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Biomedical subjects

C J Clements

Publications and source records attributed to C J Clements.

13 recordsLinked to original sources
PubMed1992

The epidemiology of measles.

Measles is a highly infectious disease which has a major impact on child survival, particularly in developing countries. The importance of understanding the epidemiology of this disease is underlined by its ability to change rapidly in the face of increasing immunization coverage. Much is still to be learned about its epidemiology and the best strategies for administering measles vaccines. However, it is clear that tremendous progress can be made in preventing death and disease from measles with existing knowledge about the disease, and by using the presently available vaccines and applying well-tried methods of treating cases. Research in the coming decade may provide more effective vaccines for use in immunization programmes. An understanding of the basic epidemiology of measles is a prerequisite for effective control measures.

Child, Preschool↗
PubMed1991

Principles of measles control.

WHO's Expanded Programme on Immunization has significantly helped to reduce global morbidity and mortality from measles. Recently, some African countries with high vaccine coverage levels have reported measles outbreaks in children above the current target age group for immunization. Outbreaks such as these are to be expected, unless close to 100% of the population are immunized with a vaccine which is 100% effective. Success of an immunization programme requires identification of the distribution and ages of susceptible children and reduction of their concentration throughout the community. Priority should be given to urban and densely populated rural areas. In large urban areas, high coverage of infants must be achieved soon after the age at which they lose their maternal antibodies and become susceptible. This will be facilitated by the introduction of high-dose measles vaccines which can be given at 6 months of age. Where measles incidence is increasing among children aged over 2 years, immunization of older children may be considered during contacts with the health care system, or at primary school entry, if this does not divert resources from immunization of younger children. Health workers should be informed of the predicted changes in measles epidemiology following immunization. The collection, analysis and use of data on measles (vaccine coverage, morbidity and mortality) should be improved at all levels of the health care system in order to monitor the immunization programme's overall impact, identify pockets of low coverage, and allow early detection of and response to measles outbreaks.

Africa↗
PubMed1990

An anthropological perspective on the acceptability of immunization services.

This review first discusses the relevance of anthropology for Primary Health Care generally and specifically with respect to the acceptability of immunization, and summarizes some of the factors which have been found to be associated with acceptability. It then focuses on the collaboration between anthropologists and bio-medical scientists and on the deployment of anthropological methods for discovering the specific reasons for low acceptability for disparate groups. The review concludes with a cautionary note on the use of social marketing for increasing acceptability.

Anthropology↗
PubMed1989

1988 New Zealand national immunisation survey: methodology.

In 1985 the Department of Health carried out a survey using a two stage stratified random sampling technique to select approximately 3000 children (made up of equal numbers of 5, 10 and 15 year olds). The principal aim was to provide a random sample of sera which could be used or stored for the future to evaluate the national immunisation programme and for screening of an ethical nature. The sampling frame was the 1983 list of public and private schools as provided by the Department of Education. Ninety primary schools and 50 secondary schools were identified, from which 3688 children were asked to participate. There was a 79% consent response rate. The survey largely succeeded in its objective of providing a nationally representative group of children, although the response rate was lower in 5 year olds (74%), in Pacific Islanders (67%), in children from upper socioeconomic status groups (75%), and in children who were reported not to have been immunised (56%). A similar survey is recommended every five years. In the mean time, laboratory analysis of the collected serum samples continues and results will be published separately.

Adolescent↗
PubMed1989

Measles immunization research: a review.

Most global estimates indicate that more than 1 million children a year die from acute measles. The actual number of deaths may, however, be considerably higher than this. In addition, the impact of delayed mortality as a result of measles infection is only now being realized. Many months after they contract measles, children continue to experience higher levels of mortality and morbidity than those who do not. Immunization of children against measles therefore prevents mortality and morbidity not only during the acute phase but also during subsequent months. The impact of measles immunization programmes may therefore have generally been underestimated. The effects of measles infection on children during the early months of life are more damaging than those experienced by older children. Children should therefore be immunized against measles as early in life as possible, given the limitations of existing vaccines.

Child↗
PubMed1988

The 1985 national immunisation survey: hepatitis A.

In April 1985 a national immunisation survey was carried out, during which sera were collected from approximately 3000 randomly selected children throughout New Zealand. The sample comprised approximately equal numbers of new school entrants (mean age 5 years), standard 3 pupils (mean age 10 years) and form 4 students (mean age 15 years). This collection of sera was tested for antibody to hepatitis A virus, a marker of past infection with this virus, by means of a sensitive ELISA test. Prevalence of infection was found to be less than 1% in the 5 year olds, about 3% in the 10 year olds, and about 9% in the 15 year olds. Amongst the 10 and 15 year olds, but not the 5 year olds, Maori children were approximately three times more likely to have been infected than European children. Children resident in the eastern part of the North Island had a higher risk of infection than other children, even after controlling for ethnic distribution.

Adolescent↗
PubMed1987

Human immunodeficiency virus infection and routine childhood immunisation.

Current experience with the safety and efficacy of vaccines in infected children and adults is reviewed to examine the basis for decisions about routine immunisations of children infected with the human immunodeficiency virus (HIV). No adverse reactions to inactivated vaccines have been noted, but complications with live vaccines have been recorded with both BCG and smallpox. Limited experience with live poliomyelitis and measles vaccines in HIV-infected children has not yet shown any severe complications from these vaccines. Theoretical concerns that immunisation might accelerate the course of HIV infection are not supported by available data. Serological response to most inactivated and live vaccines is reduced in HIV-infected persons, and is related to the degree of immunosuppression present. Preliminary evidence suggests that the severity of some vaccine-preventable diseases is increased in HIV-infected children. This review finds general support for recommendations on immunisation of HIV-infected children that have been developed by the World Health Organisation.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Hepatitis B in New Zealand children: the 1985 national immunisation survey.

In April 1985 a national immunisation survey was conducted, in the course of which blood samples were collected from 3000 randomly selected children throughout the country. There were 1000 new school entrants (mean age 5 years), 1000 standard 3 pupils (mean age 10 years), and 1000 form 4 students (mean age 15 years). The sera were tested for hepatitis B surface antigen, antibody to hepatitis B surface antigen, and antibody to hepatitis B core antigen, by ELISA. The prevalence of infection rose with age until by 15 years of age 13.1% of the study population (8.2% of the European and 42.0% of the Maori children) were marker positive. At all ages, Maori children were five times more likely to be positive for any marker, and approximately thirteen times more likely to be positive for antigen (actively infected), than the European children. Even when the data had been standardised for age and race, children resident in the eastern North Island were still almost three times more at risk than children in the South Island. Children in the remaining areas of the North Island were at approximately equal degrees of risk, intermediate between the high and low endemic areas mentioned. We conclude that universal childhood immunisation is necessary to control horizontal transmission of heptatis B virus in New Zealand.

Adolescent↗
PubMed1985

Recommendations for routine cervical screening.

Because of concern about the rising incidence of cervical cancer in young women, the Department of Health and the Cancer Society invited a working group to make recommendations on cervical screening. There is now compelling evidence that cytological screening is an effective preventive measure. All women who have had sexual intercourse should be offered screening. They should be screened as soon as possible after commencing sexual activity, or when first receiving contraceptive advice, antenatal care, or treatment of a sexually transmitted disease. If the first smear is negative, it should thereafter be repeated at least every three years. A special effort must be made to reach women who have never been screened, including those who are middle-aged, or elderly. The cervical smear test should be part of the assessment of women with gynaecological symptoms regardless of whether there has been a negative smear within the previous three years. The three-yearly schedule also does not apply to women who have had an abnormal smear.

Adult↗