Consumption of raw vegetables and fruits: a risk factor for Campylobacter infections.

The purpose of this study was to determine the prevalence of Campylobacter in fresh vegetables and fruits at retail level in the Netherlands, and to estimate its implications on the importance of vegetables and fruits as risk factor for campylobacteriosis. Thirteen of the 5640 vegetable and fruit samples were Campylobacter positive, resulting in a prevalence of 0.23% (95% confidence interval (Cl): 0.12-0.39%). The prevalence of packaged products (0.36%, 95% Cl: 0.17-0.66) was significantly higher than of unpackaged products (0.07; 95% Cl: 0.01-0.27). No statistical differences were found between seasons. Combining the mean prevalence found in this study with data on the consumption of vegetables and fruits, an exposure of 0.0048 campylobacters ingested per person per day in the Netherlands by transmission via vegetables and fruits, was calculated. This exposure, as input in a Beta-Poisson dose-response model, resulted in an estimated number of 5.3×105 cases of infection with Campylobacter per year for the whole Dutch population. This constitutes the consumption of raw vegetables and fruits, especially when packaged, to be a risk factor for Campylobacter infections.

Studies of missed opportunities for immunization in developing and industrialized countries.

Missed opportunities for immunization are an obstacle to raising immunization coverage among children and women of childbearing age. To determine their global magnitude and reasons, studies reported up to July 1991 were reviewed. A standard measure for the prevalence of missed opportunities was calculated for each study. Seventy-nine studies were identified from 45 countries; 18 were population-based, 52 were health-service-based, and 9 were intervention trials. A median of 32% (range, 0-99%) of the children and women of childbearing age who were surveyed had missed opportunities during visits to the health services for immunization or other reasons. Missed opportunities were mainly due to failure to administer simultaneously all vaccines for which a child was eligible; false contraindications; health workers' practices, including not opening a multidose vaccine vial for a small number of persons to avoid vaccine wastage; and logistical problems. To eliminate missed opportunities for immunization, programmes should emphasize routine supervision and periodic in-service training of health workers which would ensure simultaneous immunizations, reinforce information about true contraindications, and improve health workers' practices.

PIP: The authors review studies reported up to July, 1991, on the global magnitude of and reasons for missed opportunities to immunize children and women of childbearing age. A standard measure was calculated for the prevalence of missed opportunities for each of the 79 studies identified from 45 countries; 18 were population-based, 52 were health-service-based, and 9 were intervention trials. A median of 32% over a range of 0-99% children and women of childbearing age surveyed had missed opportunities during visits to health services for immunization or other reasons. These outcomes were due mainly to the future to administer simultaneously all vaccines for which a child was eligible; false contraindications; health workers' practices; and logistical problems. To eliminate these missed opportunities, programs should emphasize routine supervision and the periodic in-service training of health workers. This approach would ensure simultaneous immunizations, reinforce information about true contraindications, and improve health workers' practices.