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PubMed1993

Non-efficacy of low-dose intradermal vaccination against hepatitis B in Down's syndrome.

Persons with Down's syndrome (DS) constitute a risk group for hepatitis B (HB) and are recommended to be immunized. Of 123 persons with DS in Orebro county screened for markers of HB, 31% had such markers; 16% were potentially contagious. 83 persons without markers participated in a comparative trial of the immunogenicity of a recombinant HB vaccine given either intramuscularly (IM) or in a lower dose intradermally (ID). Immunity developed in 73% after IM vaccination as compared to 29% of those given ID vaccination (p < 0.005). At 3-year follow-up half and two-thirds of the immune persons, respectively, had lost their immunity. Those > 30 years had a poor immunization response compared to the younger ones (p < 0.01). Only 19% of the non-responders developed immunity after an IM booster dose given 10 months after the third injection. Intradermal vaccination is not warranted in persons with DS, especially not in middle aged and older persons. A booster dose of vaccine does not ascertain immunity in those who do not respond with immunity to the ordinary immunization schedule. Post-vaccination immunity should therefore be controlled.

Adolescent↗

PubMed2000

Levels and avidity of antibodies to tetanus toxoid in children aged 1-15 years in Dar es Salaam and Bagamoyo, Tanzania.

A study was undertaken to determine the serological response in children (aged 1-15 years) immunized with diphtheria-pertussis-tetanus vaccine (DPT) alone or with a tetanus toxoid (TT) booster dose under the Expanded Programme on Immunization in Dar es Salaam and Bagamoyo, Tanzania. Using an ELISA technique, serum levels of anti-TT antibody, antibody avidity and anti-TT IgG subclasses were determined in 138 apparently healthy children. Our findings revealed that 94.7% and 98% of children aged 1-5 years in Dar es Salaam and Bagamoyo, respectively, had anti-TT antibody levels above that considered protective (> or = 0.1 IU/ml). Among 6-15-year-old children, 53.3% in Dar es Salaam and 55% in Bagamoyo had anti-TT antibody levels > or = 0.1 IU/ml. The avidity index of anti-TT antibodies was high in most of the younger children, 84.2% in Dar es Salaam and 92% in Bagamoyo. Significantly fewer older children in Dar es Salaam and Bagamoyo (53.3% and 50%, respectively) had high avidity index antibodies. The predominant anti-TT IgG subclasses were IgG1 and IgG3. It is concluded that the current DPT immunization schedule provides adequate tetanus immunity for children under 5. However, about half of the older children had no protection against tetanus.

Adolescent↗

PubMed1984

Dengue virus type 2 vaccine: reactogenicity and immunogenicity in soldiers.

A live dengue virus type 2 (dengue-2) vaccine (PR-159/S-1) was tested for reactogenicity and immunogenicity in a placebo-controlled, double-blind clinical trial involving 98 soldiers. Seroconversion rates based on the development of neutralizing antibody to dengue-2 were 90% in 70 recipients with immunity to yellow fever and 61% in 28 vaccinees without such immunity (P less than .01). Peak titers of neutralizing antibody were three times higher in recipients with antibody to yellow fever virus and persisted in most for at least 18 months. Individuals seroconverting to the vaccine virus more frequently experienced systemic symptoms than those who received placebo (P less than .02). Future users of this dengue-2 vaccine may wish to employ immunization schedules that include preliminary immunization against yellow fever and must be prepared to accept mild vaccine-related symptoms in some recipients.

Adolescent↗

PubMed1979

Effects of dose and schedule of immune stimulant on efficacy of combination Corynebacterium parvum-cyclophosphamide treatment for a murine mammary adenocarcinoma.

Certain variables which might influence the outcome of combining cytotoxic drug and immune stimulant therapy were studied to optimize the effectiveness of Corynebacterium parvum combined with cyclophosphamide (CY) as treatment for a murine mammary adenocarcinoma (CaD2). Optimal effects of combined C. parvum-CY treatment in the CaD2 system were obtained when 443 to 1400 microgram of this immune stimulant per mouse were injected 2 to 3 days after CY chemotherapy and when combination treatment was continued on a weekly basis. The most critical factors contributing to the effectiveness of combination treatment in this system were the dose of C. parvum and the treatment frequency. The interval between chemotherapy and immune stimulant therapy was less critical to the outcome of combination treatment. Combination treatment given once or weekly significantly decreased tumor size in comparison to single or weekly CY treatment. A single treatment with CY and C. parvum significantly improved the survival over mice given a single CY treatment, but weekly CY and C. parvum treatment did not increase the survival over mice, given weekly chemotherapy.

Adenocarcinoma↗

PubMed2006

An analysis of the pediatric vaccine supply shortage problem.

In 2002, several factors resulted in pediatric vaccine manufacturers not being able to produce a sufficient number of vaccines to vaccinate all the children in the United States according to the Recommended Childhood Immunization Schedule. The resulting vaccine supply shortage resulted in thousands of children not being fully immunized according to this schedule, and hence, created an unnecessary risk for epidemic outbreaks of several childhood diseases. The Centers for Disease Control and Prevention responded to this crisis by using pediatric vaccine stockpiles to mitigate the impact of future shortages. This paper presents a stochastic model that captures the vaccine supply during production interruptions. This model is used to assess the impact of pediatric vaccine stockpile levels on vaccination coverage rates, by considering the probability that all children can be immunized according to the Recommended Childhood Immunization Schedule over a given time period and the expected minimum vaccine supply. The model is also used to assess the proposed pediatric vaccine stockpile levels recommended by the United States Department of Health and Human Services. The results of this analysis suggest that the proposed vaccine stockpile levels are adequate to meet future vaccine production interruptions, provided that such production interruptions do not last more than six months (which is not surprising, given that is the time period for which they were designed). However, given that recent vaccine production interruptions have lasted (on average) for over one year, the proposed vaccine stockpile levels are insufficient to meet the nation's pediatric immunization needs during such time periods, which in turn could lead to localized and/or widespread disease outbreaks. Moreover, a moderate investment in higher vaccine stockpile levels would lead to a significantly reduced risk of such events.

Child↗

PubMed1992

Local and systemic antibody response in Balb/c mice immunized with Entamoeba histolytica trophozoites.

Several immunization schedules with E. histolytica trophozoites were tested on Balb/c mice in order to induce antibody responses, both in intestinal secretions and in serum. Mice were immunized either orally, systemically, or using one of two combined schedules: the oral route followed by the systemic route (footpad), or vice versa. Each of the immunization schedules used in this project induced an anti-E. histolytica antibody response and there appears to be a correlation between the immunization route employed and the immunoglobulin isotype induced in the gut. Secretory IgA production is favored by the oral administration of trophozoites, whereas mucosal IgG appears to be enhanced by the systemic immunization route. Both schedules are effective in the induction of secretory IgA in the gut, yet higher and earlier levels of IgA appear in orally immunized mice. When systemic immunization is employed, the increase in antibody levels in the intestinal fluid is slower, and IgG is the predominant class. The combined oral/systemic routes of immunization appear to be comparably effective for the induction of local and systemic IgA and IgM antibody production. However, mice immunized first systemically and then locally produce more IgG in both compartments. Combined schedules modify the isotype pattern of antibody responses in serum and in intestinal secretions when compared with single (i.e., oral or systemic) schedules, but they do not appear to favor a secretory IgA immune response.

Administration, Oral↗

PubMed1999

Hepatitis B vaccine administered to children and adolescents at yearly intervals.

OBJECTIVE: Hepatitis B vaccines are usually administered on a schedule of 0, 1 to 2, and 6 months. Longer intervals between the second and third doses have been studied, but the effectiveness of hepatitis B vaccine administered at intervals of >2 months between the first and second doses have not been studied. Our objective was to compare the antibody response in recipients of Engerix-B hepatitis B vaccine administered at 12-month intervals to the response to vaccine administered at 0-, 1-, and 6-month intervals. METHODS: A total of 389 children, 5 through 16 years of age, were randomized to receive Engerix-B (10 mg) at a schedule of either 0-, 1-, and 6-month intervals or 0-, 12-, and 24-month intervals. Blood was drawn before and 1 month after the third dose. RESULTS: Immediately before the third dose of vaccine, 92.3% of children who received vaccine on the 0-, 1-, and 6-month schedule and 88.8% of children who received the 0-, 12-, and 24-month schedule had antibody to hepatitis B surface (anti-HBs) antigen concentrations >/=10 mIU/mL. Of the children in the 0-, 1-, and 6-month schedule, 95% received the third dose according to protocol versus 90% of those in the 0-, 12-, 24-month schedule. The geometric mean anti-HBs concentration just before the third dose for recipients of the 0-, 1-, and 6-month schedule (117.9 mIU/mL) was somewhat lower than that for the children who had received vaccine on the 0-, 12-, and 24-month schedule (162.1 mIU/mL). One month after the third dose, >98% of all children had anti-HBs concentrations >/=10 mIU/mL and high geometric mean antibody concentrations were observed in both groups: 5687 mIU/mL for children on the 0-, 1-, and 6-month schedule and 3159 mIU/mL for children on the 0-, 12-, and 24-month schedule. Body mass index was correlated inversely with final antibody concentration, but age was not a factor after adjustment for body mass index. DISCUSSION: Engerix-B administered on a 0-, 12-, and 24-month schedule is highly immunogenic. Providers should consider this alternate immunization schedule for children who are at low risk of immediate exposure to hepatitis B infections.

Acute Disease↗

PubMed1997

Optimization of murine CD8+ cytotoxic T-lymphocyte responses to pseudorabies virus.

The aim of this work was to optimize the procedures used to elicit a cellular immune response to pseudorabies virus (PrV) in mice, using various immunization schedules and routes. An Eu-labeling-based cytotoxic T-lymphocyte (CTL) test was developed to measure the response. This necessitated optimization of numerous steps. In suspension, Eu labeling required high concentrations of dextran-sulfate (DXS) and Eu with a 30-min labeling time at room temperature. For anchored cells, the labeling time was 1 to 48 h, and the labeling efficiency depended strongly on the Eu concentration, but only marginally on the DXS concentration. In vivo and in vitro stimulation protocols were also optimized for the CTL test. For in vitro stimulation, spleen cells were cultured in T-25 flasks at a multiplicity of infection (m.o.i.) of 2. The CTL test was validated by specific depletion of CD8+ CTL, FACS analysis, and by comparing Eu and 51 Cr labeling. Then groups of mice were vaccinated once or twice by various routes (intraperitoneal (i.p.), intravenous (i.v.), subcutaneous (s.c.) and in the rear footpads (FP)) and according to different time schedules. CTL activity was detected only in boosted animals immunized FP, i.p. or i.v. That the cellular immune response contributes to protection was further suggested by the observation that i.p. immunization conferred better protection against challenge than s.c. immunization.

3T3 Cells↗

PubMed1975

Immunization activities of private-practice physicians: a record audit.

A record audit of the office immunization records of 13 private-practice Idaho physicians included 813 2-year-old children. Thirty-six percent had completed all the Public Health Service recommended immunizations for a 2-year-old child. Forty-four percent of the "active" patients (those seen by the physician within the previous 12 months) were complete as opposed to 8% of the "inactive" patients. In general, the children who received immunizations exclusively from their private physician were better immunized (38% complete) than those who received immunizations from both their private physicians and the health department clinics (22% complete). Despite the low percentage of overall completeness, the vaccine-specific immunization levels were at least as high as the levels computed from the National Immunization Survey. While the limitations of the study prevent application of the results to physicians in general, the data suggest that the inability to complete an immunization schedule, once begun, is a major weakness in the immunization activities of private-practice physicians.

Child, Preschool↗

PubMed1990

Maternal education and child immunization.

This article explores the hypothesis that formal education of women results in increased child survival because of greater knowledge of the protective function of the major childhood immunizations. Education is also associated with greater awareness of proper immunization schedules. Irrespective of mother's formal education level, specific immunization knowledge is associated with an increased likelihood of using immunization. The Indonesian analysis is important as a model for preventive health campaigns among other populations with low education levels among women.

Adult↗

PubMed1996

Simultaneous control of measles and rubella by multidose vaccination schedules.

There is currently a preference for using measles-mumps-rubella vaccine to simultaneously control these three diseases. Here an age-specific transmission model is used to investigate the consequences, on cases of measles and congenital rubella syndrome, of switching from a one-dose vaccination with this vaccine to a two-dose vaccination schedule. The model allows for a period of maternally acquired immunity and assumes that infection leads to permanent immunity, while vaccine-induced immunity is allowed to wane. The vaccination coverage at the second dose is expressed in terms of availability for vaccination, which depends on whether the individual received the first dose and the age of the individual. It is found that the optimal age for the first vaccination is not very sensitive to variations in the force of infection and is close to age 1 year for both measles and rubella. However, the optimal age for a second vaccination, offered indiscriminately, depends significantly on the age-specific forces of infection. This emphasizes that decisions about immunization schedules require reliable information about age-specific forces of infection in the community. In some circumstances control may be significantly more effective when the ages for the second dose differ for measles and rubella. It is found that the addition of a catch-up vaccination, offered to previously unvaccinated children at school entry, makes it more feasible to find a common age for the second dose that controls both measles and rubella effectively.

Adolescent↗

PubMed1998

A population-based survey of immunization coverage in children aged 2 years and younger in New South Wales.

OBJECTIVE: To provide a population-based baseline of immunization rates in children aged 2 years and younger in New South Wales (NSW) in 1992, permitting more accurate evaluation of the efficacy of current programmes. METHODS: A cross-sectional population-based survey of 622 households from areas resident to over 73% of all children aged 4 years and younger in NSW. RESULTS: Of the 322 households with children aged 3-24 months, 212 (66%; confidence interval (CI): 57-75%) were up-to-date with the recommended immunization schedule, 68 (21%; CI: 15-27%) had not commenced any immunization, and 42 (13%; CI: 9-17%) were partially immunised. Ability to read English (odds ratio (OR): 5.43; CI: 2.37-12.44) and receipt of hepatitis B immunization (OR; 2.54; CI: 1.27-5.07%) were highly associated with up-to-date immunization; whilst a history of any illnesses, frequent doctor visits in the past 12 months (OR: 0.47; CI: 0.27-0.85%) and older age (16-24 months) (OR: 0.26; CI: 0.12-0.50%) were less likely to be associated with up-to-date immunization. CONCLUSIONS: In 1992 NSW had low levels of up-to-date immunization. Significantly, one-fifth of NSW families with children aged 3-24 months did not have a record of any immunizations. This could not be explained by delay in commencing immunization. Poor competency in reading English was strongly associated with failure to immunise, suggesting that there had been inadequate targeting of immunization campaigns in non-English-speaking communities.

Child Health Services↗

PubMed1978

The immunological response of Nigerian infants to attenuated and inactivated poliovaccines.

A comparison was made of the immunity conferred by injected formalin-killed poliomyelitis vaccine and orally administered attenuated poliomyelitis vaccine in Nigerian infants under tropical conditions where interfering enteroviruses have caused poor conversion rates with attenuated poliomyelitis vaccine. Two hundred and thirty infants completed the immunization schedules. The levels of antibodies to polioviruses were assessed before immunization and at periodic intervals during the trial. Seventy-four per cent, 72% and 85% of the children lacked antibodies to poliovirus types 1, 2 and 3 respectively at 6 months if they received no vaccine, the comparative proportions respectively were 52%, 8% and 48% if they had oral attenuated poliovaccine and 2%, 4% and 0% if they had three doses of inactivated poliovaccine. It is suggested that killed poliovaccine incorporated in a quadruple vaccine may have a place in developing countries like Nigeria in the control of diphtheria, tetanus, whooping cough and poliomyelitis.

Antibodies, Viral↗

PubMed1995

Combination vaccines for diphtheria, tetanus, pertussis, and Haemophilus influenzae type b.

The ability to combine the standard DTP and Haemophilus b conjugate vaccine considerably simplifies the childhood immunization schedule and process. In addition to reducing the number of immunizations by half, the combination product reduces administrative aspects associated with vaccination including tracking. Simplification of the immunization process should have a positive impact on the vaccine delivery and utilization. Perhaps more importantly, an ability to create combination vaccines will be critical for inclusion of new antigens appropriate for infant vaccines. The combination of DTP and HbOC reduces the number of immunizations routinely given at 2, 4, and 6 months of age by half. Since it is unlikely that parents or pediatricians will accept more than two shots per visit, this reduction is critical. As new vaccines are licensed for such important childhood pathogens as Streptococcus pneumoniae and respiratory syncytial virus, designing stable combination products will become even more critical. Having stated that, we must also not lose site of the fact that combination products must meet the criteria for stability, safety, and efficacy comparable to the separately delivered products. These considerations are not trivial. In the development of Tetramune (DTP-HbOC), stability of the product and consistency of the immune response were critical design parameters for both the preclinical and clinical research. Likewise, the experience with other DTP-Haemophilus b combinations has shown that simple mixing of products prior to injection can reduce the immune response in ways that are not necessarily predictable. In contrast, the response to each of the components of Tetramune was in fact higher than when the vaccines were given separately. This increased response to all of the antigens was not anticipated based on the vaccine composition and points to the need for not only physical characterization of new combinations, but also clinical testing of final combined products before they are introduced for routine use.

Antibodies, Bacterial↗

PubMedDate not supplied

Vaccine verification guide: demystifying childhood immunizations for inpatient and other nurses.

Provision of childhood immunizations continues to be an essential component in reducing morbidity and mortality worldwide. Inpatient nurses can play an essential role in assuring that children who are eligible for vaccinations are identified and provided with the appropriate immunizations. However, maintaining current knowledge of the rapidly changing immunization schedule can be a barrier, especially in a setting where immunizations and preventive care are not the main focus. This article emphasizes the importance of hospital nurses advocating for immunization of children and presents a Vaccine Verification Guide that serves as a tool for quickly and accurately identifying the vaccination needs of children, whether on-track or delayed in their immunizations.

Adolescent↗

PubMed1975

Production of influenza virus complement-fixing antibody in mouse ascitic fluid.

Suspension cultures of BHK-21/13s cells infected with either A/Hong Kong/8/68 or B/Massachusetts/3/66 strains of influenza were used to prepare type-specific influenza ribonucleoprotein-immunizing antigens. These antigens were used in comparing four immunization schedules in the production of immune mouse ascitic fluids. Large volumes of ascitic fluids were obtained by these schedules. These fluids contained type-specific complement-fixing antibody and were devoid of nonspecific host tissue or heterologous cross-reactions.

Animals↗

PubMed2003

Seroprevalence of rubella in school girls and pregnant women.

Many studies have been assigned to investigate the surveillance of congenital rubella syndrome, acquired rubella and seroprevalence in different countries to determine the new vaccination program and national vaccination schedules. Seroprevalence of rubella in Turkey is still insufficient and national immunization schedules do not include routine rubella vaccination. In this study we aimed to investigate the seroprevalence of rubella at child bearing age in an unvaccinated population in Adana, southern Turkey, to help determine whether routine rubella vaccination is necessary, if so when it should be administered. Ninety-four school girls aged 12-18 years living in Adana were selected for the study and stratified according to the socioeconomic status of their parents and evaluated for rubella antibodies. One hundred pregnant women aged 18-25 years and 100 pregnant women aged 26-35 years were sampled rubella antibodies. Rubella specific IgG antibody was measured qualitatively and quantitatively by using microparticule enzyme immune assay technology. Rubella specific IgG antibody was positive in 87-94 school girls (92.5%). The geometric mean rubella specific IgG antibody value was found be 148.14 IU/ml. No correlation was found between socioeconomic status and rubella seropositivity (p = 0.6521). In all pregnant women rubella specific IgG antibody was found to be positive. In conclusion rubella vaccination should be considered carefully in developing countries. Because of the high seropositivity to rubella in our region we do not recommend rubella vaccination in early childhood. Yet this is a preliminary study and further studies with larger population size are needed to determine the national immunization policy for rubella.

Adolescent↗

PubMed2001

Sequential immunization of macaques with two differentially attenuated vaccines induced long-term virus-specific immune responses and conferred protection against AIDS caused by heterologous simian human immunodeficiency Virus (SHIV(89.6)P).

Four rhesus macaques were sequentially immunized with live vaccines DeltavpuDeltanefSHIV-4 (vaccine-I) and Deltavpu SHIV(PPC) (vaccine-II). The vaccine viruses did not replicate productively in the peripheral blood mononuclear cells (PBMCs) of the vaccinated animals. All four animals developed binding antibodies against both the vaccine-I and -II envelope glycoproteins but neutralizing antibodies only against vaccine-I. They developed vaccine virus-specific CTLs that also recognized homologous as well as heterologous pathogenic SHIVs. Thirty weeks after the last immunization, the vaccinated animals and three unvaccinated control animals were challenged iv with a highly virulent heterologous SHIV(89.6)P. As expected, the three unvaccinated control animals developed large numbers of infectious PBMCs, high plasma viremia, and precipitous loss of CD4(+) T cells. Two controls did not develop any immune response and succumbed to AIDS in about 6 months. The third control animal developed neutralizing antibodies and had a more chronic disease course, but eventually succumbed to AIDS-related complications 81 weeks after inoculation. The four vaccinated animals became infected with challenge virus as indicated by the presence of challenge virus-specific DNA in the PBMCs and RNA in plasma. However, virus in these animals replicated approximately 200- to 60,000-fold less efficiently than in control animals and eventually, plasma viral RNA became undetectable in three of the four vaccinates. The animals maintained normal CD4(+) T-cell levels throughout the observation period of 85 weeks after a transient drop at Week 3 postchallenge. They also maintained CTL responses throughout the observation period. These studies thus showed that the graded immunization schedule resulted in a safe and highly effective long-lasting immune response that was associated with protection against AIDS by highly pathogenic heterologous SHIV(89.6)P.

AIDS Vaccines↗