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PubMed2002

Hepatitis A booster vaccine in children after infant immunization.

BACKGROUND: Hepatitis A vaccine provides long term protection against hepatitis A infection in adults and children older than 2 years of age. Few data are available regarding children younger than 2 years of age. METHODS: Children who were vaccinated in infancy with hepatitis A vaccine were revaccinated at 4 years of age, and antibody titers were followed. Forty-four subjects who had been vaccinated with hepatitis A vaccine [Havrix, 360 enzyme-linked immunosorbent assay units (EU)] at the age of 2, 4 and 6 months were revaccinated with 720 EU of inactivated hepatitis A vaccine (Havrix) at 4 years of age. RESULTS: Geometric mean titer (GMT) of 44 evaluable cases was 41 mIU/ml and 34 children (77.3%) were seropositive before the booster dose. Postvaccination blood samples were obtained from 37 cases. One month after booster dose GMT increased to 2884 mIU/ml, and all subjects were seropositive. Ten seronegative cases also seroconverted. The GMT of the seropositive cases showed anamnestic response after the booster dose (57 mIU/ml before booster dose, 5623 mIU/ml after the booster). No serious adverse event was seen after the booster dose. CONCLUSION: We conclude that childhood hepatitis A virus revaccination after infant immunization is highly immunogenic and safe.

Antibodies, Viral↗

PubMed2003

Regional variation in the cost effectiveness of childhood hepatitis A immunization.

BACKGROUND: Routine childhood hepatitis A immunization is recommended in regions with incidence rates twice the national average, but it may be cost-effective in a wider geographic area. OBJECTIVE: To evaluate the costs and benefits of potential hepatitis A immunization of healthy US children in regions with varying hepatitis A incidences. METHODS: We considered vaccination of the 2000 US birth cohort in states defined by historic hepatitis A incidence rates. Infections among potential vaccinees and their personal contacts were predicted from age 2 through 85 years. Net vaccination costs were estimated from health system and societal perspectives and were compared with life-years saved and quality-adjusted life years (QALYs) gained using a 3% discount rate. RESULTS Nationally vaccination would prevent >75 000 cases of overt hepatitis A disease. Approximately two-thirds of health benefits would accrue to personal contacts rather than to vaccinees themselves. In states with incidence rates of > or =200%, 100 to 199%, 50 to 99% and <50% the national average, societal costs per QALY gained would be <0, <0, 13,800 and 63,000 US dollars, respectively. Nationally vaccination would cost 9100 US dollars per QALY gained from the perspective of the health system and 1400 US dollars per QALY gained from society's perspective. Results are most sensitive to vaccination costs and rates of disease transmission through personal contact. CONCLUSION: Childhood hepatitis A vaccination is most cost-effective in areas with the highest incidence rates but would also meet accepted standards of economic efficiency in most of the US. A national immunization policy would prevent substantial morbidity and mortality, with cost effectiveness similar to that of other childhood immunizations.

Adolescent↗

PubMed2004

Management guidelines for laboratory exposures to agents of bioterrorism.

Over the past several years, funding for biodefense research has increased dramatically, leading to the possibility of increased laboratory-acquired infections with potential bioterrorism agents. The Special Immunizations Program at United States Army Medical Research Institute of Infectious Diseases reviewed its policy and management of potential occupational exposures (1989-2002) to assess guidelines for determining the risk of exposure and disease and to determine criteria for initiating postexposure prophylaxis (PEP). Initiating antibiotic PEP was based primarily on exposure risk but was also influenced by vaccination status and agent virulence. PEP was given to nearly all moderate- and high-risk bacterial exposures, regardless of vaccination status, to most unvaccinated and subsets of vaccinated minimal-risk exposures, but generally not to negligible-risk exposures. Algorithms for evaluating and managing potential exposures are presented to provide guidance to other agencies as they begin to work with these agents.

Antibiotic Prophylaxis↗

PubMed2002

Epidemic spreading in a variety of scale free networks.

We have shown that the epidemic spreading in scale-free networks is very sensitive to the statistics of degree distribution characterized by the index gamma, the effective spreading rate lambda, the social strategy used by individuals to choose a partner, and the policy of administrating a cure to an infected node. Depending on the interplay of these four factors, the stationary fractions of infected population F(gamma) as well as the epidemic threshold properties can be essentially different. We have given an example of the evolutionary scale-free network which is disposed to the spreading and the persistence of infections at any spreading rate lambda>0 for any gamma. Probably, it is impossible to obtain a simple immunization program that can be simultaneously effective for all types of scale-free networks. We have also studied the dynamical solutions for the evolution equation governed by the epidemic spreading in scale-free networks and found that for the case of vanishingly small cure rate delta<<1 the initial configuration of infected nodes would feature the solution for very long times.

Journal Article↗

PubMed2004

EPI vaccines-induced antibody prevalence in 8-9 year-olds in The Gambia.

OBJECTIVES: We evaluated antibody prevalence to measles, polio 1 and 3, and tetanus toxoid antibodies in 8-9 year-old children in The Gambia within the framework of the Gambia Hepatitis Intervention Study (GHIS), a large vaccine trial aimed at evaluating vaccine efficacy against hepatitis B virus (HBV) infection, chronic carriage and primary liver cancer in a high risk population. The results of the present survey were compared with a previous survey performed with the same objectives and same methodology but in different children at 3-4 years of age. METHODS: Four clusters of 200 children each were sampled as representative of the whole country. Children would have received BCG, diphtheria-pertussis-tetanus vaccine (DPT), poliovirus vaccine (OPV), measles and yellow fever immunization. The measles haemoagglutination inhibition test (HAI) was used to detect measles antibody. Antibodies to polioviruses 1 and 3 were tested using the standard polio neutralization assay described in the EPI manual (WHO 1990). An enzyme-linked immuno-sorbent assay (ELISA) was used to measure tetanus toxoid antibodies. RESULTS: A high proportion of children were fully vaccinated in both age groups. Measles antibody concentrations were < or =1 : 8 in 8.2% of 8-9 year-old vaccinated children. In the previous survey of 3-4 year-old children this was 11.3%. In the present survey, GMC was lower than in the 3-4 year-old children; 88% of 3-4 year-olds and 89% of 8-9 year-olds had detectable antibody levels against poliovirus type 1. Fewer children at 8-9 years of age had antibodies against poliovirus type 3 than 3-4 year-olds (78%vs. 89% P < 0.001). A significant overall lower proportion of 8-9 year-old children had detectable tetanus toxoid antibodies compared to 3-4 year-old children (87%vs. 95% P < 0.001), as well as those who received four doses of DPT (90%vs. 97% P < 0.001). Conclusions High vaccine coverage is achieved in The Gambia with EPI. With time the number of vaccinated children who are not protected against measles, poliovirus 3 and tetanus increases. Besides the maintenance of high vaccine coverage in infants and young children, booster doses of some of the EPI vaccines in adolescents should be considered.

Antibodies, Bacterial↗

PubMed1996

"On the spot' vaccination: does it work?

OBJECTIVE: To trial and evaluate a system of "on the spot' vaccination for children up to the age of 15 years in the Early Childhood Centres of the Central Sydney Area Health Service, at the Royal Alexandra Hospital for Children and in a number of general practices in the area. METHODOLOGY: A brief questionnaire was used to collect data from parents and health care professionals about the child's vaccination status and vaccines given "on the spot'. RESULTS: Over an 8 week period in August-September 1993, 5162 questionnaires were completed; 71% of children were up to date with their vaccination. If Haemophilus influenzae type b vaccine, which had been introduced only 2 months before commencement of the study, was excluded, 84% of the children were up to date. A total of 441 children were given 663 vaccinations "on the spot'. Very few children were too ill to be vaccinated (6%). However, only 30% of those who needed vaccination "on the spot' actually received it (441 of 1480), and only 41% (24 of 58) of a subset of those who were not vaccinated were known to have complied 1 month later. Children attending Early Childhood Centres were younger than children attending general practices or the hospital. CONCLUSIONS: A high proportion of children who attended for routine or acute health care had vaccinations overdue (30%). If this scheme could be continued and expanded it would have an important impact on vaccination coverage, and hence on the incidence of vaccine-preventable diseases.

Child↗

PubMedDate not supplied

Comprehensive health assessment for newly arrived refugee children in Australia.

Providing appropriate and responsive care to refugees from diverse backgrounds and with unique health needs is challenging. Refugee children may present with a wide range of conditions, which may be unfamiliar to health professionals in developed countries. Additionally, refugees may experience unfamiliarity with the Australian health system and distrust of authority figures and/or medical practitioners. This article provides an overview of the priority areas in health and health management for paediatric refugee patients for paediatricians as well as other relevant health care providers caring for this group. Specific issues covered include general health assessment, infectious diseases, immunization, growth and nutrition, oral health, development and disability, mental health and child protection. Comprehensive health assessment can assist in identifying children at risk of poor health and to provide them with timely and effective care, advocacy and appropriate referral.

Australia↗

PubMed2004

Safety and efficacy of acellular pertussis vaccine in Japan, evaluated by 23 years of its use for routine immunization.

BACKGROUND: Real evaluation of any vaccine can only be done after the vaccine has been in routine use for a substantially long period of time. In Japan, acellular pertussis vaccine was introduced and totally replaced whole cell pertussis vaccine in 1981. From 1982 to 1988 40.3 million doses of acellular pertussis vaccine were given to 2-year-olds and from 1989 to 2001 59.3 million doses of acellular pertussis vaccine were given to 3-month-olds. It is now time to evaluate the efficacy and safety of acellular pertussis vaccine by the use of national data officially supplied by the Government. METHODS: Government national surveillance of pertussis, which began in 1981, was used to analyze epidemiology of pertussis. Official Government reports on acceptance rates of pertussis were analyzed. A peer review has been made on all severe neurological illnesses/death occurring after pertussis immunization which have been applied for through the Vaccine Injury Compensation System, Ministry of Health Labor and Welfare, Japan. RESULTS: High acceptance rates of acellular pertussis vaccine combined with diphtheria and tetanus toxoids (DTaP) has been maintained and a dramatic decrease in pertussis was noted over the past 23 years. Neurological illnesses temporally associated both with whole cell and with acellular pertussis vaccination has been a rare phenomenon. However, incidences of encephalopathy/encephalitis and status epileptics/frequent convulsions, febrile seizures/provocation of convulsions, and sudden deaths were significantly lower with acellular pertussis vaccination than with whole cell pertussis vaccination. CONCLUSION: With the use of acellular pertussis vaccine which has been accepted by the public, pertussis has been well controlled in Japan.

Age Distribution↗

PubMed2003

Measles vaccination coverage among five-year-old children: implications for disease elimination in Australia.

OBJECTIVES: To (i) assess under-reporting of measles-mumps-rubella (MMR) vaccinations to the Australian Childhood Immunisation Register (ACIR); (ii) estimate MMR coverage among five-year-old children and the proportion immune to measles infection; (iii) identify factors related to non-uptake of MMR vaccination. METHODS: We analysed ACIR data for a birth cohort of approximately 64,000 children aged five years. The parents of a sample of 506 children with no ACIR record for the second MMR vaccination (MMR2), due at four years of age, were interviewed by telephone to assess under-reporting to the ACIR and reasons for non-uptake of MMR vaccination. RESULTS: Parents reported that 22% (n = 111) of the surveyed 506 children had received MMR2 before their fifth birthday, and 42% (n = 214) by approximately 5.5 years of age. After correcting for this level of under-reporting to the ACIR, MMR2 coverage for the entire cohort at five years of age was 52.9% (95% CI 52.3-53.4), and increased to 84.1% (95% CI 83.4-84.8) by approximately 5.5 years of age. This was 4.3% and 8.2%, respectively, higher than ACIR coverage estimates at the two ages. Based on the corrected MMR coverage estimates, 93% of the cohort was immune to measles due to vaccination. The most common parent-reported reason for incomplete vaccination was lack of knowledge about the MMR vaccination schedule. CONCLUSIONS: Measles elimination in Australia will require continued effort in vaccination coverage and timeliness among pre-school children. School-entry requirements are important for MMR2 uptake. Strategies are needed to improve reporting to the ACIR for more accurate measurement of coverage.

Attitude to Health↗

PubMed2004

Getting it right--the Australian Childhood Immunisation Register and immunisation rates in south-eastern Sydney.

OBJECTIVES: To assess the completeness of ACIR data for south-eastern Sydney children at 12 to < 15 months of age and to develop strategies to improve rates. METHODS: We surveyed children aged 12 to < 15 months listed as overdue on the ACIR011A report, December 2001, by contacting the last immunisation provider or the parents. RESULTS: From the 470 children listed as overdue, 162 children were systematically selected to form the study group. Seventeen were lost to follow-up and results are available for 145 children. Eighty children were up to date (69, encounter forms incorrect or not sent; 11, vaccinated overseas) and 11 children had moved overseas. Fifty-four children were overdue (30, provider error due to incorrect Haemophilus influenzae type b (Hib) schedule or Hib vaccine omitted; 18 did not complete schedule; 6 conscientious objectors). CONCLUSIONS: Our study indicates that between 6-9% of children on the register were likely to be overdue, whereas the ACIR011A report identified 19%. Failure of immunisation providers to correctly complete, or send encounter forms to the ACIR was the main reason for this discrepancy. Migration and failure to record overseas vaccination were also factors. IMPLICATIONS: Public health units should develop good working relationships with immunisation providers to assist and encourage immunisation and the completion and submission of encounter forms. A quarterly review, using the third dose assumption, of all children aged 12 to < 15 months identified on the ACIR011A report as overdue for immunisation may be an effective way for public health units to increase apparent rates for their area.

Bacterial Capsules↗

PubMed2004

Predictors of incomplete immunisation in Victorian children.

OBJECTIVE: Using probabilistic record linkage, this study aimed to determine the predictors of incomplete immunisation in Victorian children. METHODS: Records of all births in Victoria in 1998 were linked with records from the Australian Childhood Immunisation Register (ACIR). The outcomes of interest were the predictors of immunisation status at 12 and 24 months of age. RESULTS: A total of 91.1% of birth records were linked with records from the ACIR (n=55,129). Immunisation coverage was 92.8% at 12 months and 89.2% at 24 months. After multivariate analysis, the following maternal factors were significant predictors of incomplete immunisation in children aged 12 months: higher parity, 12-23 months interval between pregnancies, not being married, Aboriginal or Torres Strait Islander or born overseas, younger age, no private health insurance, home birth, metropolitan place of birth, and being in the highest or lowest socioeconomic quintiles. Low birthweight and singleton birth were also significant predictors. All of these factors were also predictive of incomplete immunisation in children aged 24 months, with the exception of low birth weight, which was only significant in the very low birth weight category. Congenital malformations or prematurity were not significant predictors. CONCLUSIONS AND IMPLICATIONS: Record linkage is an effective means of determining the relationship between immunisation status and socio-demographic and health-related factors. It enabled small groups within a large population to be studied, confirming findings from previous survey studies and indicating that several population groups were at increased risk of incomplete immunisation. The main limitation of the study was the under-reporting of immunisation status to the ACIR.

Birth Certificates↗

PubMed2005

Monitoring measles elimination in Victoria.

OBJECTIVES: To weigh the evidence from outbreak data that Victoria has achieved, and is maintaining, elimination of measles. To identify age groups that measles vaccination has not protected adequately. METHODS: Data on observed measles outbreaks in Victoria since the start of 1998 are used to estimate the reproduction number of cases, and the probability that it is maintained below unity, its threshold value for elimination. The relative susceptibility to measles is estimated as a function of age, with confidence intervals. RESULTS: Seventeen measles introductions led to secondary cases, while 22 were single-case introductions. From these, the probability that the reproduction number for cases exceeds unity is estimated to be 0.044, or less, depending on assumptions made. There is no evidence that the reproduction number increased over time. Those aged between 19 and 32 years were most susceptible, followed by those in the first and second year of life. CONCLUSIONS: The data provide strong evidence that Victoria has maintained elimination of measles over the period 1998 to mid-2003. There is scope to improve the immunisation coverage. It is not clear how much outbreak intervention is contributing to the success in achieving apparent elimination. IMPLICATIONS: To prevent importations from causing a major epidemic of measles, Victoria must maintain its immunisation coverage and outbreak control at current levels, or better. It is important to monitor the control of measles even when elimination is achieved.

Adolescent↗

PubMed2005

Nucleic acid test screening of blood donors for orthopoxviruses can potentially prevent dispersion of viral agents in case of bioterrorism.

BACKGROUND: Microbiologic agents such as variola virus (VAR) are very attractive for terrorism. As a result of international collaboration under the WHO eradication campaign, smallpox was declared eradicated in 1980. Therefore, the immunization programs were discontinued worldwide. Because most people are now immunologically naive, VAR is considered to be a potential threat agent or bioterrorist weapon. Real-time polymerase chain reaction (PCR) followed by melting analysis was developed for fast and safe analysis and allows differentiation of VAR from other orthopoxviruses (OPVs) like vaccinia or camelpox virus. STUDY DESIGN AND METHODS: A RealArt Orthopox LC PCR kit (Artus GmbH) was used to amplify OPV sequences from blood donor samples. A total of 31,500 blood donor samples were tested in minipools of up to 96 samples. To evaluate the sensitivity of the assay, routine donor minipools (90 +/- 6 samples per pool) were spiked with vaccinia virus used as positive control. RESULTS: Specificity was 100 percent because none of 31,500 blood donors was positive for the presence OPV. The detection limit of the assay was 10.6 copies per PCR procedure. Therefore, a sensitivity of 1590 copies per mL was calculated. Overall, 0.28 percent of test results had to be considered invalid owing to negative internal controls. CONCLUSION: The RealArt Orthopox LC PCR kit enables reliable detection of OPV DNA in viremic blood donor samples, even at the beginning of the disease when patients present minor clinical symptoms, and could be implemented in our routine screening procedure immediately. Thus, the assay could potentially help to prevent dispersion of viral agents by blood transfusion in case of bioterrorism.

Bioterrorism↗

PubMed1995

Immunization and the prevention of childhood diseases.

Nursing has an important role in improving the incidence of childhood immunization. An understanding of the immunologic deficiencies of children, especially those younger than 5 years, demonstrates the need for this population-wide protection. Knowledge of the various products, their efficacy, schedule, side effects, and contraindications will assist the neonatal and pediatric nurse in coordinating immunizations and teaching parents about this important health priority for their children. Research is focusing on the development of combination vaccines and products for infectious diseases that currently have difficult or nonexistent treatment.

Child↗

PubMed1982

Neurological complications of swine influenza vaccination.

The emphasis upon the remarkably large number of cases of Guillain-Barre syndrome which resulted from the 1976 National Swine Influenza immunization program in the U.S.A. has obscured the fact that other neurological complications, involving the central nervous system also occurred. The anatomical distribution of lesions is almost identical with that seen following other types of vaccination: involvement of the brain, cerebellum, optic nerve, cranial nerves and spinal cord occurred with approximately the same frequency. 5 instances of the very rare subacute or chronic, progressive, post-vaccinal encephalopathy are described, a situation which is identical to the subacute and chronic forms of polyradiculoneuropathy. In a number of cases, in particular the myelopathies, a subclinical involvement of peripheral nerves was demonstrated by means of electrodiagnostic studies, illustrating the often overlooked fact that central nervous system involvement will mask peripheral nerve lesions. The etiological significance of the swine influenza vaccination was overlooked and completely erroneous diagnoses were established in a surprisingly large number of the 26 new cases reported here.

Adolescent↗

PubMed1999

Burden of human rotavirus-associated hospitalizations in three geographic regions of Hungary.

Data on hospital admissions and laboratory reports were used to estimate the number of hospitalizations of children aged 14 y or less in three geographic regions of Hungary due to group A rotavirus infection. Between January 1993 and December 1996, 9182 hospitalizations for gastroenteritis occurred, of which 1946 (21%) were associated with rotavirus infection. Most (90%) of the rotavirus detections were among children aged 4 y or less. By extrapolation, an estimated 5000 rotavirus-related hospitalizations (8.4/1000 children aged 4 y or less/y) occurred in Hungary during the study period. Marked seasonality of rotavirus infections was observed, with a peak of incidence from December to February. Rotaviruses with "long" RNA electropherotypes predominated each year, but in 1995/1996 20% of electropherotypes in the Budapest area were "short". Effective surveillance is required for all children hospitalized for diarrhoea as part of a rotavirus immunization program in Hungary.

Child, Preschool↗

PubMed2005

Vaccination coverage among adolescents in certain provinces of Greece.

AIM: To estimate the vaccination coverage in a sample of adolescents in Greece. METHODS: Vaccination status was estimated in 483 adolescents aged 15-19 y in four prefectures. The criteria for full vaccination were based on the recommendations of the Greek National Vaccination Schedule. RESULTS: The participation rate in the study was 78.7% (380/483 adolescents). The rates of full vaccination were 94.2% for poliomyelitis, 78.4% for hepatitis B, 77.4% for BCG, 65.0% for tetanus and 54.4% for diphtheria. The rates of full vaccination for measles, rubella and mumps were 65.0%, 57.6%, and 56.0%, respectively. For pertussis, the full vaccination rate was only 36.0%, and 7.1% of the study population was totally unvaccinated. The most missed dose for all vaccines was the final booster dose, which is usually administered in older children or adolescents. CONCLUSION: Adolescent vaccination coverage was not satisfactory in this study, mainly due to non-compliance to the final booster dose. Completion of missing vaccines at this age represents the last opportunity for massive intervention and would be of essential value for individual and community protection against common preventable diseases.

Adolescent↗

PubMed2005

Is Europe ready to embrace a policy of universal varicella vaccination?

For the first time, a live attenuated varicella vaccine with an indication for universal vaccination is licensed in all EU countries. It is now time to consider whether in Europe there should be widespread vaccination against varicella to prevent this common and highly infectious disease. Increasing numbers of countries are adopting vaccination programmes against the disease. In those countries where a routine vaccination policy has been adopted, the success of the vaccine has been significant. The USA, which prior to the launch of a universal vaccination programme in 1995 had 4 million cases of varicella per year, has seen a dramatic reduction in varicella morbidity and mortality rates. A universal varicella vaccination policy is an option that needs to be considered for Europe not only in medical terms but also because it would be socially and economically appropriate.

Adolescent↗