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B Guyer

Publications and source records attributed to B Guyer.

99 records · Page 6Linked to original sources
PubMedDate not supplied

Measles control in Yaounde: justification of a one dose, nine month minimum age vaccination policy in tropical Africa.

For tropical countries the World Health Organisation recommends a single dose of measles vaccine, administered at a minimum age of 9 months. In some African nations, however, up to 26% of all reported measles occurs before the age of 9 months, and many African nations have been reluctant to follow the WHO recommendation. In 1974 the Ministry of Health of the United Republic of Cameroon made several changes in the existing measles control strategy, including increasing the minimum age for measles vaccination from 6 to 9 months. Surveillance of measles in Yaounde, the capital city, during the five years after the increase in age at vaccination did not reveal a need to return to the minimum age of 6 months. In fact, by 1979, with measles vaccination coverage among children 12-23 months of age at 40%, there had been a 44% decrease in reported measles among children of all ages, including a 64% decrease in the measles attack rate among children under the age of 9 months. These observations support the one dose, 9 month minimum age measles vaccination policy in tropical Africa.

Acute Disease↗
PubMedDate not supplied

Classification and analysis of fetal deaths in Massachusetts.

Fetal deaths, in contrast to infant deaths, have been subject to epidemiologic analysis infrequently. We characterized 574 Massachusetts resident fetal deaths from 1982 and assessed the accuracy of cause-of-death information available from vital records compared with that from corresponding fetal autopsies. The fetal death rate exceeded the neonatal mortality rate. Fetal mortality was higher among black, unmarried, and older mothers. Fetuses of multiple-gestation pregnancies had an unusually high risk of fetal death. Autopsy reports were obtained for 61% of fetal deaths. The underlying cause of death from the fetal death record differed from that on the autopsy report in 55% of cases. Systematic collection of population-based autopsy data is a useful approach for improving the quality and accuracy of mortality statistics on fetal deaths. Many stillbirths remain unexplained, however, and research is needed to identify pathological markers that might reduce the heterogeneity within the fetal deaths currently ascribed to unknown causes.

Adult↗
PubMedDate not supplied

Failure to vaccinate children against measles during the second year of life. An analysis of immunization practices in two Tennessee county health departments.

In many Tennessee counties, children under the care of health departments have low measles vaccination levels. An immunization survey and a health department record audit of 2-year-olds were undertaken in two counties to determine the reasons for this situation. The results indicated that faulty clinic procedures played a large part in the failure to vaccinate against measles. Nearly half of the unvaccinated 2-year-olds with health department records had been present in the health department clinic at the appropriate age for measles vaccination; the remainder had dropped out of the well-child program before their first birthday. Emphasis on tuberculin skin testing and delay in the administration of the basic series of DTP immunizations correlated with the failure to vaccinate against measles. For more than half of the children who attended the clinic after their first birthday, no reason was recorded for the failure to vaccinate them against measles. Improved clinic procedures could bring measles vaccination levels within the acceptable range. These procedures would include new methods for correcting immunization delinquency, simultaneous tuberculin skin testing and measles vaccination of children without a history of tuberculosis exposure, emphasis on vaccinating at-risk groups, and more convenient vaccination clinic hours.

Age Factors↗
PubMedDate not supplied

Estimating vaccination coverage using parental recall, vaccination cards, and medical records.

OBJECTIVE: To compare estimates based on vaccination cards, parental recall, and medical records of the percentages of children up-to-date on vaccinations for diphtheria, tetanus, and pertussis; polio; and measles, mumps, and rubella. METHOD: The authors analyzed parent interview and medical records data from the Baltimore Immunization Study for 525 2-year-olds born from August 1988 through March 1989 to mothers living in low-income Census tracts of the city of Baltimore. RESULTS: Only one-third of children had vaccination cards; based on medical records, these children had higher up-to-date coverage at 24 months of age than did children without cards. For individual vaccines, only two-thirds of parents could provide information to calculate coverage rates; however, almost all provided enough information to estimate coverage for the primary series. For each vaccine and the series, parental recall estimates were at least 17 percentage points higher than estimates from medical records. For children without vaccination cards whose parents could not provide coverage information, up-to-date rates based on medical records were consistently lower than for children with cards or with parents who provided coverage information. CONCLUSIONS: Population-based vaccine coverage surveys that rely on vaccination cards or parental recall or both may overestimate vaccination coverage.

Baltimore↗
PubMedDate not supplied

Deficiencies in current childhood immunization indicators.

OBJECTIVE: To investigate "up-to-date" and "age-appropriate" indicators of preschool vaccination status and their implications for vaccination policy. METHODS: The authors analyzed medical records data from the Baltimore Immunization Study for 525 2-year-olds born from August 1988 through March 1989 to mothers living in low-income Census tracts of the city of Baltimore. RESULTS: While only 54% of 24-month-old children were up-to-date for the primary series, indicators of up-to-date coverage were consistently higher, by 37 or more percentage points, than corresponding age-appropriate indicators. Almost 80% of children who failed to receive the first dose of DTP or OPV age-appropriately failed to be up-to-date by 24 months of age for the primary series. CONCLUSIONS: Age-appropriate immunization indicators more accurately reflect adequacy of protection for preschoolers than up-to-date indicators at both the individual and population levels. Age-appropriate receipt of the first dose of DTP should be monitored to identify children likely to be underimmunized. Age-appropriate indicators should also be incorporated as vaccination coverage estimators in population-based surveys and as quality of care indicators for managed care organizations. These changes would require accurate dates for each vaccination and support the need to develop population-based registries.

Baltimore↗