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PubMed1992

Impact of national immunization schedule on vaccine preventable diseases: a hospital based study.

An analysis of vaccine preventable diseases (VPD) in two block years, i.e., 1972-1975 and 1986-1989 showed an overall decline in morbidity and mortality. Improvement in morbidity was most noticeable in typhoid fever followed by polio and tetanus. However, in tuberculosis and measles with compilations, there was a significant increase in admission rates 3.8 vs 4.4% and 1.8 vs 2.2%, respectively. Mortality in vaccine preventable diseases except polio has declined significantly.

Child↗
PubMed1996

Cost-effectiveness of incorporating inactivated poliovirus vaccine into the routine childhood immunization schedule.

OBJECTIVE: To evaluate the economic consequences of introducing inactivated poliovirus vaccine (IPV) into the routine vaccination schedule in the United States to reduce vaccine-associated paralytic poliomyelitis (VAPP). DESIGN: Cost-benefit and cost-effectiveness models were formulated to compare the current national 4-dose live attenuated oral poliovirus vaccine (OPV) schedule with a 4-dose IPV schedule or a sequential schedule of 2 doses of IPV followed by 2 doses of OPV. Model assumptions were derived from the National Health Interview Survey (1994), current prices for OPV and IPV, a Delphi panel, compensatory awards by the National Vaccine Injury Compensation Program, and published and unpublished reports. MAIN OUTCOME MEASURES: Annual societal incremental cost relative to the current schedule for the cost-benefit model; cost per VAPP case prevented for the cost-effectiveness model. RESULTS: Changing to an IPV-only or a sequential schedule would cost $28.1 million and $14.7 million, respectively. The costs per case of VAPP prevented were estimated as $3.0 million and $3.1 million for each option, respectively. Outcomes were most sensitive to the number of additional visits that may occur to avoid multiple injections. CONCLUSIONS: The introduction of IPV into the routine vaccination schedule would not be cost-beneficial at current vaccine prices and with the current compensation awards paid to VAPP cases. The analysis provides a range of costs that policymakers need to consider if they wish to prevent VAPP. Although these costs are higher than those of other public health prevention programs, they may be justified because VAPP continues to occur as a result of government-mandated vaccination policies in the absence of known wild poliovirus transmission in the United States.

Child↗
PubMed1976

Immunization schedules for the new human diploid cell vaccine against rabies.

Clinical and antibody responses of human volunteers to four different serial production lots of human diploid cell vaccine (HDCV) each with a different antigenic value are described. Three to four doses of HDCV administered over a period of 14 days produced high levels of virus neutralizing antibodies with an average titer up to 20 times higher than the titer elicited by four doses of duck embryo vaccine. Antibodies were still present one year after completion of vaccination. Only minimal differences in antibody response could be observed between groups receiving vaccines of different antigenic values. Untoward reactions to the vaccine were few. The possibility of using the vaccine as part of postexposure human prophylaxis against rabies is discussed.

Animals↗
PubMed1993

Serological evaluation of a simplified immunization schedule using quadruple DPT-polio vaccine in Burkina Faso.

The immunogenicity of quadruple DPT-polio vaccine used in a two-dose regimen was investigated in a cross-sectional serological survey involving 355 children under 5 years of age. This schedule is currently applied in the EPI programme in three provinces in Burkina Faso, West Africa. It was found that two doses of quadruple DPT-polio vaccine induced antibodies at protective levels to diphtheria and tetanus toxin, and to the three types of polioviruses in over 90% of 179 children. The persistence of antibodies to tetanus and polioviruses is good, since over 90% of the children studied still had antibodies more than 2 years after their last vaccination. The antibodies to diphtheria toxin tend to decline in the first 6 months after vaccination, which is not uncommon. However, our data indicate clearly that a very high percentage (98%) of children have been primed to diphtheria toxin. Of 176 non-vaccinated children, up to 25% of the older ones had antibodies to polioviruses, most of them only to one type. This appears to be a sensitive parameter for the circulation of wild polioviruses in the environment. As the vaccination coverage in the study area was low (< 60%), it was to be expected that the circulation of polioviruses in the community could not be interrupted. The present study demonstrates the applicability of a two-dose strategy for primary immunization with a quadruple DPT-polio vaccine especially for poliovirus components and the toxoids. To induce pertussis immunity, however, a third vaccination is recommended.

Antibodies, Bacterial↗
PubMed1977

[Utilization of the MVA-immunization schedule from the view point of the public health service].

The world-wide smallpox eradication program sponsored by the WHO has been successful. Furthermore the legislation regarding smallpox vaccination in the Federal Republic of Germany has been given a new form. The place of the previous mass-vaccination has been taken by vaccination of individuals. Under this aspect safe procedures for vaccination are required. Any vaccination used by Public Health Service has to fulfill the following criteria: High protection against the disease without adverse side-effects or risks; it should be simple to administer and applicable under ordinary circumstances. For primary vaccination against smallpox the MVA-vaccination meets these demands entirely. It is reported about own experiences with 700 vaccinations using the attenuated virus "MVA"; complete documentation is given. Not a single complication nor any adverse side-effects have been seen. The Public Health Service has gained great experience in the field of vaccination. It is responsible for the protection of the individual as well as the public, as it is undesirable that there develops and unvaccinated group within the population. The individual claim a complete protection through vaccination which should be absolutely free of any risk.

Adolescent↗
PubMed1996

Expanded programme on immunization (EPI). Immunization schedules in the WHO eastern Mediterranean region, 1995.

There are 23 countries/areas in this Region (Tables 1-3). BCG is used in all but 3 countries (Cyprus, Jordan and Lebanon). Most countries/areas give BCG vaccine at birth, 2 countries (Bahrain and Tunisia) schedule additional doses at school age and Kuwait uses 1 dose at the age of 3 1/2-4 years. Diphtheria-pertussis-tetanus (DPT) vaccine is used as a primary series of 3 doses in all countries/areas. Fifteen countries/areas use a fourth dose of DPT vaccine in the second year of age or later (Bahrain, Cyprus, Egypt, Iran [Islamic Republic of], Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Tunisia, and the United Arab Emirates, the United Nations Relief and Works Agency for Palestine Refugees in the Near East [UNRWA]). Six countries use 5 doses of DPT vaccine, the fifth dose being given at the age of 4-6 years (Bahrain, Cyprus, Iran [Islamic Republic of], Kuwait, Qatar, and Saudi Arabia). One or 2 booster doses of diphtheria-tetanus (DT) vaccine are used in 9 countries/areas from the age of 6-12 years. Td vaccine is used as a booster in Bahrain and Cyprus. Oral poliovirus vaccine (OPV) is used in a primary series of 3 doses simultaneously with DPT vaccine in all countries/areas. Ten countries/areas use an additional dose of OPV at birth (Djibouti, Iran [Islamic Republic of], Iraq, Kuwait, Libyan Arab Jamahiriya, Morocco, Oman, Pakistan, Syrian Arab Republic, and UNRWA). An additional dose of OPV in the second year of life is used in 15 countries, and additional doses of OPV are recommended in some countries. In UNRWA, the first 2 doses of OPV 2 and 3 months of age are given simultaneously with the inactivated poliovirus vaccine (IPV). Measles vaccine is given in most countries/areas at 9-12 months of age, usually in the form of monovalent measles vaccine. The 2-dose policy is implemented in 12 countries. In 8 countries, the second dose is given as measles-mumps-rubella (MMR) vaccine, and in 3 countries as monovalent measles vaccine. The age for the second dose varies. In 10 countries, it is given at 12-15 months of age, and in the Libyan Arab Jamahiriya at 18 months of age. The United Arab Emirates uses 3 doses. Rubella vaccine is scheduled for girls of 12-13 years of age in Bahrain, the United Arab Emirates and UNRWA and for boys and girls in Kuwait at 12 years of age. Hepatitis B vaccine is used in 15 countries/areas. All these countries use 3 primary doses of vaccine in infancy. The immunization time varies from birth (12 countries/areas) to 9 months of age. In Cyprus, hepatitis B vaccine is used in a 4-dose schedule, including a booster dose given to 5 to 6-year-old children. Tetanus toxoid is used for pregnant or non-pregnant women of childbearing age. It is also given to school-children in the Islamic Republic of Iran. The schedule includes 2-5 doses.

Child↗
PubMed1998

Comparison of multiple immunization schedules for Haemophilus influenzae type b-conjugate and tetanus toxoid vaccines following bone marrow transplantation.

Antibody concentrations to vaccine-preventable diseases decline following BMT and an optimal schedule for vaccination after transplant has not been established. We examined antibody responses to tetanus toxoid (TT) and Haemophilus influenzae type b-conjugate (HIB) vaccines of BMT patients immunized at 6, 12 and 24 months (6 month group, n = 21) and compared them to those previously reported for patients immunized at 3, 6, 12 and 24 months (3 month group, n = 74) or at 12 and 24 months (12 month group, n = 17) following transplantation. Geometric mean total anti-HIB and IgG anti-TT concentrations were significantly higher after the 12 month dose in the 3 and 6 month immunization groups compared to the group who received their first dose at 12 months. Although HIB antibody concentrations were higher in the 3 month and 6 month groups 12 to 24 months after BMT, the proportion of patients with protective levels was not significantly different from the proportion protected in the 12 month group. Following the 24 month immunizations, geometric mean antibody concentrations to HIB and TT were similar for all three immunization groups. The proportion of patients in each group with protective levels of HIB antibody after the 24 month dose was > or = 80%. A two dose schedule of HIB and TT vaccines at 12 and 24 months after BMT should afford protection.

Adolescent↗
PubMed2000

Policy analysis of the use of hepatitis B, Haemophilus influenzae type b-, Streptococcus pneumoniae-conjugate and rotavirus vaccines in national immunization schedules.

After the development of national vaccine programmes to deliver six vaccines to infants, new vaccine adoption has been limited. Analysis of the health and economic implications of new vaccination options can help national policy-makers. Country specific quantitative policy analyses were conducted to estimate the impact of vaccination against hepatitis B (HB), Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (SP) and rotavirus. Disease burden, programme costs and the potential reduction of disease from vaccination was assessed for each vaccine. Without vaccination, these four vaccine preventable diseases contribute up to 4.1 million deaths in each successive birth cohort. Routine scheduled use of HB and Hib vaccines could prevent up to 1.7 million deaths; SP and rotavirus vaccines, an additional 1.4 million deaths, annually. The global cost per life-year saved ranged from $29 to $150 with great variation by income and economic groups. With a few exceptions for a few countries, these vaccines would cost a fraction of average per-capita gross domestic product to save a life-year. The addition of HB and Hib vaccines, should be considered for integration in all national immunization programmes. SP and rotavirus vaccines, with the given assumptions, would also be cost-effective. Proactive analysis of the economic and epidemiologic impact of these vaccines can hasten their introduction into national vaccination schedules.

Bacterial Vaccines↗
PubMed1992

Determination of the immunization schedule for field trials with the synthetic malaria vaccine SPf 66.

The synthetic malaria vaccine SPf 66 has been shown to be safe, immunogenic and effective in trials performed with controlled groups naturally and experimentally exposed to the disease. In order to continue the trials in open populations, it was necessary to standardize the vaccination characteristics. We have performed four field trials with soldier volunteers with the aim, among others, of defining the number of doses required, the intervals between applications, the protein concentration, and the adjuvant to be used. In these trials, the vaccinated individuals' immune responses were evaluated by assaying anti-SPf 66 antibody titres, in vitro growth inhibition of the P. falciparum parasite, and the vaccinees' capacity to recognize P. falciparum native proteins. From these results we conclude that the best vaccination schedule, for adults, is three doses administered subcutaneously on days 0, 30 and 180, each containing 2 mg of the synthetic polymerized petide SPf 66 adsorbed to alum hydroxide.

Adjuvants, Immunologic↗
PubMed1990

Immunization.

Scheduled immunization is one of the most important ways that individuals can protect themselves and their children from preventable communicable disease. Through diligent public health efforts, diseases that were once considered common have been mostly eradicated, sparing millions from not only the disease themselves, but their potentially devastating after-effects.

Adolescent↗
PubMed1985

Optimization of immunization schedule to standardize antibody response in mice to pertussis vaccines.

The intracerebral challenge test for determining the protective potency of pertussis vaccines has long been in use. In an effort to elucidate what antibodies are responsible for such protection, a study was undertaken to analyse serum antibodies against filamentous hemagglutinin, lymphocytosis promoting factor and agglutinogens. Conventional pertussis vaccines induced antibodies to FHA and agglutinogens in mice whereas no demonstrable antibodies to LPF were stimulated. By toxoiding LPF on cells with 0.4 per cent formaldehyde, preparations were obtained which induced anti-LPF antibodies in mice. This treatment however, resulted in considerable reduction in potency as judged by the intracerebral challenge test. Apparently the protective potency of pertussis vaccines in mice is based on the adjuvant properties of LPF and not its antigenic properties. An optimized schedule is outlined for the laboratory standardization of pertussis vaccines by measuring antibody responses and especially anti-LPF in mice. Highest titers were obtained in mice when the interval between immunization and booster injections was 28 days.

Adjuvants, Immunologic↗
PubMed1995

Coronavirus-induced encephalomyelitis: balance between protection and immune pathology depends on the immunization schedule with spike protein S.

The neurotropic mouse hepatitis virus MHV-JHM induces central nervous system (CNS) demyelination in Lewis rats that pathologically resembles CNS lesions in multiple sclerosis. The mechanisms of MHV-JHM-induced demyelination remain unclear and several studies have implicated the role of the immune response in this process. We have shown previously that protective immunity against MHV-JHM-induced encephalomyelitis was induced by immunization with a vaccinia virus (VV) recombinant expressing MHV-JHM S-protein (VV-S). Here, we present evidence that the time of MHV-JHM challenge after immunization with VV-S plays a critical role in protective immunity. The induction of virus-neutralizing S-protein-specific antibodies prior to the MHV-JHM challenge modulates the disease process and a subacute encephalomyelitis based on a persistent virus infection developed. Typical pathological alterations were lesions of inflammatory demyelination. In addition, the results indicate that after seroconversion, CD8+ T cells were no longer essential for virus elimination in contrast to their role in protection during acute encephalomyelitis.

Animals↗
PubMed1999

[Immunization schedule: dynamics and updating]

OBJECTIVES: The objective of this article is to make an analysis of the dynamics of the imunization schedule and an updating of the practical aspects of the vaccination. METHODS: The authors, based on the official recommendations, in the imunization schedule of the Infectology Department of the Brazilian Society of Pediatrics and on their experience, present practical aspects to facilitate the understanding of the dynamics of application of the calendar. RESULTS: The current calendar of the Brazilian Society of Pediatrics (SBP) is presented with a practical analysis of the vaccines BCG, hepatitis B, poliomyelitis, Haemophilus influenzae type b (Hib), DPT and triple viral, which are also part of the Calendar of the National Program of Immunizations. Besides this, they analyze two other suitable vaccines for SBP, against varicella and hepatitis A. Finally they comment on the risk of urbanization of the yellow fever and the increasing indication of vaccination against this disease in Brazil. CONCLUSIONS: The imunization schedule should be dynamic, adapted to the epidemiologic characteristics of each country or place. The presented calendar is what is now recommended by the Infectology Department of the Brazilian Society of Pediatrics (SBP).

Journal Article↗
PubMed2006

Absence of detectable measles virus genome sequence in blood of autistic children who have had their MMR vaccination during the routine childhood immunization schedule of UK.

Leukocyte preparations from children with documented evidence of MMR vaccination and confirmed diagnosis of autism were examined by several assays designed to target multiple regions of the measles virus genome sequence. No sample was found positive by any method. The assays applied were highly sensitive, specific and robust in nature, and were based on the amplification of measles virus RNA transcripts by real-time quantitative RT-PCR (QRT-PCR) as well as by conventional RT-PCR-nested PCR. The assays applied were potentially able to detect measles virus RNA down to single figure copy numbers per reaction. The amount of total nucleic acid extract of leukocytes subjected to various measles virus-specific investigations was several fold higher than minimally required of a sample where measles virus persistence is well documented. This study failed to substantiate reports of the persistence of measles virus in autistic children with development regression.

Adolescent↗