Canadian immunization: public programs or private enterprise?
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Canada↗
SEARCH · PubMed Health
Results for “Immunization Programs”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Expanded government program for childhood immunizations begins.
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Adolescent↗
[Description and survey of a measles epidemic in Burkina Faso].
Measles remains a major cause of child and infant mortality in Africa. Burkina Faso was the first country in Africa to run mass measles vaccination campaigns. The "Commando" vaccination program in 1984 immunized children aged between 9 months and 6 years old. The EPI was then implemented across the whole country; and with particular emphasis on the North Central region (with the help of two Non Governmental Organizations). Coverage cluster surveys were conducted in 1987 and 1989. In addition, a community-based evaluation of the immunization program and a serological survey were run in January 1989. A measles epidemic started in March 1989 in the Eastern province (Namentenga) of the North Central region and lasted until the rainy season. A survey reported 230 cases of which a large proportion were adults. Vaccine efficacy (85%) was normal. Index cases were from a neighbouring province. Epidemiological and serological surveys in 1989 indicated that the circulation of the wild type virus had been low since the 1984 "Commando" vaccination program. The epidemic was due to unsatisfactory vaccinal coverage (53%) which had further declined (35%). Consequently the primary health care system is being mobilized to improve vaccinal coverage.
Adolescent↗
Five-year follow-up of immune response to hepatitis B vaccine in juveniles.
The persistence of anti-HBs was investigated in 95 juveniles who received plasma-derived HBV vaccine (vaccine group) and 63 counterparts who got anti-HBs from natural HBV infection (infection group) for a period of five years. The positive rates of anti-HBs from the first to fifth year in the vaccine group are 97.89%, 98.95%, 81.05%, 78.95% and 72.63% respectively with one recipient remaining anti-HBs negative after being immunized with three dosages of 10 micrograms plasma-derived HBV vaccine in 0, 1st, 2nd month and the mean S/N values (GMV) are 30.94, 22.18, 13.61, 12.02 and 9.18 respectively. There are 26 recipients whose anti-HBs turned from positive to negative at the end of the study with a negative rate of 27.37%. The S/N GMVs in the infection group are 36.37, 27.33, 24.08 at the first, third and fifth year of the study, respectively. Both the S/N GMV and negative rate are lower than that of the vaccine group (P < 0.01). No one was found to have positive HBsAg or elevated ALT in both groups. Questions such as immune dosage, immune program and booster immunization in juvenile population are discussed.
Adolescent↗
Legal implications of the Smallpox Vaccination Program.
President George W. Bush's Smallpox Immunization Program will expose health care workers and public health agencies to liability for negligent administration of the vaccine. Section 304 of the Homeland Security Act, supplemented by Secretary Thompson's Emergency Declaration, shifts liability to the federal government. State indemnification laws and workers' compensation laws protect some potential defendants. The Smallpox Personnel Protection Act of 2003 provided a new source of compensation to injured health care workers. This article examines the scope of protection offered by these laws.
Compensation and Redress↗
A shot in the arm for children's health in Atlanta. Interview by Kathryn Taylor.
Three years ago, Atlanta's Scottish Rite Children's Medical Center began a statewide children's immunization program. The success of that program has encouraged other community organizations to model themselves after Scottish Rite's, including a similar initiative launched by The Atlanta Project (TAP). The medical center lent its expertise--and that of senior vice president Judson L. Hawk Jr., M.D.--to TAP. Staff Editor Kathryn Taylor recently spoke to Hawk about his three-year stint as senior adviser for children's issues at TAP, and his role in developing an immunization program for the Atlanta area.
Child↗
Prevention of hepatitis B transmission in Indo-Chinese refugees with active and passive immunization.
Hepatitis B is a cause of disability and death worldwide, with high rates of perinatal transmission in third world countries, including those of Indochina. Prevention of transmission by active and passive immunization has been available since 1982. This study looked at the serological response of Indo-Chinese refugees to these products in an outpatient primary care clinic and at the compliance problems found in this setting. The carrier rate of all patients screened was 81/446 (18.5%), with 37/233 (15.8%) of prenatal patients as carriers. Newborns whose mothers were carriers were started on an immunization program. The combination of HBIG and vaccine was more than 90% effective in inducing immunity and preventing the carrier state; only two children of the 26 studied who received both active and passive immunization became carriers. Both failures were in children of HBeAg positive mothers. In contrast, those children exposed who had not received treatment (because of birth prior to 1982) had a 33% carrier rate. This success rate was found despite compliance problems in completing the immunizations on schedule. Only 23% of children received their vaccine within four weeks of the recommended schedule, with a mean delay of 1.3 months. Of the 79 children beginning immunizations, 11 moved before completion. All children remaining in San Diego completed the regimen. Thus, the benefits of giving the passive and active immunization to infants of hepatitis B carriers were clear. However, compliance problems jeopardize the effectiveness of a hepatitis B immunization program in this population.(ABSTRACT TRUNCATED AT 250 WORDS)
Asia, Southeastern↗
Performance of US hospitals on recommended screening and immunization practices for pregnant and postpartum women.
OBJECTIVE: Recommendations by most national advisory committees on immunization include evaluating all pregnant women for chronic hepatitis B virus infection and immunity to rubella. It is recommended that all pregnant women be screened for hepatitis B surface antigen during an early prenatal visit and that rubella vaccine be administered in the postpartum period to women not known to be immune. This study determined the extent to which hospitals with labor and delivery services adhere to these recommendations. METHODS: We conducted a mail survey of a stratified random sample of all US medical-surgical hospitals to (1) determine the proportion of hospitals with hepatitis B screening policies and rubella immunization programs and (2) identify significant factors associated with the presence of these policies and programs. Hospitals were stratified by number of beds (<100, 100-499, and > or =500) and affiliation with a medical school. RESULTS: Of 986 institutions surveyed, 858 (87%) responded. Of these, 635 (74%) were labor and delivery hospitals. Approximately half of these (51%) had hospital policies related to screening pregnant women for the hepatitis B surface antigen. Twenty-one percent had rubella immunization programs for postpartum women. Only 14% of labor and delivery hospitals were in full compliance with published recommendations for hepatitis B surface antigen screening and rubella postpartum vaccination. Hospitals were more likely to be compliant if they had more than 100 beds, were private rather than public institutions, were affiliated with a medical school, and were in states with laws regarding hepatitis B surface antigen screening of pregnant women. CONCLUSIONS: Almost half, and more than three quarters, of hospitals were not in compliance with hepatitis B screening and rubella postpartum immunization recommendations, respectively. Hospitals should develop and implement policies for these preventive services.
Female↗
Characteristics of long-term care facilities associated with standing order programs to deliver influenza and pneumococcal vaccinations to residents in 13 states.
BACKGROUND: Standing order programs (SOPs) are effective evidence-based interventions in which nurses or pharmacists are authorized to vaccinate according to an approved protocol without a physician order or examination. National rates for influenza and pneumococcal vaccination in long-term care facilities (LTCF) are far below HP2010 goals of 90%. OBJECTIVES: The aim of this study was to describe the prevalence of SOPs and other types of immunization programs in LTCFs and determine characteristics of LTCFs implementing SOPs. DESIGN: Mailed survey. SETTING: All Medicare- or Medicaid-licensed LTCFs in 13 states. PARTICIPANTS: Directors of Nursing (DONs). MEASUREMENTS: Survey collecting information on SOPs and barriers to their use in respondents' LTCF. Data from this survey were linked to the On-line Survey and Certification Administrative Record (OSCAR), a federal administrative database containing structural, staffing and other information on LTCFs. RESULTS: A total of 3,451 of 4,366 (79%) LTCFs completed surveys. Few facilities used SOPs for influenza (9%) or pneumococcal vaccination (7%). The greatest use of influenza SOPs compared with other immunization program types were seen in facilities that were government owned or owned by nonprofit entities compared with for-profit entities (15% and 10% vs. 7%; odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.5 to 3.4 and OR = 1.4, CI = 1.1 to 1.8, respectively); dually-certified (both Medicare- and Medicaid-certified) nursing facilities compared with distinct part skilled nursing facilities in which beds are set aside for residents with a specific payment source (11% vs. 7%; OR = 1.6, CI = 1.3 to 2.1); independent facility compared with one that is part of a multi-facility chain (10% vs. 7%; OR = 1.3, CI = 1.1 to 1.7); and lower acuity index (resident resource needs) compared with higher (10% vs. 7%; OR = 1.4, CI = 1.1 to 1.7). Findings were similar for pneumococcal vaccination SOPs. SOP use varied substantially by state (range = 0% to 23% influenza; range = 3% to 15% pneumococcal). The most frequently reported barriers to SOP use were legal concerns: liability for the facility (53%) and staff lacking legal authority (39%) to vaccinate by standing orders. CONCLUSIONS: Although LTCFs with certain characteristics used SOPs more often, overall few facilities (<10%) used SOPs to improve vaccination rates. SOP use varied by state indicating that state policies or other factors may promote or inhibit SOP use. More studies are needed to examine the causes of state-level variations in vaccination interventions and their relationships to health outcomes of residents in LTCFs. The federal government's resources to promote SOPs should focus on all LTCFs, but with a particular focus on those that are less likely to be using SOPs and that represent a large proportion of homes nationally (i.e., for-profit and chain facilities).
Aged↗
[The Expanded Program on Immunization in the WHO African region: current situation and implementation constraints].
The expanded Programme on Immunization in the African region was launched in 1978 and by the mid-eighties, all countries had established national immunization programmes. A mid decade evaluation, conducted in 1985, indicates that the regional immunization coverage was still under 20% for all antigens. For this reason, member states agreed to accelerate the programme. They adopted a resolution declaring 1986 the "African Immunization Year" and pursued implementation of various accelerated efforts until 1990. During the acceleration phase, the political commitment was strong, with the involvement of top national officials and First Ladies in launching the immunization campaign in many countries. The resources required were supplied mainly from external funding agencies. As a result, sixteen countries reached the 80% immunization coverage rates for antigens administered to the infants and remarkable progress has been achieved in the control of the EPI priority diseases. Concerning polio eradication, at least fourteen countries, representing 20% of the regional population have reported zero incidence of poliomyelitis for two consecutive years, during the period 1991-1993. In five of these countries independent teams of international and national experts assessed the quality of the epidemiological surveillance and confirmed that polio cases may have been eliminated. This suggests that a polio-free zone has emerged in the southern part of Africa, where most of these countries are located. In the meantime, an outbreak of poliomyelitis (with 28 cases confirmed by isolation of type 1 poliovirus) was reported from one country (Namibia) where no cases had been reported for the last few years. It is still unclear whether poliovirus was imported or the virus continued to circulate without causing paralytic cases.(ABSTRACT TRUNCATED AT 250 WORDS)
Africa↗
Immunization mall programs.
This descriptive survey provided the Health Department and its CHNs with data heretofore unexamined. The survey provided a beginning analysis and description of three major areas which assisted the County Health Department in establishing vital base line information regarding: (a) where people usually went for immunizations, (b) how they heard about the mall program, and (c) whether they would return to future mall programs. Recommendations from the survey demonstrate the need for the county health department and CHNs to increase the number and length of programs and to meet client demand. The survey has implications for all public health departments and CHNs as they examine the most cost effective strategies to promote and provide immunizations for vaccine preventable disease to clients of all ages.
Commerce↗
Accelerated measles control in the Western Pacific region.
By the 1990s, an immunization program in the western Pacific had dramatically reduced measles morbidity and mortality. Building on the region's successful elimination of polio, several countries and areas achieved or are close to measles elimination, thus showing the potential for global eradication. The diverse challenges for measles control in different parts of the region have produced lessons that will help with future control, including the need for surveillance of sufficient standard to guide and monitor progress. A group of experts recognized both the potential and the challenges of the measles immunization program and proposed regional elimination as the appropriate disease control target for the region. No date was recommended for its achievement. If progress continues at the present rate, the western Pacific region should soon be able to set a target date for measles elimination.
Adolescent↗
Immunization status as determined by patients' hand-held cards vs medical records.
OBJECTIVE: To determine whether patients' hand-held immunization cards provide accurate assessments of immunization status when compared with their corresponding medical records. SETTING: Urban hospital emergency department immunization program. DESIGN: Comparison of 2 criterion standards. PATIENTS: Children aged 4 months to 6 years who presented consecutively with their immunization cards and received routine care in the hospital's pediatric clinic. SELECTION: Of 673 eligible patients seen in the immunization program from November 1992 to October 1993, 140 were randomly selected for comparison of immunization card and medical record immunization dates; in addition, all 123 eligible patients seen between August and October 1994 were selected. Of the total of 263 children, medical records for 257 (98%) were available for review. The dates of diphtheria-tetanus-pertussis, polio, measles-mumps-rubella, and Haemophilus influenzae type b immunization from immunization cards and medical records were recorded, as were patient age, sex, and ethnicity. Immunization card-medical record immunization date pairs were compared. Each immunization card and medical record was categorized as up to date, due for immunization, or delayed 2 months or more for any immunization at the time of the visit. RESULTS: In 218 (85%) of 257 cases, the immunization card and medical record immunization dates were identical (McNemar test, P = .63). The immunization card and medical record agreed that patients were due for immunization in 91 cases and agreed that patients were not due for immunization in 138 cases (kappa = 0.77; 95% confidence interval, 0.70-0.85). The immunization card and medical record agreed that patients were delayed for 1 or more immunizations in 51 cases and agreed that patients were not delayed in 187 cases (kappa = 0.79; 95% confidence interval, 0.71-0.88). CONCLUSION: The hand-held immunization card is a suitable alternative to the medical record when the need for immunization is assessed or when rates of immunization delay in populations are determined.
Emergency Service, Hospital↗
A low rate of hepatitis B virus vaccine breakthrough infections in Mongolia.
A nation-wide hepatitis B virus (HBV) immunization program of all newborn babies was launched in Mongolia in 1991. However, the continuation of clinical icteric viral hepatitis infections in children led to the investigation to determine whether HBV breakthrough infections were occurring and if any were due to hepatitis B surface antigen (HBsAg) mutants. Hepatitis A virus (HAV) infections accounted for most of these cases with 3% of the jaundiced children shown to have acute hepatitis B. Hepatitis B vaccine protection was 93% against HBV infection and 97% against HBV carriage. A G145A "escape mutant" was found in one HBV carrier child only. Anti-HBs levels, however, were low with 85% having titers less than 100 IU/L, 46% of whom had levels less than 10 IU/L. The results from this study demonstrate that the HBV immunization program in Mongolia provides an effective level of protection. However, continued surveillance of breakthrough infections and close monitoring of "vaccine escape" mutants is required.
Adult↗
Epidemiology of rotavirus in India.
Rotavirus is the leading cause of childhood diarrhea worldwide, causing an estimated 600,000 deaths each year. To assess the potential benefits of a national rotavirus immunization program in India, we analyzed 40 published studies of rotavirus that were conducted between 1976 and 1997 and included a total of approximately 13,000 Indian pediatric inpatients. Pediatric studies featuring 100 or more patients and lasting at least 12 months in duration and all neonatal studies were analyzed. Rotavirus was detected in a median of 18% of pediatric patients and 28% of neonates surveyed. Fifty percent of all children hospitalized with rotavirus by age 5 were hospitalized by the age of 6 months, 75% by the age of 9 months, and almost 100% by the age of 2 years. Rotavirus was most prevalent (31%) in children between 7 and 12 months of age, followed by children between 1 and 2 years of age (20%), and children < 7 months of age (13%). VP7 genotypes G1 and G2 were most commonly isolated although significant heterogeneity of serotypes was observed. P[11], G9 strains were most frequently isolated among neonates. In 1998; approximately 98,000 childhood deaths were caused by rotavirus. These data underscore the urgent need for safe and effective interventions against rotavirus such as vaccines. The significant diversity of rotavirus strains and young age of hospitalization pose unique challenges to the formulation of a rotavirus immunization program in India, but raise the possibility of utilizing a neonatal vaccine to provide effective coverage.
Child, Preschool↗
Immune-Like Malignant Epithelial Programs Shape Tumor-Immune Interactions and Inform Prognostic Stratification in Lung Adenocarcinoma.
Lung adenocarcinoma (LUAD) is characterized by marked cellular heterogeneity, yet how malignant epithelial states contribute to immune regulation and clinical outcomes remains incompletely defined. We integrated single-cell RNA-sequencing data to map the cellular landscape of LUAD and identify malignant epithelial cells based on inferred copy-number alterations. Epithelial states were further examined through trajectory inference, transcription factor analysis, and cell-cell communication profiling. Single-cell-derived genes were subsequently integrated with TCGA and independent GEO cohorts to construct and validate a machine learning-based prognostic signature. Malignant epithelial cells displayed distinct functional programs, including an immune-like state associated with genomic instability, immune-related transcriptional activity, tumor-immune communication, and patient outcomes. The resulting immune-like malignant epithelial cell signature (IMEC-Sig) consistently stratified survival across multiple cohorts. Low IMEC-Sig scores were accompanied by greater immune infiltration, higher immune checkpoint expression, and increased immunophenoscore, whereas high scores were linked to a comparatively immunosuppressive phenotype. Pan-cancer analyses further identified KRT8 as a gene associated with unfavorable prognosis, and functional experiments showed that KRT8 silencing suppressed proliferation, migration, invasion, and colony formation in LUAD cells. Together, these findings connect malignant epithelial heterogeneity with the immune context and clinical outcomes, support IMEC-Sig as a biologically informed prognostic tool, and nominate KRT8 as a potential therapeutic target in LUAD.
Humans↗
Occurrence of Haemophilus influenzae strains in three Brazilian states since the introduction of a conjugate Haemophilus influenzae type b vaccine.
Few vaccines in history have induced such a dramatic decline in incidence over such a short period of time as the Haemophilus influenzae type b (Hib) conjugate. This vaccine was introduced in 1988 in the United States, but only in 1999 was Hib immunization introduced by the Brazilian Ministry of Health as part of the routine infant National Immunization Program. The authors analyzed 229 H. influenzae (Hi) isolates from Public Health Laboratories in three Brazilian states: Pernambuco (Northeast, N = 54), Santa Catarina (South, N = 19), and Rio de Janeiro (Southeast, N = 156). The isolates were collected from Brazilian children 0-10 years of age with meningitis and other infections from 1990 to 2003 and were part of the research collection of the National Institute of Quality Control in Health, FIOCRUZ. Bacterial strains were characterized by serotyping and biotyping. During the pre-vaccination period the prevalence infection due to Hib was of 165 isolates and only 2 non-b Hi among all the notified meningitis infections caused by Hi. Our results showed a significant decrease in the prevalence of Hib meningitis from 165 to 33 isolates after 1999. However, during the post-vaccination period of 2001-2003 we observed an increase in the number of non-b Hi isolates: only 2 non-b strains isolated from 1990 to 1999 and 29 from 1999 to 2003. Based on the present data, the authors emphasize the need for more sensitive epidemiological and bacteriological studies aiming the improvement of the available Hib vaccine, in order to protect the susceptible population to infections due to other serological types of Hi and the reevaluation of immunization schedules used by the National Immunization Program.
Bacterial Capsules↗
[15 years of Rh-immunization prevention program].
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Abortion, Spontaneous↗