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PubMed2002

Maternal modulation of neonatal immune system development.

Changes in programming of neonatal immune development were effected through maternal immune modulation (Leishmania major inoculation). In progeny of these dams, immune profiles in both blood and spleen were changed throughout the neonatal period and were pronounced after weaning. White blood cell (WBC) and lymphocyte counts in blood of 45-day-old progeny were two-fold less than control animals. In blood, proportions of B cells were greater, while T helpers, Tc/s and NK cells were less than in controls. In contrast, proportions of splenic B and NK cells were greater than controls. But, proportions of all T and Tc/s cells on d20 and 45 were lower than controls. In blood, absolute numbers of all T, Th naïve and Th memory cells were lower than in controls. In contrast, in the spleen, numbers of NK, T and Th naive and memory cells were up to 200% greater than in control pups. Cytokine responses of splenic lymphocytes stimulated through CD3 ligation revealed no difference in IL-4 production. In contrast, IL-2 and IFNgamma were lower on d45 and 5, respectively, in the experimental compared to control mice. These data support the hypothesis that maternal immune events during gestation can modulate the pattern of immune development in offspring.

Animals↗
PubMed2001

An analysis of the immunization status of preschool children enrolled in a statewide Medicaid managed care program.

OBJECTIVES: To measure immunization coverage rates for children enrolled in a statewide Medicaid managed care program and determine the impact of sociodemographic characteristics and the type of primary care provider site on immunization coverage. STUDY DESIGN: A random sample of 2000 was chosen from children between the ages of 19 and 35 months who had been continuously enrolled in the Medicaid managed care program for 1 year. Sociodemographic data and a list of primary care providers for the study children were obtained from administrative databases. Immunization histories were determined by medical record review. RESULTS: Vaccine-specific immunization rates for diphtheria-tetanus-pertussis, polio, Haemophilus influenzae type b, hepatitis B, and measles-mumps-rubella ranged from 87% to 94%, with an overall coverage rate of 75%. Overall immunization status varied by primary care provider site as follows: office-based, 72%; community health center, 75%; hospital-based clinic, 79%; and staff model health maintenance organization, 85% (chi(2) test, P =.008). CONCLUSIONS: Immunization rates compare favorably with national rates for this low-income group. Sociodemographic characteristics were not important predictors of underimmunization, but rates did vary by the type of primary care provider site.

Child Health Services↗
PubMed1998

Tools for immunization guideline knowledge maintenance. I. Automated generation of the logic "kernel" for immunization forecasting.

IMM/Def is a prototype computer program designed to facilitate the building and maintenance of a rule-based program which performs childhood immunization forecasting. An immunization forecasting program takes as input a child's immunization history and produces recommendations as to which vaccinations are due and which should be scheduled next. A significant amount of the knowledge required for immunization forecasting can be expressed in tabular form, including the parameters that indicate the minimum age when each dose may be given and the minimum intervals between doses. The choice of which of these sets of parameters apply to a particular case depends upon additional clinical logic. To perform forecasting, this logic must be applied in three temporal contexts: (1) a dose is due now, (2) a dose is not yet due, and (3) a dose must be scheduled to follow a dose which is due now. Building and maintaining this logic by hand is a formidable challenge. IMM/Def demonstrates how this task can be simplified by first defining immunization "definition logic" which can be automatically translated into if-then rules for each of the three contexts. The approach has been applied successfully to the six childhood vaccination series which are routinely administered. A key advantage is that IMM/Def allows one to have two specifications of the logic that can be examined independently and that can be cross-checked to help assure completeness, consistency, and accuracy of the logic. The paper describes how IMM/Def performs its translation and discusses several design issues and lessons learned.

Child↗
PubMed2001

[The expanded program of vaccination: 25 years tomorrow].

The expanded program on immunization will soon celebrate its 25th anniversary. The original program included vaccination against diphtheria, tetanus, pertussis, poliomyelitis, measles, and tuberculoses. It was expanded to include first yellow fever and hepatitis B and later haemophilus. Results are mixed. Diphtheria was under control but has made a major comeback since vaccination was halted in eastern Europe. Tetanus in newborns should no longer be a public health problem by 2005. Control of pertussis has not been achieved because the vaccine has been unsuccessful in interrupting transmission. Poliomyelitis is no longer reported in the Americas. Hopefully transmission of the wild virus will be stopped by 2003 and total eradication of poliomyelitis will be achieved by 2005. For several reasons, there has been an alarming increase in tuberculosis with an estimated annual incidence of 5 million cases worldwide. Eradication of measles was achieved in the Americas in 2000 and is expected in the European region by 2007 and in the east Mediterranean area by 2010. Current data on yellow fever and hepatitis B is inadequate, these vaccination being still poorly implemented in endemic areas. A more widespread use of the vaccine will be needed. However spending cutbacks and changing priorities in the Health Ministries will require a renewal of commitment to this immunization policy.

Adolescent↗
PubMed2004

[Outbreak of meningitis in the province of Logone occidental (Chad): descriptive study using health ministry data from 1998 to 2001].

UNLABELLED: Outbreaks of meningitis are a public health problem in sub-Saharan Africa where more than thousand cases are declared every year In Chad, the last outbreak happened between 1998 and 2001. The objective of this study is to describe epidemiologic profile of meningitis in the province of Logone Occidental from 1998 to 2001. METHODS: Study used epidemiologic data of surveillance's tools from years 1998 to 2001 in Chad. RESULTS: Data of the study indicated a two-yearly cycle with outbreaks in 1998 and 2000 occurring in endemic background during 1999 and 2001. The first cases began in January with an incidence rate close to 30 for 100.000/week. The epidemic peak occurred on the 11th week (1999-2001), on the 12th week (1998-2000) during dry season. Outbreak continued 9 weeks and stopped on the 16th week (April-May). The lethality average was 12% and reached 30% at the beginning of the outbreak. DISCUSSION: Despite vaccination campaigns during outbreaks, epidemiology did not change in Chad. Quality of epidemiological surveillance is not sufficient and political reaction is too slow. Moreover, human, material and financial deficiency add to these difficulties. Integrated vaccination against meningitis into the immunization preventive program was evocated but would not permit enough collective immunity. Biotope changes generated by human activity could contribute to perpetuating outbreaks. New outbreak of W135 meningitis in Burkina Faso (2002) may change the epidemiological profile of the meningitis in sub-Saharan Africa. CONCLUSION: Meningitis outbreaks control using vaccination after the first cases appears to be limited, however this strategy must be evaluated in Chad to know vaccination covering, target population and protection after vaccination.

Chad↗
PubMed1990

Immunization practices in children.

The resurgence of measles has highlighted concerns about U.S. programs for immunization in infants and children. In order to put the problems into perspective, this review will address such issues as the safety of pertussis vaccines; oral vs inactivated poliovirus vaccine; vaccines for measles-mumps-rubella, Hemophilus influenzae type B, and hepatitis B; and varicella vaccine.

Child, Preschool↗
PubMed2000

Immunization pockets of need: science and practice.

Despite high overall immunization coverage levels among U.S. preschool children, areas of underimmunization, called pockets of need, remain. These areas, which pose both a personal health and a public health risk, are typically poor, crowded, urban areas in which barriers to immunization are difficult to overcome and health care resources are limited. The purpose of this report is to review barriers to immunization of preschool children living in pockets of need and to discuss current issues in the identification of and implementation of interventions within these areas. The Centers for Disease Control and Prevention administers a federal grants program that funds state and metropolitan immunization programs. This program promotes a three-pronged approach for addressing pockets of need: (1) identification of target areas, (2) selection and implementation of programmatic strategies to improve immunization coverage, and (3) evaluation of progress or impact. At each step, scientific evidence can guide programmatic efforts. While there is evidence that state and metropolitan immunization programs are currently making efforts to address pockets of need, much work remains to be done to improve immunization coverage levels in pockets of need. Public health agencies must take on a broadened role of accountability, new partnerships must be forged, and it may be necessary to strengthen the oversight authority of public health. These tasks will require a concentration and redirection of resources to support the development of an immunization delivery infrastructure capable of ensuring the timely delivery of immunizations to the most vulnerable of America's children.

Centers for Disease Control and Prevention, U.S.↗
PubMed1997

Effect of the vaccines for children program on inner-city neighborhood physicians.

OBJECTIVE: To determine the probable effect of the Vaccines for Children (VFC) program on immunization coverage. DESIGN: Preintervention and postintervention study design, with data collected before and after enrollment in the VFC program. SETTING: Twenty-three inner-city neighborhood physicians' offices in New York City. PARTICIPANTS: In 1993, 30 physicians were randomly selected from 8 neighborhoods with the highest proportions of Medicaid-eligible individuals in New York City. In 1995-1996, the 30 physicians were contacted again. Twenty-three agreed to an interview and medical record review. Within each office, the medical records of children aged 3 to 35 months, with at least 3 visits in a 3-month or longer period, were randomly selected. Medical record reviews were conducted for 173 eligible children in 1993 and 528 in 1995-1996. INTERVENTIONS: The VFC program was implemented in October 1994. The administration fee increased from $2 to $17.85; physicians received vaccines free. MAIN OUTCOME MEASURES: Up-to-date status for immunizations and lead and tuberculosis screening; percentage of visits that are missed opportunities to immunize; and percentage of visits that were well-child visits. Up-to-date status, missed opportunities to immunize, and well-child visits were compared across time using chi 2 analysis, corrected for the use of cluster sampling. RESULTS: Up-to-date status changed significantly before and alter enrollment in the VFC program (P < .05) for all immunizations and for lead and tuberculosis screening. For the diphtheria toxoid, tetanus toxoid, and pertussis vaccine, oral poliovirus vaccine, and measles, mumps, and rubella vaccine combined, coverage increased from 17.9% to 42.2%, up by 24.3 percentage points (P < .05). Missed opportunities to immunize did not change, but well-child visits increased from 15.0% to 21.6% (P < .05). Physicians generally attributed performance improvements to the VFC program and not to other competing hypotheses. CONCLUSIONS: The VFC program seems to be responsible for an increase in immunization rates among these physicians.

Child, Preschool↗
PubMed2000

Standing orders for influenza vaccination increased vaccination rates in inpatient settings compared with community rates.

BACKGROUND: Hospitalization of older adults during the period of influenza vaccination in the fall of each year presents a barrier to immunization against influenza. This study evaluates a program using standing orders for influenza vaccination to increase vaccination rates among hospitalized older adults and to determine the effect of vaccination on readmission rates for influenza-like illness. METHODS: An influenza vaccination program using a standing order policy was implemented to vaccinate all consenting persons 65 years and older prior to hospital discharge. This was a prospective, single center, cohort study in a tertiary care university teaching hospital during an 8-week vaccination period in the fall of 1994 and follow-up during the subsequent influenza season. The vaccination status of each patient was recorded as no vaccination, vaccination received in hospital, or vaccination in the community prior to or after the hospitalization. Hospital vaccination rates were compared with the rate of vaccination of older adults in the community. During the subsequent influenza season, the number of subjects reporting symptoms of influenza-like illness (ILI) or who were readmitted to hospital with influenza-related illness was compared in an analysis of vaccinated versus unvaccinated subjects. RESULTS: Seven hundred and sixty-one patients were interviewed, and 332 of these individuals had been vaccinated in the community prior to their hospital admission. Of the remaining 429 unvaccinated patients who were eligible for vaccination in the study, 171 were vaccinated in our immunization program, eight were vaccinated in the community after discharge, and 244 were not vaccinated. We were able to increase the absolute vaccination rate by 22%, when compared with community rates, with our immunization program. The number of subjects with ILI symptoms or readmission to hospital was too small to compare the vaccinated to the unvaccinated group in the study. CONCLUSIONS: An inpatient influenza immunization program using a standing order policy was able to target a particularly high-risk subset of persons 65 years and over who might otherwise have not received influenza vaccination.

Aged↗
PubMed1986

A comprehensive investigation of immunity to poliomyelitis in a developing country.

A comprehensive nationwide surveillance program of serologic immunity of two-year-old black children, combined with evaluation of vaccine quality and distribution, was carried out in South Africa during 1983-1984. Sera were randomly collected from urban and rural groups and cluster samples collected from the semi-urban group. The sample represented 0.23% of the total target population. Satisfactory levels of immunity were found in the urban (80%) and semi-urban (71%) groups but a disquietingly low level was found for the rural group (59%). Individual districts in the rural group could be singled out for directed cluster sampling at a later stage. History and documentation of immunization corresponded well to serologic findings and revealed also a fairly substantial level of natural immunization among individuals who, on history, had received no vaccine. Some 95% of random samples of vaccine recalled from the field showed satisfactory levels of potency. An immunity surveillance program such as this is ideally suited and highly cost-effective for developing countries with incomplete immunization to prevent large-scale buildup of immunity deficit. The technique, however, is too insensitive to detect localized community immunity defects.

Antibodies, Viral↗
PubMed1999

Persistence of susceptibility to measles in France despite routine immunization: a cohort analysis.

OBJECTIVES: This study examined the impact of French routine programs urging the combined measles-mumps-rubella immunization of 15-month-old children. METHODS: We applied a cohort analysis to surveillance data collected by general practitioners to estimate the cumulative incidence rate per 1000 unvaccinated children and the proportion of susceptible children, by age and for each birth cohort between 1985 and 1995. RESULTS: More than 70% of unvaccinated children born in 1985 and 1986 had measles by the age of 10. This incidence rate dramatically decreased after implementation of the routine measles-mumps-rubella immunization program in 1989, but the proportion of 5-year-olds susceptible to measles has not decreased appreciably. In 1996, more than 15% of the children born between 1990 and 1995 were susceptible. CONCLUSIONS: The measles vaccine coverage achieved by the French routine immunization program remains insufficient as regards reducing the number of susceptible children.

Age Distribution↗