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At least 721 records · Page 40Linked to original sources

PubMed1992

Low-cost hepatitis B vaccine improves uptake among self-paying health-care students.

Advisory committees recommend hepatitis B (HBV) immunization for professional and student health-care workers. However, the currently licensed vaccines are expensive, and previous surveys have shown that few students (14%) have been immunized in Canada. A low-cost immunization program was offered to health-care students in order to determine whether the effectiveness of HBV immunization could be improved by substantially reducing the vaccine cost to recipients. The immunogenicity, side effects, and 3-dose completion rate of a low-cost Korean HBV vaccine were compared with a similar U.S.-made vaccine. A total of 922 postsecondary students enrolled in 6 health-care disciplines in Ottawa, Canada were surveyed for hepatitis-B immunization status. Nonimmunized students were subsequently offered HBV vaccine at total cost of $15 (Canadian), randomly allocated to receive 3 intramuscular doses of either Korean or U.S.-made plasma-derived HBV vaccine in a double-blind fashion, surveyed about side effects, and tested for hepatitis B surface antibody seroconversion. Only 12% of the 922 surveyed students had been previously immunized when vaccine was obtainable only at high cost. However, 66% of those not immunized participated in the vaccine trial and paid the $15 fee. Hepatitis-B surface antibody seroconversion (greater than or equal to 10 sample ratio units by radioimmunoassay) occurred in 291/311 (93.6%) and 299/310 (96.5%) of recipients of 3 doses of the Korean and U.S. vaccines, respectively (P = 0.10). There were no meaningful differences in vaccine adverse effects, and 92.6% of recipients of either vaccine completed 3 doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1984

Influenza and aging: age-related changes and the effects of thymosin on the antibody response to influenza vaccine.

Despite massive immunization programs, influenza remains a major cause of morbidity and mortality for elderly people. This may occur because immune senescent recipients may respond to vaccination with inadequate antibody production. We measured antibody response to the trivalent 1983-1984 influenza vaccine in young and elderly volunteers and found a significantly reduced response in the latter. The age-associated decreased antibody production was also observed in lymphocyte cultures in which specific antiinfluenza antibody synthesis was measured. In these cultures, however, the addition of a thymic hormone preparation (either thymosin fraction 5 or thymosin alpha 1) was shown to enhance specific antibody synthesis to a greater extent in the cultures established from the elderly volunteers. If this in vitro observation of thymosin induced increased antibody production reflects what might occur in a clinical trial in which elderly subjects receive thymosin coincident with vaccine, greater protection against influenza infection may result.

Adult↗

PubMed2005

Requiring influenza vaccination for health care workers: seven truths we must accept.

In this paper we outline the seven primary truths supporting the call for requiring influenza immunization of all health care workers. We view this as a serious patient safety issue, given the clear and compelling data regarding the frequency and severity of influenza infection. In addition, clear-cut safety, efficacy, economic, legal, and ethical platforms support the use of influenza vaccine. Unfortunately health care workers have demonstrated, over almost 25 years that they are unwilling to comply with voluntary influenza immunization programs utilizing a variety of education and incentive programs, at rates sufficient to protect the patients in their care. We suggest that an annual influenza immunization should be required for every health care worker with direct patient contact, unless a medical contraindication or religious objection exists, or an informed declination is signed by the health care worker. High rates of health care worker immunization will benefit patients, health care workers, their families and employers, and the communities within which they work and live.

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

PubMed1993

Perceptions of vaccine efficacy, illness, and health among inner-city parents.

A resurgence of measles in the past decade has focused attention on the limitations of current immunization programs, particularly for inner-city, low-income populations. As part of a larger study of immunization rates, we discussed perceptions of disease severity and vaccine efficacy, as well as the prioritization of the tasks of parenthood, with 40 parents of infants living in inner-city Baltimore to discover their beliefs about immunization. Vaccines were considered only partly successful; susceptibility to chickenpox after vaccination was repeatedly cited as evidence of vaccine failure. Fever was seen as a primary indicator of illness; thus, vaccines were believed to cause, rather than prevent, illness. Immunization was not considered a high-priority parental responsibility. These findings suggest future interventions be aimed at changing parental perceptions of vaccines as ineffective and of fever after immunization as an indicator of illness. Finally, immunizations should be made easily available, even during clinic visits for a child's illness.

Baltimore↗

PubMedDate not supplied

Mycobacterium bovis lymphadenitis complicating BCG immunization in an infant with symptomatic HIV-1 infection.

A 3-month-old infant with HIV-1 infection who recently immigrated from Ethiopia developed regional lymphadenitis and systemic symptoms subsequent to BCG immunization. She was suffering from axillary lymphadenitis ipsilateral to the BCG vaccination site, failure to thrive, unresolving fever and hepatosplenomegaly. Acid-fast bacilli were seen on staining and Mycobacterium bovis was isolated from the regional lymph node. The infant responded promptly to triple antituberculous therapy but died 2 months later from overwhelming pneumonia and respiratory failure. This case emphasizes the iatrogenic hazards of BCG immunization in HIV-1 infected infants. With the increasing prevalence of pediatric HIV-1 infection, indiscriminate BCG immunization programs should be reconsidered. While infants with asymptomatic HIV-1 infection at risk for tuberculosis should be immunized, BCG immunization should be withheld in those with symptomatic disease.

BCG Vaccine↗

PubMed2002

Investigation into a cluster of infant deaths following immunization: evidence for methanol intoxication.

A cluster of infant deaths due to severe metabolic acidosis following immunization was reported in a prosperous farming village in Egypt. Fears that more deaths might occur, and of a deleterious effect on national immunization programs prompted an urgent investigation by national and international partners. The deaths, and other previously unrecognized illness following immunization, were associated with excessive topical application of methanol. Methanol was employed as an anti-pyretic and anti-inflammatory agent following injections. Fear of adverse reactions to vaccine had encouraged increasing use of methanol for these purposes. Local physicians and nurses were unaware of the toxicity of methanol and did not consider it in the differential diagnosis, and thus did not offer appropriate life-saving therapy. The interaction of traditional practices and modern medical interventions can have clinically important consequences, and should be considered when programs are introduced and as they are monitored.

Cohort Studies↗

PubMed1995

Hepatitis B immunization in adolescents.

This article reviews the epidemiology of hepatitis B in the United States, previous vaccination strategy, and reasons for its failure and issues leading to the recommendation to vaccinate all adolescents. A review of specific hepatitis B virus risk behaviors of adolescents and barriers to vaccinating adolescents is covered. Strategies that favor successful completion of the immunization series are also examined. Hepatitis B infection is an important public health concern for adolescents. The previous vaccine strategy to immunize only individuals though to be at high risk was unsuccessful, especially because providers of care could not identify these individuals. Furthermore, many individuals thought not to be at high risk for infection were exposed through contacts which could not be identified. Challenges to immunization of adolescents include logistical issues, patient education, cost of the vaccine, and patient compliance. Several of these issues can be addressed by a school-based hepatitis B immunization program. The body of evidence and national policy is rapidly changing to support the recommendation that all adolescents receive the hepatitis B immunization series. The series would be most effective if administered during the middle-school years. A universal adolescent hepatitis B vaccination program would result in the most immediate health benefits and acceleration toward the eradication of hepatitis B in the United States.

Adolescent↗

PubMed1989

Hepatitis B infection in the United States. Recent trends and future strategies for control.

Viral hepatitis is the second most common reportable infectious disease in the United States, with hepatitis B accounting for about 45 percent of cases. Although approximately 25,000 cases of hepatitis B are reported to the Centers for Disease Control each year, it is estimated that there are actually about 300,000 annual infections (up from 200,000 in the early 1980s). This increase has occurred despite the availability of a safe and effective hepatitis B vaccine since 1982. Hepatitis B occurs primarily in young adults because of lifestyle or occupationally related exposure. Reported cases in homosexual men have decreased, probably because of changes in behavior related to the acquired immunodeficiency syndrome epidemic. Cases due to heterosexual transmission and intravenous drug use are increasing. The proportion of cases in health care workers has decreased, possibly because 30 to 40 percent of high-risk health care workers have been vaccinated. Because of the increase in hepatitis B infection, the strategy of controlling this disease by vaccinating high-risk groups must be reconsidered. Alternative strategies include selective or universal immunization of infants or adolescents. Although integrating hepatitis B vaccine into infant immunization programs takes advantage of the existing system, it would not lead to measurable disease reduction for two decades. Immunizing adolescents would more rapidly reduce the incidence of hepatitis B, but currently no structured health care setting reaches them.

Diagnosis, Differential↗

PubMedDate not supplied

Control of poliomyelitis by vaccination in Belgium.

This article reviews the epidemiologic impact of the immunization policies in Belgium since the time efficacious vaccines became available, including recent serologic and virologic surveys as well as evidence for the relative effectiveness of inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine ( OPV ) in routine immunization programs. Poliomyelitis as an indigenous disease has disappeared in Belgium since the late 1960s as a result of immunization with IPV from 1958 to 1969 and with OPV since 1963. In the immediate prevaccine era, the annual average number of cases of paralytic poliomyelitis per million inhabitants was 37 between 1951 and 1954 and 71 between 1955 and 1958, with a peak of 1,038 cases in 1956. Soon after the initial successful control of poliomyelitis in the early 1960s, the acceptance rate of vaccination decreased. In order for a high level of immunity to the disease in the population to be maintained, immunization of children before the age of 18 months was made compulsory by Royal Decree on January 1, 1967.

Adolescent↗

PubMed1994

Oral immunization: turning fantasy into reality.

The application of oral immunization as the primary means to deliver multivalent vaccines to large populations has many theoretical advantages. However, widespread success in achieving protective immunity against these diseases through oral immunization requires additional understanding of the basic mechanisms of host resistance in the mucosal tissues. Fundamental issues, such as the lineage and repertoire or regulatory pathway of mucosal effector cells, are only now just beginning to be understood. A more comprehensive understanding of these issues could greatly enhance our success at designing and applying successful oral immunization programs.

Administration, Oral↗

PubMed1990

Immunization of hospital personnel and other health care workers.

Hospital personnel and other health care workers are at increased risk of acquiring certain communicable diseases that can be prevented by immunization. These include hepatitis B, influenza, rubella, measles, and mumps, among others. The use of vaccines to protect health care workers as well as certain barriers to institutional immunization programs is discussed.

Hepatitis B Vaccines↗

PubMed1983

Present and future use of viral vaccines in Israel.

Implementation of a routine immunization program is the result of the changing pattern of infectious diseases in the area, or of the availability of new vaccines against diseases of importance. Thus, on the one hand, smallpox and BCG vaccination at birth have been discontinued and inactivated polio vaccine (IPV) has been added to the routine program; on the other hand, mumps vaccine, already available, is a very serious candidate for inclusion in the immunization schedule, while prevention of hepatitis A awaits an effective vaccine that is acceptable for mass use.

Hepatitis A↗

PubMed2004

Protective effect of neonatal BCG vaccines against tuberculous meningitis.

Neonatal BCG vaccination reduces the risk of tuberculosis and provides protection higher than 80% against the development of meningeal and miliary tuberculosis in newborns. Tuberculosis meningitis remains a major problem and also an important cause of death in some countries. In countries with high and moderate incidence of tuberculosis, prevention from the most severe complications of tuberculosis can be achieved only with a high coverage of the universal BCG neonatal immunization, being higher than 98% in the cohort of newborns. The decrease in BCG immunization coverage within immunization program during the year 2003 in Bosnia and Herzegovina influenced the increase in tuberculous meningitis. During 2002, when coverage with BCG vaccination in cohort of newborns was 90%, the incidence rate of tuberculous meningitis was 19. 04%oo. With the 68% decrease in BCG immunization coverage in the cohort of newborns in Bosnia and Herzegovina during the year 2003, the incidence of tuberculous meningitis raised to 33 33%oo. It has been proven that the 22% decrease of the neonatal BCG immunization coverage in the cohort of newborns /vaccination program of children/ caused 175 times higher number of the tuberculous meningitis cases. Newborns affected by the tuberculous meningitis were not BCG vaccinated. BCG vaccine provided effective protection against tuberculous meningitis, as well against the death of newborns caused by tuberculosis.

BCG Vaccine↗

PubMed2003

Challenges and opportunities in establishing and maintaining newborn screening systems.

Newborn screening began in the early 1960s and during the four decades it has existed, has become a recognized vital public health prevention program. It has evolved conceptually from a laboratory test for a single disorder, phenylketonuria, to a comprehensive 6-part public health system of education, screening, follow-up, diagnosis, management, and evaluation. Newborn screening in different countries has been successful because of the efforts of a single individual or group of individuals interested in improving the health of children. Newborn screening has been shown to successfully detect serious disorders before symptoms appear and to significantly reduce the morbidity and mortality that might result if left undetected and untreated, yet there have been (and continue to be) obstacles to implementing newborn screening programs. The obstacles are the same for developed or developing programs and include: (1) adequate financing, (2) technology implementation, (3) program logistics, (4) cultural sensitivity, (5) education, and (6) political support. All newborn screening programs must exist within the limitations of their local environment in this regard. Each program confronts these barriers in its own way and various examples of overcoming barriers are discussed including linkages to immunization programs, regional planning, program advocacy, and legislation.

Global Health↗

PubMed1998

[Estimation of the efficacy of three strains of mumps vaccines during an epidemic of mumps in the Geneva canton (Switzerland)].

BACKGROUND: The number of mumps cases reported in Switzerland markedly increased from 1993 to 1995 although vaccination coverage against mumps had risen steadily since the national MMR immunization program was launched in 1987. In 1991, an estimated 80% of children 27 to 36 month-old were immunized against mumps. The purpose of the present study was to assess the hypothesis that the epidemic was the consequence of a low vaccine efficacy of the Rubini strain--a mumps vaccine strain that has been widely used in Switzerland. METHODS: Vaccine efficacy was assessed by measuring secondary attack rates among immunized and nonimmunized children 16 year-old or younger who wre family contacts of cases. RESULTS: From February 1993 to April 1996, Geneva pediatricians reported 283 primary cases of mumps and 63 secondary cases. Estimate of vaccine efficacy was equal to 6.3% (95% CI: -45.9; 39.8) for the Rubini strain, as compared to 73.1% (95% CI: 41.8; 87.6) for the Urabe Am 9 strain, and 61.6% (95% CI: 0.0; 85.4) for the Jeryl Lynn strain, two vaccine strains of mumps that had also been used in Geneva. CONCLUSION: Our study supports the hypothesis that the Rubini vaccine strain of mumps does not confer sufficient long-lasting protection against mumps.

Adolescent↗

PubMed2004

[Reduction in infant mortality in Chile between 1990 and 2001].

OBJECTIVES: To present the change in infant mortality (IM) in Chile and its possible explanations. METHODS: We performed a time-series study. Data on infant mortality were gathered from the demographic yearbooks of the National Institute of Statistics and from the health programs implemented by the Ministry of Health. RESULTS: The IM rate fell from 16 per 1000 live newborns in 1990 to 8.3 per 1000 in 2001. Programs for the use of surfactant and for the surgical management of cardiac malformations in newborns were implemented. Programs for the early treatment of acute respiratory infection were also implemented and new vaccines were introduced into the National Immunization Program in infants. CONCLUSIONS: The fall in infant mortality in Chile between 1990 and 2001 may be partly due to the implementation of the above-mentioned programs.

Birth Rate↗

PubMed1981

Epidemic measles and rubella in air force recruits: impact of immunization.

The safety of attenuated viral vaccines against measles and rubella and their efficacy in controlling a massive outbreak of these two diseases in air force recruits at Lackland Air Force Base, Texas, were studied. Recorded cases of measles declined from a high of 1,345 in 1976 to a low of 227 in 1979. Similarly, rubella cases declined from a peak before the immunization program of 1,361 in 1977 to a low of 67 in 1979. A controlled study of morbidity related to immunization revealed that there is less immediate local morbidity from immunizations against measles and rubella than with other routine immunizations. Recruits who received the attenuated viral vaccines reported fever, myalgias, and diarrhea only slightly more frequently than did recruits in the concurrent control group. The present data indicate that measles and rubella, increasingly consequential diseases among young adults, can be safely and effectively controlled with attenuated viral vaccines.

Disease Outbreaks↗

PubMed1976

Immunologic mechanisms responsible for adverse reactions to routine immunizations in children.

The principal licensed biologicals for human use in the United States have been listed with special emphasis given to antiviral vaccines. Possible adverse reactions of an immunologic nature which may be encountered in the use of these agents in routine immunization programs are described, while at the same time, their relative rarity is emphasized. The special problems one may encounter in immunizing the atopic child, the immunodeficient child, the child with active tuberculosis and the pregnant woman are considered separately, as are the undesirable consequences of hyperimmunization are mentioned.

Anaphylaxis↗