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At least 595 records · Page 33Linked to original sources

PubMed2000

Immunization status of children of India.

OBJECTIVE: To assess the immunization status of children in 90 districts of the country giving due representation to all States and UTs. METHODS: WHO 30 cluster survey methodology with certain modifications incorporating information on sex, literacy and distance of the village. RESULTS: Information was collected for about nineteen thousand children. Immunization program could touch about 90% of target children. About 63% of children received all the vaccines (BCG, DPT, OPV, Measles). In the states of Bihar, Rajasthan, UP, MP, and NE States (combined) coverage levels were relatively lower. The coverage levels were also lower for children of illiterate mothers and in small, inaccessible and tribal village. CONCLUSION: Immunization coverage of children has improved in recent years. Further improvement may be achieved by targeting illiterate mothers, inaccessible and tribal areas and low performing states.

Child↗

PubMedDate not supplied

A successful approach to immunizing men who have sex with men against hepatitis B.

This paper reports the success of outreach efforts to immunize adults at high risk of acquiring hepatitis B virus (HBV) infection. Local health department testers recruited clients when they sought anonymous HIV testing. Interested clients were serologically tested for HBV infection. Susceptibles were offered a free hepatitis B vaccine. Of 189 clients who were tested, 161 (86%) were susceptible to HBV infection and 140 (74%) were men who have sex with men (MSM). Of the susceptibles, 82 (51%) started the hepatitis B vaccine series. Sixty-five (80%) received three doses of hepatitis B vaccine and an additional 10 (12%) received two doses. Completing the hepatitis B vaccine series was associated with being a MSM (odds ratio [OR] 8.8, confidence interval [CI] 1.5-56.0) and with not being an injection drug user (IDU) (OR 0.2, CI 0.02-1.0). One way to provide hepatitis B vaccine to MSM is to attach an immunization program to a successful anonymous HIV testing program. The feasibility of implementing such programs would increase if public vaccine policymakers made more federally purchased hepatitis B vaccine available for adults.

Adolescent↗

PubMedDate not supplied

Cost effectiveness of alternative strategies for poliomyelitis immunization in Brazil.

Costs for immunization programs are reported for 16 municipalities in Brazil (January to June 1982). Costs per immunization are higher for all immunizations when given by routinely available, on-demand services. Both intensification of services, in which the medical staff provides outreach immunization clinics, and mass campaign strategies have lower average costs than do the routine services. In the case of immunization with oral poliovirus vaccine, average costs fall from approximately +1.59 to +0.68 (U.S.) when routine and mass campaign strategies are compared. Choice of the most cost-effective immunization policy is shown to involve considerations of vaccine types and target groups as well as delivery strategies and thus involves linking the economic data to epidemiologic considerations (vaccine efficacy and morbidity and mortality levels with and without immunization). Multiple-vaccine programs are likely to have a greater impact per dollar spent than are single-vaccine programs because of the low incremental costs of providing additional vaccinations.

Brazil↗

PubMed2001

Processes for obtaining nonmedical exemptions to state immunization laws.

OBJECTIVES: This study sought to determine the specific processes required for obtaining religious and philosophical exemptions to school immunization laws. METHODS: State health department immunization program managers in the 48 states that offer nonmedical exemptions were surveyed. Categories were assigned to reflect the complexity of the procedure within a state for obtaining an exemption. RESULTS: Sixteen of the states delegated sole authority for processing exemptions to school officials. Nine states had written policies informing parents who seek an exemption of the risks of not immunizing. The complexity of the exemption process, in terms of paperwork or effort required, was inversely associated with the proportion of exemptions field. CONCLUSIONS: In many states, the process of claiming a nonmedical exemption requires less effort than fulfilling immunization requirements.

Child↗

PubMed1997

National immunization days: state of the art.

National immunization days (NIDs) are nationwide mass campaigns to deliver supplemental doses of oral poliovirus vaccine to interrupt the circulation of wild polioviruses. They constitute one of the critical strategies for global poliomyelitis eradication and should be implemented in all countries with widespread poliovirus transmission. The certification of wild poliovirus eradication from the Western Hemisphere in September 1994 verified the effectiveness of this aspect of the World Health Organization's (WHO) overall strategy for polio eradication by the year 2000. NIDs require careful advanced planning and orchestration by each country. WHO provides specific guidelines for NIDs regarding the season, target age group, duration, frequency, inclusion of other interventions, vaccine delivery strategies, and evaluation. With strong routine immunization programs and the effective implementation of NIDs, "mop-up" campaigns, and acute flaccid paralysis surveillance, the goal of global polio eradication will be achieved.

Global Health↗

PubMed2001

Vaccines as tools for advancing more than public health: perspectives of a former director of the National Vaccine Program office.

With application of new technologies and licensing of new vaccines, vaccines will soon be better by several orders of magnitude. Yet barriers impede the introduction and wide use of new vaccines. Most of the diseases for which we will have vaccines in the future have not evoked enthusiasm from public health professionals, but not consumer demand, despite ongoing high rates of disease and death. Furthermore, the public's attention turns from the now rarely occurring vaccine-preventable diseases to reports of fears and confirmed adverse events associated with the same vaccines that so effectively continue to prevent disease. New vaccines will be held to a much higher standard; thus we will need more capacity for disease studies, vaccine trials, and surveillance systems. Vaccines and immunization programs contribute to the societal fabric and are an expression of social responsibility. Vaccine research and implementation programs must have the foundation and capacity to keep pace with evolving scientific and societal realities so that their broad benefits can be fully realized.

Altruism↗

PubMed1996

Prospects for childhood immunization registries in public health assessment and assurance: initial observations from the All Kids Count initiative projects.

This article offers an overview of selected evaluation findings from the initial implementation year of the Robert Wood Johnson Foundation's All Kids Count childhood immunization initiative in which demonstration projects were funded to develop community-based immunization registry and follow-up systems in 14 sites throughout the United States. The basic components of these systems, the process through which these registries were developed, efforts to secure the participation of private sector providers, the prospects for system success at the community level, and the potential for these immunization programs to influence other aspects of primary health care for children are addressed.

Health Services Accessibility↗

PubMedDate not supplied

Elimination of poliomyelitis in Europe: remaining problems to solve.

Global eradication of paralytic poliomyelitis is feasible since the causative agents, three serotypes of poliovirus, have no other natural host species and since the vaccines developed against poliomyelitis are highly effective. The WHO program for 'Global Eradication of Paralytic Poliomyelitis by the Year 2000' has made great progress during the last few years. Yet, more than 100,000 new cases of the disease still occur annually in the world. In Europe, paralytic poliomyelitis is a rare disease but appears to persist in restricted areas and occurs at a very low incidence in several European countries, mostly as an imported entity. Importation of wild polioviruses to Europe will continue as long as endemic circulation of the viruses is taking place somewhere in the world. Attention has to be paid to improve the surveillance of both suspected clinical cases and of putative wild poliovirus circulation in the population. In several Eastern European countries political and economic turbulence may endanger the maintenance of immunization programs. International collaboration is needed to prevent reestablishment of indigenous poliovirus circulation in these regions.

Economics↗

PubMed2001

Universal hepatitis B vaccination and the decreased mortality from fulminant hepatitis in infants in Taiwan.

OBJECTIVES: To assess the annual mortality rate associated with fulminant hepatitis in infants before and after the mass immunization program that was launched in Taiwan in July 1984. STUDY DESIGN: From the National Mortality Registry System, the data on the mortality from fulminant hepatitis in infants from 1975 to 1998 were retrieved. Poisson regression analysis was used to assess the difference in average mortality from fulminant hepatitis in infants before (1975-1984) and after (1985-1998) the implementation of the mass hepatitis B vaccination program. RESULTS: The ratio of yearly mortality from 1975 to 1998 was 1.10 (P <.001), representing a progressive decrease in the number of the cases. The average mortality associated with fulminant hepatitis in infants from 1975 to 1984 and from 1985 to 1998 was 5.36 and 1.71 per 100,000 infants, respectively. The ratio of the average mortality in the period from 1985 to 1998 to that in the period from 1975 to 1984 was 0.32 (P <.001). CONCLUSIONS: These data indicate that since the institution of a program of mass hepatitis B vaccination in Taiwan, the mortality associated with fulminant hepatitis in infants has declined significantly.

Hepatitis B Surface Antigens↗

PubMed2002

Progress in the prevention and control of viral hepatitis type B: closing remarks.

Hepatitis type B remains an important disease globally. Rapid advances have been made during the last two decades in the understanding of the biology of HBV, the complex interaction between the virus and the host, and the pathology and the clinical aspects of infection. Mass vaccination has been shown to be a safe and highly effective means for the control and prevention of hepatitis B. The presence of a large worldwide reservoir of carriers requires a continuous effort to develop new drugs for the treatment of persistent HBV infection. Efforts to sustain immunization programs and to make vaccines and drugs available to countries with limited resources, are the main challenges to the eradication of hepatitis B in the next few decades.

Adult↗

PubMed2002

Interventions aimed at improving immunization rates.

BACKGROUND: Immunization rates for children and adults are rising, but coverage levels have not reached national goals. As a result of low immunization rates, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care physicians, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. A common theme across immunization programs in all nations involves the challenge of determining the denominator of eligible recipients (e.g., all children who should receive the measles vaccine), and identifying the best strategy to ensure high vaccination rates. Strategies have focused on patient-oriented interventions (e.g., patient reminders), provider interventions, and system interventions. One intervention strategy involves patient reminder/recall systems. OBJECTIVES: Assess the effectiveness of patient reminder/recall systems in improving immunization rates, and compare the effects of various types of reminders in different settings or patient populations. SEARCH STRATEGY: A systematic search was performed using MEDLINE (1966-1998) and 4 other bibliographic databases: EMBASE, PsychINFO, Sociological Abstracts, and CAB Abstracts. Authors also performed a search of EPOC in April 2001 to update the review. Two authors reviewed the lists of titles and abstracts, and used the inclusion criteria to mark potentially relevant articles for full review. The reference lists of all relevant articles and reviews were back searched for additional studies. Publications of abstracts, proceedings from scientific meetings, and files of study collaborators were also searched for references. SELECTION CRITERIA STUDY DESIGN: Randomized controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series (ITS) studies written in English. TYPES OF PARTICIPANTS: Health care personnel who deliver immunizations and children (birth to 18 years) or adults (18 years and up) who receive immunizations in any setting. Types of interventions: Any intervention that falls within the Effective Practice and Organization of Care Group (EPOC) scope and that includes patient reminder and/or recall in at least one arm of the study. Types of outcome measures: Immunization rates, or the proportion of the target population up-to-date on recommended immunizations. Outcomes were acceptable for either individual vaccinations (e.g., influenza vaccination) or standard combinations of recommended vaccinations (e.g., all recommended vaccinations by a specific date or age). DATA COLLECTION AND ANALYSIS DATA COLLECTION: Each study was read independently by two reviewers. Disagreements between reviewers were resolved by a formal reconciliation process to achieve consensus. ANALYSIS: Results are presented for individual studies as relative rates for randomized controlled trials, and as absolute changes in percentage points for controlled before and after studies. Pooled results were presented using the random effects model. MAIN RESULTS: Patient reminder/recall systems were effective in improving immunization rates in 33 of 41 included studies, irrespective of baseline immunization rates, patient ages, type of setting, or type of vaccination. Increases in immunization rates due to reminders were in the range of 5 to 20 percentage points. Reminders were effective for childhood vaccinations (OR=2.02, 95% CI =1.49,2.72), childhood influenza vaccinations (OR=4.19, 95% CI =2.07,8.49), adult pneumococcus or tetanus (OR=5.14, 95%CI = 1.21, 21.8), and adult influenza vaccinations (OR=2.29, 95%CI = 1.69, 3.10). While reminders were most effective in academic settings (OR = 3.33, 95% CI = 1.98, 5.58), they were also highly effective in private practice settings (OR=1.79, 95% CI = 1.45, 2.22) and public health clinics (OR = 2.09, 95% CI = 1.42, 3.07). All types of reminders were effective (postcards, letters, telephone or autodialer calls), with telephone being the most effective but most costly. REVIEWER'S CONCLUSIONS: Patient reminder/recall systems in primary care settings are effective in improving immunization rates.

Humans↗

PubMed2002

Immunization for seniors.

Vaccine-preventable diseases remain a significant health problem for adults in the United States. Far more adults die from the complications of vaccine-preventable diseases than do children in this country. Available vaccines that are effective in preventing morbidity and mortality from these conditions are underutilized, and significant racial and ethnic disparities in rates of utilization of adult vaccines persist. A variety of important vaccine-preventable diseases affect seniors. However, influenza and pneumococcal infections stand out as being responsible for more cases and more deaths each year among seniors than all other vaccine-preventable diseases in the United States combined. Current vaccination rates for these two diseases are far short of the Healthy People 2010 target rates of 90% immunization of the population of adults aged 65 years or over. Despite state efforts to improve vaccination rates of seniors, efforts that have included regulatory and educational approaches, significant challenges remain in designing immunization programs for seniors that are universally effective.

Black or African American↗

PubMed2004

[Strategy for administering hepatitis B vaccine to newborns in Bosnia-Herzegovina].

BACKGROUND: Neonatal hepatitis B vaccination is the best effective measure for prevention hepatitis B infection in the countries with intermediate to high levels of HB endemicity. METHODS: Epidemiological methods of research had the aim to follow the incidence rates of viral hepatitis B and HBsAg carriers and to determine influence on the risks of transmission hepatitis B infection in new-borns in Bosnia and Herzegovina. Serologic immunogenic quality of hepatitis B vaccine is researched. RESULTS: Bosnia and Herzegovina has high incidence of hepatitis B virus in the Europe. The incidence of HBsAg carriers is changing with increasing from 2000. to 2003. Data from this surveillance show in Bosnia and Herzegovina that in one notified case of hepatitis B there is 3.59 cases of HBsAg carriers. Hepatitis B vaccine induces anti-HBs antibodies titres > 10 IJ/ml, considered as seroprotective in 99, 10% vaccinated. CONCLUSION: Neonatal hepatitis B vaccination is new vaccine in national immunization program in Bosnia and Herzegovina. Hepatitis B vaccines are safe and effective in inducing neutralizing HBs antibodies play and have important role in protecting new-borns.

Bosnia and Herzegovina↗

PubMed2005

Patient reminder and patient recall systems to improve immunization rates.

BACKGROUND: Immunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result of low immunization rates, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care and large demands on primary care physicians, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. A common theme across immunization programs in all nations involves the challenge of determining the denominator of eligible recipients (e.g. all children who should receive the measles vaccine) and identifying the best strategy to ensure high vaccination rates. Strategies have focused on patient-oriented interventions (e.g., patient reminders), provider interventions and system interventions. One intervention strategy involves patient reminder and recall systems. OBJECTIVES: To assess the effectiveness of patient reminder and recall systems in improving immunization rates and compare the effects of various types of reminders in different settings or patient populations. SEARCH STRATEGY: A systematic search was performed for the initial review using MEDLINE (1966-1998) and four other bibliographic databases: EMBASE, PsychINFO, Sociological Abstracts, and CAB Abstracts. Authors also performed a search of The Effective Practice and Organisation of Care (EPOC) register in April 2001 to update the review. Two authors reviewed the lists of titles and abstracts and used the inclusion criteria to mark potentially relevant articles for full review. The reference lists of all relevant articles and reviews were back searched for additional studies. Publications of abstracts, proceedings from scientific meetings and files of study collaborators were also searched for references. In December 2004 the EPOC register was searched to identify relevant articles to update the review. SELECTION CRITERIA STUDY DESIGN: Randomized controlled trials (RCT), controlled before and after studies (CBA) and interrupted time series (ITS) studies written in English. TYPES OF PARTICIPANTS: Health care personnel who deliver immunizations and children (birth to 18 years) or adults (18 years and up) who receive immunizations in any setting. TYPES OF INTERVENTIONS: Any intervention that falls within the EPOC scope (See Group Details) and that includes patient reminder or recall systems, or both, in at least one arm of the study. TYPES OF OUTCOME MEASURES: Immunization rates or the proportion of the target population up-to-date on recommended immunizations. Outcomes were acceptable for either individual vaccinations (e.g. influenza vaccination) or standard combinations of recommended vaccinations (e.g. all recommended vaccinations by a specific date or age). DATA COLLECTION AND ANALYSIS DATA COLLECTION: Each study was read independently by two reviewers. Disagreements between reviewers were resolved by a formal reconciliation process to achieve consensus. ANALYSIS: Results are presented for individual studies as relative rates for randomized controlled trials and as absolute changes in percentage points for controlled before and after studies. Pooled results for RCTs only were presented using the random effects model. MAIN RESULTS: Five new studies were added for this update. Increases in immunization rates due to reminders were in the range of 1 to 20 percentage points. Reminders were effective for childhood vaccinations (OR = 1.45, 95% CI =1.28, 1.66), childhood influenza vaccinations (OR = 2.87, 95% CI = 1.65, 4.98), adult pneumococcus, tetanus, and Hepatitis B (OR = 2.19, 95% CI = 1.21, 3.99), and adult influenza vaccinations (OR = 1.66, 95% CI = 1.31, 2.09). All types of reminders were effective (postcards, letters, telephone or autodialer calls), with telephone being the most effective but most costly. AUTHORS' CONCLUSIONS: Patient reminder and recall systems in primary care settings are effective in improving immunization rates within developed countries.

Adult↗

PubMedDate not supplied

Vaccine policies across the pond: looking at the U.K. and U.S. systems.

Major differences exist in the immunization programs of the United Kingdom and the United States. If one believes that most health policy decisions in Western industrialized democracies are political, then many of the differences may seem to reflect the variance in the nature of political systems. However, each program has unique components that appear paradoxical, and what works in one society will not necessarily work in another. Those who seek to substitute portions of one vaccine system with those of another must appreciate the context within which each functions.

Culture↗

PubMedDate not supplied

Mumps and rubella eliminated from Finland.

Many countries use trivalent measles-mumps-rubella (MMR) vaccine for their mumps and rubella immunization programs. In Finland, a national 2-dose MMR vaccination program for children, free of charge and on a voluntary basis, was launched in 1982. Serological confirmation of all suspected cases of mumps and rubella has been required since 1987. Despite intensive surveillance, no persistent sequelae or deaths attributable to vaccination have been detected. Indigenous mumps and rubella were eliminated in 1996, but 4 imported cases of mumps and 2 of rubella occurred from 1997 to 1999. Lack of secondary cases indicates sufficient immunity in the community. Compared with an epidemic year, up to thousands of cases of mumps meningoencephalitis and orchitis and around 50 cases of congenital rubella syndrome are now avoided annually. A 2-dose vaccine regimen in children during the last 17 years (1983-1999) has interrupted circulation of the target viruses entirely. Finland is the first country documented to be free of indigenous mumps and rubella (measles was eliminated in 1996). Despite the ongoing possibility of imported disease, major outbreaks probably can be avoided by maintaining high vaccination coverage and the 2-dose policy. JAMA. 2000;284:2643-2647.

Child↗

PubMed2005

A mathematical model to estimate global hepatitis B disease burden and vaccination impact.

BACKGROUND: Limited data are available regarding global hepatitis B virus (HBV)-related morbidity and mortality and potential reduction in disease burden from hepatitis B vaccination. METHODS: A model was developed to calculate the age-specific risk of acquiring HBV infection, acute hepatitis B (illness and death), and progression to chronic HBV infection. HBV-related deaths among chronically infected persons were determined from HBV-related cirrhosis and hepatocellular carcinoma (HCC) mortality curves, adjusted for background mortality. The effect of hepatitis B vaccination was calculated from vaccine efficacy and vaccination series coverage, with and without administration of the first dose of vaccine within 24 h of birth (i.e. birth dose) to prevent perinatal HBV infection. RESULTS: For the year 2000, the model estimated 620,000 persons died worldwide from HBV-related causes: 580,000 (94%) from chronic infection-related cirrhosis and HCC and 40,000 (6%) from acute hepatitis B. In the surviving birth cohort for the year 2000, the model estimated that without vaccination, 64.8 million would become HBV-infected and 1.4 million would die from HBV-related disease. Infections acquired during the perinatal period, in early childhood (<5 years old), and > or = 5 years of age accounted for 21, 48, and 31% of deaths, respectively. Routine infant hepatitis B vaccination, with 90% coverage and the first dose administered at birth would prevent 84% of global HBV-related deaths. CONCLUSION: Globally, most HBV-related deaths result from the chronic sequelae of infection acquired in the perinatal and early childhood periods. Inclusion of hepatitis B vaccine into national infant immunization programs could prevent >80% of HBV-related deaths.

Adolescent↗

PubMed2006

[Flu vaccine in children: state of the art].

Influenza is an acute respiratory illness that year to year causes considerable morbidity and mortality. . All children, healthy or at high risk, are susceptible to this infection. Influenza vaccine seems to be effective in preventing influenza-like illness, laboratory-confirmed infection, and hospitalizations and deaths, demonstrating cost-effectiveness. Inactivated and live-attenuated vaccines have a similar efficacy profile. . Due to high influenza associated hospitalization rates in children, some countries have recommended incorporating influenza vaccination into the universal immunization program for healthy infants between 6-24 months of age. Considering that this public-health policy has been incorporated in Chile, local studies assessing its impact are needed.

Child↗