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PubMed1997

Adolescent immunization: focus on implementation.

On March 11-12, 1996, a workshop on how to implement new adolescent immunization (AI) recommendations was held in Atlanta, Ga. Sponsored by the Centers for Disease Control and Prevention, it was a collaborative effort of the National Immunization Program, the Division of Adolescent and School Health/National Center for Chronic Disease Prevention and Health Promotion, and the Hepatitis Branch/National Center for Infectious Diseases. The workshop brought together organizations and individuals interested in adolescent health and immunizations so they could address how new AI recommendations can be implemented most effectively. This article offers an overview of their discussions and suggestions, including issues of cooperation, education, legislation, and AI program development among health provider organizations, health department, schools, community groups and various other agencies relating to adolescent health services.

Adolescent↗

PubMed1995

Immunity to diphtheria in children three-to-six year of age in four counties of Taiwan.

An immunization program against diphtheria has been implemented in Taiwan since 1955, using combined diphtheria, pertussis and tetanus (DPT) vaccine. Diphtheria immunoglobulin (DIG) level was assessed in serum samples obtained from 1138 children, aged 3-6 years from north, south, east and central part of Taiwan by the VERO cell neutralization method. Specimens were collected by simple random sampling of residents from Hsinchu, Taichung, Pingtung and Hwalien counties, including both aborigines and non-aborigines. The former lived in one or two villages in each county, and the latter lived in a single village next to the former. Ninety-five percent (1086/1138) had a DIG titre > or = 0.01 IU/ml. There was no significant difference by sex, or by residential area. Seventy-nine percent (901/1138) of the children had completed the primary immunization schedule (at the age of 2, 4, 6 and 18 months), and the prevalence of DIG titre > or = 0.1 IU/ml considered to be long-term protective was as follows: 74.6% for 3-year group; 74.5% for 4-year group; 67.9% for 5-year group; 84.7% for 6-year group (including 52.2% who had had a booster shot at early primary school). These findings show that the diphtheria vaccination program provides good immunity in childhood.

Animals↗

PubMed2001

Combination vaccines: choices or chaos? A practitioner's perspective.

Combination vaccines are necessary and important for the continuing success of our immunization program, especially when more vaccines are added to the already crowded immunization schedule. However, the multiplicity of competing vaccine products, with various overlapping antigen menu and subtle immunologic differences, may be confusing to the busy practitioner. The cost-effectiveness of the use of combination vaccines will depend on a number of factors, including fair and competitive pricing, appropriate reimbursement for vaccine administration fees, and critical economic algorithms for vaccine selection and purchase.

Cost-Benefit Analysis↗

PubMedDate not supplied

Diphtheria antitoxin levels in the Netherlands: a population-based study.

In a population-based study in the Netherlands, diphtheria antitoxin antibodies were measured with a toxin-binding inhibition assay in 9, 134 sera from the general population and religious communities refusing vaccination. The Dutch immunization program appears to induce long-term protection against diphtheria. However, a substantial number of adults born before the program was introduced had no protective diphtheria antibody levels. Although herd immunity seems adequate, long-term population protection cannot be assured. As more than 60% of orthodox reformed persons have antibody levels lower than 0.01 IU/ml, introduction of diphtheria into religious communities refusing vaccination may constitute a danger of spread of the bacterium.

Adolescent↗

PubMed2000

Pertussis seroepidemiology in Taipei.

PURPOSE: We evaluated the seroprevalence of pertussis among apparently healthy Taipei residents. METHODS: From January 1992 through December 1994, we recruited subjects from a well baby clinic (children < 3 years), kindergartens, primary, and secondary schools and colleges (3-20 years), a health exam clinic (> 20 years), and obstetric clinics (pregnant women). Subjects were stratified into 12 groups according to age and pregnant women were considered separately. The serum antibody titers against filamentous hemagglutinin (FHA) and pertussis toxin (PT) were measured by enzyme-linked immunosorbent assay. RESULTS: The anti-PT and anti-FHA titers were elevated in the 4 to 6-month and 19 to 20-month age groups, coinciding with regular pertussis vaccinations. The anti-PT titers rose again in the 3 to 4-year age group, reflecting a higher prevalence of natural pertussis infection. The anti-PT titers gradually decreased among older age groups, although a peak occurred in the 11 to 15-year age group. The sequential changes in anti-FHA titers followed those of anti-Pt titers in the younger age groups, but the anti-FHA titers were persistently elevated beyond 15 years of age. The antibody levels were similar in the two sexes, except that anti-PT titers were higher in males of 19 to 20 months and 21 to 30 years of age. Anti-PT titers were equivalent between neonates (0-2 months) and pregnant women, but anti-FHA titers were much lower in neonates. CONCLUSIONS: The seroprevalence patterns in this study indicate that young children, adolescents, and even adults remain at risk of pertussis, despite the current immunization program. Booster vaccinations after completion of the current four-dose immunization schedule, possibly continuing into adolescence, should be considered to block the transmission of infection.

Adhesins, Bacterial↗

PubMed2001

Control and prevention of rubella: evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome.

Outbreaks of rubella continue to occur in the United States despite widespread use of the measles-mumps-rubella (MMR) vaccine. Throughout the mid- to late-1990s, rubella outbreaks were characterized by increased numbers of cases among adults born in countries that do not have or have only recently instituted a national rubella vaccination program. To address this change in disease epidemiology, CDC's National Immunization Program (NIP) developed the following recommendations in conjunction with public health officials in the field. Public health officials should implement appropriate responses to reports of suspected rubella to determine if an outbreak exists, evaluate its scope, and implement appropriate control measures. Health-care providers should be aware of the need for rubella prevention and control among women of childbearing age and of the appropriate follow-up for pregnant women exposed to rubella. Comprehensive surveillance for congenital rubella syndrome should begin during a rubella outbreak.

Adolescent↗

PubMed2005

Surveillance of natural acquired antibodies to Haemophilus influenzae type b among children in Cairo-Egyptian.

In Egypt, the incidence of invasive Haemophilus influenzae type b (Hib) disease is not common and the vaccine is still not included into the national immunization program. The aim of this study was to evaluate the natural immunity to Hib in healthy children at Egyptian capitol (Cairo). One hundred and two children were enrolled in our study of age one month to 15 year. Anti-capsular polysaccharide (PRP) of Hib specific IgM and IgG antibody concentrations were estimated using enzyme immunoassay. The majority (64.7%, 75.5%) of children had a protective levels>or=15 microg/ml of specific antibodies (IgM and IgG). Fortunately, a total of 95.5% of the children under 5 years old had a protective level. Our result will provide evidence that in Egypt capitol, the natural immunity against Hib can be acquired at an early age.

Adolescent↗

PubMedDate not supplied

Factors influencing the acceptance of hepatitis B vaccine by students in health disciplines in Ottawa.

Few students in health care disciplines are immunized against hepatitis B. In order to determine the immunization prevalence and identify the factors influencing the intentions of students to accept hepatitis B vaccine, we administered a questionnaire to 435 university and community college students in health care disciplines in Ottawa where there was no hepatitis B immunization program. We found that only 14% of the students had been immunized. There was significant variability among student groups in their perceptions of the risk of acquiring hepatitis B, beliefs about the efficacy of the vaccine, and their willingness to pay for it. The need for a low-cost vaccine was demonstrated by the fact that only 35% of students would pay the wholesale price of the vaccine ($100), but 94% said they would pay $15.

Canada↗

PubMed1989

Tetanus immunity in kibbutz women.

The clinic records of 1,009 women, aged greater than or equal to 28, who comprised the entire cohort of the six kibbutzim studied, were reviewed concerning basic tetanus immunization and booster injections. Immunization was incomplete in 6.5% of women aged 28 to 39 years (the youngest age-group), 13.7% in those aged 40 to 49, 55% in the 50 to 59 year age-group, and 68.2% in those aged greater than or equal to 60. There were no significant differences between the age-groups regarding the number of booster doses given. Blood samples drawn at random from 120 of the women whose records were surveyed (30 from each age-group) showed that all had a protective titer of antibody to tetanus toxin as determined by the passive hemagglutination method: 15 of them (12.5%) had never received basic immunization or a booster dose. Whatever the method chosen for determining immunity--chart review or antibody titer--the level of protection was lower in the older age-groups. The implications of this finding for future immunization programs, and the possibility that there may be widespread, acquired natural immunity to tetanus in rural communities, are discussed.

Adult↗

PubMedDate not supplied

Reduction of anticoccidial drug resistance by massive introduction of drug-sensitive coccidia.

Massive introduction of a drug-sensitive attenuated strain of Eimeria tenella in a floor-pen heavily contaminated with a drug-resistant strain produced a marked reduction in the proportion of drug-resistant oocytsts in the litter. This provides a useful adjunct to planned immunization programs since the procedure protects the birds against subsequent challenge through immunity imparted by the introduced strain while restoring the effectiveness of the anticoccidial drug which was previously ineffective because of the predominance of drug-resistant coccidia.

Animals↗

PubMedDate not supplied

Cytokine and chemokine responses underlying acute and chronic Trichuris muris infection.

Intestinal nematode parasites are some of the most prevalent infections of man. Infections tend to be chronic and, after drug treatment, have high reinfection rates. Control programs relying solely on drugs are thus at best short-term solutions; immunization programs are our long-term goal. A prerequisite to effective disease control by immunotherapy is the need to understand the immune responses that underlie resistance and susceptibility to infection. Most of our current understanding of immunity to Trichuris trichiura infection in man has come from the laboratory model, Trichuris muris in the mouse. Over the last decade we have learned that the type of T helper cell response (Th1 or Th2) mounted by the host is critical to the outcome of infection, and we have identified key Th2- and Th1-associated cytokines that contribute to resistance or susceptibility, respectively. Notably, the number of these key cytokines is still growing. Our model of immunity to Trichuris has developed from one resolving round IL-4 and IFN-gamma to one that also has to accommodate IL-9, IL-10, IL-13, TNF-alpha, IL-12, and IL-18. Importantly, resistance to infection is not just about making an appropriate type 2 response. Effector cells have to be recruited locally to the site of infection in order to culminate in worm expulsion, which brings new key players into our model, including chemokines.

Acute Disease↗

PubMedDate not supplied

[Estimate of the cost/benefit ratio of measles vaccination].

Among primary health care programs, one of those that has the highest benefit/cost ratio is measles immunization. An estimate of cases, complicated cases and deaths that could have occurred if such immunization program would not have been run, and costs of medical care (hospitalization, physician's visits, medical treatment and rehabilitation), were calculated. Since population at risk has a steady-state given by those who enter -births- and releave it -when they are 15 years old-, if the program did not exist more than 2 million cases and at least 60,000 deaths from measles would have occurred annually. This hypothetical situation is compared with the actual situation of measles in Mexico during the 80's; 1) no more than 100,000 cases could have been estimated to occur in the very extreme case of notifying only one out of 10 cases. 2) The proportions of vaccinated and immune children under five reach 70 percent; this situation has produced 3) a fade out of epidemicity and has increased the critical size of community population for epidemics and doubled the interepidemic interval with the corollary of 4) increasing the average age of infection. The average cost of vaccinating a child was estimated near 1.25 dollars (US). Estimated costs of disease are related to individual losses. Taking into account these factors, benefit/cost ratio of measles immunization in Mexico is, at least, 100:1. Measles transmission patterns in Mexico are discussed since they lead to increase the benefit/cost ratio as compared to countries where the age of infection was put up before the immunization era. To expand investments on measles immunization is recommended.

Child, Preschool↗

PubMed1999

HIV immunization: acceptability and anticipated effects on sexual behavior among adolescents.

Adolescents rated hypothetical human immunodeficiency virus vaccines described as 90% and 50% efficacious and discussed how immunization might influence behavior of their peers. The low-efficacy vaccine was largely unacceptable and most believed immunization with the high-efficacy vaccine would cause increased risk behaviors. Immunization programs will need to address vaccine acceptability issues and behavioral responses to immunization.

AIDS Vaccines↗

PubMed1993

Inadequate immunizations. Identification using clinic charts.

Immunizations are cost-effective measures for assuring public health. However, recent outbreaks of measles, mumps, and pertussis underscore the inadequacy of current immunization programs. A model identifying those children who are likely to be inadequately immunized could focus the use of limited health funds. A retrospective examination of the medical charts of 101 children in a large inner-city clinic was undertaken to determine if specific factors were associated with inadequate immunization status. Fifty percent of the children were inadequately immunized by 18 months of age (no measles-mumps-rubella or fewer than three diphtheria-pertussis-tetanus vaccinations). Logistic regression analyses showed that older maternal age, no recurrent or chronic illnesses, and vaginal delivery were independently associated with inadequate immunization status. However, on many charts, information on maternal, social, and environmental variables was incomplete. The increasing use of structured medical charts will enhance data collection and the determination of an appropriate index. A prospective study of the variables identified, along with standardization of medical records and inclusion of social history data, is necessary to further investigate the utility of screening criteria for inadequate immunizations.

Child, Preschool↗

PubMed2001

Prevalence of hepatitis B virus infection and related risk factors in a rural community of Mexico.

A cross-sectional survey of the seroprevalence of hepatitis B virus (HBV) markers among healthy people was conducted in San Juanito, a rural community in the northern state of Chihuahua, Mexico. The overall prevalence in 970 people was 6.6% for antibody to hepatitis B core antigen. There was an age effect on the prevalence of HBV infection, and a gradual increase in prevalence was observed in patients up to the age of 40 years. Those subjects with a history of dental procedures had a 2-fold higher risk for HBV infection (odds ratio [OR], 2.4; 95% confidence intervals [CI], 1.01-5.86), and there was a 74% increased risk for each blood product transfusion (OR, 1.74; 95% CI, 1.09-2.77). Horizontal transmission seems to be the major source of endemicity in San Juanito because no woman was a chronic carrier. To lower HBV transmission rate, an adequate active screening program for blood donors should be implemented, together with a universal infant immunization program.

Adolescent↗

PubMed2002

Serologic immunity to diphtheria and tetanus in the United States.

BACKGROUND: Serologic data on diseases that are preventable by vaccine are useful to evaluate the success of immunization programs and to identify susceptible subgroups. OBJECTIVE: To provide national estimates of immunity to diphtheria and tetanus by measurement of serum antibody levels. DESIGN: Examination of data from the Third National Health and Nutrition Examination Survey, a representative cross-sectional sample of the U.S. population. SETTING: 89 randomly selected locations throughout the United States. PARTICIPANTS: 18 045 persons 6 years of age or older who were examined from 1988 to 1994. MEASUREMENTS: Serum samples obtained at a single time point were tested for diphtheria and tetanus antitoxin. RESULTS: Overall, 60.5% of Americans 6 years of age or older had fully protective levels of diphtheria antibody (> or =0.10 IU/mL) and 72.3% had protective levels of tetanus antibody (> 0.15 IU/mL). Ninety-one percent of Americans 6 to 11 years of age had protective levels of both diphtheria and tetanus antibody; this proportion decreased to approximately 30% among persons 70 years of age (29.5% for diphtheria and 31.0% for tetanus). Adult Mexican-Americans were slightly less likely to have protective levels of antibody to both toxins. Only 47% of persons 20 years of age or older had levels that were protective against both diseases, and only 63% of adults who were protected against tetanus were also protected against diphtheria. CONCLUSIONS: A substantial proportion of adults in the United States do not have antibody levels that are protective against diphtheria and tetanus. In addition, although the recommended vaccine is a combination of tetanus and diphtheria, only 63% of adults with protective antibody to tetanus also had protective antibody to diphtheria.

Adolescent↗

PubMedDate not supplied

[The response to PPD and its relation to allergic diseases in children vaccinated at birth with BCG].

BACKGROUND: The increase of the atopical disorders can be partially explained by two factors, the infectious disease in developed and developing countries, and the changes in immunization programs, infections such as measles, whooping cough or tuberculosis can modify the immune response. Recent studies have demonstrated that an inverse relation could exist between the response to late cutaneus hypersensitivity to Mycobacterium tuberculosis and atopic condition. Also, a strong positive response has been associated with low levels of IgE and Th1 cytokines. However some authors have not found positivity between low prevalence in allergic diseases and PPD. OBJECTIVE: To determine the reaction to PPD in children vaccinated with BCG at birth and its disorders. MATERIAL AND METHOD: The study sample included male and female children from 2 to 7 years old, vaccinated with BCG at birth, this fact was corroborated with the post vaccination scar. They had all been diagnosed with allergic disease with clinical compatible data, positive Prick test, elevated serum IgE, and absence of any associated immune deficiency. RESULTS: A total of 50 patients, with a mean age of 4.7 years (2.0 to 7.7 years) were studied. 72% (36) were males and 28% (14) females. Twenty-two percent had diagnosis of asthma, 8% allergic rhinitis, and 62% both diagnosis. The average diameter of tuberculin induration was of 5 mm; 5 patients (10%) had positive reaction (+10 mm); 23 patients (46%) were between 5-9 mm; 8 patients (16%) between 1-4 mm, and 14 of the patients (28%) without reactivity. CONCLUSION: We demonstrated that the vaccination with BCG do not protect against the development of allergy, and the negative tuberculin response may mean a reduced cell response. So, it is necessary to assess the cell immunity and revaccination with BCG, with determination of immunological markers, before and after, such as IL 4, IL 2, INF and allergy symptoms.

Asthma↗

PubMed1976

Immunization of broiler chickens with a commercial infectious laryngotracheitis vaccine in the drinking water.

Seventy-five thousand broiler chickens in four flocks were immunized at four weeks of age with a commercial infectious laryngotracheitis vaccine administered in the drinking water. Three of the flocks exhibited a vaccine reaction represented by mild respiratory illness between seven and 14 days after vaccination. Immunity challenge experiments demonstrated 97% protection in one trial and 67% in another trial in which the dose of challenge virus was increased fourfold. In the latter trial a parallel comparative vaccination by eye administration was 87% protective. None of the vaccinated birds died of the challenge exposure whereas all the unvaccinated control chickens became ill, several showed the acute severe form of the disease and 36% died. Similar favourable results were obtained in large-scale water immunization programs involving more than 200,000 birds. Serum antibody levels determined before immunity challenge were, within wide limits, inversely related to the severity of clinical disease which developed from the challenge inoculation.

Administration, Oral↗