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[The knowledge about measles, mumps and rubella among parents in the county of Roskilde].

INTRODUCTION: The aim was to determine how much knowledge parents have of MMR diseases and the side effects of the vaccine, and what influence this has on acceptance of the vaccination programme. MATERIALS AND METHODS: Sampling three districts of Roskilde County was done by the distribution of 1867 questionnaires to the parents of children aged 0-15 years in 22 institutions and schools (1 January to 28 February 2000). RESULTS: Of the 878 (47%) replies, 825 (94%) had followed the vaccination programme. There was no difference between those who had followed the programme and those who had not with respect to reports of complications to the diseases, but the latter group reported more complications to the vaccine. In the vaccinated group, there were significantly more who stated that the doctor's opinion of the vaccine was positive, and acceptance of the remaining vaccination programme was also greater in this group. More children in the non-vaccinated group were involved in the decision about vaccination. DISCUSSION: Though knowledge of the diseases does not seem to influence the decision about vaccination, the responses raise the question of how information is to reach the general public. An open debate is needed on vaccination complications, as it is these or uncertainty about them that seem to influence the parents' choice. For 70% of parents, the doctor is their source of information, and it is therefore important for acceptance of the MMR vaccine that doctors have a positive view and are able to communicate this view to the parents.

Adolescent↗

Osteomyelitis as a late complication of Bacille Calmette-Guérin vaccination.

Bacille Calmette-Guérin (BCG) osteomyelitis is a very rare complication of BCG vaccination. We report a 14-month-old boy who received BCG vaccination at birth. He developed pain and swelling in his left calf at 11 months of age. BCG osteomyelitis was diagnosed in right femur and left tibia. He had no evidence of immunodeficiency. After antituberculous therapy and surgical treatment, the bone lesions disappeared and he was discharged from hospital without any sequela during 11 months of follow-up.

Antitubercular Agents↗

BCG vaccine and post-BCG complications among infants in Gaza Strip, 1999.

The relationship between post-BCG complications and the practices of administration and/or use of certain batches of BCG vaccine was investigated. A questionnaire were given to nurses administering BCG vaccination. An abstraction sheet was used to analyse cases with BCG complications among infants (n = 552) and schoolchildren (n = 97). The rate of complications was 14.7/1000 among infants and 2.5/1000 among schoolchildren in 1997. The complications rate was 19.1/1000 at UNRWA and 8.3/1000 at governmental health services. It was found that a single batch of BCG 2611-11 combined with incorrect administering of the vaccine was responsible for this outbreak of complications. Therefore, the establishment of a surveillance system to monitor adverse events following immunization is needed.

Abscess↗

Neurologic complications in oral polio vaccine recipients.

Between April 1982 and June 1983 four children 3 to 24 months of age were referred for evaluation of neurologic abnormalities found to be compatible with vaccine-related poliovirus infection, which had not been suspected by referring physicians. Patients were epidemiologically unrelated residents of Indiana, and none had prior symptoms suggestive of immunodeficiency. All had received poliovirus vaccine orally (first dose in three, fourth dose in one) and a diphtheria-tetanus-pertussis injection in the left anterior thigh within 30 days of symptoms. A vaccine-like strain of poliovirus was isolated from each patient, and each had symptoms (left leg paralysis in three; developmental regression, spasticity, and progressive fatal cerebral atrophy in one) persisting for at least 6 months. Immune function was normal in two with poliovirus type 3 infection, and abnormal (hypogammaglobulinemia, combined immunodeficiency) in two with type 1 and type 2 infection, respectively. The incidence of observed vaccine-related poliovirus infection in Indiana recipients of orally administered poliovirus vaccine was 0.058 per 100,000 per year, significantly greater (P less than 0.001) than predicted.

Atrophy↗

Rare complication of Q fever vaccination.

A 32-year-old woman with a past history of malignant melanoma presented with a lump in the upper left arm that was excised. Histological examination revealed a granulomatous dermatitis and panniculitis that proved to be a rare reaction to Q fever vaccination.

Adult↗

Industry perspective on clinical trial issues for combination vaccines.

The development and production of vaccines remains complicated, largely because of the complexity of the vaccines, which are virtually always manufactured in a biological system; the nature of most vaccines precludes the use of the detailed chemical analysis that is possible for simple chemical entities. Therefore, approval and release of vaccines is dependent upon careful view of the manufacturing processes, the analytical data that are available, and data from clinical trials of consistency lots. The makeup of consistency lots from combinations, the purpose and utility of such lots, and the timing of their production depend not only on the maturity of the manufacturing process but also upon mutual agreement between the sponsor and the regulators. Consistency of application of regulations and precedent are important in the sponsor's ability to carry out successful development programs. The science of adjuvants is still in its infancy, but opportunities for it to mature are legion. Aluminum salts remain the mainstay of contemporary adjuvants but will no doubt be supplanted in the near future. The ethics of doing efficacy studies in infants who could be protected by safe and well-tolerated vaccines must be debated openly. Closely related to efficacy studies are the use of surrogates, which should be developed, recognized, and utilized. Finally, the potential utility of M-M-R IIV was shown by studies of the individual attenuated virus components in vaccines.

Adjuvants, Immunologic↗