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PubMedDate not supplied

Hepatitis B immunization in a low-incidence province of Canada: comparing alternative strategies.

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.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

A benefit-cost analysis of two-dose measles immunization in Canada.

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.

Adolescent↗

PubMed1998

[Representative early summer meningoencephalitis vaccination rates of school children in Styria].

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.

Adolescent↗

PubMed1992

Diagnostic and predictive value of an immune monitoring program for complications after kidney transplantation.

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.

Antibodies, Monoclonal↗

PubMed1985

Benefits, risks and costs of immunization for measles, mumps and rubella.

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.

Adolescent↗

PubMed2000

Calling the shots: immunization finance policies and practices. Executive summary of the report of the Institute of Medicine.

Federal, state, and private-sector investments in vaccine purchases and immunization programs are lagging behind emerging opportunities to reduce the risks of vaccine-preventable disease. Although federal assistance to the states for immunization programs and data collection efforts rapidly expanded in the early part of the 1990s, significant cutbacks have occurred in the last 5 years that have reduced the size of state grant awards by more than 50% from their highest point. During this same period, the vaccine delivery system for children and adults has become more complex and fragmented. This combination of new challenges and reduced resources has led to instability in the public health infrastructure that supports the U. S. immunization system. Many states have reduced the scale of their immunization programs and currently lack adequate strength in areas such as data collection among at-risk populations, strategic planning, program coordination, and assessment of immunization status in communities that are served by multiple health care providers. If unmet immunization needs are not identified and addressed, states will have difficulty in achieving the national goal of 90% coverage by the year 2010 for completion of the childhood immunization series for young children. Furthermore, state and national coverage rates, which reached record levels for vaccines in widespread use (79%, 1998), can be expected to decline and preventable disease outbreaks may occur as a result, particularly among persons who are vulnerable to vaccine-preventable disease because of their underimmunization status. The Institute of Medicine (IOM) Committee on Immunization Finance Policies and Practices has therefore concluded that a renewal and strengthening of the federal and state immunization partnership is necessary. The goal of this renewed partnership is to prevent infectious disease; to monitor, sustain, and improve vaccine coverage rates for child and adult populations within more numerous and increasingly diversified health care settings; and to respond to vaccine-safety concerns. To achieve this renewal, states require a consistent strategy, additional funds, and a multiyear finance plan that can help expedite the delivery of new vaccines; strengthen the immunization assessment, assurance, and policy development functions in each state; and adapt childhood immunization programs to serve the needs of new age groups (especially adults with chronic diseases) in different health care environments. The IOM committee recommends that federal and state governments adopt a national finance strategy that would allocate $1.5 billion in federal and state resources over the first 5 years to strengthen the infrastructure for child and adult immunization-an annual increase of $175 million over current spending levels. These resources would consist of $200 million per year in state infrastructure grants awarded by the Centers for Disease Control and Prevention (the Section 317 program) and an additional $100 million per year in increased state contributions. The committee also recommends that the Congress replace the current discretionary Section 317 grants with a formula approach for state immunization grant awards to improve the targeting and stability of federal immunization grants. The formula should provide a base level of support to all states, as well as additional amounts related to each state's need, capacity, and performance. The committee further recommends that Congress introduce a state match requirement for the receipt of increased federal funds to help strengthen and stabilize the infrastructure that supports long-term public health assessment, assurance, and policy development efforts. (ABSTRACT TRUNCATED)

Adult↗

PubMed1999

Worksite influenza immunization. Successful program.

The planning, implementation, and evaluation of worksite health promotion programs can benefit from adapting and using the steps in each phase of the PRECEDE-PROCEED model. The model provides a framework to build and sustain support from employers and employees, and a valuable tool to increase program efficiency, effectiveness, and accountability. During the PRECEDE phases of planning, the model provides opportunities for continuous communication and feedback to all levels of management. The evaluation phases in PROCEED provide occupational health nurses with valuable information to share with corporate planners, influence management behavior, and contribute to evidence based decisions for future programming.

Humans↗

PubMed1983

Influenza and pneumococcal immunization in medical clinics, 1978-1980.

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.

Humans↗

PubMed1990

Worldwide control of disease through immunization. Progress and prospects.

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.

BCG Vaccine↗

PubMed1983

Hepatitis B virus vaccine. An analysis of its potential use in medical workers.

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.

Cost-Benefit Analysis↗

PubMed1991

Reaching the unreached: a miracle in the making.

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.

Child↗

PubMed1981

Measuring effectiveness of service aides in infant immunization surveillance program in North Central Texas.

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.

Community Health Workers↗

PubMedDate not supplied

[The use of anthropologic methods for studying the causes of lack of vaccination. The case of Nativitas, Xochimilco].

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.

Anthropology, Cultural↗

PubMed1998

Failure to immunize the elderly: a systems problem or a statement of personal values?

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.

Aged↗

PubMed1997

[MMR, diphtheria-tetanus and polio vaccination of students in Aargau].

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.

Child↗

PubMedDate not supplied

The control of measles in tropical Africa: a review of past and present efforts.

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.

Africa↗

PubMed1989

Assessment of compliance with the expanded program on immunization schedule in King Khalid University Hospital.

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.

Humans↗

PubMed1994

Essential factors in the implementation of an Expanded Program on Immunization in an urban-periurban community in Nigeria.

The aim of this study was to identify some of the factors that affected the implementation of the Expanded Program on Immunization (EPI) in the Local Government Area (LGA). The study covered the three communities in Calabar LGA. Data on vaccine-eligible children and pregnant women were sought with questionnaires; other information on technical and community aspects of the EPI was gathered with specially designed checklists. EPI coverage for most antigens increased between 70-100% in response to highly-organized immunization campaigns initiated in 1985. In subsequent years, up to 1989, similar campaign-induced responses to national, state and local campaign efforts were observed. In contrast, coverage levels attributable to routine immunization remained unsatisfactory. When tested with the Z-statistic using 1985 as the base year (p < 0.05), there was a significant difference between the proportion of eligible children and pregnant women who did not receive their full dose of immunization. Socio-logistic variables found to be important in EPI implementations included scheduling, health staff attitude, intersectoral collaboration, and health education. Lack of community participation was also found to be a crucial constraining factor. As community participation/involvement is critical in sustaining health programs, social marketing techniques are suggested for future use.

Female↗