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PubMed1996

Expanded programme on immunization (EPI). Immunization schedules in the WHO eastern Mediterranean region, 1995.

There are 23 countries/areas in this Region (Tables 1-3). BCG is used in all but 3 countries (Cyprus, Jordan and Lebanon). Most countries/areas give BCG vaccine at birth, 2 countries (Bahrain and Tunisia) schedule additional doses at school age and Kuwait uses 1 dose at the age of 3 1/2-4 years. Diphtheria-pertussis-tetanus (DPT) vaccine is used as a primary series of 3 doses in all countries/areas. Fifteen countries/areas use a fourth dose of DPT vaccine in the second year of age or later (Bahrain, Cyprus, Egypt, Iran [Islamic Republic of], Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Tunisia, and the United Arab Emirates, the United Nations Relief and Works Agency for Palestine Refugees in the Near East [UNRWA]). Six countries use 5 doses of DPT vaccine, the fifth dose being given at the age of 4-6 years (Bahrain, Cyprus, Iran [Islamic Republic of], Kuwait, Qatar, and Saudi Arabia). One or 2 booster doses of diphtheria-tetanus (DT) vaccine are used in 9 countries/areas from the age of 6-12 years. Td vaccine is used as a booster in Bahrain and Cyprus. Oral poliovirus vaccine (OPV) is used in a primary series of 3 doses simultaneously with DPT vaccine in all countries/areas. Ten countries/areas use an additional dose of OPV at birth (Djibouti, Iran [Islamic Republic of], Iraq, Kuwait, Libyan Arab Jamahiriya, Morocco, Oman, Pakistan, Syrian Arab Republic, and UNRWA). An additional dose of OPV in the second year of life is used in 15 countries, and additional doses of OPV are recommended in some countries. In UNRWA, the first 2 doses of OPV 2 and 3 months of age are given simultaneously with the inactivated poliovirus vaccine (IPV). Measles vaccine is given in most countries/areas at 9-12 months of age, usually in the form of monovalent measles vaccine. The 2-dose policy is implemented in 12 countries. In 8 countries, the second dose is given as measles-mumps-rubella (MMR) vaccine, and in 3 countries as monovalent measles vaccine. The age for the second dose varies. In 10 countries, it is given at 12-15 months of age, and in the Libyan Arab Jamahiriya at 18 months of age. The United Arab Emirates uses 3 doses. Rubella vaccine is scheduled for girls of 12-13 years of age in Bahrain, the United Arab Emirates and UNRWA and for boys and girls in Kuwait at 12 years of age. Hepatitis B vaccine is used in 15 countries/areas. All these countries use 3 primary doses of vaccine in infancy. The immunization time varies from birth (12 countries/areas) to 9 months of age. In Cyprus, hepatitis B vaccine is used in a 4-dose schedule, including a booster dose given to 5 to 6-year-old children. Tetanus toxoid is used for pregnant or non-pregnant women of childbearing age. It is also given to school-children in the Islamic Republic of Iran. The schedule includes 2-5 doses.

Child↗
PubMed1996

The impact of the standards for pediatric immunization practices on vaccination coverage levels.

OBJECTIVE: To assess the impact on clinic-specific vaccination coverage of implementing the Standards for Pediatric Immunization Practices. DESIGN: A nonrandomized intervention trial conducted for 1 year. SETTING: Two public health clinics in Albuquerque, NM: 1 intervention site and 1 control site, each serving 1 of 4 city quadrants. PARTICIPANTS: All children enrolled in the 2 city public health clinics. INTERVENTIONS: Implementation of the Standards for Pediatric Immunization Practices. OUTCOME MEASURES: Assessment of up-to-date vaccination coverage levels prior to and at the conclusion of the project. The impact on the proportion of children who dropped out of vaccination services after receiving 1 dose by 3 months of age. RESULTS: At the intervention site, up-to-date coverage at 12 months of age rose from 57.5% to 80.4%, while levels at the control site decreased from 42.1% to 41.9%. Before the intervention, 24% of children at the intervention site who received the first dose of diphtheria and tetanus toxoids and pertussis vaccine (DTP 1) by 3 months of age failed to receive the third dose of DTP (DTP 3) by 12 months of age vs 5% after the intervention. At the control site, the proportion of children who received DTP 1 by 3 months of age, but not DTP 3 by 12 months of age, increased from 39% to 51%. CONCLUSION: Implementation of the Standards for Pediatric Immunization Practices in a public health clinic was associated with important increases in vaccination coverage levels and a reduction in the proportion of children who dropped out of vaccination services.

Child↗
PubMedDate not supplied

[The comparison of adverse reactions to anti-influenza vaccines of split-vision and surface antigens].

BACKGROUND: Fear of adverse reactions is one of the reasons why influenza immunization programs for hospital workers have not met wide acceptance. We conducted a study in order to compare the frequency of adverse reactions following administration of standard split-virion (VVF) and subunit-virion (VAS) influenza vaccines, mostly among hospital personnel. METHODS: Trial with volunteers who were systematically assigned to receive one of the vaccines, alternating every ten participants, during the influenza inmunization campaing 1994-95. The adverse effects were recorded by telephone interview 10 days after vaccination. RESULTS: Out the 182 subjects recruited, 163 were included in the study, of whom 100 received VAS and 63, VVF. Almost 13% of the participants reported any adverse effects with no significant difference between both groups (VAS: 11% and VVF: 15.6%, p = 0.38). There were also no significant differences relating to systemic and local reactions, separately. The subjects who had adverse reactions to previous influenza vaccination showed more frecuent systemic reactions (25% vs. 7.5%, p = 0.04) in a significant way. CONCLUSIONS: Both vaccines have been proved to be very safe, only causing adverse reactions in a small proportion and very mild in every case. The VAS presents a frequency of adverse effects similar to that of VVF, in spite of containing only surface antigens. It's likely that a certain hypersensitivity to influenza vaccine exists in some people, specially to the split-virion one.

Adult↗
PubMed1996

Expanded programme on immunization (EPI). Immunization schedules in the WHO South-East Asia region, 1995.

There are 10 countries in this Region. BCG is given at birth and up to 1 week of life in 5 countries: Bangladesh, Democratic People's Republic of Korea, India, Indonesia and Nepal (Table 1). In 3 other countries, BCG is given from birth up to 1 year of age (Bhutan, Myanmar and Thailand) and in the remaining 2 countries, BCG is offered from birth to 3 years of age (Maldives) and to 5 years of age (Sri Lanka).

Asia, Southeastern↗
PubMed1996

Expanded programme on immunization (EPI). Immunization schedules in the WHO African region, 1995.

There are 48 countries/areas in this Region (Tables 1-3). No data are available from Reunion and Saint Helena. BCG is given at birth in 46 countries. Diphtheria-pertussis-tetanus (DPT) vaccine is used as a primary series of 3 doses in 46 countries. In 35 countries, DPT is given from 6 weeks of age; in 6 countries at 2 months of age (Angola, Botswana, Burkina Faso, Congo, Gambia and Zambia); and in 5 countries at 3 months of age (Algeria, Mauritius, Seychelles, Swaziland and Zimbabwe). Eight countries give 4 doses of DPT (Benin, Burundi, Congo, Equatorial Guinea, Rwanda, Seychelles, South Africa and Zambia) while 2 countries give 5 doses of DPT (Algeria and Togo). Diphtheria-tetanus (DT) is given in 3 countries: in Botswana at 6 years, in Mauritius at 2 and 5 years and in South Africa at 5 years of age. No Td* is given in any of the countries in this Region. Oral poliovirus vaccine (OPV) is used in a primary series of 3 doses simultaneously with DPT vaccine in all countries. Eighteen countries give OPV at birth. Measles vaccine is given at 9 months of age in 45 countries. Seychelles gives measles vaccine at 15 months of age. None of these countries give a combined measles-mumps-rubella (MMR) vaccine. Rubella vaccine alone is also not given in any of the countries in the Region. Hepatitis B vaccine is used in 7 countries (Botswana, Gabon, Gambia, Nigeria, South Africa, Uganda and Zimbabwe). It is given in 2 doses in 2 countries (Gambia and Nigeria) and at birth in 4 countries (Botswana, Gabon, Gambia and Nigeria). Thirty-one countries are at risk for yellow fever. However, yellow fever vaccine is given only in 10 countries (Central African Republic, Chad, Côte d'Ivoire, Gabon, Gambia, Ghana, Niger, Sao Tome and Principe, Senegal and Togo). Six countries give yellow fever vaccine at 9 months, Chad gives it at 6 months, Gabon and Sao Tome and Principe at 1 year of age and Togo at 10 months. Tetanus toxoid (TT) is used for pregnant women or non-pregnant women of childbearing age. The schedules include 2 to 5 doses. Forty-two countries use a 5-dose schedule. TT is given to schoolchildren in 5 countries (Botswana, Comoros, Guinea, Lesotho and Madagascar).

Africa↗
PubMed1996

Expanded programme on immunization (EPI) immunization schedules in the WHO Western Pacific Region, 1995.

There are 36 countries/areas in this Region; Mongolia was transferred to the Western Pacific Region in 1995. No data are available from the Cook Islands, Nauru, and New Caledonia (Tables 1-3). BCG is used in all but 6 countries/areas (American Samoa, Australia, Guam, New Zealand, Northern Mariana Islands and Palau). Most countries/areas give BCG at birth; Japan gives it at 3 months, the Republic of Korea at 4 weeks, and Samoa at 5 years of age. Nine countries give 2 doses of BCG and 4 give 3 doses, up to 15 years of age. Mongolia gives 4 doses up to 18 years of age. Diphtheria-pertussis-tetanus (DPT) vaccine is used as a primary series of 3 doses in all countries/areas; 17 countries give 1 to 3 booster doses of DPT vaccine in the first year of life or later. Diphtheria-tetanus (DT) booster doses are given in Brunei Darussalam, Mongolia and New Zealand. Td is also given in New Zealand. Oral poliovirus vaccine (OPV) is used in a primary series of 3 doses simultaneously with DPT vaccine in all countries/areas. Eight countries/areas use an additional dose of OPV at birth (Cambodia, Fiji, Hong Kong, Kiribati, Lao People's Democratic Republic, Marshall Islands, Papua New Guinea and Tuvalu). A booster dose of OPV in the second year of life is used in 9 countries/areas and a booster dose of OPV is given to schoolchildren in 16 countries/areas. Measles vaccine is given in all countries/areas from 8-15 months of age usually in the form of monovalent measles vaccine, except in Macau. In 4 countries/areas, it is given in the form of measles-mumps-rubella (MMR) vaccine (Guam, Hong Kong, Palau and Singapore). The 2-dose policy is implemented in 4 countries/areas (American Samoa, New Zealand, Palau, and Samoa). In Australia and Palau, the second dose is given as MMR vaccine. The age at the second dose varies from 4 to 13 years of age. Rubella vaccine is given in 4 countries/areas to girls between 10 and 14 years of age (Fiji, French Polynesia, Japan and Macau). In Hong Kong, it is not specified if only girls receive rubella vaccine. In Australia and New Zealand, rubella vaccine is given to seronegative women immediately after delivery. Hepatitis B is used in all but 7 countries/areas (Cambodia, China, Guam, Kiribati, Lao People's Democratic Republic, Tokelau and Viet Nam). All countries which give hepatitis B vaccine use 3 primary doses in infancy, the first dose being given at birth in 23 countries/areas. In Australia and Japan, this vaccine is given to groups at risk. Tetanus toxoid (TT) is used for pregnant or nonpregnant women of childbearing age. It is used in 14 countries/areas, but in Australia and Palau the target group is schoolchildren. The schedules include 2-5 doses of TT.

Adolescent↗
PubMed1977

Where is the malpractice crisis taking us?

There have been several approaches taken to solve the malpractice insurance problem in this country. However, since the cost of malpractice insurance continues to climb, the changes so far have not solved the problem, and more changes seem inevitable. A major change could be the development of a patient insurance plan that would provide compensation for certain injuries related to medical care. The insurance coverage would be centered on hospital care. If certain requirements are met, the plan may not be more expensive than the current tort liability system, and would offer several advantages. In addition to the patient injury insurance, there could be federal assumption of liability for national immunization programs.

Costs and Cost Analysis↗