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Lancet. 1990 Mar 24;335(8691):707-10.

Immunisation practice in developed countries.

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Center for Prevention Services, Centers for Disease Control, Atlanta, GA 30333.



Immunization practice in 32 countries in Europe, North America, Japan, and Australia is reviewed. in most countries, immunization practices are set by the federal government which sometimes works with the private sector. Almost all countries routinely immunize against diphtheria, tetanus, whooping cough, polio, and measles. About half try to prevent rubella, several try to prevent mumps, usually in combination with measles and rubella (MMR). More than half use bacillus Calmette-Guerin (BGG) vaccine to prevent tuberculosis, and a few give Hemophilus Influenza type B polysaccharide. Poliomyelitis vaccine comes in 2 forms: 1) oral live attenuated (OPV) or injectable inactivated (IPV). OPV is more used, but there is a new "enhanced potency IPV." All countries except Japan give DPT in 3 doses during the 1st year of life. OPV is usually given at the same time that DPT is. Measles vaccine or MMR is usually given between 12 and 18 months of age. Primary vaccine failure occurs in 2-5% of people who get measles vaccine, but this may be enough to "sustain transmission." In most countries, the government provides for immunizing children. An exception in the US. In the UK, low coverage has taken place because of concern for adverse reactions (whooping cough) or lack of appreciation of the disease's impact (measles). Coverage against both measles and pertussis has improved in the UK lately. In each developed country, vaccines have had "spectacular" effects. However, there are too many contraindications and there is "undue fear of adverse events." Also, there are surveillance deficiencies, a lack of coordination, and countries vary in their commitment to "reduction/elimination targets." Varicella vaccine, respiratory syncytial virus vaccine, and rotavirus vaccine are being considered for universal use. Attempts are being made to improve the safety of some vaccine.

[Indexed for MEDLINE]

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