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At least 937 records · Page 52Linked to original sources
PubMed2003

Impact of influenza on young children and the shaping of United States influenza vaccine policy.

BACKGROUND: In 2002 the Advisory Committee on Immunization Practices (ACIP) began encouraging annual influenza vaccination of children 6 to 23 months of age, when feasible. METHODS: Literature and issues related to annual influenza vaccination of young children were reviewed. RESULTS: The ACIP first encouraged influenza vaccination of children 6 to 23 months of age in 2002 because recent studies showed that influenza-related hospital admissions were substantially higher among healthy children <2 years than among healthy older children or young adults. However, the ACIP deferred a full recommendation for several reasons, including limited safety and efficacy data on trivalent inactivated influenza virus in the 6- to 23-month age group, the need for more education of parents and physicians and concerns over the stability and adequacy of the vaccine supply. CONCLUSIONS: The risk of hospital admission from influenza-related causes is high in young children and similar to the risk in the elderly and other high risk groups for whom annual influenza vaccination is already recommended. Data from additional studies, especially those on vaccine safety and efficacy, will be important for proceeding to a full recommendation for annual influenza vaccination of children 6 to 23 months.

Adolescent↗
PubMedDate not supplied

Strategies for poliomyelitis eradication in developing countries.

Oral polio vaccine (OPV) delivered only through routine services does not appear to interrupt wild virus transmission in the developing countries. The experience in the Americas, which despite intensive surveillance has not confirmed any cases of paralytic poliomyelitis due to wild poliovirus since 23 August 1991, has shown the necessity of delivery of additional doses of OPV through mass campaigns targeted at all children under five years of age regardless of their previous immunization status and in special mop-up operations targeted at this same age group in areas categorized as at high risk of virus transmission, such as those that harbored the virus in the recent past. High-risk areas were determined by empirical observations, which were subsequently confirmed by molecular epidemiology which indicated the presence of several "reservoirs" that helped maintain transmission over several years. During mop-ups, OPV is delivered house by house. This paper discusses the rationale for the utilization of these strategies and outlines the phases for their preparation and evaluation, with illustrations from recent experiences with the last cases of paralytic poliomyelitis in the Americas.

Adolescent↗
PubMed1994

The global capacity for manufacturing vaccines. Prospects for competition and collaboration among producers in the next decade.

Can the world respond to the demands of the Children's Vaccine Initiative (CVI) to produce large quantities of affordable vaccines that have never been manufactured previously? Vaccines for the world's birth cohort of 150 million will continue to be produced in the countries that use the greatest part of the global vaccine supply. Thus, the CVI will rely on increased self sufficiency in vaccine production in the developing world and "shared development" of new and improved vaccines. The CVI's goal is to direct product development to meet the needs of immunization programs, but it must not neglect production. Thus, from the start, investment at the front end of the development and production sequence requires attention to the ultimate production capacity.

Child Welfare↗
PubMed1999

Resurgence of measles in Singapore: profile of hospital cases.

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (</= 18 months) and those aged 16-20 years. The majority was unvaccinated (58/87). A proportion (11/87) demonstrated vaccine failure, most likely primary failures. CONCLUSION: This changing measles epidemiology suggests lowering of herd immunity. 'Catch up' vaccinations in July- October 1997 given to school children aged 12-18 years (200 000 individuals or 82% of cohort), may have helped contain the outbreak. These results substantiated the need for a two-dose policy and 'catch-up' immunization program.

Adolescent↗
PubMed2002

Delayed-type hypersensitivity reaction to anthrax vaccine.

The Anthrax Vaccine Immunization Program is a Department of Defense initiative to protect military personnel against the threat of anthrax. Surveillance for adverse events associated with anthrax vaccination has shown that mild local reactions are not uncommon while systemic reactions are extremely rare. We present a case of 26-year-old male with delayed-type hypersensitivity after two doses of anthrax vaccine.

Adult↗
PubMed1990

[Medical examination of asylum seekers at entry].

It was the purpose of this analysis to summarize the salient findings made with the initial medical examination of asylum seekers in Switzerland. The evaluation covered the period from 1984 to 1987. The epidemiologic impact of diseases discovered by this screening and the logistic problems encountered with the decentralization of the program have required a modification and a reassessment of the necessary measures. As a consequence, indiscriminate stool examinations for bacteria and parasites have been abandoned. These examinations had required a considerable investment which is not considered to be justified by the limited epidemiologic significance of these intestinal pathogens. More emphasis is being placed on improved tuberculosis control measures, by providing concise guidelines for screening, prevention, and treatment. A simplified procedure for hepatitis B screening is to be maintained for the time being, conditional upon special emphasis on children, adolescents and adults of reproductive age groups. Hepatitis B vaccination of seronegative persons is a part of the standard basic immunization program. The core of the screening program and the delivery of initial preventive measures is to be carried out in the federal registration and transit centers for asylum seekers.

Communicable Diseases↗
PubMed1994

The desired field-performance characteristics of new improved vaccines for the developing world.

Although the vaccination initiatives undertaken during the past decade are the cornerstones for protecting the world's children and helping to ensure their survival and development, the vaccines currently being employed may become obstacles for further disease reduction or eradication. Their characteristics complicate or increase the burden on health care infrastructures to maintain or expand vaccine delivery systems. This paper examines an experience with the vaccine technologies that currently are being used by immunization programs in developing countries, illustrating the field problems and obstacles associated with their use. It discusses the advantages and benefits that would accrue if new or improved, heat-stable, multi-antigen vaccines that require only one or two, preferably oral, doses were to become available.

Child Health Services↗
PubMed2002

Simultaneous administration of meningococcal C conjugate vaccine and diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine in children: a randomized double-blind study.

BACKGROUND: Meningococcal C disease can be life-threatening in infants, young children and adolescents. New conjugate vaccines are immunogenic in young infants and induce immunologic memory, so we should consider incorporating them into the routine childhood immunization program. The objective of this study was to measure the safety and immunogenicity of a meningococcal C conjugate vaccine when given with routine childhood vaccines. METHODS: We carried out a randomized, double-blind, controlled clinical trial at children's hospitals in 3 Canadian cities. A convenience sample of 351 healthy 2-month-old infants was enrolled from the community and randomly allocated to receive either meningococcal C conjugate vaccine or the control (hepatitis B) vaccine. All participants received a concurrent injection of the combined diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b (DTaP-IPV-Hib) conjugate vaccine in the opposite limb. Participants were immunized at 2, 4, 6 and 15 months of age; adverse events were recorded after each dose. Serum bactericidal and ELISA meningococcal antibody levels in the participants were measured at 6, 7, 15 and 16 months of age; diphtheria, tetanus, H. influenzae type b, poliovirus and pertussis antibodies were measured at 7 months of age. A total of 323 (92%) participants completed all aspects of the study. The proportion of participants who suffered adverse events after each vaccine dose was the primary safety outcome. Geometric mean antibody titres and the proportion of participants with protective antibody levels after immunization were the primary immunologic outcomes. RESULTS: After 2 doses of the meningococcal C conjugate vaccine 99% of participants achieved a protective ( > or = 1:8) bactericidal meningococcal serogroup C antibody level, and after 3 doses this rate increased to 100%. Antibody levels to the concomitant vaccine antigens in the group receiving meningococcal C vaccine were similar to those in the control group except for higher antidiphtheria antibody titres (p < 0.001). Local injection site reactions (redness and induration) after the meningococcal conjugate vaccine were more frequent than after hepatitis B vaccine but less frequent than after the DTaP-IPV-Hib vaccine. CONCLUSIONS: The meningococcal C conjugate vaccine can be safely and effectively administered at the same visit as the other vaccine antigens routinely given to infants in Canada.

Antibody Formation↗
PubMed1997

Hepatitis B immunisation coverage of infants born to chronic carrier mothers in Victoria.

Infants born to HBsAg- (hepatitis B surface antigen) carrier mothers are highly likely to become chronic hepatitis B (HB) carriers themselves unless their status is recognised at birth and they are immunised with three doses of HB vaccine, the first within 48 hours of birth, concurrent with hepatitis B immune globulin (HBIG). This study was designed to determine how many infants born in Victoria to carrier mothers completed three doses of HB vaccine. We sent the names of all infants of HBsAg-carrier mothers notified in Victoria between 1.7.91 and 30.6.92 to the appropriate local government immunisation providers and requested information on how many doses of HB vaccine, DTP (diphtheria-tetanus-pertussis) or CDT (combined diphtheria-tetanus), and OPV (oral polio vaccine) they had received. The HBsAg-carrier prevalence of women giving birth in Victoria in 1991-92 was at least 0.52%. Of the 336 infants notified, 239 (71.1%) were recorded in local government records. Of these 239, 90.8% received at least two doses and 80.8% received at least three doses of hepatitis B vaccine. There was no significant difference in the number who received three doses of HB vaccine compared with three doses of DTP or CDT vaccine. Of the entire cohort of 336, only 57.4% were documented as being completely immunised against hepatitis B. HB immunisation coverage for these infants needs to be improved. The high rate of loss to follow-up, especially between the maternity hospital and the community, is disturbing. Mechanisms for intensive prospective follow-up of these infants should be developed to prevent loss to follow-up and to encourage full immunisation against HB. Improving HB immunisation coverage of infants in high HBsAg-prevalence ethnic groups and introduction of universal infant HB immunisation may lead to increased coverage of infants of carriers by serving as back-up mechanisms for those lost to follow-up.

Carrier State↗
PubMed1998

Antiretroviral therapy for pediatric and adolescent HIV.

As the number of children infected in the HIV epidemic increases, the school nurse can play an important role in ensuring that these children receive comprehensive health care. Compliance with following an immunization program for HIV-infected children is a potential problem for various reasons. Many of these children come from homes where the mother also has HIV/AIDS. She is likely to be involved in keeping her family together, caring for her own health needs, and meeting financial and social needs of her family. Access to health care may be limited. The majority of vaccines administered within the first few months of life are parenteral and consist of inactivated antigens. Children or infants who are immunosuppressed may be unable to respond to the immunogen, thus rendering them susceptible to many infectious diseases. Heterosexual transmission and pregnancy compound the problems of HIV/AIDS (Flynn, 1994). Compliance following an immunization schedule becomes a greater challenge when working with the adolescent population. Parents may not understand that the risk of receiving vaccine, MMR for example, is less than the risk of severe complications associated with the diseases themselves. Coordination of care between the child, parent, and school district personnel is imperative to minimize the risk of further health-related problems of the HIV-infected child. Encouraging regular immunizations can decrease the child's susceptibility to infection, and administering medications properly can enhance the benefits of the drug therapy. An excellent resource for answering questions of school nurses related to HIV/AIDS is the National Pediatric and Family HIV Resource Center; contact Elaine Gross, R.N., M.S. at 1-800-362-0071.

Adolescent↗
PubMed1980

Federal polices affecting vaccine research and production.

The federal government is the single most important determinant of the extent of vaccine research, development, and use in the United States. Federal actions having a positive effect include the finacing of vaccine research and development and of major public immunization programs. Federal policies that may be contributing to a decline in the private sector's commitment to vaccine development include an unwillingness to resolve certain liability issues. The nation depends heavily on vaccines to prevent several childhood diseases. For that and other reasons, decisive government efforts are needed to help stimulate the creation of new vaccines and to ensure the continued supply and use of existing safe and efficacious vaccines.

Humans↗
PubMed2004

Evaluation of vaccine safety after the events of 11 September 2001: role of cohort and case-control studies.

As immunization programs world-wide "mature" with high vaccine coverage and near elimination of vaccine-preventable disease, vaccine safety issues have increased in relative prominence. In the wake of events of 11 September 2001, fear of bioterrorism has reemerged. The paradigm of eradicating vaccine-preventable diseases, stopping vaccinations and thereby also eradicating the associated vaccine adverse events (a la smallpox) may unfortunately be obsolete. If all vaccinations have to be continued indefinitely, research is needed more than ever to understand and prevent rare vaccine adverse events. Case-control studies are usually best suited for such purposes, especially when nested within a pre-existing large-linked administrative database cohort to minimize bias. The new clinical immunization safety assessment centers may play an important role in bridging the sometimes conflicting clinical and epidemiologic perspectives in vaccine safety.

Case-Control Studies↗
PubMed2005

Epidemiological profile of rotaviral infection in India: challenges for the 21st century.

BACKGROUND: Rotaviruses cause acute viral gastroenteritis worldwide. It has been estimated that, each year, 440,000 deaths that occur among children are attributed to rotavirus infection, mainly in developing countries. In India, the diversity of rotaviruses reported during the 1980s and 1990s emphasizes the need for surveillance of cocirculating strains, to follow the rapid changes in circulation and to detect novel strains. METHODS: We analyzed data from published epidemiological studies, to collate available information on serotyping and genotyping of rotaviruses before the initiation of a national rotavirus surveillance program. The studies included 18 Indian cities and were performed during 1996-2001. RESULTS: Rotaviruses were detected in 23.4% of patients with diarrhea who presented to the hospital. There were marked geographic differences in virus circulation, with G1 being the single most common G type identified in all parts of India, except for western India. Group B rotaviruses were reported from Kolkata and Pune. Human infections with strains G6, G8, G10, and G9P[19], which may occur as a result of zoonotic transmission of bovine and porcine rotaviruses, were reported from western, southern, and eastern India. CONCLUSIONS: The remarkable diversity of rotaviruses circulating in India highlights the need for uniform, widespread surveillance for rotaviruses before the initiation and during the implementation of immunization programs.

Animals↗
PubMedDate not supplied

Biomedical immunization waste management--an AP experience.

The partnership project with Gates foundation grant in 2001 was rolled out in a phased manner to strengthen routine immunization with introduction of Hepatitis B and AD syringes into immunization program. Initial success lead to reworking of plans for fast expansion, in three years with consolidation and strengthening in last two years. With introduction of AD Syringes the issue of safe disposal became prominent. Operational research on the safety box led to modifications in the prototype, introduced new challenges to find local manufacturers to make the product for wider introduction. This improved scope to coordinate with other projects to integrate safe injection pits into the disposal system, try out new solutions for sharps waste management in light of new pollution control guidelines. Study at Mehboobnagar district point towards feasibility of introducing small puncture proof containers and needle cutters as a solution for sharps waste management at the rural settings. Injection safety has been introduced in immunization sector and the challenge still remains to extend this to the curative sector, which contributes to more than 90% of the problem.

Guidelines as Topic↗
PubMed1998

Molecular mechanisms of bacterial pathogenicity.

Cautious optimism has arisen over recent decades with respect to the long struggle against bacteria, viruses, and parasites. This has been offset, however, by a fatal complacency stemming from previous successes such as the development of antimicrobial drugs, the eradication of smallpox, and global immunization programs. Infectious diseases nevertheless remain the world's leading cause of death, killing at least 17 million persons annually [61]. Diarrheal diseases caused by Vibrio cholerae or Shigella dysenteriae kill about 3 million persons every year, most of them young children: Another 4 million die of tuberculosis or tetanus. Outbreaks of diphtheria in Eastern Europe threatens the population with a disease that had previously seemed to be overcome. Efforts to control infectious diseases more comprehensively are undermined not only by socioeconomic conditions but also by the nature of the pathogenic organisms itself; some isolates of Staphylococcus aureus and Enterobacter have become so resistant to drugs by horizontal gene transfer that they are almost untreatable. In addition, the mechanism of genetic variability helps pathogens to evade the human immune system, thus compromising the development of powerful vaccines. Therefore detailed knowledge of the molecular mechanisms of microbial pathogenicity is absolutely necessary to develop new strategies against infectious diseases and thus to lower their impact on human health and social development.

Bacteria↗
PubMedDate not supplied

Measles immunization in Saudi Arabia: the need for change.

This paper describes the measles immunization programme in Saudi Arabia and the change from the single-dose schedule with the Schwartz vaccine to the double-dose schedule with the Edmonston-Zagreb vaccine. The recent measles-mumps-rubella school campaign is also described.

Antibodies, Viral↗
PubMed2004

Seroprevalence of hepatitis B and C in the Western Brazilian Amazon region (Rio Branco, Acre): a pilot study carried out during a hepatitis B vaccination program.

In 1999, on the occasion of the application of the first vaccine dose during the state vaccination campaign against hepatitis B virus (HBV), 390 individuals from the town of Rio Branco, Acre, aged two or more years were selected for the determination of the seroprevalence of HBV and HCV. HBV markers (HBsAg, anti-HBs, and anti-HBc IgG) were determined on this occasion and anti-HBs antibodies were also assessed 30 days after the third vaccine dose. At the time of vaccination, 39% of the individuals were still susceptible to HBV, while 61% presented serologic evidence of previous HBV contact or previous vaccination. The individuals with previous HBV contact were significantly older (p<0.001) than those without HBV markers. Of the 192 individuals who returned for reexamination, 30 days after the third dose, 158 (82.3%) had received three vaccine doses, and only 60 (31.2%) belonged to the group without HBV markers. In these individuals, the seroconversion rate after the third dose was 92% (55/60). In conclusion, we found considerable HBV in this population, indicating the need for pursuing the immunization programs. We also found high rates of vaccination coverage in the Western Brazilian Amazon region.

Adolescent↗