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PubMed2002

Economic analysis of the 1992-1993 mass immunization campaign against serogroup C meningococcal disease in Quebec.

The objective of the study was to evaluate the cost-effectiveness and utility of the mass immunization campaign performed in the province of Quebec in 1992-1993, following an outbreak of serogroup C meningococcal disease (CMD). Effectiveness data were extracted from a population-based cohort study, and cost estimates were obtained from surveys. Costs of the campaign to the health system were $ 26 million (1993 Canadian dollars). Between 48 and 74 CMD cases, and between 7 and 11 deaths were prevented in the following 5 years. Net societal costs were between $ 18 and 21 million (using a 3% discount rate), net costs per death averted were between $ 1.7 and 3.0 million, between $ 58,000 and 105,000 per life-year gained, and between $ 49,000 and 87,000 per quality-adjusted life-year gained. These economic indices are less favorable than those for current routine immunization programs in Canada, but within the range of those for other common health interventions.

Cohort Studies↗

PubMed2004

Evaluation of strategies for use of acellular pertussis vaccine in adolescents and adults: a cost-benefit analysis.

Pertussis is increasingly recognized as a source of infection in adults who then commonly infect young children. Immunity to illness caused by Bordetella pertussis is not long-lived, so optimal control of pertussis may require booster immunizations. In a cost-benefit analysis, we evaluated the benefits of 7 independent strategies for administering a pertussis booster, in the form of a diphtheria-tetanus-acellular pertussis vaccine, to adolescents and adults. Break-even vaccine costs for each strategy were calculated by dividing costs preventable by vaccine by the number of persons eligible for vaccination. Of these strategies, the most economical would be to immunize adolescents 10-19 years of age, which would prevent 0.7-1.8 million pertussis cases and save 0.6 dollars-1.6 billion dollars over a decade. Although justified by our analysis, routine adult booster vaccinations every decade would be more expensive and more difficult to implement. A recommendation for booster vaccinations every 10 years requires more information about duration of immunity, program costs, compliance, and nonmedical costs associated with pertussis.

Adolescent↗

PubMed2002

Recommended adult immunization schedule--United States, 2002-2003.

Although the childhood immunization program in the United States has reduced the burden of vaccine-preventable disease substantially among children, substantial vaccine-preventable morbidity and mortality from diseases such as hepatitis A, hepatitis B, influenza, and pneumococcal infections continue to occur among adults. In February 2002, the Advisory Committee on Immunization Practices (ACIP) approved for the first time a schedule for the routine vaccination of persons aged > or = 19 years. The Adult Immunization Schedule has been accepted by the American Academy of Family Physicians (AAFP) and the American College of Obstetricians and Gynecologists (ACOG). ACIP will review and approve annually both the recommended adult and childhood immunization schedules. Together, these schedules provide a comprehensive summary of recommendations for prevention of vaccine-preventable diseases during the life span of persons in the United States.

Adult↗

PubMed2005

Prevalence of tetanus immunity in the Kocaeli Region, Turkey.

We assessed the antibody levels and risk factors for tetanus in an adult population in the Kocaeli Region of Turkey. In 595 individuals over 20 years of age, serum concentrations of anti-tetanus antibodies were detected by enzyme-linked immunosorbent assay and a brief questionnaire was administered. The overall immunity rate was approximately 80% and there was a progressive decline in protection with increasing age. Antibody levels were significantly higher in educated people (80.1%), in employed people (90.3%), in those under 40 years of age (95.0%) and in those who stated that they had received a previous tetanus vaccination (87.9%). There was no association between antibody level and sex, residence, socioeconomic status, military status or history of injury. These data indicate that a vigorous post-injury prophylaxy with antitoxin and antisera should be put into practice, especially for older people, and that immunization programs applied every 10 years must be strengthened.

Adult↗

PubMed1995

Immunization compliance outside the health plans. A non-HMO report card.

PURPOSE: To assess the rate of completed immunizations by age 24 months in children cared for by a private medical practice. METHODS: A chart review of all children born between January 1, 1990, and June 30, 1992, and seen by a provider in this private medical practice at least once between ages 15 months and 24 months. RESULTS: Overall, 77% of children received four DTP immunizations, 78% received at least three OPV immunizations, and 82% at least one MMR by 24 months of age. Seventy-two percent received the recommended combination of one MMR, three OPV, and four DTP immunizations by age 2. Rates were about 5% to 10% higher in children delivered by physicians of the group practice where the study occurred. The presence of a serious medical problem did not statistically significantly change the rates of completed immunizations. The rate of missed opportunities was almost three times as high in those not completing the basic DTP, OPV, MMR immunization series by age 24 months. CONCLUSIONS: Rates of immunizations are high in this private group practice and comparable to those reported by HMOs that care exclusively for children with insurance. However, the rate of missed opportunities is also high, with three to four visits for each child who did not complete the basic immunization series by age 24 months. This private practice report card will be used to improve immunization practices in our medical group.

Child, Preschool↗

PubMed2001

Importance of attributable risk in monitoring adverse events after immunization: hepatitis B vaccination in children.

OBJECTIVES: Most vaccine safety data present only the postvaccination incidence of all adverse events rather than an estimate of attributable risk. This study sought to illustrate the difference between the 2 estimates with data from a hepatitis B immunization program. METHODS: The incidence of health problems occurring before and after each dose of hepatitis B vaccine in a cohort of 1130 children were compared. RESULTS: Although 47.5% of all children reported an adverse event during the 4 weeks following each of the 3 doses, adverse events attributable to immunization occurred in only 10.6% of children. CONCLUSIONS: Postimmunization incidence systematically overestimates the risk of adverse events. Estimating actual attributable risk is necessary to avoid false beliefs regarding immunization.

Adverse Drug Reaction Reporting Systems↗

PubMed1979

Protective efficacy of live influenza vaccines. Its assessment in field and experimental conditions.

Cost benefit estimates of immunization programs are critically dependent on an accurate and reliable assessment of the protection offered by the vaccines. Consequently, the selection of appropriate parameters of protection becomes an issue of major importance. The protective efficacy of live influenza virus vaccines has been established for several vaccinal strains used in routine immunization. This was established under conditions of natural and artificial exposure to both homologous and heterologous influenza viruses. Reduction in the incidence of specific disease--respiratory illness, confirmed by influenza virus isolation and/or four-fold increase in serum HAI titer, was found to be significant. These data will be discussed in relation to available epidemiological models that have been developed for the evaluation of disease modifying properties of immunoprophylactic agents.

Adult↗

PubMed1993

Reactions of pediatricians to a new Centers for Disease Control recommendation for universal immunization of infants with hepatitis B vaccine.

Despite immunization programs targeting high-risk groups, the incidence of hepatitis B has risen 37% over the last decade with 300,000 new infections and 5000 related deaths now occurring annually in the United States. As a new strategy to control the spread of hepatitis B, the Advisory Committee on Immunization Practices of the Centers for Disease Control (CDC) recommended in November 1991 universal hepatitis B immunization of infants. Details were published in an addendum to Morbidity and Mortality Weekly Report. There was no other federal effort to disseminate this recommendation. On February 14, 1992, the American Academy of Pediatrics (AAP) issued a similar recommendation. The time between the CDC and AAP recommendations presented the opportunity to determine the singular effect on clinical practice of the CDC's dissemination effort. The purpose of this study was to assess (1) the effectiveness of the CDC in disseminating a new immunization recommendation, (2) the effect of the new recommendation on clinical practice, and (3) the degree to which noneconomic barriers may affect adoption of universal hepatitis B immunization. All 778 pediatricians in North Carolina were surveyed by mail 2 to 3 months after publication of the new CDC recommendation. Descriptive statistics, chi 2 analysis, and logistic regression were used to assess the relationship of variables hypothesized to predict physician awareness of and/or agreement with the new recommendation. The response rate was 78%. Although 82% of pediatricians who administer immunizations were aware of the new recommendation, only 32% believed it was warranted in their practices.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

PubMed1992

Vaccination levels and missed opportunities for measles vaccination: a record audit in a public pediatric clinic.

A record audit of 254 children attending a public clinic in Los Angeles was conducted to assess immunization levels prior to a measles outbreak in the community. Coverage with all vaccines appropriate for age decreased from 67% at 3 months to 25% at 19 months. Delay in initiating vaccination was associated with increasing risk for delayed measles-mumps-rubella vaccine beyond age 2 years (P less than .05). In one third of children, health care providers missed an opportunity to administer measles-mumps-rubella vaccine. Recall systems and elimination of missed opportunities may increase vaccination levels in clinic populations. Record audits should be considered for use in guiding the management of immunization programs.

Age Factors↗

PubMed1999

Making vaccination policy: the experience with rubella.

The massive rubella epidemic of 1962-1965 stimulated the development of rubella vaccine. Once vaccines were developed, the U.S. vaccination program, initially focused on infants and children, reduced both rubella and congenital rubella. However, later extension of vaccination to certain older age groups achieved significantly better control. While rubella clearly is not the perfect model for pertussis, a review of its history is illuminating. Current rubella vaccination policies resulted from an evolution in scientific understanding. Controversies, including those related to communicability, reactivity, and teratogenicity of the rubella vaccine virus, duration of immunity following vaccination, and protection following reinfection, led countries to use different approaches for national immunization programs. These differences were eventually resolved by clinical and epidemiological research coupled with rigorous scientific debate. Increased scientific understanding of pertussis, its epidemiology, and the effects of the new pertussis vaccines will similarly enable informed decision making on whether to extend pertussis immunization to adolescents and adults.

Adolescent↗

PubMed2006

Lessons and implications from a mass immunization campaign in squatter settlements of Karachi, Pakistan: an experience from a cluster-randomized double-blinded vaccine trial [NCT00125047].

OBJECTIVE: To determine the safety and logistic feasibility of a mass immunization strategy outside the local immunization program in the pediatric population of urban squatter settlements in Karachi, Pakistan. METHODS: A cluster-randomized double blind preventive trial was launched in August 2003 in 60 geographic clusters covering 21,059 children ages 2 to 16 years. After consent was obtained from parents or guardians, eligible children were immunized parenterally at vaccination posts in each cluster with Vi polysaccharide or hepatitis A vaccine. Safety, logistics, and standards were monitored and documented. RESULTS: The vaccine coverage of the population was 74% and was higher in those under age 10 years. No life-threatening serious adverse events were reported. Adverse events occurred in less than 1% of all vaccine recipients and the main reactions reported were fever and local pain. The proportion of adverse events in Vi polysaccharide and hepatitis A recipients will not be known until the end of the trial when the code is broken. Throughout the vaccination campaign safe injection practices were maintained and the cold chain was not interrupted. Mass vaccination in slums had good acceptance. Because populations in such areas are highly mobile, settlement conditions could affect coverage. Systemic reactions were uncommon and local reactions were mild and transient. Close community involvement was pivotal for information dissemination and immunization coverage. CONCLUSION: This vaccine strategy described together with other information that will soon be available in the area (cost/effectiveness, vaccine delivery costs, etc) will make typhoid fever control become a reality in the near future.

Journal Article↗

PubMed2005

Follow-up of infants given measles vaccine at 6 months of age: antibody and CMI responses to MMRII at 15 months of age and antibody levels at 27 months of age.

The worldwide elimination of measles is an important target. In developed countries, to control measles outbreaks, immunization from 6 months of age is recommended. In this study, infants (n = 290) who were (1) born to mothers with natural immunity or to vaccinated mothers and (2) previously immunized with Connaught (CLL) or AIK-C measles vaccine at 6 months of age, were evaluated for measles immunity before and after measles-mumps-rubella (MMRII at 15 months of age. Eight weeks after MMRII, 98.9% of infants were seropositive by enzyme immunoassay (EIA) and 70% demonstrated measles specific cellular immunity by blast transformation (BT) of lymphocytes. At 27 months of age, 98.4% of infants had protective antibody levels by plaque reduction neutralization (PRN) test. These results suggest that AIK-C and CLL vaccines elicit durable protective immunity in young infants when used in early immunization programs.

Aging↗

PubMedDate not supplied

Selective primary health care: strategies for control of disease in the developing world. IV. Measles.

Measles, a highly contagious viral disease, kills several hundred thousand infants and young children yearly. Essentially all children will become infected; at least 1% of those living in developing countries will die unless protected by immunization. In urban areas, peak incidence occurs in those younger than three years. The youngest and most undernourished children suffer the most severe complications and the highest risk of death. Diarrhea, malnutrition, pneumonia, and blindness associated with vitamin A deficiency are the worst complications. The infection is preventable by the timely administration of a potent vaccine. This endeavor requires a well-managed technical and administrative network that remains difficult to organize in many areas of the world. The vaccine is efficacious and has few adverse effects but must be provided to children during the short interval between loss of transplacentally acquired antibodies and the acquisition of natural infection. The improvements in heat stability of the vaccine increase the likelihood of providing potent vaccine, but a well-managed cold chain remains a prerequisite for any successful immunization program. Health education, improved management skills, publicity, and community support are all important factors for ultimately preventing the morbidity and mortality from this disease.

Adolescent↗

PubMedDate not supplied

Decline in infant mortality of Alaskan Yupik Eskimos from 1960 to 1980.

A 1960-62 study of southwestern Alaskan Eskimos documented an infant mortality rate--102.6 deaths per 1,000 live births--that was four times greater than that of U.S. whites. In 1980-81, 20 years after the original study, a similar cohort was identified in this population so that changes in infant mortality and other birth characteristics could be examined. Average birth weight and the amount of prenatal care received by the mothers increased from 1960 to 1980. Birth weight and prenatal visits were positively correlated. Results of the followup also revealed a 1980-81 infant mortality rate--17.1 deaths per 1,000 live births--that was less than a fifth of the 1960-62 rate and no longer significantly different from the national rate. Major changes associated with the decrease in mortality during the first 28 days of life (neonatal mortality) were a significant increase in the proportion of infants born in hospitals and an associated decrease in the number of deaths of infants weighing less than 2,500 grams at birth. The reduction in mortality during the rest of the first year of life was related to a decrease in deaths due to infectious diseases, particularly measles and pertussis. Changes in infant mortality reflect the increased availability of health care in this region, improved immunization programs, and the establishment of the Bethel Prematernal Home in Bethel, AK.

Adult↗

PubMed1989

Modeling malaria vaccines. II: Population effects of stage-specific malaria vaccines dependent on natural boosting.

Population effects of malaria vaccination programs will depend on the stage specificity of the vaccine, its duration of effectiveness, whether it is responsive to natural boosting, the proportion vaccinated, and the preexisting endemic conditions. This paper develops models of infection-blocking (sporozoite), disease-modifying (merozoite), and transmission-blocking (gametic) vaccines. It explores numerically their different effects on prevalence of infection and disease when utilized in different types of immunization programs at various levels of coverage. Simulations show that possible qualitative consequences of malaria vaccination programs include decreased prevalence of infection and disease and decreased prevalence of infection without a corresponding decrease in prevalence of disease. Epidemics, either one-time or cyclical, could occur. These effects could be accompanied by changes in the age distribution of disease. Finally, vaccination could contribute to elimination of transmission. The duration of effectiveness of the malaria vaccine relative to the duration of natural immunity could have important consequences for the unvaccinated. The problem of predicting a threshold for elimination of transmission is discussed.

Animals↗

PubMed2006

Evaluation of immunity against rubella in Iranian after mass campaign for measles-rubella vaccination on December 2003.

BACKGROUND: Prevention of congenital rubella syndrome (CRS) is the main goal of rubella immunization. The World Health Organization (WHO) recommends that countries undertaking measles elimination should take the opportunity to eliminate rubella as well through use of measles-rubella (MR) or measles-mumps-rubella (MMR) vaccine in their childhood immunization programs and campaigns. On December 2003, during a mass campaign for measles-rubella vaccination in Iran, more than 33 million doses of vaccine were administered to 5- to 25-year-old males and females. METHODS: In this study, immunoglobulin (Ig)G avidity assay was used to evaluate the rubella vaccine produced immunity among susceptible populations. RESULTS: Findings indicated that 61.9% of vaccinees (1202 out of 1940) were immune against rubella before vaccination, and 38.1% (738 out of 1940) were susceptible to rubella before vaccination. Our results also showed that 98% of the susceptible group (723 out of 738) acquired immunity against rubella after vaccination, and 2% of them (15 out of 738) did not acquire vaccine-induced immunity to rubella. CONCLUSION: Findings revealed that mass vaccination in December 2003 provided appropriate immune coverage among vaccinees. Also, rubella vaccine induced favorable immunity in a part of the childbearing age female (15-25 years) population, which could prevent congenital rubella syndrome among those females.

Adolescent↗

PubMedDate not supplied

Eradication of poliomyelitis in the United States.

Mass immunization with oral poliovirus vaccine (OPV) was begun in the United States in 1963, and the least natural outbreak of poliomyelitis occurred in 1972. Since immunization programs fail to reach the total population, eradication has been achieved in the presence of a residual susceptible population of at least 5% (2-5 million children under the age of 15 years). It is proposed that the fade-out of wild polioviruses is explained by their disappearance during the winter, a low point in the yearly cycle of the virus. In the post-eradication era, the continued presence of millions of susceptible children and adults presents a constant potential hazard. Every effort should be made to maintain maximal levels of immunization with oral poliovirus vaccine and to prevent the reintroduction of wild polioviruses into the United States.

Adolescent↗

PubMed2000

An adult formulation of a five-component acellular pertussis vaccine combined with diphtheria and tetanus toxoids is safe and immunogenic in adolescents and adults.

Pertussis is increasingly being recognized as an important cause of cough illness in adolescents and adults. To evaluate the safety and immunogenicity of an adult formulation of a five-component (pertussis toxoid, filamentous hemagglutinin, pertactin, fimbriae 2 and 3) acellular pertussis vaccine combined with diphtheria and tetanus toxoids, we randomly allocated 749 healthy adolescents and adults from 12-54 years of age recruited from five Canadian communities to receive either tetanus-diphtheria vaccine (Td), acellular pertussis vaccine (aP) or combined diphtheria-tetanus-acellular pertussis vaccine (TdaP). Subjects and personnel were unaware of the vaccine allocation. Antibody levels were measured before and one month postimmunization; adverse events were collected at 24 and 72 h and 8 to 10 days. Adverse events were reported in similar frequency amongst the three vaccine groups. Moderate pain at the injection site was reported less frequently in the aP group than the TdaP group (10.7% compared to 19.4%; relative risk 0.6, 95% confidence interval 0.3-0.9). Chills were reported less frequently after Td (5.3%) than after TdaP (12.5%; relative risk 0.4, 95% confidence interval 0.2-0.9). There were no statistically significant differences between recipients of Td and TdaP in tetanus and diphtheria antitoxin levels achieved. Antibody response against Bordetella pertussis antigens was vigorous in all groups although recipients of aP alone had higher levels of antibody levels against pertussis toxoid, fimbriae, and agglutinins and lower antibody levels against pertactin than did TdaP recipients. We conclude that this adult formulation 5-component acellular pertussis vaccine is safe and immunogenic in adolescents and adults and is a candidate vaccine for adolescent and adult immunization programs.

Adolescent↗