CDC Reports on Vaccination Coverage of Children Entering School

One of the nation's health goals for 2010 is to have 95 percent or higher vaccination coverage of kindergarten and first grade children for the following vaccines: hepatitis B; diphtheria and tetanus toxoids and pertussis (DTP); diphtheria and tetanus toxoids and acellular pertussis (DTaP); diphtheria-tetanus (DT); poliovirus; measles, mumps, and rubella (MMR); and varicella. The Centers for Disease Control and Prevention (CDC) analyzed data from 48 states and the District of Columbia for the 2005–2006 school year to determine vaccination rates among children entering school. The analysis was published in the October 20, 2006, issue of Morbidity and Mortality Weekly Report and can be found at http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5541a3.htm.

All states (except Wyoming and Illinois) and the District of Columbia submitted assessments based on public schools; 47 also included private schools, and 17 included home schools. Various methods were used to report vaccination coverage. Because of varied vaccination timing and local requirements, the CDC evaluated the up-to-date status of vaccinations rather than the number of doses received at the time data were collected.

Thirty-six states and the District of Columbia (71 percent) reported a 90 percent or higher coverage rate for the newest recommended vaccine (varicella), with 29 of those states reporting a 95 percent or higher rate. MMR and hepatitis vaccines had a 95 percent or higher coverage rate in 31 states (61 percent), and DTP, DTaP, and DT vaccines had a 95 percent or higher coverage rate in 34 states (67 percent).

More than one half of the states that participated in the study have already achieved the goal of 95 percent or higher vaccination coverage, and those that have not appear to be making steps in that direction. However, these data may be over- or underestimated because reporting methods and vaccination requirements varied from state to state.

ACOG Releases Opinion on Inducing Labor for VBAC

There is a continued debate regarding whether the induction of labor with or without prostaglandins increases the risk of uterine rupture during labor. For this reason, a committee of the American College of Obstetricians and Gynecologists (ACOG) has released an updated opinion on inducing labor for vaginal birth after cesarean delivery (VBAC). The statement was published in the August 2006 issue of Obstetrics & Gynecology.

Several studies have shown an increased risk of uterine rupture after induction of labor in women who have had a previous cesarean delivery. One population-based retrospective cohort study of more than 20,000 women who had a previous cesarean delivery found that the rate of uterine rupture was 0.16 percent in those who had another cesarean delivery, 0.52 percent in those who had spontaneous labor, 0.77 percent in those with induction of labor without prostaglandins, and 2.4 percent in those with induction of labor with prostaglandins. Two larger trials of women with previous cesarean delivery found that uterine rupture was more likely to occur when labor was augmented or induced. Several studies also found that the uterine rupture rate was significantly lower in women who had successful trials of labor compared with those who had failed trials of labor (0.01 percent and 2.0 to 2.3 percent, respectively).

A review of these studies indicates that rates of uterine rupture are increased when labor is induced and prostaglandins and oxytocin (Pitocin) are used. However, the most consistently increased rates of uterine rupture occur in failed trials of labor. Labor induction is a reasonable option, and it may be necessary in patients with VBAC. By choosing women who are most likely to give birth vaginally and avoiding the repeated use of prostaglandins and oxytocin, risk of uterine rupture can be reduced. Still, the risk of uterine rupture should be discussed with the patient and documented in the medical record.