[Infant Institutes, their function and perspectives].

BACKGROUND: In 1997, the Advisory Committee on Immunization Practices (ACIP) recommended a switch from oral polio vaccine (OPV) to inactivated polio vaccine (IPV) for the first two infant doses. The ACIP also recommended use of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) for infants. These recommendations resulted in two additional injections at the 2- and 4-month immunization visits. This study evaluates the implementation of new IPV and DTaP immunization recommendations and their impact on immunization coverage levels. METHODS: Immunization coverage was assessed in public clinics in three urban areas before and after the recommendations. One pre- and three post-recommendation cohorts were followed to 12 months of age. RESULTS: Almost all (> or = 88%) infants in the pre-recommendation cohort received OPV, DTP, and only one or two injections. Almost all (> or = 78%) infants in the post-recommendation cohorts received IPV, DTaP, and three or four injections. The percentage of infants in the post-recommendation cohorts up-to-date for immunizations at 12 months of age was slightly higher than those in the pre-recommendation cohort. CONCLUSIONS: Providers rapidly switched from OPV and DTP to IPV and DTaP. Coverage at 12 months of age was higher among IPV/DTaP recipients than among OPV/DTP recipients. Provider and parent acceptance of four injections at a visit was high. The recent pneumococcal conjugate vaccine recommendations potentially add a fifth injection at 2 and 4 months of age. Acceptance or rejection of five injections by providers and parents needs early assessment.

Child Health Services↗

PubMed2001

The effectiveness of routine health examinations at 2, 6, 9 and 12 months of age: experiences based on data from a Swedish county.

AIM: The aim of this study was to elucidate the role of health surveillance for infants during the first year of life in detecting severe health problems. Two central questions were addressed: (1) what health problems were detected by routine health examinations at the Child Health Centre at the 2-, 6- and 12-month check-ups by a physician and at the 9-month check-up by a nurse; and (2) to what extent did the health examinations contribute to early identification of children with following key abnormalities: congenital heart disease, congenital dislocation of the hip, abnormalities as registered at the habilitation centre and severe hearing impairments? MATERIAL AND INCLUSION CRITERIA: The study population included all children in Uppsala county, born January 1995 to October 1996, who had participated in at least one of the four health check-ups. There were 3107-3487 children in the respective check-ups. METHOD: Data from a county health register as well as child health records and information regarding referrals were analysed to categorize the health problems by type, severity and action taken. Data on children with key abnormalities were obtained from specialist units. RESULTS: The rate of suspected new health problems varied between 1.9% and 2.8% at the respective check-ups. Of the new problems detected by the physician, 21%-36% were false-positive, 34%-44% were minor and 10%-15% were moderate. Only two severe health problems were detected among all the children during the four check-ups. Of all key abnormalities, 20% were detected by way of child health surveillance during the first year of life. IMPLICATIONS: Severe health problems and key abnormalities in infants were detected only to a limited extent through routine health examinations at 2, 6, 9 and 12 months of age. The minor and moderate problems detected justify a health surveillance programme, but the organization and content of the programme could be reconsidered.

Child Health Services↗