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PubMed2004

[Vaccines for all occasions].

The strategy of immunizing a population at risk of infectious disease has been enormously successful medically and has also proven to be cost effective. Development of effective immunogens, that induce active immunization, is a long process that requires careful monitoring and assurance of short and long term safety, induction of protective immunity and proven efficacy in preventing the disease. A successful immunization program is also dependent on delivery of the vaccine to as many susceptible individuals as possible, so as to attain herd immunity. Passive immunization with antibodies, usually used prior to the development of active vaccines has also been remarkably effective. The special circumstances of the field and crowded conditions have demanded that the Medical Corps of the Israeli army cater for the needs of our soldiers. In this issue, the past achievements and current immunization policy are outlined for the first time. Their contribution to the health of our soldiers is commendable. Close monitoring of the epidemiology of infectious disease in the special circumstances of field conditions has prompted successful programs to markedly reduce infectious hepatitis A by passive immunization with gamma globulin in the past and, nowadays, with the killed active viral vaccine. In addition, prevention of influenza by killed viral vaccine and invasive bacterial disease by Neisseria meningitidis with multivalent polysaccharide vaccines are being used. This group has also improved hygienic conditions in the field to cope with shigellosis and salmonella infections. Research in the development of effective vaccines for protection of shigellosis has also been addressed by this group. New challenges posed by the emerging infectious diseases and the possible effects of bioterrorism are certain to keep this group on their toes.

Communicable Disease Control↗

PubMed1979

Administrative costs of the influenza control program of 1976--1977 in Illinois.

In 1976, many resources of state and local agencies were devoted to planning, organizing, implementing and evaluating the influenza immunization program. The costs included salaries and other expenses of specifically employed personnel; diversion of the time of others from their usual responsibilities; and donated resources. They were assessed retrospectively and reported by responsible local agency personnel on a questionnaire. Costs of donated services and other resources were estimated based on assigned unit value. The total cost of the program in Illinois was $3.334 per dose of which $1.733 was accounted for by local agencies, $0.075 by the state agency, and $1.526 by the federal government, including the cost of vaccine doses remaining unused. If the program could have been carried through to include the intended larger numbers of persons, both the administrative costs and the vaccine costs per dose administered would have been much less. The financial cost of the campaign exceeded the federal grant. It must be weighed against the administrative benefits including improved ability to conduct large scale preventive programs and awareness of the importance of both risks of benefits of immunization.

Administrative Personnel↗

PubMed2003

Diphtheria immunization rates and the effect of several sociodemographic factors on immunization of children in eastern Turkey.

BACKGROUND: One of the aims of the World Health Organization is to eliminate diphtheria in all countries. Thus, it is important to achieve a high level of childhood immunization. The present study was performed to determine the level of child immunization against diphtheria and the effect of several sociodemographic factors on immunization of children aged 0-6 years. METHODS: Using the cluster-sampling method, 767 healthy children were selected at random from three provinces in eastern Turkey. Children were categorized as completely vaccinated, incompletely vaccinated, unvaccinated or vaccination status unknown. If the child had no immunization card, he/she was categorized as vaccination status unknown. RESULTS: Of the 767 children, 72.3% were completely vaccinated, 18.3% were incompletely vaccinated and 5.7% were not vaccinated. Vaccination status was unknown for 3.7% of children. As the age of the children increased, the proportion of completely vaccinated children increased and the proportion of non-vaccinated and incompletely vaccinated children decreased. The vaccination rates increased in parallel with the education level of the parents. While the vaccination rate was significantly correlated with the socioeconomic level of the families, it was inversely correlated with sibling number. CONCLUSIONS: The results of the present study show that the immunization status necessary for the elimination of diphtheria has not yet been reached in eastern Turkey. In immunization programs for children in eastern Turkey, priority should be given to increasing primary immunization levels to 90-95% with three or more doses of diphtheria toxoid.

Child↗

PubMedDate not supplied

Measles in India.

Measles is an important cause of morbidity and mortality among the children of India. In spite of this it is not considered a serious problem by the health authorities. Practically no cases are reported, and only those children with significant complications are hospitalized. Thus hospital records do not reflect the magnitude of the problem. In recent years attention has been focused on the evaluation of the morbidity and mortality due to measles in India. In the absence of reliable estimates, it is presumed that almost everyone in India suffers from measles before the age of 10 years. Hospital-based studies have found that 20%-70% of children with measles develop minor and major complications. On the basis of the few hospital-based studies and community surveys, it appears that the mortality rate due to measles is 3%-15%, depending on the health-care system in the community. All available data point to the necessity of immunization programs against measles, but logistical and economic constraints have prevented introduction of measles immunization in the Expanded Programme on Immunization. A limited experience with measles vaccine in India has shown that practically no cases occur among immunized children and that seroconversion rates are excellent. It is urgent to create awareness among health authorities, physicians, and health workers of the problem of measles.

Child↗

PubMedDate not supplied

A pediatrician and his mothers and infants.

Pediatricians are in a unique place in society by being able not only to care for the health and well-being of mothers and which, are their clinical responsibility, but also by being able to act as advocates for those patients who are often among the most vulnerable of our population. This article illustrates some of these points by referring to Australian Aboriginals from the vast desert areas of Westerns Australia. In remote areas of Western Australia, Aboriginal infants have high rates of low birth weight, failure to thrive and undernutrition. They also have high rates of respiratory, gastrointestinal and other infections. Aboriginal infant mortality has improved significantly over recent years, but Aboriginal health and mortality rates are still much worse than those of non-Aboriginal children and tend to be worst in more remote parts of the state. Overall, Aboriginal infants less than one year in age were hospitalized 9.5 times more frequently than non-Aboriginal infants for respiratory diseases (such as pneumonia, acute bronchiolitis and asthma); diarrheal diseases and skin infections were other very important causes of hospitalization for Aboriginal infants. Another poorly understood aspect of Aboriginal health is their widespread proneness to urinary tract infections. This is very important now in Australian Aboriginals in whom end-stage renal failure is becoming very prevalent. Rapid social and lifesyle changes have been very important in the poor health status of Aboriginals. They are also subject to severe socio-economic discrimination, underemployment, limited education, overcrowding, social depression and severely depressed housing conditions, relative inaccessibility to adequate and nutritious foodstuffs, and limited access to clinical services. Aboriginal people are prone to obesity, hypertension, type-2 diabetes mellitus and cardiovascular diseases. Overuse of alcohol and tobacco smoking have also become important challenges, particularly among adolescents and young adults. For the past twenty years or so, special programs have been developed to help overcome some of these problems; these include immunization programs, an extensive child health care program, special childhood screening programs, and oral rehydration therapy to reduce the high rates of mortality and morbidity associated with diarrheal diseases. These improvements have been achieved despite a set of socio-economic circumstances that face Aboriginal infants and children who live with adverse social factors. This was termed "Down and Out in 1996" in an editorial in The New Scientist (27 January 1996). A strategy that Australian Aboriginals are using now is to increase their own role through Aboriginal-controlled health and medical services including child health programs.

Adult↗

PubMed1989

Influenza A among hospital personnel and patients. Implications for recognition, prevention, and control.

An outbreak of influenza A/Philippines H3N2 at a 1156-bed Veterans Administration Hospital involved 118 hospital personnel and 49 patients. Prospective surveillance methods that had been established within the hospital were not useful in identifying the number of involved individuals. Community indicators of influenza, which were reviewed retrospectively, would not have identified circulating influenza in this population. Control of the outbreak was accomplished using a creative approach that immunized over a third of the physician and nursing staff. This immunization program was successfully used in subsequent years to increase personnel compliance with the Immunization Practices Advisory Committee recommendations to annually immunize hospital personnel.

Cross Infection↗

PubMed2005

Subacute sclerosing panencephalitis: results of the Canadian Paediatric Surveillance Program and review of the literature.

BACKGROUND: Subacute Sclerosing Panencephalitis (SSPE) is so rare in developed countries with measles immunization programs that national active surveillance is now needed to capture sufficient number of cases for meaningful analysis of data. Through the Canadian Paediatric Surveillance Program (CPSP), the SSPE study was able to document a national incidence and determine the epidemiology of affected Canadian children. METHODS: Between 1997 and 2000, the CPSP surveyed monthly 1978 to 2294 Canadian pediatricians and sub-specialists for SSPE cases. The response rate varied from 82-86% over those years. RESULTS: Altogether, four SSPE cases were reported to the CPSP: one case before, two during and one after the study period. The incidence of SSPE in Canadian children was 0.06/million children/year. Of the four cases, diagnosed between ages four and 17 years, three children had measles infection in infancy. All children showed a progressive course of dementia, loss of motor skills and epilepsy. Two children were treated with isoprinosine and intraventricular interferon but died in less than three years from disease onset. One child did not have any treatment and died after seven years of illness. One child received intraventricular ribavirin and remains alive, but markedly impaired, nine years following diagnosis. CONCLUSION: The CPSP has demonstrated that Canadian paediatricians and paediatric neurologists may encounter cases of SSPE. This report highlights the clinical course of affected Canadian children and provides a review of the disease and its management.

Adolescent↗

PubMedDate not supplied

Criteria for assessing accomplishment of poliomyelitis control.

The goals of control of poliomyelitis include the control of paralytic poliomyelitis, of infection by polioviruses, and of the presence and spread of polioviruses in the environment. Criteria for assessing control of paralytic poliomyelitis include required and special reporting, data from hospitals and clinics, and lameness surveys. Control of infection is evaluated by immunization histories, studies of vaccine quality and usage, and by serologic surveys for antibody prevalence. Environmental control is measured by lack of reported cases, lack of wild polioviruses in sewage, and the absence of poliovirus in the stools of healthy persons who have not received oral poliovirus vaccine. Each country must determine its own objective for control and the criteria most suited for measuring the attainment of those goals. The advantages and disadvantages of these different criteria are discussed. Developing countries will have to place primary reliance on school and household lameness surveys to evaluate control of poliomyelitis since other methods are too expensive and/or require strong health infrastructures . Developed countries can use regular and special surveillance systems for reporting cases, laboratory diagnosis for confirming suspected and vaccine-associated cases, and serologic surveys for monitoring the need and progress of immunization programs.

Antibodies, Viral↗

PubMed2001

Vaccine safety: risk communication--a global perspective.

The complexity of risks connected with both vaccine-preventable diseases as well as with immunization will be discussed and used as the basis for conclusions: -what should be done to avoid damage to current and future immunization programs and -how to improve risk communication. The need for more complete data on true, perceived and unknown immunization risks necessitates strengthening our research capabilities as well as surveillance and vaccine safety programs, and to critically examine the factors influencing public sentiments, taking into account that public perceptions of risk vary depending on the characteristics of risk. A concerted effort is needed to improve benefit and risk communication at all levels. The medical community should play a key role for improved communication.

Communication↗

PubMed2006

The controversial role of adenoviral-derived vectors in gene therapy programs: where do we stand?

The high immunogenicity of recombinant adenoviral vectors is one of the major issues in the field of gene therapy. Adenoviral-based vectors are susceptible both to cytotoxic T-lymphocyte and humoral immune responses. In addition, leaky adenoviral genes also render transduced cells susceptible to host immune responses. These are the main reasons why adenoviral-based vectors are not suitable to correct genetic disorders, which require long-term expression of the transgene. Another limit to long-term transgene expression is posed by the fact that adenoviral-based vectors do not integrate their genome into the cellular chromosomal DNA of transduced cell populations. As it stands, adenoviral-mediated gene transfer is a promising tool for cancer therapy and for genetic immunization programs against infectious diseases, provided that host immune responses are carefully controlled.

Adenoviridae↗

PubMed1996

The impact of the vaccine for children's program on child immunization delivery. A policy analysis.

The Vaccine for Children (VFC) program was proposed as part of President Clinton's 1993 Childhood Immunization Initiative. It is a federal vaccine-financing program that pays for and distributes free vaccine to providers serving 4 classes of children: (1) Medicaid insured, (2) uninsured, (3) children with private insurance that does not cover immunizations, and (4) American Indian and Alaskan Native children. Despite support from major professional organizations, the VFC program has come under intense criticism, with critics arguing that the cost of vaccines is not a major barrier to immunization receipt. In this article, we analyze how the VFC program will influence the receipt of immunizations by children under different child health care delivery and financing systems. We conclude that the impact of VFC on access to immunizations will be uneven; however, VFC could significantly improve access to immunizations for the over one third of US children who are either uninsured or covered under Medicaid fee for service. With further augmentations and refinements, VFC could be fashioned to overcome significant and persistent barriers to the timely delivery of immunizations in our disjointed child health financing and delivery systems.

Child↗

PubMed1995

A hepatitis B vaccination program targeting adolescents.

PURPOSE: To determine the effectiveness of using a middle school for hepatitis B vaccination of adolescents. METHODS: An immunization program was designed to educate parents and students about hepatitis B virus (HBV) infection and hepatitis B vaccination using science class presentations and mailings. Students were given at each visit and on vaccination series completion. Costs were calculated and divided by the number of students completing the series to obtain per student cost. RESULTS: Of the 654 students, 519 (79%) received at least one dose of hepatitis B vaccine, 497 (76%) two doses, and 425 (65%) three doses. Student participation did not vary by grade level, gender, or income. Per student vaccination cost was $77.23 for those receiving three doses of hepatitis B vaccine and $66.04 when those receiving at least two doses were included. Of 103 students with postvaccination serologic testing, three had evidence of previous hepatitis B virus infection, four had no evidence of vaccine induced immunity, and 96 (96% of susceptible students) developed protective levels of antibodies against hepatitis B surface antigen. The geometric mean antibody titer among persons responding to vaccination was 661 mIU. CONCLUSION: Hepatitis B vaccination of adolescents can be successfully integrated into a middle school setting.

Adolescent↗

PubMed1998

[The premature infant confronting community-acquired infections. Which prophylaxis?].

Preterm infants are at high risk of severe community acquired infections. In particular viral respiratory infections, mainly respiratory syncitial virus infections (RVS), are responsible for a high incidence of rehospitalizations of preterm infants during their 2 first years of life. Prevention relies upon 1/the application of an immunization program identical to the program applied to normal term infants, a cardiorespiratory monitoring during 48-72 hours following immunization being recommended in those infants who carry a risk of recurrent apnea; 2/general measures with a demonstrated protective effect, i.e., breast feeding, elimination of smoking at home, and when possible limitation of contacts with infant and children communities. Immunoprophylaxis against RVS infections has been shown to be effective in reducing the severity of RVS infections in preterm infants but is presently not available in European countries.

Community-Acquired Infections↗

PubMed1990

Current immunization practices in adults.

Can the successes of pediatric immunization programs be matched in adults? The question relates both to infections due to waning immunity and to those primarily acquired in adulthood. It is given urgency by rising prevalence of vaccine-preventable diseases in adults. Strategies with available vaccines are reviewed, and vaccines in development are discussed.

Adult↗

PubMed2006

Protection against hepatitis B by the Butang recombinant vaccine in newborn children in South Brazil.

The prevention of hepatitis B by vaccination is one of the most efficient tools to avoid the transmission of the virus. This study evaluated the immunogenicity of the national vaccine Butang in children born in Campo Mourão City, state of Paraná, Brazil, aged 7 to 12 months, by determining the anti-HBsAg antibodies levels after completion of the National Immunization Program Protocol for hepatitis B. All 70 children evaluated by the MEIA method (immune-enzymatic micro particles) showed seroconversion to the Butang vaccine. Nine children (12.9%) presented a low response, with anti-HBs titers between 11 and 100 mUI/ml; 39 children (55.7%) showed a good response to the vaccine, with titers between 101 and 1000 mUI/ml; and 22 children (31.4%) showed antibodies titers higher than 1000 mUI/ml. The mean titer of the anti-HBs antibody titers was 1408.1 +/- 2870.26 mUI/ml (15.7 to 19560.0 m UI/ml). The levels of antibodies produced by the prematurely-born children were not statistically different from those found in the newborns. Fifty-five children were also evaluated through the ELFA method (ELISA with a final detection in fluorescence), which presented similar results. The results obtained in our study corroborated the effectiveness of the national vaccine Butang in newborn children of Campo Mourão City, Paraná, even if they were premature.

Brazil↗

PubMed1979

Practical immunization of chickens against coccidiosis using an attenuated strain of Eimeria tenella.

Three floor-pen trials were conducted to compare two attenuated strains of Eimeria tenella (Wis-F-96 and Wis-F-125) with the strain of E. tenella used in a commercial planned immunization program (Coccivac). Broiler cockerels were started in floor pens on new pine shavings litter. Immunizing oocysts were administered in the drinking water during the first week with total dose per bird of 175 oocysts of the control strain (Coccivac); 175, 350, or 700 oocysts of the Wis-F-125; 350 oocysts of Wis-F-96; or no oocysts (non-seeded control). The control strain was more pathogenic than the Wis-F-125 or the Wis-F-96 strains as indicated by significantly higher lesion scores 17 days after initial exposure and by loss of two birds in the control strain exposed groups. Low lesion scores and no deaths due to coccidiosis characterized the use of the Wis-F-125 strain. Flock immunity, as determined by immunity challenge, was equivalent between the control strain and the higher dosages of Wis-F-125. The Wis-F-96 strain did not adequately immunize chickens in these experiments.

Animals↗

PubMed1990

Pertussis vaccines: present status.

The eradication of pertussis as a worldwide disease is unforeseeable for the present and immediate future. Mortality and morbidity from clinical pertussis are still commonly reported, especially in underdeveloped countries where mass immunization programs are virtually nonexistent. To achieve control of the disease, a high level of immunization coverage is necessary, and pertussis WCPV still remains one of the most effective bacterial vaccines. But, primarily because of its reactogenicity for infants, much effort has been directed toward the characterization of bacterial components important in pathogenesis and for the development of acellular vaccines. Progress in the last decade has resulted in the production and use of such vaccines for routine vaccination, and their use in Japan, as well as the recent clinical trials in Sweden and several phase I/II studies in other countries, has shown that these preparations are safer than conventional WCPV, and equally effective, in preventing disease. The development of future acellular pertussis vaccines by gene manipulation may finally inspire public confidence for vaccine prophylaxis, eventually leading to eradication of the disease. However, the production and use of such sophisticated vaccines is dependent on many factors, and consequently conventional WCPV may still be used in many countries for several years to come.

Antigens, Bacterial↗

PubMed1989

Linkages between immunization and breastfeeding promotion programs.

Breastfeeding promotion and immunization are important interventions of child survival programs, especially in developing countries. Linkages between breastfeeding promotion programs and the Expanded Programme on Immunization (EPI) in developing countries mean that health care workers can make use of every contact with the mother and child to reinforce the educational messages of both programs. Breastfeeding does not interfere with vaccinations administered in accordance with the routine schedule recommended by the EPI Global Advisory Group for use in developing countries. Breastfeeding benefits the EPI and the EPI also benefits breastfeeding. The maximum reduction of morbidity and mortality will be achieved when all child survival interventions are applied in a balanced, complementary manner as envisaged in the concept of primary health care.

Breast Feeding↗