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PubMed2005

Risks and benefits of immunizing pregnant women: the risk of doing nothing.

The medical, social and legal risks of immunizing pregnant women are obstacles preventing the initiation of programs to immunize women for their protection and for their infant's protection. Recent projects devoted to vaccine development have focused on protecting newborns and infants. But there are many other reasons for developing or utilizing vaccines before or during pregnancy, beyond the protection of the newborn. Besides the usual reasons for utilizing immunizations to protect the mother and the neonate, the threat of bio-terrorism adds a new dimension to the necessity for addressing this issue. The potential advantages for thinking about vaccinating pregnant women include an array of possible programs associated with risks and benefits. The immunization of pregnant women or women of reproductive age has multiple purposes: to protect the mother, to protect the newborn and infant and to prevent diseases and complications of pregnancy. (1) Preparation of vaccines against infectious agents that are known to result in reproductive pathology and congenital malformation if the infection of the mother occurs during pregnancy. (2) To utilize vaccines used routinely to protect the non-pregnant population, for administration during pregnancy, i.e., influenza, tetanus and other vaccines. Should these vaccines and other routinely used vaccines for children and non-pregnant adults be administered to women during pregnancy if they are medically indicated? (3) Utilization of vaccines to protect women from diseases to which they are susceptible because of pregnancy (poliomyelitis, hepatitis). (4) Utilization of vaccines for use before or during pregnancy, primarily to protect the newborn and infant via maternal transplacental antibodies, i.e., GBD (group B streptococcus). (5) The prevention of intrauterine infection that has been alleged to initiate premature labor. (6) The preparation of a vaccine for use before or during pregnancy to protect both the mother and the neonate, i.e., botulism toxin vaccine. The regulatory agencies and the vaccine producers will need a great deal of objective scientific advice and support and it is the scientific community's responsibility to provide that support. If the scientific and medical community ignores the opportunity to develop vaccines that could reduce the occurrence of reproductive and developmental problems, then we can be accused of acquiescing to the "risk of doing nothing."

Adult↗

PubMed1996

Immunization coverage and child mortality in two rural districts of Sierra Leone.

The study, which is based on data from a household level health survey conducted in early 1993 in the rural areas of the districts of Western Area and Port Loko of Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant and child mortality, and disease symptoms in children who died under age five in the study area. The results of the study indicated that the infant and child mortality rate per thousand live births declined from about 162 in the mid 1980s to about 77 in 1993. This decline was associated with immunization coverage which considerably increased by 1993, reaching as high as above 60% of the eligible children. The study further reveals that the major symptoms of disease at the time of death of an infant or a child were fever, cough, troubled breathing, and diarrhea in that order. While fever and cough could reflect the persistence of malaria and pneumonia-two major causes of infant and child deaths not covered by existing EPI-the study also revealed that many children failed to take full doses of immunization. Similarly, inadequate coverage of domiciliary oral rehydration therapy (ORT) might have been the reason of high incidence of diarrhea-related deaths. Simple medical technologies to eliminate many of the existing major causes of infant and child mortality in rural Sierra Leone are now available. Perhaps, a strengthened primary health care service, including an extensive rural health care network, aimed at eliminating these diseases, would go a long way in reducing infant and child mortality to irreducible minimum.

Cause of Death↗

PubMed2003

10 year assessment of infant hepatitis B vaccination program, in the Loyalty Islands (New Caledonia).

OBJECTIVES OF THE STUDY: To evaluate the decrease of hepatitis B prevalence in New Caledonia 10 years after the implementation of a neonatal vaccination program and discuss the need of any booster in preadolescents. METHOD: A survey was conducted in the Loyalty Islands, involving 593 children aged 8-11 years. Serological profiles were determined using three parameters: antibodies to core and surface antigens and HBs Ag. RESULTS: The vaccine coverage rate is 93 and 89% of the children are protected against hepatitis B. However, 8% of them did have contact with the virus and 1.3% are carriers. Thirty-eight percent of the vaccinated children had their first injection later than the age of 3 months. CONCLUSION: This study attests that the neonatal immunisation is accepted and followed. The prevalence reduction is not as great as expected, probably due to excess delay in primary vaccination. Hepatitis B eradication could be achieved in New Caledonia by starting immunisation at birth, and by implementing a global catch-up program among preadolescents.

Child↗

PubMed2006

A 24-year review on the epidemiology and control of measles in Singapore, 1981-2004.

The objective of our paper is to review the epidemiology of measles in Singapore and the impact of the measles vaccination program on the control of measles. Our review will form the basis for a critical appraisal of our future measles control program. We analyzed the trend of reported measles cases in relationship to measles vaccination coverage from 1981 to 2004 using routine measles notifications and measles vaccination data submitted to the Ministry of Health and the National Immunization Registry, respectively. We determined the measles vaccine efficacy using data from epidemiological investigations of reported institutional measles outbreaks. The herd immunity of the population against measles was accessed through three seroepidemiological surveys that we conducted in 1989/1990, 1993 and 1998. In addition, we collected blood specimens from every clinically diagnosed case of measles notified to the Ministry in 1998/1999 to for measles-specific IgM antibodies in order to evaluate the proportion of clinically diagnosed cases of measles that were laboratory confirmed. The incidence of measles has decreased significantly since 1981 as a result of increased vaccination coverage of 89-93% following implementation of compulsory measles vaccination in 1985. However, resurgences still occurred in 1992/1993 and 1997. With the implementation of the two-dose measles vaccination schedule, the annual number of laboratory confirmed cases of measles to date has been less than 150. Vaccine efficacy of the trivalent MMR vaccine based on institutional outbreak investigations was consistently above 92%. We also found that the overall seroprevalence of the population to measles has decreased from approximately 91.5% in 1989/1990 to 1993 to 77.9% in 1998 (mainly in children < 4 years old) and that only 7% of clinically notified cases of measles were serologically confirmed to be positive for measles. Achieving a vaccination coverage of more than 95%, tightening our MMR vaccine delivery system and strengthening surveillance of measles are essential components which must be addressed in order to interrupt measles transmission in Singapore.

Adolescent↗

PubMed2000

Need for an external proficiency testing program for cytokines, chemokines, and plasma markers of immune activation.

An external evaluation program for measuring the performance of laboratories testing for cytokines and immune activation markers in biological fluids was developed. Cytokines, chemokines, soluble cytokine receptors, and other soluble markers of immune activation (CSM) were measured in plasma from a healthy human immunodeficiency virus (HIV)-seronegative reference population and from HIV-seropositive individuals as well as in supernatant fluids from in vitro-stimulated human immune cells. The 14 components measured were tumor necrosis factor (TNF) alpha, gamma interferon, interleukin-1 (IL-1), IL-2, IL-4, IL-6, IL-10, Rantes, MIP-Ia, MIP-Ibeta, soluble TNF receptor II, soluble IL-2 receptor alpha, beta(2)-microglobulin, and neopterin. Twelve laboratories associated with the Adult and Pediatric AIDS Clinical Trial Groups participated in the study. The performance features that were evaluated included intralaboratory variability, interlaboratory variability, comparison of reagent sources, and ability to detect CSM in the plasma of normal subjects as well as the changes occurring in disease. The principal findings were as follows: (i) on initial testing, i.e., before participating in the program, laboratories frequently differed markedly in their analytic results; (ii) the quality of testing of a CSM in individual participating laboratories could be assessed; (iii) most commercial kits allowed distinction between normal and abnormal plasma CSM levels and between supernatants of stimulated and unstimulated cells; (iv) different sources of reagents and reference standards frequently provided different absolute values; (v) inexperienced laboratories can benefit from participating in the program; (vi) laboratory performance improved during active participation in the program; and (vii) comparability between analyses conducted at different sites can be ensured by an external proficiency testing program.

Adult↗

PubMed2000

Diphtheria in Estonia, 1991-1996.

Clinical diphtheria reappeared in Estonia in 1991. Between 1991 and 1996, 61 cases and 5 deaths occurred; 19 cases were among children 5-9 years of age, and 11 were among persons 40-49 years of age. From 1993-1995, vaccine supplies donated by Finland were used in vaccination programs. In 1995, the International Federation of Red Cross and Red Crescent Societies and the Estonian Red Cross launched a mass vaccination campaign targeting the adult population. By the end of 1997, it was estimated that 46% of adults had received at least one dose of vaccine. Although the vaccination campaigns did not target the pediatric population, vaccination coverage in school-aged children remained high due to continuing routine vaccination programs. The reappearance and epidemic of clinical diphtheria cases and the mass vaccination campaign efforts demonstrated that preventive measures are important and must be maintained in order to keep diphtheria under control.

Adolescent↗

PubMed2005

Acellular pertussis vaccines in Japan: past, present and future.

An antivaccine movement developed in Japan as a consequence of increasing numbers of adverse reactions to whole-cell pertussis vaccines in the mid-1970s. After two infants died within 24 h of the vaccination from 1974 to 1975, the Japanese government temporarily suspended vaccinations. Subsequently, the public and the government witnessed the re-emergence of whooping cough, with 41 deaths in 1979. This series of unfortunate events revealed to the public that the vaccine had, in fact, been beneficial. Furthermore, researchers and the Japanese government proceeded to develop safer pertussis vaccines. Japan now has the most experience worldwide with acellular pertussis vaccines, being the first country to have approved their use. This review describes the major events associated with the Japanese vaccination program. The Japanese experience should be valuable to other countries that are considering the development and use of such vaccines.

Humans↗

PubMed2001

Challenges to vaccine safety.

The end of the 20th century saw the realization of a goal that was previously only dreamed about: the near elimination of many deadly infectious diseases through universal vaccination. As one disease after another has been driven from memory, it is vaccination programs themselves that have come to occupy the public's mind. With increased scrutiny comes the promise that vaccines will become even safer, but there is also the threat that ill-founded concerns will result in reduced immunization rates, and diseases will resurge. This article reviews scientific data relating to current vaccine safety concerns.

Attitude to Health↗

PubMedDate not supplied

The status of child health and child survival and development programs in Turkey.

"Child Survival Activities in Turkey" are: growth monitoring programs, expanded programs of immunization (elimination of neonatal tetanus, reducing morbidity and mortality of measles, eradication of polio), control of diarrheal diseases (oral rehydration therapy), control of deaths from pneumonia (ARI), baby-friendly hospitals initiative and promotion of breast-feeding, salt iodization programs, elimination of vitamin A deficiency, safe motherhood projects, and phenylketonuria screening programs. Furthermore, family planning, nutrition and education of the mother were among the subjects covered because of their role in child health. The activities, aims and strategies related to these programs are taken up separately. The status of child health and some of the child survival and development programs (growth monitoring program, expanded program of immunization, control of diarrheal diseases, control of deaths from pneumonia, baby-friendly hospitals initiative and promotion of breast-feeding) are discussed in the article.

Child↗

PubMed2006

Accelerated versus classical hepatitis B virus vaccination programs in healthcare workers accelerated vs. classical HBV vaccination.

BACKGROUND: The aim of this study was to compare the efficacy of a standard hepatitis B virus vaccination program (day 0-30-60) with an accelerated vaccination program (day 0-10-21) in healthy healthcare workers. MATERIAL/METHODS: Participants were randomly assigned to a classical (group 1, days 0, 30, and 60) or an accelerated vaccination program (group 2, days 0, 10, and 21). The vaccine used was 20 pg recombinant hepatitis B vaccine (recombinant hepatitis B vaccine derived from yeast cells, Engerix B, Smith Cline Beachum). HBV markers were re-examined for the emergence of anti-HBsAg and also to detect the development of a possible acute HBV infection one, two, and three months after the last dose of vaccine. Anti-HBsAg titers >10 mIU/l were accepted as protective. RESULTS: The seroprotection rates were similar one, two, and three months after the last dose of vaccine in both groups. Anti-HBsAg titers in group 1 were higher than in group 2 two and three months after the last dose of vaccination (p<0.05). CONCLUSIONS: Our data indicate that the accelerated HBV vaccination program was as effective as the classical vaccination program.

Adult↗

PubMed1994

[Tetanus--the forgotten disease].

Tetanus is preventable by proper immunization, which has almost eradicated the disease in countries with a high standard of living. However, the disease is still prevalent even in the most advanced countries and it often appears in the elderly. We emphasize this fact and alert primary care physicians, and duty physicians in emergency rooms, to the possibility of tetanus developing in older patients. Because of their age, they often do not remember when they last had tetanus immunization, nor are records always adequate. We point out the necessity and feasibility of incorporating a special immunization review program for the elderly, including a cost-benefit analysis.

Aged↗

PubMed1997

Impact of measurement and feedback on vaccination coverage in public clinics, 1988-1994.

OBJECTIVE: To investigate whether a reported rise in vaccination coverage in Georgia public clinics during the period 1988 through 1994 was artifactual or real and, if real, to determine the extent to which the rise could be associated with a program of measurement and feedback. DESIGN: Examination of data from Georgia public clinics, doses-administered records, and National Health Interview Surveys. SETTING/PARTICIPANTS: Children attending Georgia public clinics. INTERVENTION: Measurement of vaccination coverage and feedback to providers. MAIN OUTCOME MEASURE: Vaccination coverage rates. RESULTS: For the period 1988 through 1994, 136 004 Georgia public clinic vaccination records for children 21 to 23 months of age were reviewed. Median series-completion rates at public clinics rose from 53% to 89%, while indexes of under-vaccination fell: missed opportunities for simultaneous vaccination (6% to 0%), lost contact for more than 12 months (14% to 1%), and first vaccination more than 1 month late (19% to 8%). According to the independent doses-administered database, the proportion of children starting the primary series very late (> or =12 months old) fell from 14% to 6%, and the series-completion index rose from 64% to 83%, suggesting that improvements could not be wholly ascribed to better clinic record keeping. In 1988, vaccination coverage of children 24 months of age in the National Health Interview Survey (NHIS) was 53%, identical to median public clinic coverage in Georgia; in 1993, NHIS coverage was 60%, while median public clinic coverage in Georgia was 90%, suggesting that the rise in coverage in Georgia public clinics exceeded national trends. Patterns within the coverage changes suggest an association with the process of measurement and feedback. CONCLUSIONS: A marked increase in vaccination coverage occurred in Georgia public clinics associated with a program of annual measurement and feedback.

Community Health Centers↗

PubMed1992

A new EPI strategy to reach high risk urban children in Bangladesh: urban volunteers.

Many community based outreach programs in low income countries utilize illiterate women to provide health services. However, illiteracy may present special problems in immunization or other programs requiring extensive record-keeping and follow-up. In a trial involving twenty-nine volunteers from urban slum communities in Dhaka, Bangladesh, a community-based referral and record-keeping system for use by semi-literate and illiterate volunteers in immunization outreach activities was evaluated over a thirteen month period. The women were uniformly, regardless of literacy, able to use the system to effectively refer and follow-up clients. Although volunteer performance as measured by numbers of referrals was below initial targets, completion rates were high; 87% of children and 96% of women referred completed the full series of immunizations. By facilitating active community participation, the system provides a feasible approach to reducing the high drop-out rates currently associated with immunization programs.

Bangladesh↗

PubMed1996

An adolescent hepatitis B immunisation program. The Preston experience.

An adolescent hepatitis B immunisation program was conducted in all post primary schools in the City of Preston, Melbourne, Victoria, in 1993. The program was funded entirely by the City of Preston using SmithKline Beecham, Engerix B Adult Vaccine. A total of 857 Year 9 students in 8 schools were offered a three-dose course of Hepatitis B vaccine; 85% of all students elected to enter the program; 78% of all students completed the program; 95% of students who started the program completed the three-dose schedule. No side effects from the 2041 doses were reported. The program was well accepted and tolerated by the students with minimum side effects at a total cost of $34 per completed course.

Adolescent↗

PubMed2006

Can the quality of care in family practice be measured using administrative data?

OBJECTIVE: To explore the feasibility of using administrative data to develop process indicators for measuring quality in primary care. DATA SOURCES/STUDY SETTING: The Population Health Research Data Repository (Repository) housed at the Manitoba Centre for Health Policy which includes physician claims, hospital discharge abstracts, pharmaceutical use (Drug Program Information Network (DPIN)), and the Manitoba Immunization Monitoring Program (MIMS) for all residents of Manitoba, Canada who used the health care system during the 2001/02 fiscal year. Family physicians were identified from the Physician Resource Database. Indicators were developed based on a literature review and focus group validation. DATA COLLECTION/EXTRACTION METHODS: Data files were extracted from administrative data available in the Repository. We extracted data based on the ICD-9-CM codes and ATC-class drugs prescribed and then linked them to the Physician Resource Database. Physician practices were defined by allocating patients to their most responsible physician. Every family physician in Manitoba that met the inclusion criteria (having either 5 or 10 eligible patients depending on the indicator) was 'scored' on each indicator. Physicians were then grouped according to the proportion of the patients allocated to their practice who received the recommended care for the specific indicator. PRINCIPAL FINDINGS: Using administrative health data we were able to develop and measure eight indicators of quality of care covering both preventive care services and chronic disease management. The number of eligible physicians and patients varied for each indicator as did the percent of patients with recommended care, per physician. For example, the childhood immunization indicator included 544 physicians who, on average, provided immunization for 65 percent of their patients. CONCLUSIONS: Quality of care provided by family physicians can be measured using administrative data. Despite the limitations addressed in this paper, this work establishes a practical methodology to measure quality of care provided by family physicians that can be used for quality improvement initiatives.

Data Collection↗

PubMed1994

Progress toward poliomyelitis eradication--Egypt, 1993.

Since 1990, the Ministry of Health in Egypt has directed efforts toward achieving poliomyelitis eradication by the end of 1994. To achieve this goal, the Egyptian Expanded Program on Immunization (EPI) has progressively implemented each of four World Health Organization (WHO)-recommended strategies: 1) increasing and sustaining routine coverage with oral poliovirus vaccine (OPV); 2) conducting National Immunization Days (NIDs); 3) developing surveillance for acute flaccid paralysis (AFP), including laboratory confirmation of cases; and 4) instituting "mopping-up" vaccination (i.e., house-to-house administration of two doses of OPV at an interval of 4-6 weeks to all children aged < 3 years who reside in areas where risk for wild poliovirus transmission is highest). This report summarizes the poliomyelitis eradication effort in Egypt based on a program review conducted during November 20-30, 1993, by the Egyptian Ministry of Health; Cairo University; the High Institute for Public Health in Alexandria, Egypt; WHO; Rotary International; and CDC.

Egypt↗

PubMed2004

Pneumonia in HIV-infected and HIV-uninfected children in developing countries: epidemiology, clinical features, and management.

PURPOSE OF REVIEW: Pneumonia is a leading cause of illness and death in children younger than 5 years in developing countries, accounting for approximately 20% of childhood deaths. The HIV epidemic has sharply increased the incidence, severity, and mortality of childhood pneumonia in the developing world, particularly in sub-Saharan Africa. This article reviews recent findings on the epidemiology, clinical features, and management of HIV-infected and -uninfected children with pneumonia in developing countries. RECENT FINDINGS: Bacterial infection remains a major cause of pneumonia mortality; in HIV-infected children, a broader spectrum of pathogens including gram-negative infections and Pneumocystis jiroveci occurs. Mycobacterium tuberculosis is an important cause of acute pneumonia among children from high tuberculosis prevalence areas. Use of case management guidelines substantially reduces neonatal, infant, and under-5 mortality and pneumonia-specific mortality in developing countries. New advances in therapy include the use of short-course antibiotics and high-dose amoxicillin twice daily for ambulatory treatment of HIV-negative children with pneumonia. New preventive interventions include the development of conjugate vaccines against Streptococcus pneumoniae and Haemophilus influenzae, but these are not widely affordable nor available in developing countries. Despite a lower efficacy in HIV-infected children, these vaccines still protect against disease in a significant proportion of children. Available preventive interventions including micronutrient supplementation with zinc and vitamin A, and immunization as contained in the WHO Expanded Program of Immunization can substantially reduce the burden of childhood pneumonia. SUMMARY: Urgent measures to implement existing available, effective interventions for prevention and treatment of childhood pneumonia and achieve high coverage rates in developing countries are needed.

AIDS-Related Opportunistic Infections↗

PubMed1994

[The childhood vaccination program. Background, status and future].

Surveillance of the Danish childhood immunization programme has taken place at Statens Seruminstitut since 1980. A description of the prevalence of the diseases, which are included in the programme, is presented. The Danish childhood immunization programme has for many years been one of the best in the world although it differs markedly from other countries. The polio immunization programme with inactivated polio vaccine given first and then later live attennuated vaccine is probably the optimal polio immunization programme. The childhood immunization programme began in 1943 with free diphtheria vaccination, and tetanus immunization was added in 1949. There was a big polio epidemic in 1952/53 and the polio vaccine was introduced in 1955. All three vaccines have markedly reduced the prevalence of these diseases. Pertussis vaccine was introduced in 1961 and measles, mumps and rubella vaccination in 1987. Vaccination against Haemophilus Influenzae type b was introduced with success in 1993. In the future several changes will probably be made in the programme because of the possibility using new combined vaccines.

Bacterial Vaccines↗