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ABBREVIATIONS. MMR, measles, mumps, and rubella vaccine; HMO, health maintenance organization (HMO); GHC, Group Health Cooperative of Puget Sound; NCK, Northern California Kaiser; OR, odds ratio; CI, confidence interval; CLR, [...]

There does not appear to be any link between rubella vaccination and joint disease. Researchers evaluated the health records of 4,884 women in a large HMO who were tested for rubella during pregnancy. A total of 971 were subsequently vaccinated and their risk of joint disease was compared to that in 3,345 unvaccinated women. Overall, 34 women developed some kind of joint disease within one year, 9 of whom had been vaccinated. Six of the vaccinated women developed symptoms within 6 weeks of vaccination. In most of the women, the symptoms lasted 6 weeks or less., Context. -- A review by the institute of Medicine found a possible relationship between rubella vaccination and chronic arthritis among women. Objective. -- To evaluate the risk of persistent joint and neurologic symptoms in rubella seronegative women subsequently vaccinated with RA 27/3 rubella vaccine. Design. -- Retrospective cohort study based on computerized laboratory data and medical record review. Records were reviewed for symptoms occurring within 2 years before and after the date of serological testing and to identify vaccinees. Possible cases were evaluated by a rheumatologist blinded to serological findings and vaccination status. Setting. -- Large health maintenance organization in northern California. Patients. -- Women aged 15 to 59 years serotested for rubella during 1990 with continuous health plan membership for 2 years before and after the date of their serological test. Seronegative women immunized within 1 year of serotesting (n = 971) were defined as exposed. Primary comparison groups included all unvaccinated, seronegative women (n = 924) and randomly selected seropositive, unvaccinated women (n = 2421) matched to exposed subjects on serological test date and age ([+ or -3 years). Main Outcome Measures. -- Prevalence and incidence of chronic joint and neurologic symptoms during 1-year follow-up period stratified by age and serological findings, immunization, and postpartum status. Results. -- No significantly increased risk was associated with receipt of rubella vaccine for any outcome except for prevalence of carpal tunnel syndrome in vaccinated women at least 30 years old compared with seropositive, unvaccinated women (2.9% vs 1.4%; P = .03). A total of 34 women had onset of conditions within the 1-year follow-up period; 9 of these were in the group of seronegative, immunized women, of whom 6 had onset of symptoms within 6 weeks of vaccination. Among these 6 women, symptoms included transient arthritis or arthralgias ([is less than] 6 weeks duration) in 4 women, arthralgia of indeterminate chronicity in 1 woman, and carpal tunnel syndrome in 1 woman. Postpartum women across all groups were less likely to be seen for nontraumatic arthropathies than nonpostpartum women (4.5% vs 7.2%, P = .08 in vaccinated women; 4.8% vs 8.1 %, P = .09 in seronegative controls; and 4.8% vs 1 0.0%, P = .01 in seropositive controls). Conclusions. -- In this large retrospective cohort analysis there was no evidence of any increased risk of new onset chronic arthropathies or neurologic conditions in women receiving the RA 27/3 rubella vaccine. These data support the continued vaccination of rubella-susceptible women to reduce the risk of congenital rubella syndrome. JAMA. 1997;278:551-556

One of every four toddlers in the United States (US) remains underimmunized despite a national campaign to improve vaccination coverage to 90%.[1,2] Expanded financial coverage, such as that provided by [...]

Objectives. Improving the timely delivery of childhood immunizations has become a national imperative. This study aimed to identify nonfinancial predictors of delayed immunization among patients with good financial access to preventive care. Methods. This prospective cohort study used telephone interviews and a computerized immunization tracking system to evaluate 13-month-old children (n = 530) in a regional group-model health maintenance organization. Results. More than one third of parents interviewed did not know when the next immunization was due. Thirteen percent were late for the measles-mumps-rubella immunization, recommended at 15 months of age, by 90 days or more. Independent predictors of delayed immunization included having a larger number of children (odds ratio [OR] = 1.4, P < .01), not having a regular doctor (OR = 2.9, P < .05), not knowing when the shot was due (OR = 2.0, P < .01), and not worrying about the risks of shots (OR = 1.4, P < .05). Conclusions. Financial access alone does not guarantee timely childhood immunization. In managed care settings, which may cover increasing numbers of children under health care reform, interventions are needed to better inform parents of when immunizations are due. (Am J Public Health. 1994;84:1621-1625), Just because the cost of immunizations is covered by insurance does not guarantee timely immunization of children. A study of 530 13-month-old children enrolled in the Kaiser health maintenance organization (HMO) revealed that one in eight children was at least three months late for their measles-mumps-rubella (MMR) vaccination. More than one-third of parents were unaware of when the next immunization was due. Managed care organizations may need to use other interventions besides financial coverage to improve children's immunization rates. Suggested interventions include improving the written information on due dates that is provided to parents at immunization visits and reminding families of upcoming immunization visits or at least of missed immunizations. No association was found between education, income, or language with delayed immunization. Children from large families and minority children were more likely to be underimmunized.