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PubMed1998

Epidemiology of invasive pneumococcal infections in infants and young children in Metropolitan Santiago, Chile, a newly industrializing country.

AIM: To study the epidemiology of invasive pneumococcal infections in infants and young children in Santiago, Chile, as a representative pediatric population in a newly industrializing country where pneumococcal conjugate vaccines may be used in the future. METHODS: A 5-year retrospective laboratory-based review (1989 to 1993) was followed by a 3-year prospective laboratory and hospital surveillance study in two of the six health administrative areas of Santiago to detect all hospitalized cases of invasive pneumococcal disease (defined as Streptococcus pneumoniae isolated from blood, cerebrospinal fluid or another normally sterile site) among infants and children (0 to 23 months of age in the retrospective and 0 to 59 months of age in the prospective study). RESULTS: During the 5-year retrospective survey the incidence of invasive pneumococcal disease was 90.6 cases per 10(5) infants 0 to 11 months old and 18.5 cases per 10(5) toddlers 12 to 23 months old. Similar rates (60.2 per 10(5) infants and 18.1 per 10(5) toddlers) were recorded during the 3 years of prospective surveillance. Among the 110 cases in children 0 to 59 months of age detected during the 3-year prospective surveillance, 2 clinical forms, pneumonia and meningitis, accounted for 87.2% of all cases; 13 of the 49 pneumonia patients (26%) had empyema as a complication. Notably 40 of the 110 cases (36.4%) occurred before 6 months of age (63.4% of the 63 infant cases). Serotypes 1, 14, 5 and 6B were the most prevalent. Overall 76 and 69%, respectively, of S. pneumoniae isolates were antigenic types that would be covered by the 11- or 9-valent conjugate vaccines under development. CONCLUSIONS: Invasive pneumococcal infections in Santiago, Chile, exhibit an epidemiologic pattern intermediate between that of developing and industrialized countries. The high burden of disease in early infancy dictates that an accelerated immunization schedule (beginning in the perinatal period) or maternal immunization with pneumococcal vaccines should be explored.

Age Factors↗
PubMed2000

Impact of an encounter-based prompting system on resident vaccine administration performance and immunization knowledge.

OBJECTIVES: To evaluate an encounter-based immunization prompting system on resident performance in administering vaccines and knowledge of immunization guidelines. DESIGN/METHODS: Prospective randomized, controlled trial. Subjects were first- and second-year pediatric residents in a hospital-based continuity clinic. The intervention group received manual prompts of immunizations due. Postclinic chart review compared immunizations due with those administered. Acceptable and unacceptable reasons for not administering vaccines were assigned. Resident knowledge was measured by a 70-item examination. RESULTS: The intervention group had significantly less missed opportunities/vaccine administration errors (11.4% vs 21.6%). The most common reason for unacceptable errors in the intervention group: vaccine was given too early; in the control group: vaccine was postponed to next visit. Pre- and postintervention knowledge scores were similar: intervention group (75.5% vs 80.7%, control group; 76.5% vs 81.3%). CONCLUSION: An immunization prompting system in a hospital-based pediatric resident continuity clinic reduced missed opportunities/vaccine administration errors without significantly impacting resident knowledge of immunization guidelines.immunization schedule, vaccination, immunization, prompting systems, resident education.

Adult↗
PubMed1985

Pertussis immunization of infants using a new combined DTP-polio vaccine.

As part of the evaluation of a new combined Diphtheria-Tetanus-Pertussis-Poliomyelitis (DTP-Polio) inactivated vaccine, the pertussis agglutinin response was studied in 62 infants, two to three months old. Each dose of vaccine combined these antigens in a 0.5 ml volume, and contained at least four International Protective Units of pertussis antigen adsorbed on aluminium hydroxide. Infants were vaccinated with three doses of DTP-Polio vaccine at two month intervals. Pertussis agglutinin determinations showed a satisfactory response after two DTP-Polio vaccine doses. Although higher agglutinin titres were apparent after three doses than after two, no significant difference was observed in the seroconversion rate after two or three doses (88.8% and 96.3% respectively). The DTP-Polio vaccine would thus seem suitable for use in a two-dose primary immunization schedule against pertussis.

Agglutinins↗
PubMedDate not supplied

Impaired antibody response rates after high dose short interval hepatitis B virus vaccination of immunosuppressed individuals.

BACKGROUND/AIMS: Because a more rapid and high dose vaccination schedule may be advantageous in immunosuppressed individuals to induce an earlier immunization, the aim of the present study was to assess the response to high dose, short interval hepatitis B virus vaccination in various immunosuppressed-patient populations. METHODOLOGY: A total of one hundred and thirty-eight immunosuppressed patients (86 cirrhotics, 42 dialysis patients, 10 allogeneic hematopoietic cell transplants) and 26 healthy subjects as controls were vaccinated utilizing a high dose vaccine (40 mcg) and a shortened immunization schedule. RESULTS: Ninety-two percent of the controls responded to the high dose, short interval hepatitis B virus vaccination schedule. In contrast, only 48% of the immunosuppressed patients seroconverted to anti-HBs positivity (p < 0.001). No difference in the antibody response rate was seen between the various immunosuppressed populations studied. No significant hepatitis B virus vaccination-related adverse effects were seen in any of the groups vaccinated. CONCLUSIONS: Although a high dose, short interval hepatitis B virus vaccination schedule is safe in immunosuppressed patients, the antibody response is still significantly reduced as compared to healthy subjects and only slightly greater than that achieved with standard vaccination schedules, as reported in literature. The possibility of achieving an earlier immunization, however, may be of some advantage to protect acquired viral infection.

Adolescent↗
PubMed2002

Evaluating acceptability and completeness of overseas immunization records of internationally adopted children.

BACKGROUND: Increasing numbers of families in the United States are adopting children who were born in other countries. Appropriate immunization of internationally adopted children provides a challenge to pediatricians who must evaluate documentation of vaccines administered overseas and fulfill the recommended US childhood immunization schedule. The acceptability of vaccinations received outside the United States was addressed by the Advisory Committee on Immunization Practices in 1994, but few population-based studies assessing these vaccinations have been reported. METHODS: We performed a retrospective cohort study of 504 children who were adopted from other countries and evaluated in 1997 and 1998. Our goal was to determine the acceptability of overseas vaccinations for meeting US immunization requirements. We assessed immunization records for both valid documentation of receipt of vaccine and comparability with the recommended US schedule. We also determined the number of children who were up to date (UTD) for diphtheria-tetanus-pertussis, polio, hepatitis B, and measles-mumps-rubella vaccines under the US schedule. RESULTS: The children's mean age at initial US evaluation was 19 months; 71% were girls, and most (88%) had resided in orphanages. They were adopted from 16 countries, most frequently from China (48%) and Russia (31%). Thirty-five percent (178) of children had overseas immunization records, 167 (94%) of which were considered valid. Most children with valid records (112 [67%] of 167) were UTD for 1 or more vaccine series under the US schedule. CONCLUSION: The majority (65%) of internationally adopted children had no written records of overseas immunizations. Among the 178 children with documented overseas immunizations, 167 (94%) had valid records and some vaccine doses that were acceptable and UTD under the US schedule. Additional research and more specific guidance in the most cost-effective approaches to evaluation of overseas vaccinations are needed to ensure appropriate state-side vaccination and to improve the health of these children and their communities.

Adoption↗
PubMed1987

Induction of protective immunity against Schistosoma mansoni by a non-living vaccine. V. Effects of varying the immunization and infection schedule and site.

Intradermal (i.d.) injection with non-living schistosome antigens plus bacterial adjuvant protects mice against subsequent infection with Schistosoma mansoni. This protection became apparent within 2 weeks after a single inoculation and persisted for at least 8 weeks. Administration of one or more booster immunizations enhanced the level of protection but never produced complete resistance to cercarial challenge under the conditions tested. All immunized mice recognized the Sm 97 antigen in adult worms, as measured by antibody reactivity in ELISA, although the level of reactivity did not correlate with the level of resistance. Significant protection was observed when mice were immunized in the skin of the chest, the footpad or at the base of the tail if challenge infection was administered percutaneously either on the abdomen or back. However, when mice were infected by cercarial exposure of the tail skin, the level of resistance was consistently lower regardless of the immunization site. Vaccinated mice were not resistant to infection with lung stage parasites. These results demonstrate that the i.d. vaccine induces significant and persistent resistance in mice, the level of which is strengthened by booster immunization. The resistance is unrelated to inflammation at the site of immunization. However, immune response at the challenge site may play a critical role in the effector mechanism of resistance in this model.

Animals↗
PubMed1996

Maximizing immunization coverage through home visits: a controlled trial in an urban area of Ghana.

A strategy of home visits to maximize children's immunization coverage was implemented in three towns in Ghana. The strategy was tested in town 1 in a controlled trial where clusters of children were allocated to the intervention and control groups. A total of 200 mothers in the intervention group were visited at home by non-health workers and their children were referred to a routine under-fives' clinic. Subsequent home visits targeted at those who failed to complete immunization schedules were made by nurses. After 6 months, coverage had risen from 60% to 85%, which was 20% higher than in the town 1 control group of 219 age-matched children (P < 0.005). A similar home-visiting strategy in a neighbouring town resulted in a rise in coverage from 38% to 91% (n = 55), mainly through home immunizations. Children were more likely to complete the schedule if their fathers were interviewed and participated in the decision to send them to the clinic. Countries with national service programmes can use a home-visiting strategy to supplement and strengthen their routine immunization programmes. A wide range of other community-based primary health care interventions could also be tested and implemented using this methodology.

Adult↗
PubMed1991

Efficacy of HSV-1 ISCOM vaccine in the guinea-pig model of HSV-2 infection.

The capability of a herpes simplex virus (HSV)-1 ISCOM vaccine to protect against intravaginal HSV-2 challenge infection in guinea-pigs is described. The protective efficacy of the HSV-1 ISCOM vaccine is compared with that of a purified, aqueous HSV-1 antigen preparation administered using a similar immunization schedule. The results show that female guinea-pigs immunized with two doses of HSV-1 ISCOM vaccine, each consisting of 20 micrograms of protein given 2 weeks apart responded with high ELISA and neutralization antibody titres, and are almost completely protected against the clinical effects of intravaginal challenge with 10(5.2) TCID50 of HSV-2. This cross-protection is significantly greater than that observed in guinea-pigs immunized with a single dose of HSV-1 ISCOM vaccine, two doses of aqueous HSV-1 antigen preparation or two doses of a mock ISCOM vaccine. However, none of the vaccine preparations completely prevented HSV-2 replication following challenge. Western blot and radioimmunoprecipitation of sera from immunized guinea-pigs show the HSV-1 ISCOM vaccine preparation to contain the major HSV-1 glycoproteins. These findings are discussed in relation to the value and potential use of HSV-1 ISCOM vaccine in humans.

Animals↗
PubMed1997

In vivo cimetidine immunomodulatory effects on the cutaneous reaction to oxazolone in the chicken.

The effect of the histamine H2-receptor antagonist, cimetidine, on the cutaneous Arthus-like hypersensitivity to oxazolone elicited injecting subcutaneously oxazolone conjugated to egg-albumin (EA-OX) has been examined in the chicken. Cimetidine had opposite effects on the cutaneous reaction to oxazolone in relation to a different immunization schedule. Cimetidine enhanced the cutaneous reaction to oxazolone obtained immunizing chickens with oxazolone dissolved in ethanol (Eth-OX); instead cimetidine inhibited the cutaneous reaction obtained in chickens immunized with oxazolone dissolved in complete Freund adjuvant (CFA-OX). Optimum enhancement of the cutaneous arthus-like reaction to oxazolone occurred when cimetidine was given for three consecutive days starting at the immunization. The enhancing effect was absent in neonatally bursectomized chickens. Moreover, cimetidine stimulated bursal cell proliferation at day 1 after sensitization. The study of the immunoglobulin class of oxazolone antibodies produced in the immunized chickens demonstrated that cimetidine stimulated the IgM oxazolone antibody synthesis in Eth-OX immunized chickens and inhibited the IgY oxazolone antibody production in Eth-OX and total oxazolone antibody production in CFA-OX immunized chickens. The relationship between increased IgM oxazolone antibody synthesis and enhancement of the cutaneous Arthus reaction is discussed. The role of IgM antibodies in the pathogenesis of Arthus reaction in the chicken is hypothesized.

Adjuvants, Immunologic↗
PubMedDate not supplied

Competitive indirect ELISA for ceftiofur sodium and the effect of different immunizing and coating antigen conjugates.

Ceftiofur sodium is a broad spectrum, beta-lactamase-resistant cephalosporin. Ceftiofur and desfuroylceftiofur were used to develop competitive indirect enzyme-linked immunosorbent assays (CI-ELISA) for the determination of ceftiofur sodium. Hapten-protein conjugates were made using three different carrier proteins and three methods of conjugation. The first two methods use the free amine of ceftiofur as the site of conjugation, and coupling to bovine serum albumin and ovalbumin was achieved by using two different cross-linking reagents. The third conjugation procedure joins the hydrolyzed form of ceftiofur, desfuroylceftiofur, to the maleimide-activated carrier proteins, bovine serum albumin and keyhole limpet hemocyanin. A variety of immunization schedules is presented to show the effect of repeated immunizations on antibody maturation. Serum antibody levels were evaluated for each conjugation method using both homologous and heterologous conjugates as antigens. All of the immunogens resulted in the generation of anticeftiofur antibodies. The heterologous assay systems on average yielded more sensitive assays, but antisera obtained from all three immunogens were used successfully in developing enzyme-linked immunosorbent assays (ELISA's) for ceftiofur. Ceftiofur was detected in mouse sera in a concentration range of 3-500 ppb. The results illustrate that the method used to couple the hapten to a carrier protein as well as the site of coupling significantly influence the resulting enzyme-linked immunosorbent assays (ELISA's).

Animals↗
PubMed2003

Immunogenicity and safety of two doses of a paediatric hepatitis A vaccine in thai children: comparison of three vaccination schedules.

As fewer children in Thailand are exposed to hepatitis A virus (HAV) and so do not have seroprotective anti-HAV antibodies, they are becoming an important source of HAV transmission. A flexible HAV vaccination schedule would facilitate incorporation of the vaccine into existing immunization programmes, and we compared the immunogenicity and safety of three HAV immunization schedules. An open, randomized, clinical trial was carried out in which healthy children were given a primary dose of the inactivated hepatitis A vaccine, Avaxim 80 paediatric, with a booster dose 6, 12 or 18 months later. Anti-HAV geometric mean concentrations (GMC), seroconversion rates, and GMC ratios (GMCR) of the three schedules were compared and reactogenicity was evaluated. Seroconversion rates were above 98 per cent (per group) up to the booster. The three schedules were equivalent in terms of GMCRs, each eliciting a large booster effect. Local reactions were reported for fewer than 9 per cent of each group after dose one and less frequently after the booster dose. Injection site pain, gastrointestinal tract disorders and fever were the most commonly reported adverse events. No vaccine-related serious adverse events were reported. It was concluded that the hepatitis A vaccine, Avaxim 80 paediatric, is safe and immunogenic when given as a two-dose schedule to healthy seronegative children aged 5-10 years, with the second dose given at either 6, 12 or 18 months after the first.

Child↗
PubMed1979

Prevention of spontaneous leukemia in AKR mice by passive immunization and type specificity of this protection.

AKR mice were given sc injections of goat antiviral immune globulin from birth through 14 or 31 days of age. Although the shorter immunization schedule greatly reduced expression of spontaneous leukemia, the longer immunization period was required for essentially complete prevention of leukemia. Immune globulin with a high neutralization titer for ecotropic virus provided this protection, whereas antibody with a high neutralization titer for murine xenotropic virus did not.

Animals↗
PubMed1990

Reduction in the dosage schedule of BPL-inactivated neural tissue vaccine for rabies prophylaxis in man.

There exist two different immunization schedules for neural tissue rabies vaccine (NTV) for human use in India, the amount of vaccine given by the schedule recommended by Central Research Institute (CRI), Kasauli, being higher than that recommended by Pasteur Institute of India (PII), Coonoor. A study was therefore undertaken to assess the feasibility of reducing the CRI dosage schedule for rabies prophylaxis. The antirabies antibody response in laboratory animals and human subjects following 7, 10 and 14 daily doses of NTV with or without administering rabies immune globulin (RIG) was much higher than the minimum protective level of 0.5 IU/ml of serum. Based on these results, the CRI schedule could be reduced from 14 x 5 ml of NTV to 10 x 5 ml in class II and class III rabies exposure cases.

Adult↗
PubMed1998

Long-term efficacy and immune responses following immunization with the RTS,S malaria vaccine.

The malaria sporozoite vaccine candidate RTS,S, formulated with an oil-in-water emulsion plus the immunostimulants monophosphoryl lipid A and the saponin derivative QS21 (vaccine 3), recently showed superior efficacy over two other experimental formulations. Immunized volunteers were followed to determine the duration of protective immune responses. Antibody levels decreased to between one-third and one-half of peak values 6 months after the last dose of vaccine. T cell proliferation and interferon-gamma production in vitro were observed in response to RTS,S or hepatitis B surface antigen. Seven previously protected volunteers received sporozoite challenge, and 2 remained protected (1/1 for vaccine 1, 0/1 for vaccine 2, and 1/5 for vaccine 3). The prepatent period was 10.8 days for the control group and 13.2 days for the vaccinees (P < .01). Immune responses did not correlate with protection. Further optimization in vaccine composition and/or immunization schedule will be required to induce longer-lasting protective immunity.

Adolescent↗
PubMed1998

Epidemiology of pertussis in French hospitals in 1993 and 1994: thirty years after a routine use of vaccination.

BACKGROUND: Despite widespread vaccination during 30 years, the hypothesis of a resurgence of pertussis in France has been raised by outbreaks and sporadic case reports. No surveillance data were available after 1985. METHODS: A survey was undertaken in 1993 and 1994 in a pediatric hospital network able to confirm cases; the network (22 hospitals) represents 19.6% of pediatric admissions in France. Case definition included clinical (> or = 21 days of paroxysmal cough), laboratory-confirmed (culture or serology by immunoblot) or epidemiologically confirmed pertussis (documented contact with a laboratory-confirmed case). The pattern of transmission was studied in the household. Vaccine status was obtained from health records. RESULTS: during a 15-month period 560 cases (316 index cases, 244 household contact cases) were reported; 49% of index cases and 20% of contact cases were confirmed by culture and/or serology. Sixty-five percent of index cases were younger than 1 year of age (the incidence in this age group could be estimated to be 95/100000) and 66% were hospitalized for a mean duration of 2 weeks. Infection was acquired from parents (34%) and siblings (46%). Seventy-three percent of index cases were unvaccinated. CONCLUSIONS: Although pertussis vaccination coverage is very high in France, the organism is still circulating, affecting, within the pediatric population, mostly non- or incompletely vaccinated infants. These results strongly support the importance of adhering to the immunization schedule and suggest introducing booster dose(s) to prolong vaccine immunity and reduce the exposure to Bordetella pertussis of infants too young to be immunized.

Adolescent↗
PubMed2004

Immunization for hospital staff.

PURPOSE OF REVIEW: In this review the recent literature on the topic of immunization of healthcare workers is assessed. The emphasis lies on immunizations that are directly related to the risks of healthcare workers in the workplace. RECENT FINDINGS: Acceptance of influenza immunization by healthcare workers remains too low, whereas other preventive measures such as hepatitis B vaccination are usually not disputed. Efforts to improve the knowledge of healthcare workers about influenza, its epidemic potential and clinical consequences have contributed to higher immunization rates in some hospitals. Immunization against varicella zoster virus does not result in immunity in all vaccinated persons. This lack of complete protection has infection-control implications, namely the recommendation to wear a mask when caring for clinical cases, regardless of the immunization status. The topic of immunization of healthcare workers has recently been dominated by the discussion of smallpox vaccination, which was promoted by the American public-health authorities for some groups of healthcare workers. SUMMARY: Immunization is a preventive measure that is highly cost-effective. Healthcare workers are responsible for the safety and well-being of their patients and should do their utmost to prevent the transmission of infectious pathogens to them. Another positive result of the adherence of healthcare workers to the recommended immunization schedule is the improved self-protection at the workplace. Immunization against some highly contagious infectious agents has been recommended for many years. The list is now being expanded again by the recommendation of smallpox vaccination. Regarding this indication, several questions and safety issues must be resolved in order to positively influence the currently rather sceptical attitude of healthcare workers towards this vaccine.

Humans↗
PubMed1990

Role of circumsporozoite protein-specific T-cells in protective immunity against Plasmodium berghei.

The Plasmodium berghei circumsporozoite (CS) protein-specific T-cell repertoire was analysed in C57Bl/6 (H-2b), Balb/c (H-2d), and C3H/HeN (H-2k) mice immunized with irradiated sporozoites and the proliferative responses were correlated with the protective status of each strain. Splenic lymphocytes responded to the priming antigen, but the responses varied according to both murine strain and immunization schedule. Analysis of cytolytic T lymphocyte (CTL) responses in mice immunized with irradiated P. berghei sporozoites or with a Salmonella-recombinant CS protein construct revealed that each immunization induces CTLs recognizing different epitopes on the target cells. The variations in immune reactivities among different murine strains to the CS protein antigens and the variations in the responses to the authentic versus recombinantly expressed CS protein suggest that distinct immune mechanisms may be involved in rendering immune protection. Furthermore, the molecular context of the immunizing antigen may influence the outcome of the fine specificity of T cells involved in immune protection.

Animals↗