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PubMed2000

Immunization (EPI) in Ethiopia: acceptance, coverage, and sustainability.

Ethiopia has been engaged in expanding immunization services against the six childhood diseases since 1980. According to plans set at the beginning of the program, the country should have achieved universal child immunization by now. However, the child immunization coverage has never reached the level that is desired to curtail disease transmission and to reduce the morbidity burden associated with the target diseases. This study used the potential of social science research methods in understanding social, cultural, political and economic factors that influence the efficiency and effectiveness of immunization programs in the Ethiopian context. A better understanding of these factors is believed to improve the quality and sustainability of immunization programs. This research focused on relevant issues at micro- and macro-levels. The study basically utilized qualitative research methods involving multiple data collection tools and information sources. Factors related to acceptors, immunization service providers and organization of health services that influence the successful implementation and sustainability of the immunization program in the Ethiopian context are identified and discussed. Strengthening efforts to improve technical capacity of service providers, increasing social mobilization activities, instituting quality assurance schemes and improving management of resources (human, finance and material) are among the major recommendations.

Child↗
PubMed2004

An economic analysis of the current universal 2-dose measles-mumps-rubella vaccination program in the United States.

To evaluate the economic impact of the current 2-dose measles-mumps-rubella (MMR) vaccination program in the United States, a decision tree-based analysis was conducted with population-based vaccination coverage and disease incidence data. All costs were estimated for a hypothetical US birth cohort of 3803295 infants born in 2001. The 2-dose MMR vaccination program was cost-saving from both the direct cost and societal perspectives compared with the absence of MMR vaccination, with net savings (net present value) from the direct cost and societal perspectives of US dollars 3.5 billion and US dollars 7.6 billion, respectively. The direct and societal benefit-cost ratios for the MMR vaccination program were 14.2 and 26.0. Analysis of the incremental benefit-cost of the second dose showed that direct and societal benefit-cost ratios were 0.31 and 0.49, respectively. Varying the proportion of vaccines purchased and administered in the public versus the private sector had little effect on the results. From both perspectives under even the most conservative assumptions, the national 2-dose MMR vaccination program is highly cost-beneficial and results in substantial cost savings.

Adolescent↗
PubMed2002

Beliefs and attitudes of caregivers toward compliance with childhood immunisations in Cameroon.

This study analysed factors associated with caregiver compliance and childhood immunisation schedules using a framework based on the Health Belief Model and a cross-sectional questionnaire survey. Participants were caregivers who were enrolling their children (average age 5 y) into class one at randomly selected primary schools in Bamenda, Cameroon. Schools were selected using a stratified random sampling methodology. Seventy-two percent of the 550 participants responded that their children were up-to-date with their immunisations. Perceived susceptibility with an odds ratio (OR)=0.75, perceived severity (OR=0.74), and self-efficacy (OR=1.57) were found to be associated with caregiver compliance to childhood immunisations. Higher level of education and living in an urban location were also found to be associated with increased likelihood of caregivers being up-to-date with their children's immunisations. Results suggest that health service planning should include health education and health promotion programs targeting caregiver compliance with recommended immunisation schedules with resultant improvements in communicable disease control and child health in Cameroon.

Cameroon↗
PubMed2005

[Seroprevalence of measles antibody and its attributable factors in elementary students of routine 2-dose schedule era with vaccination record].

OBJECTIVES: We investigated the seroprevalence of the measles antibody and its attributable factors for the students who underwent routine 2-dose Schedule Era. METHODS: The subjects were 996 students of the national measles seroepidemiologic study in December 2000 who had vaccination records. We conducted a questionnaire survey and we performed serologic testing for the measles-specific IgG by using an enzyme linked immunosorbent assay. RESULTS: The coverage for the first dose of the MMR vaccination at 12-15 months of age was 95.1% and the coverage for the second dose of MMR at 4-6 years of age was 35.0%. The proportion of subjects undergoing 2-doses of MMR decreased as the age of the subjects increased. The seropositive rate of the measles antibody was significantly high in the second dose vaccinees (93.5% in the second dose group, 84.7% in the non-second dose group, p<0.001) and it was 72.0% in the 0-dose group, 85.4% in the 1-dose group and 93.7% in the 2-dose group (p<0.001). Two point eight percent of the subjects had a past history of measles infection. On the multiple logistic regression analysis, the first and second dose (odds ratio, 8.54; 95% CI.=3.05-23.91), the first dose (odds ratio, 3.06; 95% CI.=1.20-7.81) and the outbreak in the year 2000 (odds ratio, 1.89; 95% CI.=1.24-2.88) were the significant factors for the seropositivity. CONCLUSIONS: Maintaining high coverage with a 2-dose vaccination program would be the decisive factor to prevent an outbreak of measles and to eliminate measles in Korea.

Antibodies, Viral↗
PubMed1998

Impact of the hepatitis B mass vaccination program in the southern part of Thailand.

By 1992, hepatitis B vaccine had been included in the Expanded Program of Immunization (EPI) on a nation-wide scale in Thailand. With the results now available from Songkhla Province in the south of Thailand, we are able to fully evaluate its impact on the prevalence of HBV infection and carrier rate. The population studied comprised 180 randomly selected children aged between 2 months and 15 years who had attended Hat Yai hospital due to any acute illness affecting neither the liver nor the immune system. Their sera were examined for the hepatitis markers HBsAg, anti-HBs and anti-HBc, respectively, using a commercially available test kit. We detected anti-HBs in 106 of the 180 children (58.9%) with its prevalence peaking within the age groups of 0-2 (94.4%) and 3-5 years (75.6%), respectively. Six children, five within the age groups of 6-10 and 11-15 years showed anti-HBc, one of them was diagnosed as a chronic carrier; the sixth one of the age group of 0-2 years most probably displayed passive maternal antibodies. The overall HBV carrier rate amounted to 0.55%. The hepatitis B mass vaccination program has proved highly efficient in protecting newborns from infection and heralds the promise of eventually eradicating hepatitis B virus in the not so far future.

Adolescent↗
PubMedDate not supplied

Immunization update: a community-based nursing education program.

BACKGROUND: Nurses play key roles as advocates, educators, and researchers to eliminate barriers to access as well as educate the public on the importance of vaccines for children in the United States. METHOD: Fifty-four nurses attending a community-based immunization program completed a pretest questionnaire which included identification of related practice behaviors and general knowledge questions. Twenty-four responded to a similar posttest survey 6 months later. The investigators compared knowledge pretest and posttest scores with a t test. Behavioral changes were compared between the pretest and posttest group by analyzing the percentage of change between the time period. RESULTS: The mean score in the knowledge section increased significantly from a pretest mean of 52% to 75% during the posttest period (p < 005). Behavior change was not statistically significant because of the low number of posttest responses indicating actual immunization practices in the clinical setting. The investigators analyzed trends in practice by comparing percentages of responses. CONCLUSION: These findings suggest that a multifaceted, community-based nursing continuing education program including both local, ethnic community perspectives and information related to the latest standards of practice can impact knowledge levels and some practice behaviors.

Child↗
PubMed1999

Impact of community volunteers on immunization rates of children younger than 2 years.

OBJECTIVE: To assess the effectiveness of a volunteer-driven outreach program on immunization rates in children younger than 2 years. DESIGN: Randomized controlled trial. SETTING: Pediatric ambulatory clinics in New York, NY. PATIENTS: A total of 163 children were randomly assigned to receive services from the volunteer-driven outreach program or to serve as control subjects. All children were (1) younger than 2 years, (2) no-shows for a scheduled appointment in the pediatric clinic, and (3) due or overdue for a vaccine. INTERVENTION: Immunization outreach, tracking, and follow-up were provided by community volunteers throughout follow-up (mean, 6.5 months). Control children were notified of immunization status at enrollment but received no further contact until the conclusion of follow-up (mean, 6.4 months). MAIN OUTCOME MEASURE: Immunization status 6 months after enrollment. RESULTS: Significantly more intervention children were up-to-date with their vaccination series than controls (75% vs. 54%; P = .03). Children in the control group were 2.8 times more likely to be late for a vaccine than intervention children (odds ratio = 2.8; P = .02). In addition, an immunization delay of longer than 30 days at enrollment was a significant predictor of final immunization delay (odds ratio = 2.6; P = .02). CONCLUSIONS: This volunteer-driven program significantly improved immunization rates among intervention children compared with controls. Results confirm previous findings that indicate an increased risk of an incomplete immunization series by 2 years of age among children who fall behind early in their primary vaccination series. However, control children were almost 3 times more likely to be late (for > or =1 vaccines) than intervention children, regardless of whether an earlier immunization delay was present.

Ambulatory Care↗
PubMed1998

Universal hepatitis B vaccination: hospital factors influencing first-dose uptake for neonates in Darwin.

A universal neonatal hepatitis B vaccination program was introduced in the Northern Territory in 1990. We compared live births with vaccine usage to determine the uptake of the first dose of hepatitis B vaccine under this new policy and to identify hospital factors that influenced this rate. Attitudes and vaccine administration practices were determined through interviews, using standard questions with midwifery and paediatric nursing staff at both hospitals. Hepatitis B vaccines dispensed at Hospital A indicated a 96 per cent coverage of neonates in 1993 and 93 per cent in 1994. Vaccination at Hospital B indicated 71 per cent coverage in 1993 and 77 per cent in 1994. Differences in vaccine uptake appeared to be influenced by the use of standing drug orders, the nursing staff's attitudes and knowledge, and misinformation among health professionals. Education programs for health professionals and parents need to be established before the introduction of a universal hepatitis B vaccination policy for it to be well accepted. Standing orders for hepatitis B vaccine in postnatal wards allow nursing staff to promote it and thus maximise coverage rates.

Attitude to Health↗
PubMed2005

Serious adverse events associated with bacille Calmette-Guérin vaccine in Canada.

BACKGROUND: Targeted Bacille Calmette-Guérin (BCG) vaccination is offered to neonates in some First Nations and Inuit (FNI) communities in Canada. Serious adverse events associated with BCG vaccine prompted a review to assess causality. METHODS: The Immunization Monitoring Program Active (IMPACT), a pediatric hospital-based active surveillance network, reported admissions for BCG-related adverse events between 1993 and April 2002. The Canadian Advisory Committee on Causality Assessment (ACCA) reviewed the reports to assess causality. Data between 1987 and September 2002 from the Vaccine-Associated Adverse Event Surveillance (VAAES) Program, a passive national reporting system, were also reviewed. RESULTS: IMPACT identified 21 pediatric cases; 19 were Canadian-born, and 18 were FNI. Six disseminated BCG cases were identified; 5 were FNI infants who subsequently died. All had immunodeficiencies and concurrent infections. Other adverse events included 2 cases of osteomyelitis, BCG abscesses and lymphadenitis. ACCA reviewed the 21 cases and determined that 14 were very likely associated with the vaccine, including the 6 disseminated BCGs; 5 were probably associated and 1 was possibly associated with the vaccine; 1 was unclassifiable. The VAAES program identified 157 adverse events. No additional serious systemic adverse events (disseminated BCG or osteomyelitis) were identified. CONCLUSIONS: Serious BCG vaccine-associated complications continue to occur in Canada. The numbers of FNI children with disseminated disease was greater than expected from reported rates in the literature.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

[Tetanus vaccination in the accident and emergency department].

While tetanus is a rare disease in industrialized countries, this infectious disease is still responsible for up to 1,000,000 deaths per year in the developing world. In Germany, the introduction of a country-wide vaccination program (STIKO) has led to a decrease in the frequency of tetanus infection from 115 cases per year in the 1960s to fewer than 15 cases per year in the years from 1990 to 2000. In spite of all the treatment now available, tetanus infection still has a lethal outcome in up to 40% of cases. The Robert-Koch Institute recommends active or passive vaccination depending on the wound classification and the patient's current vaccination status. Since when patients have multiple trauma the emphasis while they are being treated for shock is on stabilisation and diagnosis, there is a real risk of underestimating the size and the level of contamination of existing wounds. Since it is not possible to ascertain the patient's vaccination status in most cases, we recommend simultaneous immunization of polytraumatized patients with skin lesions using Tetanol-Tetagam early in the course of the diagnostic procedures while the patients are still in the emergency room.

Algorithms↗
PubMed1998

[Vaccination status and implementation of recommendations for vaccination with special reference to measles-mumps-rubella vaccination. 1995 program for school entrance].

Children who took part in the medical examination for elementary school starters and who could present a certificate of vaccination were given a written vaccination recommendation. On the first day of school the recommendation sheets filled out by the family doctor or a paediatrician were collected and analysed anonymously. 2194 of 2965 children received a vaccination recommendation. 1047 sheets could be interpreted. Based on the current recommendation of the STIKO (German official vaccination council) a MMR (measles, mumps, rubella) vaccination was suggested in 1001 cases. Only 53.1% of the proposed vaccinations have been given, despite consultation with the family doctor or paediatrician.

Child↗
PubMed2005

In utero DNA immunisation. Immunity over tolerance in fetal life.

The function and plasticity of the developing immune system during embryonic life has been central to immunological thinking for half a century. A classical view is that antigen encountered during fetal life induces a state of acquired immunological tolerance. However, the ability to develop T cell immune responses during the perinatal period would be of great importance against intracellular pathogens. Recent experiments have challenged this notion and shown that neonatal tolerance can be circumvented by extrinsic immunological manipulations. Here, we used DNA immunization targeted at B lymphocytes to induce a CD4 T cell response that could be measured 2 weeks after birth. We conclude that T cell immunity can be programmed in utero by manipulating the parameters of the immune response in the fetal environment. Furthermore, our data suggest that under appropriate conditions the fetal immune system can be programmed to immunity.

Animals↗
PubMed2001

[Anti-HBs titers after a vaccination program in children and adolescents. Should a booster dose be given?].

OBJECTIVES: To determine the efficacy and immunogenicity achieved 6 years after the start of a massive vaccination campaign against hepatitis B in newborn infants and adolescents (12 years). The persistence of anti-hepatitis B virus surface antigen (HBS) levels and the need for a booster dose were also assessed. MATERIALS AND METHODS: From 1993 to 1997 the Engerix vaccine (10 micrograms) and since then the Recombivax vaccine (5 micrograms). The vaccination schedule was the standard of three doses (0, 1, 6). Blood analyses were used for determination of anti-HBs between October of 1998 and May of 2000. RESULTS: We studied 382 cases. Five years after the first dose, 96.1% (73/76) has anti-HBs and in 75% (57/76) levels were above 10UI/L. Six to seven years after vaccination anti-HBs were detected in 94,1 (32/34) of the children and in 70.6% (24/34) of these, levels were above 10UI/L. CONCLUSIONS: A high percentage of children were found to have good levels of anti-HBs 67 years after vaccination. Recent studies show that booster doses are not required because of the immunologic memory that produces the vaccine. The anti-HB protective level (> or = 10UI/l) should not be taken into consideration because this level is only valid when passive immunity with immunoglobulins is applied.

Adolescent↗
PubMed2000

Safety and immunogenicity of a nonavalent pneumococcal vaccine conjugated to CRM197 administered simultaneously but in a separate syringe with diphtheria, tetanus and pertussis vaccines in Gambian infants.

BACKGROUND: Unrelenting high morbidity and mortality have mandated that immunogenic vaccines be used to combat pneumococcal disease in infants. OBJECTIVES: To evaluate the safety and immunogenicity of a nonavalent pneumococcal conjugate vaccine and the antigenic interaction when administered simultaneously with diphtheria, tetanus and pertussis vaccines. METHODS: Two hundred seven infants were randomized to receive three doses of either nonavalent protein conjugate pneumococcal vaccine (PnCV) or inactivated polio vaccine (IPV) at 2, 3 and 4 months of age with routine Expanded Program of Immunization vaccines as scheduled. Vaccinees were visited on Days 1, 2 and 7 to observe local and systemic adverse reactions. Blood was drawn before the first dose and 1 month after the third dose. Antibody concentrations in sera were measured by standardized enzyme-linked immunosorbent assay. Nasopharyngeal carriage of pneumococci was tested at 5 and 9 months of age. RESULTS: No serious reactions were observed. Local induration and tenderness were observed more commonly at the site of administration of diphtheria, tetanus and pertussis vaccines than at the site of administration of IPV or PnCV. Between 79 and 91% achieved >1 microg/ml antibody against specific pneumococcal serotypes. Antibody responses to diphtheria and pertussis antigens were similar in both groups; however, antibody response to tetanus toxoid was significantly lower in infants who received PnCV (geometric mean concentration, 11.1 vs. 17.4; P < 0.001). Nasopharyngeal carriage in PnCV-vaccinated children was reduced but not significantly different from those vaccinated with IPV. CONCLUSION: Simultaneous administration of PnCV with Expanded Program of Immunization vaccines is safe and immunogenic. immune response to the composite antigens is likely to confer protection.

Antibodies, Bacterial↗
PubMed2001

Optimal age for vaccination against measles in the State of São Paulo, Brazil, taking into account the mother's serostatus.

In order to investigate if the changing levels of measles antibody in women resulting from extensive vaccination programs influence the susceptibility of children, we measured the seroprevalence of measles virus antibody of children in the first year of life and of their mothers. We compared maternal antibody decay of two groups of children: those whose mothers were 25 years old or more (mothers born in the pre-vaccination era), and less than 25 years old (mothers born in the vaccination era). Therefore, the 25-year-age cut-off was chosen to distinguish between vaccinated and non-vaccinated mothers. We also compared the immunogenicity of measles vaccine in children from 6 to 12 months of age, in these two groups and also according to their mother's serostatus. The optimal age of vaccination for a routine program was estimated by means of mathematical models. This study was carried out in a sample of 1216 mothers and their respective children. Our results indicate that the optimal age for vaccination of the whole sample was 15 months, 17 months for children born from older mothers, 14 months for children born from younger mothers, 17 months for children born from seropositive mothers and 12 months for children born from seronegative mothers. Therefore, a change to an earlier age of routine vaccination is not justified by our results.

Adult↗