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The study aims to evaluate the effect of rotavirus vaccine on death from diarrhea occurring among children in Mexico during 2008 and 2009. The results indicate that there was a significant reduction in mortality following the introduction of the vaccine among Mexican children.

Objective: Between May and June 2002 an outbreak of chickenpox (CP) occurred at a child care centre in Perth, Western Australia. An epidemiological study was undertaken in order to determine the characteristics of the outbreak, assess vaccine effectiveness, and to define the direct and indirect costs associated with (CP) infections in young children. Methods: A cohort study of the outbreak utilising attendance records and a telephone survey of parents was conducted. Results: Of the 211 children attending the child care centre at the time of the outbreak, 44 contracted CP (attack rate 25.7%). In addition, two staff members, five secondary household contacts (secondary attack rate 38.5%) and four secondary non-household associated contacts were infected. There were no severe complications or any hospitalisations recorded in infected persons. Two cases had been vaccinated previously. Vaccine effectiveness for CP of any severity was 78.0% (95% (CI 15.4-94.3%) while vaccine effectiveness against severe CP was 100%. Direct costs during this outbreak were estimated to be $54 per case and the total costs, including cost of parental time off work or study, were estimated to be $525.73 per case. Conclusions and Implications: Although morbidity associated with CP in young children is not great, infection in childhood is almost universal. This study found that the average costs associated with each CP case were considerable. Since varicella vaccine affords good protection against CP, the recent inclusion of this vaccine in the Australian childhood vaccination schedule should save the community a considerable amount in direct and indirect costs if high coverage rates can be achieved. Key words: Chickenpox, outbreak, child care centre, costs, vaccination.

MEASLES, MUMPS, RUBELLA, and varicella cause significant morbidity and death. Children in the United States are vaccinated routinely against measles, mumps, and rubella with M-M-RII (Merck & Co, Inc, West [...], BACKGROUND. In the United States, children receive primary doses of M-M-RII (Merck & Co, Inc, West Point, PA) and Varivax (Merck & Co, Inc) beginning at 12 months, often at the same health care visit. Currently a second dose of M-M-RII is given to 4- to 6-year-old children, to increase vaccination rates and to reduce the number of individuals without detectable antibodies. A second dose of a varicella-containing vaccine may result in similar benefits. OBJECTIVES.TO demonstrate that ProQuad (measles, mumps, rubella, and varicella virus vaccine live; Merck & Co, Inc) may be given in place of a second dose of M-M-RII or second doses of M-M-RII and Varivax for 4- to 6-year-old children. METHODS. Four- to 6-year-old children who had been immunized previously with M-M-RII and Varivax were assigned randomly to receive either ProQuad and placebo (N = 399), M-M-RII and placebo (N = 195), or M-M-RII and Varivax (N = 205) and were then monitored for safety and immunogenicity. RESULTS. ProQuad was generally well tolerated. Similarity (noninferiority) was demonstrated in postvaccination antibody responses to measles, mumps, and rubella between recipients of ProQuad and all recipients of M-M-RII and in responses to varicella between recipients of ProQuad and recipients of Varivax. Postvaccination seropositivity rates for antibodies against all 4 viruses were nearly 100% in all 3 groups. Small fold increases were observed for measles, mumps, and rubella antibody titers. In contrast, substantial boosts in varicella antibody titers were observed among recipients of a second dose of varicella vaccine, administered as ProQuad or Varivax. CONCLUSIONS. ProQuad may be used in place of a second dose of M-M-RII or second doses of M-M-RII and Varivax for 4- to 6-year-old children. Key Words measles, mumps, rubella, varicella, vaccine, ProQuad, Varivax, M-M-RII, immunization, second dose Abbreviations gpELISA--glycoprotein antigen-based enzyme-linked immunosorbent assay GMT--geometric mean titer ELISA--enzyme-linked immunosorbent assay CI--confidence interval VRC--vaccination report card

A study is conducted to determine the extent of delay of vaccination during the first 24 months of life of children in the United States. The study concluded that more than 1 in 3 children were undervaccinated for more than 6 months during their first 24 months of life and 1 in 4 children were delayed for at least 4 vaccines.

The effects of changes in recommendations regarding administration of a hepatitis B birth dose on vaccination coverage is determined. Reductions in hepatitis B vaccine birth-dose coverage persisted after recommendations were made to resume previous newborn vaccination practices.

Objective: To determine the proportion of Victorian primary school students protected against measles infection one year after the completion of the measles `catch-up' immunisation campaign of 1998 and to compare this with the proportion of year 9 and 10 (aged 14-16 years) students. Design & setting: Three-stage random cluster survey in Victorian primary and secondary schools. Main outcome measures: Proportion of primary and year 9 and 10 secondary school students protected against measles infection one year after the completion of the mass `catch-up' immunisation campaign. Secondary outcomes: the proportion of both primary and year 9 and 10 secondary school students protected against both mumps and rubella. Results: Of 1,037 Victorian primary and 2,357 years 9 and 10 secondary school students invited to participate in this study, 403 (39%) and 752 (32%) respectively provided a blood specimen for serological testing for antibodies against measles, mumps and rubella. 94.8% (95% confidence interval, 91.5, 96.9) of primary school and 93.1% (90.9, 94.8) of year 9 and 10 students were protected against measles infection. Conclusion: One year after the completion of the school-based measles `catch-up' immunisation campaign the level of protection in Victorian primary school aged students is sufficient to prevent the continuing circulation of measles virus within this age group. The proportion of year 9 and 10 secondary school students protected against measles is also probably sufficient to prevent continuing circulation of wild type virus in Victoria, even though this age group was not specifically targeted by the `catch-up' campaign.

A randomized, double-blind, placebo-controlled trial was conducted to evaluate the effect of simultaneous vitamin A supplementation and diphtheria, pertussis and tetanus (DPT) vaccination on the antibody levels. Infants aged 6-17 wk (n = 56) were randomly given 15 mg oral vitamin A or placebo at the time of their DPT immunization. Three such doses were given at monthly intervals. Immunoglobulin (Ig) G antibodies to diphtheria, pertussis and tetanus were assayed on enrollment and 1 mo after the third dose. Baseline antibody concentrations to diphtheria, pertussis and tetanus did not differ between the vitamin A-supplemented and placebo-treated groups. The postdose antibody to diphtheria level was significantly greater in the vitamin A than in the placebo-treated group. The geometric mean +/- SEM antibody levels (mg/L) were 22.9 +/- 1.2 and 11.0 +/- 1.3 in the vitamin A and placebo groups, respectively (P = 0.029). The postsupplementation concentrations of antibodies to pertussis and tetanus did not differ between the two groups. These results suggest that antibody response to diphtheria vaccination was potentiated by simultaneous vitamin A administration and DPT immunization.

After a report of reduced seroconversion to measles in infants, aged 6 mo, given vitamin A with their measles vaccination, serious concerns were raised regarding the safety of the WHO's recommendation that infants be supplemented with vitamin A at the time of measles immunization. To determine the impact of coadministered vitamin A on the antibody response to measles vaccine given to infants aged 9 mo, the more common age for immunization in developing countries, we conducted a randomized, double-blind, placebo-controlled trial in an urban slum community in Delhi. Infants (618) were randomly allocated to receive 30 mg vitamin A or a placebo with the measles immunization. Antibodies to measles were measured by ELISA in serum samples obtained at before (baseline) and 12 wk after immunization. Overall, the seroconversion rates did not differ between vitamin A (89.5%) and placebo (87.6%) groups. There were no significant differences in the geometric mean titers in the two groups (ratio of geometric means, 1.19; 95% confidence interval, 0.97-1.46). Among malnourished infants, the geometric mean titer was significantly greater in the vitamin A group compared to the placebo group (ratio of geometric means, 1.57; 95% confidence interval, 1.18-2.0), but seroconversion rates did not differ. There were no differences in seroconversion rates and geometric mean titers in the two study groups among the well-nourished children. These results indicate that 30 mg vitamin A does not reduce the immune response to the coadministered vaccine and, therefore, can be continued to be given safely in public health programs. KEY WORDS: vitamin A; measles immunization; infants; immune response

The global rates for poliomyelitis are low, but children and adolescents need to be vaccinated against the disease. The Western Hemisphere was certified as free of the wild-type of virus in 1994, but there is some risk of vaccine-associated poliomyelitis from oral polio vaccine. Many public health authorities recommend a series of vaccinations for children from two months to 6 years.

Universal childhood vaccination against hepatitis B in Taiwan appears to have reduced the incidence of hepatocellular carcinoma. This is a type of liver cancer caused by chronic hepatitis B infection. An analysis of nationwide statistics on cancer reveal that the average annual incidence of hepatocellular carcinoma in children 6 to 14 years old was reduced by half between 1981-1986 and 1990-1994. Mortality rates from this disease also dropped during this period. In contrast, the rates of another type of childhood cancer, brain tumors, did not decrease.

ABBREVIATIONS. GMT, geometric mean titer; MSD, Merck Sharp & Dohme; PRN, plaque reduction neutralization; OR, odds ratio. The determination of the optimal age for measles vaccination is based on the [...]

There appear to be significant side effects associated with some childhood vaccinations however the evidence remains inconclusive for many reported occurrences, according to a September 1993 report by the Institute of Medicine. The report used both published and unpublished information to evaluate the relationship between administration of, and side effects from, Haemophilus influenzae type b (Hib) vaccines; hepatitis B vaccines (HBV); measles, mumps and measles-mumps-rubella vaccines (MMR); inactivated and oral polio vaccines; and diphtheria and tetanus toxoids. A causal relationship was identified for seven vaccine administrations and adverse reactions. Diphtheria and tetanus toxoids were associated with a severe allergic reaction known as anaphylaxis. MMR vaccine appeared to be associated with with anaphylaxis, thrombocytopenia and death from vaccination-strain viral infection. Polio vaccination was associated with death from polio vaccine-strain infection and polio in the recipient or someone who had contact with the recipient. HBV vaccine was associated with anaphylaxis., In September 1993, the Institute of Medicine released a report entitled Adverse Events Associated With Childhood Vaccines: Evidence Bearing on Causality. The report examined putative serious adverse consequences associated with administration of diphtheria and tetanus toxoids; measles, mumps, and measles-mumps-rubella vaccines; oral polio vaccine and inactivated polio vaccine; hepatitis B vaccines; and Haemophilus influenzae type b (Hib) vaccines. The committee spent 18 months reviewing all available scientific and medical data, from individual case reports (published and unpublished) to controlled clinical trials. The committee found that the evidence favored the rejection of a causal relation between diphtheria and tetanus toxoids and encephalopathy, infantile spasms, and sudden infant death syndrome, and between conjugate Hib vaccines and susceptibility to Hib disease. The committee found that the evidence favored acceptance of a causal relation between diphtheria and tetanus toxoids and Guillain-Barre syndrome and brachial neuritis, between measles vaccine and anaphylaxis, between oral polio vaccine and Guillain-Barre syndrome, and between unconjugated Hib vaccine and susceptibility to Hib disease. The committee found that the evidence established causality between diphtheria and tetanus toxoids and anaphylaxis, between measles vaccine and death from measles vaccine-strain viral infection, between measles-mumps-rubella vaccine and thrombocytopenia and anaphylaxis, between oral polio vaccine and poliomyelitis and death from polio vaccine-strain viral infection, and between hepatitis B vaccine and anaphylaxis. For five vaccine-related adverse events, there was no evidence identified. For the remaining 33 vaccine-related adverse events, the evidence was inadequate to accept or reject a causal relation. (JAMA. 1994;271:1602-1605)

A number of studies have reported an increased incidence (number of new cases) of invasive bacterial disease in children soon after they have received various vaccines. This study assessed whether there was an increased risk for invasive bacterial disease in children soon after they were given the diphtheria, tetanus, and pertussis (DPT) vaccine, the measles, mumps, and rubella (MMR) vaccine, or the oral poliovirus (OPV) vaccine. The medical and vaccination records of 223 children, aged one month to two years, who had acquired invasive bacterial disease were examined. Two control subjects, matched for similarities to each case, were randomly chosen, and telephone interviews were conducted for both the children who had bacterial disease and the controls. Final data was obtained from 202 of the cases and 414 controls. Results showed that the controls were more likely to have been immunized prior to the onset of illness than the children who became seriously ill. The risk for developing disease soon after vaccination with DPT or OPV was lower by a factor of 0.07 to 0.44. When other differences were examined, it was found that the risk for invasive bacterial disease was higher among children in day-care; their risk was 2.4 times greater than that of children who were not in day-care. In addition, the risk of invasive bacterial disease was four times greater in children whose records did not show routine well-care visits, compared with those who had such visits. When these factors were assessed, the protective effect of recent immunization was reduced to insignificant levels. The results indicate that recent vaccination does not increase children's chances for developing invasive bacterial disease, but, in fact, may provide a slight protective effect. (Consumer Summary produced by Reliance Medical Information, Inc.)

A recent study has indicated that children are at a higher risk for developing invasive bacterial infection soon after they have been vaccinated with pertussis (whooping cough) vaccine. Another study found that children developed symptoms of infection soon after receiving the diphtheria, tetanus, and pertussis (DTP) vaccine. This study examined if the incidence (number of new cases) of invasive bacterial infection was higher in Native Alaskan infants and children soon after they received the DTP vaccine. This population was chosen because they have a high rate of invasive bacterial disease and the state of Alaska has made a concerted effort to have children vaccinated with DTP and keeps detailed records. Cases of invasive bacterial disease in Native Alaskan children between the ages of 2 and 24 months who had received DTP vaccine were examined. A total of 186 cases and 186 matched controls were evaluated. Results showed that characteristics of the cases and the controls were similar. The number of case subjects who were immunized within 30 days of developing invasive bacterial disease was equal to the number of control subjects who were immunized within 30 days of the reference date. When an analysis was made of all illnesses suffered from 30 days before to 30 days after immunization with both groups combined, the rate of illness was 53 percent prior to and 43 percent following vaccination. These results indicate that the risk for invasive bacterial infection does not increase after Native Alaskan children receive DTP vaccine. (Consumer Summary produced by Reliance Medical Information, Inc.)

It is inevitable that any changes to the childhood vaccination schedule will cause a level of concern among parents and lead to new sets of questions. Practice nurses can play [...]

Childhood immunization programs may provide infrastructure for delivering vitamin A supplements to infants in developing countries. The effect of giving vitamin A, an immune enhancer, on antibody responses to trivalent oral poliovirus vaccine (TOPV) is unknown. A randomized, double-blind, placebo-controlled clinical trial was conducted to determine the effect of giving vitamin A simultaneously with TOPV on antibody responses to poliovirus. Infants (n = 467) received oral vitamin A, 15 mg retinol equivalent (RE), 7.5 mg RE or placebo with TOPV at 6, 10 and 14 wk of age. Antibody responses to poliovirus types 1, 2 and 3 were measured by a microvirus neutralization assay at enrollment and at 9 mo of age. Seroconversion rates to poliovirus types 1, 2 and 3 ranged from 98 to 100% in the three treatment groups, and there were no differences in mean antibody titers to poliovirus types 1, 2 and 3 among treatment groups. This study demonstrates that oral vitamin A does not affect antibody responses to poliovirus vaccine when integrated with the Expanded Program on Immunization.

A program designed to vaccinate all newborn infants in Darwin, Australia against hepatitis B was begun in 1990. Vaccination rates varied from 71 to 96% in 1993 and 1994. Differences in vaccination rates appear to be caused by how standing drug orders were used, nursing staff attitudes, and misinformation among health professionals. Parent and hospital staff need to have improved vaccination education before universal vaccination can be achieved.

Typhoid fever commonly affects young children in endemic areas and antibiotic resistance is increasing (in a large epidemic in Tajikistan in 1996-98 over 90% of the organisms were multidrug resistant […]