Edmond F. Maes

Vaccines for Children Program, United States, 1997

Objectives. 1) To determine the proportion of preschool children receiving immunizations from providers enrolled in the Vaccines for Children (VFC) program; 2) to assess whether their immunization providers serve as their medical home for primary care; and 3) to examine the relationship between various provider characteristics and immunization status. Design.  Two-phase national survey consisting of parent interviews verified by provider record check. Setting. A total of 78 survey areas (50 states, the District of Columbia, and 27 urban areas). Patients or Other Participants. Noninstitutionalized children from 19 to 35 months of age in 1997. Interventions. None. Outcome Measures. VFC penetration rate (the percentage of children who received all or some vaccines from a VFC-enrolled provider); the frequency with which children received all or some vaccines within a medical home; the number of parent-reported immunization providers; and 4:3:1:3 up-to-date status at 19 to 35 months of age. Results. Of 28 298 children interviewed for whom consent to contact providers was obtained, complete provider data were available for 21 522 (76%). Of these children, ∼75% received all or some immunizations from a VFC-enrolled provider, 73% received all or some immunizations within a medical home, and 75% had one immunization provider. Children received all or some immunizations from a VFC-enrolled provider more frequently when vaccinated by pediatricians versus family physicians or in public facilities versus private practice. After controlling for poverty, immunization coverage varied only slightly with receipt of vaccines from a VFC-enrolled provider, receipt of vaccines within a medical home, and the number of parent-reported providers. Among children vaccinated within a medical home, those vaccinated solely by pediatricians were 1.63 times as likely to be 4:3:1:3 up-to-date than were those vaccinated solely by family physicians after removing the effects of poverty. Recommendations. Greater numbers of children are likely to benefit from an even higher participation rate among immunization providers in the VFC program, particularly among family physicians and private physicians. The public–private collaboration developed by the VFC program should be capitalized on so that public sector resources can help pediatricians and family physicians practice according to theStandards for Pediatric Immunization Practices.

Evaluation of the erythrocyte protoporphyrin test as a screen for elevated blood lead levels

To study the effect of lowering the definition of an elevated blood lead level on the performance of the erythrocyte protoporphyrin screening test and the number of children who would require follow-up, we collected laboratory data from a screening program. The estimated sensitivity of an erythrocyte protoporphyrin level greater than or equal to 35 micrograms/dl for identifying children with elevated blood lead levels was 73% when we used 1985 Centers for Disease Control guidelines (elevated blood lead level greater than or equal to 25 micrograms/dl). Eight percent of the tests showed positive results. When we redefined an elevated blood lead level as greater than or equal to 15 micrograms/dl, the sensitivity estimate was reduced to 37% and the number of positive test results increased fourfold.

Investigation of an outbreak of bloody diarrhea complicated with hemolytic uremic syndrome

In July–August 2009, eight patients with bloody diarrhea complicated by hemolytic uremic syndrome (HUS) were admitted to hospitals in Tbilisi, Georgia. We started active surveillance in two regions for bloody diarrhea and post-diarrheal HUS. Of 25 case-patients who developed HUS, including the initial 8 cases, half were ⩾15 years old, 67% were female and seven (28%) died. No common exposures were identified. Among 20 HUS case-patients tested, Shiga toxin was detected in the stools of 2 patients (one with elevated serum IgG titers to several Escherichia coli serogroups, including O111 and O104). Among 56 persons with only bloody diarrhea, we isolated Shiga toxin-producing E. coli (STEC) O104:H4 from 2 and Shigella from 10; 2 had serologic evidence of E. coli O26 infection. These cases may indicate a previously unrecognized burden of HUS in Georgia. We recommend national reporting of HUS and improving STEC detection capacity.

Medical Home and Provider Specialty of Preschool Immunization Providers: Results from the 1997 National Immunization Survey ♦ 675

Medical Home and Provider Specialty of Preschool Immunization Providers: Results from the 1997 National Immunization Survey ♦ 675

Cost-analysis of different management policies for patients with mild hepatitis A virus infection in Kazakhstan

ObjectiveFor patients with mild hepatitis A virus (HAV) infection, this study compared estimates of total costs associated with managing cases under a policy of mandatory hospitalization in the Republic of Kazakhstan and estimates of total costs associated with managing cases in outpatient settings. Costs were estimated both from the perspective of the Ministry of Health and from a broader societal perspective.MethodsData were collected by using a standardized structured questionnaire. For cases of mild HAV infection, medical records were obtained from 200 patients managed by hospitalization and from 251 patients managed in an outpatient setting. Personal interviews were also conducted to collect information on productivity losses and out-of-pocket expenses.ResultsNationally, we estimated about 21,600 cases of mild HAV infection annually. The mean annual treatment costs in hospital for mild HAV infection was estimated at US

Assessing the potency and immunogenicity of inactivated poliovirus vaccine after exposure to freezing temperatures

3.39 million (2001 US

Changing Levels of Measles Antibody Titers in Women and Children in the United States: Impact on Response to Vaccination

) (95% confidence interval [CI] = [US

Diagnosis of Measles with an IgM Capture EIA: The Optimal Timing of Specimen Collection after Rash Onset

3.26 million – US

The Impact of Record Scattering on the Measurement of Immunization Coverage

3.52 million]). The total annual mild HAV infection cost to the society, including direct medical and nonmedical costs and productivity losses due to 721,440 lost work days, was estimated at US

Immunization performance measurement in a changing immunization environment.

6.26 million (95% CI [US