continued efforts to integrate MNI with maternal and child health services will be critical to furthering the MNI platform as well. [ABSTRACT FROM AUTHOR]

Objective. Identify barriers and reasons why children under 5 do not get vaccinated in some Colombian cities. Methods. Qualitative design based on interviews and focus groups of health workers and caregivers in four Colombian cities selected according vaccination coverage and population densities. Results. Different factors were identified that may hinder completion of vaccination schedules in the two municipalities with low coverage, such as fear of a post-vaccination reaction, socioeconomic and geographical conditions and population safety, working conditions of the vaccination staff, administrative and economic problems, and precarious information systems. Conclusions. From a qualitative standpoint, the vaccination teams and caregivers pointed to social and institutional issues that may hinder vaccination coverage in the cities that participated in the study. [ABSTRACT FROM AUTHOR]

This article synthesizes the important lessons learned from polio eradication in the Region of the Americas, including initial and more recent challenges and best practices, as well as particular factors surrounding attainment of this ambitious goal. Using documents, interviews, and country surveys, the authors describe and analyze the strategies and lessons learned during the 40 years of the Expanded Program on Immunization (1977 - 2017). Some major milestones and challenges specifically covered are: the Vaccine-derived Poliovirus (VDPV) outbreak in the Dominican Republic; the regional "mop-up operation;" poliovirus containment in essential facilities; the unprecedented introduction of inactivated polio vaccine (IPV); the synchronized switch from trivalent to bivalent OPV; and the countries' unfailing commitment to the cause. [ABSTRACT FROM AUTHOR]

In 2014, Brazil introduced an HPV immunization program for girls 9-13 years of age as part of the Unified Health System's (SUS) National Immunization Program. The first doses were administered in March 2014; the second ones, in September 2014. In less than 3 months more than 3 million girls received the first dose of quadrivalent HPV vaccine, surpassing the target rate of 80%. This paper examines three elements that may influence the program's long-term success in Brazil: sustaining effective outreach, managing a large technology-transfer collaboration, and developing an electronic immunization registry, with a focus on the State of São Paulo. If these three factors are managed, the Government of Brazil is primed to serve as a model of success for other countries interested in implementing a national HPV vaccination program to decrease HPV-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective. To identify and describe 1) progress achieved thus far in meeting the commitments of the Fourth Millennium Development Goal (MDG 4) in Mexico, mainly the contribution of the Universal Immunization Program (UIP) over the last 20 years, and 2) new opportunities for further reducing mortality among children under 5 years old. Methods. An observational, descriptive, retrospective study was carried out to examine registered causes of death in children under 5 between 1990 and 2010. Indicators were built according to the recommendations of the United Nations. Results. In 2010, deaths among children under 5 decreased 64.3% compared to the baseline (1990) figure. Of the total deaths of the children under 5, the neonatal period was the most affected (52.8%), followed by the 1 to 11 months (30.9%), and the 12 to 59 months (16.2%) groups. A 34% overall mortality reduction was observed after the universalization of immunization against influenza, rotavirus, and pneumococcus in children under 5. Conclusions. Despite a significant reduction in under-5 mortality in Mexico over the last 20 years, largely due to the successes of the UIP, several challenges remain, particularly in improving preventive and curative services during pre- and postnatal care. [ABSTRACT FROM AUTHOR]