- Email: [email protected]
COVERAGE OF MMR VACCINE
1533 the case if, because of inadequacies in the methods appears that Eldorado has been attained.
applied,
it
University Department Medicine, General Infirmary, Leeds LS1 3EX
THOMAS PULLAR
Centre for Rheumatic Diseases,
Glasgow Royal Infirmary,
HILARY A. CAPELL
Glasgow
1. Pullar T, Capell HA. Can treatment really influence the radiological progression of rheumatoid arthritis? Br J Rheumatol 1986; 25: 2-6. 2. Pullar T, Capell HA. Selection of suitable patients for second-line therapy m rheumatoid arthritis. Br Rheumatol 1986; 25: 276-81. J 3. Scott DL, Spector TD, Pullar T, McConkey B. What should we hope to achieve when treating rheumatoid arthritis? Ann Rheum Dhs 1989; 48: 256-61. 4. Richards IM1, Fraser SM, Hunter JA, Capell HA. Comparison of phenytoin and gold as second line drugs m rheumatoid arthritis. Ann Rheum Dis 1987; 46: 667-69. 5. Belch JJF, Madhok R, McArdle B, et al. The effect of increasing fibrinolysis in patients with rheumatoid arthritis: a double blind study of stanozolol. Q J Med 1986; 225: 19-27.
COVERAGE OF MMR VACCINE
SiR,—Combined measles, mumps, and rubella (MMR) vaccine was
introduced into the UK childhood immunisation schedule in
October, 1988.1 The Cover of Vaccination Evaluated Rapidly (COVER) schemewhich is run by the Communicable Disease Surveillance Centre of the Public Health Laboratory Service, has provided timely statistics of coverage for diphtheria, pertussis, and measles in England and Wales since 1987. MMR was included in the scheme in October, 1988, and preliminary results are now available. MMR coverage by 15 months of age was assessed in nineteen health districts in England and Wales from November, 1988. The data were obtained with a standard programme from the statistical package of the child health system.3 MMR coverage was evaluated is six consecutive monthly cohorts of children bom between July 1 and Dec 31, 1987. Each monthly cohort was studied shortly after the youngest member had reached 15 months of age. For example, children bom in July, 1987, were evaluated in November, 1988. Evaluations of subsequent cohorts were conducted between December, 1988, and April, 1989. For comparison, measles coverage by age 15 months was evaluated in six consecutive monthly cohorts of children born in 1986 in the same period and in the same district. With the exception of children born in July, 1987, MMR coverage in each monthly cohort exceeded measles coverage in the previous year by 1-5% (figure). The measles (but not the MMR) data include immunisations done by 15 months of age but not reported until later; this has the effect of underestimating coverage for MMR but not for measles. Neither the MMR nor the measles data included immunisations done after 15 months. Subsequent evaluations of MMR coverage in the cohort of children born in July, 1987, showed that by February, 1989 (ie, by 18 months), it had risen from 26% (at 15 months) to 59%, and by August, 1989 (ie, by 2 years), it was 74%. Coverage by 2 years of age will increase further when late reported immunisations have been included.
These results suggest that the introduction of MMR has been associated with some improvement in immunisation coverage. This improvement has also been seen in other countries.4,s Measles coverage in the UK has, however, been increasing steadily for several years and it is not clear whether the introduction of MMR has accelerated this process. More comprehensive information on MMR coverage will become available in 1990 from both the COVER scheme and Department of Health statistics. Although these results are encouraging, further improvements are needed if measles, mumps, rubella, and congenital rubella syndrome are to be eliminated. A greater commitment to immunisation is needed by all professionals involved in the delivery of preventive child health services. PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ
NORMAN BEGG SARAH HANDFORD
1. Badenoch J. Big bang for vaccination. Br Med J 1988; 297: 750-51. 2. Begg NT, Gill ON, White JM. COVER (Cover of Vaccination Evaluated Rapidly): description of the England and Wales scheme Publ Hlth 1989; 103: 81-89. 3. Child Health Computing Committee, 1987. The child health system a statistical guide. Cardiff. Welsh Health Common Services Authority, 1987. 4. Bottiger M, Chnstenson B, Romanus V, Taranger J, Strandell A. Swedish experience of two dose vaccination programme aiming at eliminating measles, mumps and rubella. Br Med J 1987; 295: 1264-67. 5. Peltola H, Karanko V, Kurki T, et al. Rapid effect on endemic measles, mumps, and rubella of nationwide vaccination programme m Finland. Lancet 1986; 1: 137-39.
EFFECT OF RACE AND BLOOD GROUP ON THE IMMUNE RESPONSE TO BACTERIAL POLYSACCHARIDE AND CONJUGATE VACCINES
SiR,—The ability of an individual to produce an antibody following vaccination is regulated by many factors. Non-responsiveness to hepatitis B vaccine has been attributed to the response
absence of a dominant immune-response gene in the major histocompatibility complex.! The presence of Km(l) immunoglobulin allotype in black, but not white, children has been associated with an increased concentration of serum antibody following immunisation with Haemophilus influenzae type b polysaccharide vaccine.2 Expression of the G2m(n) allotype of IgG2 results in a significantly greater immune response to H influenzae type b polysaccharide and 8 of 11pneumococcal polysaccharides after vaccination compared with subjects who were G2m(n) negative.3 Furthermore, the increased susceptibility of certain ethnic populations to invasive disease caused by encapsulated bacteria suggests that race may also play a part in the immune response to polysaccharide antigens. 3,4 We have described the safety and immunogenicity of a polyvalent Klebsiella capsular polysaccharide vaccine and a Pseudomonas aeruginosa 0-polysaccharide-toxin A vaccine in man. 5,6 We have used these two vaccines to immunise simultaneously 62 healthy volunteers, about two-thirds of whom were of hispanic origin, the remainder being white. This presented a unique opportunity to evaluate the immune response to conjugated and non-conjugated polysaccharide antigens as determined by age, race, and blood group.
too-,
Age did not seem to affect the ability of vaccinees to mount a antibody response (response is defined as a 4-fold rise to
serum
EFFECT OF BLOOD GROUP AND RACE ON ANTIBODY RESPONSE TO PS AERUGINOSA VACCINES 1-
I
Jul
Aug
Sep
Study
Oct
Nov
Dec
cohort birth month
Coverage of
MMR and measles by age 15 months in nineteen health districts of England and Wales.
No of children evaluated in each month ranged from 5461
to
6358.
*p < 0-05 (hispanic vs white; group 0 vs group A), by both Fisher’s exact test and X2 analysis with Yates’ correction for continuity. NC = not considered
as a
variable.
applied,
it
University Department Medicine, General Infirmary, Leeds LS1 3EX
THOMAS PULLAR
Centre for Rheumatic Diseases,
Glasgow Royal Infirmary,
HILARY A. CAPELL
Glasgow
1. Pullar T, Capell HA. Can treatment really influence the radiological progression of rheumatoid arthritis? Br J Rheumatol 1986; 25: 2-6. 2. Pullar T, Capell HA. Selection of suitable patients for second-line therapy m rheumatoid arthritis. Br Rheumatol 1986; 25: 276-81. J 3. Scott DL, Spector TD, Pullar T, McConkey B. What should we hope to achieve when treating rheumatoid arthritis? Ann Rheum Dhs 1989; 48: 256-61. 4. Richards IM1, Fraser SM, Hunter JA, Capell HA. Comparison of phenytoin and gold as second line drugs m rheumatoid arthritis. Ann Rheum Dis 1987; 46: 667-69. 5. Belch JJF, Madhok R, McArdle B, et al. The effect of increasing fibrinolysis in patients with rheumatoid arthritis: a double blind study of stanozolol. Q J Med 1986; 225: 19-27.
COVERAGE OF MMR VACCINE
SiR,—Combined measles, mumps, and rubella (MMR) vaccine was
introduced into the UK childhood immunisation schedule in
October, 1988.1 The Cover of Vaccination Evaluated Rapidly (COVER) schemewhich is run by the Communicable Disease Surveillance Centre of the Public Health Laboratory Service, has provided timely statistics of coverage for diphtheria, pertussis, and measles in England and Wales since 1987. MMR was included in the scheme in October, 1988, and preliminary results are now available. MMR coverage by 15 months of age was assessed in nineteen health districts in England and Wales from November, 1988. The data were obtained with a standard programme from the statistical package of the child health system.3 MMR coverage was evaluated is six consecutive monthly cohorts of children bom between July 1 and Dec 31, 1987. Each monthly cohort was studied shortly after the youngest member had reached 15 months of age. For example, children bom in July, 1987, were evaluated in November, 1988. Evaluations of subsequent cohorts were conducted between December, 1988, and April, 1989. For comparison, measles coverage by age 15 months was evaluated in six consecutive monthly cohorts of children born in 1986 in the same period and in the same district. With the exception of children born in July, 1987, MMR coverage in each monthly cohort exceeded measles coverage in the previous year by 1-5% (figure). The measles (but not the MMR) data include immunisations done by 15 months of age but not reported until later; this has the effect of underestimating coverage for MMR but not for measles. Neither the MMR nor the measles data included immunisations done after 15 months. Subsequent evaluations of MMR coverage in the cohort of children born in July, 1987, showed that by February, 1989 (ie, by 18 months), it had risen from 26% (at 15 months) to 59%, and by August, 1989 (ie, by 2 years), it was 74%. Coverage by 2 years of age will increase further when late reported immunisations have been included.
These results suggest that the introduction of MMR has been associated with some improvement in immunisation coverage. This improvement has also been seen in other countries.4,s Measles coverage in the UK has, however, been increasing steadily for several years and it is not clear whether the introduction of MMR has accelerated this process. More comprehensive information on MMR coverage will become available in 1990 from both the COVER scheme and Department of Health statistics. Although these results are encouraging, further improvements are needed if measles, mumps, rubella, and congenital rubella syndrome are to be eliminated. A greater commitment to immunisation is needed by all professionals involved in the delivery of preventive child health services. PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ
NORMAN BEGG SARAH HANDFORD
1. Badenoch J. Big bang for vaccination. Br Med J 1988; 297: 750-51. 2. Begg NT, Gill ON, White JM. COVER (Cover of Vaccination Evaluated Rapidly): description of the England and Wales scheme Publ Hlth 1989; 103: 81-89. 3. Child Health Computing Committee, 1987. The child health system a statistical guide. Cardiff. Welsh Health Common Services Authority, 1987. 4. Bottiger M, Chnstenson B, Romanus V, Taranger J, Strandell A. Swedish experience of two dose vaccination programme aiming at eliminating measles, mumps and rubella. Br Med J 1987; 295: 1264-67. 5. Peltola H, Karanko V, Kurki T, et al. Rapid effect on endemic measles, mumps, and rubella of nationwide vaccination programme m Finland. Lancet 1986; 1: 137-39.
EFFECT OF RACE AND BLOOD GROUP ON THE IMMUNE RESPONSE TO BACTERIAL POLYSACCHARIDE AND CONJUGATE VACCINES
SiR,—The ability of an individual to produce an antibody following vaccination is regulated by many factors. Non-responsiveness to hepatitis B vaccine has been attributed to the response
absence of a dominant immune-response gene in the major histocompatibility complex.! The presence of Km(l) immunoglobulin allotype in black, but not white, children has been associated with an increased concentration of serum antibody following immunisation with Haemophilus influenzae type b polysaccharide vaccine.2 Expression of the G2m(n) allotype of IgG2 results in a significantly greater immune response to H influenzae type b polysaccharide and 8 of 11pneumococcal polysaccharides after vaccination compared with subjects who were G2m(n) negative.3 Furthermore, the increased susceptibility of certain ethnic populations to invasive disease caused by encapsulated bacteria suggests that race may also play a part in the immune response to polysaccharide antigens. 3,4 We have described the safety and immunogenicity of a polyvalent Klebsiella capsular polysaccharide vaccine and a Pseudomonas aeruginosa 0-polysaccharide-toxin A vaccine in man. 5,6 We have used these two vaccines to immunise simultaneously 62 healthy volunteers, about two-thirds of whom were of hispanic origin, the remainder being white. This presented a unique opportunity to evaluate the immune response to conjugated and non-conjugated polysaccharide antigens as determined by age, race, and blood group.
too-,
Age did not seem to affect the ability of vaccinees to mount a antibody response (response is defined as a 4-fold rise to
serum
EFFECT OF BLOOD GROUP AND RACE ON ANTIBODY RESPONSE TO PS AERUGINOSA VACCINES 1-
I
Jul
Aug
Sep
Study
Oct
Nov
Dec
cohort birth month
Coverage of
MMR and measles by age 15 months in nineteen health districts of England and Wales.
No of children evaluated in each month ranged from 5461
to
6358.
*p < 0-05 (hispanic vs white; group 0 vs group A), by both Fisher’s exact test and X2 analysis with Yates’ correction for continuity. NC = not considered
as a
variable.