Transmission of TB, particularly among high-risk groups, may go undetected for years. Our investigation demonstrated the value of universal genotyping in revealing unsuspected recent TB transmission and previously unrecognized sites of transmission, which can be targeted for specific TB interventions.

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ABSTRACT. Objective. To determine hepatitis A vaccination coverage and factors associated with not receiving hepatitis A vaccine among children.Methods. A random cluster sample survey was conducted of parents of children who attended kindergarten in Butte County, California, in 2000. Because of a history of recurrent epidemics, an aggressive hepatitis A vaccination program was ongoing during the time this study was conducted. Receipt of 1 or 2 doses of hepatitis A vaccine was studied.Results. Of 896 surveys sent, 648 (72%) were completed. The vaccination coverage for at least 1 dose of hepatitis A vaccine was 398 (62%) and for 2 doses was 272 (42%). Factors associated with not receiving the vaccine included lack of provider recommendation (vs having recommendation; odds ratio [OR]: 7.8; 95% confidence interval [CI]: 4.9 -12.2), not having heard of the vaccine (OR: 2.4; 95% CI: 1.2-4.9), and parent's not perceiving child is likely to get hepatitis A (vs perceiving child might get disease; OR: 2.1; CI: 1.6 -2.9).Conclusions. Vaccination coverage among kindergartners did not reach high levels (ie, >90%), despite aggressive vaccination efforts in this community. Lack of provider recommendation and lack of parental awareness of hepatitis A vaccine were the 2 most significant factors associated with failure to receive vaccine. These findings will facilitate the development of vaccination strategies for communities in which hepatitis A vaccination is recommended. unpublished data, 2002). Because of clinically unrecognized or asymptomatic infections, especially among children, the number of infections may be up to 10 times higher. 1 Because children account for at least one third of cases and also are a potential source of infection for others, routine vaccination of children is likely to be an effective way to reduce hepatitis A incidence. 2 In October 1999, the Advisory Committee on Immunization Practices (ACIP) updated recommendations for hepatitis A vaccination to include routine vaccination of children age Ն2 years in states, counties, and communities with hepatitis A incidence rates that were at least twice the 1987-1997 national average (Ն20 cases per 100 000 population). 2 Over time, this strategy has the potential to substantially lower disease incidence and possibly eliminate indigenous transmission of hepatitis A virus. 3 Butte County is located in the Sacramento Valley of northern California and had an estimated population in 2000 of 207 000. The county has had recurrent outbreaks since hepatitis A became reportable in 1966 and meets the ACIP's criteria for routine childhood hepatitis A vaccination. 4 During 1987-1997, the average annual hepatitis A incidence rate was 45.3 per 100 000 (CDC, unpublished data, 2001).From January 1995 through December 2000, a demonstration project was implemented in Butte County to assess the impact of routine vaccination of children on disease incidence over time. Hepatitis A vaccine was made widely available free of charge to children aged 2 to 12 years in 1995 and to succes...