Timely MMR vaccination in infancy: influence of attitudes and medical advice on the willingness to vaccinate.

In light of the failure to eliminate measles by 2010, the closure of any gaps in immunisation coverage is of paramount importance to interrupt transmission and to protect vulnerable individuals. Not only vaccination-critical attitudes of parents but furthermore the medical advice by physician in charge influence the vaccine uptake. 3 groups of factors which potentially influence parental decisions on child vaccination were analysed by univariable and multivariable logistic regression for the timely uptake of the first and the second dose of measles vaccination: parents' attitudes towards immunization, the influence of medical and laypersons and the influence of the advice of a medical doctor. A total of 3 041 children were eligible for the analysis. 53.0% of these received the first and 42.9% the second MMR dose in time. If parents considered that vaccinations are important and protective as well as the consulted physician advices towards vaccinations, children had significantly higher chances of a timely vaccination. Whereas, if parents were afraid of vaccinations or get advised by an alternative practitioner, the children had lower chances of being vaccinated in time. If medical providers help parents to reduce uncertainties about vaccination the chance for children to be vaccinated in time increased. It appeared that there still are unmet information needs after the medical consultation. By and large the medical advice plays an important role for vaccination uptake and its timing. In order to raise the vaccination rates further target-population specific approaches are needed.

[Risk factors for delayed or missed measles vaccination in young children]. / Risikofaktoren für eine verspätete oder nicht erfolgte Masernimpfung bei Kleinkindern.

Because of low measles vaccine coverage rates, measles outbreaks have been observed several times during recent years in Germany. The aim of this study is to identify parents' attitudes and beliefs towards immunisations and socio-economic factors which are associated with delayed or missed first measles vaccination in young children. We used data from a representative German-wide immunisation survey on 2116 children born between 1 January 2002 and December 2004 by collecting precise vaccination information from vaccination cards. The influence of socio-economic determinants and parental attitudes towards immunisations on the timing of the first measles dose was analysed by using multivariable Cox regression. Of these children 46.8% (95% CI: 44.5-49.1) received their first measles dose according to the recommendations of the standing committee on vaccination (STIKO) by month 15. In multivariable analysis, fathers aged 28-33 years and birth order as well as parents' belief in homeopathy and other parental attitudes indicating lack of knowledge about the importance of vaccinations significantly influenced an early immunisation. Not general opposition, but insufficient parental knowledge about the harmfulness of measles infection seemed to be responsible for the low measles vaccination rates.

[Surveillance programmes to evaluate the effectiveness of vaccination programmes using vaccination against Haemophilus influenzae type b and varicella as examples]. / Durchführung von Surveillanceprogrammen zur Uberprüfung der Wirksamkeit von Impfprogrammen am Beispiel von Haemophilus influenzae Typ b und Varizellen.

To evaluate the effectiveness of vaccination programmes, it is not only important to know the effectiveness of the specific vaccine itself but also to have knowledge about the epidemiology of the corresponding vaccine-preventable disease. Only a high acceptance of a vaccination programme by the population will show an effect at the population level (herd immunity). At the moment, data routinely collected in Germany are not sufficient to evaluate the effectiveness of vaccination programmes. Hence, additional surveillance programmes have to be initialised. The frequency of the vaccine-preventable disease in the population under surveillance determines mainly the design of the surveillance. In this article we describe the different requirements for surveillance programmes for common as well as for rare vaccine-preventable diseases. An example for the latter will be the ESPED study on the effectiveness of hexavalent vaccines against Haemophilus influenzae type b, an example for the first will be the varicella sentinel of the Working Group on Measles and Varicella. Both surveillance programmes for evaluation of the effectiveness of the respective vaccination programme are financed only partly by the public funds. We discuss the possible limitations of a funding from other sources.

The effect of breastfeeding on weight gain in infants: results of a birth cohort study.

The objective of this study was to examine whether duration of exclusive breastfeeding is associated with elevated weight gain in infants during the first two years of life. In this prospective cohort study 2624 healthy term neonates were followed from birth to age 2 years in 4 German study centres. Data on breastfeeding and potential confounders were gathered by questionnaires. Data on anthropometric measures at birth and age 2 years were obtained from routine standardised medical check up documentation. Odds ratios for the association between breastfeeding and weight gain until age 2 years (> or = 90th sex-specific percentile of the cohort) were calculated by logistic regression, adjusting for age at introduction and composition of solid food, maternal BMI, maternal smoking during pregnancy, socioeconomic status, study centre, birth order and, in unstratified analysis, sex. Children exclusively breastfed for less than 6 months had a greater risk of elevated weight gain at the age of 2 years than children breastfed for 6 months and more (OR (95% CI): 1.65 (1.17, 2.30)). Duration of exclusive breastfeeding was inversely associated with the risk of elevated weight gain in a strongly duration-dependent way. Those infants who were exclusively breastfed 1 month at the most had twice as often elevated weight gain (OR (95% CI): 1.99 (1.34, 2.97)) compared to infants breastfed at least 6 months. Our data show that exclusive breastfeeding protects against elevated weight gain during infancy which may be the first step on the pathway of obesity development.

DTPa(+)/Hib combination vaccines: the German experience

Background The introduction of polysaccharide-protein conjugate vaccines against Haemophilus influenzae type b (Hib) in the 1990's resulted in a dramatic reduction in the number of cases of invasive Hib disease. In Germany, following the launch of DTPa/Hib combination vaccines in late 1996 and DTPa-IPV/Hib in 1998, the majority of Hib immunisations are made with such combinations. It is well established that such combinations elicit lower anti-Hib antibody concentrations than the equivalent Hib conjugate administered as a separate injection. While there are good reasons to assume that this is of no clinical relevance the clinical impact of this phenomenon has not yet been fully evaluated. Methods and Findings To assess the impact of DTPa/Hib combination vaccines on the incidence of invasive Hib disease in Germany two independent, one hospital- and one laboratory-based, surveillance systems were used during 1998-99 for detection of cases. Tetra- and penta- valent DTPa-Hib vaccines accounted for 92.1 % of all Hib vaccines used in 1999. During the 2 year study period the annual number of invasive Haemophilus influenzae b disease decreased further from 28 in 1998 to 13 in 99. National vaccination coverage rates for 1998/99 revealed that only 70 % of children given DTPa/Hib or DTPa-IPV/Hib received the recommended 3 doses in their first year of life, the overall effectiveness of the most used combination vaccine was high at 97.4 % (95 % CI: 96.0-98.3) for those who had received at least one dose of such a vaccine. In subjects who received the full 3-dose schedule effectiveness was 98.8 % (95 % CI: 98.1-99.2). Conclusion These data show that the lower anti-Hib antibody concentrations observed with DTPa/Hib combination vaccines are of no clinical relevance (AU)

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Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982-1997.

OBJECTIVE: To examine the prevalence of overweight and obesity in the entire population of 5- and 6-y-old children entering school in Germany, Bavaria, and to assess time trends over the last 15 y and the impact of ethnicity. DESIGN: Cross-sectional studies were based on the obligatory school entry health examinations: all health districts of Bavaria in 1997 (n=127 735); three health districts every 5 y from 1982 to 1997 (n=16 281). MEASUREMENTS: Body mass index (BMI; kg/m(2)) was calculated and the prevalence of overweight and obesity was defined based on national and international agreed cut-off points. Ethnicity was measured as German and non-German nationality. RESULTS: The prevalence of overweight and obese children as defined by international reference values was 9.4 and 3.1% for 5-y-old boys, 10.0 and 2.9% for 6-y-old boys, 12.2 and 3.3% for 5-y-old girls and 12.4 and 3.3% for 6-y-old girls. The whole BMI distribution in non-German children compared to German children was shifted to the right with median values in non-German children 0.3-0.5 kg/m(2) higher. In these the prevalence of overweight/obesity was 1.9/2.4 times higher for boys and 1.5/1.9 times higher for girls. The time trend between 1982 and 1997 shows an increase of the BMI distribution in the upper percentiles, whereas the lower percentiles did not change substantially. The increased prevalences of overweight/obesity for both sexes as defined by international references increased from 8.5/1.8% in 1982 to 12.3/2.8% in 1997. CONCLUSION: This large study on all children entering school in Bavaria in 1997 shows patterns of overweight and obesity which are comparable with other European data but are lower than US and Australian data. Increasing prevalences since 1982 indicate that overweight and obesity in children are of increasing public health importance in Bavaria. The upwards shift of the BMI distribution in non-German children needs further investigation.