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Results for “Immunization Programs”

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At least 613 records · Page 34Linked to original sources

PubMed1993

Measles vaccination in pediatric emergency departments during a measles outbreak.

OBJECTIVE: To determine the proportion of preschool-aged patients attending two inner-city hospital pediatric emergency departments (EDs) who were eligible for measles vaccination, to describe their demographic and clinical characteristics, and to assess the performance of the ED immunization programs that were implemented during a measles outbreak in vaccinating eligible children. DESIGN: Cross-sectional study. SETTING: Pediatric EDs of two urban hospitals in Chicago, Ill, in 1989. PARTICIPANTS: Children 6 months to 5 years of age seen in the EDs. INTERVENTION: None. MAIN OUTCOME MEASURES: The proportion of preschool-aged patients attending the two EDs who were eligible for measles vaccination and the proportion of vaccine-eligible children who were given measles vaccine. RESULTS: Of 508 ED patients at hospital A and 255 patients at hospital B, 18% and 29%, respectively, were considered to be vaccine eligible. The most common discharge diagnoses of eligible patients were viral syndrome, otitis media, and minor trauma. Of vaccine-eligible patients, 59% at hospitals A and B were not vaccinated in the ED. At hospital B, patients with an infectious or respiratory disease diagnosis were less likely to be vaccinated than those with other diagnoses (P < .05). CONCLUSIONS: Many children seen in these EDs were eligible for measles vaccination, and many eligible patients were not vaccinated. During community outbreaks of measles, optimal vaccination programs in pediatric EDs could increase vaccination coverage among inner-city preschool-aged children who may have limited access to health care.

Chicago↗

PubMedDate not supplied

Hepatitis B: long-term outcome and benefits from mass vaccination in children.

Hepatitis B viruses can cause chronic liver diseases in both children and adults. In hyperendemic areas, although most related complications occur during adulthood, nearly half of the primary infection in chronic hepatitis B virus carriers occurs in perinatal period through maternal transmission and the other half are from horizontal transmission mainly through intrafamilial spread or injection using unsterilized needles. Children with chronic hepatitis B virus infection are mostly asymptomatic. They are generally active and growing well with very rare exceptions. Even with acute exacerbation of liver function and active inflammation, jaundice or growth failure is uncommon. Mild histologic abnormalities in the liver begins early in life and may progress to severe liver impairment in later life. Severe liver damage, with bridging hepatic necrosis or fibrosis, or cirrhosis of the liver may occur, but is rare during childhood. Universal immunization program of hepatitis B virus has been proved to be effective in reducing hepatitis B carrier rate for more than 10 folds, and the incidence of hepatocellular carcinoma in children has also been reduced significantly.

Child↗

PubMed2004

Neurologic complications of immunization.

In the United States and many other developed countries, active immunization of children has virtually eliminated poliomyelitis, measles, rubella, tetanus, and other diseases, such as disease due to Haemophilus influenzae type b. Individual vaccines can produce systemic or neurologic reactions ranging from minor events, such as pain and erythema at the injection site, to major complications, such as seizures, shock, encephalopathy, or death. Immunization programs have also generated considerable controversy, as witnessed by recent concerns regarding the relationship between vaccines or their constituents and autism or multiple sclerosis. This review summarizes current information regarding vaccines, the diseases that they prevent, and the potential relationships between vaccines and neurologic disease.

Child↗

PubMedDate not supplied

Young adults and HIV vaccine: determinants of the intention of getting immunized.

The aim of this study was to evaluate the acceptability of a hypothetical HIV vaccine and to identify the psychosocial determinants of the intention of receiving HIV immunization, based upon Ajzen's Theory of Planned Behaviour (TPB). Of the 136 young adults surveyed, 120 (88%) had a moderate to high intention to receive the HIV vaccine. A logistic regression was performed and two psychosocial factors from the TPB were significant predictors of the young adults' intention of getting HIV immunization: their attitude towards getting HIV immunization (OR = 4.80, CI 95% = 2.08; 13.05) and the perceived behavioural control of getting HIV immunization (OR = 2.52, CI 95% = 1.17; 6.05). These results show that HIV immunization is well accepted by young adults. This finding is particularly relevant because the effectiveness of HIV immunization programs will depend on an individual's acceptance of this vaccine. Also, our results suggest that psychosocial determinants can influence a young adult's decision to receive the HIV vaccine once it becomes available.

AIDS Vaccines↗

PubMed2004

Acute measles mortality in the United States, 1987-2002.

We used capture-recapture methodology to estimate total deaths and efficiency of reporting for 2 systems. During 1987-1992, there were 165 measles-associated deaths in the multiple-cause mortality database at the National Center for Health Statistics (NCHS) and 184 reported to the measles surveillance system at the National Immunization Program (NIP). We estimated that 259 measles deaths actually occurred; the reporting efficiencies were 64% for the NCHS and 71% for the NIP. Overall the death-to-case ratio was 2.54 and 2.83 deaths/1000 reported cases, using the NCHS and NIP data, respectively. Pneumonia was a complication among 67% of measles-related deaths in the NCHS data and 86% of deaths in the NIP data. Encephalitis was reported in 11% of deaths in both databases. Preexisting conditions related to immune deficiency were reported for 16% of deaths in the NCHS system and 14% in the NIP; the most common was human immunodeficiency virus infection. Overall, 90% of deaths reported to the NIP occurred in persons who had not been vaccinated against measles. During 1993-1999, only 1 acute measles-related death was reported to the NCHS and no deaths were reported to the NIP. This is consistent with the extremely low reported incidence of measles in the United States during these years.

Acute Disease↗

PubMedDate not supplied

Andhra Pradesh builds a model immunization system Indian state protects millions and shows what new vaccines and technologies can do.

Andhra Pradesh has built a model immunization program over the last few years. Main accomplishments include the state's adoption of hepatitis B for all its newborns and now, for the first time, the Indian government is offering universal coverage of all Indian infants with Hepatitis B vaccine. The AP government, working in partnership with PATH, an international, nonprofit organization based out of Seattle, Washington, USA, has made a series of improvements to the health system. The partnership fostered widespread adoption of safe injection practices and technologies, and improved immunization systems through responsive, supportive management. Japanese encephalitis (JE) control was greatly enhanced through the AP government partnership with PATH, resulting in a 90 percent reduction in cases of JE within the first year of joint efforts.

Biomedical Technology↗

PubMed1997

Managed care organizations and public health: exploring collaboration on adolescent immunizations.

Managed care organizations (MCOs) joined local and state public health agencies in a pilot effort to improve hepatitis B immunization rates of adolescents in an urban and a suburban/rural school district. The pilot also explored issues inherent in public and private collaboration on population health improvement. Local public health agencies provided links to schools in their communities, took the lead in implementing school-based immunization programs, and provided health education materials. MCOs contributed financial support necessary for the project. The final cost per fully vaccinated student, not taking into account the work group's planning and coordination time, was little more than the catalog price of the vaccine alone. Managed care organizations face challenges that complicate their participation and funding of school-based vaccinations: 1) Limited data on health plans of participating students complicate allocation of costs to each MCO; 2) Double-paying occurs for MCOs paying clinics a monthly, per-member rate that already includes adolescent immunizations; 3) When schools provide adolescent immunizations, MCOs lose the "hook" that draws adolescents to clinics for comprehensive health services. When self-consenting is permitted, schools can achieve a high consent and completion rates for multi-dose adolescent immunizations such as hepatitis B. At the same time, MCOs have the responsibility to provide members with comprehensive care and should continue to examine both internal modifications and external partnerships as opportunities to improve their services to adolescents.

Adolescent↗

PubMed1996

The epidemiology of rotavirus diarrhea in the United States: surveillance and estimates of disease burden.

The decision to develop rotavirus vaccines was predicated on the extensive burden of rotavirus disease among children worldwide. US reports on nationwide hospitalizations (1979-1992) and deaths (1968-1991) due to diarrhea and weekly reports of rotavirus infection by 74 laboratories were reviewed to estimate the burden of rotavirus disease, identify epidemiologic trends, and consider methods for evaluating an immunization program when a vaccine becomes available. From 1968 to 1985, diarrhea-related deaths among US children <5 years old declined from 1100 to 300/year. This decline was associated with the disappearance of winter peaks for diarrhea-related deaths previously associated with rotavirus infection among children 4-23 months old. From 1979 to 1992, however, hospitalizations for diarrhea averaged 186,000/year and retained their winter peaks, which have been linked to rotavirus infections. Each year an estimated 54,000-55,000 US children are hospitalized for diarrhea, but <40 die with rotavirus. A rotavirus vaccine program will require improved surveillance, including the timely collection of data from sentinel hospitals, in which a diagnosis of rotavirus can be established or ruled out for all children hospitalized for diarrhea.

Child↗

PubMedDate not supplied

Immunity against measles in school-aged children: implications for measles revaccination strategies.

Measles serum antibody levels were determined by plaque reduction neutralization (PRN) test in 1,075 children in the age bracket of 5 to 17 years who received a single dose of measles-mumps-rubella (MMR II) vaccine at one year of age. Of these, 297 children (28%) had measles PRN titres < 120 which may not be protective against measles infection. The proportion of susceptible children by age ranged from 14 to 35%; however, there was no consistent age-dependent trend in susceptibility rates. The study data indicate the decline in protective immunity occurs before five years of age, and the proportion susceptible increases only slightly thereafter. This supports the current move towards a two-dose immunization strategy in the control and elimination of measles, with the second dose being given before school entry. The present data also underscore the need to consider a mass catch-up immunization program in the interim to prevent potential outbreaks of measles in school settings. The combination of the above approaches, if implemented as soon as possible, can potentially eliminate indigenous measles in Canada by the year 2000, the target date set by the Pan American Health Organization.

Adolescent↗

PubMed2006

Vaccine preventable deaths and the Global Immunization Vision and Strategy, 2006-2015.

Immunization is among the most successful and cost-effective public health interventions. Immunization programs have led to eradication of smallpox, elimination of measles and poliomyelitis in regions of the world, and substantial reductions in the morbidity and mortality attributed to diphtheria, tetanus, and pertussis. The World Health Organization (WHO) estimates that 2 million child deaths were prevented by vaccinations in 2003. Nonetheless, more deaths can be prevented through optimal use of currently existing vaccines. This report summarizes estimates of deaths attributed to vaccine-preventable diseases (VPDs) and vaccination coverage by WHO region and outlines the Global Immunization Vision and Strategy developed by WHO and the United Nations Children's Fund (UNICEF) and partners for implementation during 2006-2015.

Global Health↗

PubMed2005

[Recurrent respiratory tract infections: how should we investigate and treat?].

Recurrent respiratory tract infections are a common reason for visits to primary care practitioners or hospital physicians. They are placed at the junction of several medical specialities: paediatrics, ENT, pneumology, allergology, immunology, infectiology. The great diversity of the laboratory tests requested and on the other hand the proposed treatments, are the consequences of the diversity of the patients encountered and the paucity of the evidence based-medicine studies in this setting. The dilemma is how to identify the child for which recurrent respiratory tract infections are the witness of underlying condition, without performing repeated medical examinations, laboratory tests and treatments for normal children for which immunologic development occurs normally. The essential tools are the history analysis, physical examination and few laboratory tests. The other questions are how to include, for these patients, influenza and pneumococcal vaccines in the immunization program and how to assess the benefit/risk ratio and the cost of surgical treatments. This paper presents the thought of an expert group trying to define the situations where biological tests or treatments are useful.

Child↗

PubMedDate not supplied

Pharmacy immunization partnerships: a rural model.

OBJECTIVES: To describe the Pharmacy Immunization Project, a pharmacy/county health department (CHD) partnership model for immunizing infants and adults in rural areas, and to develop service procedures and disseminate lessons learned for adapting the model to different settings. SETTING: Independent community pharmacies in five contiguous rural counties in West Virginia. PRACTICE DESCRIPTION: Participating pharmacies varied markedly in space, prescription volume, and population of service areas. PRACTICE INNOVATION: Childhood and adult immunization service. INTERVENTIONS: Pharmacists partnered with nurses from CHDs to offer year-round immunizations at times when other providers were typically closed. Working under standing orders of the CHD medical directors, nurses also conducted routine well-baby examinations in the pharmacy. Promotions involved direct mailing, posters, fliers, direct communication, and ads in newspapers, radio, and TV. MAIN OUTCOME MEASURES: Pharmacists' and CHDs' continued willingness to participate, use of the service by local citizens, and feedback from participants and other health care providers and the West Virginia Immunization Program (WVIP). RESULTS: All sites except one continued their participation through the life of the project. The one exception was a pharmacy with few infant patients, which discontinued participation during year 4 of the project. Remaining sites were used and well accepted by the community. The WVIP remains a loyal supporter, and no problems arose with local health care providers. CONCLUSION: The model appears adaptable to urban as well as rural practice and to chain as well as independent practice in states not authorizing pharmacists to administer vaccines, for pharmacists who for other reasons prefer not to administer, and for those who prefer to offer adult immunization on a seasonal basis. From the CHD perspective, the partnership model is useful in establishing "satellite" locations to target hard-to-reach patients. Recommendations regarding agreements and responsibilities are available, as are lessons learned during project development.

Adult↗

PubMed2003

Immunization safety priority project at the World Health Organization.

In 1999, the World Health Organization's (WHO) Department of Vaccines and Biologicals launched the Immunization Safety Priority Project with the aim of establishing a comprehensive system to ensure the safety of all immunizations given in national immunization programs. Countries are the primary focus of the project. WHO has a role, not only because of its technical and normative role, but also because of its privileged relationship with country authorities and other partners, and its global vision and mandate. The four major areas of focus in the project are to (1) promote and coordinate research and development of safer and simpler delivery systems; (2) ensure vaccine safety, from vaccine development all the way through clinical trials and vaccine distribution until use; (3) broaden access to safer and more efficient systems for vaccine delivery and management of sharps waste; and (4) establish efficient mechanisms to detect serious or potentially serious adverse events following immunization, and enable prompt and effective response. The project emphasizes the importance of advocating safety and building capacity at national levels.

Advisory Committees↗

PubMedDate not supplied

Expected adverse events in a mass smallpox vaccination campaign.

CONTEXT: Recent anthrax attacks in the United States have raised concern about the nation's vulnerability to a smallpox attack. Many strategies have been suggested to minimize the impact of such an attack, ranging from quarantine and vaccination of case contacts to resumption of routine vaccination. Before the latter strategy is adopted, an understanding of the likely consequences of mass vaccination is essential. COUNT: Number of adverse events resulting from two vaccination campaigns: vaccinating persons 1 to 29 years of age and vaccinating those 1 to 65 years of age. CALCULATION: Number of adverse events = incidence rate of adverse events x number vaccinated. We assumed 75% vaccine uptake in the target group (i.e., we estimated that about 25% of potential vaccine recipients would be excluded because they are, or have close contact with, individuals who have eczema or are immunocompromised). DATA SOURCE: Historical data on the incidence of adverse events from smallpox vaccination were identified by a literature search. Number vaccinated was drawn from the January 2000 U.S. Census estimate. RESULTS: Fever (<1 case per 5 vaccine recipients) and rash (<1 case per 100 vaccine recipients) would be the most common adverse events. Serious adverse events, including encephalitis (<3 cases per million) and death (<2 cases per million), although rare, would be more common than with other currently recommended vaccines. After excluding high-risk individuals and their contacts, we estimate that a vaccination strategy directed at people aged 1 to 29 years would result in approximately 1600 serious adverse events and 190 deaths. Vaccinating people aged 1 to 65 years would result in approximately 4600 serious adverse events and 285 deaths. LIMITATIONS: While advances in health care over the past three decades could mitigate vaccine complications, the increased number of unimmunized high-risk individuals (e.g., those with eczema or immune suppression) could increase complication rates. CONCLUSIONS: The decision to resume smallpox vaccination depends on weighing the likelihood of a smallpox attack and its anticipated mortality against expected harm from a mass immunization program. Smallpox vaccine has a higher complication rate than any other vaccine currently being used. Careful prevaccination exclusion of high-risk individuals and their close contacts would be essential to minimize complications of a mass vaccination campaign, although such exclusions necessarily mean that some proportion of the population will remain susceptible to smallpox.

Adolescent↗

PubMed1997

A state-based immunization campaign: the New Mexico experience.

Hepatitis B prophylaxis in the form of immunization has become an increasingly effective protective measure across the United States. Various cohorts have been targeted and methodologies used by public health officials to attain optimal coverage of the population. New Mexico is in its third year of school-based hepatitis B immunization programs. New Mexico's approach to this issue is characterized by significant rates of participation (66% in middle schools and 56% in high schools), high vaccination series completion (88% in middle schools and 89% in high schools), and minimal financial investment (cost of vaccine). The "Roll Up Your Sleeves" campaign was piloted, modified, and adapted to New Mexico's multi-lingual and multi-cultural environment, resulting in these successes.

Adolescent↗

PubMed2004

Seroepidemiology of rubella in northern Greece.

In light of two rubella outbreaks in northern Greece during the last decade (1993 and 1999) and periodic changes to the immunization strategy, the present study was conducted to determine the current status of rubella immunity in this region. Among the 729 subjects studied the total vaccination rate was 30.4% and the seroprevalence rate was 82.4% (odds ratio, 0.618; 95% confidence interval, 0.415-0.921). A higher seroprevalence (83.2%) was observed among people born before 1989, when the national rubella immunization program was introduced, compared to the individuals born after 1989 (67.1%; P=0.000). Among women of reproductive age (i.e. 16-40 years), who represented 69.6% of the study population, 10.3% were susceptible to rubella and only 16.4% were vaccinated. The results indicate a comprehensive policy is still needed in order to eliminate rubella and congenital rubella syndrome in Greece.

Adolescent↗

PubMed2005

Rotavirus vaccines: targeting the developing world.

For the past 2 decades, rotavirus infection, the most common cause of severe diarrhea in children, has been a priority target for vaccine development. This decision to develop rotavirus vaccines is predicated on the great burden associated with fatal rotavirus disease (i.e., 440,000 deaths/year), the firm scientific basis for developing live oral vaccines, the belief that increased investment in development at this time could speed the introduction of vaccines in developing countries, and the appreciation that implementation of a vaccine program should result in a measurable decrease in the number of hospitalizations and deaths associated with rotavirus disease within 2-3 years. RotaShield (Wyeth-Ayerst), the first rotavirus vaccine licensed in the United States, was withdrawn after 9 months because of a rare association of the vaccine with the development of intussusception. In the developing world, this vaccine could still have had a measurable effect, because the benefits of preventing deaths due to rotavirus disease would have been substantially greater than the rare risk of intussusception. Two live oral vaccines being prepared by GlaxoSmithKline and Merck have completed large-scale clinical trials. The GlaxoSmithKline vaccine has been licensed in Mexico and the Dominican Republic, and the Merck vaccine could be licensed in the United States within 1 year; several other candidate vaccines are in earlier stages of testing. However, many challenges remain before any of these vaccines can be incorporated into childhood immunization programs in the developing world. First, vaccine efficacy, which has already been demonstrated in children in industrialized and middle-income countries, needs to be proven in poor developing countries in Africa and Asia. The safety of vaccines with regard to the associated risk of intussusception must be demonstrated as well. Novel financing strategies will be needed to ensure that new vaccines are affordable and available in the developing world. Decision makers and parents in developing countries need to know about this disease that has little name recognition and is rarely diagnosed. Finally, for the global effort toward the prevention of rotavirus disease to be successful, special efforts will be required in India, China, and Indonesia, because one-third of all deaths due to rotavirus disease occur in these countries, and because these countries depend almost entirely on vaccines manufactured domestically.

Administration, Oral↗

PubMed2000

The Vaccine Safety Datalink: immunization research in health maintenance organizations in the USA.

The Vaccine Safety Datalink is a collaborative project involving the National Immunization Program of the Centers for Disease Control and Prevention and several large health maintenance organizations in the USA. The project began in 1990 with the primary purpose of rigorously evaluating concerns about the safety of vaccines. Computerized data on vaccination, medical outcome (e.g. outpatient visits, emergency room visits, hospitalizations, and deaths) and covariates (e.g. birth certificates, census data) are prospectively collected and linked under joint protocol at multiple health maintenance organizations for analysis. Approximately 6 million persons (2% of the population of the USA) are now members of health maintenance organizations participating in the Vaccine Safety Datalink, which has proved to be a valuable resource providing important information on a number of vaccine safety issues. The databases and infrastructure created for the Vaccine Safety Datalink have also provided opportunities to address vaccination coverage, cost-effectiveness and other matters connected with immunization as well as matters outside this field.

Centers for Disease Control and Prevention, U.S.↗