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In response to the outbreak, public health officials worked over a two-year period to identify cases and contacts, provide education, and ensure opportunities for vaccination of close contacts to cases and vulnerable populations. Nurses took vaccines into homeless camps and set up clinics in jails, emergency departments, syringe exchange programs, drug treatment facilities, and homeless shelters. First deaths due to hepatitis A outbreak.

The purpose of this study was to contrast vaccination rates of Utah children continuously enrolled in a private insurance with statewide vaccination rates by utilizing claims data to track the age at which children received vaccines and compare this information with the recommended vaccine schedule of 4-3-1-3-3 (four doses of diphtheria, tetanus, and pertussis vaccine; three doses of polio vaccine; one or more doses of measles, mumps, and rubella vaccine; three doses of Haemophilus influenzae type b vaccine; and three doses of hepatitis B vaccine). The vaccination histories of 3,577 children were reviewed for completeness of the 4-3-1-3-3 vaccine schedule by the age of 2 years. Well-child visits are traditionally used to administer vaccines. This study evaluated compliance with the recommended schedule of well-child visits, according to the American Academy of Pediatrics, compared with the receipt of the 4-3-1-3-3 vaccine schedule by the age of 2 years. This study also examined Deseret Mutual Benefits Administrators (DMBA) claims data to evaluate the rate of attendance of the recommended well-child visits according to the American Academy of Pediatrics schedule during the first 2 years of life and the receipt of recommended childhood vaccines. The study included 3,558 children continuously enrolled in the DMBA from birth through a minimum of 2 years. Four hundred thirty-one (12%) children received the 4-3-1-3-3 series of vaccines by the age of 2 years. However, when a 4-2-1-3-3 series was used, the number of 2-year-olds adequately immunized was 1,905 (53.3%). The reason for this difference in vaccine adequacy is that the hospital-administered dose of hepatitis B is not included in the claims data of most children in the cohort. Four hundred thirty-three (12.2%) children received all of the eight recommended well-child visits. One thousand three hundred ten (78.3%) children were not up-to-date on vaccines and they had had a nonwell-child visit at which vaccines could have been administered. The study also demonstrated that most children have other nonwell-child visits at which time needed vaccines could be administered. There were 10,838 missed opportunities for vaccines. Each child who failed to receive all of the recommended well-child visits and who did not receive all of the recommended vaccines had an average of 8.3 \"other\" visits at which vaccines could have been administered.

Liverpool hardly springs to mind as the Garden of England, but this summer's International Garden Festival aims to put it on the tourist map and give its ailing economy a shot in the arm.

Pleasant pocket gardens are a delightful alternative to the great parks. Audrey Stevenson leads us to leafy discoveries

For those who'd like to learn a little, the choice ranges from hearty spadework to leisurely appreciation