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At least 397 records · Page 22Linked to original sources
PubMed1999

Epidemiological, clinical, and laboratory aspects of pertussis in adults.

In populations without immunization, pertussis is a high-incidence, endemic disease with cyclic epidemic peaks occurring every 2-5 years. The universal use of pertussis vaccines in children results in a marked reduction in incidence, but the frequency of disease cycles does not lengthen. This indicates that the organism (Bordetella pertussis) remains prevalent in the population. Studies of prolonged cough illnesses in adolescents and adults indicate that between 12% and 32% are the result of B. pertussis infection. Serological survey data indicate that all adults have been previously infected, and IgA antibody studies suggest that infections in adults are as frequent in the United States, where pertussis has been controlled, as in Germany, where pertussis has been epidemic. Because of the apparent reservoir of B. pertussis infections in adolescents and adults, I believe that B. pertussis circulation cannot be controlled by our present childhood immunization program. Acellular pertussis vaccines make adolescent and adult booster immunization programs possible, and these could lead to a decrease in the circulation of the organism.

Adolescent↗
PubMed1997

Age-related hepatitis B seroconversion rates in health care workers.

BACKGROUND: Protective hepatitis titers are reported for more than 90% of healthy adults who received three intradeltoid injections of vaccine. Some factors that influence seroconversion rates include age, sex, and presence of chronic diseases. METHODS: Because of work-related factors that placed them at risk of acquiring hepatitis B, 112 employees, who ranged in age from 20 to 70 years with a mean age of 39.2 years, completed the hepatitis B vaccination series between 1986 and 1993. All participants received three vaccinations. RESULTS: Hepatitis B surface antibody did not develop in 16 of 112 recipients (14.2%, 95% CI, 7.6% to 20.8%). Race, sex, and duration to antibody titer did not affect rates of seroconversion. Age greater than 50 years was associated with significantly decreased seroconversion rates (64.7%, 95% CI, 42.0% to 87.4%) compared with seroconversion rates of those younger than 50 years of age (89.5%, 95% CI 83.3% to 95.7%, p = 0.02). CONCLUSIONS: Our results indicate that when a hepatitis B immunization program is implemented, seroconversion rates are lower than published rates for healthy adults and adolescents. We recommend that seroconversion data from immunization programs for employees at risk for hepatitis B be reviewed and that postimmunization testing be considered to ensure adequate protection for those employees at highest risk for nonconversion.

Adult↗
PubMed2004

The strategy to control New Zealand's epidemic of group B meningococcal disease.

BACKGROUND: In New Zealand today, babies of Pacific ethnicity born in South Auckland have a 1-in-48 chance of contracting meningococcal disease by the time they are 5 years of age. METHODS: The New Zealand government, Chiron Vaccines and the University of Auckland have collaborated to develop and investigate a group B meningococcal vaccine to allow a mass-immunization program to control a prolonged and intense epidemic. Within 3 years, a strain-specific meningococcal outer membrane vesicle vaccine has been developed, and overlapping clinical trials have been undertaken; a report was submitted for regulatory approval within 2 years. An important aspect of the project's strategy was to apply, with physicochemical data, the results of the New Zealand outer membrane vesicle vaccine trials to the parent vaccine produced and evaluated by the Norwegian National Institute of Public Health. Immunogenicity results for the New Zealand vaccine are promising, with the vaccine showing a reactogenicity profile similar to that of the parent vaccine. CONCLUSIONS: Controlling the epidemic depends on delivering an effective vaccine to the individuals at greatest risk, ie, mainly Maori and Pacific populations that previous health programs have struggled to reach. Participation of and partnership with these communities in public health decision-making and vaccine delivery will be critical to a successful immunization program.

Child, Preschool↗
PubMed2004

Natural immunity to Haemophilus influenzae type B in children of Ankara, Turkey.

BACKGROUND: Haemophilus influenzae type b (Hib) infection has a high morbidity and mortality rate especially in children under 5 years of age. The incidence of Hib disease in Turkey is not known, and Hib vaccine is not included in the National Immunization Program. The aim of this study was to determine the natural immunity to Hib of children 6-60 months of age living in the Park Health Center region of Ankara, Turkey. METHODS: A total of 270 children were selected by layered random sampling method, and 242 of them (89.6%) participated in the study. A questionnaire was given to the parents of the children who were included in the study and blood samples were taken from those children. Anti-Hib IgG antibody (anti-PRP) level was determined in the serum by using anti-Haemophilus influenzae IgG EIA kit and anti-PRP antibody levels of 0.15 microg/mL and over were accepted as the natural immunity. RESULTS: Natural immunity was determined in 65.3% of the children. A relationship was determined statistically between the history of disease with possible Hib agent and with natural immunity. CONCLUSIONS: The exposure rate of children with Hib was higher than expected, even in children who were just a few months old. Our data revealed that multicentric, national studies should be done to define the burden of Hib disease before making a decision for Hib vaccine to be included in the National Immunization Program.

Antibodies, Bacterial↗
PubMed2005

CHIP shots: association between the State Children's Health Insurance Programs and immunization rates.

OBJECTIVE: The Balanced Budget Act of 1997 established the State Children's Health Insurance Program (SCHIP), which makes health insurance available to children in near-poor families who are ineligible for Medicaid. SCHIP mandates that all state plans cover the cost and administration of childhood vaccines. Whether SCHIP has narrowed immunization coverage rates between near-poor and nonpoor children is unknown. The objective of this study was to use data from the National Immunization Survey from 1995 to 2002 to analyze changes in immunization coverage rates among poor, near-poor, and nonpoor children before and after implementation of SCHIP. METHODS: A prepost analysis was made of changes in immunization rates among poor, near-poor, and nonpoor children before and after implementation of SCHIP in all 50 states and 28 Immunization Action Plan areas from 1995 to 2002. All children in the National Immunization Survey for whom information on vaccinations was available from the respondents' shot cards and/or from the children's immunization providers (N = 264214) were studied. Up-to-date status for the 4:3:1 (4 doses of diphtheria-tetanus toxoids-pertussis vaccine/3 doses of poliovirus vaccine/1 dose of measles-mumps-rubella vaccine) and the 4:3:1:3:3 (4 doses of diphtheria-tetanus toxoids-pertussis vaccine/3 doses of poliovirus vaccine/1 dose of measles-mumps-rubella vaccine/3 doses of Haemophilus influenzae type B vaccine/3 doses of hepatitis B vaccine) series as well at the hepatitis B and varicella vaccines was measured. RESULTS: The probability that a poor or near-poor child was up to date for the 4:3:1:3:3 vaccine series increased approximately 11 percentage points after implementation of SCHIP. However, we observed a similar increase for nonpoor children. The proportion of poor and near-poor children who were up to date for the varicella vaccine increased between 7 and 8 percentage points more than among nonpoor children after implementation of SCHIP. Relative increases among poor and near-poor children were greater in the 28 Immunization Action Plan areas, in states with high rates of uninsured children, and among Hispanics. CONCLUSION: SCHIP seems not to be associated with changes in the up-to-date status of poor and near-poor children for the 4:3:1 and the 4:3:1:3:3 vaccine series. Vaccine coverage rates increased broadly among all income groups between 1995 and 2002.

Chickenpox Vaccine↗
PubMed2001

Integration of vitamin A supplementation with the Expanded Programme on Immunization: lack of impact on morbidity or infant growth.

UNLABELLED: Vitamin A deficiency is associated with increased morbidity and mortality from diarrheal disease, measles, and malaria. It has been proposed that vitamin A supplementation could be linked with childhood immunization programs to improve child health. We conducted a randomized, double-blind, placebo-controlled clinical trial to evaluate the impact of linking vitamin A supplementation with the Expanded Programme on Immunization on morbidity and child growth. In West Java, Indonesia, 467 six-week-old infants were randomized to receive 7.5 mg retinol equivalent (RE), 15 mg RE, or placebo with childhood immunization contacts at 6, 10, and 14 wks and 9 mo of age. Child growth was assessed through anthropometry, and morbidity histories were obtained. Vitamin A supplementation had no apparent impact upon linear or ponderal growth or infectious disease morbidity in the first 15 mo of age when integrated with the Expanded Programme on Immunization. CONCLUSION: Although improving vitamin A nutriture is of general importance in reducing diarrheal and measles morbidity and mortality in developing countries, this clinical trial showed no apparent benefit of vitamin A capsules for infant health when given through childhood immunization programs.

Child Development↗
PubMedDate not supplied

Comparing benefits and risks of immunization.

BACKGROUND: This paper uses a straightforward method of quantifying the benefits and risks of immunization, illustrated by universal immunization programs in British Columbia against invasive Haemophilus influenzae type b disease (Hib), measles, rubella, and paralytic poliomyelitis. METHODS: Data were extracted from provincial communicable disease and vaccine adverse event surveillance systems. Average disease incidence was compared before and after implementing universal immunization programs. Estimates of prevented deaths and serious disease complications were calculated and compared with expected numbers of serious vaccine-associated adverse events (VAAEs). RESULTS: Average incidence of reported cases decreased 90 to 100% over a 5-year period after implementing universal programs. These benefits were sustained or strengthened over time. Rates of reported serious VAAEs were low. DISCUSSION: The remarkable success of immunization has created a paradox. Despite a low absolute risk of serious VAAEs, the relative risk of some VAAEs can exceed risk of disease in the province.

British Columbia↗
PubMedDate not supplied

Development of immunization policy and its implementation in the United Kingdom.

The U.K. immunization program is managed through a tightly connected process that links the ways policy is developed, submitted to independent expert review and recommendation, adopted into strategy, and implemented into practice. There is one advisory body for immunization. Its recommendations, once accepted by government, are centrally funded, and vaccines are provided at no cost to recipients. Although the present system has worked well, changes in health care management at the peripheral level mean that the immunization program will need to adapt to retain the health gains achieved. Rates of vaccine-preventable disease are at historically low levels, although challenges related to costs and effectiveness remain.

Health Policy↗
PubMedDate not supplied

Practice survey of immunization in Canada.

A survey was undertaken in September 1991 to document current immunization practice across Canada. Information was obtained during interviews with provincial epidemiologists and key persons involved in immunization programs and recorded on standard data collection forms. Variations in practice are described in five areas: public/private health administration; legislation; monitoring system/coverage rates/surveillance; vaccine management and costs. As changes are being considered to immunization programs, a critical examination of issues such as standardization (in coding, in assessment of waste, in assessment of coverage), surveillance systems and the use of serosurveys would be beneficial.

Canada↗
PubMedDate not supplied

Poliomyelitis in India: prospects and problems of control.

Based on many surveys of residual paralysis and limited surveillance, the incidence of acute paralytic poliomyelitis in India has been calculated to be 20-40 per 100,000 population per year; thus greater than 200,000 cases occur annually, or 500 every day. Although oral polio vaccine ( OPV ) has been highly effective in controlling outbreaks, its introduction in routine immunization programs has not succeeded in controlling poliomyelitis in India. This failure is the result of inappropriate immunization strategy and low rates of antibody response to vaccine virus. Injectable polio vaccine, although found to be highly effective in routine immunization programs, is very costly and in short supply. The annual immunization of the susceptible age group with OPV during a short period (pulse immunization) has been found to be highly effective; this strategy is recommended for national control of poliomyelitis.

Child, Preschool↗
PubMed2005

Seroprevalence of hepatitis B virus and hepatitis C virus in Monte Negro in the Brazilian western Amazon region.

PURPOSE: This study was carried out in Monte Negro (state of Rondônia), a village in the Brazilian western Amazon region, where a University of São Paulo Medical School program for medical student training in rural assistance took place. It aimed to determine the prevalence of hepatitis B virus and hepatitis C virus, to investigate risk factors for infection, and to evaluate the State immunization program against hepatitis B virus in the region. METHODS: The study is a cross-sectional seroprevalence survey, comprising 267 volunteers who answered a comprehensive questionnaire and had blood samples collected, which were analyzed in São Paulo for the presence of antibodies against hepatitis B virus (Hbs Ag, anti-Hbs, and anti-Hbc) and hepatitis C virus using commercial kits. Data were stored in a specific data bank, and the association between seropositivity and potential risk factors was analyzed by means of uni-, bi-, and multi-variate analysis, considering +/- 5%. RESULTS: The seroprevalence of hepatitis B virus was 61.79% and of hepatitis C virus was 0.38%. Statistical analysis on the data bank showed that the prevalence of hepatitis B virus rose significantly with age, especially after adolescence. Infection was higher in those coming from outside the state of Rondônia. Exposure to vaccination against hepatitis B virus was higher in younger individuals and in those who were born in Rondônia. CONCLUSION: Monte Negro is a highly endemic region for hepatitis B virus but not for hepatitis C virus. Our results also provide indirect evidence indicating a significant improvement in the immunization program in Rondônia in recent years.

Adolescent↗
PubMed2005

Incidence of hepatitis A in Israel following universal immunization of toddlers.

CONTEXT: In Israel, the mean annual incidence of hepatitis A disease was 50.4 per 100 000 during 1993-1998. A 2-dose universal hepatitis A immunization program aimed at children aged 18 and 24 months (without a catch-up campaign) was started in 1999. OBJECTIVE: To observe the impact of toddlers-only universal vaccination on hepatitis A virus disease in Israel. DESIGN AND SETTING: Ongoing passive national surveillance of hepatitis A cases in Israel has been conducted since 1993 by the Ministry of Health. An active surveillance program in the Jerusalem district in 1999-2003 provided validation for the passive program. MAIN OUTCOME MEASURE: Incidence of reported hepatitis A disease, 1993-2004. RESULTS: Overall vaccine coverage in Israel in 2001-2002 was 90% for the first dose and 85% for the second dose. A decline in disease rates was observed before 1999 among the Jewish but not the non-Jewish population. After initiation of the program, a sharp decrease in disease rates was observed in both populations. The annual incidence of 2.2 to 2.5 per 100 000 during 2002-2004 represents a 95% or greater reduction for each year with respect to the mean incidence during 1993-1998 (P<.001). For children aged 1 through 4 years, a 98.2% reduction in disease was observed in 2002-2004, compared with the prevaccination period (P<.001). However, a sharp decline was also observed in all other age groups (84.3% [<1 year], 96.5% [5-9 years], 95.2% [10-14 years], 91.3% [15-44 years], 90.6% [45-64 years], and 77.3% [>or=65 years]). Among the Jewish population in the Jerusalem district, in whom the active surveillance program was successfully conducted, a more than 90% reduction of disease was demonstrated. Of the 433 cases reported nationwide in 2002-2004 in whom vaccination status could be ascertained, 424 (97.9%) received no vaccine and none received 2 doses. CONCLUSION: This universal toddlers-only immunization program in Israel demonstrated not only high effectiveness of hepatitis A vaccination but also marked herd protection, challenging the need for catch-up hepatitis A vaccination programs.

Adolescent↗
PubMedDate not supplied

Impact of an immunization education program on middle school adolescents.

OBJECTIVES: To raise middle school student awareness, attitudes, and proactive behaviors about immunization, and to increase immunization rates among middle school students through implementation of a comprehensive integrated immunization promotion curriculum (Immunization Plus!) METHODS: Evaluation used a quasi-experimental non-equivalent comparison-groups design conducted in a sample of 40 classrooms in 22 schools in California. RESULTS: Sixth-grade students exposed to the curriculum developed more positive knowledge and attitudes, and were more likely to be immunized, to intend to obtain newly required immunizations, and to tell parents about immunizations. CONCLUSION: Infectious disease control and immunizations are under-developed subject areas within school-based health promotion in the United States that can be effectively taught to middle school students.

Adolescent↗
PubMed1990

Basic immunologic principles underlying vaccination procedures.

Mass immunization programs and routine immunization of infants and children have significantly reduced the incidence of several serious diseases. This article describes the immunologic principles that guide the use of vaccines and explains the mechanisms of protective immunity, adverse side reactions associated with immunization, and new molecular approaches for producing vaccines.

Antibody Formation↗
PubMedDate not supplied

Measles in Israel, the West Bank, and Gaza: continuing incidence and the case for a new eradication strategy.

Measles continues to occur in epidemic waves in Israel, Gaza, and the West Bank, causing morbidity and mortality. In Israel, immunization of infants against measles began in 1967, and 90% had been immunized by the mid-1980s. In Gaza and the West Bank, where immunization of infants against measles began in 1973 and 1976, respectively, the immunization rate reached 75% in the late 1970s and increased to greater than 90% in the 1980s. Measles epidemics, which previously had occurred in 5- to 7-year cycles, occurred every 2-4 years in the 1980s and affected individuals who were older than those affected in previous years. Israel's commitment to eradicating measles by 1992 will require a substantially expanded immunization program in comparison with the traditional program that requires immunization of infants alone. The benefits of several alternative immunization strategies considerably exceed their costs. A new, two-dose immunization will be needed as a minimal strategy, and a campaign for administering booster doses to school-aged children may be required as well to achieve control and eradication of measles. Measles is a serious but preventable public health problem; appropriate strategies must be devised by national and international public health officials to control the disease in developing and developed countries.

Adolescent↗
PubMed2005

Nursing home resident and facility characteristics associated with pneumococcal vaccination: national nursing home survey, 1995-1999.

OBJECTIVES: To assess Advisory Committee for Immunization Practices recommendations for the pneumococcal vaccine in nursing home residents using national surveys to examine factors associated with vaccination. DESIGN: Cross-sectional national sample surveys of nursing homes and nursing home residents with a two-stage probability design, stratified on size and Medicare and Medicaid certification status. SETTING: U.S. nursing homes during 1995, 1997, and 1999. PARTICIPANTS: Six current residents were randomly selected from each facility (n=approximately 8,000 each year). MEASUREMENTS: Residents' pneumococcal vaccination status was obtained by asking the facility respondent for each resident: "Has [the resident] EVER had a pneumococcal vaccine, that is a pneumonia vaccination?" Vaccination status was coded as yes, no, and unknown. RESULTS: The proportion of residents aged 65 and older that received pneumococcal vaccination increased significantly, from 23.6% in 1995 to 28.2% in 1997 to 37.4% in 1999 (P<.001). The proportion of residents in homes with pneumococcal immunization programs increased significantly, from 65.2% in 1995 to 88.9% in 1999. CONCLUSION: The proportion of nursing home residents aged 65 and older receiving the pneumococcal vaccine increased significantly from 1995 to 1999. Residents living in nursing homes with programs for pneumococcal immunizations were significantly more likely to be vaccinated.

Aged↗
PubMed2005

A review of the literature: the economic impact of preventive dental hygiene services.

The contributions of dental hygiene as a discipline of prevention, the inception of systemic fluoride in community water systems, the continual research conducted by the National Institute of Dental and Craniofacial Research (NIDCR), and the success of dental sealants have all contributed to the decrease in incidences of dental diseases. The prevalence of employer-based dental insurance must also be recognized as contributing to a substantial paradigm shift on the utilization of oral health preventive services. This review of the economic impact of oral health preventive services on the consumer and the private dental practice suggests that these services have had a significant impact. Dentistry's challenge remains to extend these considerable gains in oral health status to the 150 million U.S. citizens who do not have access to oral health care services identified in the 2000 Oral Health in America: A Report of the Surgeon General. Utilizing preventive, therapeutic, and educational aspects of dental hygiene services, reaching communities without fluoridation of the public water supply, and incorporating mass pediatric dental sealant programs analogous to immunization programs would improve the oral health status of underserved populations.

Cost-Benefit Analysis↗