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PubMed2006

Oral poliovaccine: will it help eradicate polio or cause the next epidemic?

BACKGROUND: Poliovirus rapidly evolves by nucleic acid substitutions and genetic recombination with other polioviruses and non-polio enteroviruses. Evolving oral poliovaccine can rapidly revert to neurovirulence and undergo antigenic alterations. OBJECTIVES: To evaluate the threat of vaccine-derived poliovirus (1-15% divergence from the respective Sabin strain) for a poliomyelitis-free population in a country with a long-standing routine vaccination program. METHODS: We characterized genetic and antigenic changes in OPV (Sabin) strains isolated from sewage in Israel and evaluated intestinal immunity by measuring fecal excretion after OPV challenge of vaccinated children. RESULTS: Characterization of poliovirus from sewage revealed eight type 2 and three type 3 vaccine polioviruses that had replicated and started to evolve (vaccine that replicated and diverged by 0.5 to < or = 1.0%) and nine highly diverged type 2 vaccine-derived polioviruses (1-15% divergence from the respective Sabin strain) with 8-14% divergence between the years 1998 and 2005. Six of the eleven VRPV uniquely recombined with OPV and/or NPEV. The nine VDPV were epidemically related, genotypically neurovirulent, and had 10-15 amino acid substitutions in antigenic sites altering their antigenicity, but shared a single recombination. Type 2 OPV was excreted by 23% and 17% of infants challenged with OPV 3 months after partial immunization (two doses each of OPV and enhanced inactivated poliovirus) or full immunization (three doses of each) respectively, despite high humoral antibody titers. CONCLUSIONS: Our findings, which show that OPV is excreted for a significant period by children with high humoral immunity, emphasize the long-term potential threat from VDPV in highly vaccinated populations. An adequate immunization program, combined with environmental surveillance, is necessary to prevent poliomyelitis and community transmission of poliovirus.

Adolescent↗
PubMed1998

[Risks associated with vaccinations].

Since Jenner and Pasteur, various vaccines have been developed and administered in immunization program conducted by WHO in order to diminish the circulation of pathogenic agents and eradicate some diseases. Risks associated with immunization are revealed by the collection and assessment of adverse events reported after the use of these drugs. They vary according to the type of vaccines. With high rates of immunization and a low incidence of infectious diseases, adverse events receive increasing attention. Frequent and mostly expected adverse events are reported in clinical trials. Unexpected rare adverse events are reported after marketing authorization by spontaneous reporting and post marketing surveillance studies. Post marketing surveillance should be adapted to vaccines (vaccino-vigilance) and should take into account the risk linked to the disease they may protect against. Adverse events are often temporally associated with vaccines, that does not mean they are causally related. Specific studies should be conducted to assess the causal relationship between vaccines and post immunization adverse events. In order to reduce the risk associated with immunization, a strict follow-up of recommendations, warnings and contraindications in addition to appropriate information being delivered to both vaccinees and physicians are required.

Adult↗
PubMed1999

Long-term effectiveness of infancy low-dose hepatitis B vaccine immunization in Zhuang minority area in China.

AIM:To observe the long-term effectiveness of low-dose immunization strategy and risk factors of HBsAg carriers in immunized children of Zhuang minorities of Longan County in the 9th year after infancy immunization.METHODS:Two epidemiologic methods,a cross-sectional follow-up study and a case-control study,were used for the evaluation of the serological effect and the determination of the risk factors. Hepatitis B virus markers were detected with radioimmunoassay.RESULTS:The protective anti-HBs-positive rate was 43.8% in 1183 children aged 1-9 years,who were immunized with three doses of 10&mgr;g hepatitis B vaccine in infancy according to 0, 1 and 6 months schedul.It declined from 87.9% in the first year to 37.1% in the 9th year after vaccination.The HbsAg-positive rate was 1.6%, not increasing with age during 9 years after the infant immunization program. Compared with 14.0% of HbsAg-positive rate of the baseline survey in 1985, the effectiveness of hepatitis B vaccine immunization was 88.6%. Of 36 immunized children with positive HBsAg, 89.1% were likely attributable to HBsAg positivity of their mothers.CONCLUSION:The long-term effectiveness of infancy low-dose hepatitis B vaccine immunization is high,and the booster is not needed 9 years after the vaccination in the Zhuang minority area where hepatitis B is highly endemic.A high-dose immunization strategy should be recommended in order to further decrease the current HbsAg-positive rate.

Journal Article↗
PubMedDate not supplied

The president's child immunization initiative--a summary of the problem and the response.

After only 24 days in office, President Bill Clinton announced a comprehensive childhood immunization initiative designed to assure that all children in the United States lead healthier lives by receiving age-appropriate immunizations against preventable diseases such as polio, mumps, measles, whooping cough, and diphtheria. As part of his economic stimulus proposal, the President requested $300 million for Fiscal Year 1993 to reinforce the nation's immunization infrastructure by providing funding for communities to extend clinic hours, provide more staff, and increase information and education efforts and for the planning and implementation of a national immunization tracking system. In its Fiscal 1994 budget request, the Administration asked for a doubling of the Centers for Disease Control and Prevention's immunization program funding to $667 million. In cooperation with key congressional committees, the Administration has also prepared legislation that would provide recommended childhood vaccines to States for free distribution to health care providers who serve children enrolled in Medicaid or who don't have health insurance that covers immunization services. Providers could not charge for the vaccine but could charge a fee for administration. State Medicaid programs would also be required to reimburse providers reasonably for vaccine administration. This measure is designed to improve universal access to immunization services by helping to remove financial barriers that impede children from being immunized at the appropriate age.

Child↗
PubMed2004

[Meningococcal disease].

Due to a high complication and case fatality rate, meningococcal diseases are important health problems both in tropical countries experiencing severe epidemics as well as in countries of moderate climate zones. Worldwide N. meningitidis of sero-groups A, B, and C are predominant and to a lesser extent serogroups W (135) and Y play a role, whereas in Europe more than 90 % of meningococcal diseases are caused by serogroups B and C of N. meningitidis. In Germany and other developed countries the majority of cases occur in very young children and adolescents. Since many years, meningococcal polysaccharide vaccines against diseases due to N.meningitidis serogroup A, C, Y and W (135) are commercially available. Unfortunately, a vaccine against diseases caused by N. meningitidis serogroup B is still under development. The recently developed and licensed conjugated meningococcal vaccines against N. meningitidis serogroup C are also protective against disease in very young children. Eight countries in Western Europe as well as Australia have already established country-wide immunization programs for children and adolescents. Within only 2 to 3 years, well managed programs have achieved far-reaching control of meningococcal C disease in UK and the Netherlands. In Germany, the Advisory Committee on Immunization (STIKO recommends immunization for selected risk groups. The current increase of the percentage of meningococcal C diseases to 28 - 30 % gives reason for further discussion regarding immunization strategies. How-ever, the STIKO expressively declares, that in addition to the recommendation for risk groups, the physician can use all vaccines licensed in Germany without any restriction. It is his/her responsibility to advice the patients regarding immunization possibilities against the life-threatening meningococcal disease, particularly if cases are occurring.

England↗
PubMed1994

Sustainable development and quality health care.

On the occasion of Development Week in Canada, Dr. Remi Sogunro spoke in February, 1994, about the many achievements of quality primary health care and PLAN's strategy to achieve sustainability. In one generation, under-5 mortality has been cut by a third. Deaths from measles has been reduced from 2.5 million to 1 million a year. Skeletal deformities from polio also have been reduced from 1/2 million to less than 140,000. Despite all this, there is much more to be attained. 35,000 children under 5 die from preventable diseases every day in developing countries. The health community is working hard to address these silent emergencies. PLAN International's primary health care program targets the poor and undeserved populations where diseases are prevalent. The main focus of PLAN's programs are mothers and children who are most vulnerable to disease. Key interventions that PLAN gives priority to are childhood and maternal immunization programs, including pre- and post-natal care for mothers. Other interventions under PLAN's comprehensive primary health care program include: control of diarrheal diseases and acute respiratory infections, growth monitoring, nutrition and control of STDs and HIV/AIDS infection, water and sanitation, family planning information and educational services, and rehabilitation of the handicapped. "Go in search of people, begin with what they know, build on what they have," goes a Chinese proverb. This also summarizes PLAN's guiding principle for achieving sustainable development: the importance of investing in people. PLAN's programs in the field build partnerships and empower communities. PLAN's emphasis on institution-building and capacity-building with local institutions is an important part of organizational strategy to ensure sustained development.

Achievement↗
PubMed2005

Rotavirus vaccines and intussusception risk.

PURPOSE OF REVIEW: Rotavirus infection is the leading cause of severe dehydrating gastroenteritis, responsible for an estimated 440,000 deaths per year in children less than 5 years of age worldwide. There was great optimism when the first rotavirus vaccine was licensed in the United States in July 1998 (rhesus rotavirus tetravalent, RRV-TV, Rotashield, Wyeth Laboratories, Marietta, PA). However, 9 months after the vaccine become available, the rotavirus immunization program was suspended due to reports of an association between the vaccine and intussusception. The estimation of risk of intussusception with Rotashield immunization has been the subject of debate and is discussed in this review. RECENT FINDINGS: The risk of intussusception following Rotashield immunization is estimated to be between 1 in 10,000 to 1 in 32,000 vaccinees. The risk is highest during the 3 to 14 days following receipt of the first dose of vaccine. Infants older than 3 months at the time of the first dose of vaccine are at increased risk of intussusception. SUMMARY: The association between Rotashield and the development of intussusception has presented a major challenge to the development of rotavirus vaccines. Intussusception risk is greatest in the first 3 to 14 days following the receipt of the first dose of Rotashield in infants older than 3 months of age. Although there continues to be debate surrounding the exact quantitation of risk of intussusception, it is accepted as a rare adverse event. The development of alternate rotavirus vaccines and emerging manufacturers in developing countries has renewed optimism for the reduction of the global burden of rotavirus disease.

Diarrhea, Infantile↗
PubMed1991

Prevention of measles in Israel: short- and long-term intervention strategies.

Measles morbidity and mortality have declined in Israel since the introduction of routine vaccination in 1967. The reported incidence of civilian cases of measles declined from 50/100,000 in 1968-72, to 27/100,000 in 1983-87. There was also a decrease from 108 to 49 measles deaths, and from 84 to 29 cases of subacute sclerosing panencephalitis in these respective periods. The measles epidemic in 1982 included 7,864 reported civilian cases with an additional 3,000 cases in the Israel Defense Forces. The 1985-86 epidemic included 4,956 reported civilian cases. Current immunity levels leave large numbers (15-20%) of children and young persons susceptible to the disease and its transmission. Despite the long-standing childhood immunization program, the goal of complete control over and elimination of the disease will not be achieved in the near future by current immunization policies. The 3-4 year cycle of measles epidemics may be expected to cause large-scale morbidity and some mortality in the 1990-92 period. Short- and long-term measles control policies for this preventable disease are discussed.

Adolescent↗
PubMedDate not supplied

Expanded Programme on Immunization in Thailand.

In 1976, despite a 20-year immunization program, vaccine-preventable diseases (other than smallpox) remained important causes of morbidity and mortality in Thailand. Three major problems were identified: a lack of proper target age groups, inadequate vaccination coverage, and a defective cold chain. The National Expanded Programme on Immunization (EPI), focusing on diphtheria, pertussis, tetanus, poliomyelitis, measles, and tuberculosis, was initiated on a nationwide basis in 1977. Data indicate that the program has reduced morbidity and mortality from most vaccine-preventable diseases in Thailand. The goal of the EPI is to have every eligible child fully immunized with efficacious vaccines by 1990. Strategies have been developed and are being used by the "accelerated EPI" to achieve this goal.

Child↗
PubMedDate not supplied

Long-term use of oral poliovirus vaccine from Sabin strains in the Soviet Union.

Success in control of poliomyelitis in the USSR has been achieved after mass immunization with oral polio vaccine ( OPV ) manufactured from attenuated Sabin strains. Procedures for large-scale production of the OPV have been developed by Soviet researchers with the leadership of Chumakov and Smorodintsev , and the safety and efficacy of the vaccine have since been demonstrated. A mass immunization program was initiated in the USSR in 1959 and completed in 1960, covering 77.5 million people or 36.7% of the entire population. This immunization campaign resulted in a sharp decrease in the incidence of poliomyelitis: from 10.6 per 100,000 population in 1958 to 0.43 in 1963. Beginning in 1964 the incidence remained at a level of 0.01-0.1 per 100,000 population. At present the vaccination schedule consists of three basic vaccinations given to infants. Over 20 years of experience with OPV in the USSR has shown that this vaccine is a safe and efficient preparation.

Humans↗
PubMedDate not supplied

Medical surveillance in the biotechnology industry.

A medical program appropriate for employees in biomedical laboratories should be based upon specific understanding of the risks and hazards associated with the work activities. Components of a medical program might include: preplacement examinations, periodic monitoring evaluations, tracking of prolonged or unusual illness, specific illness or exposure-related evaluations, epidemiological studies, immunization programs, and exit (or termination) evaluations.

Accident Prevention↗
PubMed1991

Comparative study of mothers' knowledge of children immunization before and after mass media.

Past experience about immunization programs calls for continuous monitoring of a healthy attitude among users towards vaccination. The aim of this study was to assess the effect of health education messages (mass media) on knowledge and practice of mothers as regards compulsory vaccination schedule. Data were collected from 250 females attending MCH centers during the first half of 1991 for either vaccinating their children or receiving antenatal care (exposed group). These data were compared to the data collected from a group of mothers before implementation of the intense mass media campaign on immunization (1983), (non-exposed group). There was a significant increase in the mean score of knowledge among the exposed mothers. The mass media messages became the main source of information among the majority of the exposed group. Females utilizing mass media as their main source of information were largely having a satisfactory level of knowledge. This study recommends enforcement of mass media educational campaigns on childhood immunization as well as reconsideration paid to the nature and content of messages.

Educational Status↗
PubMed2005

Tetanus and trauma: a review and recommendations.

BACKGROUND: This review covers the pathogenesis and treatment of the disease along with the reexamination of the current recommendations for prophylaxis against tetanus in the United States. Although tetanus is still a major problem worldwide, the incidence in North America has become almost negligible because of the highly effective primary immunization program. Recently, there have been no deaths reported attributable to tetanus in the United States in trauma patients who had received the primary childhood immunization. However, tetanus immunization and prophylaxis in the acute injury setting is frequently misused and misunderstood. METHODS: A review of the literature regarding tetanus. RESULTS: After review, the authors recommend tetanus toxoid in adults only if it has been more than 10 years since their last immunization. There is no urgency for the administration of tetanus toxoid in the acute setting, as it provides protection against the next injury and not the current injury. Tetanus-diphtheria toxoid is not required unless there are plans for the injured patient to travel to diphtheria-prone countries in the future, as the incidence of diphtheria is negligible in the United States. CONCLUSION: The review of reported cases of tetanus demonstrates that it is not possible to clinically determine which wounds are tetanus prone, as tetanus can occur after minor, seemingly innocuous injuries, yet is rare after severely contaminated wounds. Tetanus immunoglobulin should be reserved for patients with wounds who had never received primary immunization against tetanus.

Adult↗
PubMed2003

Vaccination coverage among children enrolled in Head Start programs, licensed child care facilities, and entering school--United States, 2000-01 school year.

The implementation of state and local requirements for vaccination before entry to Head Start programs, licensed child care facilities, and school has resulted in high vaccination levels among preschool and school children. One of the national health objectives for 2010 is to maintain > or = 95% vaccination coverage among children attending licensed child care centers and kindergarten through postsecondary school (objective 12-23). National estimates of vaccination coverage among children in Head Start programs, licensed child care facilities, and those entering school have been published each year since 1997 on the basis of reports from federally funded immunization programs (IPs) in the 50 states, five cities, eight territories, and the District of Columbia. This report summarizes data reported by states, cities, and the District of Columbia for the 2000-01 school year. Although vaccination coverage for 2000-01 appears similar to that for previous years, the number of programs reporting and the completeness of the reports are lower than in previous years and do not permit precise estimation of coverage at the national level. IPs use school data to identify undervaccinated children enrolled in Head Start programs, licensed child care facilities, and those entering school; evaluate the success of prevention programs targeting these children; and document the proportion of children whose parents claim exemptions from one or more vaccines. Plans are ongoing to assist IPs in applying successful strategies for collecting, reporting, and increasing the precision of coverage estimates for these populations.

Child↗
PubMed1992

Vaccinations.

Tetanus-diphtheria toxoid, influenza virus vaccines, and pneumococcal vaccine are recommended for older persons in the United States by the Centers for Disease Control. But most high-risk older persons remain unvaccinated, despite experiencing relatively high rates of tetanus, influenza-related complications, and pneumococcal disease, and having available effective, safe, and low-cost vaccines. Strategies for improving these vaccination rates require an intensive approach focused on (1) identifying older persons with high-risk conditions, (2) improving the delivery of vaccines, (3) improving the acceptance of vaccines by older persons, and (4) establishing mandatory immunization programs.

Aged↗
PubMedDate not supplied

BCG vaccination in India and tuberculosis in children: newer facets.

With the extended programme of immunisation and since 1985 the universal programme of immunisation and the coverage status of BCG vaccination in India has been very good, although it is still unsatisfactory in the eastern states. It is emphasized that BCG vaccination cannot prevent natural tuberculous infection of the lungs and its local complications, although it reduces the haematogenous complications of primary infection. However, this is not true for malnourished children who, inspite of BCG vaccination, develop serious, and often fatal types of tuberculosis such as miliary, meningitic and disseminated tuberculosis. The tuberculin anergy in malnourished children, is mainly responsible for high morbidity and mortality. BCG vaccinated, well-nourished children manifest modified patterns of tuberculous disease, following infection. The most important manifestation is the increased incidence of intrathoracic tuberculosis, specially enlargement of the various groups of mediastinal nodes and their local complications. Localisation of the disease by T cell immunity, due to BCG vaccination is responsible for this and the much lower incidence of haemotological complications such as neurotuberculosis and disseminated disease. In these children, the clinical picture of neurotuberculosis is also modified, with a tendency for more localised involvement of the brain and meninges. Similarly, vaccinated children may present with hepatomegaly, splenomegaly or isolated organ disease. It is important to relearn the new patterns of tuberculosis disease seen in vaccinated, non-malnourished children, and to a lesser extent in children with grade 1 to 2 protein energy malnutrition (PEM). With these limitations of BCG vaccination, other strategies like chemoprophylaxis need multicentric trials in high risk children, in different parts of the country.

BCG Vaccine↗
PubMed1995

Prevention of hepatitis B by immunization of the newborn infant--a long-term follow-up study in Stockholm, Sweden.

In order to assess the present hepatitis B immunization program in Stockholm, Sweden, 212 children of HBsAg carrier mothers were followed up 2-9 years after birth. In babies of HBeAg-positive mothers a combined passive and active immunization schedule with hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine was used. Among 25 children to such mothers, 1 HBsAg carrier and 5 children with asymptomatic seroconversion were found. To newborns of HBeAg-negative/anti-HBe-negative mothers, only vaccine was given. Among 15 such children, no HBsAg carrier (but 1 child with an asymptomatic seroconversion) was found. In babies of HBeAg-negative/anti-HBe-positive mothers, immunization was withheld between 1983 and 1987. Among 90 such children, 1 HBsAg carrier and 8 asymptomatic seroconversions were detected. After 1987, newborns in this group were vaccinated whereafter 3 asymptomatic seroconversions were found among 82 children. We conclude that in low prevalence areas a screening program for HBsAg should be offered to pregnant women originating from hepatitis B endemic regions, since immunoprophylaxis gave long-term protection to most children at risk. Children born to HBeAg-positive mothers should receive vaccine in combination with HBIg, whereas for children of mothers lacking HBeAg, vaccination only seems sufficient, at least if a rapid vaccination schedule is used.

Carrier State↗