These data support the current second routine measles immunisation prior to school entry, and reinforce the need to promote the first routine dose to achieve measles elimination.

Objective To examine the anamnestic response to hepatitis B vaccine in previously vaccinated subjects. Design Subjects who had received a course of hepatitis B vaccine at least two years previously had a sample of blood taken before and seven days after a low‐dose booster of hepatitis B vaccine. Setting and participants A pilot group of laboratory scientists in the Microbiological Diagnostic Unit; fifth year medical students, University of Melbourne; and a group of ambulance officers from the Geelong Ambulance Depot (Victoria). All participants volunteered after having been informed of the study. Outcome measures Serum levels of antibody to hepatitis B surface antigen (HBsAg) were measured before and after the booster dose of vaccine and, when available, in serum taken a month after the end of the primary course of vaccine, and the changes in antibody level were studied. Results Although some individuals with a restricted antibody response were identified, most showed a quick response. There was limited evidence that this rise peaked early and began to fall within weeks. Conclusions In many subjects, levels of antibody to HBsAg peak early after booster doses of vaccine but the rapid anamnestic response to small amounts of antigen make it probable that effective protection from symptomatic Illness may be long lasting, when there has been a satisfactory primary response. This provides an argument for testing for adequate seroconversion after vaccination.

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From the start of clinical testing for human immunodeficiency virus (HlV) antibody in 1985 until the end ofJune 1994, the Microbiological Diagnostic Unit tested 134 346 serum samples from 109 391 individuals, identifymg 672 as infected. A suitable database, using coded identities, was established from the beginning. Because the sera came from a variety of clinical settings, it was possible to extract information about patterns of requests for tests and about the yield of seropositive cases. The data were able to highlight factors associated with high. rates of positive tests that can be lost in amalgamated statewide data. The discovery of HIV-positive females was sporadic and there was a much lower detection rate than from testing males. While males were most commonly diagnosed through specialist venereology services, 61 per cent of diagnoses in females were through nonspecialised practices, often those without previous experience in diagnosis and management of HIV infection. Despite some individual exceptions, the requesting of HIV tests appears generally to have been justifiable (particularly in view of the direction of official preventive campaigns) and not profligate. Overall, where practice was unsatisfactory, this lay less in thoughtless ordering of tests than in failing to include with the specimen the elementary, but vital, epidemiological information requested. able on the standard request forms was established and has been maintained since. Although the labe ratory serviced a changing clinical practice base in the first decade of HIV testing, for all of the period covered here it performed HIV tests for Pentridge Prison and the major metropolitan public sexually transmitted diseases clinic, now named the Melbourne Sexual Health Centre. From 1987, the population being tested became more diverse, with the laboratory receiving specimens from a major private pathology practice with a significant market share. In 1989, another large private pathology

Objective To determine whether intradermal hepatitis B vaccination is an effective procedure. Design A study of antibody responses to hepatitis B vaccine in 753 medical students. Setting Routine vaccination of medical students with intradermal doses of hepatitis B vaccines of various origins. Outcome measures Rates of seroconversion and geometric mean levels of antibody achieved. Results Seroconversion rates, indicated by antibody to hepatitis B surface antigen (anti‐HBs) levels of 10 mIU/mL or more, varied between 82% and 94.7% with different preparations of the vaccine. With a four‐dose intradermal schedule over two successive cohorts, Engerix‐B (SmithKline Beecham) gave better responses, in this context, than H‐B‐Vax II (Merck Sharp & Dohme). Any reactions to the vaccination were mild and local. Conclusion The intradermal route is a practical method of vaccination against hepatitis B in healthy young adults when the cost of the vaccine is an inhibiting factor.