Impact on the performance of family welfare assistants for their involvement in Expanded Program on Immunization.
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Asia↗
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State-level perspectives on immunization policies, practices, and program financing in the 1990s.
This article reports on a series of structured interviews with immunization program officials in all 50 states regarding the effects of changes in federal policies and funding in the 1990s on the goals, priorities, and activities of state immunization programs. The purchase of vaccines is a major component of all state immunization programs. The Vaccines for Children (VFC) program, implemented in 1994, has become the primary source of vaccine purchase support in almost all states. A concern of many state immunization programs is their ability to ensure that vaccines are available to children who are not VFC eligible.State immunization programs also are involved in a myriad of activities necessary to ensure that children are adequately and appropriately immunized (e.g. , vaccine administration, outreach to parents). Federal funding to support these activities increased significantly during the mid-1990s, but was substantially reduced beginning in 1997. Because of these funding decreases, most states had to reduce the scale and scope of their immunization activities.State-level funding support for immunization programs varies, with state governments more likely to support vaccine purchase than immunization activities. Immunization will never be completed. Along with each new birth cohort, changes to the primary immunization schedule (i.e., addition of new vaccines and expansion of existing recommendations to encompass broader target groups) create ongoing needs for vaccine purchase and other immunization activities. Long-term immunization planning must reflect these continually expanding needs.
Centers for Disease Control and Prevention, U.S.↗
General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP).
This report is a revision of General Recommendations on Immunization and updates the 1994 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1994;43[No. RR-1]:1-38). The principal changes include expansion of the discussion of vaccination spacing and timing, recommendations for vaccinations administered by an incorrect route, information regarding needle-free injection technology, vaccination of children adopted from countries outside the United States, timing of live-virus vaccination and tuberculosis screening, expansion of the discussion and tables of contraindications and precautions regarding vaccinations, and addition of a directory of immunization resources. These recommendations are not comprehensive for each vaccine. The most recent ACIP recommendations for each specific vaccine should be consulted for additional details. This report, ACIP recommendations for each vaccine, and other information regarding immunization can be accessed at CDCs National Immunization Program website at http.//www.cdc.gov/nip (accessed October 11, 2001).
Adolescent↗
The Expanded Program on Immunization in the Americas: a review.
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Americas↗
Measles seroprevalence of an adolescent population vaccinated with a single dose of measles vaccine before their first birthday.
This study determined the age-specific measles seroprevalence of an adolescent population in Ankara vaccinated with a single dose of measles vaccine before their first birthday. The study sample included 440 adolescents (227 female, 213 male) aged 9-16 years admitted to the Adolescent Outpatient Clinic of Hacettepe University Faculty of Medicine. For each participant, a questionnaire was completed and measles specific IgG antibodies screened quantitatively by the enzyme linked immunosorbent assay. Of the 440 subjects screened for measles antibodies, 114 (25.9 %) were seronegative. Measles seronegativity according to sex and age groups were, 32.6, 24.7, 13.3% in females and 29.5, 30.1, 6.3% in males in the age groups of 9-11, 12-14, 15-16 years, respectively. In countries where the two dose vaccination schedule against measles has not been incorporated to the national immunization program, the adolescent health maintenance visit at age 11-12 years should serve as an opportunity to evaluate vaccination status and administer MMR vaccine to all adolescents who have not received two doses at the recommended ages.
Adolescent↗
[Public laboratories for vaccine production: a new paradigm].
In Latin America and the Caribbean, public laboratories that produce vaccines have contributed in varying degrees to the control and eradication of vaccine-preventable diseases, and several of them are manufacturing vaccines that are routinely applied in national immunization programs, such as the vaccine against tuberculosis (made with the bacillus of Calmette-Guérin, BCG), the triple vaccine against diphtheriatetanus-pertussis (DTP), tetanus toxoid (TT), the vaccine against measles and the oral vaccine against polio. Thanks to recent scientific strides, one can foresee an important increase in the number of safe and effective vaccines that will be available in the near future for use in routine vaccination programs. However, there are high costs involved in developing such vaccines and in protecting the intellectual property rights involved, and few laboratories in Latin America have the technical capacity to research and develop these vaccines. Such factors will affect the speed with which they are assimilated into vaccination programs in countries of the Region. Currently, public laboratories that manufacture vaccines in the Region are not equipped to compete in this new scenario and run the risk of being completely outmarketed. Thus, they must radically change their style of management and their scientific and technical capabilities, backed by a commitment from governments to improve and strengthen those political and financial aspects that can assure that national laboratories participate in the sustainable supply of vaccines to immunization programs, as well as in researching, developing, and producing new vaccines.
Caribbean Region↗
Frequency and causes of vaccine wastage.
UNLABELLED: Assessing the frequency of vaccine wastage and the relative magnitude of its various causes may help to target efforts to reduce these losses and to husband funds for increasingly expensive vaccines. METHODS: As a preliminary overview of wastage in the United States, 64 public-sector state and local health department immunization programs were polled in 1998 and 1999 for wastage recording practices. Actual wastage data were collected from a non-random subset of five states. Data on returns of wasted vaccine to manufacturers were analyzed from routine national biologics surveillance and from an ad-hoc survey. Excise tax credit requests for such returns between 1994 and 1999 were reviewed. RESULTS: Rates of wastage among the five states ranged from about 1 to 5% in 1998, with an overall rate of 2.6% among 57 immunization programs in 1999. Categories of wastage used by the health departments varied widely, with overlapping classifications. The major causes appeared to be refrigeration (cold chain) lapses, followed by expiration. Overall rates of vaccine returns varied up to 8% by manufacturer, and from 1 to 50% by vaccine type, with higher return rates generally found for lesser-used vaccines. CONCLUSIONS: If these wastage estimates of 1-5% applied nationally, in 1998 there would have been approximately US dollars 6-31 million worth of unused vaccine in the public sector alone. The two most common forms of wastage reveal the potential value of developing vaccines with improved heat stability and longer shelf lives. We propose six main classifications of vaccine wastage for use in routine monitoring and reporting.
Humans↗
Vaccination in special situations.
OBJECTIVE: To review the indications, contraindications and efficacy of vaccination in some special situations: immunosuppression, prematurity, pregnancy and post-exposure situations. SOURCES OF DATA: Systematic review of articles published during the two last decades, found in MEDLINE, SciELO and Lilacs databases; guidelines of Programa Nacional de Imunizações (Brazilian National Immunization Program), 2001 to 2004, and of Programa Nacional de DST/AIDS (Brazilian National STD/AIDS Program), 2004. Abstracts published in national and international pediatric and infectious disease congress annals during the last five years were also consulted. SUMMARY OF THE FINDINGS: Some special situations, such as immunosuppression, prematurity, pregnancy and exposure to infectious diseases increased the risk of diseases or adverse post-vaccination events. In these situations, special vaccines or special vaccination schedules are indicated, or vaccines should be postponed or even forbidden. In general, toxoid or inactivated vaccines can be used, considering the possibility of insufficient immune response. For immunosuppressed patients, in accordance with the type of immunosuppression, live virus or bacterial vaccines should be avoided, because of the risk of vaccine agent spread. Immunization should include not only the patient, but his/her home and day-care contacts as well. CONCLUSIONS: Knowledge about the schedule indicated for each situation improves the chances of better vaccine protection and decreases the risk of adverse events. Immunosuppressed or immunodeficient patients whose post-vaccine antibody titers are not available should be considered susceptible when exposed to infectious disease, and all the available prophylactic measures should be implemented, even when the vaccination schedule is correct.
Adolescent↗
Immunizations in the United States: a rite of passage.
Today, vaccination is a cornerstone of pediatric preventive health care and a rite of passage for nearly all of the approximately 11,000 infants born daily in the United States. This article reviews the US immunization program with an emphasis on its role in ensuring that vaccines are effective, safe, and available and highlights several new vaccines and recommendations that will affect the health of children and adolescents and the practice of pediatric medicine in future decades.
Adolescent↗
Vaccination coverage among children entering school--United States, 2003-04 school year.
One of the national health objectives for 2010 is to sustain > or =95% vaccination coverage among children in kindergarten through first grade (objective 14-23). To determine the percentage of vaccination coverage among children entering kindergarten, data on vaccination coverage were analyzed from reports submitted to the National Immunization Program by states, the District of Columbia (DC), and eight current or former U.S. territories for the 2003-04 school year. This report summarizes the results of that analysis, which determined that coverage for all vaccines except hepatitis B (HepB) and varicella was reported at >90% in 45 areas. However, the vaccines required in each reporting area and the methods for surveying kindergarten-aged children vary substantially; in seven states, <20% of eligible children were surveyed. The wide variations in survey populations underscore the need for CDC to continue working with immunization programs in states, DC, and current or former territories to improve survey methods and automate reporting of data.
Child↗
[Diphtheria in Denmark 1956-1989. Occurrence of Corynebacterium diphtheriae and other diphtheria toxigenic bacteria].
The public immunization program against diphtheria, established in 1941, has almost eradicated the disease in Denmark, and 1956 became the first year without any notified cases. Since then, toxigenic strains have only been isolated five times--three cases of clinical diphtheria due to Corynebacterium diphtheriae biovar. mitis and two cases of tonsillitis/pharyngitis due to Corynebacterium ulcerans. The source of the infection was not identified in any of the cases. The first case of diphtheria in 1968 was imported from abroad. The following two cases in 1983 and 1985 were due to strains of the same phage type and peptide profile as the strains isolated during the epidemic in Sweden in 1984-1986. This indicates that the Danish cases and the Swedish epidemic derived from the same source. The diphtheria immunity of the Danish population is decreasing, and the level of protection is approaching the Swedish level. The impact is that a situation like that in Sweden may be anticipated with diphtheria epidemic in the lowest socio-economical groups--the skid row dwellers, alcoholics and drug abusers--if the immunization program against diphtheria is not intensified.
Adult↗
Immunogenicity and safety of four different doses of Haemophilus influenzae type b-tetanus toxoid conjugated vaccine, combined with diphtheria-tetanus-pertussis vaccine (DTP-Hib), in Indonesian infants.
Widespread use of Haemophilus influenzae type b (Hib) conjugated vaccine in industrialized countries has resulted in a dramatic decline in the incidence of invasive Hib diseases, but the vaccine's cost has prevented its inclusion in basic immunization programs in developing countries. To overcome this problem, combination with diphtheria-tetanus-pertussis (DTP) vaccine or reduction in the dose of Hib vaccine has been proposed. To evaluate the immunogenicity and adverse reactions from lower doses of Hib-polyribosylphosphate (PRP) conjugated with tetanus toxoid (PRP-T), a double-blind study was conducted in Jakarta, Indonesia, and its suburbs. A total of 1048 infants 6 weeks to 6 months of age received three doses of DTP vaccine combined with the usual 10 microg dose or with a reduced dose of 5, 2.5 or 1.25 microg of PRP-T at two-monthly intervals. Antibodies were measured prior to the first dose and 4-6 weeks following the third dose. Adverse reactions were similar among all four groups. The only significant difference was a higher rate of irritability (p<0.02) and of temperature elevation >38 degrees C (p<0.009) after doses 1 and 2 in the lowest dose group (1.25 microg PRP-T) compared to the other groups. All participants tested had a 4-fold increase in antibodies against all DTP antigens. In addition, after a fourth booster dose of Hib, 99.6% of infants produced >or=0.15 microg/ml of antibody to Hib-PRP, and 96.4% showed levels >or=1.0 microg/ml after primary immunization, level that correlate with short- and long-term immunity, respectively. Antibody titers to the PRP antigen showed no significant differences among dosage groups with the exception of the 5.0 microg group, which had a significantly higher GMC than the 1.25 microg group (p<0.012). This study demonstrates that primary vaccination with half, one-fourth, or one-eighth of the usual dose of PRP-T, combined with DTP vaccine, produces protective immune responses, and has side effects that are comparable to DTP vaccination alone. In these lower dosages, PRP-T conjugate vaccine can lower vaccine costs to a level that is affordable for infant immunization programs in developing countries.
Antibodies, Bacterial↗
Guillain-Barré syndrome after influenza vaccination in adults: a population-based study.
BACKGROUND: Whether influenza vaccination is associated with Guillain-Barré syndrome (GBS) remains uncertain. METHODS: We conducted 2 studies using population-based health care data from the province of Ontario, Canada. In the first study, we used the self-matched case-series method to explore the temporal association between probable influenza vaccination (adults vaccinated during October and November) and subsequent hospitalization because of GBS. In the second study, we used time-series analysis to determine whether the institution of a universal influenza immunization program in October 2000 was associated with a subsequent increase in hospital admissions because of GBS at the population level. RESULTS: From April 1, 1992, to March 31, 2004, we identified 1601 incident hospital admissions because of GBS in Ontario. In 269 patients, GBS was diagnosed within 43 weeks of vaccination against influenza. The estimated relative incidence of GBS during the primary risk interval (weeks 2 through 7) compared with the control interval (weeks 20 through 43) was 1.45 (95% confidence interval, 1.05-1.99; P = .02). This association persisted in several sensitivity analyses using risk and control intervals of different durations. However, a separate time-series analysis demonstrated no evidence of seasonality and revealed no statistically significant increase in hospital admissions because of GBS after the introduction of the universal influenza immunization program. CONCLUSION: Influenza vaccination is associated with a small but significantly increased risk for hospitalization because of GBS.
Adult↗
Rubella vaccination: fertility control in a large-scale vaccination program for postpubertal women.
Despite nationwide immunization programs, rubella infections during pregnancy continue. To solve this serious health problem direct immunization of women of reproductive age may be required. On a clinic basis, using nonphysician personnel, we vaccinated 404 susceptible women, ages 18 to 33; half were sexually active. Since pregnancy is proscribed for 2 to 3 months following rubella vaccination, a full range of family-planning services and a variety of contraceptive methods were used to ensure sustained fertility control. Sixteen vaccinees presented with possible conceptions in a 3 month follow-up. Of these, only five required treatment: two received diethylstilbestrol, two had menstrual inductions, and one an abortion. Administration of vaccine during a menstrual period was effective in preventing inadvertent vaccination of pregnant women. It was concluded that contraceptive counseling with adequate pregnancy termination backup makes it feasible to give rubella vaccine to highly motivated women.
Contraception↗
[Evolution of the vaccination timetable in Morocco].
Morocco has always been aware of the importance of vaccination and has been implementing an ambitious vaccination policy for several decades. The first vaccination campaigns started in the sixties. The Extended Vaccination Program (EVP) was launched in 1981 and restructured six years later, being renamed the National Immunization Program (NIP). Regular follow-up of vaccine efficacy has led to several changes in the national vaccination timetable, including new antigens and boosters. Protection against tuberculosis, diphtheria, tetanus, whooping cough, poliomyelitis, etc. has considerably improved in Morocco. Neonatal tetanus and diphtheria have been eliminated, along with poliomyelitis (certified by WHO in 2001). Future efforts will focus on reducing urban-rural disparities, and on implementing the WHO program for eliminating measles and congenital rubella.
Adult↗
EPI vaccination in Nepal.
A number of surveys, small or large, have been undertaken by various agencies for coverage evaluation of immunization programs. The most commonly used design is the WHO-30 cluster sampling method. Other new methods are the Institute for Refresh Medical Statistics (IRMS) New Delhi method and the lot quality assurance sampling method. This paper describes the National Immunization Day (NID) method to evaluate the immunization coverage of the Expanded Program on Immunization (EPI) vaccines in the Sunsari district of Nepal. A total number of 3,332 respondents (69.4% females and 30.6% males) were interviewed regarding the immunization status of their children during NID. The children with complete immunization (BCG, measles and three doses of DPT and OPV) were 65.7%. The individual coverage by EPI vaccines (except OPV III and measles) was more than 80%. The result shows that there is positive relationship between immunization coverage and educational level of the respondents.
Adult↗
Long-term in vivo provision of antigen-specific T cell immunity by programming hematopoietic stem cells.
A method to genetically program mouse hematopoietic stem cells to develop into functional CD8 or CD4 T cells of defined specificity in vivo is described. For this purpose, a bicistronic retroviral vector was engineered that efficiently delivers genes for both alpha and beta chains of T cell receptor (TCR) to hematopoietic stem cells. When modified cell populations were used to reconstruct the hematopoietic lineages of recipient mice, significant percentages of antigen-specific CD8 or CD4 T cells were observed. These cells expressed normal surface markers and responded to peptide antigen stimulation by proliferation and cytokine production. Moreover, they could mature into memory cells after peptide stimulation. Using TCRs specific for a model tumor antigen, we found that the recipient mice were able to partially resist a challenge with tumor cells carrying the antigen. By combining cells modified with CD8- and CD4-specific TCRs, and boosting with dendritic cells pulsed with cognate peptides, complete suppression of tumor could be achieved and even tumors that had become established would regress and be eliminated after dendritic cell/peptide immunization. This methodology of "instructive immunotherapy" could be developed for controlling the growth of human tumors and attacking established pathogens.
Animals↗
[Vaccines: a public affair?] [corrected].
In spite of the expectation that the development of vaccines would help in the control of some of the main transmissible diseases in Brazil, which are responsible for a large share of endemic illness in the country, efficient and safe vaccines against no less serious contagious diseases are available, yet underutilized. The reason is simple: some vaccines are not included in the National Immunization Program (PNI) and are this not the object of government campaigns. Despite the competence with which the National Health Foundation has acted-through the PNI-in reducing prevalence of diseases such as diphteria, whooping cough, measles, and polio, lack of information and prejudice make several vaccines inaccessible to a major share of the Brazilian population. Since the government-through its vaccination campaigns-exerts the most important influence on public opinion in this area, a vaccine procedure which is not the object of such campaigns will obviously not become part of popular culture. The result of this lack of information is that the population fails to utilize vaccines against such diseases as rubella, mumps, and hepatitis B or against Haemophilus influenza type b and pneumococcus infections. We therefore argue for information on the existence and availability of these vaccines, so that not only the part of the population that has access to private medicine can benefit, but mainly so that pressure can be brought to bear on the government for all public health care services to supply them to the neediest portion of the population. We suggest that strategies for the socialization of immunoprophylatics should be defined with participation by all segments of society, incorporating measures such as the gradual expansion of the National Immunization Program, coverage of vaccine costs by health insurance policies, and granting of fiscal incentives to companies that vaccinate their employees and families. Finally, we propose a struggle against the prejudice surrounding participation by private initiative in collective health actions, as well as defense of the interaction between private and public sectors in all aspects of health throughout Brazil.
English Abstract↗