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PubMed2006

Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations.

BACKGROUND: The prevalence of pervasive developmental disorders has increased in recent years. Links with the measles component of the measles-mumps-rubella vaccine and the cumulative exposure to thimerosal through other vaccines have been postulated. OBJECTIVES: The purpose of this work was to estimate the pervasive developmental disorder prevalence in Montreal, Canada, in cohorts born from 1987 to 1998 and evaluate the relationship of trends in pervasive developmental disorder rates with: (1) changes in cumulative exposure to ethylmercury (thimerosal) occurring through modifications in the immunization schedule of young children and (2) trends in measles-mumps-rubella vaccination use rates and the introduction of a 2-measles-mumps-rubella dosing schedule during the study period. METHODS: We surveyed 27749 children born from 1987 to 1998 attending 55 schools from the largest Anglophone school board. Children with pervasive developmental disorders were identified by a special needs team. The cumulative exposure by age 2 years to thimerosal was calculated for 1987-1998 birth cohorts. Ethylmercury exposure ranged from medium (100-125 microg) from 1987 to 1991 to high (200-225 microg) from 1992 to 1995 to nil from 1996 onwards when thimerosal was entirely discontinued. Measles-mumps-rubella coverage for each birth cohort was estimated through surveys of vaccination rates. The immunization schedule included a measles-mumps-rubella single dose at 12 months of age up to 1995, and a second measles-mumps-rubella dose at 18 months of age was added on after 1996. RESULTS: We found 180 children (82.8% males) with a pervasive developmental disorder diagnosis who attended the surveyed schools, yielding a prevalence for pervasive developmental disorder of 64.9 per 10000. The prevalence for specific pervasive developmental disorder subtypes were, for autistic disorder: 21.6 of 10000; for pervasive developmental disorder not otherwise specified: 32.8 of 10000; and for Asperger syndrome: 10.1 of 10000. A statistically significant linear increase in pervasive developmental disorder prevalence was noted during the study period. The prevalence of pervasive developmental disorder in thimerosal-free birth cohorts was significantly higher than that in thimerosal-exposed cohorts (82.7 of 10000 vs 59.5 of 10000). Using logistic regression models of the prevalence data, we found no significant effect of thimerosal exposure used either as a continuous or a categorical variable. Thus, thimerosal exposure was unrelated to the increasing trend in pervasive developmental disorder prevalence. These results were robust when additional analyses were performed to address possible limitations because of the ecological nature of the data and to evaluate potential effects of misclassification on exposure or diagnosis. Measles-mumps-rubella vaccination coverage averaged 93% during the study interval with a statistically significant decreasing trend from 96.1% in the older birth cohorts (1988-89) to approximately 92.4% in younger birth cohorts (1996-1998). Thus, pervasive developmental disorder rates significantly increased when measles-mumps-rubella vaccination uptake rates significantly decreased. In addition, pervasive developmental disorder prevalence increased at the same rate before and after the introduction in 1996 of the second measles-mumps-rubella dose, suggesting no increased risk of pervasive developmental disorder associated with a 2-measles-mumps-rubella dosing schedule before age 2 years. Results held true when additional analyses were performed to test for the potential effects of misclassification on exposure or diagnostic status. Thus, no relationship was found between pervasive developmental disorder rates and 1- or 2-dose measles-mumps-rubella immunization schedule. CONCLUSIONS: The prevalence of pervasive developmental disorder in Montreal was high, increasing in recent birth cohorts as found in most countries. Factors accounting for the increase include a broadening of diagnostic concepts and criteria, increased awareness and, therefore, better identification of children with pervasive developmental disorders in communities and epidemiologic surveys, and improved access to services. The findings ruled out an association between pervasive developmental disorder and either high levels of ethylmercury exposure comparable with those experienced in the United States in the 1990s or 1- or 2-dose measles-mumps-rubella vaccinations.

Adolescent↗
PubMed2003

Vaccine schedules and procedures, 2003.

Recent, rapid changes in recommendations regarding vaccination represent challenges for busy clinicians who need to be familiar with new developments. This article reviews the current age-based recommendations that are fundamental to the United States vaccine program, as well as current recommendations regarding contraindications, precautions, administration techniques, and storage procedures for routinely administered vaccines. The 2003 Recommended Childhood Immunization Schedule, the 2002-2003 Recommended Adult Immunization Schedule, contraindications for immunization, and general guidelines on immunization procedures are presented. Recent changes in recommendations for children are instituting thimerosal-free hepatitis B vaccine as soon after birth as possible (before hospital discharge) and encouraging immunization of all children aged 6 to 23 months against influenza.

Adult↗
PubMed2005

Knowledge about tetanus immunization among doctors in Delhi.

BACKGROUND: In spite of the clear-cut guidelines regarding tetanus immunization, we have observed that tetanus toxoid injection is often given after injury without considering previous immunization status. One of the reasons for this could be that the doctors themselves are not aware of the correct immunization schedules against tetanus. AIMS: 1. To assess the knowledge about tetanus immunization in relation to injuries among doctors. 2. To assess their knowledge about tetanus immunization schedules in children, pregnant women and adults. SETTING AND DESIGN: It was a cross-sectional study conducted in Delhi. MATERIALS AND METHODS: After complete enlisting of all the government allopathic hospitals and dispensaries, a representative sample (including private practitioners from the nearby area of selected dispensaries) of doctors was selected. All the doctors were personally contacted and information was collected through a pre-structured self-administered proforma. STATISTICAL ANALYSIS: Data was analyzed using a computer and wherever applicable Chi-square test/Z test or Fishers' Exact test was applied. RESULTS AND CONCLUSION: As many as 38.3% of doctors favored tetanus toxoid injection after every injury. The correct knowledge of immunization against tetanus in children, pregnant women and adults was 75%, 90.8% and 35.8% respectively. The knowledge regarding when to give boosters was even poorer. The present study showed that doctors had poor knowledge about tetanus immunization that needs to be improved.

Adult↗
PubMed1999

Immunity to poliomyelitis, diphtheria and tetanus in pediatric patients before and after renal or liver transplantation.

Few studies have considered the safety, efficacy and appropriateness of vaccinations in pediatric patients before and after solid organ transplantation. The aim of this study was to evaluate the immune status after primary vaccination to diphtheria, tetanus and poliomyelitis in pediatric patients before and after hepatic transplantation and to poliomyelitis in pediatric patients before and after renal transplantation. All the patients had received a complete primary immunization schedule for diphtheria and tetanus and poliomyelitis. Immunity to the three polioviruses was evaluated in 56 patients with renal transplant, 27 on chronic dialysis and 33 controls and in 39 patients with hepatic transplant, 25 with chronic hepatic failure and their 36 controls. Immunity to diphtheria and tetanus was evaluated in 52 liver transplant patients, 29 children with chronic hepatic failure and 54 healthy children. Renal transplant patients were less protected and had lower antibody geometric mean titers than healthy controls for polioviruses 1 and 2. Whereas, protection in the children liver transplant patients was similar to that in their controls. Patients with chronic hepatic failure had higher antibody geometric mean titers to diphtheria and polioviruses 1 and 3 than their control group. Immunosuppression after transplantation has a negative influence on the immune status after primary vaccination in children with renal transplant. Whereas children with chronic hepatic failure have higher antibodies than a normal population. When possible, it could be advisable to individualize immunization schedules in patients at high risk.

Adolescent↗
PubMed1978

Immunization for the common communicable diseases.

Infectious diseases have dropped from the limelight in developed countries with the advent of immunization and antibiotics, but their worldwide significance in the terms of morbidity and mortality is still considerable. Whereas there are grounds for substantial differences in immunization schedules between the developed and developing countries, the acceptance of simplified immunization schedules in the former remains a crucial factor for gaining significant cover of young children and success in control of the target diseases. In the developed countries, continuing surveillance and re-evaluation of programmes is necessary to ensure that the benefits so far obtained are maintained. This paper summarizes the approach to immunization programmes both in developing countries and in Australia, and outlines the schedule recommended by the National Health and Medical Research Council at its 85th Session in June, 1978.

Adolescent↗
PubMed1997

Vaccines for hepatitis A and B. The latest recommendations on safe and extended protection.

Hepatitis A vaccines (Havrix and Vaqta), administered in two doses, provide long-term protection. Target groups include international travelers, children in high-risk communities, homosexually active men, injecting drug users, persons who work with nonhuman primates, patients with chronic hepatitis, and recipients of clotting factors. The place of hepatitis A vaccination in the childhood-immunization schedule has not been determined. Postexposure prophylaxis for hepatitis A consists of administration of immune globulin within 2 weeks of exposure. Hepatitis B vaccines (Recombivax HB and Engerix-B), administered in three doses, provide protective antibody levels in more than 95% of recipients. Duration of protection appears to approach 10 years. Booster doses are not currently recommended. Hepatitis B vaccination has been incorporated into the routine childhood-immunization schedule. Additional target groups include medical personnel exposed to blood products, household and sexual contacts of infected persons, injecting drug users, and homosexually active men. Postexposure prophylaxis consists of administration of hepatitis B immune globulin as soon after exposure as possible, along with the initial dose of vaccine if desired.

Hepatitis A↗
PubMed1997

Parental perceptions of barriers to childhood immunization: results of focus groups conducted in an urban population.

The current US immunization rates for 2 year olds are approximately half of the goal set for the year 2000. Research studies have focused primarily on the perception of health care providers in the identification of barriers and benefits to childhood immunization. While health care providers are an important part of the immunization delivery process, the perceptions of parents are also important. In this study, qualitative methods were used to explore perceived parental barriers to childhood immunization delivery. Twelve focus groups comprising White, African-American, Hispanic, urban and non-urban people were conducted at a variety of sites, including clinics, churches, schools and work sites. The results indicated that time off from work, access to well-child care and difficulty understanding the complexity of the immunization schedule were seen as barriers to adhering to an immunization schedule. Participants emphasized problems in taking time off from work to get immunizations, sometimes without pay, and expressed fears that doing so would jeopardize promotions and raises. While some of the parental perceptions were similar to those identified in studies of health care providers in the literature, many were not. This study emphasizes the importance of gathering information from parents as well as from health care providers.

Attitude to Health↗
PubMed1995

Randomized, controlled trial of trivalent oral poliovirus vaccine (Sabin) starting at birth in Ghana.

To evaluate the efficacy of the schedule currently recommended for immunization with trivalent oral poliovirus vaccine (TOPV) (i.e., at birth, 6 weeks, 10 weeks, and 14 weeks after birth), we randomly assigned 452 infants into test (231 infants) and control (221 infants) groups. The test group received TOPV as currently recommended, and the dose at birth was omitted for the control group. At 10, 14, and 18 weeks of age, the levels of poliovirus neutralizing antibodies as well as seroconversion rates were consistently higher for the test group than for the control group. The final seroconversion rates against poliovirus types 1, 2, and 3 were 83.5%, 91% and 83%, respectively, for the test group and 75%, 83.2%, and 79.1%, respectively, for the control group. The TOPV immunization schedule starting at birth therefore produced better results. Seroconversion rates as well as antibody levels were highest in infants with low maternal antibodies.

Antibodies, Viral↗
PubMed2000

Tetanus immunization among adolescent girls in rural Haryana.

This survey was undertaken to estimate tetanus immunization coverage of adolescent girls in a selected rural community of Haryana and to ascertain the knowledge of these girls and their mothers about tetanus. The study period was between April 1996-March 1997. A 30-cluster immunization coverage house to house survey was carried out by a female social worker. The total population covered was 30,448. Twelve roadside villages were selectively chosen. Eleven year and 17 year old girls (210 in each group) were surveyed for coverage evaluation. For K.A.P. survey 114 girls (aged 17 years) and 98 mothers (of 11 year old girls) were interviewed. Chi square, percentage and 95% confidence interval were used for statistical analysis. Coverage for tetanus immunization was 44.3% among 17 year old girls and 26.7% among 11 year old girls. The coverage was better (35%) among school going girls as compared to non-school going girls (13%). Correct immunization schedule of pregnant women was told by 16 (7.5%) respondents. None of them told the correct immunization schedule for children. Death was told as the main danger from tetanus by 172 (81%) respondents. Most (98%) were aware of the role of clean-stump (umbilical cord) at the time of delivery in the etiology of tetanus neonatorum. Tetanus immunization coverage needs to be improved among adolescents. They also need to be educated on various aspects of tetanus.

Adolescent↗
PubMed1990

[The efficacy of a cultured rabies vaccine studied on guinea pigs previously infected with the rabies street virus].

In this work materials on the development of an experimental model for the study of rabies vaccines are presented. The comparative study of different immunization schedules for vaccines with different protective potency has been carried out. Guinea pigs infected with street rabies virus, strain k, were used as an experimental model. As shown in this investigation the optimum method of infecting the animals with strain k was intramuscular injection causing 50% mortality among the animals, the incubation period lasting 10-24 days. Only those tissue-culture rabies vaccines which had activity equal to 1.0-1.3 I. U. and, when injected into the animals, ensured survival rate ranging from 57% to 76%, depending on the immunization schedule, were shown to possess protective potency. It should be pointed out that survival rate among the animals receiving the preparation according to the reduced schedules recommended by WHO was higher than among those immunized daily for 14 days. In all groups immune response was observed. Still in the animals receiving the preparation according to the reduced schedules a higher level of virus-neutralizing antibodies was registered. Thus, an experimental model capable of being used for the evaluation of the quality of existing and newly developed antirabies preparations was obtained. Besides, we believe it to be expedient to carry out the field trial of rabies vaccines with activity equal to 1.0-1.3 I. U., using the reduced immunization schedules.

Animals↗
PubMedDate not supplied

[Control of hepatitis B in French Polynesia with a program of systematic vaccination of newborns with the Genhevac B vaccine].

In 1988, a 5-year vaccination program against hepatitis B was launched for all newborns in a pilot area, the Austral archipelago in French Polynesia. Genhevac B, a recombinant vaccine produced from mammalian cells was administered. Three different immunization schedules were used, none of them including additional specific immunoglobulin: i) four doses, one at each months (M) 0, 1, 2, and 12; ii) three doses one at each MO, M1 and M6; and iii) three doses one at each MO, M1 and M12. Each year during the 5 year period a serological survey was conducted. Of the 837 children who received at least one vaccine dose, 5 were HBsAg carriers. Seroprotection rates for anti-HBs and anti-PreS2 antibodies were 88% after one dose and 97% after two doses. After the third dose, seroprotection rates and geometric mean titers of anti-HBs antibodies were 95% and 217 mIU/ml for schedule (i) (three dose only); 92% and 389 mIU/ml for schedule (ii) and 93% and 344 mIU/ml for schedule (iii) respectively. After four doses (schedule i) the values were 100% and 1228 mIU/ml. Of the 18 newborns whose mothers were positive for both HBsAg and HBeAg, one was a HBsAg carrier. The estimated protective rate for prevention of perinatal transmission was 94%. This study suggests that in field conditions, systematic vaccination of newborns without using specific immunoglobulins can confer early protection. The schedule recommended for use in French Polynesia was three doses, at MO, M1 and M6-12 (between 6 and 12 months) with an additional booster dose at age 6 years, the last year of nursery school. Since April 1992, all children born in French Polynesia have been vaccinated according to this schedule. A catch-up program has been implemented for children aged 4 to 10 years old using a similar immunization schedule.

Child↗
PubMed2006

Tick-borne encephalitis (TBE) vaccination: applying the most suitable vaccination schedule.

Tick-borne encephalitis (TBE) is caused by an arthropod-borne virus, belonging to the family of Flaviviridae. In case of disease, which can lead to neurological sequelae or even fatal outcomes, only symptomatic treatment is available. TBE can be prevented by vaccination. Various primary immunization schedules have been developed. To identify the most suitable schedule, the present randomised, controlled study was designed to provide data on the immune response elicited by four different immunization schedules obtained by ELISA and by neutralization test (NT). A total of 398 healthy subjects aged > or =12 years were randomised to vaccination according to either the rapid schedule (Group R, vaccination on days 0, 7 and 21), the conventional schedule (Group C, vaccination on days 0, 28 and 300), the modified conventional schedule (Group M, vaccination on days 0, 21 and 300) or the accelerated conventional schedule (Group A, vaccination on days 0, 14 and 300). Within 3 weeks (i.e. by day 21) antibody levels were higher in Group R and Group A than in Group M and Group C. Group R and Group C both had higher titres on days 42, 180 and 300, than Group A and Group M. The rapid schedule thus combines the advantages of fast protection and of high titres over the observation period of 300 days.

Adolescent↗
PubMed1990

Experimental autoimmune uveoretinitis in mice. Induction by a single eliciting event and dependence on quantitative parameters of immunization.

Experimental autoimmune uveoretinitis (EAU) in the mouse is a recently developed model of ocular autoimmunity. Dependence of disease induction on qualitative and quantitative parameters of immunization was studied in B10.A mice immunized with interphotoreceptor retinoid-binding protein (IRBP). It was found that use of Bordetella pertussis adjuvant as well as its mode of preparation was of critical importance for disease induction; no disease was induced if pertussis adjuvant was omitted. The minimal effective protocol for EAU induction when the vaccine form of B. pertussis adjuvant was used consisted of pretreatment with cyclophosphamide, two divided doses of IRBP in complete Freund's adjuvant (CFA), and two divided doses of B. pertussis vaccine. Any reduction in the immunization schedule resulted in reduced incidence of disease. In contrast, substituting purified B. pertussis toxin (PTX) for the vaccine allowed reduction of the immunization schedule to a single dose of IRBP in CFA and omission of the cyclophosphamide pretreatment. Severity and incidence of disease could be quantitatively controlled by varying the respective doses of IRBP and PTX. In addition, a chronic or an acute clinical course of EAU could be obtained by using either a low-dose or a high-dose immunization, respectively. Establishment of a single dose induction protocol and the quantitation of the immunopathogenic response as a function of the variables of immunization lay the foundation for the further development and utilization of this promising model of ocular autoimmunity.

Adjuvants, Immunologic↗
PubMed2006

Control of pneumococcal disease in the United Kingdom--the start of a new era.

In 2000, a multi-valent pneumococcal conjugate vaccine, known as Prevnar, was licensed for use in infants and young children in the USA. The subsequent introduction of the vaccine into the childhood immunization schedule in that country led to a significant decrease in pneumococcal disease. The vaccine is effective against invasive and non-invasive pneumococcal infection, can be used in young children as well as adults and, like all conjugate vaccines, provides long-lasting immunity. Moreover, it reduces the incidence of antibiotic resistance because a number of resistant serotypes are targeted by the vaccine. Prevnar, also known as Prevenar, has since been licensed in numerous countries, including the UK. On 8 February 2006, the Departments of Health in England, Scotland and Wales announced the inclusion of Prevenar in the childhood immunization schedule. This announcement has important implications for pneumococcal infection, disease surveillance and immunization policy in the UK.

Adult↗
PubMed1999

Magnitude of recall bias in the estimation of immunization coverage and its determinants.

OBJECTIVE: To study the magnitude of recall bias in the estimation of immunization coverage and to identify its determinants. DESIGN: A follow-up study of cohort of children for one year; followed by a cross-sectional recall survey. SUBJECTS: All live births in two contiguous PHC areas in Villupuram district, Tamil Nadu. METHODS: The prospective data collected from mothers of 774 children was considered as 'Gold Standard' and the retrospective recall data from them was compared with it. This was carried out for individual immunization schedules, namely, DPT, OPV, BCG and measles and for the combined immunization status. Measures such as sensitivity, specificity, positive and negative predictive values were computed. Logistic Regression technique was employed for evaluating the determinants of agreement. RESULTS: Less than 50% of mothers has immunization cards with them and more than 70% of the cards did not have complete information. The sensitivity of the recall method was 41.3% and the specificity was 79.5% when the complete immunization status was considered. For individual immunization schedules, the sensitivity ranged from 95% for BCG to 53% for measles vaccination and the specificity ranged from 30% for BCG to 68% for measles vaccination. Mother's age emerged out as a significant determinant in the agreement of two methods. Maintenance of immunization cards were very poor. CONCLUSIONS: Method of obtaining immunization status through recall survey is not sensitive. Proper maintenance of immunization cards and ensuring the availability of them with mothers for inspection are recommended for obtaining accurate estimation of vaccine coverages.

Adult↗
PubMed2000

Characterization of mice antisera elicited with a ciguatoxin tetracyclic synthetic ring fragment (JKLM) conjugated to carrier proteins.

As a good alternative to the lack of pure ciguatoxin (CTX), conjugates of JKLM ring fragment, a carboxylic derivative of the right-hand tetracyclic terminus portion of CTX-1B (the most potent CTX) with two carrier proteins have been synthesized. Two procedures using different amount of hapten were evaluated: (i) a bulk technique (3-5 mg) via the N-hydroxysuccinimide ester of the carboxylic fragment in the presence of a water-soluble carbodiimide according to the standard method in aqueous buffer, or (ii) a micro-scale technique (300 microg) via the mixed anhydride method performed in a reversed micellar medium. In both cases, bovine serum albumin and ovalbumin were respectively used for immunization of BALB/c mice and antibody screening by a solid phase enzyme-linked immunosorbent assay (ELISA). Using the conjugates obtained through the micro-scale procedure, a long-term immunization schedule appeared to be more efficient to specifically trigger the mice immune system. These antisera titers determined in an end-point titration standard ELISA format were found around 1/128,000 as compared to 1/16,000 obtained in the short-term protocol (immunogen prepared via the bulk procedure). In competitive inhibition ELISA experiments, both types of antisera did not significantly cross-react with a brevetoxin congener (PbTx-3), okadaic acid (OA), monensin or other polyether compounds, but only sera from the short-term protocol did show high cross-reactivity to CTX-1B (133%). With sera from the long-term protocol, a lower detection limit for JKLM (1.23 x 10(-9) M) was achieved by implementation of a biotin-avidin amplification system rather than by miniaturization of the assay in Terasaki plates. This study confirms the feasibility of the immunological approach for CTXs assay in fish tissues, but also emphasizes the importance of (i) the choice of the hapten to construct a relevant well-defined immunogen, (ii) the immunization schedule to obtain hapten-specific Abs still exhibiting high cross-reactivity to CTXs.

Animals↗
PubMed1978

Vaccines and vaccinations in the under-fives in Ghana, a tropical developing country.

In this paper, an attempt has been made to focus attention on the important childhood killer but immunizable diseases in Ghana, giving where available morbidity and mortality figures. Immunization schedules currently adopted in Ghana are discussed in the light of immunological considerations, the half-life of acquired maternal antibodies and from the point of view of known epidemiological patterns of these immunizable diseases. An attempt was thus made to justify the adoption of the immunization schedules currently in force in Ghana. Problems relating to some of the vaccines used in immunization of the under-fives in Ghana have been discussed in the light of personal experiences and the experiences of other colleagues, giving--where possible--suggestions for improvement. Finally, the paper delineates problem areas in immunization programmes of the under-fives in Ghana.

Bacterial Vaccines↗