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Routine vaccines include those listed on the Recommended Childhood and Adolescent Immunization Schedule and the Recommended Adult Immunization Schedule. The disease burden, rationale for vaccination, efficacy, adverse reactions, and recommendations are discussed in relation to each vaccine. Pictures of vaccine-preventable diseases are included.
Comparison of the serological results from the NIAID-funded Multicenter Acellular Pertussis Trial (MAPT) and the efficacy trials are complicated by differences in assay methods, immunization schedules, vaccine lots and populations immunized. In spite of these differences, serological results closely approximating those obtained in the MAPT were found for most or all of the assayed antibodies in the Mainz and Erlangen studies. Serological results for some of the antigens included in the vaccines used in the Italian and Stockholm trials were similar to the MAPT results, while significant differences were noted with other antigens. Differences in immunization schedules and serological assay methods made comparisons between MAPT and the Gothenburg and Senegal trials more difficult. Our understanding of the efficacy trial results, and our ability to apply those results to the U.S. population, would be enhanced markedly by simultaneous re-analysis of stored sera from MAPT and selected efficacy trials. This goal should be given priority by the study organizers and sponsors.
Group B streptococcus (GBS) remains a major cause of neonatal infection. Maternal immunization-induced GBS antibody may protect neonates from GBS disease. Since the opsonophagocytosis assay correlates well with survival in GBS infected suckling rats, we sought to determine an immunization schedule which would induce type III GBS opsonic antibody in rat dams above a predetermined level of 10 dilution-1 (dil-1). This schedule could then be used for future studies of maternal-fetal immunity. Wistar rat dams (n = 12) were given killed GBS type III using three immunization schedules (primary injection, initial booster at 7, 14 or 22 days and then weekly boosters). Opsonic GBS type III antibody and total immunoglobulin (IgG) were measured. Only the schedule with a 7-day initial booster resulted in GBS type-specific opsonic antibody consistently above 10 dil-1. The IgG (467 +/- 83 mg/100 ml) remained constant while the opsonic antibody increased significantly to 50 and 63 dil-1 (P less than 0.01 compared to day 0) after boosters on day 7 and 14 respectively. Eight pregnant dams, who received a primary immunization and boosters at 7 and 14 days, developed GBS type III opsonic antibody titers (72 dil-1) similar to non-pregnant dams and potentially adequate to protect suckling rats from GBS disease. This model may now be used to study other adjuvants, immunogens, and maternal-fetal immunity using established suckling rat models of GBS disease.
An inactivated hepatitis A vaccine was given to 104 seronegative volunteers aged between 19 and 60 years according to two schedules: 0, 1 and 2 months or 0, 1 and 6 months. The vaccine was well tolerated and 97 and 100% of vaccinees developed a serum antibody response following a single and two doses of vaccine respectively. Geometric mean titres increased progressively after each dose; responses following the 0, 1, 6 month schedule were significantly higher at one year but, among those tested at two years, these differences were less marked. Vaccinees, when compared with naturally infected persons, developed poor or undetectable hepatitis-A-virus-specific immunoglobulin G and A antibody responses in saliva and parotid fluid. Such differences are, however, unlikely to affect the protective efficacy of the vaccine.
OBJECTIVE: To study the awareness among general public and health care providers about tetanus immunization in relation to injuries, and their knowledge about tetanus immunization schedules in children, pregnant females and adults. METHODS: It was a cross-sectional study done at a perfect health mela and all the government allopathic health agencies in Delhi. RESULTS: The knowledge of tetanus immunization was poor among general public as well as health care providers. A substantial proportion of them indicated tetanus injection after every injury, which was unwarranted. The knowledge of tetanus immunization schedule for adults was poor among all categories of respondents, though it was comparatively better for pregnant females, but only 75% of doctors and 51.1% of nursing personnel correctly knew the immunization schedule against tetanus in children. CONCLUSION: There is a need to upgrade the level of knowledge among health care providers so as to ensure that schedules of tetanus are followed properly and unnecessary repeated immunizations are avoided and the same knowledge is passed on to the general public also.
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The development of serum and nasopharyngeal antibody response, and the magnitude and temporal pattern of fecal shedding of vaccine and revertant polioviruses was examined in infants previously immunized with one or more doses of oral poliovirus vaccine (OPV), enhanced-potency inactivated poliovirus vaccine (EIPV), or both. The fecal samples were collected at different intervals after the last OPV dose. The nucleic acid sequences of the purified RNA obtained from all virus isolates were examined in the 5' noncoding region by dideoxysequencing to determine whether the viruses shed represent revertants (vaccine), nonrevertants, or both. The frequency and duration of vaccine virus-shedding appeared to be similar in both immunization schedules. Revertant virus shedding was not demonstrated 30 days after immunization with OPV alone. However, shedding of revertants was detected for as long as 60 days in some subjects previously immunized with EIPV. The duration of shedding of revertant virus differed with different serotypes and different immunization regimens. Prior immunization with one or more doses of OPV reduced the length of shedding of revertant virus. Significantly, however, prior immunization with one or more doses of EIPV was not associated with reduced shedding of revertant virus types. The nature of serum immune response as determined by ELISA or neutralizing antibody appeared to be similar after either immunization schedule, although the antibody titers were quantitatively higher after two doses of IPV than observed after a similar schedule with OPV. Highest antibody activity was detected in subjects immunized with a combination of IPV followed by OPV. ELISA antibody activity in the nasopharynx was regularly detected after either form of immunization.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND AND OBJECTIVES: The dynamic nature of immunization schedules, shortages, and administration techniques makes keeping up to date with current national recommendations difficult and necessitates periodic evaluation of immunization teaching resources. METHODS: This study surveyed family practice residency program directors in 1998 to assess their satisfaction with immunization teaching resources and interest in new resources. Subsequently, with funding from the Centers for Disease Control and Prevention, the Society of Teachers of Family Medicine Group on Immunization Education developed a series of educational materials devoted to educating family physicians about immunizations. In 2001, residency directors were surveyed again to evaluate the educational resources. RESULTS: Most program directors reported satisfaction with resources currently available to them for teaching residents about childhood immunizations, but about half (41% in 1998 versus 55% in 2001) agreed that keeping up to date on childhood immunizations was difficult. The corresponding figures for adult immunizations were 27% in 1998 and 36% in 2001. Pocket-size immunization schedules were ranked highly important (53% in 1998 versus 45% in 2001). Many would use handheld computer immunization schedules (53%). Although satisfaction with available resources did not increase following introduction of a newly developed journal supplement and Web site, the limited response received was favorable. CONCLUSIONS: Immunization teaching materials developed by family physicians, especially those that make use of evolving technologies, can be useful resources for individuals teaching family practice residents and for keeping up to date on recommendations for immunizations.
BACKGROUND: During the past two decades the number of injections that are required per office visit to fulfill the recommended childhood immunization schedule has increased dramatically. METHODS: By reviewing the literature, the principles associated with pediatric combination vaccines are discussed, and practical issues related to their use in clinical practice are evaluated. RESULTS: The ideal combination vaccine is safe, effective and easy to store and use, and its antigenic components fit within the recommended immunization schedule. The ideal combination is associated with fewer adverse reactions than the separately administered antigens, with improved efficacy and higher immune responses compared with its component vaccines. An acceptable combination vaccine must provide comparable efficacy and safety to its component vaccines. Although there are a limited number of combination vaccines already available [diphtheria-tetanus-pertussis, inactivated poliovirus vaccine (IPV) and measles-mumps-rubella], effort is being focused on combining these vaccines with other routine vaccines of infancy including Haemophilus influenzae type b (Hib) and hepatitis B vaccine (HepB). Currently under review by the Food and Drug Administration are diphtheria-tetanus-acellular pertussis (DTPa)-HepB-IPV and DTPa-Hib-IPV combination vaccines, and two DTPa-HepB-IPV-Hib vaccines have been licensed in Europe. As more combination vaccines become available, issues such as interchangeability and administration of extra doses are raised; however, it is important not to miss a vaccination opportunity. CONCLUSIONS: The number of injections required to fulfill the recommended childhood immunization schedule at each visit creates problems for patients and practitioner, sometimes risking a missed opportunity for vaccination. The development of combination vaccines will circumvent this problem and increase compliance and vaccination coverage rates.
The purpose of this randomized, double-blind study was to test the safety and immunogenicity of an HIV-1LAI recombinant gp160 (rgp160) vaccine in healthy, uninfected volunteers using accelerated dosing schedules. Thirty volunteers were randomly assigned to receive 50-micrograms doses of rgp160 in one of two immunization schedules. Group 1 received rgp160 at times 0, 1, 2 and 5 months; and group 2 received rgp160 at times 0, 1, 2, 3 and 4 months. The vaccine was safe and stimulated high levels of HIV-1 envelope-specific binding antibody and T cell memory. There was a trend (P < 0.10) suggesting neutralizing antibodies were better induced by the regimen incorporating a rest period before the final immunization in group 1 volunteers. Both accelerated immunization schedules induced immune responses at levels similar to or better than those achieved by four rgp160 vaccine injections given over 12-18 months in other studies.
The Recommended Childhood Immunization Schedule provides guidelines that allow pediatricians to administer childhood vaccines in an efficient and effective manner. Research by vaccine manufacturers has resulted in the development of new vaccines that protect against a growing number of diseases. This has created a dilemma for how to insert such new vaccines into an already crowded immunization schedule, and prompted vaccine manufacturers to develop vaccine products that combine several individual vaccines into a single injection. Such combination vaccines permit new vaccines to be inserted into the immunization schedule without requiring children to be exposed to an unacceptable number of injections during a single clinic visit. Given this advantage, combination vaccines merit an economic premium. The purpose of this paper is to describe how Monte Carlo simulation can be used to assess and quantify this premium by studying four combination vaccines that may become available for distribution within the United States. Each combination vaccine is added to twelve licensed vaccine products for six childhood diseases (diphtheria, tetanus, pertussis, haemophilus influenzae type B, hepatitis B, and polio). Monte Carlo simulation with an integer programming model is used to determine the (maximal) inclusion price distribution of four combination vaccines, by randomizing the cost of an injection. The results of this study suggest that combination vaccines warrant price premiums based on the cost assigned to administering an injection, and that further developments and innovations in this area by vaccine manufacturers may provide significant economic and societal benefits.
Nine European laboratories contributed a total of 98 macaques towards a collaborative trial to study the ability of formaldehyde-inactivated or subunit SIV vaccines to protect immunized animals against live virus challenges. Four adjuvants, three dose levels and two immunization schedules were compared. Fifty-two of 61 (85%) immunized animals were protected against infection after challenge with either homologous or heterologous virus strains grown in human cells. Optimum protection required a high dose of antigen and a prolonged immunization schedule. On the day of challenge the titres of antibodies to SIV and to host cell components, as well as the titres of neutralizing antibodies, were significantly higher in the protected animals than in the non-protected. Forty-four vaccinated macaques (of which 36 were protected against previous challenges grown in human cells) and 28 naive animals were then challenged with extracellular or cell-associated SIV grown in simian cells. All naive animals and all vaccinees challenged with extracellular SIV became infected. Four of the eight animals challenged with cell-associated viruses were protected. These results clearly indicate that vaccines which potently protect against SIV grown in human cells, do not protect against SIV grown in simian cells. The cell substrate on which challenge viruses are grown is clearly significant in interpreting the results of vaccine trials. This trial has demonstrated that SIV vaccines using different adjuvants can protect macaques against SIV grown in human cells but not against extracellular SIV grown in simian cells. These results have important relevance to the development of HIV vaccines for humans.(ABSTRACT TRUNCATED AT 250 WORDS)
Although vaccine against tetanus has been in use for more than two decades, often people are not aware of tetanus immunization schedules and its significance in preventing tetanus. The current cross-sectional study was carried out to (1) assess knowledge about tetanus immunization (in relation to injury) among persons attending a health mela and (2) To assess their knowledge about tetanus immunization schedules in children, pregnant women and adults. Every tenth person above 15 years of age, who came to health post in the mela was interviewed. A total of 231 persons attending a health mela in Delhi in October 2003 were interviewed. About two third of them were males. Majority (55%) were graduates or above. Only half of them indicated that they would give tetanus immunization after an injury, two fifth indicated it after animal bite and only one fourth indicated it after burns. Knowledge was higher among females and with higher education. However, knowledge regarding correct immunization schedules, prevention of tetanus by DPT and when to give booster in case of injury after primary immunization was poor. There is need to create greater awareness among people about immunization against tetanus, duration of immunity and disease prevented by it. This is to ensure immunization when it is needed and avoid unnecessary repeated immunization.
Protein vaccines were prepared from the serotype antigen of group B Neisseria meningitidis strain M986. The detergents Triton X-100, Emulphogene BC-720, and deoxycholate were used to removed the toxic lipopolysaccharide (LPS) portion of the serotype antigen. The LPS was most preferentially solubilized by Emulphogene. Guinea pigs were immunized with one or two doses of vaccine given intramuscularly without adjuvants and the antibody response quantitated by an enzyme-linked immunosorbant assay. Immunization with graded doses of vaccine between 25 to 200 microgram protein indicated a wide range of effective dosage and that a two-dose immunization schedule was superior to a single immunization. The vaccines elicited peak mean serum antibody levels of approximately 30 microgram/ml with bactericidal titers of 1:1,600-1:6,400. The peak antibody levels occurred 5-6 wk after immunization and persisted above preimmune levels for several months. To evaluate the protective effects of immunization, stainless steel springs were implanted subcutaneously into the guinea pigs. The resulting chambers, in unimmunized animals, could be infected with less than 100 type 2 organisms. A single 25-50 microgram dose of vaccine protected 50% of animals from challenge by 5 X 10(5) type 2 meningococci, and as little as 1 microgram vaccine significantly reduced the severity of infection. A two-dose immunization schedule was best and provided nearly complete protection for at least 4 mo against type 2 strains of meningococcal groups B, C, and Y.
Contrary to the regular immunization schedule for children, the majority of immunization are done in adulthood in case of special risks only, such as old age, chronic illness or exposure. The protection against a variety of communicable diseases has to be monitored and if necessary to be boosted regularly. Based on the routine vaccination scheme 1991 of the Federal Department of Public Health, the following vaccinations which are commercially available in Switzerland are discussed in this review: diphtheria, Haemophilus influenzae, hepatitis B, influenza, measles + mumps + rubella, meningococci, pertussis, pneumococci, poliomyelitis, tetanus, rabies, tuberculosis, varicella and tick encephalitis. Furthermore, the current recommendations are given for the prophylactic and therapeutic use of immunoglobuline preparations.
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Hepatitis B is a frequent complication in haemodialysis patients because of their repeated exposure to blood products, and their impaired cellular and humoral response; trials with plasma-derived hepatitis B vaccine (PDV) show lower immune responses than those in healthy adults. Using a yeast-derived hepatitis B vaccine (YDV), the immunogenicity of two different dose levels (20 and 40 micrograms) and three vaccination schedules were compared in over 270 seronegative dialysis patients. Vaccination with 40 micrograms gave slightly better results than with the 20 micrograms dose. Seroconversion rates were higher with four dose, 40 micrograms vaccination schedules than a three dose schedule, and ranged from 80 to 86%. As the 40 micrograms, 0, 1, 2, 6 month schedule leads to a more rapid rise in antibody levels than the 40 micrograms, 0, 1, 2, 12 month schedule, it appears to be the most appropriate schedule in this patient group.