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The American Academy of Pediatrics (AAP) has recommended that children younger than 24 months of age not be exposed to television. Nevertheless, television programs and home videos are increasingly produced for very young children. This article reviews the extant research concerning television and very young children with respect to the AAP recommendation. More very young children are currently watching television than in the recent past; they pay substantial attention to TV programs and videos made for them. When learning from videos is assessed in comparison to equivalent live presentations, there is usually substantially less learning from videos. Although one study finds positive associations of language learning with exposure to some children's TV programs, other studies find negative associations of viewing with language, cognitive, and attentional development. Background TV is also a disruptive influence. Evidence thus far indicates that the AAP recommendation is well taken, although considerably more research is needed. Keywords: television; children; infants; attention; media

Author's Abstract, COPYRIGHT 1999, Elsevier Science Ltd. Immunization is one of the major public health interventions to prevent childhood morbidity and death. The Expanded Programme on Immunization has gathered momentum worldwide since 1974. The range of vaccines in the programme is being expanded in the years to come. All across the globe, a high level of vaccination coverage has been reached and now needs to be sustained. In part, the coverage has been made possible by the broad acceptance of vaccinations, although there are variations resulting in different configurations of fully, partially and non-immunized children. Using the results of studies carried out by the Socail Science and Immunization Project in Bangladesh, Ethiopia, India, Malawi, the Netherlands and the Philippines, this article describes and discusses patterns of vaccination acceptance and non-acceptance. It shows how context affects acceptance of vaccinations, and analyses the underlying reasons behind refusal and resistance. The article also develops conceptual tools for the analysis and acceptance and non-acceptance and discusses explanatory theoretical perspectives. Keywords: Acceptance; Non-acceptance; Compliance; Vaccination; Immunization; Sustainability; Resistance

Estimates of immunization coverage in developing countries are typically made on a 'card plus history' basis, combining information obtained from vaccination cards with information from mothers' reports, for children for whom such cards are not available. A recent survey in rural lower Egypt was able to test the accuracy of mothers' reports for a subset of children whose cards were not seen at round 1 of the survey but were seen a year later at round 3. Comparisons of the unsubstantiated reports at round 1 with information recorded from cards seen at round 3 indicate that mothers' reports are of very high quality; mothers' reports at round 1 were confirmed by card data at round 3 for between 83 and 93%, depending on vaccine, of children aged 12-23 months, and for 88 to 98% of children aged 24-35 months. Mothers of children who had not been vaccinated were more likely to give consistent responses than were mothers of vaccinated children. Thus, these 'card plus history' estimates slightly understate true coverage levels. Most of the inconsistencies between round 1 and round 3 data apparently arose from interviewer or data processing error rather than from misreporting by mothers. Key words - vaccination coverage, EPI, child immunization, Egypt

I. Introduction A major goal of public health agencies in both industrialized and less-developed countries is to reduce the persistent occurrence of vaccine-preventable diseases. These infectious diseases induce enormous morbidity [...]

Reduction of the number of inoculations needed in children's vaccines may be the best way to improve the health benefits and costs of such vaccinations, according to a model used to predict the effects of research. Researcher devised models of vaccinations to predict the effects of different advances in vaccine research. If the number of inoculations required with the DTP vaccine were reduced from five to four, the annual number of cases of diptheria, tetanus, or pertussis would decrease by approximately 800 and approximately $90 million would be saved annually. If one of the three to four inoculations with the Hib vaccine became unnecessary, the annual number of cases would drop by 493 and the annual costs would drop by $105 million. If the number of doses of MMR vaccine were reduced from two to one, the annual cases of measles, mumps, and rubella would decrease by 300 and the health care costs of $186 million would be almost halved.

Introduction The much documented inadequate seroresponse to trivalent oral poliovirus (Sabin) vaccine (TOPV) in some tropical countries [1-6] has made it necessary to find other ways of achieving better immunization [...], To evaluate the efficacy of the schedule currently recommended for immunization with trivalent oral poliovirus vaccine (TOPV) (i.e., at birth, 6 weeks, 10 weeks, and 14 weeks after birth), we randomly assigned 452 infants into test (231 infants) and control (221 infants) groups. The test group received TOPV as currently recommended, and the dose at birth was omitted for the control group. At 10, 14, and 18 weeks of age, the levels of poliovirus neutralizing antibodies as well as seroconversion rates were consistently higher for the test group than for the control group. The final seroconversion rates against poliovirus types 1, 2, and 3 were 83.5%, 91% and 83%, respectively, for the test group and 75%, 83.2%, and 79.1 %, respectively, for the control group. The TOPV immunization schedule starting at birth therefore produced better results. Seroconversion rates as well as antibody levels were highest in infants with low maternal antibodies.

Rotaviruses, a group of viruses, are a major cause of acute gastrointestinal disturbances in infants and small children. A vaccine, rhesus Rotavirus vaccine (RRV-1), has been developed using an attenuated (inactivated) virus strain. The vaccine is administered orally. The results of a two-year trial which involved 200 infants, ranging in age from two to five months, are described. A bovine (from cattle) Rotavirus vaccine and a placebo were used in this study which assessed the vaccine's effectiveness and safety. The vaccine produced only partial protection in the children; a fourfold rise in antibodies against Rotavirus was observed in 62 percent of the infants. Twenty-six percent of the children who received the Rotavirus vaccine developed a fever reaction which lasted between three and four days. A total of 26 cases of Rotavirus diarrhea were confirmed; 16 cases occurred in the placebo group and 10 in the group given the vaccine. Based on these results, a 38 percent vaccine protection rate was determined. The children who received the vaccine experienced milder episodes of Rotavirus diarrhea. When the clinical severity of the diarrhea was assessed, 13 severe cases occurred in the placebo group, compared with 5 in the vaccinated group. Although some degree of protection was afforded by the vaccine, it was not effective enough to indicate general use. Experimentation with factors such as different serotypes, dosage variations, and age of immunization should be considered in order to modify the Rotavirus vaccine and increase its effectiveness. Further clinical trials are recommended to determine the optimal combination of factors for maximum protection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measles causes extensive disability and death among children in developing countries, killing an estimated two million annually. Live vaccines are most effective in infants older than nine months, since the presence of maternal antibodies in younger babies reduces the vaccine's effect. But many infants lose these antibodies before they reach nine months of age and are then susceptible to measles. It is possible that a different type of measles vaccine from the commonly used Schwarz strain would be more effective in this young group. Randomized trials of three different doses of both the Edmonston-Zagreb and Schwarz vaccines were given to a total of 1,081 six-month-old infants, while a group of 299 nine-month-old babies (299) received a standard dose of each vaccine. Blood samples were taken before inoculation and again eight and 18 weeks later. Presence of measles antibody in infants who had not had antibody before vaccination (seroconversion) and the amount of that antibody (seropositivity) were noted in all three samples. For six-month-old babies, the Edmonston-Zagreb vaccine at all doses produced higher seroconversion rates and seropositivity than did comparable doses of the Schwarz vaccine. Antibody response, for the most part, increased with higher doses. For nine-month-olds, the Edmonston-Zagreb vaccine produced higher seroconversion rates than the Schwarz vaccine, but it did not produce more seropositivity. Since the Schwarz vaccine is so widely used that it constitutes a sort of standard, it was of interest to compare its effectiveness in the older group with the effects of the Edmonston-Zagreb vaccine in the younger. The response at all doses of the latter vaccine was greater than the response to the Schwarz vaccine according to both seroconversion and seropositivity measures. Two strains of the Edmonston-Zagreb vaccine were used - one produced in Yugoslavia, one in Mexico - and the Mexican vaccine was the most potent in these trials. In addition to suggesting that the Edmonston-Zagreb vaccine is safe and effective for infants six months of age, the results also indicate that dose level of a vaccine can make a difference in the magnitude of the antibody response, something generally not held to be true. (Consumer Summary produced by Reliance Medical Information, Inc.)

Results of 45 cluster sample surveys to evaluate the immunization coverage in Iran during 1986 is reported. Overall, 55% of children between the ages of 12-23 months have complete immunization. Apart from mothers' knowledge and motivations, residence in the rural areas and utilization of antenatal care show positive association with immunization coverage. On the other hand, maternal tetanus immunization, hospital delivery and education of birth attendants for deliveries outside hospital, and the sex of the child do not seem to be associated with the child's immunization status. These and other results are discussed.

Infection with the bacteria Haemophilus influenzae most often affects the respiratory system, but it also causes influenzal meningitis, or inflammation of the membranes of the brain and spinal cord; conjunctivitis, or inflammation of the membrane lining the eye; and septicemia, or bacterial infection of the blood. H. influenzae infection can be prevented by a vaccine that promotes the production of antibodies, or immune proteins, specifically directed against H. influenzae. The original vaccine, called H. influenzae type b polysaccharide (HbPs) vaccine, was not very effective in boosting immunity in infants less than 18 to 24 months of age. Conjugate vaccines consist of a protein and saccharide (sugar) component of the bacteria, and have two major functions: to promote the production of antibodies directed against H. influenzae and to prime, or prepare, the immune system so that subsequent exposure to H. influenzae can activate the production of antibody. The H. influenzae type b oligosaccharide-CRM 197 conjugate vaccine (HbOC) is a newly licensed conjugate vaccine. The effects of the HbOC and HbPs vaccines on the immune responses of infants aged 7 to 15 months were assessed. The study involved 71 infants who received three doses of the HbOC vaccine, 47 who were given two doses of HbOC vaccine followed by one dose of HbPs, and 53 who received one dose of HbOC vaccine followed by two doses of the HbPs vaccine. The infants were vaccinated at birth, two months and six months. A second dose of the HbPs vaccine caused a smaller increase in antibody levels than the HbOC vaccine. Furthermore, infants given two doses of HbOC had large and similar increases in antibody levels one and six months after vaccination. These findings show that the conjugated HbOC vaccine is effective in causing the production of antibodies to levels that protect against H. influenza infection and prime the immune system for subsequent exposure. The HbPs vaccine can be given as a booster immunization. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objectives. To determine the reactogenicity and immunogenicity of a fourth dose of 2 three-component acellular pertussis vaccines combined with diphtheria-tetanus-acellular pertussis (DTaP) when administered at preschool age to children primed in infancy with 3 doses of the same DTaP and who had received a diphtheria-tetanus (DT) dose at the age of 12 months. Setting. Local health units of 4 Italian regions. Study Design. Three thousand five hundred twenty-two children, who had been randomized in the first year of life to be immunized with a DTaP vaccine by either SmithKline Beecham or Chiron Biocine, were offered a booster of the same vaccine or, if refusing, a DT vaccine at the age of 5 to 6 years. Families of children were aware of the vaccine administered. The occurrence of adverse events was compared between the children who received a DTaP booster and those boosted with a DT only. Antibody titers to pertussis vaccine components (pertussis toxin, filamentous hemoagglutinin, and pertactin) were determined on 558 paired sera taken before and 30 days after the DTaP booster administration. Results. Four episodes of temperature [is greater than or equal to] 39.5 [degrees] C, 2 in each DTaP group, were recorded. Fever [is greater than or equal to] 38 [degrees] C occurred infrequently in both DTaP and DT recipients (DTaP range: 2.5%-2.8%; DT range: 0%-4.8%), as did irritability (DTaP range: 10.1%-11.7%; DT range: 7.4%-12.6%). The frequency of local reactions was significantly higher for DTaP recipients (range: 44.0%-52.8%), with respect to DT recipients (range: 29.5%-44.4%). Extensive local reactions were observed in 1.2% of DTaP recipients and in .5% of DT recipients. Both DTaP vaccines induced high antibody titers against pertussis toxin, filamentous hemoagglutinin, and pertactin, with an increase of [is greater than] 10 times the prebooster geometric mean titers. Conclusions. A booster dose of DTaP at preschool age in children primed with the same acellular pertussis vaccine is safe and immunogenic. However, the frequency of local reactions is higher compared with that following primary immunization and with that following booster with DT only, and parents should be informed of the potential for these reactions to occur. Pediatrics 2001; 107(2). URL: http://www.pediatrics.org/cgi/content/full/ 107/2/e25; pertussis vaccine, adverse effects, immunoresponse, booster dose, children.

ABBREVIATIONS. P, postcard; T, telephone call; PT, postcard or telephone call; OR, odds ratio; CI, confidence interval. Reminding parents that their children's vaccinations are due or delayed is an effective [...], Objective. To test if appointment reminders blinded to immunization status improve kept-appointment and vaccination coverage rates. Design. Controlled trial. Setting. Pediatric clinic serving a low-income community in New York City. Intervention. Children ages 4 through 18 months (n = 1273) scheduled sequentially for clinic appointments were systematically assigned to 1 of 4 study groups: control (n = 346); postcard (n = 314); telephone call (n = 307); and postcard and telephone call (n = 306). Outcome Measures. Kept-appointment and vaccination coverage rates. Results. Children assigned to the postcard and telephone group were 1.75 times more likely to keep their appointments than controls (95% confidence interval [CI] = 1.2, 2.5). Children who actually received the postcard and telephone reminders were 2.3 times more likely to keep an appointment than controls (95% CI = 1.4, 3.7). Children who kept appointments were 2.3 times more likely to be up-to-date with their immunizations (95% CI = 1.7, 3.2). The reminders selectively increased vaccination coverage for the subgroup of children who were not up-to-date before the appointment ([chi square] = 11.2). The cost of the reminders was $.67 for the postcard and $1.58 for the postcard and telephone. Assuming 5000 visits per year and $100 reimbursement per visit, the return on each dollar invested was $10 for the postcard and $7.28 for the postcard and telephone reminder. Conclusions. Appointment reminders blind to immunization status are a practical and cost-effective strategy to increase kept-appointment rates for all children, and, through this mechanism, reach and vaccinate children who are not up-to-date. Pediatrics 2000;106: 919-923; appointment reminder, vaccination coverage.

ABBREVIATIONS. WIC, Special Supplemental Nutrition Program for Women, Infants, and Children; UTD, up-to-date; UTD-E, up-to-date status per encounter; DTP/DtaP, diphtheria-tetanus toxoids and (cellular or acellular) pertussis; OPV, poliovirus vaccine; MMR, [...], Background. Accurate identification of underimmunized children is needed to determine which children need vaccination. Previous studies have found the accuracy of manually determining the immunization status from a personal vaccination record to be low ([is less than] 50%). Objective. To determine the accuracy of manual immunization status assessment for preschool-aged children. Subjects and Setting. Children [is less than or equal to] 32 months old (n = 21 263) seen over 1 year at 12 women, infants, and children (WIC) sites in San Diego, California. Age at evaluation was between 0 and 24 months. Methods. Paraprofessional immunization specialists conducted manual immunization status assessment using the WIC client's personal vaccination record. Immunization status as recorded in the WIC record was compared with computerized assessment (the gold standard). Measures and Results. For all patient encounters, 29 078 (80%) of 36 368 were assessed correctly; manual assessment outcome was not recorded in the WIC record for 2171 (6%) of encounters. Accuracy varied by WIC site (range: 70%-90%). The sensitivity at correctly identifying an underimmunized child per encounter was 53.6%; the specificity at correctly identifying a fully vaccinated child per encounter was 89.4%. The 3 most common vaccines that were incorrectly assessed in identifying an underimmunized child were Haemophilus influenzae type b (43%), hepatitis B (37%), and diphtheria-tetanus toxoids and (cellular or acellular) pertussis vaccine (24%). Children with no outcome as recorded in the WIC record were 5 times as likely to be up-to-date. Conclusions. Manual immunization assessment was specific but only moderately sensitive at identifying underimmunized children. Thus, many underimmunized children will by missed but only 10% of children will be referred inappropriately. Pediatrics 2000;106:493-496; immunization, vaccination, assessment, WIC.

ABBREVIATIONS. AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AAFP, American Academy of Family Physicians; DPT, diphtheria-pertussis-tetanus vaccine; SPSS, Statistical Product and Service Solutions. Immunization rates for [...], Objectives. To evaluate an encounter-based immunization prompting system on resident performance in administering vaccines and knowledge of immunization guidelines. Design/Methods. Prospective randomized, controlled trial. Subjects were first- and second-year pediatric residents in a hospital-based continuity clinic. The intervention group received manual prompts of immunizations due. Postclinic chart review compared immunizations due with those administered. Acceptable and unacceptable reasons for hot administering vaccines were assigned. Resident knowledge was measured by a 70-item examination. Results. The intervention group had significantly less missed opportunities/vaccine administration errors (11.4% vs 21.6%). The most common reason for unacceptable errors in the intervention group: vaccine was given too early; in the control group: vaccine was postponed to next visit. Pre- and postintervention knowledge scores were similar: intervention group (75.5% vs 80.7%, control group; 76.5% vs 81.3%). Conclusion. An immunization prompting system in a hospital-based pediatric resident continuity clinic reduced missed opportunities/vaccine administration errors without significantly impacting resident knowledge of immunization guidelines. Pediatrics 2000;105:978-983; immunization schedule, vaccination, immunization, prompting systems, resident education.

Current recommendations on measles vaccination suggest that minor illnesses with or without accompanying fever are not a good reason to avoid giving the vaccine. Because some vaccinations have been deferred due to minor illness, unvaccinated children have gone on to develop measles. Not all cases of measles are due to lack of vaccination. Some children experience primary vaccine failure, where the vaccine does not induce the immune response necessary to protect against the illness. Some of these vaccine failures are due to residual antibodies the infant's mother passes on which are interfering with the vaccine. Other failures may be attributed to inappropriate handling of the vaccine. A new study suggests that some children with minor upper respiratory infections with or without fever appear to experience primary measles vaccine failure. The authors of a study reported in the April 24, 1991 issue of The Journal of the American Medical Association suggested that perhaps the children's illnesses caused them to produce quantities of the protein interferon, which inhibited the vaccine's ability to produce immunity. However, measles vaccine is generally given in conjunction with mumps and rubella (German measles) vaccines, and these are generally effective, even when the children have respiratory infections. Since interferon has a broad spectrum of activity, it would be expected that the children who did not respond to measles vaccine should not respond to mumps or rubella, if interferon was the cause of the vaccine failure. Given that 79 percent of the children with upper respiratory illnesses did develop immunity to measles with vaccination, the vaccine should continue to be given to children on schedule, with a second dose given at a later date to ensure protection. (Consumer Summary produced by Reliance Medical Information, Inc.)