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PubMed1997

[Frankfurt Vaccination Intervention Study--Friva].

The success of the recommendation of vaccinations on the occasion of school-beginner examinations is assessed. The feedback rate of the intervention group amounts to 65%. The recommended vaccinations were carried out at 60% (measles-mumps-rubella) up to 90% (tetanus).

Child↗
PubMed1997

[Predictive medicine and its ethics].

The concept of predictive medicine based on the detection of genetic markers for disease susceptibility stemmed from the finding that many diseases are associated with specific HLA alleles. This model suggested that similar associations probably existed with other genes located all along the human genome. The Human Specimen Study Center (HSSC) was created to assist in investigating this possibility and has contributed significantly to the knowledge contained in current genetic and physical human genome maps. Predictive medicine is intended not for patients but for healthy individuals, its goal being to determine whether their susceptibility to a specific disease is increased or not. Fetuses with evidence of disease are excluded from the province of predictive medicine, which can, however, determine whether a healthy fetus is at high risk for developing a disease in adolescence or adulthood. Predictive medicine is based on probabilities: it evaluates diseases susceptibility but cannot predict with 100% certainty that a specific disease will occur. Whereas many preventive interventions are directed at groups (e.g., immunization programs), predictive medicine is conducted on an individualized basis. For instance, glaucoma is a monogenic disease whose early detection can allow to prevent permanent loss of vision. The fruits of predictive medicine are expected to be greatest, however, in the polygenic multifactorial diseases that are prevalent in industrialized countries, such as diabetes mellitus, hypertension, myocardial infarction, hyperlipidemia, and arteriosclerosis. An ability to detect subjects who are susceptible to breast cancer would be extraordinarily useful, and may be a goal within reach since two breast cancer susceptibility genes have already been identified. Genes associated with increased susceptibility to colon cancer have also been reported. Predictive medicine raises a number of sensitive ethical issues. Individuals should be free to accept or decline disease susceptibility testing after having been fully informed. Confidentiality is vital. The results of susceptibility tests should not be made available to employers or insurance agencies. Susceptibility testing should be offered only if the disease requires a specific treatment or lifestyle modification. Unnecessary anxiety may be one of the main adverse effects of susceptibility testing. A large number of disease susceptibility or resistance genes will probably be identified in the near future, and this will inevitably have an impact on the way physicians approach their patients. Physicians in the XXIst century will spend an increasingly large proportion of their time counselling their patients on how to stay healthy. This trend can be expected to translate into a marked increase in life expectancy. Rather than seeking to add years to life, physicians will strive to add life to years.

Confidentiality↗
PubMed1997

[Vaccination of chronically ill children].

Children with chronic diseases (hematologic, metabolic and renal diseases, children with chronic heart and lung disease, children with cerebral defects and immunodeficient patients) have an increased risk to suffer from infectious diseases and should be immunized with priority. In addition to routine immunization, these high-risk children may benefit from influenza, pneumococcal and hepatitis A vaccination. In this paper, general recommendations for vaccination in children with chronic diseases are being discussed, with emphasis on certain disease entities. Furthermore, the importance and indications for influenza and pneumococcal vaccine are being presented.

Adolescent↗
PubMed1997

Safety and immunogenicity of a Haemophilus influenzae type B polysaccharide-tetanus toxoid conjugate vaccine combined with diphtheria, tetanus and pertussis vaccines in Thai infants.

A randomized, open, multicenter trial was conducted to determine the safety and immunogenicity of a Haemophilus influenzae type b polysaccharide-tetanus toxoid (PRP-T) conjugate vaccine combined with tetanus, diphtheria and pertussis (DTP) vaccine in 271 Thai infants born to mothers immunized against tetanus during pregnancy. Infants were immunized at approximately 2, 4 and 6 months of age with these vaccines. To determine if elevated levels of anti-tetanus toxin antibodies suppressed the anti-PRP antibody response, a second group of infants were immunized with PRP complexed with outer membrane proteins of Neisseria meningitidis (Pedvax HIB) in one limb at 2 and 4 months of age and DTP vaccine in the other limb at 2, 4 and 6 months of age. A third group of infants received only DTP vaccine at 2, 4 and 6 months of age. The occurrence of both local and systemic adverse reactions were comparable in all 3 groups. The geometric mean anti-tetanus antibody titer was > 1 IU/ml at baseline. Approximately 1 month after the administration of the third dose of vaccine, 98.5%, 99.3% and 9.7% of the children immunized with DTP+Pedvax HIB, DTP-PRP-T or DTP possessed > or = 0.15 microgram of anti-PRP antibody per ml. No child in the DTP group achieved > or = 1 microgram/ml while 74.2% and 89.3% did so after immunization with DTP+Pedvax HIB, or DTP-PRP-T, respectively (p < 0.05). Immune responses to diphtheria, tetanus and pertussis antigens were similar in all vaccine groups. These results demonstrate that elevated tetanus antibody titers do not diminish the anti-PRP antibody response following immunization with a PRP-T conjugate combined with DTP vaccine.

Antibodies, Bacterial↗
PubMed1997

[Preventive vaccination for viral hepatitis].

Viral hepatitis A-E belong to the most important infectious diseases worldwide. Viral hepatitis is highly endemic in most developing countries in Africa, South East Asia, and southern America; however also in industrialized countries as Germany hepatitis A, B and C represent a thread which should not be underestimated. In Germany, there are about 20,000 to 40,000 hepatitis A infections every year, most of them acquired abroad; about 50,000 new hepatitis B infections and about 5,000 to 8,000 infections with hepatitis C virus occur every year. About 500,000 individuals are chronic carriers of hepatitis B virus and roughly the same number is supposed to be chronically infected with hepatitis C virus. As possibilities for therapeutic intervention in chronic hepatitis B and C are still limited, immunoprophylactic measures are of particular importance. Passive and active immunization is available for hepatitis A and B but so far not for hepatitis C. Passive immunization by application of specific immunoglobulins gives protection which is effective within a few hours but is limited according to the amount of immunoglobulin to six to twelve months. Active immunization on the other hand induces a specific immune response starting after a delay of usually days or sometimes weeks but nevertheless lasting for at least several years. The combination of both methods, passive-active immunization, has the advantage of immediate protection due to the immunoglobulin which lasts until the active immunization induces an endogenous antibody production.

Adult↗
PubMed1997

Lone parent families are an independent risk factor for lower rates of childhood immunisation in London.

The aim of this study was to determine associations between indicators of social deprivation and the uptake of primary immunisation in London. Correlation coefficients were calculated between immunisation coverage in London for each of the 28 inner and outer London district health authorities in November 1991 and a range of possible explanatory variables from small area statistics data from the November 1991 census. The proportions of children under 5 years of age, lone parent families, unemployed members of the workforce, domestic overcrowding, ethnic minorities, and unskilled workforce were correlated significantly with the coverage of primary immunisation for third dose diphtheria (D3) and pertussis (P3) at 12 months. A significant correlation with measles, mumps, and rubella (MMR) at 24 months existed only for lone parent families. Multiple linear regression weighted by population size was used to identify independent predictors of variation in immunisation cover. The proportion of lone parent families in each district health authority was the only significant independent risk factor consistently associated with variation in immunisation coverage for D3, P3, and MMR. The proportion of lone parent families explained 42% of the variation in coverage for D3 in November 1991. This study has identified lone parenthood as an important independent risk factor in London for failure to complete immunisation.

Adult↗
PubMed1997

[BCG vaccines for the prevention of tuberculosis in the world].

The BCG vaccines will celebrate the 100th anniversary of their discovery in a decade at the beginning of the next century since Albert Calmette and Camille Guerin had presented it before the Academie des Sciences in 1908. At present tuberculosis kills more people than any other infectious disease about 3 million people a year, including almost 300,000 children under 15, and is producing over 7,000 deaths and over 24,000 new cases every day. Therefore, WHO declared a global health emergency in 1993. More worse, recently multi-drug resistant tubercle bacilli are emerging rapidly making TB patients incurable. Under these situations we need a potent anti-tuberculosis vaccine. So first of all, we must check the century-old BCG before proceeding further. At moment, the BCG vaccines are being used worldwide in the largest quantities in the world, but still most controversial vaccines anywhere. I would like to describe here their success and failure in the combat against the white plague. 1. The Expanded Programme on Immunization (EPI). In 1974, when the EPI was launched by WHO, less than 5% of the world children were immunized against six infectious diseases including tuberculosis. In 1995 statistics, BCG gave the highest vaccination coverage, 87% higher than any other 5 vaccines of EPI for children. The BCG in EPI must have saved a lot of infants as the vaccine, has been proved to be most effective against the blood-born tuberculosis of child type. 2. The efficacy of BCG vaccination against tuberculosis. Results of each 10 of randomized controlled trials (RCT) and Case-control studies (CCS) showed the protective efficacy against tuberculosis as uncertain, unpredictable, as protective efficacy varied from 80% to 0%. More recently, a Meta-analysis of selected papers on BCG field trials which were so far collected. They recalculated vaccine protective effect separately for pulmonary TB and for meningeal/miliary TB in the trials. As the result, it was found that protective effect against pulmonary TB could not be calculated, but protective effect against meningeal and miliary TB was calculated as 86%, 75% respectively, in RCT and CCS, being higher than against pulmonary TB. 3. The duration of BCG efficacy against tuberculosis was confirmed to continue for 15 years after vaccination. The incidence of every form of tuberculosis decreased steeply during the 15 years following vaccination. 4. BCG revaccination. A WHO statement was issued in 1995 mentioning that there is no definitive evidence that repeated BCG vaccination confers additional protection against tuberculosis. Therefore WHO has not recommended to repeat BCG vaccination because of no scientific evidence to support this practice. Multiple BCG revaccinations are not indicated in any persons. 5. Complications with BCG Second IUATLD study (1988) on complications induced by BCG was reviewed, especially following two points: 1-2) Regional suppurative lymphadenitis 3) Generalized lesions: fatal cases 1-2 Several African regions had experienced that the risk of outbreak of suppurative BCG lymphadenitis was low for vaccines with Glaxo and Japanese strains, but much higher for vaccines with Pasteur. This experience in nineteen eighties has led EPI to replace the Pasteur BCG vaccine with less reactogenic BCG, Japanese or Glaxo BCG to solve the outbreak of suppurative adenitis complication. 3 At moment, the only contra-indication of EPI BCG vaccination is symptomatic HIV infection (AIDS), but in the future asymptomatic HIV infection should be placed on alert, because fatal BCG generalized disseminations have already been experienced by HIV positive vaccinees although in a few cases in USA. 6. BCG seed lots for use of vaccination in the world. Nearly 10 seed lots (BCG) are being used in the world at present. However, they are more or less different each other in various characteristics: morphological, biochemical, biophysical, immunological, vaccinological and so on. None of them is the same

BCG Vaccine↗
PubMed1997

[Vaccination project for vocational students].

As part of a North-Rhine-Westphalian state project the district of Unna developed a vaccination programme for continuation schools in 1996. The reason for this programme realized for the first time in a vocational school, was a considerable lack of protection by vaccination in ninth year classes. The present results from the first vocational school show a significant lack of standard vaccination as well as boosters. To improve the current situation it will be necessary to authorize and enable the Public Health Services to carry out even more standard and indication vaccinations at secondary and vocational schools as well as at institutions for the handicapped.

Adolescent↗
PubMed1998

[Routine vaccination in childhood].

Some major modifications of the recommended Swiss vaccination schedule have been introduced in spring 1996: 1. The vaccination against pertussis using the new acellular vaccines, which cause fewer side-effects. This allows the administration of a fourth and a fifth dose at the age of 2 and 4-7 years, respectively. 2. The consideration of combination vaccines, which contain the vaccinations against diphtheria, tetanus and pertussis as well as the vaccine against invasive diseases caused by Haemophilus influenzae type b. 3. In order to increase the individual vaccination protection, a second dose of MMR vaccine is recommended, preferably at the age of 4-7 years. A general recommendation for hepatitis B vaccination during adolescence may be expected in 1998.

Adolescent↗
PubMed1998

[Routine preventive vaccinations].

In 1996, a second measles, mumps and rubella (MMR) vaccination at the time of school entry was included in the Swiss Childhood Immunization schedule, and universal hepatitis B immunization will likely be added in 1998. An additional innovation is the possibility to use acellular pertussis vaccines which have a lower rate of side effects. Each physician who is involved in immunizations should be familiar with the arguments that support the official immunization recommendations in order to be able to provide competent advice to patients or their parents.

Adolescent↗
PubMedDate not supplied

Prevention of vertical transmission of hepatitis B virus infection. Is there a standard policy in Flanders (Belgium)?

The perinatal transmission of hepatitis B virus (HBV) from mother to child can be effectively prevented by the combined administration of hepatitis B immunoglobulins (HBIg) and hepatitis B vaccine (HB vaccine) immediately after birth. This requires prenatal screening of all pregnant women for HBsAg. In Belgium, a standard prevention policy does not exist. This study evaluated the current prevention policy of paediatricians in Flanders, regarding the prevention of vertical transmission of HBV, and their knowledge regarding the reimbursement of the HB vaccine for neonates of HBsAg-positive mothers. Ninety-one percent out of 134 participants administered both HBIg and HB vaccine. The recommended timing, within 12 hours post-partum, was observed in 60.0% for HBIg and in 50.3% for HB vaccine. Twenty-five percent of the respondents answered not to be well informed regarding the reimbursement of the HB vaccine. A preliminary study in Flanders among gynaecologists showed that 27 out of 29 routinely screened pregnant women for HBV, but the type of serology tested and the timing of this prenatal screening were very heterogeneous. We conclude that a standard policy regarding the prevention of vertical transmission of HBV is currently lacking in Flanders.

Belgium↗