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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↗

PubMed2006

Immunity to poliovirus among children and the elderly in north-east Italy.

INTRODUCTION: Italy and Europe were declared polio-free in June 2002, but increasing migration, even from undeveloped countries where polio still exists, may lead to a come-back of circulating poliovirus (PV) and infection in previously polio-free areas. It is consequently advisable to continue to monitor the immunity of the population in polio-free areas. The aim of this study was to assess the current prevalence of neutralizing antibodies in recently-immunized children and in elderly people who were never vaccinated. METHODS: Sera from 511 healthy subjects resident in the Veneto Region were examined to assay their antibody titer for PV 1, 2 and 3, using the microneutralization test. Data were analyzed by chi-squared test, Student's t-test and linear regression analysis, using EPI-Info 2000 supplied by the Centers for Disease Control and Prevention (Atlanta, GA, USA). RESULTS: Neutralizing antibodies in group A (231 subjects aged 1-17 years) showed significantly higher geometric mean titers (GMTs) than in group B (280 subjects aged 65-100 years) for all three PV serotypes (P < 0.001). Nobody simultaneously lacked neutralizing antibodies for all three serotypes. There were no difference between the two groups in terms of male/female GMTs for the three PV Antibodies decreased with time since vaccination, but the difference was only significant for PV 3. GMTs were lower in the elderly, with no significant difference among the three PV. DISCUSSION: The population examined showed a good level of protection against the three PV strains: both groups A (vaccinated) and B (naturally immunized) revealed a valid immunity to poliovirus. CONCLUSION: Immunization programs and immunity status population screening are still advisable until polio has been world-wide eradicated.

Adolescent↗

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↗

PubMed2006

Prevention of congenital rubella syndrome--what makes sense in 2006?

This review summarizes the practical aspects of rubella immunization programs in both developed and developing countries. Routine use of rubella vaccine is gradually resulting in the elimination of endemic rubella and congenital rubella syndrome (CRS) in the developed world, and routine use of vaccine in young children is now being implemented in many developing countries. However, such programs must achieve high immunization rates or be supplemented by the immunization of seronegative women of childbearing age to prevent a paradoxical increase in CRS as the burden of illness is shifted to an older age group. There are many successful prenatal screening programs for rubella immunity in developed countries, but screening prior to pregnancy could theoretically prevent even more cases of CRS. Enzyme-linked immunosorbent assay is the most commonly used laboratory test for screening, but the protective titer remains to be established. The need for reimmunization of women who serorevert or who remain seronegative following rubella vaccine has not been established. Surveillance for rubella cases and for CRS is vital in assessment of the ongoing success of rubella immunization programs.

Antibodies, Viral↗

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↗

PubMed2003

Decreasing incidence of hepatocellular carcinoma among children following universal hepatitis B immunization.

Hepatocellular carcinoma (HCC) is one of the 10 most common malignant tumors worldwide. Chronic infection with hepatitis B or C virus is closely related to hepatocarcinogenesis. The outcome of current therapies for HCC is not satisfactory. Prevention is the best way to control HCC. Among the various strategies of HCC prevention, immunization against hepatitis B virus infection is the most effective. Universal hepatitis B immunization has proved to be effective in reducing the incidence of HCC to 1/4-1/3 of that in children born before the hepatitis B vaccination era in Taiwan. The problems we face in achieving global control of hepatitis-related HCC include: (1) no effective vaccine for the prevention of hepatitis C and its related HCC; (2) no immunization program for hepatitis B in areas with inadequate resources; (3) poor compliance to the immunization program as a result of ignorance, anxiety, or poverty; and (4) vaccine failure. Integration of the hepatitis B vaccination program into the expanded program of immunization for all infants throughout the world will be most urgent and important for HCC control. The reduction of the incidence of HCC will be seen in adults 30-40 years of age after the launch of the universal hepatitis B vaccination program. This concept of cancer vaccine can be applied to other infectious agents and their related cancers.

Carcinoma, Hepatocellular↗

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↗

PubMed2004

Impact of the Expanded Program of Immunization against hepatitis B infection in school children in Malaysia.

The implementation of the Expanded Program of Immunization (EPI) in 1989 has dramatic impact on hepatitis B virus (HBV) infection in school children in Malaysia. A cross-sectional seroprevalence study of HBV infection in 190,077 school children aged 7-12 years from 1997 to 2003 showed a steady decline of HBV surface antigen (HBsAg) prevalence rate from 2.5% for children born in 1985 to 0.4% among school children born in 1996. The overall prevalence of HBsAg was 0.6%, 0.7% in males and 0.6% in females. Over 92.7% of school children had been vaccinated with HBV vaccine, in which 93.7% were vaccinated under the EPI and 6.3% on voluntary basis. The school children vaccinated under EPI had a 0.4% HBsAg carrier rate, which was significantly lower than school children vaccinated on a voluntary basis (HBsAg carrier rate 1.3%) and non-vaccinated school children (HBsAg carrier rate 2.7%), suggesting that HBV vaccination of infants was the most effective measure in preventing vertical transmission of HBV in the hyperendemic region.

Carrier State↗

PubMed2003

Immunization Monitoring Program, Active: a model of active surveillance of vaccine safety.

In Canada since 1993 the nation's passive system for reporting postimmunization adverse events has been supplemented by the active surveillance of inpatients at 10 to 12 pediatric referral centers, a system referred to as the Immunization Monitoring Program, Active. Participating centers are located from coast-to-coast and receive referrals from every province and territory. Approximately 20 percent of the population aged 0 to 12 years lives in the immediate vicinity of these centers. Nurse monitors at each center search for numerous target conditions, including postimmunization adverse events and vaccine-preventable infections. Vaccine safety observations have included (1) a substantial decrease in the risk of the development of febrile seizures and hypotonic-hyporesponsive episodes since the country switched from whole-cell to acellular pertussis-containing vaccines, (2) no evidence for encephalopathy resulting from the latter vaccines, (3) a generally benign outcome with postimmunization thrombocytopenia cases, and (4) an unexpectedly high rate of disseminated bacille Calmette-Guérin infections among aboriginal infants. Concomitant disease surveillance has been important for sustaining the surveillance system because few postimmunization adverse events require hospital admission.

Adverse Drug Reaction Reporting Systems↗

PubMed2001

Risk factors for improper vaccine storage and handling in private provider offices.

CONTEXT: Preventing loss of vaccine potency during storage and handling is increasingly important as new, more expensive vaccines are introduced, in at least 1 case requiring a different approach to storage. Little information is available about the extent to which staff in private physicians' offices meet quality assurance needs for vaccines or have the necessary equipment. Although the National Immunization Program at the Centers for Disease Control and Prevention (CDC) in 1997 developed a draft manual to promote reliable vaccine storage and to supplement published information already available from the CDC and the American Academy of Pediatrics, the best ways to improve vaccine storage and handling have not been defined. OBJECTIVES: To estimate the statewide prevalence of offices with suboptimal storage and handling, to identify the risk factors for suboptimal situations in the offices of private physicians, and to evaluate whether the distribution of a new National Immunization Program draft manual improved storage and handling practices. DESIGN: Population-based survey, including site visits to a stratified, random sample of consenting private physicians' offices. At least 2 months before the site visits, nearly half (intervention group) of the offices were randomly selected to receive a draft CDC manual entitled, "Guideline for Vaccine Storage and Handling." The remainder was considered the control group. Trained graduate students conducted site visits, all being blinded to whether offices were in the intervention or control groups. Each site visit included measurements of refrigerator and freezer temperatures with digital thermometers (Digi-thermo, Model 15-077-8B, Control Company, Friendswood, TX; specified accuracy +/- 1 degrees C). Their metal-tipped probes were left in the center shelf of cold storage compartments for at least 20 minutes to allow them to stabilize. The type of refrigerator/freezer unit, temperature-monitoring equipment, and records were noted, as were the locations of vaccines in refrigerator and freezer, and the presence of expired vaccines. Other information collected included the following: staff training, use of written guidelines, receipt of vaccine deliveries, management of problems, number of patients, type of office, type of medical specialty, and the professional educational level of the individual designated as vaccine coordinator. PARTICIPANTS: Two hundred twenty-one private physicians' offices known by the Georgia Immunization Program in 1997 to immunize children routinely with government-provided vaccines. OUTCOME MEASURES: Estimates (prevalence, 95% confidence interval [CI]) of immunization sites found to have a suboptimally stored vaccine at a single point in time, defined as: vaccine past expiration date, at a temperature of </=1 degrees C or >/=9 degrees C in a refrigerator or >/=-14 degrees C (recommended for varicella vaccine) in freezer, and odds ratios (ORs) for risk factors associated with outcomes. We performed chi(2) analysis and Student's t tests to compare the administrative characteristics and quality assurance practices of offices with optimal vaccine storage with those with suboptimal storage, and to compare the proportion of offices with suboptimal storage practices in the groups that did and did not receive the CDC manual. RESULTS: Statewide estimates of offices with at least 1 type of suboptimal vaccine storage included: freezer temperatures measuring >/=-14 degrees C = 17% (95% CI: 10.98, 23.06); offices with refrigerator temperatures >/=9 degrees C = 4.5% (95% CI: 1.08, 7.86); offices with expired vaccines = 9% (95% CI: 4.51, 13.37); and offices with at least 1 documented storage problem, 44% (95% CI: 35.79, 51.23). Major risk factors associated with vaccine storage outside recommended temperature ranges were: lack of thermometer in freezer (OR: 7.15; 95% CI: 3.46, 14.60); use of freezer compartment in small cold storage units (OR: 5.46; 95% CI = 2.70, 10.99); lack of thermometer in refrigerator (OR: 3.07; 95% CI: 1.15,8.20); and failure to maintain temperature log of freezer (OR: 2.70; 95% CI: 1.40, 5.23). Offices that adhered to daily temperature monitoring for all vaccine cold storage compartments, compared with those that did not, were 2 to 3 times more likely to assign this task to staff with higher levels of training, have received a recent visit from the state immunization program, and be affiliated with a hospital or have Federally Qualified Health Center status. In addition, sites using >1 refrigerator/freezer for vaccine storage were more likely to have at least 1 cold storage compartment outside recommended temperature ranges. We found no significant differences in the data reported above between the intervention group (received copy of the draft manual) and the control group (did not receive copy of draft manual), even when controlling for the annual number of immunizations given or the type of office. (ABSTRACT TRUNCATED)

Child↗

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↗

PubMed2004

Molecular epidemiology of rubella virus in Asia: utility for reduction in the burden of diseases due to congenital rubella syndrome.

BACKGROUND: Rubella is a mild disease mainly of infants, involving a rash and a fever. However, when women who have no immunity to rubella are infected during the early stage of pregnancy, their babies are often born with congenital rubella syndrome (CRS), which is characterized by a few disorders including deafness, cataracts and heart malformations. To prevent CRS, several strains of live attenuated rubella vaccine have been developed and introduced into immunization programs in many countries. In most Asian countries except Japan, Singapore and Taiwan, rubella remains uncontrolled, and the burden of diseases from CRS is high. In order to develop a control program to reduce the number of CRS cases in Asian countries, it is necessary to conduct a survey of rubella and CRS cases, and to then determine the genotype of the circulating rubella virus in each country. METHODS: Cases of rubella and CRS, based on national reporting systems or active surveillance in the Asian countries, are summarized. Sequences of the E1 gene of the virus isolates from the Asian countries were compared by phylogenic analysis. RESULTS: Recent studies of the molecular epidemiology of rubella virus worldwide revealed that there are two genotypes, and that genotype I is circulating almost worldwide, while genotype II is an Asian prototype restricted to the Asian continent. Genotype I viruses fall into a number of groups, some of which are geographically localized. Antigenically these two genotypes are cross-reactive and immunization with either virus results in immunity to all rubella viruses. DISCUSSION: The hypotheses that rubella virus has evolved on the Asian continent is proposed. The World Health Organization (WHO) has recognized that a rubella immunization program can be combined with the measles immunization program. Inclusion of rubella in the expanded program of immunization (EPI) of measles would be ideal in Asian countries, as it would be efficient and cost effective to administer one injection containing a three-combined vaccine (MMR). It would also be desirable given that WHO require laboratory tests to confirm the presence of measles or rubella as part of it's measles control project, because rubella is often misdiagnosed as measles.

Asia↗

PubMed2006

Immunization to protect the US Armed Forces: heritage, current practice, and prospects.

Americans serving with the US Armed Forces need protection from the dangerous infections that they can contract during training, based on occupation, during overseas deployment, or because of underlying health status. For over 230 years, the military health-care system has immunized troops to protect them personally and to help them accomplish their missions. Military researchers have invented, developed, and improved vaccines and immunization delivery methods against more than 20 diseases. This article consolidates content from several previous historical reviews, adds additional sources, and cites primary literature regarding military contributions and accomplishments. Discussion emphasizes smallpox, typhoid fever, tetanus, influenza, meningococcal disease, adenovirus, yellow fever, pneumococcal disease, and anthrax. Delivery issues include documentation, simultaneous immunization, seroscreening, safety surveillance, jet injection, and cold-chain management. Immunization policies for each major US conflict are described. Military immunization programs need to be individualized on the basis of personal contraindications and prior immunity. The proper conduct of military immunization programs respects the need for detailed education of military personnel, maximizes quality in immunization delivery, and supports quality clinical care to prevent and treat adverse events after immunization. Military immunization programs maintain the health of soldiers, marines, sailors, airmen, and coast guardsmen, the resources most critical to military success.

Bacterial Vaccines↗

PubMed2006

The costs of introducing a malaria vaccine through the expanded program on immunization in Tanzania.

This report presents an approach to costing the delivery of a malaria vaccine through the expanded program on immunization (EPI), and presents the predicted cost per dose delivered and cost per fully immunized child (FIC) in Tanzania, which are key inputs to the cost-effectiveness analysis. The costs included in the analysis are those related to the purchase of the vaccine taking into account the wastage rate; the costs of distributing and storing the vaccine at central, zonal, district, and facility level; those of managing the vaccination program; the costs of delivery at facility level (including personnel, syringes, safety boxes, and waste management); and those of additional training of EPI personnel and of social mobilization activities. The average cost per FIC increases almost linearly from US 4.2 dollars per FIC at a vaccine price of US 1 dollars per dose to US 31.2 dollars at vaccine price of US 10 dollars per dose. The marginal cost is approximately 5% less than the average cost. Although the vaccine price still determines most of the total delivery costs, the analysis shows that other costs are relevant and should be taken into account before marketing the vaccine and planning its inclusion into the EPI.

Cost-Benefit Analysis↗