Vaccination status of children in the Women, Infants, and Children (WIC) Program: are we doing enough to improve coverage?

BACKGROUND: Vaccination-promoting strategies in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been shown to produce dramatic improvements in coverage and other health outcomes. OBJECTIVES: To determine national and state-specific population-based vaccine coverage rates among preschool children who participate in the WIC program, and to describe the strategies for promoting vaccination in WIC. DESIGN/METHODS: Demographic data, WIC participation, and vaccination histories for children aged 24 to 35 months in 1999 were collected from parents through the National Immunization Survey. The healthcare providers for the children in the survey were contacted to verify and complete vaccination information. We defined children as up-to-date (UTD) if they had received four doses of diphtheria and tetanus toxoids and pertussis vaccine (DPT), three doses of poliovirus vaccine, one dose of measles-mumps-rubella vaccine (MMR), and three doses of Haemophilus influenzae type b vaccine (Hib) by 24 months. Description of state-level vaccination-promoting activities in WIC was collected through an annual survey completed by the state WIC and immunization program directors. RESULTS: Complete data were collected on 15,766 children, of whom 7783 (49%) participated in WIC sometime in their lives. Nationally, children who had ever participated in WIC were less well-immunized at 24 months compared to children who had not: 72.9% UTD (95% CI, 71.3-74.5) versus 80.8% UTD (95% CI, 79.5-82.1), respectively. In 42 states, 24-month coverage among WIC participants was less than among non-WIC participants, including 13 states where the difference was > or = 10%. Vaccination activities linked with WIC were reported from 76% of 8287 WIC sites nationwide. States conducting more-frequent interventions and reaching a higher proportion of WIC participants had 40% higher vaccination coverage levels for the WIC participants in that state (p<0.05). CONCLUSIONS: Children served by WIC remain less well-immunized than the nation's more-affluent children who do not participate in WIC. Thus, WIC remains a good place to target these children. This study provides evidence that fully implemented WIC linkage works to improve vaccination rates. Strategies that have been shown to improve the vaccination coverage levels of WIC participants should be expanded and adequately funded to protect these children.

The public health perspective in health promotion and disability prevention for older adults: the role of the Centers for Disease Control and Prevention.

As the United States federal public health agency, the role of the Centers for Disease Control and Prevention (CDC) in health promotion and disability prevention with older adults encompasses research, surveillance and program activities in aging. This article characterizes the objectives and context of prevention in later life and summarizes CDCs functions, collaborative partnerships with public health agencies and other organizations, and range of activities in older adult health. As a major focus of these efforts, chronic disease risk reduction is examined through CDC's efforts in the area of physical activity; a longitudinal investigation of osteoarthritis in an older biracial rural population; and chronic illness self-management programs as a prototype for secondary prevention. Other CDC activities highlighted include addressing the burden of vaccine-preventable diseases through CDC-funded programs to improve immunization coverage in older adults, and falls prevention interventions and resources. Future directions in aging at CDC are also outlined.

Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. The Task Force on Community Preventive Services.

This paper presents the results of systematic reviews of the effectiveness, applicability, other effects, economic impact, and barriers to use of selected population-based interventions intended to improve vaccination coverage. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis for recommendations by the Task Force on Community Preventive Services (the Task Force) regarding the use of these selected interventions. The Task Force recommendations are presented on pp. 92-96 of this issue.

Cholera from raw seaweed transported from the Philippines to California.

In March 1994, a California woman without any recent travel developed acute, profuse, watery diarrhea. Her astute physician diagnosed cholera after ordering the appropriate stool culture, and the patient improved on an oral antibiotic. Epidemiologic investigation implicated seaweed from the Philippines that was transported by a friend to California and subsequently eaten raw as the vehicle of infection.

A cluster of Escherichia coli O157:H7 infections with the hemolytic-uremic syndrome and death in California. A mandate for improved surveillance.

In mid-January 1993, an outbreak of Escherichia coli O157:H7 infections associated with eating hamburger patties at a fast-food restaurant chain (chain A) was reported in Washington State. From mid-December to mid-January, 9 cases of E coli O157:H7-associated bloody diarrhea and the hemolytic-uremic syndrome had been reported in San Diego County, California. A total of 34 persons had bloody diarrhea, the hemolytic-uremic syndrome, or E coli O157:H7 organisms isolated from stool during the period November 15, 1992, through January 31, 1993. Organisms of E coli O157:H7 identified from 6 persons were indistinguishable from those of the Washington outbreak strain. Illness was associated with eating at chain A restaurants in San Diego (odds ratio, 13; 95% confidence interval, 1.7, 99) and with eating regular-sized hamburgers (odds ratio, undefined; lower-limit 95% confidence interval, 1.3). Improved surveillance by mandating laboratory- and physician-based reporting of cases of E coli O157:H7 infection and the hemolytic-uremic syndrome might have alerted health officials to this outbreak sooner, which could have resulted in earlier investigation and the institution of measures to prevent more cases.

Hantavirus pulmonary syndrome in California: report of two cases and investigation.

We report two cases of hantavirus pulmonary syndrome that were probably acquired in California. Genetic analysis of tissue specimens from one of the patients revealed that the virus isolated is a variant of the strain (Sin Nombre virus) identified in the outbreak of hantavirus pulmonary syndrome that occurred in the Four Corners region of the southwestern United States in 1993. In addition to presenting the clinical features of the two cases, we discuss the possible risk factors for infection.