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A new reduced-osmolarity rehydration solution (ORS) that contains less sodium and glucose is recommended instead of original ORS for oral therapy for cholera.

The hepatitis A vaccine can reduce the rate of hepatitis A in a community by over 90%, according to a vaccination project in Butte County, California from January 12, 1995, to December 31, 2000. Over 200 cases of hepatitis A occurred in this county in 1994 but only four cases occurred in 2000., Context The impact of routine hepatitis A vaccination of children living in large communities with elevated disease rates has not been evaluated. Objective To determine the effect of routine vaccination of children on disease incidence in a community with recurrent hepatitis A epidemics. Design, Setting, and Participants Community-based demonstration project conducted from January 12, 1995, through December 31, 2000, in Butte County, California, among children aged 2 to 17 years. Intervention In 1995, vaccination was offered to children aged 2 to 12 years during vaccination clinics conducted on 2 occasions 6 to 12 months apart at most schools in the county. In 1996-2000, vaccine was distributed to community health care clinicians, who vaccinated eligible children without charge. Vaccine was also available at health department clinics, selected child care centers, and other sites. Main Outcome Measures Hepatitis A vaccination coverage, hepatitis A incidence, and vaccine effectiveness. Results During the study period, 29 789 (66.2%) of an estimated 44 982 eligible children received at least 1 vaccine dose; 17 681 (39.3%) received a second dose. The number of hepatitis A cases among the entire county population declined 93.5% during the study period, from 57 cases in 1995 to 4 in 2000, the lowest number of cases reported in the county since hepatitis A surveillance began in 1966. The 2000 incidence rate of 1.9 per 100 000 population was the lowest of any county in the state. Of the 245 cases reported during the 6-year period, 40 (16.3%) occurred among children 17 years of age or younger, of which 16 (40%) occurred in 1995 and only 1 in 2000. One of the 27 case patients eligible for vaccination had been vaccinated, having received the first dose 3 days before symptom onset. The estimated protective vaccine efficacy was 98% (95% confidence interval, 86%-100%). Conclusions In this population, hepatitis A vaccine was highly effective in preventing disease among recipients. Childhood vaccination appears to have decreased hepatitis A incidence among children and adults and controlled the disease in a community with recurrent epidemics.

Immunizing 6-month-old infants in epidemic areas who are born to mothers vaccine-immune to the measles virus but with a low titer of measles antibody may be indicated. Little risk of immune tolerance was discovered in this small study of 34 infants. The Advisory Committee on Immunization Practices recommends that 6-month-old infants in epidemic areas be immunized against measles. In nonepidemic areas, infants are usually immunized against measles at 15 months. The study compared the antibody levels of immunized 6-month-olds to immunized 15-month-olds, and found that 74% of infants aged 6 months and 100% of 15-month-olds showed antibodies to the measles virus. The 6-month-olds were reimmunized at 15 months, after which all were found to have antibodies to measles., Hypothesis. The low titer of measles antibody in infants of mothers with vaccine-induced immunity may allow immunization against measles before 15 months of age. Methods. Six- and 15-month-old infants born to mothers 30 years of age with no history of measles were recruited. Infants enrolled at 6 months of age were immunized with monovalent measles vaccine (Attenuvax), and maternal serum and infant pre- and postvaccination sera were obtained. Those enrolled for primary vaccination at 15 months of age received either Attenuvax (N = 12) or M-M-[R.sub.II], (N = 3). Six-month-old infants were revaccinated with M-M-[R.sub.II], at 15 months of age, pre- and postrevaccination sera were again obtained. Three antibody assays were used: a measles neutralizing assay (NT) and two enzyme immunoassays (EIA) for measles IgG and measles IgM. Results. Among primary vaccinees, 14 of 19 infants aged 6 months (74%) developed NT antibody, as did 15 of 15 infants aged 15 months (100%). The reciprocal geometric mean titer of 6-month-old seroresponders was 23.3, significantly lower than that of the 15-month-old primary vaccinees (87.7, P < .001). Primary seroconversion rates by EIA were 53% for 6-month-old infants and 100% for those aged 15 months. Revaccination of infants who had received Attenuvax at 6 months of age resulted in 100% NT positivity; the geometric mean titer rose to equal that of the group given primary immunization at 15 months of age. Measles IgM antibody was detected in 10 of 14 infants tested 1 month after primary vaccination at 15 months, but was not detected in any of the revaccinated infants after the second dose at 15 months of age (P < .001). Conclusions. 1) Immunization with measles vaccine in infants born to vaccine-immune mothers at 6 months of age induced NT antibody in 74% of infants. 2) Revaccination of prior 6-month-old vaccinees at 15 months resulted in antibody titers equivalent to 15-month-old vaccinees. 3) Lack of an IgM response following revaccination suggests that even seronegative infants may be primed to respond on re-exposure to measles. Pediatrics 1994;93:939-944; measles vaccine, vaccine immunogenicity.

An inactivated hepatitis A vaccine may be a safe and effective method for preventing hepatitis A in children. An inactivated vaccine consists of killed virus, which stimulates a protective immunological response without causing the disease. Of 1,037 children from a Hasidic Jewish community that had recurrent outbreaks of hepatitis A, 519 received injected vaccine and 518 received a placebo, an inactive substance. Within 21 days of vaccination, seven children who were vaccinated developed hepatitis A, compared with three children in the placebo group. After day 21, none of the children in the vaccine group developed hepatitis A, compared with 34 children in the placebo group. None of the children who were vaccinated experienced a serious adverse reaction to the vaccine. Some children experienced redness and swelling at the site of injection and fever.

To the Editor.-- Oral rehydration therapy with the WHO formulation has saved millions of lives, (1) but has yet to achieve universal acceptance because, although it performs the essential function [...]