Tetanus-diphtheria toxoids (Td) booster immunization is generally recommended for Grade 9 students (14- to 16-year-olds) but targeting younger students may enhance vaccine uptake or facilitate simultaneous vaccinations. However, earlier vaccination might cause greater side effects. This study was undertaken to compare the safety of Td vaccinations in students in Grade 6 (11 to 12 years old) and Grade 9.
A controlled, sequential assessment of Td vaccine, adsorbed, was conducted in one urban school district, starting with Grade 9 students. Grade 6 students were given Td concurrently with Dose 3 of hepatitis B vaccine. Adverse effects were assessed during visits 2 days after vaccination. Participation criteria, immunization technique and assessment procedures were standardized.
Of 410 students vaccinated, 204 in Grade 9 and 206 in Grade 6, 391 (95.4%) were assessed in person. Nineteen missed follow-up visits but telephone interviewers established that none missed school because of vaccine side effects. At follow-up Grade 6 students more often reported deltoid pain with arm movement (35.2% vs. 10.8%, P or = 50 mm in diameter was present in 12.2% of Grade 6 and 3.6% of Grade 9 students (P or = 50 mm diameter was present in 22.4 and 10.8%, respectively (P
The coverage of children by immunization against diphtheria, pertussis and tetanus during the first 3 years of life as indicated in forms No. 112 and No. 63 in 4 districts of Moscow was studied on the basis of the analysis of 1688 children's development histories. The coverage of children by immunization was found to be on the average 71.7%, fluctuating in individual districts from 58.6% to 85.9%. Immunization against measles covered 41.8% of children with fluctuations 24.2-51.2%. The most frequent reasons for the absence of prophylactic immunization in children during the first 3 years of life, or belated immunization in comparison with the specified terms, were contraindications due to neurological diseases (40.4%), exudative diathesis (15.9%) and recurrent viral infections (16.2%). Medical objections to immunization without sufficient grounds constituted 12.1% of all contraindications; among such objections those given by neuropathologists (9.8%) and pediatricians (2.3%) prevailed. To increase the coverage of children by immunization in the specified terms, the use of such measures as improving work with parents (explaining to them the importance of timely prophylactic immunization) and strict observance of instructions on medical contraindications may be considered most effective.