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PubMed2000

Epidemiology and control of diphtheria in the Republic of Moldova, 1946-1996.

In 1994-1996, the Republic of Moldova was stricken with an epidemic of diphtheria after >30 years of routine diphtheria immunization and the near absence of the disease for nearly 20 years. The intensity of the epidemic gradually grew, reaching a peak in 1994-1995. The epidemiology of diphtheria in Moldova during this period is described along with laboratory findings and control measures. Pharyngeal diphtheria was the predominant clinical form of the disease (97% of cases), and it most often developed in a localized form (70%), with 20% in the toxic form. The clinical diagnosis of diphtheria was bacteriologically confirmed in 91% of cases: Of the cases tested for biotype, 91.3% were gravis, 8.5% were mitis, and 0. 2% were intermedius. Of 494 toxigenic isolates from cases and carriers at the beginning of the epidemic, 47% were nonphagotypeable strains, and 25.7% were phagotype VI strains. Aggressive population-based diphtheria control measures, a mass immunization campaign, rapid case identification, antibiotic prophylaxis and supplemental immunization of close contacts in clusters of infection, and high coverage with routine immunization rapidly controlled the epidemic within Moldova.

Adolescent↗
PubMed2000

Epidemic investigation of diphtheria in the Republic of Armenia, 1990-1996.

While incidence rates of diphtheria steadily declined in Armenia after World War II, reemergence of the disease in 1990 brought about changes in public health practices and identified resource needs. The Armenian Ministry of Health (MOH) routinely collected diphtheria case reports, as a reportable health outcome. Diphtheria incidence rates increased from 0.02/100,000 in 1993 to 1/100,000 (36 cases) in 1994. The distribution of cases showed that the greatest number of illnesses and deaths occurred among persons 5-14 years old, yet incidence rates among persons 1-4 and 5-14 years old were similar (4. 4 cases/ and 4.3 cases/100,000, respectively). During 1990-1996, 9 (75%) of 12 cases who died and 18 (21%) of 84 cases who survived had not been vaccinated. The diphtheria epidemic in Armenia was an important, serious, and signal public health event. The Armenian MOH responded by revising immunization practices (1994), improving epidemic control measures (1995), and soliciting international resources (1992-1996).

Adolescent↗
PubMed2000

Universal immunization: the diphtheria control strategy of choice in the Republic of Tajikistan, 1993-1997.

During the 1993-1997 diphtheria epidemic in Tajikistan, the incidence rate was the highest observed throughout the Newly Independent States of the former Soviet Union (76.2 cases/100,000 population in 1995). Factors that contributed to this situation included an increase in the number of persons who were not fully immunized, a breakdown of health care services and disease surveillance, civil war, an increase in migration, shortages of qualified medical personnel, and shortages of products, resources, and services. The Ministry of Health and numerous international organizations have worked to address the needs of the republic, and in the fourth quarter of 1995, the number of reported cases began to decrease. It is believed that this decrease was largely the result of routine immunization, implementation of national immunization days, and use of a World Health Organization-recommended system for working with patients and contacts, and it underscores the importance of universal diphtheria immunization with special booster doses in such an epidemic setting.

Adolescent↗
PubMed2000

Epidemic diphtheria in the Newly Independent States of the Former Soviet Union: implications for diphtheria control in the United States.

The re-emergence of diphtheria in the Newly Independent States of the former Soviet Union in the 1990s raised global awareness of the potential for resurgent disease in countries with long-standing immunization programs. In the United States, the large population of susceptible adults and the possibility of a reintroduction of toxigenic strains of diphtheria create a setting in which diphtheria could spread. In addition, at least one focus of continued circulation of endemic toxigenic Corynebacterium diphtheriae has been identified. Few physicians now have expertise in the diagnosis and treatment of persons with diphtheria, and laboratory capacity is lacking throughout the country. These concerns highlight the importance of maintaining high levels of age-appropriate diphtheria toxoid vaccination, surveillance, accessible and reliable laboratory testing, and training of health care providers. Although the risk of resurgence of diphtheria in the United States is low, public health authorities must ensure that the capacity to recognize, diagnose, and control diphtheria is maintained.

Age Factors↗
PubMed2000

Ability of 3 different meningococcal C conjugate vaccines to induce immunologic memory after a single dose in UK toddlers.

To test for immunologic memory after a single dose of meningococcal C conjugate (MCC) vaccine in toddlers, 226 children 12-18 months old were randomized to receive 1 of 3 MCC vaccines, with a C polysaccharide booster 6 months later. The protein conjugate was diphtheria mutant toxoid in 2 vaccines (MCC-CRM(197)) and was tetanus toxoid in the third (MCC-TT). One month after the MCC vaccines, 91%-100% of children had serum bactericidal antibody (SBA) titers > or =8, and 89%-100% had a > or =4-fold increase. Geometric mean titer (GMT) increased from <4 to 215 (95% confidence interval [CI], 166-279). MCC-TT induced higher SBA GMTs (P<.001) and higher proportions with SBA > or =8 (P=.02) than did the MCC-CRM(197) vaccines. By 6 months, GMTs had decreased to 55.1 (95% CI, 40-76), but IgG antibody avidity increased (P<.001). Induction of immunologic memory was confirmed by a GMT of 1977 (range, 1535-2547) after the polysaccharide booster and a further increase in avidity. This evidence justified the use of a single dose in a catch-up immunization program for children 1-18 years old.

Antibodies, Bacterial↗
PubMed2002

Effectiveness of acellular pertussis vaccine assessed by hospital-based active surveillance in Germany.

We assessed the effectiveness of complete and partial pertussis vaccination in Germany--a country where acellular vaccine is predominantly used--for the prevention of cases of pertussis requiring hospitalization. Vaccine effectiveness was estimated by means of a screening method. Vaccine coverage of children born during the period of June 1996 through December 1998 was assessed by a telephone survey. Data from hospitalized children with pertussis in 1997-1998 and from patients with pertussis complications in 1997-2000 were acquired by a nationwide, hospital-based, active surveillance system. Age-adjusted vaccine effectiveness of completed primary vaccination was estimated to be 99.8% (95% confidence interval [95% CI], 98.9-100). After receipt of 1 dose of vaccine, vaccine effectiveness was as high as 68.0% (95% CI, 45.6-81.1), increasing to 91.8% (95% CI, 84.7-95.7) after receipt of the second dose. Vaccine effectiveness was even slightly higher for pertussis with complications. Thus, even after partial vaccination, acellular pertussis vaccine is highly effective in preventing hospitalizations for pertussis.

Adolescent↗
PubMed2004

Global measles elimination efforts: the significance of measles elimination in the United States.

Lessons learned from the successful end of endemic measles virus transmission (i.e., elimination) in the United States include the critical roles of strong political commitment, a regionwide initiative, adequate funding, and a broad coalition of partners. Implications of measles elimination in the United States for global measles control and regional elimination efforts include demonstration of the high vaccination coverage and, in turn, population immunity needed for elimination; the importance of accurate monitoring of vaccination coverage at local, state, and national levels; a vaccination strategy that includes at least 2 opportunities for measles immunization; and the essential role of integrated epidemiological and laboratory surveillance. The United States, with a population of 288 million, is, to our knowledge, the largest country to have ended endemic measles transmission. This experience provides evidence that sustained interruption of transmission can be achieved in large geographic areas, suggesting the feasibility of global eradication of measles.

Global Health↗
PubMed2004

Penicillin and macrolide resistance in pneumococcal pneumonia: does in vitro resistance affect clinical outcomes?

In vitro resistance to antimicrobial agents is escalating among pathogens responsible for the most serious respiratory tract infections. Some reports have suggested that this has direct clinical implications. Because of penicillin and macrolide resistance in Streptococcus pneumoniae, current guidelines for the initial treatment of respiratory tract infections advocate less reliance on the use of either of these classes of drugs in single-agent therapy. Recent studies that have assessed the impact of beta -lactam and macrolide resistance on clinical outcomes in community-acquired pneumonia fail to provide incontrovertible evidence for a direct link between in vitro resistance and treatment failure. However, there are anecdotal reports of breakthrough bacteremia due to macrolide-resistant pneumococci among patients receiving macrolide therapy, unlike the situation for beta -lactams and penicillin-resistant pneumococci. Continued efforts, including in vitro surveillance, appropriate antibiotic use campaigns, and immunization programs, will be important in limiting the spread of drug-resistant S. pneumoniae.

Community-Acquired Infections↗
PubMed2005

Hepatitis B immunity in United States military recruits.

BACKGROUND: In 2002, the US Department of Defense (DoD) mandated hepatitis B immunization for military recruits. A DoD study reported that screening for immunity with selective immunization would be cost-effective at a prevalence of immunity of >12%. The prevalence of hepatitis B immunity in the military recruit population was unknown. METHODS: We studied a random sample of Army, Navy, and Marine Corps new recruits (2400 men and women from all 50 states, Puerto Rico, and US territories). Banked serum samples collected in 2001 were tested for antibody to hepatitis B surface antigen (anti-HBs) by AUSAB enzyme-linked immunoassay (EIA). Results were evaluated by military service branch, age, sex, race, level of education, geographic region of origin, and presence of state immunization laws. RESULTS: The overall prevalence of anti-HBs seropositivity, adjusted to the age distribution of the recruit population in 2001, was 31.5% (95% confidence interval [CI], 29.6%-33.4%). The prevalence of anti-HBs seropositivity, directly adjusted to the 18-35-year-old US population in 2000, was 23.0% (95% CI, 20.7%-25.3%). Anti-HBs seropositivity prevalence was highest among the young, decreased with increasing age, and was higher in women, recruits from the Northeast and West, and recruits from states with laws mandating hepatitis B immunization before entry into elementary and middle school. CONCLUSIONS: Screening new recruits for evidence of immunity before hepatitis B immunization is indicated. The prevalence of immunity increased with successive birth cohorts and may reflect the success of childhood immunization programs.

Adolescent↗
PubMed1998

Hospitalizations associated with rotavirus diarrhea in the United States, 1993 through 1995: surveillance based on the new ICD-9-CM rotavirus-specific diagnostic code.

The introduction of a specific International Classification of Diseases code for rotavirus diarrhea in 1992 prompted examination of the National Hospital Discharge Survey (NHDS) for trends in rotavirus-associated hospitalizations among US children aged 1 month through 4 years. During 1993-1995, 13.5% of hospitalizations were associated with diarrhea (n = 162,478/year). Rotavirus was the most common pathogen identified, coded in 16.5% of diarrhea cases (n = 26,798/year), and increased from 13.3% in 1993 to 18.9% in 1995. The age distribution and seasonality of hospitalizations of presumed noninfectious and viral etiology resembled those associated with rotavirus. Rotavirus was reported as a cause of diarrhea more frequently by hospitals that were large (> or =100 beds), proprietary-owned, or in the West/Midwest. Although these findings suggest incomplete detection of rotavirus diarrhea cases, the large number of rotavirus-associated hospitalizations underscores the need for vaccines and indicates that NHDS data could be used to monitor the impact of a US rotavirus immunization program.

Age Factors↗
PubMed2002

Characterization of haemophilus influenzae isolated from invasive disease in Brazil from 1990 to 1999.

The Haemophilus influenzae serotype b (Hib) conjugate vaccine was introduced in the National Immunization Program in Brazil in the second half of 1999. A retrospective analysis on serotypes, biotypes, and antimicrobial resistance of Hi invasive strains obtained through Hi survey was conducted to document the characteristics of this pathogenic agent during a decade prior the use of Hib vaccine. A total 3,204 strains from 1990 to 1999 were studied, being 88.2% isolated from cerebrospinal fluid, 10.7% from blood, and 1.1% from pleural fluid. The rate of 90.9% of strains was obtained from children up to 4 years old, and the age group >6 months old to 1 year was the higher risk to Hi infection. Type b was, by far, the most common type (97.8%), followed in frequency by type a (0.5%); only 1.5% was a nontypable strain. Biotypes I and II accounted for 97.8% of isolates. Resistance to ampicillin (AM) and chloramphenicol (CO) was detected at rates of 18.1% and 19.1%, respectively, whereas simultaneous resistance to AM and CO was identified in 13.9% of strains. Total concordance was found between AM resistance and beta-lactamase production. No strain showed resistance to ceftriaxone and rifampicin. In conclusion, the data generated through this laboratory-based surveillance should serve as a reference for assessing the impact of Hib vaccination and to detect changes on the pattern of Hi diseases in the country.

Adolescent↗
PubMed2006

Pediatric HIV type 1 vaccine trial acceptability among mothers in Kenya.

Vaccination of infants against human immunodeficiency virus type 1 (HIV-1) may prevent mother-to-child HIV-1 transmission. Successful trials and immunization efforts will depend on the willingness of individuals to participate in pediatric vaccine research and acceptance of infant HIV-1 vaccines. In a cross-sectional study, pregnant women presenting to a Nairobi antenatal clinic for routine care were interviewed regarding their attitudes toward participation in research studies and HIV-1 vaccine acceptability for their infants. Among 805 women, 782 (97%) reported they would vaccinate their infant against HIV-1 and 729 (91%) reported willingness to enroll their infant in a research study. However, only 644 (80%) would enroll their infants if HIV- 1 testing was required every 3 months and 513 (64%) would agree to HIV-1 vaccine trial participation. Reasons for not wanting to enroll in a pediatric HIV-1 vaccine trial included concerns about side effects (75%), partner objection (34%), and fear of discrimination (10%), HIV-1 acquisition (8%), or false-positive HIV-1 results (5%). The strongest correlate of pediatric vaccine trial participation was maternal willingness to be a vaccine trial participant herself; in univariate and multivariate models this was associated with a 17-fold increased likelihood of participation (HR 17.1; 95% CI 11.7-25; p < 0.001). We conclude from these results that immunizing infants against HIV-1 and participation in pediatric vaccine trials are generally acceptable to women at high risk for HIV-1 infection. It will be important to address barriers identified in this study and to include male partners when mobilizing communities for pediatric HIV-1 vaccine trials and immunization programs.

AIDS Vaccines↗
PubMed1995

Tetanus immunity in elderly people.

The aims of this study were to document the level of tetanus immunity in elderly people; to assess the value of immunization history in predicting tetanus immune status and to determine the response to tetanus immunization in elderly people compared with younger subjects. One-hundred day-hospital attenders (group 1), 100 long-term-care residents (group 2) and 50 young subjects (group 3) were recruited. Protective titres of tetanus antitoxin antibodies were detected in 20% of group 1, 45% of group 2 and 80% of group 3. Tetanus immunization history was a poor predictor of immune status in older people with a positive predictive value of 50% and a negative predictive value of 76%. The response to tetanus immunization was slower and of lower magnitude in older people. However, 36 of 37 older subjects developed protective levels of tetanus antitoxin antibodies on completion of a primary immunization programme.

Adult↗
PubMed1992

A search for Bordetella pertussis infection in university students.

University students with persistent cough of greater than or equal to 6 days' duration were evaluated for evidence of infection with Bordetella pertussis. Of 130 students studied during a 30-month period, 34 (26%) were found to have evidence of recent infections with B. pertussis. Infection was identified by direct fluorescent antibody assay of a nasopharyngeal specimen in one student and serologically in 33 additional subjects. B. pertussis was not recovered on culture of nasopharyngeal specimens from any subjects. Students with B. pertussis infection were identified in seven of the eight 3-month periods in which students were enrolled during the 30-month investigation, suggesting an endemic rather than epidemic pattern of infection in this university population. Illnesses of students with pertussis were similar to the illnesses of students without pertussis. The findings in this study suggest that adult populations in which endemic illness occurs at a relatively constant rate may be the reservoirs for pertussis outbreaks in susceptible children. Immunization programs in the future will need to employ booster doses for adults if complete control of B. pertussis infection is our goal.

Adhesins, Bacterial↗
PubMedDate not supplied

Herd immunity and measles.

The basic concept of herd immunity is directly applicable only under very special conditions. The agents of disease must be restricted to a single host species within which transmission occurs by relatively direct contact, and infection induces solid immunity. Also outbreaks must occur only in randomly mixing populations. In free-living populations, susceptibles are not distributed homogeneously but tend to cluster in subgroups defined by age and by such factors as ethnicity and socioeconomic status. The requisite for occurrence of epidemics, namely a large enough number of susceptibles in frequent contact with each other, exists in virtually all large populations, regardless of the total proportion of the population that is immune. Experience with measles illustrates these conditions. Total prevalence of immunity of greater than or equal to 90% in developing countries does not prevent annual epidemics among the susceptibles, most of whom are children younger than three years of age. Where vaccination is widely practiced, as in the United States since 1962, measles has continued to occur in poorly immunized subgroups that are characterized by low educational level and economic status, very young age, or religious beliefs forbidding acceptance of vaccine. Ultimate success of a systematic immunization program requires knowledge of distribution of susceptibles by age and subgroup and maximal effort to reduce the concentration of susceptibles throughout the community rather than aiming to reach any specific proportion of the overall population.

Child, Preschool↗