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The incidence of pertussis in the United States (1) declined dramatically after the introduction of pertussis vaccine in the 1940s. Before that, an average of 160,000 cases of pertussis (150/100,000 [...]

Background: Retrospective immunization coverage surveys conducted during 1991 and 1992 demonstrated that coverage levels for the routine childhood vaccines by 24 months of age in selected urban areas of the United States ranged from 10% to 52%, far below the US Public Health Service goal of 90%. Therefore, appropriate programmatic changes must be identified and incorporated. Methods: We analyzed coverage survey data collected from 21 sites to measure the potential impact on coverage levels of implementing selected changes in vaccination practices. In a multistaged cluster survey design, school health records of kindergarten or first-grade students were randomly selected and dates of vaccination assessed. We evaluated changes in the vaccination practices, such as eliminating missed opportunities for simultaneous administration of vaccines and ensuring that children initiated the vaccination series on time (ie, by 3 months of age). We then calculated potential increases in coverage levels for a best-case scenario. Results: From 77% to 96% of all children in the 21 sites had received at least one vaccination by their first birthday. Children were 2.3 to 17 times more likely to be up to date on their vaccinations by 24 months of age if they were up to date at 3 months of age. Each child had many opportunities for the simultaneous administration of diphtheria and tetanus toxoids and pertussis (DTP) vaccine, oral polio vaccine (OPV), and measles-mumps-rubella (MMR) vaccine that, if used appropriately, could have potentially raised coverage levels by 12% to 22% (median, 17%). The highest coverage levels could have been attained if all children had started the series on time and if advantage had been taken of all opportunities for simultaneous vaccination. Coverage levels for four doses of DTP vaccine, three doses of OPV, and one dose of MMR vaccine would have increased from a baseline of 10% to 52% to levels of 54% to 83%. Conclusions: Although the majority of children received a vaccination by their first birthday, the coverage level at 24 months of age was low. Tracking systems are needed to ensure that children do not drop out of the system once they have begun the vaccination series. In addition, all children who are late in beginning their vaccination series are at increased risk of not completing the recommended vaccination series on time, and these children need intensive follow-up and recall efforts. Also, providers need to administer all needed vaccines simultaneously. (Arch Pediatr Adolesc Med. 1994;148:943-949), Missed opportunities to vaccinate children contribute to low rates of immunization in children under two years of age. Children are more likely to be adequately immunized if they begin and complete each immunization series before age two. A retrospective analysis of immunization coverage surveys in 21 cities from 1991 and 1992 revealed that coverage levels were well below the U.S. Public Health Service goal of 90%. Coverage levels may be increased if vaccines are administered simultaneously in one visit, if children begin immunization series on time, and if better tracking systems are developed. Simultaneous administration of vaccines may increase immunization rates by 17%. Children who begin immunization series late may need to be aggressively followed up to ensure they do not remain underimmunized. Educating pediatric vaccine providers and parents about the need to administer vaccines simultaneously may also increase coverage levels.

Pediatric medicine is a rapidly changing field: new antibiotics, new vaccinations, and even new diseases (such as pediatric AIDS) are continually being discovered. A tendency among pediatricians is to cling to known ways, even when they are antiquated and clearly outmoded. While some reasons for this are understandable, flexibility is necessary in the face of change. Practices that are commonly in use, but which should be changed in light of scientific evidence, are reviewed. Sterilization of infant formula, necessary in the days when refrigeration was not universally available, can be replaced by a clean method of formula preparation where the bottles and nipples are simply washed with hot, soapy water. Nonetheless, commercial formula companies and many pediatricians still recommend sterilization. When testing newborn infants for sepsis (systemic infection), culturing skin sites and the fluid aspirated from the stomach (an approach taught in medical schools years ago) does not provide an accurate indication of whether infection is present. Cerebrospinal fluid (in which the brain is bathed), blood, and urine cultures better provide such information. Infants with ''dehydration fever,'' believed by some pediatricians to result from poor fluid intake, should be checked instead for infectious disease. The use of a routine spinal tap at the end of a course of antibiotic treatment for spinal meningitis (inflammation of the membranes surrounding the spinal cord) to determine whether infection is still present should be questioned. Nor do spinal taps need to be performed on children if they experience a febrile seizure, unless meningitis is suspected. Iron-fortified infant formulas are recommended for non-breast-fed infants, in spite of many pediatricians' beliefs that these can cause diarrhea, constipation, or spitting up. Partial doses of DPT vaccine (diphtheria, tetanus, pertussis or whooping cough) do not reduce the risk of side effects, and may not confer full immunity. Prophylactic acetaminophen at the time of the immunization will mitigate fever and pain after DPT vaccination. Finally, when repeated blood samples from the same patient are injected into culture bottles, needles do not need to be changed each time. (Consumer Summary produced by Reliance Medical Information, Inc.)

Introduction In May 1990 the Department of Health introduced an accelerated schedule of primary immunisation. The ages at which children receive combined diphtheria/ tetanus/pertussis vaccine (triple vaccine) and oral polio [...]

More news from the Advisory Committee on Immunization Practices regarding guidelines for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines (Tdap) in adolescents. Two Tdap vaccines were [...]

BOOSTRIX.sup.', TdaP for Adolescents By Stan Deresinski, MD, FACP, Clinical Professor of Medicine, Stanford; Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, is Editor for Infectious Disease Alert [...]

According to data compiled by the CDC, 53% of adult Americans--and as many as 70% of people aged 70 and over--are at risk for tetanus and diphtheria because of inattention [...]

The US Centers for Disease Control and Prevention (CDC) has asked doctors to delay giving children their last injection of the tetanus, pertussis, and diptheria (DTP) vaccine until they are [...]

ATLANTA -- It's best to use the same diphtheria-tetanus-acellular pertussis vaccine for all five doses in infants and children, but any available DTaP vaccine can be used for the fifth [...]

This year's harmonized childhood immunization schedule comes in two parts. The first part (on this page and next) is valid January-June 2004, and contains only minor changes from 2003. A [...]

In July, the Food and Drug Administration approved a fifth dose for a second diphtheria, tetanus toxoids, and acellular pertussis vaccine on the U.S. market. Approving a fifth dose of [...]

Despite 2005 recommendations that people aged 10-64 years receive the tetanus, diphtheria, and acellular pertussis vaccine every 10 years, vaccination rates remain suboptimal, according to a report. In 2008, just [...]

The Health Protection Agency (HPA) is asking practice nurses to check that patients are up to date with routine vaccinations following the death of a child in London from diphtheria. [...]

The adult formula of the tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) can be given to children and adolescents starting at 18 months after a children's formula tetanus [...]

ATLANTA -- Health care workers in hospitals or ambulatory care settings and those who have direct patient contact should receive the adolescent/adult formulation of the tetanus-diphtheria-acelular pertussis vaccine, the Advisory [...]

Investigators compared the immunogenicity and reactogenicity of booster doses of a tetanus-diphtheria 5-component acellular pertussis vaccine (Tdap) against those measures of efficacy of tetanus and diphtheria vaccines (Td) in adolescents [...]

ATLANTA -- The new adolescent/adult formula tetanus-diphtheria-acellular pertussis vaccine should be routinely administered to 11- to 12-year-olds, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted [...]

ATLANTA -- Physicians who take care of adolescents are likely to accept routine vaccination of 11- to 12-year-olds with a tetanusdiphtheria-acellular pertussis vaccine instead of the current tetanus-diphtheria vaccine, Karen [...]