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Purpose: To evaluate the completeness of identification of pregnant women testing positive for hepatitis B surface antigen (HBsAg) and birth dose hepatitis B vaccine administration, and the extent of appropriate prophylaxis of infants born to women with and without maternal HBsAg status documented in the infant medical record., Methods: We conducted medical record reviews of 3058 maternal and infant pairs at 58 Wisconsin maternity hospitals that cumulatively delivered 90% of Wisconsin's 2010 birth cohort., Results: A documented HBsAg test result for the current pregnancy was included in 2928 (95.7%) of maternal records, and in 2676 (87.5%) infant records. Four infants (15%) were born to HBsAg-positive women; all 4 infants received appropriate prophylaxis: hepatitis B immunoglobulin (HBIG) and a dose of hepatitis B vaccine within 12 hours of birth. However, among 382 infants without a documented maternal HBsAg test result in the infant medical record, only 135 (35%) received appropriate prophylaxis: a dose of hepatitis B vaccine within 12 hours of birth or a dose of hepatitis B vaccine and HBIG within 12 hours of birth for infants weighing < 2000 g. Among all infants, 81.6% received hepatitis B vaccine prior to hospital discharge., Conclusions: Hospitals must ensure that infants without a documented maternal HBsAg test result receive appropriate prophylaxis to prevent hepatitis B vaccine infection. All infants, regardless of maternal HBsAg test result, should receive a dose of hepatitis B vaccine before hospital discharge to serve as a "safety net" to prevent infection among infants born to HBsAg-positive women who are not identified prenatally. A written hospital policy for universal hepatitis B vaccine birth dose administration should be developed to reinforce admission orders.

Children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are at risk for low immunization coverage and other adverse health-related outcomes. Immunization-promoting strategies in WIC have been shown to produce dramatic improvements in immunization coverage. This evaluation of a local WIC initiative in Milwaukee is the first study to evaluate the impact of these strategies on improving the utilization of other clinical preventive services at the medical home. The use of more intensive immunization-promoting strategies in WIC may improve utilization of well child care visits and receipt of other clinical preventive services in the medical home.

During an outbreak of pertussis in residents and staff of a facility for the developmentally disabled, 149 persons had laboratory evidence of Bordetella pertussis infection; 130 (87%) reported respiratory illness. Infection rates (IR) in affected wards ranged from 6% to 91%. Most residents were adolescents and adults and had received a full course of diphtheria-tetanus toxoids-pertussis (DTP) vaccine; IRs increased with increasing time after the last DTP dose in fully vaccinated residents. The IR was lower in residents on wards where erythromycin treatment/prophylaxis was started two or fewer weeks after the onset of illness in the first case on the ward (IR, 16%), compared with four or more weeks after onset (IR, 75%; P less than 10(-6)). Respiratory symptoms were milder in ill residents treated within seven days of onset of illness. Although B. pertussis transmission was substantial, erythromycin treatment of patients and prophylaxis of exposed persons was effective in decreasing transmission and disease severity. Carbamazepine toxicity occurred in seven (19%) of 37 residents when carbamazepine was administered with erythromycin.

Two hundred fifty-four infants who had received measles vaccine at less than 10 months of age were revaccinated at greater than or equal to 15 months of age, and their immune responses were compared with 129 control infants who received their first doses of measles vaccine at greater than or equal to 15 months of age. Sera were collected at the time of revaccination (study infants) or primary vaccination (control infants), 3 weeks, and 8 months later and tested for antibody by hemagglutination inhibition (HI), enzyme-linked immunosorbent assay (ELISA), and cytopathic effect neutralization (CPEN). Of the 121 study infants who were initially HI negative, 116 (95.9%) made HI antibody 3 weeks postrevaccination compared with 126 (99.2%) of 127 control infants (P = 0.19). Of the 63 study infants with no initial detectable antibody by any of the three tests, 14 (22.2%) had a measles-specific IgM response 3 weeks postrevaccination compared with 37 of 50 (74.0%) randomly chosen control infants. By 8 months after revaccination, the 121 initially HI-negative study infants were significantly less likely to have detectable HI antibodies than control infants (52.1% v 97.6%) (P less than .001). However, 96.7% of these 121 study infants had detectable neutralizing antibody 8 months postrevaccination, an antibody thought to correlate best with protection. This study confirms the altered immune response to revaccination in infants first vaccinated prior to 10 months of age; however, the data suggest that most of these infants were successfully primed and are probably protected after revaccination.