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PubMed1978

The expanded program in immunization. Ghana's experience.

The expanded programme on immunization feasibility studies is currently running into its second year of operations. The objectives of the study are to test the possibility of increased coverage using both fixed centre and mobile field teams for the vaccination of children under the age of 2 years against measles, poliomyelitis, diphtheria, pertussis, tuberculosis and smallpox and also to test the immunological response to two doses of pertussis and two doses of oral polio. Reports so far indicate some success in the areas of training and manpower development as well as the development of the cold chain system which is considered to be the most important requirement for an efficient, expanded immunization programme. It goes without saying that the progress of the study has been marked by some technical, social and administrative constraints.

Child↗
PubMed1987

Immunizations among hospital personnel.

To minimize the likelihood of transmission of certain infectious diseases within the hospital, the 5 million US health care personnel are becoming a special target group for immunization programs. A review of immunizations conducted by a hospital employee health service demonstrated that 80% of hospital employees are adequately protected against tetanus/diphtheria, and 97% are immune to rubella. In contrast, only 28% of at-risk employees are immunized against hepatitis B and only 2% are immunized against influenza. Vaccination programs for tetanus/diphtheria and rubella, which are supported by appropriate legislation, are more effective than vaccination programs for hepatitis B and influenza, which are not supported by appropriate legislation.

Diphtheria↗
PubMed1998

A nationwide prospective surveillance study in Israel to document pediatric invasive infections, with an emphasis on Haemophilus influenzae type b infections. Israeli Pediatric Bacteremia and Meningitis Group.

BACKGROUND AND METHODS: An ongoing nationwide prospective surveillance study was initiated in Israel in October, 1988, to document childhood invasive infections caused by Haemophilus influenzae type b (Hib), Streptococcus pneumoniae and Neisseria meningitidis. This study enabled us to document the effect on childhood invasive Hib disease of the introduction of conjugate Hib vaccines to Israel. RESULTS: The incidence of invasive Hib disease before the age of 5 years dropped from 34 per 100000 before initiation of immunization to < 5 per 100000 in 1995 and is projected to be <4 in 1996. After <2 years, when various conjugate vaccines had been available in the private sector alone and had achieved partial coverage only, the Israeli Ministry of Health decided to add Hib conjugate vaccine to the regular infant immunization program, free of charge, effective for all infants born after January 1, 1994. The vaccine chosen was Hib polysaccharide linked to outer membrane protein complex of N. meningitidis B. Vaccine coverage has exceeded 90% of all infants born since January 1, 1994. Efficacy and effectiveness during the first 34 months of the program (January 1, 1994, to October 31, 1996) were 95.4 and 99.7%, respectively, for all invasive Hib disease and 97 and 99.4%, respectively, for Hib meningitis. CONCLUSION: The described ongoing surveillance program showed the existence and extent of Hib problems in Israel and documented the success of the immunization program in essentially eliminating the disease in Israel.

Child, Preschool↗
PubMed1998

[Hepatitis B vaccination: knowledge and acceptance by Swiss physicians].

Difficulties with the acceptance of immunization recommendations by physicians have been documented. A recommendation for universal hepatitis B vaccination was published in 1998 for Switzerland. We conducted a qualitative study of pediatricians and family physicians in the fall of 1996 with eight focus groups stratified by region of the country and medical specialty. Sixty-two physicians participated. Most participants felt that universal hepatitis B immunization would be useful. Pediatricians in the French-speaking part of the country were more willing to implement such a recommendation, while family physicians in the German-speaking regions were least willing. Before supporting universal hepatitis B immunization, physicians stated that they need more information about the epidemiology of the infection, the effectiveness and safety of the vaccine, and the perceived high cost of an immunization program. Participants felt that two injections per visit was the maximum tolerable for infants and young children. Many preferred to immunize older children or adolescents against hepatitis B, both because fewer injections are currently recommended at that age and because adolescence is a developmentally appropriate age to address sexuality and drug abuse. Physicians expected the population to be reluctant to accept universal hepatitis B vaccination, partly because of a lack of understanding of the disease and partly because of a feeling that children already receive more than enough immunizations. While the general sentiment for a universal hepatitis B immunization recommendation in Switzerland seems to be positive among physicians, concerns regarding its implementation linger. It remains to be seen how hepatitis B will be perceived in the population, and how willing parents and adolescents will be to get their children and themselves vaccinated. Helping physicians to understand the importance of this measure, in addition to convincing them to immunize their patients, will be an important first step towards achieving sufficient hepatitis B immunization coverage.

Adolescent↗
PubMed1985

PolioPlus programme: criteria for funding of polio immunization programmes.

To date, the Rotary Foundation of Rotary International has allocated over US$12 million for polio immunization programs in 26 countries to protect more than 87 million children and has pledged to raise US$120 million within 3 years. The 1st major polio immunization project assisted was launched in the Philippines in 1980. On 14 May 1985, Rotary joined PAHO/WHO in the goal to eradicate polio in the Americas by 1990. Rotarians have provided support to many recent accelerated immunization programs in cooperation with governments, UNICEF, and WHO.

Delivery of Health Care↗
PubMed2000

The Immunization Monitoring Program Active (IMPACT) prospective five year study of Canadian children hospitalized for chickenpox or an associated complication.

BACKGROUND: Varicella vaccine was approved for use in Canada in 1998. A major goal of universal varicella vaccine programs is to reduce severe infection and associated complications. Baseline data are essential against which to judge the effectiveness of routine childhood immunization. OBJECTIVE: To describe morbidity and mortality among children hospitalized for chickenpox. Methods. From January 1, 1991, to March 31, 1996, chickenpox admissions to 11 pediatric referral centers were actively identified. Patient and illness characteristics were compared for 3 subgroups defined by prior health: healthy; unhealthy but immunocompetent; immunocompromised. RESULTS: Of 861 cases 488 (56.7%) were healthy, 75(8.7%) were unhealthy and 298 (34.6%) were immunocompromised. The immunocompromised children differed from healthy/unhealthy cases in mean age (6.4 vs. 4.0/4.6 years, respectively, P < 0.0001); median interval from rash onset to admission (2 vs. 5/5 days, P < 0.0001); complication rate (20% vs. 90%/79%; P = 0.001); and rate of acyclovir therapy (98% vs. 24%/39%; P = 0.001). Unhealthy vs. healthy cases had a higher frequency (P < 0.01) of intensive care (13.3% vs. 4.7%), ventilation (9.3% vs. 2.0%) and death (4% vs. 0.2%). CONCLUSION: These data provide a baseline for morbidity/mortality resulting from chickenpox before varicella vaccine use in Canada.

Adolescent↗
PubMedDate not supplied

[Integration of the Expanded Program on Immunization into primary health care: examples of Benin and Guinea].

Since 1986, two West African countries have been delivering immunizations within the framework of reorganized peripheral health systems. This revitalization is based on strategies which are implemented by an increasing number of African countries under the name "Bamako Initiative". It aims at providing universal access to a minimum package of maternal and child health priority interventions starting with immunizations, pre and perinatal care, oral rehydration for diarrhoea, treatment of malaria and acute lower respiratory infections. Within this package, immunization has been given high priority. Several strategies aimed at improving immunization coverage have been implemented: services have been reorganized so that any child or woman making contact with the health system receives immunization if needed. Health information systems have been revised so as to allow for active individual follow up and better management of health centre resources. Health staff have been given training in management and a biannual monitoring/microplanning process at health centre level has been introduced. The goal of monitoring is to enable health personnel to identify the obstacles to attaining optimum coverages with the priority interventions and to select locally appropriate corrective strategies. Health centres have also been provided with a motorcycle allowing for regular outreach activities. To cover the running costs of the services (mainly restocking of drugs, running and maintenance of the cold chain and the motorbike, and staff incentives), financial contribution from local communities have been sought through a fee-for-treatment system. Prices have been set at an affordable level by limiting the number of drugs to a minimal list purchased under generic names by international tendering procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Benin↗
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↗
PubMed1998

Prevention and control of tetanus in childhood.

Until recently, tetanus was estimated to be killing well over half a million children each year in the developing world, most commonly through neonatal tetanus, the incidence of which was around six per 1000 live births. Neonatal tetanus most commonly occurs through cord contamination of the umbilical stump. Vaccination of pregnant women and infants is an effective and inexpensive intervention that results in major health gains, although educating traditional birth attendants and mothers about safer birthing practices probably also lowers the incidence of tetanus. Recently, however, new vigor and strategies in immunization programs have resulted in substantial improvements. Immunization of pregnant women, and identification and targeting of areas and populations in which neonatal tetanus is occurring are especially effective. Tetanus will continue to be a pediatric problem until vaccination strategies are effectively implemented, surveillance systems are improved, and hygienic birthing practices become standard in all countries.

Child↗
PubMed2002

Measles outbreak in an orphanage, Bangkok, Thailand, September-October 2000.

In Thailand, the morbidity rate of measles has declined since measles vaccination was included in the National Immunization Programme. A measles outbreak affected 41 infants in an orphanage in Bangkok during September-October 2000 prompted an investigation to study the epidemiological distribution, assess vaccine coverage and vaccine effectiveness. The attack rate was 66 per cent, among infants aged 6-12 months in two separate rooms. Sixty-three per cent of the 41 cases were less than 9 months old. Measles vaccine coverage among infants over 9 months was 45 per cent due to delay in immunization caused by mild illnesses of the infants and the vaccine effectiveness was 91 per cent (95%CI 42%-99%). Inefficiency of the surveillance system to early detect and respond to the outbreak was observed. A catch-up immunization program, close supervision for surveillance and immunization systems and an increase of measles vaccine coverage to more than 95 per cent in this and other orphanages in Thailand were recommended.

Cohort Studies↗
PubMed2003

Do we practice what we preach? Health care worker screening and vaccination.

OBJECTIVE: To describe the current screening and immunization practices in New South Wales (NSW) hospitals and the experience of NSW nurses in relation to screening and immunization and to identify areas that can be targeted for improvement. DESIGN: This was a cross-sectional survey. SETTING: The study was performed in NSW, Australia. METHODS: We used a written questionnaire to survey the infection control/occupational health coordinators of all of the 85 private hospitals and 204 eligible public hospitals in NSW and 800 randomly sampled registered nurses. RESULTS: Response rates were high (hospitals [90%], nurses [70%]). Hospitals almost universally offered hepatitis B vaccination to nurses (251/261, 96%), but more than one quarter (132/473, 28%) of nurses reported incomplete vaccination. Provision to physicians was relatively poor (142/261, 54%). The majority of nurses (> 80%) had been vaccinated with bacille Calmette-Guérin vaccine, but hospitals reported variable tuberculosis screening practices. Both hospitals and nurses reported low rates (< 30%) of screening and vaccination provision for varicella and measles-mumps-rubella. Two thirds of NSW hospitals (174/261, 67%) provided annual influenza vaccination. CONCLUSIONS: Even though hepatitis B immunization programs were widespread, their effectiveness could be improved by ensuring that vaccination schedules are completed and by targeting physicians. Varicella and measles-mumps-rubella screening and immunization programs are currently lacking. Better strategies are needed to improve the implementation of health care worker protection guidelines in hospitals.

Adult↗
PubMed1994

[Vaccination in Togo].

The author describes her participation in an immunization project in Togo, one of many such projects supported by Canada's International Immunization Program. The Togo project was run by CUSO in partnership with the Canadian Public Health Association. In Togo, the infant mortality rate is significant. Thus the institution of an immunization program against major childhood illness (diphtheria, polio, tetanus, pertussis, measles and tuberculosis) was of paramount importance. Based in the maritime region of Togo, the project the author worked on helped 60,000 children and 200,000 women of childbearing age. The health team didn't attempt to change the behavior of the people of Togo since their cultural health care beliefs have existed for centuries and differ significantly from those of North Americans. Rather, efforts centered on health teaching, which increased the immunization rate from 16 to 63 per cent and decreased the incidence of disease.

Humans↗
PubMed2003

Subacute sclerosing panencephalitis with remission in a Bosnian refugee child.

Subacute sclerosing panencephalitis (SSPE) virtually disappeared from the US after mass measles immunization programs dating from the 1960s. However, SSPE has reappeared in internationally adopted children and in refugee children emigrating from developing or war torn countries lacking effective measles immunization programs. SSPE usually occurs 6 to 8 years after a bout of measles in early childhood; death typically follows within 1 to 3 years. What is often not reported in textbooks is that spontaneous remission occurs in a small subset of children with documented SSPE.

Bosnia and Herzegovina↗
PubMed2005

Canadian experience with implementation of an acellular pertussis vaccine booster-dose program in adolescents: implications for the United States.

BACKGROUND: In Canada, the epidemiology of pertussis has changed during the past decade such that more cases occur in adolescents than in any other age cohort. METHODS: The implications of the Canadian experience, as well as the experiences of France, Germany, and Australia, on the universal implementation of an acellular pertussis, diphtheria, and tetanus booster vaccine in the United States are discussed. RESULTS: In 1999, an acellular pertussis vaccine combined with diphtheria and tetanus toxoids formulated for adolescents and adults was licensed for use in Canada. It has taken >5 years for this vaccine to be introduced universally into the immunization programs of all provinces and territories. The delay in implementation has likely been the result of insufficient epidemiologic data available to the National Advisory Committee on Immunization and the lack of a consensus on the appropriate goals of the national pertussis control strategy. Implementation of an immunization program in all parts of the country occurred only after a national consensus was achieved and federal funding was made available for vaccine purchase. CONCLUSIONS: The Canadian experience demonstrates that an adolescent pertussis vaccine program can be implemented on a national scale after several factors have been considered.

Adolescent↗
PubMed2005

Prevention of hepatocellular carcinoma by universal vaccination against hepatitis B virus: the effect and problems.

PURPOSE: In spite of the success of hepatitis B immunization, still a significant proportion of childhood hepatocellular carcinoma (HCC) failed to be prevented by the hepatitis B immunization program. This study is aimed to investigate the problems in the HCC prevention in children. EXPERIMENTAL DESIGN: All HCC children ages 6 to 14 diagnosed between 1981 and 2000 in Taiwan were collected from two national childhood HCC registry systems. We analyzed the causes of HCC prevention failure and the risk ratio of HCC among hepatitis B carriers born before versus after the vaccination program. RESULTS: The incidence of HCC per 100,000 children declined from 0.54 to 0.20 in those born before versus after the vaccination program (risk ratio, 0.36). Vaccine failure (33.3-51.4%) and failure to receive hepatitis B immunoglobulin at birth (42.4-57.5%) were the main causes of HCC prevention failure. Mother-to-child transmission of hepatitis B virus infection is an important risk factor of HCC development. This is evidenced by the very high hepatitis B surface antigen seropositive rate in our HCC children (97%) and their mothers (96%). Hepatitis B carrier children born after the vaccination program had a higher risk of developing HCC than those born before the program (risk ratio, 2.3-4.5). CONCLUSIONS: Vaccine failure and failure to receive hepatitis B immunoglobulin are the main problems preventing eradication of HCC. Hepatitis B carrier children born after the immunization program have a higher risk of developing HCC than those born before.

Adolescent↗
PubMed1991

Operational evaluation of the efficacy of vaccines by the case control method.

To maintain high efficacy and cost-effectiveness of health interventions, such as immunization programs and health information, systematic and careful evaluation is necessary. This is particularly relevant when health resources are scarce, as in most developing countries. Whereas vaccines used in immunization programs are generally evaluated for efficacy and safety prior to their application in routine health service, very little attention is paid to continuous or operational evaluation. Because of practical reasons (cost, time, feasibility, etc.) or ethical reasons (randomization), the most reliable method for evaluation, the classical RCT, cannot be applied for the operational evaluation of vaccine efficacy, and alternative methods such as the case control method are needed. This method is relatively cheap, quicker, poses fewer ethical problems, and can also provide continuous evaluation.

Case-Control Studies↗