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In 2010, an expert advisory panel convened by the World Health Organization to assess the feasibility of measles eradication concluded that (1) measles can and should be eradicated, (2) eradication by 2020 is feasible if measurable progress is made toward existing 2015 measles mortality reduction targets, (3) measles eradication activities should occur in the context of strengthening routine immunization services, and (4) measles eradication activities should be used to accelerate control and elimination of rubella and congenital rubella syndrome (CRS). The expert advisory panel also emphasized the critical role of research and innovation in any disease control or eradication program. In May 2011, a meeting was held to identify and prioritize research priorities to support measles and rubella/CRS control and potential eradication activities. This summary presents the questions identified by the meeting participants and their relative priority within the following categories: (1) measles epidemiology, (2) vaccine development and alternative vaccine delivery, (3) surveillance and laboratory methods, (4) immunization strategies, (5) mathematical modeling and economic analyses, and (6) rubella/CRS control and elimination.

Japanese encephalitis (JE) virus is the most important vaccine-preventable cause of encephalitis in the AsiaPacific region. WHO recommends integration of JE vaccination into national immunization schedules in all areas where [...]

Since the launch of the global Expanded Programme on Immunization (EPI) in 1974, vaccination against 6 diseases (tuberculosis, polio, diphtheria, tetanus, pertussis, and measles) has prevented millions of deaths and [...]

A study to establish a relation between obesity during pregnancy and the increased usage of health care is conducted. Results confirm the hypothesis that obesity during pregnancy is associated with an increased usage of health care.

OBJECTIVES. This study explored how vaccination coverage is associated with not being insured and with insurance type among children who are insured and to show how these associations are modified by race/ethnicity. METHODS. We determined whether 8324 children sampled in the National Immunization Survey in 2001 and 2002 were covered by private insurance only, Medicaid/State Children's Health Insurance Program, or another insurance type or were uninsured at the time of the National Immunization Survey interview or were uninsured at some time before the interview. Children were up to date if, by the date of the interview, their vaccination providers had administered [greater than or equal to] 4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, [greater than or equal to] 3 doses of polio vaccine, [greater than or equal to] 1 dose of measles-mumps-rubella vaccine, [greater than or equal to] 3 doses of Haemophilus influenzae type b vaccine, and [greater than or equal to] 3 doses of hepatitis B vaccine. To evaluate the association between insurance type and breaks in insurance with timely completion of the recommended vaccination schedule soon after 19 months of age, we restricted our analyses to children 19 to 24 months of age. RESULTS. Nationally, 12.6 [+ or -] 1.6% of all children 19 to 24 months of age were uninsured at some time. Children who were uninsured at the time of the National Immunization Survey interview had significantly lower vaccination coverage than did children with Medicaid/State Children's Health Insurance Program coverage or children with private insurance only (52.6% vs 70.0% and 75.6%). Children who had never been insured and children who were insured but had a break in insurance coverage in the 12 months immediately preceding the National Immunization Survey interview had significantly lower vaccination coverage than did children who had been insured continuously (47.4% and 64.8% vs 73.5%). CONCLUSIONS. Approximately 1 of 8 children were uninsured at some time, and those children were at greater risk of not being vaccinated on time as recommended. Key Words insurance, Medicaid, State Children's Health insurance Program, survey, vaccines Abbreviations NIS--National Immunization Survey PRC--provider record check RDD--random-digit-dialing SCHIP--State Children's Health Insurance Program CI--confidence interval, COST HAS ALWAYS been a barrier to receiving and/or providing timely preventive medical care to children living in poverty. Under the Social Security Amendments of 1965, the Medicaid program was [...]

Background. The Vaccines for Children (VFC) program is designed to reduce the cost of vaccines for vulnerable children, including Medicaid-eligible children, American Indian/Alaska Native children, uninsured children, and underinsured children whose health insurance does not cover the cost of vaccinations. A desired consequence of the program is to promote comprehensive continuous medical care within a medical home for these children. Objectives. To explore how having a medical home is associated with vaccination coverage among children eligible for the program. Participants. A total of 24 514 children 19 to 35 months of age sampled by the National Immunization Survey. Design. VFC eligibility was evaluated for 24 514 children 19 to 35 months of age who were sampled by the National Immunization Survey. Children were considered to have a medical home if they had a doctor, nurse, or physician's assistant who provided them with ongoing routine care, including well-child care, preventive care, and sick care, according to their parents. Sampled children were determined to be 4:3:1:3:3 up-to-date (UTD) if their vaccination providers reported administering [greater than or equal to] 4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, [greater than or equal to] 3 doses of polio vaccine, [greater than or equal to] 1 dose of measles-mumps-rubella vaccine, [greater than or equal to] 3 doses of Haemophilus influenzae type b vaccine, and [greater than or equal to] 3 doses of hepatitis B vaccine. Results. Nationally, 44.9% of all children were VFC eligible and 93.0% of the VFC-eligible children received all vaccine doses at a provider enrolled in the VFC program. Compared with children who were not VFC eligible, VFC-eligible children were less likely to be UTD (70.8% vs 77.7%) and less likely to have a medical home (82.1% vs 95.0%). However, among VFC-eligible children, children who had a medical home were significantly more likely to be UTD, compared with children who did not have a medical home (72.3% vs 63.5%). Also, among VFC-eligible children who had a medical home, children who used their medical home consistently to receive all of their vaccination doses were significantly more likely to be UTD, compared with children who did not receive all of their doses from their medical home (75.3% vs 65.7%). Finally, the 4:3:1:3:3 vaccination coverage rate among VFC-eligible children who received all of their vaccination doses from their medical home was not significantly different from that among non-VFC-eligible children, after controlling for significant differences in sociodemographic factors between these groups (adjusted difference: 2.8%; 95% confidence interval: -0.1% to 5.7%). Conclusions. Although the vaccination coverage rate among VFC-eligible children who had a medical home and received all vaccine doses from their medical home was essentially equivalent to that of non-VFC-eligible children, substantial percentages of VFC-eligible children either did not have a medical home or did not use their medical home to receive all of their recommended vaccinations. The vaccination coverage rate among these children was significantly lower. This suggests that there may be opportunities to increase vaccination coverage by removing barriers that prevent the adoption and consistent use of a medical home among these children. Pediatrics 2005;116:130-139; medical home, survey, relative risk, vaccination coverage. ABBREVIATIONS. CI, confidence interval; NIS, National Immunization Survey; RDD, random-digit dialing; UTD, up-to-date; VFC, Vaccines for Children; MSA, metropolitan statistical area; SCHIP, State Children's Health Insurance Program; CASRO, Council of American Survey Research Organizations; 4:3:1:3:3, 4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, 3 doses of polio vaccine, 1 dose of measles-mumps-rubella vaccine, 3 doses of Haemophilus influenzae type b vaccine, and 3 doses of hepatitis B vaccine; HIM, Health Insurance Module., In 1993, the Childhood Immunization Initiative was proposed to address significant gaps in vaccination coverage among young children in the United States. (1) One goal of the Initiative was to [...]

Context. Each year 2.1 million children 19 to 35 months of age are undervaccinated. Among these are children who have received no vaccinations. Unvaccinated children are at increased risk of acquiring and transmitting vaccine-preventable diseases. Objectives. To assess whether the characteristics of children with no vaccinations differ from those of undervaccinated children, to monitor trends in the numbers of unvaccinated children, and to identify states with high rates and counties with large numbers of unvaccinated children. Design. A nationally representative probability sample of children 19 to 35 months of age was collected annually between 1995 and 2001. Vaccination histories were ascertained from children's medical providers. Undervaccinated children had received [greater than or equal to] 1 dose of diphtheria-tetanus-pertussis, polio, measles, Haemophilus influenzae type b, hepatitis B, or varicella vaccine but were not fully vaccinated. Unvaccinated children were children who were reported as having no medical providers and having received no vaccinations or children whose medical providers reported administering no vaccinations. Participants. A total of 151 720 children sampled between 1995 and 2001, 795 of whom were unvaccinated. Results. Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city. Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding $75 000, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children. Unvaccinated children were more likely to be male than female. Annually, ~17 000 children were unvaccinated. The largest numbers of unvaccinated children lived in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan. States that allowed philosophical exemptions to laws mandating vaccinations for children as they entered school had significantly higher estimated rates of unvaccinated children. Conclusions. Unvaccinated children have characteristics that are distinctly different from those of undervaccinated children. Unvaccinated children are clustered geographically, increasing the risk of transmitting vaccine-preventable diseases to both unvaccinated and undervaccinated children. Pediatrics 2004;114:187-195; exemptor, undervaccinated, unvaccinated. ABBREVIATIONS. CI, confidence interval; NIS, National Immunization Survey; PKAM, Parental Knowledge and Attitudes topical module; RDD, random-digit dialing; UTD, up-to-date; NUTD, not up-to-date; VPD, vaccine-preventable disease; MSA, metropolitan statistical area., Children who have received no vaccinations have not been well studied in the United States. Many studies have assumed that children with no vaccinations are similar to undervaccinated children and [...]

Objectives. We examined current racial/ethnic differences in immunization coverage rates among US preschool children. Methods. Using National Immunization Survey data from 1996 through 2001, we compared vaccination coverage rates between non-Hispanic White, non-Hispanic Black, Hispanic, and Asian preschool children. Results. During the 6-year study period, the immunization coverage gap between White and Black children widened by an average of 1.1% each year, and the gap between White and Hispanic children widened by an average of 0.5% each year. The gap between White and Asian children narrowed by an average of 0.8% each year. Conclusions. Racial/ethnic disparities in preschool immunization coverage rates have increased significantly among some groups; critical improvements in identifying, understanding, and addressing race/ethnicity-specific health care differences are needed to achieve the Healthy People 2010 goal of eliminating disparities.

Objective. Mothers can be instrumental in gaining access to vaccination services for their children. This study examines maternal characteristics associated with vaccination in US preschool children. Methods. We analyzed data from 21 212 children aged 19 to 35 months in the National Immunization Survey. Bivariate and multivariate analyses were used to identify maternal characteristics associated with completion of all recommended vaccinations in these children. Results. Factors most strongly associated with under-vaccination included having mothers who were black; had less than a high school education; were divorced, separated, or widowed; had multiple children; were eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) but not participating; or had incomes below 50% of the federal poverty level. Conclusion. Because most mothers play an important role in their children's vaccination, it is important to address maternal concerns and barriers when developing public health interventions for promoting childhood vaccinations. Encouraging eligible women and their children to participate in the WIC program and providing support and encouragement for immunization to mothers with multiple children may improve early childhood vaccination coverage. Pediatrics 2003;111:1215-1218; vaccination, immunization, children, mother, maternal characteristics., ABBREVIATIONS. NIS, National Immunization Survey; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children; OR, odds ratio. Vaccinations are one of the simplest and most effective ways that we [...]

Objective. To examine the timeliness of vaccine administration among infants and young children in the United States. Methods. We analyzed age at receipt of vaccines among 16 211 children aged 24 to 35 months in the 2000 National Immunization Survey and examined receipt at the recommended time of each dose and selected vaccination series, as well as receipt at 4 additional time frames: acceptably early, late, never by 24 months, and too early to be considered valid. We also examined the relationship between timeliness of vaccinations and characteristics of the child, mother, and immunization provider, using multivariate logistic regression. Results. Only 9% of children received all recommended vaccines at the recommended ages. The rates varied significantly by antigen, ranging from 24% for all Haemophilus influenzae type b doses to 75% for all hepatitis B doses as recommended. Overall, 55% of children did not receive all recommended doses by 24 months of age, and 8% of children received at least 1 vaccination dose too early to be considered valid. Factors associated with not receiving all vaccines as recommended were having more children in the household, mothers younger than 30 years, use of public providers, and multiple vaccination providers. Conclusions. By 24 months of age, 9 of 10 children received at least 1 vaccine outside the recommended age ranges. High vaccination status of children at 24 months of age does not reflect the reality that many vaccinations are not given at the appropriate ages. Timeliness of vaccination is critical to prevent disease outbreaks, protect children through their first 2 years of life, and minimize the need to repeat doses. Pediatrics 2002;110:935-939; childhood immunizations, vaccination, vaccination coverage, timeliness, age-appropriate., In the United States, the national childhood immunization schedule calls for children to receive approximately 15 vaccinations by 19 months of age and specifies ages for administration of each vaccine [...]