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Objective To test whether adolescents, who are injection limited, that is, receiving only a limited number of immunization injections per visit, are less likely to complete the human papillomavirus (HPV) immunization series. Study design For Oregon adolescents age 13-17 years, HPV series completion rates were assessed based on never receiving >1 injection per visit from age ≥9 years. Among a study subset born and resident in Oregon through adolescence, HPV series rates were assessed based on never receiving >1 or 2 injections per visit from age ≥4 years. Cox proportional hazards regression was used to assess delays owing to limiting injections, controlling for sex and rural location. Results Among 241 453 study adolescents, 16.3% had only single-injection visits from age ≥9 years. Their HPV completion rate was 7.7% as compared with 61.7% for those with no limitations of number of injections. Among study adolescents born in Oregon, 10.2% never received >1 or 2 injections per visit from age ≥4 and were less than half as likely to complete the HPV series (28.4% vs 59.1%). Conclusions Limiting the number of injections per visit is associated with decreased completion of HPV immunization. As larger cohorts of young children with early injection-limiting characteristics age into adolescence, progress on HPV immunization rates may be challenged.

In 2017, the World Health Organization (WHO) published a document aimed at facilitating influenza vaccine introduction and use in low- and middle-income countries. The document “The Immunological Basis for Immunization Series: Influenza Vaccines” is freely available on the WHO website. The main purpose of this document is to give immunization managers and vaccination professionals an authoritative but easily-understood overview of the scientific basis of influenza vaccination and the immunological basis for the WHO position on influenza vaccines. The influenza vaccine document comprises one module of the WHO Immunological Basis for Immunization series. We invite the immunization community to use these references, and we hope the influenza vaccine module will be a valuable resource for persons who manage and monitor influenza vaccine programs, particularly in low- and middle-income countries.

In 2017, the World Health Organization (WHO) published an updated document aimed at facilitating the understanding of the immunological basis of pertussis vaccines and their use. The document “The Immunological Basis for Immunization Series: Pertussis Vaccines” is freely available on the WHO website. The main purpose of the module is to provide national immunization managers and vaccination professionals with an overview of the scientific basis of vaccination against pertussis and the immunological basis for the WHO position on pertussis vaccines. The Immunological Basis for Immunization Series was initially developed in 1993. Since then the series was regularly updated and extended. They reflect the biological differences in immune responses to the individual pathogens and the differing strategies employed to create the best possible level of protection that can be provided by vaccination. We invite the immunization community to use these references, and we hope the updated pertussis vaccine module will be a valuable resource.

The successful completion of early childhood immunizations is a proxy for overall quality of early care. Immunization statuses are usually assessed by up-to-date (UTD) rates covering combined series of different immunizations. However, series UTD rates often only bear on which single immunization is missing, rather than the success of all immunizations. In the US, most series UTD rates are limited by missing fourth DTaP-containing immunizations (diphtheria/tetanus/pertussis) due at 15 to 18 months of age. Missing 4th DTaP immunizations are associated either with a lack of visits at 15 to 18 months of age, or to visits without immunizations. Typical immunization data however cannot distinguish between these two reasons. This study compared immunization records from the Oregon ALERT IIS with medical encounter records for two-year olds in the Oregon Health Plan. Among those with 3 valid DTaPs by 9 months of age, 31.6% failed to receive a timely 4th DTaP; of those without a 4th DTaP, 42.1% did not have any provider visits from 15 through 18 months of age, while 57.9% had at least one provider visit. Those with a 4th DTaP averaged 2.45 encounters, while those with encounters but without 4th DTaPs averaged 2.23 encounters.

Objectives: New vaccines in the child healthcare programme are regularly considered. When considering the introduction of the Hepatitis-B vaccine into the programme, it was asked to what extent children in Greenland were actually covered by the existing immunization series. Would introducing new vaccines make any sense if the percentage of children immunized was shown to be low? A telephone enquiry conducted in 2000 showed a tendency of very high percentage of full coverage per child (98-99 %) in small cities and settlements, as health visitors had a policy of checking up on the immunization status for each child. In big cities and Nuuk, parents alone have the responsibility of having their child immunized. The coverage was a guess of 85-95 % for infants, falling as the child grows older. Study design. Retrospective review of registration from all Greenlandic health districts. Methods. The registration included the number of immunized children in each group of age according to the childcare immunization programme. The collected data were compared to the number of children per age group in each health district. Results and conclusion. The conclusion must be taken with some reservation on the basis of several aspects of uncertainty. As a whole, the tendencies show reasonably high vaccination coverage countrywide, but variations between districts are great. A number of children probably have their vaccination postponed somewhat in relation to recommended age, but it is fairly evident that the majority of these children are dealt with later. The coverage in a few districts is lower than desired, especially concerning DiTe4 and MMR2. Keywords: diphteria, hepatitis, measles

Introduction: Recent evaluations of computer-generated reminder/recall messages have suggested that they are an inexpensive, labor-saving method of improving office visitation rates of childhood immunization providers. This study assesses the sustained impact of computer-generated messages on immunization coverage during the first two years of life.Design: Randomized, controlled trial.Setting: County health department in the Denver metropolitan area.Study Participants: Children (n = 1227) 60 to 90 days of age who had received the first dose of diphtheria-tetanus-pertussis (DTP) and/or poliovirus vaccines.Intervention: Households of children were randomized into four groups to receive: telephone messages followed by letters (Group A); telephone messages alone (Group B); letters only (Group C); or no notification (Group D). Households in the intervention groups (A, B, and C) received up to five computer-generated telephone messages and/or up to four letters each time their children became due for immunization(s).Main Outcome Measure: Immunization series completion at 24 months of age.Results: Children whose families were randomized to receive any of the interventions were 21% more likely to have completed the immunization series by 24 months of age than were children randomized into the control group (49.2% vs 40.9%; RR [rate ratio] = 1.21; CI [confidence interval] =1.01, 1.44). While not statistically significant, children in Group A were 23% more likely to complete their immunization series by 24 months of age than those in the control group (50.2% vs 40.9%; RR = 1.23; CI = 1.00, 1.52). No differences were detected among the intervention groups. The costs per additional child completing the series by 24 months of age in Group A was $226 ($79 after start-up costs were discounted). Conclusion: Computer-generated contacts, either by phone or by mail (or both combined), used each time vaccines become due, are efficacious in increasing immunization coverage of children under 2 years of age.

DOI: http://dx.doi.org/10.5915/15-1-12348 A case of chronic lymphocytic leukemia (C.L.L.) was treated with repeated administration of tumor dose Bacillus Calmette-Guerin (BCG). Following the first immunization series, the case has gone into complete remission and has remained so up to the time of this report, for about 9 years. The leukemic lymphocytes appeared to be "null” cell type.

In 1978, the United States established the objective of completing the basic immunization series of at least 90% of children by age two years by the year 1990. Although state school immunization laws have led to the immunization of over 95% of school enterers (32), the situation among preschoolers is less encouraging. Recent outbreak investigations in many inner city areas have estimated that only 40-60% of children have completed the series by age two years (12, 13, 55). This low coverage among preschoolers is reflected in the recent resurgence of measles (7, 11, 57). In 1990, the number of reported measles cases (provisional total 27, 672) was the highest since 1977 (55, 201 cases reported), compared with a nadir of 1497 cases in 1983. Approximately one half of reported cases in 1990 Were among preschool children; among vaccine-eligible preschoolers aged 16-59 months, 79% were unvaccinated (lOa). There is no mechanism similar to school immunization laws to achieve universal immunization of preschoolers. State day care immunization laws only affect licensed centers, which care for an estimated 20% of children

Combination vaccines have been used for many years in the USA as part of the primary infant immunization series. However, the current program still requires up to 24 injections by 18 months of age. The Advisory Committee on Immunization Practices in the USA recommends the use of combination vaccines whenever possible. A combination vaccine was recently licensed in the USA for the prevention of diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (DTaP-IPV/Hib). This product has been used exclusively for childhood immunizations in Canada for the last decade and shown to be safe and effective as part of a primary infant series and toddler booster immunization program. This article summarizes the available safety, immunogenicity and effectiveness data of this combination vaccine and provides a brief review of future trends in combination vaccine use.

AFTER 15 YEARS of development and extensive field trials in Europe and the United States, the Food and Drug Administration (FDA) has licensed an acellular pertussis vaccine for use in the primary diphtheria-tetanus-pertussis (DTP) immunization series at age 2, 4, and 6 months, when most serious complications of the disease occur. The new licensure does not require a new product to be manufactured. The acellular version has been licensed since 1992 for use in the fourth and fifth doses of DTP given to children up to 6 years of age. The vaccine, manufactured by Connaught Laboratories, Inc, Swiftwater, Pa, is available now to physicians for use in their pediatric practices. Marketed under the trade name Tripedia, the vaccine contains 2 antigens: pertussis toxin and filamentous hemagglutinin. Acellular vaccines were originally developed in Japan. The principle was further developed by several US manufacturers, including Connaught, in response to concerns over adverse

Objective. Hepatitis B vaccination (HBV) is unlike any other immunization series because it can be initiated in the hospital nursery. The objective of this study was to describe how hospital nurseries develop HBV policies and to describe the sources of information used for learning about national HBV recommendations. Methods. A cross-sectional telephone survey was conducted on a national random sample of nursery medical directors of 290 hospital nurseries representing all 50 states. The outcomes measured were methods used by hospital nurseries to develop HBV policy and sources of information used by nursery directors to learn about national HBV recommendations. Results. Directors at 207 (71%) of 290 eligible nurseries responded. Of the 184 nurseries that have considered developing an HBV policy, the most common method was through a formal committee (43%). In 104 (57%) of these nurseries a nurse was involved in policy development, and in 15 (8%) the nurse manager initiated the process. The most common source of initial information about the July 1999 announcement to suspend the nursery dose of HBV was the American Academy of Pediatrics. The most common initial source of information about the availability of thimerosal-free HBV was pharmaceutical companies. Physician, nurse, and pharmacist colleagues were cited as sources of information with similar frequency (12, 11, and 20 cases, respectively). Conclusions. Physicians are not the sole initiators and developers of HBV policy in the newborn nursery. Although almost all nurseries designate a physician as a nursery director, in many cases (55% of cases) the position is “rotating” or as part of another administrative position (63% of cases). Many hospital nurseries involve nurses and pharmacists in key roles to stay current with HBV recommendations and to develop subsequent policy. Using nonphysician national organizations as additional channels of information might expedite dissemination about changes in HBV recommendations and, as a result, improve nursery awareness and adoption of national HBV guidelines.

Objectives: To assess the hepatitis B immunization rate and to identify the reasons for an incomplete immunization series in newborns and infants seen in primary care practices. Design: An inception cohort study enrolling newborns and infants and assessing their hepatitis B immunization status at 9 and 18 months of age. Setting: Six primary care offices, most in rural environments. Patients: All newborns and infants seen at 1 of 6 offices. Intervention: Infants born between January 1, 1993, and September 30, 1994, were followed up through June 30, 1995. Hepatitis B immunization status and the reasons for an incomplete status were recorded at each visit. Main Outcome Measures: Hepatitis B immunization rates at 9 and 18 months of age, and the reasons for immunization failure. Results: The immunization rates of infants aged 9 and 18 months were 60% and 77%, respectively. The most common reasons for inadequate immunization of the 247 infants followed up through age 18 months were patient transfer (7%), failing to return for a scheduled visit (4%), and guardians refusing the immunization (4%). Failure to return for a scheduled visit was the reason for the incomplete immunization in 13% of the 9-month-old infants. Immunization of these patients was the most important factor in the higher immunization rate at 18 months of age. By the age of 18 months, 95% of all infants had received at least 2 doses of the hepatitis B immunization. Conclusions: A hepatitis B newborn immunization rate of 77% by age 18 months was achieved in a primary care office setting. Barriers to complete immunization by the age of 18 months include patient transfer, patient failure to return, and parental refusal of immunization. Arch Pediatr Adolesc Med. 1996;150:1173-1176

In a school-based immunization program in four states, 70% of the students were fully immunized by the end of the first year and 85% by the end of the second year. Because of student turnover, 20% of the immunization levels achieved by the end of a school year were not sustained into the subsequent year. Levels reported by the state immunization officers were higher than those recorded by school personnel. Completed immunization series for students requiring immunizations were 33% to 40% higher for students enrolled at the start of the year than for students who entered during the school year. Students who were unimmunized at the beginning of the year had a better change (P less than 0.001) of being immunized by the end of the year than those whose immunization status was unknown. To maintain high levels, a program must be sustained and continuing, provide immunizations, and have careful administrative monitoring of child-specific population-based data. Schools are uniquely able to provide all of these elements, which can augment the efforts of private practitioners.

Antigens consisting of simple fractions of T. cruzi and L. donovani produced high titer antisera in the rabbit after a short immunization series. The antisera resulting from these immunizations showed several types of serologic reactions with the living antigens when the dark-field serial dilution technique, devised for these experiments, was employed.

In the Rumanian People’s Republic the problem of blood groups was approached for the first time in 1957 by the Institute for Veterinary Research “Pasteur”, in connection with the haemolytic disease in foals and piglets.

To the Editor.— The points made by Hickman and Barness in their commentary "Immunization Program for Adults" (237:129, 1977) are well taken but deserve some amplification. First, physicians considering administration of tetanus toxoid as part of wound prophylaxis would be well advised in most cases to use tetanusdiphtheria toxoids (adult). No tetanus booster is needed following most wounds where the last booster was given less than five years previously. Thus, since diphtheria toxoid alone is not generally available and most adults never receive any boosters unless they are confronted with this need after a wound, updating against diphtheria at that time is also in order and will not cause excessive reaction to the diphtheria component. Second, when an adult has never been immunized against diphtheria, physicians should regard the booster dose of adult diphtheria-tetanus toxoids as an integral part of the immunization series and establish a reminder system to get