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PubMed2003

[Expected incidence of post-vaccination complications in vaccination programs].

Incidence rate of the harder adverse immunization reactions in the Program of the vaccination children in Federation Bosnia and Herzegovina is similar in the terms of kind and frequency as in the countries with high quality programme of the vaccination. In the period from 2002-2003 year cases of the adverse reactions were not registered, as vaccinal form of polyomyelitis, toxic syndrome or sudden acute deaths. The adverse events following immunization were classified in relation to 100,000 applicated vaccines, the incidence rate of supurative lymphadenitis at BCG vaccination reported are 32@100000, anaphylaxia at MMR vaccination 0.8@100000, DTP vaccination encephalopathy 1@100000 and at TT vaccination anaphylaxia 2@100000 administered vaccines.

Child↗
PubMed2000

The introduction of new vaccines into developing countries II. Vaccine financing.

The development of new vaccines for important childhood diseases presents an unparalleled opportunity for disease control but also a significant problem for developing countries: how to pay for them. To help address this problem, the William H. Gates Foundation has established a Global Fund for Children's Vaccine. In this paper, we discuss the allocation of this and other similar funds, which we call Global Funds. We propose that allocation of the Global Funds to individual countries be guided in part by a Vaccine Procurement Baseline (VPB). The VPB would set a minimum of 0.01% of gross national product (GNP) as an amount each developing country would devote to its own vaccine procurement. When this amount is not sufficient to procure the vaccines needed by a developing country, the Global Funds would meet the shortfall. The amount required of donors to maintain the Global Funds would be about $403 million per year for both existing EPI vaccines as well as for a hypothetical group of five new vaccines costing $0.50 per dose and requiring three doses per child. Including program costs, poor developing countries currently spend about 0.13% of GNP on EPI immunizations. In contrast, the United States, as one example donor country, spends about 0.035% of GNP for childhood immunization including several new vaccines. This paper analyzes the Global Funds requirements for hepatitis B and Haemophilus influenzae type b (Hib) vaccines. After a ramp-up period, needier countries would eventually require about $62 million for hepatitis B and $282 million for Hib at current prices. Various additional criteria could be used to qualify countries for participation in the Global Funds.

Bacterial Capsules↗
PubMed1998

Impact of a large-scale immunization initiative in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

CONTEXT: Inner-city immunization rates have lagged behind those in other areas of the country. OBJECTIVE: To evaluate the impact of an initiative linking immunization with distribution of food vouchers in the inner city. DESIGN: Retrospective analysis of immunization data gathered in 1996 and 1997. SETTING: Nineteen Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites serving 30% of the Chicago, III, birth cohort. PARTICIPANTS: A total of 16581 children 24 months old or younger. INTERVENTIONS: Voucher incentives (varying frequency of food voucher issuance based on immunization status) and assessment of immunization status and referral to immunization provider. MAIN OUTCOME MEASURES: Age-appropriate immunization rates and WIC enrollment rates. RESULTS: During the 15-month period of evaluation, immunization rates increased from 56% to 89% at sites performing voucher incentives. The proportion of children needing voucher incentives declined from 51% to 12%. Sites performing assessment and referral, but not providing voucher incentives, showed no evidence of improvement in immunization coverage. No difference was observed in enrollment rates between sites performing voucher incentives and those that did not. CONCLUSION: Applied in a large-scale, programmatic fashion, voucher incentives in WIC can rapidly increase and sustain high childhood immunization rates in an inner-city population.

Chicago↗
PubMed1983

Adult immunization: the medical record design as a facilitator for physician compliance.

A three-year prospective chart audit of a family practice residency program was performed to measure physician compliance in following the recommendations of an adult immunization program. Despite curriculum changes, performance self-evaluation, and reminders by faculty members to residents about the need for adult immunization, physician compliance was poor in the second year of the study. It was thought that components of the medical record might be improved to facilitate physician compliance in the adult immunization program. At the beginning of the third year of the audit, tetanus and pneumococcal vaccines were preprinted on the health maintenance inventory (HMI), but influenza was not. The chart design also was changed to put the HMI in a more prominent place. In the third year of the audit, physician compliance with tetanus and pneumococcus immunization improved significantly. The results of the chart review suggest that physician compliance with adult immunization programs can be improved with appropriate chart design.

Adult↗
PubMed1986

Adult immunizations.

Effective and successful vaccination programs during childhood have resulted in a growing number of unimmunized persons reaching adulthood without being exposed to common infectious diseases. Therefore, it is strongly recommended that physicians establish an ongoing immunization program for adults. Before administering a vaccine, physicians must consider a patient's risk of contracting the disease and the safety and efficacy of the vaccine.

Adolescent↗
PubMedDate not supplied

Physician attitudes and beliefs associated with patient pneumococcal polysaccharide vaccination status.

BACKGROUND: Barriers to adult immunizations persist as current rates for pneumococcal polysaccharide vaccine (PPV) receipt among eligible adults remain below national goals. This study investigated potential barriers to patients receiving the PPV, including predisposing, enabling, environmental and reinforcing factors among physicians from a variety of practice and geographic settings. METHODS: Participants were 60 primary care physicians from inner-city, rural, suburban, and Veterans Affairs practices, which included adults aged 65 years and older. Elderly patients able to complete a telephone interview were randomly selected from each physician's practice. RESULTS: Self-reported PPV vaccination status was significantly related to physician report of routinely providing PPV to their patients and to the practice providing immunization clinics or other immunization promotion programs. Physicians who were highly unlikely to refer uninsured adults to health departments for immunizations had a significantly higher percentage of patients reporting receipt of PPV (P = .03). CONCLUSIONS: Enabling and environmental factors related to physicians, such as economic and insurance issues, were significant barriers to PPV vaccination. Vaccination rates might be improved through efforts that reduce likelihood of referral for immunizations and office systems that support immunization, such as patient and provider reminders and express vaccination clinics.

Adult↗
PubMed2003

Predictors of death in infants hospitalized with pertussis: a case-control study of 16 pertussis deaths in Canada.

OBJECTIVES: To describe the clinical course of fatal cases of pertussis and identify predictors of death at the time of presentation for medical care. METHODS: Case-control study of 16 deaths from pertussis identified by the Immunization Monitoring Program, Active (IMPACT) surveillance network (January 1991-December 2001) matched with 32 nonfatal cases by age, date, and geography. Differences were compared by Fisher exact test and logistic regression. A multivariate model was developed using stepwise logistic regression. RESULTS: All 16 fatal cases were < or =6 months old; 13 were <2 months old. Fatal cases were less likely to have had cough complications during pregnancy (48% vs 14%; P=.046) and more likely to have pneumonia (63% vs 16%; P=.0024) before hospital admission and more likely to have seizures, pneumonia, leukocytosis, and hypoxemia after admission (P<.001 for all comparisons). White blood cell count and pneumonia were independent predictors of fatal outcome in the multivariate model. CONCLUSIONS: Infants too young to have begun their immunizations are at highest risk of fatal pertussis infection. Leukocytosis and pneumonia are predictors of a poor outcome; however, rapid progression of the disease may make interventions difficult.

Breast Feeding↗
PubMed2001

[Vaccination].

Vaccination has been an important part of antiinfectious prophylaxis in pediatric oncology comprising immunizations with special indication like varicella vaccine and follow-up of routine immunizations after chemotherapy and bone marrow transplantation (BMT). Studies from the last decade demonstrate a loss of long term immunity to immunization preventable disease in most patients with chemotherapy and BMT who had received appropriate immunization before. So far routine vaccination programs following intensive chemotherapy have not been studied prospectively. Immunization programs following BMT have shown that immunizations with tetanus toxoid, diphtheria toxoid, inactivated poliovirus vaccine and influenza vaccine - given at least 12 months after transplantation - are safe and effective. Vaccination with live attenuated trivalent vaccine against measles, mumps and rubella in patients without chronic "graft versus host disease" (GVHD) and without ongoing immunosuppressive therapy, performed 24 months after transplantation, proved to be safe too. Recommendations have been published by 5 different official groups: (1.) "Ständige Impfkommission" (STIKO) and (2.) "Deutsche Gesellschaft für pädiatrische Infektiologie" (DGPI) recommend varicella vaccine für children with leukemia in remission for at least 12 months, for children with solid tumors and for patients getting an organ transplantation. Both societies do not comment on the schedule of booster vaccinations (with live attenuated vaccines) after the end of chemotherapy and after BMT. (3.) "Qualitätssicherungsgruppe" der "Gesellschaft für pädiatrische Onkologie und Hämatologie" (QS-GPOH) recommends immunization with nonliving vaccines when the patient is off therapy for at least 3 months and immunization with live attenuated vaccines when he is off therapy for at least 6 months. This group does not comment on varicella vaccine which has been controversial among pediatric oncologists. (4.) The " Infectious disease working party of the European group for Blood and Marrow Transplantation" (EBMT) recommends immunization with nonliving vaccines when the patient is off transplantation for at least 12 months, without GVHD and without immunosuppressive therapy. (5.) The "Guidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant (HSCT) Recipients" published by the following american institutions and societies: "Centers for Disease Control and Prevention", "Infectious Diseases Society of America" and "American Society of Blood and Marrow Transplantation" recommend that patients should be routinely revaccinated after transplantation if they are off immunosuppressive therapy and do not suffer from GVHD: beginning of vaccinations with nonliving vaccines in the second year after HSCT, beginning of vaccinations with live attenuated vaccines in the third year after HSCT. Life-long seasonal influenza vaccination is recommended for all HSCT candidates and recipients, beginning during the influenza season before HSCT and resuming > 6 months after HSCT. IT would be appreciated if working groups of these societies could find consensus recommendations on open and controversial questions in the near future.

Adolescent↗