A short history of vaccination in Australia.

It is almost 50 years since infant vaccination for diphtheria, pertussis and tetanus became routine in Australia. Since then, the incidence of vaccine-preventable diseases has declined dramatically. We have used existing records and the recollections of experts to compile a history of vaccination in Australia, focusing on vaccines in the current childhood schedule.

Electronic temperature monitoring and feedback to correct adverse vaccine storage in general practice.

OBJECTIVE: To evaluate the effect of direct feedback of temperature conditions followed by a telephone educational questionnaire to correct adverse vaccine storage, and to determine the consistency of vaccine storage conditions at provider sites over six months. PARTICIPANTS: 32 general practitioner vaccine providers in metropolitan Adelaide. DESIGN: Temperatures were monitored for 14 days using electronic temperature monitors, with repeat monitoring at two and six months. Feedback was given to vaccine providers and an educational questionnaire was administered after initial monitoring. MAIN OUTCOME MEASURE: Number of sites with more than 20% of recordings < 2 degrees C or > 8 degrees C and/or more than 5% of recordings < 0 degree C or > 15 degrees C. RESULTS: 13 (41%) sites had initially suboptimal storage. Following the interventions, storage was corrected in all but three (23%) of these sites. Only 10 (52%) of the 19 initially optimal sites had consistent optimal storage at two and six months. CONCLUSION: Electronic monitoring with direct feedback of storage temperatures was effective in correcting adverse storage at most suboptimal sites. Vaccine storage at initially optimal sites was not consistent. Our findings have important implications for further research and public health measures aimed at correcting and maintaining optimal vaccine storage.

Vaccinating children with a history of serious reactions after vaccination or of egg allergy.

OBJECTIVE: To describe the results of vaccinating children with a history of serious adverse reactions after vaccination or of egg allergy at a special clinic established for that purpose. DESIGN: Retrospective case series. PATIENTS: Children who attended the clinic between 1 August 1994 and 31 July 1996 after being referred by vaccine providers. SETTING: A clinic conducted in the Emergency Department of The Canberra Hospital, Australian Capital Territory. MAIN OUTCOME MEASURES: Reasons for referral; vaccinations given; and subsequent adverse vaccination events. RESULTS: 91 children received 155 vaccinations at the clinic, and only one serious event--a hypotonic/hyporesponsive episode (HHE) after diphtheria-tetanus-whole-cell pertussis (DTPw), oral polio and Haemophilus influenzae type b vaccination--was subsequently reported; this child recovered spontaneously. Fifty-three children referred because of a previous serious adverse vaccination event were revaccinated at the clinic with whole-cell pertussis vaccine (47), combined diphtheria and tetanus vaccine (4), tetanus toxoid (1), and typhoid vaccine (1). Three children (referred because of previous meningitis, subdural haemorrhage or parental suspicion of allergy to DTPw) received their first dose of pertussis vaccine at the clinic. The remaining 35 children had a history of egg allergy and were given measles-mumps-rubella vaccine. CONCLUSIONS: We successfully vaccinated children with histories of serious reactions to vaccination, including HHEs, convulsions, apnoea, high temperatures and persistent screaming, as well as those with egg allergy. We believe special clinics can improve vaccination coverage.