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This cross-sectional study examined missed care in a Central New York community using the MISSCARE Survey. A great deal of the research on missed care has been focused in the midwestern United States. This study replicates a midwestern study to determine results in other parts of the United States.

We studied hepatitis B virus (HBV) transmission among 7416 Thai children from 148 schools in Kamphaeng Phet province, a rural part of northern Thailand. Their age ranged from 2 to 16 years (median 9 years). Between May 1991 and June 1992, 61 of 2593 (2.4%) in the cohort of susceptible children acquired anti-HBc immunoglobulin. Forty-seven of the 148 schools had children who acquired anti-HBc. School seroconversion rates to anti-HBc varied from 0% to 23%. There was no correlation between percent of carriers in schools and percent of anti-HBc acquisition. Of the 61 children who acquired anti-HBc, eight (13%) became HBsAg carriers but only two were symptomatic, for a clinical to subclinical infection ration of 1 : 30. One of the two symptomatic children became an HBsAg carrier. Three (38%) of the eight who were persistently antigenemic developed antibody to hepatitis B virus e antigen. Males were 2.5 times (95% CI 1.4-4.3) more likely to acquire anti-HBc than females. Risk factors for acquisition of HBc in Thailand over a 9-month period were examined in a subset of 2412 susceptible children and later in a case-control study of 22 children who acquired anti-HBc and 59 age and sex-matched controls. Risks for acquiring anti-HBc were male gender and a history of bleeding gums. In comparing this study to an earlier pilot study among 9848 children from the same area in Thailand, the yearly antibody acquisition rate to anti-HBc among Thai children dropped from 5.7% in 1989 to 2.4% in 1992. A random sample of children in the pilot study showed that 16% were HBsAg positive and 27% had anti-HBc at the beginning of the study. 34% had markers for either anti-HBc or HBsAg. 12% were repeatedly positive for HBsAg a year later.

Few prospective studies of mortality among children in developing countries have been published. Here we quantify and describe mortality and injury morbidity among a cohort of schoolchildren in rural Southeast Asia. Deaths among a cohort of 40,119 schoolchildren in Thailand were prospectively monitored over a two year period from January 1991. Additionally, data were collected with a questionnaire from a subset of 6,378 children asking them to recall all injuries over a one-year period. There were 40 deaths for an annual incidence of 50/100,000. Fifty percent of all deaths were due to injury; 25% to infectious diseases. Sixty percent of the injury deaths were due to motor vehicles and 35% to drowning. Sixty-six percent of the children reported one or more accidents. The leading categories of non-fatal injuries, in decreasing order, were: animal bite, puncture wound, burn, near-drowning, fall from a height. Boys experienced more injuries than girls for almost every type of injury. Injuries are replacing infectious diseases as the most important cause of deaths in developing countries. Additional public health initiatives to reduce childhood accidents may be warranted.

Objective: To evaluate the safety and efficacy of a new inactivated hepatitis A vaccine., Design: Double-blind randomized controlled trial stratified by community., Setting: Community-based in Thailand., Study Participants: A total of 40,119 children, aged 1 to 16 years, attending 148 primary schools: 38,157 (95%) entered surveillance a mean of 138 days after receiving vaccine dose 1; 33,586 (84%) completed the controlled trial of 532 days; and 31,075 (81%) received crossover vaccine and remained under surveillance until day 844., Intervention: Participants received hepatitis A vaccine or control hepatitis B vaccine starting January 7, 1991 (doses in months 0, 1, and 12), and crossed over to the alternate vaccine 18 months later., Main Outcome Measure: Cases of hepatitis A (symptoms, alanine aminotransferase levels of 45 U/L or higher, and IgM to hepatitis A virus) were identified by evaluating school absences of 2 or more days., Results: There were no serious adverse reactions despite administration of more than 109,000 doses of hepatitis A vaccine. Among initially seronegative recipients of two doses of hepatitis A vaccine, the proportion with 20 mIU/mL or more of antibody to hepatitis A virus before and 5 months after a 1-year booster was 94% and 99%, respectively. Of 6976 episodes of illness during the controlled trial, there were 40 cases of hepatitis A; 38 were in the control group. Of the 40 cases, six, all in controls, occurred after the 1-year booster dose. Following two doses of hepatitis A vaccine (days 138 through 386), protective efficacy was 94% (95% confidence interval, 79% to 99%); cumulative efficacy including the postbooster period (days 138 to 532) was 95% (95% confidence interval, 82% to 99%). The two hepatitis A vaccine recipients who had symptomatic infections (257 and 267 days after dose 1) appeared to have been partially protected since their illnesses were brief and associated with only slight increases in alanine aminotransferase., Conclusions: Inactivated hepatitis A vaccine is safe; when administered in two doses, it protects against hepatitis A for at least 1 year.