"Just one shot" is not enough--measles control and eradication

Measles-mumps-rubella and hepatitis B vaccination uptake in adolescents: a survey in metropolitan Melbourne

OBJECTIVE

To measure the uptake of preadolescent measles-mumps-rubella (MMR) and adolescent hepatitis B vaccinations and assess the influence of certain demographic factors on the uptake of these vaccines.

DESIGN

Prevalence surveys of uptake rates of preadolescent (school Year 6; age 10-11 years) MMR and adolescent (school Year 9; age 13-14 years) hepatitis B vaccination.

SETTING

City of Darebin, an inner northern metropolitan region of Melbourne, 1996.

SUBJECTS

1160 Year 6 school students (580 boys) and 1102 Year 9 school students (548 boys).

INTERVENTION

School-based vaccination program administered by Darebin Council.

RESULTS

83% of Year 6 students were vaccinated with the MMR vaccine (84.1% of girls and 81.9% of boys). 71.6% of Year 9 students completed the full course of hepatitis B vaccination (68.9% of boys and 74.2% of girls). There was a higher uptake of MMR in non-government primary schools, but no other demographic factors (sex, economic status, non-English-speaking background, parental education, school class size) were associated.

CONCLUSIONS

These uptake rates do not meet National Health and Medical Research Council (NHMRC) recommendations. Further study is required to determine and quantify the factors that affect vaccination uptake in adolescence. Programs may then be developed to improve vaccination uptake.

Health outcomes and infectious disease control

With the development of improved health systems, antibiotics and vaccines throughout the 20th century, the prospects of control of infectious diseases improved. During the same time-frame, an approach to disease control was developed which used the health outcomes resulting from various interventions to choose, guide and modify those interventions. Despite these major advances in the control of diseases, infectious diseases have (with occasional exceptions) not only continued to occur but in many instances the situation had deteriorated with the emergence and re-emergence in recent years of a range of infectious diseases. In this paper we consider why infectious disease control has not benefited from the move towards a health outcomes approach, why infectious disease control might benefit from such a move, and the differences between infectious and non-infectious diseases when considering health outcomes. We follow-up with some practical approaches to the use of health outcomes. We argue that appropriate use of health outcomes when planning and evaluating infectious disease control programs will improve human health.

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.

Childhood immunisation in general practice

General practitioners provide 50% of childhood vaccination services in Australia. The routine schedule has been relatively stable for over 20 years, but new vaccine developments and an improved understanding of the epidemiology of the vaccine-preventable diseases will soon result in several major changes. General practitioners should review vaccination documentation and storage of vaccines, to ensure that the service they provide is of the highest standard. National targets for "age-appropriate" vaccination could be the basis for individual practices to assess their own performance.

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

A measles immunisation survey was conducted among children who enrolled in school kindergarten classes in the Eastern Sydney Area in 1989. Its aims were to determine baseline compliance rates, to identify subpopulations at risk of poor compliance and to evaluate the impact of the bicentennial measles control campaigns on compliance among children under five years. All 73 schools participated, questionnaires were returned by 2230 (81.4%) children, and compliance with immunisation was 91.3%. 89.1% of children attending public schools were immunised, compared to 91.9% of Catholic school pupils and 95.8% of independent school pupils (chi 2 = 21.4, P less than 0.001). Among public school children, 91.6% of pupils from English-speaking families were immunised in comparison to 81.4% of pupils from non-English-speaking backgrounds (chi 2 = 20.5, P less than or equal to 0.001). The fraction of previously unimmunised children who were known to have been immunised during each year of the measles control campaigns was 16% in 1986-87, 10% in 1987-88 and 9% in 1988-89. These small increments in immunisation uptake suggest that under-five-year-olds were not effectively targeted by the measles control campaigns. However, no control group was evaluated. Immunisation delivery systems must be designed which ensure that all children receive measles-mumps-rubella vaccine as soon as possible after the first birthday. Immunisation promotions and service providers will need to target specific language and socioeconomic groups.

Reported measles immunisation and serological immunity in children attending general practitioners

To determine the feasibility of serological testing for measles immunity in children attending general practitioners and to assess the validity of establishing immune status by reported immunisation history compared with serology, a cross-sectional descriptive study was conducted in general practices in the Illawarra area south of Sydney, New South Wales. Participants were 234 children under 15 years attending general practitioners. 87 per cent of children were reported to have been immunised against measles, but 46 per cent of these children were seronegative for measles antibody using an ELISA test on finger-prick blood. This could not be explained by inaccurate reporting of immunisation. No causes other than failure to seroconvert or inadequate specificity of the test on the blood samples were evident. Failure to seroconvert as a result of inadequate adherence to cold chain requirements is a possibility that needs further investigation. The results further question whether a single vaccination is adequate to achieve the public health aims of measles immunisation programs.