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PubMed2005

Humoral and cellular immune response after measles vaccination in Taiwan.

Measles immunoglobulin G (IgG) seroepidemiologic studies have been widely used to monitor the effectiveness of measles immunization programs in Taiwan. However, studies about cellular immunity against the measles virus have been lacking. This study surveyed cellular immunity after measles, mumps and rubella combined vaccine (MMR) immunization in Taiwan. Seventy six people between 1 and 80 years of age were enrolled. All patients lived in northern Taiwan, and none of them had immunodeficient disease. Every enrolled patient donated a tube of heparinized blood between January 2004 and June 2004 for cross-sectional studies of IgG seroepidemiologic and MMR-specific lymphoproliferative response. The results showed that the current 3-dose (measles x 1 + MMR x 2) measles immunization program induced slightly higher IgG seroprevalence (100% vs 85%, p=0.244) and a higher frequency of significant (stimulation indices > or = 3) MMR-specific lymphoproliferative response (50% vs 15%, p=0.044) than a 2-dose (measles x 1 + MMR x 1) immunization program, although there was no difference in IgG titers and stimulation indices. Furthermore, the population aged older than 36 years (pre-immunization era) had higher IgG titers and seroprevalence, and similar MMR-specific lymphoproliferative responses to that of the population aged younger than 36 years (post-immunization era). In summary, with the limited data, the current 3-dose (measles x 1 + MMR x 2) measles immunization policy probably more effectively induces humoral and cellular immunity than the 2-dose (measles x 1 + MMR x 1) policy. Measles IgG seroprevalence in populations of different age groups exceeds nearly 90%. Measles has been eliminated temporarily in Taiwan. For a better understanding of the durability of vaccine-induced immunity and in order to establish the most appropriate immunization schedule, long-term and large-scale prospective studies of measles-specific seroepidemiology and cellular immunity will be needed.

Adolescent↗
PubMed1988

Immunogenicity of a polyvalent melanoma antigen vaccine in humans.

Fifty-five patients with Stage II (36 patients) or Stage III (19 patients) malignant melanoma confirmed histologically received adjuvant immunotherapy with a polyvalent melanoma antigen vaccine to evaluate toxicity and immunogenicity. There was no toxicity. Antibody and/or cellular immune responses to melanoma were induced more frequently in Stage II (36 patients [69%]) than Stage III (19 patients [53%]) disease. The ability of different immunization schedules, alum, or pretreatment with low-dose cyclophosphamide to potentiate immunogenicity was compared after 2 months of immunization. Immunization biweekly with a fixed intermediate dose of vaccine was more immunogenic than immunization weekly with escalating vaccine doses. Alum increased the intensity of cellular responses slightly, whereas pretreatment with cyclophosphamide augmented both the incidence and intensity of cellular immune responses slightly. However, these changes did not reach statistical significance. There was a reciprocal relationship between the induction of humoral and cellular immune responses. These results show that (1) active immunotherapy with a polyvalent melanoma vaccine is safe in patients with minimal disease, (2) the vaccine augments immunity to melanoma in many, but not all, patients, and (3) several immunization strategies failed to potentiate immunogenicity significantly.

Adult↗
PubMed1996

Breaking the barriers to childhood immunization.

Although about 98 percent of children have received their basic series of immunizations at the time of school entry, only 67 percent of two-year-old children are appropriately immunized. Parental, provider, economic and system barriers to immunization must be overcome if the United States is to achieve the objective that 90 percent of two-year-old children receive the basic vaccination series against the major preventable childhood diseases by 1996. Parents must be educated about the importance of vaccines and the hazards of the diseases they prevent, and they must be given proper information about vaccine side effects and contraindications. Physicians should take advantage of all appropriate patient contacts, including acute office visits for minor illnesses, to keep children's immunizations current. Audits of office records, as well as tracking or reminder systems, improve vaccination rates. The Vaccines for Children Program is intended to remove cost as a barrier to the immunization of some children. The single immunization schedule endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics and the Advisory Committee on Immunization Practices may alleviate confusion about the appropriate time to administer different vaccines.

Child↗
PubMedDate not supplied

Experimental study upon the efficacy of some accelerated vaccination schedules in tetanus prophylaxis.

In an attempt to accelerate the antitetanic vaccine-induced immune response necessary particularly in subjects with tetanigenic wounds, groups of guinea pigs or rabbits were i.d. or s.c. immunized with a nonadsorbed purified and concentrated toxoid. Concomitantly, lots of control animals were i.m. immunized with tetanic vaccine adsorbed on aluminium phosphate. The immune response was estimated by testing the serum antitetanus antitoxic titre and the resistance of guinea pigs to tetanic intoxication. The results obtained revealed a variety of responses to vaccination in which differed terms of the species of animals and the applied immunization schedule. When single vaccine doses were used the protective antitetanus limit was reached in seven days in rabbits and after ten days in guinea pigs; the adsorbed vaccine induced a stronger immune response than the non-adsorbed vaccine. When multiple immunization doses were used the non-adsorbed tetanus vaccine induced, especially in rabbits, a more rapid response that the adsorbed vaccine. The vaccination schedules used in laboratory animals and which have yielded the best results in this experiment will be analysed and checked on human subjects in a further study.

Adsorption↗
PubMed2003

American College of Preventive Medicine practice policy statement: childhood immunizations.

Vaccine-preventable diseases were a major cause of mortality and morbidity in the United States in the 20th century. With the advent of immunizations, there have been dramatic rates of decline in these diseases. Clinical studies have shown vaccines to be efficacious and cost effective. Despite the simplification of the immunization schedule, vaccination rates are still suboptimal because of missed opportunities. Although several controversies have arisen about the safety of childhood immunizations, they are yet to be validated. There have been recent concerns about the stability of the infrastructure that supports the U.S. immunization program. Research has established strong evidence that certain interventions can increase vaccination coverage rates. The American College of Preventive Medicine outlines recommendations for childhood immunizations.

Adolescent↗
PubMed2003

[Vaccinations and solid-organ transplantation: review and recommendations].

Pediatric solid-organ transplant recipients are at high risk for various infectious diseases. Many children are not fully vaccinated before transplantation. To reduce the risk of morbidity and mortality from vaccine-preventable disease, physicians treating pediatric solid-organ transplant recipients should monitor the immunization status of these patients. Consensus on the most appropriate immunization schedule for solid-organ transplant recipients is lacking. Therefore, we provide a review of the currently available data on immunization safety and efficacy and describe strategies to avoid vaccine-preventable diseases in pediatric solid-organ transplant recipients.

Child↗
PubMedDate not supplied

Israel in the elimination phase of poliomyelitis--achievements and remaining problems.

Following the introduction of a combined EIPV and OPV schedule in 1990, no more cases of paralytic poliomyelitis were diagnosed and no wild poliovirus strain was isolated in the sewage. 100% seropositivity and high geometric mean titers (GMTs) to the three types of poliovirus vaccine strains and to the type 1 poliovirus 1988 epidemic strain were observed at the completion of the immunization schedule and one year later. The study of the immune profile of various age groups vaccinated with either EIPV or OPV had shown that the immunity to the epidemic poliovirus strain was less satisfactory, in terms of percent of seropositivity and GMTs, than to the poliovirus vaccine strains. In individuals previously immunized with either EIPV or OPV a high and quick immune response to both the 1988 epidemic and vaccine strains was observed after a booster dose of OPV. Follow-up to four years after the booster pointed to some decrease in the extent and intensity of the seropositivity to the 1988 epidemic strain as compared to the immune profile to the poliovirus vaccine strains. Maintaining Israel in the phase of polio elimination requires: > 95% national coverage, homogenously distributed; maintaining high immune profile to the three poliovirus types, including a satisfactory immune level to the 1988 epidemic strain in all the age groups at risk of polio; early detection of the introduction of wild poliovirus into the environment and of the occurrence of foci of indigenous activity; reducing the risk of exposure to massive infectious doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1983

Immunity to poliomyelitis in Sydney's children.

No indigenous cases of poliomyelitis have occurred in New South Wales since 1970, and it was presumed that herd immunity was high. However, our survey of Sydney's children by the neutralization test showed that only 42% of children had antibody levels (titre 8 or higher) to all three serotypes, 30% had antibodies to two, 16% to one, and 12% had no demonstrable antibodies at all. The immune status could not be determined with confidence from the immunization history, as 48% of the children who were reported as having received four or more doses of Sabin vaccine were not fully immune. When children who had inadequate levels of antibodies were given a single dose of Sabin vaccine, 77% of them achieved adequate antibody levels to all three viruses. The Health Commission of New South Wales subsequently undertook a mass Sabin immunization campaign of primary-school children, and reviewed the recommended immunization schedule.

Antibodies, Viral↗
PubMed1988

Relationship of pertussis immunization to the onset of epilepsy, febrile convulsions and central nervous system infections: a retrospective epidemiologic study.

A change in the pertussis immunization schedule in Denmark allowed a retrospective study examining the relationship of the time of onset of selected neurologic disorders with the time of pertussis immunization in two core cohorts of children. Records of 2,199 children with febrile seizures were reviewed and a significant association between first febrile seizures and the scheduled age of pertussis immunization was noted (p = 0.004). The occurrence of epilepsy and CNS infections did not appear to be related to the time of pertussis immunization.

Central Nervous System Diseases↗
PubMed1999

Immunization levels among premature and low-birth-weight infants and risk factors for delayed up-to-date immunization status. Centers for Disease Control and Prevention Vaccine Safety Datalink Group.

CONTEXT: Studies have noted that health care professionals may not conform to proper immunization schedules for premature and low-birth-weight infants in the United States. Little is known about the success of current efforts to immunize these high-risk infants. OBJECTIVE: To describe current immunization practices for premature and low-birth-weight infants and ascertain risk factors for poor immunization status, using large population-based data sources. DESIGN AND SETTING: Cohort and case-control analyses of immunization data tracked from March 1991 through March 1997 for 3 large health maintenance organizations (HMOs) participating in the Centers for Disease Control and Prevention's Vaccine Safety Datalink project. PARTICIPANTS: A total of 11580 low-birth-weight and premature infants were enrolled from birth to age 2 months; 6832 of these were continuously enrolled from birth to age 24 months. At age 2 months, there were 173373 full-term, normal-birth-weight infants enrolled as controls; at age 24 months, there were 103 324. MAIN OUTCOME MEASURES: Age-specific immunization status by prematurity and birth weight (<1500 g, 1500-2500 g, born at <38 weeks' gestation with birth weight of >2500 g, or full-term with normal birth weight) and patient characteristics associated with up-to-date status. RESULTS: At each age, infants weighing less than 1500 g at birth had lower up-to-date immunization levels than other infants. At age 6 months, 52% to 65% of infants weighing less than 1500 g were up-to-date at each of the 3 HMOs compared with 69% to 73% of those weighing 1500 to 2500 g, 66% to 80% of premature infants weighing more than 2500 g, and 65% to 76% of full-term, normal-birth-weight infants. By age 24 months, 78% to 86% of infants weighing less than 1500 g were up-to-date, significantly less than heavier infants, who had levels of 84% to 89%. Well-child preventive care strongly predicted immunization status, while concomitant pulmonary disease did not. CONCLUSIONS: Our data suggest that infants born prematurely are vaccinated at levels approaching that of the general population, but levels of vaccination for very low-birth-weight infants lag slightly behind.

Health Maintenance Organizations↗
PubMed1997

Enhancement of immunodeficiency virus-specific immune responses in DNA-immunized rhesus macaques.

In contrast to results obtained with plasmid DNA vectors encoding antigens from viruses such as influenza and hepatitis B, plasmids coding for antigens from primate immunodeficiency viruses have elicited relatively weak antibody responses following gene gun-mediated DNA immunization of rhesus monkeys. In an effort to augment these responses, the importance of the immunization schedule was investigated, as well as the possible synergy that might result from boosting gene gun-primed animals with other routes of immunization. Here we demonstrate that endpoint gp120-specific antibody titers can be enhanced as much as tenfold by reducing the number of immunizations and lengthening the resting period between immunizations. In addition, boosting gene gun-primed animals with either recombinant subunits or gp120-expressing vaccinia recombinants resulted in synergistic responses.

AIDS Vaccines↗
PubMed1989

The hepatitis B immunization programme in Singapore.

A voluntary immunization programme to prevent perinatal transmission of hepatitis B virus (HBV) infection in Singapore was implemented on 1 October 1985 as an integral component of the national childhood immunization programme. Up to April 1988, a total of 68,845 mothers who attended government maternal and child health clinics were screened for the disease. Of these, 2432 (3.5%) were positive for hepatitis B surface antigen (HBsAg) and 904 (1.3%) for hepatitis B e antigen (HBeAg). Virtually all the babies born to carrier mothers completed the full immunization schedule; and in addition, those of HBeAg-positive mothers were given a dose of hepatitis B immunoglobulin at birth. The hepatitis B immunization programme was extended on 1 September 1987 to cover all newborns. About 90% of the 15,943 babies delivered in government institutions from September 1987 to April 1988 were immunized at birth, with the subsequent doses being administered at maternal and child health clinics at 4-6 weeks and 5 months later. More than 85% of the children given the full course of plasma-derived and yeast-derived hepatitis B vaccine from birth continued to have protective antibody to HBV two years after immunization. The programme is being closely monitored to assess the duration of immunity and the need for booster doses, while seronegative adults are also being encouraged to be vaccinated.

Adolescent↗
PubMed2001

Oral immunization with hepatitis B surface antigen expressed in transgenic plants.

Oral immunogenicity of recombinant hepatitis B surface antigen (HBsAg) derived from yeast (purified product) or in transgenic potatoes (uncooked unprocessed sample) was compared. An oral adjuvant, cholera toxin, was used to increase immune responses. Transgenic plant material containing HBsAg was the superior means of both inducing a primary immune response and priming the mice to respond to a subsequent parenteral injection of HBsAg. Electron microscopy of transgenic plant samples revealed evidence that the HBsAg accumulated intracellularly; we conclude that natural bioencapsulation of the antigen may provide protection from degradation in the digestive tract until plant cell degradation occurs near an immune effector site in the gut. The correlate of protection from hepatitis B virus infection is serum antibody titers induced by vaccination; the protective level in humans is 10 milliunits/ml or greater. Mice fed HBsAg-transgenic potatoes produced HBsAg-specific serum antibodies that exceeded the protective level and, on parenteral boosting, generated a strong long-lasting secondary antibody response. We have also shown the effectiveness of oral delivery by using a parenteral prime-oral boost immunization schedule. The demonstrated success of oral immunization for hepatitis B virus with an "edible vaccine" provides a strategy for contributing a means to achieve global immunization for hepatitis B prevention and eradication.

Animals↗
PubMed1990

Haemophilus influenzae type b infections in Victoria, Australia, 1985 to 1987.

Invasive Haemophilus influenzae type b (HIB) infections occurring from 1985 to 1987 in children younger than 16 years of age living in the state of Victoria were reviewed. There were 547 cases which fulfilled the case definition, including 231 cases of meningitis, 219 of epiglottitis and 97 other infections; 14 (2.6%) children died, 8 with meningitis, 5 with epiglottitis and 1 with pneumonia. Ninety-five percent of cases occurred in children younger than 5 years of age, in whom the case attack rate was 58.5/100,000/annum. Nearly two-thirds of cases (46% of meningitis; 91% of epiglottitis; 45% of other infections) occurred in children more than 18 months of age (the age at which vaccine is presently given in the United States). Compared with the United States, the case attack rate for HIB disease in Victoria is lower, the mean age of affected children higher and the proportion with epiglottitis is greater. However, the incidence, age distribution and clinical manifestations of HIB disease in Victoria are similar to those described in Scandinavia before the successful introduction of vaccines. Effective conjugate vaccines against HIB disease are now available and the majority of cases are preventable (depending on the immunization schedule used). These data suggest that immunization of Victorian children against HIB infection should be cost-effective.

Adolescent↗
PubMed2001

"Reverse engineering" a formulary selection algorithm to determine the economic value of pentavalent and hexavalent combination vaccines.

INTRODUCTION: Combination vaccines with overlapping, noncomplementary components are being introduced to reduce the number of separate injections required to immunize children. A vaccine selection algorithm using operations research techniques was developed as a tool for vaccine purchasers to assemble formularies of monovalent and combination vaccines that would satisfy the recommended immunization schedule. The algorithm weighs distinguishing features of economic consequence among competing vaccines to achieve the lowest overall cost to payers and/or to society for immunization. This method was adapted here to solve for the purchase price of several hypothetical future pentavalent and hexavalent combination vaccines that would permit each to "win" a place in such a lowest cost formulary. METHODS: Integer programming and an iterative bisection search method determined the maximum "inclusion price" of 4 vaccines not licensed in the United States as of September, 2001 [diphtheria-tetanus-acellular pertussis (DTPa)-Haemophilus influenzae type b (HIB)-hepatitis B (HBV), DTPa-HIB-inactivated polio vaccine (IPV), DTPa-HBV-IPV and DTPa-HIB-HBV-IPV], in competition with 15 existing formulations of licensed vaccines for these diseases at their March, 2000, federal contract discount prices. Both 5-visit and 6-visit scenarios were studied. Different preparation costs were assigned to lyophilized powder ($1.50), liquid ($0.75) and prefilled-syringe ($0.25) formulations/packaging. Injection costs were varied stepwise from $5 through $45 for each dose administered, shifting from a payer's to a societal perspective. RESULTS: Overall inclusion prices (maximum price for each candidate vaccine to be included in a lowest cost formulary) ranged from $9 to $129 per dose depending on cost assumptions and usage frequency (values would be higher if competing against private-sector vaccine prices). The range was $27 to $68 per dose for DTPa-HIB-HBV, at optimal utilization to avoid extra vaccination. Similarly, as injection costs varied from $5 to $45, DTPa-HIB-IPV ranged from $28 to $75. With the same assumptions, DTPa-HBV-IPV would earn a place in a best value formulary at prices from $35 to $76. As expected the inclusion prices for hexavalent DTPa-HIB-HBV-IPV, $40 to $123, were higher (reflecting more economic value) than for pentavalents. When the assumed injection costs rose to > or = $8, the more expensive HIB-HBV and DTPa-HIB tended to appear in lowest cost formularies, because their cost premium over separate monovalent and trivalent products was outweighed by the savings from one fewer injection. CONCLUSION: Reverse engineering the vaccine selection algorithm provides a tool to demonstrate the economic value of new combination vaccines and to make pricing decisions.

Algorithms↗
PubMed1994

Immunization of monkeys with baculovirus-dengue type-4 recombinants containing envelope and nonstructural proteins: evidence of priming and partial protection.

Groups of rhesus monkeys were immunized with baculovirus-dengue type-4 (DEN-4) recombinant-infected cell extracts. One recombinant contained all of the DEN-4 structural proteins and two nonstructural (NS) proteins (C-M-E-NS1-NS2a), while the other was a fusion protein containing a portion of the respiratory syncytial virus G glycoprotein and DEN-4 envelope glycoprotein (RSVG-E). Both preparations were immunogenic; all monkeys receiving either immunogen responded with the production of antivirion antibodies in enzyme immunoassays. All except one monkey receiving the recombinant b(C-M-E-NS1-NS2a) made antibodies to NS1. One monkey that received b(RSVG-E) showed the production of low levels of neutralizing antibodies. Following challenge with unmodified DEN-4 virus, seven of nine monkeys in the immunized group became infected and were viremic for a mean of 4.1 days. The control, sham-inoculated monkeys were also viremic; the mean number of days of viremia in this group was 4.7 days. The remaining monkeys in the immunized group (n = 7), although not protected, had evidence of priming. Hemagglutination inhibition antibody responses following challenge indicated an anamnestic response in this group of animals. Based on these results, it was concluded that future immunization schedules should be altered to optimize immune responses and that immunization with more potent and purified immunogens would probably result in higher seroconversion rates and antibody levels in monkeys.

Animals↗
PubMed2000

Child vaccination, part 2: childhood vaccination procedures.

In 1996, the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the American Medical Association recommended a well-child office visit at age 11 to 12 years to check vaccination status. Vaccination status should be assessed for varicella, hepatitis B, the second dose of measles-mumps-rubella (MMR) vaccine, and tetanus-diptheria (Td) toxoid if not given in the past 5 years. Adolescent patients should be screened for high-risk conditions indicating the need for influenza, pneumococcal, or hepatitis A vaccines. The Accelerated Immunization Schedule and Minimal Interval Table should be consulted for children who are behind schedule.

Adolescent↗