Measles immunisation compliance: poor impact of bicentennial measles control campaigns on children under five

Beliefs about childhood immunisation among Lebanese Muslim immigrants in Australia

The aim of the study was to describe and analyse care values, beliefs, and practices relating to immunisation by Lebanese Muslim immigrants in New South Wales (NSW), Australia. This ethnonursing study explored the importance of care related to immunisation, knowledge of informants relating to vaccines, diseases, side effects, and contraindications. Family responsibilities relating to immunisation care services as well as expectations and evaluations of care services provided were also examined. Data were collected via observation-participation-reflection, including in-depth interviews. The findings revealed significant care themes for Lebanese Muslim informants based on their cultural values, beliefs, and practices related to health and immunisation. Culturally congruent nursing care practices related to immunisation for Lebanese Muslims in NSW, Australia, were identified.

Cost-effectiveness of measles outbreak intervention strategies

In this study, we compared the likely cost-effectiveness of alternative strategies for controlling a school-based measles outbreak. The analysis involved assessing the expected costs and number of cases in a school-based outbreak of measles, with no intervention and with each of six control strategies. The marginal cost per case prevented ranged from $32.90 when only previously unvaccinated school children were offered vaccination to $6795 when vaccination was extended to the siblings of school children aged 6 to 12 months. This study provided further evidence of the cost-effectiveness of vaccination in outbreak control, and yielded useful information to inform control strategies in the event of a school-based outbreak. Decisions about which groups of children to aim at and whether to conduct school-based clinics will be influenced by local circumstances, particularly the baseline measles vaccination rate and the measles attack rate among infants.

A retrospective cohort study of childhood immunisation status in northern Sydney

A survey of their children's immunisation status was conducted among mothers of babies from a three-month birth cohort (January to March 1990) in the Northern Sydney Area in 1992. Its aims were to determine the uptake of immunisation in the area, to examine factors associated with immunisation status, and to assess agreement between the parent's reporting of this status and records of councils and general practitioners. Fifty-eight per cent of the questionnaires (1004) were returned. The full immunisation rate was 86 per cent, 14 per cent were partially immunised and only four children had received no immunisations. Between 74 per cent and 82 per cent of vaccinations were on time at two, four and six months; the rate dropped to 21 per cent at 12 months. Logistic regression analysis showed that premature babies are significantly more likely to be fully immunised, whereas children who have had a serious childhood illness, those with a single mother, or whose mothers are more highly educated, are significantly less likely to be fully immunised. There was 60 per cent agreement between the parent's report of immunisation status and a subgroup of 197 council and 82 general practitioner records. Although all councils in the Northern Sydney Area have a reminder system, most immunisations were found to be done in general practices (64 per cent), where reminder systems are not common.

Another vaccine, another treadmill?

OBJECTIVE

Attention is drawn to possible disadvantages arising from the introduction of universal varicella vaccination in infancy.

METHODOLOGY

Comparisons are made between universal infant varicella vaccination and the current measles immunization programme, and a review of current literature on age-specific complications of varicella and cost-benefit analyses of varicella vaccination.

RESULTS

Universal infant vaccination will cause a greater proportion of varicella cases to occur in adults, including pregnant women, who are at greater risk of serious complications compared to children. Although economic costs resulting from lost time from work will fall dramatically, health costs may rise.

CONCLUSIONS

Universal infant vaccination should only be considered if measles is first controlled, and then only if more information on duration of protection becomes available and combined measles-mumps-rubella-varicella vaccines are approved.

School health nurse interventions to increase immunisation uptake in school entrants

In New South Wales, health screening of school entrants provides the only mechanism for routine monitoring of immunisation uptake in children. School health nurses are in the best position to improve the compliance with immunisation at this age. We compared two interventions to be used by the nurses to increase immunisation uptake in school entrants who reported missing either the measles-mumps vaccine and/or the pre-school diphtheria-tetanus toxoid and oral polio vaccine boosters. Parents in the passive intervention group were sent a letter and leaflet encouraging immunisation; the active intervention group received a telephone reminder from the nurse in addition to the written materials. Both groups were followed up at a later date to assess final immunisation outcome. Of 817 children screened, 88.2% had been immunised against measles and 73.6% had received the booster; 239 children were randomised to the two interventions. Excluding children lost to follow up and those fully immunised at the start of the study, 20 (37%) of 54 were immunised following the passive intervention, and 35 (71%) out of 49 following the active intervention (P = 0.001). Receipt of the letter and leaflet was associated with an increased uptake of booster vaccination (P = 0.036). The active intervention required 14.7 telephone calls and 1.6 uses of the interpreter service per completed immunisation. The passive intervention resulted in worthwhile increases in immunisation rate with minimum cost. A greater improvement in immunisation outcome was achieved by the active intervention, but its use was labour intensive and may only be warranted if high immunisation rates in this age-group are given priority.

The epidemiology of incomplete childhood immunization: an analysis of reported immunization status in outer western Sydney

We surveyed parents of children enrolled in kindergarten in 1992 in outer western Sydney and the Blue Mountains. Using parents' reports, we determined the prevalence of immunization uptake for children starting school, compared the prevalence of immunization uptake among Catholic, government and independent schools, and identified immunization providers. We also documented parental beliefs about immunization and their influence on immunization status, and identified risk factors for incomplete immunization. Nearly 89% of children were reported to be fully immunized. Immunization status did not vary significantly among the different types of school. General practitioners provided 84% of all immunizations and local councils 11%. Incomplete immunization was associated with more negative beliefs in immunization, with post-secondary education and with families who do not speak English at home. Reminder letters had little effect on immunization status.