Questionnaires were sent to the 58 doctors during the last two months of 1981. Second letters with duplicate questionnaires were posted to non-responders, and telephone calls were made as a final reminder. Forty eight questionnaires were collected over nine months ?a response rate of 85 5,.?from 27 United Kingdom graduates and 21 overseas graduates. Some information was collected from trainers about the two United Kingdom and eight overseas graduates who did not respond.
A summary card in the form of a four page folder is described for use in the standard medical record envelope. It holds the current continuation card, has space for basic patient data, a problem list and a simple biography and provides an aid to regular screening and other preventive measures.
A study of the minor side effects from the immunization of children against diphtheria/pertussis/tetanus, diphtheria/tetanus, and measles is reported. The sample of 306 children received 1028 vaccinations. A secondary study of measles vaccine was made on 177 immunizations. A diary card was used to provide control data before injections and to measure the increase in incidence of minor symptoms after injection. The reported incidence of side effects after both diphtheria/tetanus and measles vaccinations was low and the patterns similar. The increase in side effects was greater after diphtheria/pertussis/tetanus injection, particularly when there was soreness at the injection site. The incidence of soreness was lower when the site of the injection was the buttock rather than the arm. The diary card was found to be an effective method of providing control data and of monitoring any increase in the incidence of minor symptoms following immunizations. The information obtained should assist health care workers to provide accurate advice and to reassure parents who are concerned about their children's protection.
Incidence of hepatitis A in Wales is low (average of 0.48/100,000 inhabitants from 2004-2015). We describe a community outbreak of hepatitis A involving 3 schools (primary and secondary) in South Wales between March and June 2016 and reflect on the adequacy of the control measures used. Anyone in South Wales epidemiologically linked to a serological and/or RNA positive confirmed case of hepatitis A during the 15-50 d before onset of symptoms (diarrhea, vomiting, fever, nausea, AND jaundice, or jaundice-associated symptom) was defined as a case. Case identification was based on laboratory or GP suspicion notification, changing to active surveillance toward the end. As per national guidance, household contacts were identified and offered immunisation while in schools vaccination followed evidence of transmission. We went beyond guidance by vaccinating street play mates and in secondary schools. Mass vaccination uptake was calculated. There were 17 cases, mostly in children under 16 y of age. All cases had an epidemiological link to either a school or a household case (except primary) and no travel history. Street playing was the only epidemiological link between 2 cases in different schools. A total of 139 household contacts were identified. All schools, including secondary one, had a transmission event preceding mass vaccination (overall uptake 85%, reaching 1,574 individuals) and no tertiary cases emerged after the campaigns. We recommend extending guidance to include actions taken that helped curb this outbreak: 1) vaccinating in secondary school and 2) broadening the household contact definition. Based on our learning we further suggest 3) vaccinating upon identification of a single case who attended school while infectious regardless of source and 4) active case finding by serologically testing contacts.
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