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Cumulative incidence of childhood-onset IDDM is unaffected by pertussis immunization.

OBJECTIVE: To identify a possible effect of pertussis vaccination in infancy on the risk for developing human IDDM. RESEARCH DESIGN AND METHODS: A comparison was made of the cumulative incidence of IDDM in children age 0-12 years between two birth cohorts born before pertussis vaccination and two birth cohorts born after pertussis vaccination had been excluded from the Swedish national immunization program. The Swedish Childhood Diabetes registry was used to identify cases of IDDM. Yearly nurse reports on administered vaccines were used to determine coverage for diphtheria/tetanus/pertussis (DTP) and diphtheria/tetanus (DT) vaccines. Pertussis vaccine coverage was estimated based on number of doses of vaccine made available on license. RESULTS: No difference in cumulative incidence rate of IDDM up to the age of 12 years was found when the birth cohorts for 1978 and 1979 with high DTP vaccination coverage were compared with the cohorts of 1980 and 1981 with low pertussis vaccination coverage. CONCLUSIONS: The comparison of the cumulative incidence of IDDM, up to the age of 12 years, in birth cohorts with high and low exposure to pertussis vaccine does not support the hypothesis that pertussis could induce autoimmunity to the beta-cell that may lead to IDDM.

Age Factors↗

The EUVAC-NET survey: national measles surveillance systems in the EU, Switzerland, Norway, and Iceland.

The EUVAC-NET network undertook a questionnaire study on measles surveillance systems in EU member countries, Switzerland, Norway and Iceland. All questionnaires were completed. Surveillance systems for measles are implemented in 16 of the 18 countries. Most countries have some case based data and in all countries the shift is towards case based surveillance for measles, though there are differences between countries concerning case definitions and classifications. A two-dose MMR vaccination schedule is implemented in all the EUVAC-NET countries but methods used for estimation of vaccination coverage are diverse.

Data Collection↗

Mumps vaccination of young adults is unwarranted.

A clinical and epidemiological study of mumps was carried out over a 18-month period and included 104 soldiers (61% of the reported cases in the Israel Defence Forces). The average number of days off work was 12.9 +/- 9.2 days. The most common complication was orchitis (19/72 men; 26%), followed by 3 cases of pancreatitis (3%) and 2 cases of meningitis (2%). 13 men with orchitis were tested, and all had normal spermograms. No long term important sequelae were described. The transmission rate was low with no respondent reporting more than one secondary case among soldiers serving in the same unit. The socio-economic level of mumps patients was comparable to that of the general army population at the time of the study. Our data do not support a mass immunization program of the adult population.

Adolescent↗

Risk factors for hepatitis B virus infection in heterosexuals attending a venereal disease clinic in Copenhagen.

Markers of hepatitis B virus (HBV) infection were measured in 465 non-drug-abusing heterosexually transmitted disease (STD) patients. HBV markers were found in altogether 70 persons, of whom 7 were HBsAg carriers. Those chronically infected were all born in HBV intermediate/high endemic areas. Gonorrhoea was the only STD that was correlated to an increased risk of HBV markers. Number of sexual partners, sex and age was not correlated with HBV infection, irrespective of country of origin. The risk of having HBV markers in an STD clientele in Copenhagen was highly dependent on the country of birth, as the prevalences were 7% (21/307) in persons born in Denmark, 19% (9/47) in those born in other low endemic areas and 36% (40/111) in those born in intermediate/high endemic areas. Falling incidence of gonorrhoea and other STD may render it difficult to point out risk factors indicative of HBV immunization in heterosexual STD patients. In low-risk countries, screening for HBV markers should however be offered to all immigrants and refugees as a part of an HBV immunization program.

Adolescent↗

Disseminated infection with Bacillus Calmette-Guerin in a child with advanced HIV disease.

An 8-month-old boy with vertically acquired HIV-infection who developed a disseminated BCG infection is described. The patient had been immunized at birth with BCG. In spite of a normal CD-4 lymphocyte count, he suffered from fever, anaemia and failure to thrive. BCG was isolated by culture from CSF, bone marrow and peripheral blood. Anti-tuberculous treatment initially seemed successful, but shortly after, the patient died from Pneumocystis carinii pneumonia. In symptomatic HIV-infected children originating from countries with BCG immunization programs, disseminated BCG infection should be considered.

AIDS-Related Opportunistic Infections↗

Emerging infectious diseases in Mongolia.

Since 1990, Mongolia's health system has been in transition. Impressive gains have been accomplished through a national immunization program, which was instituted in 1991. Nevertheless, the country continues to confront four major chronic infections: hepatitis B and C, brucellosis, tuberculosis, and sexually transmitted diseases (STDs). As of 2001, only two cases of HIV infections had been detected in Mongolia, but concern grows that the rate will increase along with the rising rates of STDs and increase in tourism. Other infectious diseases of importance in Mongolia include echinococcosis, plague, tularemia, anthrax, foot-and-mouth, and rabies.

Animals↗

Vaccine preventable diseases and vaccination coverage in Australia, 1993-1998.

BACKGROUND: Since the introduction of childhood vaccination for diphtheria in 1932 and the widespread use of vaccines to prevent tetanus, pertussis (whooping cough) and poliomyelitis in the 1950s, deaths in Australia from vaccine preventable diseases (VPDs) have declined by more than 99%. It is important, however, that the downward trend in morbidity and mortality from VPDs is maintained and carefully monitored, and that changes are interpreted in relation to vaccination coverage. AIM: This report aimed to bring together three national sources of routinely collected data on the morbidity and mortality (notifications, hospitalisations and deaths) from VPDs during the period 1993-1998 for the 8 diseases then on the routine childhood vaccination schedule, and for 4 other diseases potentially preventable by childhood vaccination. It also examined vaccination coverage for the same period. METHODS: Data sources included notifications from the National Notifiable Diseases Surveillance System (NNDSS), hospitalisation data from the Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity Database, deaths from the Australian Bureau of Statistics (ABS) Causes of Death Collection and vaccination coverage according to the Australian Childhood Immunisation Register (ACIR). All data sources were expected to have some limitations, the most important being under-reporting for notifications and vaccination encounters, and coding errors in the hospital morbidity data. RESULTS: Notifications for the 8 diseases covered by the routine schedule declined by 42%, from an average of 11,537 cases each year in 1993-1997 to 6700 in 1998, and hospitalisations fell by 12%, from an average of 1745 per year to 1536 in 1997/1998, while deaths remained unchanged at 7 each year over the period of review (Table 1). Tetanus caused 1 or 2 of the deaths each year. However, 6 of the 7 deaths in 1997 were in infants during a major outbreak of pertussis. Pertussis caused most of the notifications, hospitalisations and deaths during the review period. While most of these were in children, 46% of the notifications and 13% of the hospitalisations occurred in persons aged 15 years or more. There were notable declines in the numbers of notifications of invasive Haemophilus influenzae type b (Hib) disease in children under 5 years of age (77%), measles (87%) and rubella (75%), and there were no notifications of diphtheria or poliomyelitis. Vaccination coverage estimated using ACIR data increased during the review period. Coverage for the first 3 doses of diphtheria, tetanus, pertussis and Hib vaccines, assessed at 1 year of age, increased from 75% to 85%, while coverage for measles-mumps-rubella (MMR) vaccine, assessed at 2 years of age, increased from 83% to 86%. It is likely that these data underestimated coverage by 5-10%, and that the increase in coverage partly reflected better reporting to the ACIR by providers.

Adolescent↗

Uptake of influenza vaccine among Aboriginal and Torres Strait Island adults in north Queensland, 2003.

The uptake of the vaccine in at-risk Aboriginal and Torres Strait Island adults in north Queensland in 2003 was determined using the state-wide computerised immunisation register. The uptake in Aboriginal and Torres Strait Island adults > or = 50 years was 63 per cent, and assuming that a third of Aboriginal and Torres Strait Island adults 15-49 years of age had a medical risk factor, 85 per cent of those at-risk were vaccinated in 2003. There were considerable improvements in vaccine uptake in both age groups in the Cairns, Charters Towers, Mackay and the Tablelands Health Service Districts (HSDs) in 2003, but there were been considerable declines in both age groups in the Innisfail and Mt Isa HSDs in 2003 compared to 2002. There was also a decline in uptake in adults 15-49 years of age in the Townsville HSD.

Adolescent↗

Epidemiology of hemorrhagic fever with renal syndrome in endemic area of the Republic of Korea, 1995-1998.

We conducted an epidemiologic study to understand temporal and spatial patterns of hemorrhagic fever with renal syndrome (HFRS) in the Republic of Korea (ROK). We estimated the incidence among civilians in endemic areas through the active surveillance system during the major epidemic periods, from September to December, between 1996 and 1998. We also estimated the prevalence among Korean military personnel from 1995 to 1998. In addition, we assessed seroprevalence, subclinical infection rate, and vaccination rates in both civilians and military personnel. The incidence in civilians ranged from 2.1 to 6.6 per 100, 000 person-months. The annual prevalence in the military personnel was 40-64 per 100, 000 military populations, and remained generally constant throughout the study period with seasonal variation. This is the prospective epidemiologic data set on HFRS in the ROK since the inactivated Hantaan virus vaccine was licensed for use in the late 1990s. These results will be invaluable in establishing a national immunization program against HFRS.

Disease Outbreaks↗

Meningococcal carriage in adolescents and young adults in Kuwait.

BACKGROUND: Neisseria meningitidis is a major cause of invasive meningococcal disease (IMD), with asymptomatic carriage playing a crucial role in transmission. Adolescents (15-17 years) and young adults (18-20 years) have the highest carriage rates, yet data from Kuwait remain limited. This study aimed to estimate the prevalence of N. meningitidis carriage among adolescents and young adults in Kuwait. METHODS: A cross-sectional study was conducted from July 2023 to May 2024, enrolling 1,398 participants aged 15-20 years. Randomly selected individuals provided oropharyngeal swabs, and demographic, behavioral, and vaccination data were collected via standardized questionnaires. Carriage prevalence was determined using selective culture-based methods. Whole genome sequencing was performed on culture-confirmed isolates. Descriptive statistics were used to summarize participant characteristics; carriage prevalence was reported as proportions, and associations were explored using Fisher's exact or chi-square tests and logistic regression where feasible. RESULTS: The overall meningococcal carriage rate was 0.21% (3/1,398). All isolates were non-groupable (NG), with one carrying the capsule null locus (CNL). Self-reported MenACWY vaccination coverage was 94.8%. No significant associations between demographic, geographic, or behavioral factors and carriage status were identified due to the small number of positive cases. CONCLUSION: This study provides a population-based estimate of meningococcal carriage among adolescents and young adults in Kuwait using a random sampling approach. The low carriage rate, alongside high vaccination coverage, suggests that existing immunization programs in Kuwait may be effective in reducing N. meningitidis transmission. However, the presence of NG strains stresses the need for continued surveillance. Further research is required to evaluate long-term vaccination impacts and potential gaps in disease protection.

Humans↗

Viral hepatitis in the Arctic.

OBJECTIVES: Summarize research on viral hepatitis in indigenous populations in the Arctic. STUDY DESIGN: Literature review. METHODS: Medline search from 1966-2003. RESULTS: High prevalence rates of total hepatitis A antibody of > 50% and of hepatitis B of between 22% in Alaska and 42% in Greenland for total infection and between 3% in Canada and 12% in Siberia for chronic infection have been reported. Universal childhood vaccination with hepatitis A vaccine beginning at age 2 have stopped epidemics of HAV in Alaska and newborn hepatitis B immunization programs in Alaska and Canada have reduced new infections. However, in all Arctic countries several thousand persons chronically infected with HBV remain at risk for the development of cirrhosis and hepatocellular carcinoma. Prevalence rates of hepatitis C (HCV) reported are <1.4% in the Arctic. Hepatitis D virus, which co-infects with HBV, has been found in 40% of persons with HBV in Greenland. CONCLUSIONS: High rates of viral hepatitis A, B, C, and D are found in the Arctic. Effective vaccines against HAV, HBV and HDV can prevent transmission of these viruses. In addition, new antiviral therapies for HBV and HCV can be used effectively to treat many chronically infected patients.

Arctic Regions↗

Pertussis: old foe, persistent problem.

Although a safe and effective vaccine is available, pertussis continues to be an important cause of morbidity and mortality. Immunity acquired from natural infection or vaccination wanes within 5 years, making older children, adolescents, and adults important reservoirs of infection. Many neonates and infants contract pertussis from older people with mild symptoms and are at risk for developing severe, life-threatening illness. Immunization programs are being considered for adolescents and for adults who live with or care for infants.

Adolescent↗

Pneumococcal vaccine in patients with absent or dysfunctional spleen.

Four patients (3 long-term Hodgkin disease survivors and 1 recipient of an allogeneic bone marrow transplant) developed severe infections with Streptococcus pneumoniae after staging splenectomy or due to functional hyposplenism after total body irradiation and bone marrow transplantation. Current guidelines for prevention of infection recommend pneumococcal immunization for patients with Hodgkin disease treated with splenectomy and others with functional hyposplenism. Booster vaccination after 5 years is also advised. Hospital- and community-based vaccination initiatives may help identify at-risk patients.

Acute Disease↗

[New rotavirus vaccines: a reality at last].

Rotavirus is the most common cause of severe acute diarrhea among children less than 3 years of age. This infection causes 25 million medical visits, 2 million hospitalizations and 440,000 deaths every year worldwide. The development of rotavirus vaccines has followed a long and difficult path seriously hampered by the abrupt withdrawal of Rotashield in 1999 due to its association with intestinal intussusception. After six years of intense research, the world celebrates the licensing of two new rotavirus vaccines, different in formulation and administration schemes albeit clearly safe and not associated with intussusception as demonstrated by large Phase III trials including more than 60,000 children. These vaccines, Rotarix from Glaxo SmithKline Biologicals and Rotateq from Merck Sharp & Dohme, have demonstrated to be highly efficacious against severe rotavirus gastroenteritis caused by the most prevalent serotypes. Prompt incorporation of these new vaccines into the immunization programs of countries, especially those in the poorest areas of the world where these vaccines are most needed, will require joint efforts between governments, vaccine manufacturers, international and non-governmental organizations and foundations.

Acute Disease↗

Follow-up of MMR vaccination status in children referred to a pediatric immunization clinic on account of egg allergy.

OBJECTIVE: To determine timeliness and completeness of MMR immunization uptake and general immunization status of egg-allergic children referred to hospital for MMR vaccine who were referred back to their primary care providers with explanatory information that community-based vaccination is safe in these children. METHOD: Referred children's immunization status obtained from referring practices. Where the practice had no record parents were contacted. Parents whose children had not received MMR were asked reasons for their choice. Timeliness of immunizations was examined for both MMR and the primary schedule. Practices referring more than one child to immunization clinic were analysed to determine whether previous letters from the immunization clinic influenced their referring practice. RESULTS: 82 children were eligible from 67 practices. MMR status was obtained for 78 (95% response rate). Of these 78, 73 (94%) received MMR vaccination with no reported adverse events: 8 (11%) on time, 54 (69%) late and 11 (14%) timeliness unknown. Five (6%) children had not received MMR vaccination. Three practices were unwilling to carry out MMR immunization of egg-allergic children, even after recommendation from the immunization clinic. Of the five parents whose children had not received MMR, two had actively decided against vaccination. DISCUSSION: 94% children received their MMR in primary care with no reported adverse effects. The current strategy utilised by the immunization clinic appears to result in MMR immunization of egg-allergic children. While the referral process may result in delayed immunizations, continued education of health professionals may improve timeliness and immunization rates.

Child↗