National Immunization Information Hotline: Calls concerning adverse events, 1998-2000.

Data from the National Immunization Information Hotline (NIIH) concerning vaccine adverse event inquiries were analyzed from 1998 to 2000 (total n = 23,841 [public n = 14,330; health care professionals n = 9,511]). Approximately 20% of calls from the public from 1998 to 2000 concerned vaccine adverse events. These calls increased 199.5% from 1998 (n = 422) to 1999 (n = 1,264), then declined 12.4% from 1999 to 2000 (n = 1,107). A Lexus Nexus search showed that the number of news stories mentioning vaccine safety showed a similar pattern. Women were more likely to call the NIIH concerning vaccine adverse events than men, and persons 40-59 years old and persons 60 years old and over were less likely to call about vaccine adverse events than those 20-39 years. The parallel trends in news stories mentioning vaccine safety and calls to the NIIH concerning adverse events suggests that news stories may stimulate questions about vaccine safety. Understanding that news stories may elicit questions about vaccine adverse events and examining the characteristics of persons who ask vaccine adverse event questions may guide future informational interventions toward those most in need.

The National Immunization Information Hotline.

The National Immunization Information Hotline (NIIH) has been providing information regarding immunizations to the public and to health care professionals since March 1997. We describe the operations of the NIIH, its experience over the first two and a half years of operation and lessons learned for other immunization hotlines. From 1998-2000, the hotline answered 246,859 calls. Calls concerning immunization information requests totaled 175,367; data about the calls were collected from 35,102. Approximately a third of the 35,102 calls were from health care providers. Of the remaining calls from the public, the greatest number of calls concerned childhood immunizations. Immunization schedule queries from the public increased 323.0% from 1998 to 2000. While the major goal of the NIIH is to provide accurate and reliable information to the public and to health care providers, data from the hotline can be used to monitor changes over time in calls concerning inquiries about the immunization schedule in addition to other variables of interest.

Parental perceptions surrounding risks and benefits of immunization.

In recent years, parental concerns about vaccine safety have increased as the threat of disease has decreased. A national survey showed that, in general, parents agree that vaccines benefit their children and that their children may be at risk for contracting a disease if unvaccinated. When asked about understanding the benefits and risks of vaccines, most parents (57%) found numbers and statistics most helpful. A substantial minority (17%) of parents were somewhat or not confident in vaccine safety. Parents less confident in vaccine safety agreed less with the statement that they usually followed the advice of their child's doctor. Incomes and education levels affected responses. This positive relationship between confidence in vaccine safety and reliance on doctors for advice may indicate the need for healthcare providers to identify opportunities to (1) solicit questions about vaccine safety, (2) address vaccine safety-related questions in a way meaningful to parents, and (3) strengthen doctor-patient relationships. A parent communication tool is proposed.

Processes for obtaining nonmedical exemptions to state immunization laws.

OBJECTIVES: This study sought to determine the specific processes required for obtaining religious and philosophical exemptions to school immunization laws. METHODS: State health department immunization program managers in the 48 states that offer nonmedical exemptions were surveyed. Categories were assigned to reflect the complexity of the procedure within a state for obtaining an exemption. RESULTS: Sixteen of the states delegated sole authority for processing exemptions to school officials. Nine states had written policies informing parents who seek an exemption of the risks of not immunizing. The complexity of the exemption process, in terms of paperwork or effort required, was inversely associated with the proportion of exemptions field. CONCLUSIONS: In many states, the process of claiming a nonmedical exemption requires less effort than fulfilling immunization requirements.

Challenges and controversies in immunization safety.

No vaccine is perfectly safe or effective. As diseases such as diphtheria and polio fade, vaccine safety concerns, especially alleged links between vaccinations and several chronic illnesses, have become increasingly prominent in the media and to the public. This article reviews the current scientific evidence on several recent vaccine safety controversies. It also provides information on how various safety research is conducted, some of the concurrent challenges, and finally, some guidance on communicating with patients on vaccine risks.

Breast-feeding exposure of infants to cadmium, lead, and mercury: a public health viewpoint.

The purpose of this report is to provide an overview of the public health implications of exposure via breast milk to cadmium, lead, and mercury for nursing infants and to provide health-based guidance. Daily intakes were calculated and compared with guidance values used for public health assessments at hazardous waste sites. Cadmium, lead, and mercury under normal conditions are found in breast milk at concentration ranges of < 1 microgram/L, 2-5 micrograms/L, and 1.4-1.7 micrograms/L, respectively. Women exposed environmentally or occupationally can have higher levels in their breast milk. Concentrations of about 5 micrograms/L (cadmium), 20 micrograms/L (lead), and 3.5 micrograms/L (mercury) appear to be adequate screening levels. Many factors affect both the distribution of cadmium, lead, and mercury in breast milk and the health consequences to an infant. It is not clear what additional impact low-level exposure via breast milk may have on an infant born with a body burden to one of these metals. There is sufficient evidence to make the case that contaminated breast milk is a source of potential risk to infants in certain populations. Prevention strategies that include behavior modification and proper nutrition should be communicated to women at risk. Identification and elimination of exposure pathways and a critical analysis of the benefits of breast feeding versus heavy metal exposure are needed on a site-specific or individual basis. Research is required to better understand the impact of low-level exposure to heavy metals via breast milk. Breastfeeding should be encouraged under most circumstances.

Breast-feeding exposure of infants to environmental contaminants--a public health risk assessment viewpoint: chlorinated dibenzodioxins and chlorinated dibenzofurans.

Exposure of children to chlorinated dibenzodioxins and chlorinated dibenzofurans via breast-feeding has been well-documented in industrialized countries. Recent studies indicate a possible link between development of subtle health effects in children and their exposure to dioxin-like chemicals from maternal milk. Some examples of the effects are lower vitamin K levels, increased thyroxine levels, and mild changes in liver enzymes. The projected daily intakes of chlorinated dibenzodioxins and chlorinated dibenzofurans are compared with minimal risk levels for intermediate duration oral exposure (15-365 days) derived for these chemicals. Public health recommendations for future actions related to infant intake of chlorinated dibenzodioxin- and chlorinated dibenzofuran-contaminated breast milk are also addressed.

Uses and implications of the contextual approach to child custody decisions.

Child custody litigation signals parental conflicts that have serious implications for a child's long-term development. The authors describe a family systems approach to child custody decision making--the contextual approach, derived from contextual family theory. A case study analysis and pilot study illustrate the use of the approach with a small group of families who turn to the legal system to resolve custody or visitation disputes. The findings suggest the approach's usefulness in helping families create alternatives to continued disputation. The findings also reinforce the need for further research to test the preventive potential of the approach in reducing returns to court.

Minnesota workplace drug testing. Analysis of policy and procedures.

1. An employer's decision whether to drug test or not was found to correlate with the size of the company and how extensively the employer perceives a drug abuse problem exists among its work force. 2. A company's drug testing program must be designed, implemented, and evaluated within a medical-legal framework. This includes issues of: confidentiality, employee actions that trigger a drug test, the presence of a drug and alcohol policy, communicating the program to employees and unions, the employee's rights, the consequences of an employee's positive drug test, and the procedures to be followed when collecting a specimen. 3. Future studies need to explore the issue of dealing with job performance problems; in particular, the cost and effectiveness of employee drug testing vs. the use of discipline alone.