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PubMed1997

[Vaccination coverage in young children and school children in the Bern canton].

In 1995 immunization coverage at 24 months of age and after the first school year was estimated according to the method recommended by the WHO. Vaccination booklets of 840 children born in 1986, 1987, 1988 or 1991 in the Canton of Berne were reviewed. The response rate was high (96%). The immunization coverage at 24 months of age were for measles 74%, for mumps and rubella (MMR) 72% higher than for diphteria (D), tetanus (T) (62%) and poliomyelitis (polio) (60%) (4 doses) (p < 0.0001). Of the Swiss children born in 1991 32% were vaccinated against tuberculosis. Children 24 months of age of all years had generally a similar immunization coverage. The 101 children of foreign nationalities showed somewhat lower vaccination rates. Immunization uptake for MMR, DT and polio (4 doses) increased over time, so that children born in 1986 at 8.5 years of age had the rate (> 95%) to be reached at the end of the second year of life. After the first school year 88% of the 8.5 years old children presented a vaccination against MMR and 91% a vaccination against measles. Intensified efforts are necessary to achieve a higher immunization coverage at 24 months of age especially among children of foreign nationality, a timely administration of vaccines according to recommended immunization schedule and to restrict BCG vaccine to children at increased risk of tuberculosis.

Child↗

PubMed1998

[General hepatitis B vaccination in Switzerland: what is the attitude of vaccinating physicians?].

The purpose of this study is to assess Swiss physicians' knowledge on hepatitis B, their perception of parental information concerning this infection, their attitude towards planned universal vaccination, and their agreement with different universal immunisation scenarios. Vaccination scenarios were assessed in the following groups: infants, children at school entry, children aged 11 to 13, and children aged 14 to 16. Furthermore, scenarios involving the immunisation of school-aged children included the administration of the vaccine doses by the child's private physician or by the school health officer. Questionnaires were mailed to members of the Swiss Society of Pediatrics (n = 994), to a random sample of family physicians (n = 1000), to internists practicing general medicine (n = 500), and to chief medical officers of school health services in nine major Swiss cities. Physicians reported that they were sufficiently well informed on the serious potential sequelae of hepatitis B and the efficacy of vaccine prevention, but insufficiently informed on its epidemiology. They do not fundamentally disagree with the introduction of universal immunisation and think that parents are not aware of the potential long term dangers associated with this infection. Pediatricians and general practitioners believe that vaccinating infants at the cost of three extra injections would not be accepted by their peers and parents, and that immunising older children in their office would be feasible though difficult. School health officers believe that the immunisation of children aged 14 to 16 within the school health setting would be feasible. Universal vaccination of older children and adolescents is the scenario that best fits Switzerland's needs, perceptions and present circumstances.

Adolescent↗

PubMed1998

[Economic evaluation of various hepatitis B vaccination Strategies in Switzerland].

The aim of this study was to assess and compare the costs and epidemiological impact of different vaccination strategies against hepatitis B in Switzerland. A birth cohort of 85,000 individuals was followed over its lifetime using a decision tree analysis. Published data were used to simulate the risk of hepatitis B virus (HBV) infection in the cohort, the consecutive clinical outcomes and the associated costs. Five vaccination scenarios were assessed and compared to the baseline, defined as the high-risk group strategy without prenatal screening. These were: 1. systematic prenatal screening and vaccination of newborns at risk; 2. universal vaccination of infants; 3. universal vaccination of schoolchildren; 4. universal vaccination of infants and schoolchildren; 5. universal vaccination of infants, schoolchildren and adolescents. Results are presented using a 3% annual discounting rate. Systematic prenatal screening reduced the number of chronic infections by 11% and prevented 6 deaths per year. The cost per year of life saved was estimated to be 23,350 CHF. The four universal vaccination scenarios had a much larger impact on the number of chronic infections and deaths prevented (reduction of 68-78%). Costs per year of life saved for universal vaccination ranged from 8820 CHF (infant strategy) to 12,380 CHF (schoolchildren strategy). However, the vaccination of schoolchildren would be as cost-effective as the vaccination of infants using alternative assumptions (a lower compliance for infants compared to schoolchildren or the need for a booster later in the life for infants). The benefit-cost ratio ranged from 1.2 (systematic prenatal screening and vaccination of newborns at risk) to 2.9 (vaccination of infants). Universal vaccination against hepatitis B is more cost-effective than the current selective vaccination strategy of newborns.

Adolescent↗

PubMed1998

[Introduction of general hepatitis B vaccination in Switzerland].

The Swiss Federal Office of Public Health and the Advisory Board on Immunisation recommended that all adolescents aged 11 to 15 should be vaccinated against hepatitis B in December 1997. The introduction of universal immunisation is justified for epidemiological and economical reasons. Universal immunisation in no way excludes the immunisation of all persons exposed to a specific risk and the prenatal screening and immunisation of exposed newborns. Hepatitis B vaccines are safe and highly effective. The main reasons for this recommendation are summarised in the article.

Adolescent↗

PubMed1998

[Practical recommendations for general introduction of hepatitis B vaccination].

The Swiss Federal Office of Public Health and the Swiss Advisory Board on Immunisation recommended that universal vaccination against hepatitis B be introduced in January 1998. The target population for immunisation are youngsters between 11 and 15 years of age. This recommendation does not preclude ongoing selective vaccination of individuals in high risk groups, nor the routine immunisation of individuals younger or older than the target age (if needed). Injections should be given in the deltoïd area and needle length is critical to ensure proper resorption of the antigen and adequate immune response. Three doses are recommended at times 0, 1 month and 6 months with no booster dose. The time interval between the second and third dose should not be shorter than 2 months but can be longer than 5 months. Vaccination initiated with one commercial brand can be completed with a different brand. The simultaneous administration of immune globulin with the initiation of vaccination and the measurement of serum antibodies after completion of vaccination are unnecessary.

Adolescent↗

PubMed2000

Evaluation of pulse-polio immunisation in rural area of Maharashtra.

An evaluation survey on Pulse-polio Immunisation (PPI) in January 2000 was carried out in rural areas of Maharashtra to assess the immunisation coverage, the knowledge regarding pulse-polio and the routine immunisation schedule. House-to-house survey was carried out and information was collected by interviewing the parents of 778 children. It was observed that PPI coverage was excellent i.e., 98%. Majority of informants were female. Knowledge about pulse-polio had a direct relationship with literacy. But knowledge regarding routine immunisation and the polio disease was not found satisfactory. Excellent coverage of pulse-polio Immunisation was found because of an organised and extensive campaign, use of mass media like T.V., radio, and home visits of peripheral health staff (as told by the informants). The distance of approach to a polio booth was less than a kilometre in almost all cases. Behaviour of health staff was satisfactory everywhere. The time-period required for getting vaccinated after arrival at the polio booth was less than 5 minutes. Thus it was a worthwhile attempt to evaluate PPI coverage is rural areas of Maharasthra. Excellent coverage of pulse-polio immunisation gives us the picture that poliomyelitis is on the verge of being eradicated from India, if the excellent coverage of PPI is followed by effective surveillence.

Adult↗

PubMed2004

[Prevention by vaccination of children and young people. Obstacles and examples of effective measures in the Federal State of Brandenburg].

This article identifies successful vaccination strategies, obstacles to such strategies and the role that schools can play in terms of health education by analysing vaccination rates among children in the Federal State of Brandenburg. The analysis is based on the vaccination status of Brandenburg's children at day care centres and schools in relation to the social status of their parents, the extent to which preventive examinations (U up to J1) is taken advantage of and regional location. Furthermore, an evaluation is rendered of the vaccination awareness campaign which has been carried out in sixth grade students since 2002 to assess the impact of health promotion at schools. In the Federal State of Brandenburg vaccination coverage among infants and toddlers is good, with approximately 94% having received complete basic vaccination in 2003. By contrast, there are marked deficits among tenth grade schoolchildren in terms of refresher vaccinations, basic hepatitis B vaccinations and the second measles, mumps and rubella (MMR) vaccinations. Vaccination status is strongly dependent on the social status of parents and the extent to which preventive medical examinations and regional medical health-care provision are utilized. Systematic checking of vaccination documents by the public health services promotes vaccination awareness. Prevention by vaccination is most effective when combined with preventive medical examinations, effective local vaccination management and interdisciplinary interventions: education at schools, systematic tracking of vaccination documents combined with the provision of vaccinations in doctors' surgeries and additionally by the public health services.

Adolescent↗

PubMed2005

[Vaccinations in adults--who? when? why?].

Despite the success of childhood vaccinations in Europe, many infectious diseases pose a threat to adults, particularly because immunity induced by vaccination is not life long in some cases. This paper presents the rationale for adult boosters for diphtheria, hepatitis B, pertussis, poliomyelitis and tetanus. Moreover indication for adult-vaccinations against measles, mumps, German measles and varicella is discussed, as a significant part of the population in Germany is susceptible or without known immunity/vaccination history. Finally, immunisation of the elderly against infections with influenza-virus and S. pneumoniae will be described.

Adult↗

PubMed2006

Compliance with recommended immunizations in adolescents.

INTRODUCTION: Little is known about the completeness and timely administration of recommended standard immunizations in Germany. The goal of this study was to determine compliance with official standard immunization recommendations in adolescents attending secondary schools in the city of Erlangen, Germany. METHODS: Adolescents who were attending 5th grade (at approximately 11 years of age), 8th grade (14 years), or 10th and 11th grade (16-17 years) classes at any of the 13 of 14 schools that had agreed to participate were eligible to be enrolled. RESULTS: While coverage for the primary series of diphtheria, tetanus and poliomyelitis immunizations was satisfactory (98%), coverage for measles-mumps-rubella immunizations (dose 1: 89-96%; dose 2: 60-76%) and hepatitis B (doses 1-3: 61%) was suboptimal. Of note, 39% of students had not received any immunization against pertussis. Completion of immunization series generally was significantly delayed. Furthermore, rates for recommended booster doses in adolescence were disappointingly low with 21% for tetanus component vaccines and <10% for the fifth dose of pertussis. CONCLUSIONS: Significant immunization gaps for all recommended standard immunizations in adolescents were detected. This puts individuals at risk for serious vaccine-preventable diseases, contributes to suboptimal herd immunity in the population under study leaving the potential for future epidemics, and impedes national and international targets of disease reduction or elimination.

Adolescent↗

PubMed1998

Childhood immunisation in the European Union. Confederation of European Specialists in Paediatrics (CESP).

Harmonisation of working conditions is one of the major aims of the European Union. The Confederation of European Specialists in Paediatrics has elaborated documents on the harmonisation of immunisations in 1987 and 1992. The new and completely updated version focuses on the variations of immunisation practices and schedules and gives criteria for minimal agreement of immunisation schedules among the member countries. Catch-up vaccinations and false contra-indications are especially stressed.

Adolescent↗

PubMed2005

Mutation analysis of hepatitis B virus promoters in chronically infected children.

Hepatitis B viral (HBV) infection in early childhood is one of the leading causes of chronic hepatitis and liver cirrhosis that eventually lead to hepatic carcinoma. Despite the nationwide immunization programs to curtail the vertical transmission of HBV, childhood HBV infection through mothers is still occurring in Korea. As one of the efforts to understand the childhood HBV infection in Korea, four HBV promoter sequences in the sera of the chronically infected children were analyzed. Children harbored diverse viral variants as most of the chronically infected adult patients, but the deletion mutations were rare. The dominant viral sequences in the children were highly similar to the ones in the respective mothers, indicating that the maternal viruses were most likely transmitted to the children. The mutations in X, S1, S2/S promoters did not seem to show any correlation to the severity of the disease nor ages of the children. The mutations that showed some correlation to the severity of the disease were the mutations in C promoter, but the mutations did not seem to be vertically transmitted. Finally, the children with the elevated ALT/AST levels tended to have more child-specific variants suggesting that the accumulation of host-specific mutations might be associated with the development of clinical symptoms.

Adolescent↗

PubMed2004

Risk factors for undervaccination against measles in a large sample of preschool children from rural Bavaria.

BACKGROUND: Due to insufficient vaccination rates, measles outbreaks still pose a threat to public health in Germany. The purpose of this study was to identify risk factors for undervaccination against measles. PATIENTS AND METHODS: Datasets from two cross-sectional surveys were analyzed by logistic regression models. The surveys had been done prior to and after an intervention aiming to raise measles, mumps, and rubella vaccination rates among children entering primary school in five Bavarian counties. Subjects were 9,582 children aged 6 to 7 years and their parents. RESULTS: Main independent predictors of non-immunization were doctors advising against vaccination (OR 84.8; 95% CI 19.9-360.4), doctors abstaining from advice (OR 6.3; 95% CI 4.8-8.4), and parental reservations due to alternative health beliefs (OR 27.9; 95% CI 17.6-44.1). CONCLUSION: Doctors advising against measles vaccination and doctors not giving any advice proved to be important risk factors for childhood undervaccination against measles. Future strategies to increase measles vaccination rates in Germany should focus more on family doctors.

Adult↗

PubMed1996

Relationship between serum prolactin, lactation and changes in maternal blood B-cell (CD19+) percents during the first 8 months post-partum.

Lactation is an immunologically unique state when immune factors are produced by the mother for the protection of the infant rather than the mother. While several studies have focused on the immunological composition of human milk, much less information is available on maternal immune status during lactation. Sixty-four lactating and 43 bottle-feeding women at 1-2 weeks, 1, 2, 4 or 8 months post-partum were studied in a cross-sectional design, with 14 nulliparous women as controls. Flow cytometry analysis of peripheral blood lymphocytes showed dynamic, post-partum changes in the B-cell subpopulation. Among lactating women, the relative percents of CD19+ B-cells were significantly lower (P < 0.05) than control levels at 1-2 weeks and 1 month post-partum, but showed a significant, polynomial-linear rise (P < 0.05) over time, reaching control values by 2-4 months post-partum. Bottle-feeding women had an earlier rise in the percentage of CD19+ cells, with relative percents always significantly higher than their lactating counterparts. The differing patterns may be due to changes in serum prolactin concentrations because, among the post-partum women, relative percents of CD19+ cells were negatively correlated with baseline serum prolactin concentrations. These results have implications for maternal immunization programs designed to enhance maternal and/or infant well-being as well as other maternal health effects related to breastfeeding.

Adult↗

PubMed1992

Impact on the management and delivery of primary health care by a computer-based information system.

Timely and accurate information forms the basis for management to plan and for care providers to take appropriate action. We report from a developing country a research project aimed to strengthen the information infrastructure with a computer at a Primary Health Centre. The software (MCHS) was designed to assist the care providers in the information management for the Maternal and Child Health (MCH) programme activities. In Phase I, a baseline survey was conducted to identify the needs and target groups. In Phase II, the MCHS was integrated into routine delivery of MCH to monitor the target population and help in evaluation. The research project's impact is reflected in enhanced utilization of services and quality in care, as seen by reduction of dropouts from the immunization program. In economic terms, we see that the costs for a fully immunised child are reduced with reduction of dropouts; thus, the computer system contributes to quality assurance and cost effectiveness in delivery of care.

Adolescent↗

PubMed1995

Cross cultural communication of tetanus vaccinations in Bolivia.

Although neonatal tetanus (NNT) is common in developing countries, many people are unaware of its causes and prevention. A study analyzed cultural beliefs and practices to understand how people in three cultural areas in Bolivia (Aymara, Quechua and Tupi-Guarani) think about NNT and tetanus toxoid (TT) immunizations. In all three cultural areas NNT is perceived within a magical and biological framework that involves alternative healing systems and healers. Tetanus immunization programs could be more successful if tetanus were a clearly marked target for the Aymara, Quechua and Tupi-Guarani people, and vaccinators were sensitive to their cultural perceptions. Health workers need to communicate cross-culturally the relationship of TT vaccinations to how members of these ethnic groups perceive NNT.

Attitude to Health↗

PubMed1995

The use of a topical refrigerant anesthetic to reduce injection pain in children.

Early childhood experiences with painful injections may lead to anxiety and fear. These reactions need not develop if steps are taken to reduce the pain associated with injections. The purpose of this study was to assess the efficacy of a refrigerant topical anesthetic in reducing injection pain in preschool children experiencing routine diphtheria-pertussis-tetanus (DPT) immunizations. This double-blind placebo-controlled study was conducted in community health clinics in conjunction with ongoing immunization programs. Ninety subjects, aged 4-5.5 years, were randomly assigned to one of three groups: (a) refrigerant topical anesthetic; (b) placebo topical spray; and (c) no-spray control. Pain was measured subjectively using a four-point visual analogue scale. Both the refrigerant topical anesthetic spray and the placebo spray significantly reduced injection pain. Age was found to be an important factor influencing pain response in this study. Parental anxiety was not a significant factor influencing pain response. In addition, parents were not good at predicting their child's pain. The results of the study support the use of an intervention, such as refrigerant topical anesthetic, as a practical, simple, and effective treatment strategy for reduction of short-term painful procedures like injections.

Administration, Topical↗

PubMedDate not supplied

Challenges and successes of immunization registry reminders at inner-city practices.

OBJECTIVES: To assess the effectiveness of two serial registry reminder protocols and the interactive effects of reminders with child characteristics on immunization rates. METHODS: At an inner city practice network in New York City we randomized 1662 children aged 6 weeks-15 months due or late for a diphtheria-tetanus-pertussis (DTaP) to 3 groups: continuous reminders (as needed), limited reminders (up to 3) and controls, for 6 months. Reminders were triggered by the hospital registry and immunizations were tracked with both the hospital and city registries. Analyses were based on intention to treat. RESULTS: At randomization, the study groups were comparable (9.2 months of age, 77% Latino, 86% Medicaid, 49.3% up-to date). A quarter of the children were sent false reminders, 15% had incorrect contact information, and 15% had missed opportunities for vaccination. In the univariate analysis, reminders improved coverage rates, but only for the children sent continuous reminders (51.2% vs. 44.9% controls, p < .01). Multivariate analysis showed reminders had no independent effect on immunization outcomes. Age, up-to-date and Medicaid status at randomization were strong predictors of a child receiving any subsequent immunization. However, reminders interacted synergistically with Medicaid to increase the likelihood of receiving an immunization. CONCLUSION: At an inner city practice network, registry reminders were not effective at improving immunization outcomes due to major system barriers. Immunization registries are powerful vehicles for identifying children in need of immunizations and generating reminders but system challenges must be addressed if this promise is to be achieved in inner city practices.

Black or African American↗

PubMedDate not supplied

Improving influenza vaccination rates for children through year-round scheduling.

OBJECTIVE: Barriers to influenza vaccination negatively impact immunization rates contributing to the morbidity and mortality from influenza. This study sought to determine if 1) the availability of year-round scheduling of annual autumn/winter influenza vaccination was associated with improved immunization rates for 2 high-risk populations of children and 2) this system was associated with early season vaccine administration. METHODS: A retrospective cohort analysis was utilized to compare immunization rates during the 2003-2004 and 2004-2005 seasons. Billing records were used to determine eligible patients and vaccine receipt. A single, pediatric practice was studied, and two groups of patients were analyzed: 1) infants aged 6-23 months and 2) children < 21 years old with asthma. As opposed to Year 1, in Year 2 appointments in "flu clinics" for the following autumn became available 7 months prior to when vaccine became available. Patients and providers could therefore schedule an immunization appointment throughout the year. RESULTS: In Year 1, 552/1365 (40.4%) infants received at least 1 dose of influenza vaccine compared to 940/1265 (74.3%) in Year 2 (p < 0.001). For patients with asthma, 309/1332 (23.2%) received at least 1 dose of vaccine in Year 1 compared with 522/1489 (35.1%) in Year 2 (p <0.001). Both groups also achieved higher immunization rates between September and November in Year 2 (p < 0.001). CONCLUSIONS: Year-round scheduling of influenza vaccination was associated with improved immunization rates in two high-risk populations, and may remove the barrier of scheduling difficulty, allow for a consistent year-round message from providers, and improve timing of vaccine administration.

Adolescent↗