Fetal programming of immune function and respiratory disease.
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Adolescent↗
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Disseminated bacille Calmette-Guérin infection: three recent Canadian cases. IMPACT. Immunization Monitoring Program, Active.
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BCG Vaccine↗
Universal childhood hepatitis B vaccination: infants vs. preadolescents, the Canadian perspective.
BACKGROUND: In the 1980s, populations of the United States and Canada exhibited similar and increasing incidence of hepatitis B. Vaccination programs targeted at high risk populations did not impact on overall disease incidence. METHODS: Hepatitis B immunization strategies in the United States and Canada were reviewed to determine their impact on vaccination coverage. To reduce the transmission of hepatitis B, divergent vaccination plans emerged within North America. The United States added hepatitis B to its universal infant immunization schedule, and Canada implemented hepatitis B immunization programs for preadolescents (9 through 13 years of age). RESULTS: To date, both strategies have markedly increased vaccination coverage among the targeted cohort. Hepatitis B vaccination coverage of infants rose from 8% in 1992 to 82% in 1996 in the United States. In Canada, hepatitis B vaccine uptake rates among preadolescents have been high, with all major provinces reporting near or greater than 90% coverage in 1996. CONCLUSIONS: The incidence of acute and chronic hepatitis B in Canada should drop measurably within the decade as these protected preadolescents move into adulthood. In addition, the Canadian vaccine delivery infrastructure allows for the addition of new vaccines targeted for adolescents.
Adolescent↗
Vaccines in pregnancy: a review of their importance in Brazil.
Neonates and young children remain susceptible to many serious infectious diseases preventable through vaccination. In general, current vaccines strategies to prevent infectious diseases are unable to induce protective levels of antibodies in the first 6 months of life. Women vaccinated during pregnancy are capable of producing immunoglobulin antibodies that are transported actively to the fetus, and maternal immunization can benefit both the mother and the child. With few exceptions, maternal immunization is not a routine, because of the concerns related to the safety of this intervention. Ethical and cultural issues make the studies on maternal immunization difficult; however, in the last decade, the development of new vaccines, which are very immunogenic and safe has reactivated the discussions on maternal immunization. In this paper we present a review of the literature about maternal immunization based on MEDLINE data (1990 to 2002). The most important conclusions are: 1) there is no evidence of risk to the fetus by immunizing pregnant women with toxoids, polysaccharide, polysaccharide conjugated and inactive viral vaccines; 2) most viral attenuated vaccines are probably safe too, but data is still insufficient to demonstrate their safety; therefore these vaccines should be avoided in pregnant women; 3) in Brazil, there is a need for a maternal immunization program against tetanus. Many new candidate vaccines for maternal immunization are available, but studies should be conducted to evaluate their safety and efficacy, as well as regional priorities based on epidemiological data.
Bacterial Infections↗
Cost benefit analysis of Japanese encephalitis vaccination program in Thailand.
Using decision analysis, we estimated benefits, risks, and costs of implementing the Japanese encephalitis (JE) vaccination program in children aged 18 months and 6 years in Thailand. The costs for inclusion of JE vaccine into the routine immunization program at 18 months and 6 years are $2.16 and $3.68 per person, respectively. In the baseline model, the JE vaccination program will prevent 124 JE cases in the program for 18 months old children and 153 JE cases in the program for 6 years old children. The 18 month child program is more cost-effective than the 6 year child program. The cost-effectiveness ratio in the 18 month child program is $15,715 compared with $21,661 in the 6 year child program. The benefits of the JE vaccination program are the savings in treatment cost, disability care, and the future lifetime earnings from JE prevented. The 18 month child program will save $72,922 per one prevented JE compared with $66,197 in the 6 year child program. The JE vaccination program is cost-beneficial under the base-case assumption. Sensitivity analysis which alters various assumptions indicates that the JE vaccination program is worth implementing unless the incidence of JE is less than 3 per 100,000 population. Otherwise, the cost of vaccine has to be reduced.
Child↗
Improving health care planning--some lessons from immunization.
This article presents a managerial perspective on health planning by the Federal Government illustrated by the case of the Swine Flu Immunization Program. The recent national program in the U.S.A. for immunizing the entire population against the swine flu is examined in terms of the processes of health planning. It is concluded that this program was poorly planned and therefore doomed to failure from the beginning. Recommendations for improved planning of similar programs are made.
Centers for Disease Control and Prevention, U.S.↗
Adolescent immunization rates and the effect of socio-demographic factors on immunization in a cosmopolitan city (ERZURUM) in the eastern Turkey.
OBJECTIVE: Pediatric vaccinations have decreased the incidence and mortality from infectious diseases in children, but adolescents continue to be adversely affected by vaccine preventable disease. The present study was performed to determine the status of adolescents immunization and to investigate the effect of several socio-demographic factors on immunization. MATERIAL AND METHOD: Using the cluster-sampling method, 817 adolescents were selected in 24 high schools (15,000 students) in central district of Erzurum (Turkey). Adolescents were categorized as completely vaccinated, incompletely vaccinated, unvaccinated or vaccination status unknown. RESULTS: Of the 817 adolescents, 6.9% were completely vaccinated, 24.4% were incompletely vaccinated and 64.1% were unvaccinated. The vaccination status of 4.6% of adolescents was unknown. A significantly correlation was seen between the number of siblings, the level of mother and father education, the level of parent's socio-economics status, health insurance and immunization status. CONCLUSION: Our findings indicated a small percentage of adolescents receive all of the recommended vaccine. In immunization programs in Turkey, priority should be given to increase adolescent immunization rate with a middle school and/or adolescents, vaccination.
Adolescent↗
Hepatitis B immunization: a potential incentive to HIV vaccine trial participation in Thailand?
To assess the effectiveness of hepatitis B immunization as an incentive to retention in HIV seroincidence studies and future HIV vaccine trials in northern Thailand, subjects enrolled in three HIV seroincidence cohorts were screened for hepatitis B markers and seronegatives were offered free hepatitis B immunization. Cohorts studied included female commercial sex workers (CSWs), male sexually transmitted disease (STD) patients, and recently discharged military conscripts. Subjects who agreed to the immunization program were compared with those not enrolled to determine the utility of immunization as an incentive to cohort retention. Full immunization was achieved for 273 (89.5%) of 305 vaccinees; only 323 (60.6%) of 533 subjects not immunized completed the same follow-up visits (OR = 1.49, 95% and CI = 1.27, 1.75). Hepatitis B vaccination was a significant incentive for completion of the follow-up program. The vaccination program had the greatest effect on the CSWs; a similar effect was seen for male STD patients, but not for discharged conscripts. Despite the immunization program, follow-up rates at 12 months were similar in the immunized and nonimmunized groups.
AIDS Vaccines↗
Universal influenza immunization. Were Ontario family physicians prepared?
OBJECTIVE: To explore family physicians' experiences during the first year of Ontario's universal influenza immunization program. DESIGN: Qualitative study using in-depth interviews. SETTING: Thames Valley region of southwestern Ontario. PARTICIPANTS: A maximum variation sample of nine family physicians selected by snowball sampling after initial consultation with a local family physician advisory committee. METHOD: Interviews were audiotaped and transcribed verbatim. Analysis was sequential, using a combination of editing, immersion, and crystallization. Interview transcripts were read by individual members of the team who met to compare findings at several stages during data collection. MAIN FINDINGS: The program affected family physicians because immunization strategies designed for immunizing high-risk patients needed to be modified to deal with greater numbers of patients. While generally supportive of the program, physicians found it difficult to implement. Responses reflected ongoing conflict between individual and public health priorities, particularly regarding children and pregnant women. CONCLUSION: The program could have been more effective if the culture and climate of Ontario family practice had been considered during its development and implementation.
Attitude of Health Personnel↗
Childhood immunizations. Policies, problems, and remedies.
Attaining full immunization coverage, particularly for those younger than 2 years of age, is a critical investment in the well-being and future of this nation's children. Unfortunately, not all children receive this health protective intervention equally or on a timely basis. The measles epidemic of 1989-1991 caused much concern to providers, parents, and government officials and focused the spotlight on this major healthcare issue. Those involved began to question the adequacy of federal immunization laws and the effectiveness of existing immunization programs. This article examines both significant former healthcare policy/legislation focused on childhood immunizations and current concerns regarding childhood immunizations in the United States, and offers a broad range of suggestions for future policy/practice modifications to address these concerns.
Communicable Disease Control↗
Failure to reach the goal of measles elimination. Apparent paradox of measles infections in immunized persons.
BACKGROUND: Measles is the most transmissible disease known to man. During the 1980s, the number of measles cases in the United States rose dramatically. Surprisingly, 20% to 40% of these cases occurred in persons who had been appropriately immunized against measles. In response, the United States adopted a two-dose universal measles immunization program. We critically examine the effect of vaccine failure in measles occurring in immunized persons. METHODS: We performed a computerized bibliographic literature search (National Library of Medicine) for all English-language articles dealing with measles outbreaks. We limited our search to reports of US and Canadian school-based outbreaks of measles, and we spoke with experts to get estimates of vaccine failure rates. In addition, we devised a hypothetical model of a school where measles immunization rates could be varied, vaccine failure rates could be calculated, and the percentage of measles cases occurring in immunized students could be determined. RESULTS: We found 18 reports of measles outbreaks in very highly immunized school populations where 71% to 99.8% of students were immunized against measles. Despite these high rates of immunization, 30% to 100% (mean, 77%) of all measles cases in these outbreaks occurred in previously immunized students. In our hypothetical school model, after more than 95% of schoolchildren are immunized against measles, the majority of measles cases occur in appropriately immunized children. CONCLUSIONS: The apparent paradox is that as measles immunization rates rise to high levels in a population, measles becomes a disease of immunized persons. Because of the failure rate of the vaccine and the unique transmissibility of the measles virus, the currently available measles vaccine, used in a single-dose strategy, is unlikely to completely eliminate measles. The long-term success of a two-dose strategy to eliminate measles remains to be determined.
Canada↗
Antibodies to squalene in recipients of anthrax vaccine.
We previously reported that antibodies to squalene, an experimental vaccine adjuvant, are present in persons with symptoms consistent with Gulf War Syndrome (GWS) (P. B. Asa et al., Exp. Mol. Pathol 68, 196-197, 2000). The United States Department of Defense initiated the Anthrax Vaccine Immunization Program (AVIP) in 1997 to immunize 2.4 million military personnel. Because adverse reactions in vaccinated personnel were similar to symptoms of GWS, we tested AVIP participants for anti-squalene antibodies (ASA). In a pilot study, 6 of 6 vaccine recipients with GWS-like symptoms were positive for ASA. In a larger blinded study, only 32% (8/25) of AVIP personnel compared to 15.7% (3/19) of controls were positive (P > 0.05). Further analysis revealed that ASA were associated with specific lots of vaccine. The incidence of ASA in personnel in the blinded study receiving these lots was 47% (8/17) compared to an incidence of 0% (0/8; P < 0.025) of the AVIP participants receiving other lots of vaccine. Analysis of additional personnel revealed that in all but one case (19/20; 95%), ASA were restricted to personnel immunized with lots of vaccine known to contain squalene. Except for one symptomatic individual, positive clinical findings in 17 ASA-negative personnel were restricted to 4 individuals receiving vaccine from lots containing squalene. ASA were not present prior to vaccination in preimmunization sera available from 4 AVIP personnel. Three of these individuals became ASA positive after vaccination. These results suggest that the production of ASA in GWS patients is linked to the presence of squalene in certain lots of anthrax vaccine.
Adjuvants, Immunologic↗
Status of measles in The Gambia, 1981.
Measles registries were instituted in all rural health facilities in The Gambia during January through December 1981. House-to-house surveillance of three infected villages revealed a 7% acute case-fatality rate. Infected villages were followed up until December 1981. Finger-prick specimens of blood, complete measles history, and vaccination status of 380 children aged six months to five years were studied. Data on children from the area with the lowest coverage for measles vaccination in 1980 were collected and analyzed. Of the 60% of children who were vaccinated, 75% seroconverted, while 8% reported measles infection after immunization. The Gambia's immunization program is composed of static immunization units with outreach stations and rural health workers in immunization services. The strong faith of mothers in the maternal and child health services coupled with the commitment of the health workers in The Gambia is helping to provide important leadership in the struggle to attain global control and eradication of measles by the year 2000.
Antibodies, Viral↗
Rubella prevention in family practice with RA27/3 vaccine.
The literature reveals serious shortcomings in rubella immunization programs since the introduction of rubella vaccine in 1969. Current programs may be supplemented by immunizing susceptible women in the childbearing years. Family physicians are in an ideal position to add this service for their practice populations. Existing methods in two practices were assessed by chart review and found to be disorganized. Testing of immunity was haphazard and incomplete, only occasionally being followed by immunization when indicated. A method of approaching this problem in the context of provision of service in everyday practice was established and evaluated. It is concluded that preventive measures are more successful if proposed during routine patient visits for other reasons. The distribution of rubella HI antibody titers in women from ages 12 to 40 years in this practice are displayed, along with the success rate of vaccination with RA27/3 vaccine (Almevax) and the frequency and nature of adverse effects. The superiority of response to this vaccine is demonstrated, as is the practicability of inclusion of Rubella HI testing and vaccination in the daily provision of care in a family practice.
Adolescent↗
Seroepidemiology study of rubella antibodies among pregnant women from seven Asian countries: evaluation of the rubella vaccination program in Taiwan.
During 2003-2004, approximately 13% of birth in Taiwan was given by foreign-born females. The aims of this study were to compare the seroprevalence of rubella antibodies between Taiwan-born and foreign-born pregnant women and evaluate the effect of rubella vaccination program in Taiwan. We reviewed the rubella antibody test results of 5007 women during routine pregnancy check-ups at Fooyin University Hospital during 1999-2002. In Taiwan-born women, rubella antibody was undetectable in 29.2%, 7.3%, and 8.3% of the cohorts born before 1971, between 1971 and 1976, and after 1976, respectively. In the cohorts born between 1971 and 1976 and after 1976, pregnant women born in China, Vietnam, Indonesia, and Philippines had significant higher chances of being susceptible. Our results suggested that the voluntary adult vaccination program was not as effective as the school or wipe-out programs. Both Taiwanese women born before 1971 and foreign-born women were more likely to be susceptible to rubella. The introduction of 'catch-up' immunization program and enforcement of the checking of immunization record and/or blood test before pregnancy for these women are necessary in preventing CRS.
Adolescent↗
IMM/Serve: a rule-based program for childhood immunization.
A rule-based program, IMM/Serve, is being developed to help guide childhood immunization for initial use, within Oregon. The program is designed primarily for automated use with an online immunization registry, but can also be used interactively by a single user. The paper describes IMM/Serve and discusses 1) the sources of complexity in immunization logic, 2) the potential advantages of a rule-based approach for representing that logic, and 3) the potential advantage of such a program evolving to become the standard of care. Related projects include 1) a computer-based tool to help verify the completeness of the logic, 2) a tool that allows a central part of the logic to be generated automatically, and 3) an approach that allows visualization of the logic graphically.
Child↗
HMO strategies for improving childhood immunization rates.
Last fall, Group Health Association of America (GHAA) surveyed plans that are participating in the Childhood Immunization Program (see p. 29). The 121 HMOs that responded reported on a variety of immunization interventions. The survey is not representative of all HMOs because of the size of the response rate. Nevertheless, the survey provides an interesting snapshot of the immunization tactics that these HMOs are employing.
Child Health Services↗
Immunization status of 2-year-old children, year 2000 survey results.
Immunization rates among Tennessee's 2-year-olds remain at high levels, and disease remains at historically low levels. The completion rates have remained relatively stable for the past three years, although there has been an equalization of rates among the regions. The portion of the TennCare population receiving all their vaccines in the private setting will continue to require additional resources to sustain the improvements noted in this survey. Other children who have been identified as being at increased risk for incompletion are children starting their vaccine series past age 120 days and children with two or more older siblings. The Immunization Program has embarked on collaboration with the TennCare managed care organizations (MCOs) to electronically exchange immunization data with the Immunization Registry. This will eventually enable physicians, MCOs, and health department personnel to identify high-risk children and children who are behind in their immunization series for more intensive follow-up. The goal of 90% of all children being completely immunized by their second birthday is within our reach, as demonstrated by the dramatic increases in immunization levels in the past ten years. To reach that goal will require that we in the medical community, public and private, continue to use those strategies that have worked while developing new strategies that continue the progress.
Child, Preschool↗