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Despite a high-compliance school girl rubella immunization program since 1973 and a program for the immunization of women of childbearing age since 1980, sporadic cases of the congenital rubella syndrome (CRS) continue to occur in Israel, particularly following rubella epidemics. At highest risk for a child with CRS are unimmunized Arab women and immigrants from Ethiopia, although CRS has also occurred in infants of immunized non-immigrant women. In order to make progress towards the elimination of congenital rubella, the Israel Ministry of Health has incorporated into its rubella immunization program the intermediate goal of interrupting endemic rubella transmission in the country. To this end, universal rubella vaccination at age one began in 1989, a second dose at age six years was introduced in 1994, inclusion of boys in the program aimed at 12-year-olds began in late 1995, and catch-up campaigns to immunize never-immunized children, boys and girls, are planned. Moreover, women of childbearing age will be encouraged to receive a second dose of rubella vaccine. While the WHO goal of no indigenous CRS by the year 2000 will not be met, it is expected that in the coming decade substantial additional progress towards the elimination of CRS will be made.
We studied the immunization of hepatitis B vaccine integrated with of EPI. 180 children (0-9 months of age) from three towns of Shunde County were randomly divided in to three groups (two trial groups and one control group). Which were vaccinated by three different immunization schedule. The serum antibodies to different vaccines were measured before and after immunization. The results show that the seroconversion rate and GMT of each EPI vaccine are conformed with the expected EPI indexes. The seroconversion rate of anti-HBs antibody is found no significantly different among the three groups. The titres of pertussis agglutinating and three types polio neutralizing antibody is higher in trial groups than that in the control group. We conclude that the immunization of hepatitis B vaccine can be integrated into the EPI schedule. And third dose of hepatitis B vaccine can be simultaneously given with measles vaccine.
This study provides a comparative cost-effectiveness analysis of three universal immunization programs for hepatitis B virus (HBV). Using three theoretical cohorts of infants, 10-year-olds, and 12-year-olds, a universal immunization program was compared with a prenatal screening/newborn immunization program involving testing of prepartum women and immunization of newborns of HBsAg-positive mothers. A Markov long-term outcome model used Manitoba data to estimate costs and health outcomes across the lifespan. The model was based on an HBV incidence rate of 19/100,000 and a discount rate of 5% and incorporated the most recent treatment advances (interferon therapy). Cost-effectiveness was calculated as the ratio of dollars spent per year of life saved, with costs determined from the perspective of a third-party payer. The universal infant-immunization program, although not cost-saving, was associated with a low, economically attractive cost-effectiveness ratio of $15,900 (Canadian) per year of life saved, a figure substantially lower than the ratios of $97,600 and $184,800 (Canadian) associated with the universal programs for 10- and 12-year-olds, respectively. Cost-effectiveness ratios were found to be sensitive to changes in immunization costs, HBV incidence rates, and the rate at which protective antibody levels are lost over time: If these variables move in the directions suggested by current trends, the authors anticipate an increasing economic appeal of universal programs well into the future. A universal program of HBV immunization for infants appears to be economically practical in regions where HBV infection rates are low and stable.
In 1992, because of the limitations of the one-dose measles immunization program, the National Advisory Committee on Immunization (NACI) recommended a two-dose measles immunization program to eliminate measles. More recently, NACI recommended also a special catch-up program to prevent predicted measles outbreaks and to achieve an earlier elimination of measles. The objective of this study was to complete a benefit-cost analysis of a two-dose immunization program with and without a mass catch-up compaign compared with the current one-dose program. The resulting benefit: cost ratios vary between 2.61:1 and 4.31:1 depending on the strategy used and the age of the children targeted. Given the parameters established for this analysis, the benefits of a second-dose vaccination program against measles far outweight the costs of such a program under all scenarios.
Since the introduction of the Austrian TBE (tick-borne encephalitis) vaccination program in 1981 immunization coverage of children has not been investigated sufficiently. We investigated the influence of geographic and sociodemographic factors on the immunization coverage of school children in order to identify subpopulations with low immunization coverage. To this end a representative cross-sectional study was carried out in the county of Styria, Austria. The target population were children in the first, fourth and seventh year of school education. Therefore, the sample consisting of 3,196 children was divided into three age groups. children aged around 7, 10 and 13 years. The information concerning the immunization status of each child was recorded by means of an anonymous questionnaire given to parents by the classroom teachers on advice of the supervisory school authority. This procedure ensured the high overall response rate of 85.0%. The prevalence of at least one TBE vaccination was 91.4% for the 7 year old, 97.3% for the 10 and 97.1% for the 13 year old. The prevalence of basic TBE immunization was 84.0%, 91.7% and 92.3% resp. The lowest vaccination rates were found in families with four or more children and for those children who had mothers of the lowest educational level. Thus, for the future management of immunization programs it is crucial to put special emphasis on the identified population groups with deficient immunization coverage. The overall vaccination rates can be judged as satisfactory in the 13 year old children.
We have tested an immune monitoring program consisting of cytofluorometric analysis of lymphocytic and monocytic markers, using a set of different monoclonal antibodies (mAb), in about 500 transplant patients including about 300 long-term renal allograft recipients. The high sensitivity (95%) of these cytofluorometric analyses in the peripheral blood allows to discriminate between acute rejection and other causes of deteriorated kidney transplant function (infection, toxicity, arteriopathy), especially in the late phase (> 1 year) after transplantation. Additionally, the immune monitoring is sufficient to predict success of antirejection therapy as early as a few days after onset of treatment. A life-threatening complication in allograft recipients is septic disease. Proceeding from immune parameters, septic patients were found to fall into two categories: those with decreased expression of HLA-DR on monocytes (< 20%, termed as 'immunoparalysis') and patients with nearly normal HLA-DR+ monocytes. Septic immunoparalysis requires drastic reduction of immunosuppression (mortality after drastic reduction: 8%; after marginal reduction or without reduction: 90%). We have not observed severe rejection as a consequence of reduced immunosuppression in such patients. Our immune monitoring seems to be useful for management of immunosuppression in patients with unclear deterioration in graft function as well as patients with septic complications in order to minimize two risks, i.e. death by sepsis or loss of graft.
For a single year, 1983, we compared the actual and estimated morbidity, mortality, and costs attributable to measles, mumps, and rubella with having or not having a childhood immunization program using the combined measles-mumps-rubella (MMR) vaccine. Without an immunization program, an estimated 3,325,000 cases of measles would occur as compared to 2,872 actual cases in 1983 with a program. Instead of an expected 1.5 million rubella cases annually, there were only 3,816 actual cases. Mumps cases were lowered from an expected 2.1 million to 32,850 actual cases. Comparable reductions in disease-associated complications, sequelae, and deaths are gained with an immunization program. Without a vaccination program, disease costs would have been almost $1.4 billion. Based on the actual incidence of disease in 1983, costs were estimated to be approximately +14.5 million. Expenditures for immunization, including vaccine administration costs and the costs associated with vaccine reactions, totaled $96 million. The resulting benefit-cost ratio for the MMR immunization program is approximately 14:1. The savings realized due to the use of combination rather than single antigen vaccine total nearly $60 million.
In 1978 to 1979, the General Medicine Clinic (GMC) immunization program at the University of Chicago immunized 54% of 1,543 high-risk patients with influenza vaccine. In 1979 to 1980, 45% of 1,462 high-risk patients were immunized, including 72% of the patients who had been immunized the year before. Many patients who were immunized were initially undecided or did not want the vaccine. In 1978 to 1980, pneumococcal vaccine was given to 784 GMC patients, including 24% of 2,229 high-risk patients seen at least once during the two immunization program periods. Twenty-two patients (2.8%) were inadvertently reimmunized. The GMC programs were approximately seven to ten times more effective in immunizing patients than were physicians in medical subspecialty clinics without such programs. Since many patients hospitalized with influenza and pneumonia have recently received care in hospitals, organized programs for immunization in hospitals could make a substantial contribution to the prevention of these diseases.
In summary, tremendous advances have been made over the past 15 years toward the development of effective national immunization programs throughout the world. Immunization levels among children in the developing world have risen dramatically, and in some instances, now equal or exceed levels in industrialized nations. There is no room for complacency, however, because millions of children remain incompletely immunized and many die each year from measles, pertussis, and neonatal tetanus. Immunization activities need to be intensified, accelerated, and sustained within the context of the primary health care system. Expansion of immunization programs to include additional vaccines and other simple health interventions will yield further benefits in the years ahead.
At the Duke University Medical Center, Durham, NC, there are approximately ten recognized hepatitis B virus (HBV) infections per year in employees. The hospital's hepatitis control program costs $91,995 per year, including costs for workman's compensation, hyperimmune globulin, laboratory tests, lost revenue, liability, personnel, and medical treatment. A program to immunize high-risk medical center personnel and to accommodate residual HBV problems in nonimmunized employees would cost $206,304 in the first year. By seven years the cumulative costs of an immunization program would equal those without a program and at ten years would be cost saving ($746,742 with program v $919,950 without a program). Given certain assumptions, HBV vaccine is a cost-beneficial alternative for a major employee health hazard.
The survival and well-being of children is identified as the primary frontier of international health. In this regard, 1990 is identified as the most historic year ever in world history for children, and the achievements of the Universal Child Immunization program in immunizing 80% of children of the Third World under one year of age by December 1990 and the Convention on the Rights of the Child and the World Summit for Children are cited. The importance of the world community exercising its capacity to act on a common problem together, of the health services taking on a much stronger social purpose, and of the tireless and dedicated spirits in these efforts is stressed as essential for making a much better world for children in the centuries to come.
The Immunization Division of Texas Public Health Region 5 sought to measure the per cent of referrals taking immunization action as a result of service aide contact. From data collected on newborn-nonresponders during a 12-month period, results show that aides may be credited with influencing 44 percent of the referrals reporting subsequent immunization.
The relationship between the socio-cultural characteristics of a population and their participation in immunization programs is described in this paper. An anthropological approach was utilized to study the reasons why certain population groups do not participate in the immunization programs or do so inadequately. The study was undertaken in a community south of Mexico City. The paper contains the description of the community's contextual elements, the organization of the medical care services and the participation of the population in the immunization programs. It was found that a wide millieu of socio-cultural factors are related with people's behavior toward vaccination, such as: lack of information about diseases and vaccines, lack of trust on modern health services, and the strong influence of traditional medicine. Clear implications can be derived from the analysis with regards to the need for revision and modification of strategies of the health education programs, in order to promote a wider participation in immunization programs.
BACKGROUND: Despite the proven efficacy of the influenza vaccine in reducing the risk for pneumonia, hospitalization, and death and the potential savings in costs, most elderly persons do not receive annual immunizations. The study tested the influence of health care delivery system characteristics and individual personal values on the influenza immunization status. METHODS: The study involved a secondary data analysis based on the results of a mailed survey of 3,362 seniors 65 years of age and older enrolled in HealthPartners, a mixed-model health maintenance organization in Minnesota. The three care delivery systems in which respondents were enrolled varied in the intensity and consistency with which they addressed immunization. RESULTS: The immunization rate for this population (77.1%) was higher than the state rate (64%). After controlling for many variables historically known to influence the likelihood of immunization, both care delivery system characteristics and personal values remained significantly associated with immunization status. Elderly individuals getting care in delivery systems with well-developed immunization programs were more likely to be immunized. Those who avoided going to the physician and who practiced risky behaviors such as smoking were less likely to be immunized, regardless of the care delivery system they were enrolled in. DISCUSSION: Managed care can provide a number of system improvements to assist in meeting national health care objectives such as influenza immunization for the elderly. It has reduced some common barriers to immunization, such as cost and access. Yet to achieve the full benefits of a successful influenza immunization program, the role of individual values, as well as implementing systems solutions, needs to be addressed.
In order to update our information concerning immunization coverage in Switzerland we analysed data from the public school immunization program of the canton of Aargau between 1988-90. We compared these results with those of two districts from the school year 1993-94. 97% of all the matriculating or graduating school children could be reached. As expected, the immunization rates of 98% for poliomyelitis and 96% for diphtheria/tetanus were high. Following initiation of the nationwide MMR (Measles/Mumps/Rubella) Immunization Program in 1987, coverage of preschool children with the MMR-vaccination could be improved from 44% in the late 1980's to 70-80% in the early 1990's. As a result of offering the vaccine free of charge to all matriculating and graduating children, the MMR-immunization rate could be increased to 90-94%, and the measles immunization rate even further to 97% indicating the importance of the school immunization program. This high level of acceptance in Aargau shows that an increase in the immunization rate even in infant and preschool children can be realised, if the pediatricians and the general practitioners improve their efforts. In regions with similar epidemiological conditions MMR-reimmunization in school children is to be recommended.
Measles in tropical Africa is endemic and cyclical, with a high incidence that usually peaks during the dry seasons. Measles may be a contributing factor in 10% of all deaths among African children. Several problems have hindered measles immunization programs in Africa; these include difficulties in maintaining the cold chain, poor epidemiologic surveillance, and the logistical problems involved in reaching a population that is 80% rural. The United States Agency for International Development and the World Health Organization both have programs that are helping to increase immunization coverage and to solve the problems just mentioned. Many countries have begun to train their own personnel to administer immunization programs. However, because of limited staff and equipment, a high birth rate, and an uncertain social situation, no firm predictions can be made concerning the permanent control of measles in tropical Africa.
Analysis of 1,068 immunization records was carried out to assess the degree of compliance with the expanded program on immunization (EPI) schedule in King Khalid University Hospital. The overall compliance was found to be 66%, whereas individual vaccine compliance ranged between 28% to 88%. These results show that the EPI schedule is not strictly followed in this institution. A modification of the EPI schedule and the consideration of other strategies are suggested to achieve 100% coverage by 1990.