Immunogenicity and immunologic memory of meningococcal C conjugate vaccine in premature infants.

PubMed

Collins, Clare L; Ruggeberg, Jens U; Balfour, Gail; Tighe, Helen; Archer, Marion; Bowen-Morris, Jane; Diggle, Linda; Borrow, Ray; Balmer, Paul; Buttery, Jim P; Moxon, E Richard; Pollard, Andrew J; Heath, Paul T

2005-11-01

Protein-polysaccharide conjugate vaccines against Neisseria meningitidis serogroup C were introduced into the U.K. routine immunization schedule in 1999. This study is the first to describe both persistence of antibody and evidence for induction of immune memory using meningococcal C conjugate (MCC) vaccine in preterm infants. Immunogenicity and induction of immunologic memory by as MCC vaccine was assessed in premature infants; 62 preterm and 60 term controls received MCC at the accelerated schedule (2, 3 and 4 months of age). A meningococcal C polysaccharide challenge was administered at 12 months of age. Both groups achieved similar protective titers after primary immunization that then waned significantly by 1 year of age. Postchallenge serum bactericidal activity was significantly lower in preterm infants (P = 0.03); 73% of preterm versus 88% of term controls achieved a 4-fold rise in serum bactericidal activity (P = 0.07). MCC vaccine is immunogenic and primes for immunologic memory in preterm infants. The decreased memory responses in these preterm infants in conjunction with waning clinical efficacy data for all U.K. infants suggest a role for a routine booster dose of vaccine in all infants receiving MCC, especially those born preterm.

A review of measles supplementary immunization activities and the implications for Pacific Island countries and territories.

PubMed

Clements, C John; Soakai, Taniela Sunia; Sadr-Azodi, Nahad

2017-02-01

Standard measles control strategies include achieving high levels of measles vaccine coverage using routine delivery systems, supplemented by mass immunization campaigns as needed to close population immunity gaps. Areas covered: This review looks at how supplementary immunization activities (SIAs) have contributed to measles control globally, and asks whether such a strategy has a place in Pacific Islands today. Expert commentary: Very high coverage with two doses of measles vaccine seems to be the optimal strategy for controlling measles. By 2015, all but two Pacific Islands had introduced a second dose in the routine schedule; however, a number of countries have not yet reached high coverage with their second dose. The literature and the country reviews reported here suggest that a high coverage SIA combined with one dose of measles vaccine given in the routine system will also do the job. The arguments for and against the use of SIAs are complex, but it is clear that to be effective, SIAs need to be well designed to meet specific needs, must be carried out effectively and safely with very high coverage, and should, when possible, carry with them other public health interventions to make them even more cost-effective.

Progress toward measles elimination--Western Pacific Region, 2009-2012.

PubMed

2013-06-07

In 2005, the World Health Organization (WHO) Regional Committee for the Western Pacific Region (WPR) resolved that WPR should aim to eliminate measles by 2012. The recommended measles elimination strategies in WPR include 1) achieving and maintaining high (≥95%) coverage with 2 doses of measles-containing vaccine (MCV) through routine immunization services and by implementing supplementary immunization activities (SIAs), when required; 2) conducting high-quality, case-based measles surveillance; 3) ensuring high-quality laboratory surveillance, with timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus for genotyping and molecular analysis; and 4) establishing and maintaining measles outbreak preparedness for rapid response and ensuring appropriate case management. This report updates the previous report and describes progress toward eliminating measles in WPR during 2009-2012. During this period, measles incidence reached a historic low, decreasing by 83%, from 34.0 to 5.9 cases per million population. However, to achieve measles elimination in WPR, additional efforts are needed to strengthen routine immunization services in countries and areas with <95% coverage with the routine first (MCV1) or second dose of MCV (MCV2), to introduce a MCV2 dose in the four remaining countries and areas that do not yet have a routine 2-dose MCV schedule, and to use SIAs to close immunity gaps among measles-susceptible populations in countries and areas that have ongoing measles virus transmission.

Modelling the effects of booster dose vaccination schedules and recommendations for public health immunization programs: the case of Haemophilus influenzae serotype b.

PubMed

Charania, Nadia A; Moghadas, Seyed M

2017-09-13

Haemophilus influenzae serotype b (Hib) has yet to be eliminated despite the implementation of routine infant immunization programs. There is no consensus regarding the number of primary vaccine doses and an optimal schedule for the booster dose. We sought to evaluate the effect of a booster dose after receiving the primary series on the long-term disease incidence. A stochastic model of Hib transmission dynamics was constructed to compare the long-term impact of a booster vaccination and different booster schedules after receiving the primary series on the incidence of carriage and symptomatic disease. We parameterized the model with available estimates for the efficacy of Hib conjugate vaccine and durations of both vaccine-induced and naturally acquired immunity. We found that administering a booster dose substantially reduced the population burden of Hib disease compared to the scenario of only receiving the primary series. Comparing the schedules, the incidence of carriage for a 2-year delay (on average) in booster vaccination was comparable or lower than that observed for the scenario of booster dose within 1 year after primary series. The temporal reduction of symptomatic disease was similar in the two booster schedules, suggesting no superiority of one schedule over the other in terms of reducing the incidence of symptomatic disease. The findings underscore the importance of a booster vaccination for continued decline of Hib incidence. When the primary series provides a high level of protection temporarily, delaying the booster dose (still within the average duration of protection conferred by the primary series) may be beneficial to maintain longer-term protection levels and decelerate the decline of herd immunity in the population.

Feasibility of implementing a cellphone-based reminder/recall strategy to improve childhood routine immunization in a low-resource setting: a descriptive report.

PubMed

Brown, Victoria Bolanle; Oluwatosin, O Abimbola

2017-12-04

Reminder/recall systems are effective ways to improve immunization rates, but their feasibility in primary health care (PHC) settings in Nigeria has not been adequately evaluated. In this study we describe the acceptability and adaptability of immunization reminder/recall system in an urban setting in southwest Nigeria. This is a descriptive report of a cluster randomized controlled trial. Four local government areas (LGAs) were randomly assigned into a cellphone reminder/recall intervention group or a usual care control group. Within each LGA, PHC centers were purposively selected to participate in the study. In each PHC center, mothers and their infants aged 0-3 months were enrolled into the two groups during the infants' first immunization visit. Mothers (or other contact persons) in the intervention group received cellphone calls reminding them to take their child for scheduled immunizations. Follow-up of all the children lasted till the final scheduled immunization visit for each child. The intervention lasted for 13 months. A total of 595 mothers/infants pairs (295 in the intervention group and 300 in the control group) participated in the study. Almost all mothers (n = 590, 99.2%) had access to their own cellphone or had access to a cellphone belonging to a significant other. Ninety-eight percent (n = 584) of all mothers were willing to receive immunization reminder/recall phone calls. Eighty-seven percent (n = 2023) of all calls (n = 2324) for the reminder/recall intervention went through to the recipients and of these calls, 1948 (96.3%) were received. The mean cost of each call in US Dollars was about 5 cents. Immunization compliance rate (the receipt of required number of doses of routine vaccines at the appropriate age at recommended interval) was 79.2% among the children in intervention group and 46.4% in the control group (p < 0.001). Results demonstrate that cellphone reminder/recall interventions to improve routine childhood immunization are feasible in PHC settings in limited-resource settings with wide cellphone coverage, such as urban areas in Nigeria. Further research to test the potential for scale up in a variety of settings is recommended. PACTR201702002043415 ; Date of registration: 17 February 2017. (Retrospectively registered).

Study on the effectiveness and impact of pentavalent vaccination program in India and other south Asian countries.

PubMed

Sreedhar, Sreelakshmi; Antony, Anil; Poulose, Neethu

2014-01-01

Penta-valent-vaccine is a combination vaccine administered in a 3-dose schedule, offers protection against diphtheria, tetanus, pertussis (DPT), hepatitis B, and Haemophilus influenza type B (Hib). The vaccine is widely recommended by WHO and GAVI as a substitute for prevailing vaccination practices against the above mentioned diseases and viruses. The vaccine has met with both positive and negative responses, which leads to uncertainties about the vaccine's safety. The pros and cons of the vaccine are to be evaluated carefully before the same is added to routine immunization schedule.

The Mobile Solutions for Immunization (M-SIMU) Trial: A Protocol for a Cluster Randomized Controlled Trial That Assesses the Impact of Mobile Phone Delivered Reminders and Travel Subsidies to Improve Childhood Immunization Coverage Rates and Timeliness in Western Kenya.

PubMed

Gibson, Dustin G; Kagucia, E Wangeci; Ochieng, Benard; Hariharan, Nisha; Obor, David; Moulton, Lawrence H; Winch, Peter J; Levine, Orin S; Odhiambo, Frank; O'Brien, Katherine L; Feikin, Daniel R

2016-05-17

Text message (short message service, SMS) reminders and incentives are two demand-side interventions that have been shown to improve health care-seeking behaviors by targeting participant characteristics such as forgetfulness, lack of knowledge, and transport costs. Applying these interventions to routine pediatric immunizations may improve vaccination coverage and timeliness. The Mobile Solutions for Immunization (M-SIMU) trial aims to determine if text message reminders, either with or without mobile phone-based incentives, sent to infant's parents can improve immunization coverage and timeliness of routine pediatric vaccines in rural western Kenya. This is a four-arm, cluster, randomized controlled trial. Villages are randomized to one of four study arms prior to enrollment of participants. The study arms are: (1) no intervention (a general health-related text message will be texted to this group at the time of enrollment), (2) text message reminders only, (3) text message reminders and a 75 Kenyan Shilling (KES) incentive, or (4) text message reminders and a KES200 incentive. Participants assigned to study arms 2-4 will receive two text message reminders; sent 3 days before and one day before the scheduled immunization visit at 6, 10, and 14 weeks for polio and pentavalent (containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenza type b antigens) type b antigens) vaccines, and at 9 months for measles vaccine. Participants in incentive arms will, in addition to text message reminders as above, receive mobile phone-based incentives after each timely vaccination, where timely is defined as vaccination within 2 weeks of the scheduled date for each of the four routine expanded program immunization (EPI) vaccination visits. Mother-infant pairs will be followed to 12 months of age where the primary outcome, a fully immunized child, will be ascertained. A fully immunized child is defined as a child receiving vaccines for bacille Calmette-Guerin, three doses of pentavalent and polio, and measles by 12 months of age. General estimating equation (GEE) models that account for clustering will be employed for primary outcome analyses. Enrollment was completed in October 2014. Twelve month follow-up visits to ascertain immunization status from the maternal and child health booklet were completed in February 2016. This is one of the first studies to examine the effect of text message reminders on immunization coverage and timeliness in a lower income country and is the first study to assess the effect of mobile money-based incentives to improve immunization coverage. Clinicaltrials.gov NCT01878435; https://clinicaltrials.gov/ct2/show/NCT01878435 (Archived by WebCite at http://www.webcitation.org/6hQlwGYJR).

The impact of new vaccine introduction on immunization and health systems: A review of the published literature

PubMed Central

Hyde, Terri B.; Dentz, Holly; Wang, Susan A.; Burchett, Helen E.; Mounier-Jack, Sandra; Mantel, Carsten F.

2015-01-01

We conducted a systematic review of the published literature to examine the impact of new vaccine introduction on countries’ immunization and broader health systems. Six publication databases were searched using 104 vaccine and health system-related search terms. The search yielded 15,795 unique articles dating from December 31, 1911 to September 29, 2010. Based on review of the title and abstract, 654 (4%) of these articles were found to be potentially relevant and were referred for full review. After full review, 130 articles were found to be relevant and included in the analysis. These articles represented vaccines introduced to protect against 10 different diseases (hepatitis A, hepatitis B, Haemophilus influenzae type b disease, human papilloma virus infection, influenza, Japanese encephalitis, meningococcal meningitis, Streptococcus pneumoniae disease, rotavirus diarrhea and typhoid), in various formulations and combinations. Most reviewed articles (97 [75%]) reported experiences in high-income countries. New vaccine introduction was most efficient when the vaccine was introduced into an existing delivery platform and when introduced in combination with a vaccine already in the routine childhood immunization schedule (i.e., as a combination vaccine). New vaccine introduction did not impact coverage of vaccines already included in the routine childhood immunization schedule. The need for increased cold chain capacity was frequently reported. New vaccines facilitated the introduction and widespread use of auto-disable syringes into the immunization and the broader health systems. The importance of training and education for health care workers and social mobilization was frequently noted. There was evidence in high-income countries that new vaccine introduction was associated with reduced health-care costs. Future evaluations of new vaccine introductions should include the systematic and objective assessment of the impacts on a country’s immunization system and broader health system, especially in lower-income countries. PMID:22940378

Cost-effectiveness of three different vaccination strategies against measles in Zambian children.

PubMed

Dayan, Gustavo H; Cairns, Lisa; Sangrujee, Nalinee; Mtonga, Anne; Nguyen, Van; Strebel, Peter

2004-01-02

The vaccination program in Zambia includes one dose of measles vaccine at 9 months of age. The objective of this study was to compare the cost-effectiveness of the current one-dose measles vaccination program with an immunization schedule in which a second dose is provided either through routine health services or through supplemental immunization activities (SIAs). We simulated the expected cost and impact of the vaccination strategies for an annual cohort of 400,000 children, assuming 80% vaccination coverage in both routine and SIAs and an analytic horizon of 15 years. A vaccination program which includes SIAs reaching children not previously vaccinated would prevent on additional 29,242 measles cases and 1462 deaths for each vaccinated birth cohort when compared with a one-dose program. Given the parameters established for this analysis, such a program would be cost-saving and the most cost-effective vaccination strategy for Zambia.

Hexavalent IPV-based combination vaccines for public-sector markets of low-resource countries

PubMed Central

Mahmood, Kutub; Pelkowski, Sonia; Atherly, Deborah; Sitrin, Robert; Donnelly, John J

2013-01-01

In anticipation of the successful eradication of wild polio virus, alternative vaccination strategies for public-sector markets of low-resource countries are extremely important, but are still under development. Following polio eradication, inactivated polio vaccine (IPV) would be the only polio vaccine available, and would be needed for early childhood immunization for several years, as maintenance of herd immunity will be important for sustaining polio eradication. Low-cost combination vaccines containing IPV could provide reliable and continuous immunization in the post-polio eradication period. Combination vaccines can potentially simplify complex pediatric routine immunization schedules, improve compliance, and reduce costs. Hexavalent vaccines containing Diphtheria (D), Tetanus (T), whole cell pertussis (wP), Hepatitis B (HBV), Haemophilus b (Hib) and the three IPV serotype antigens have been considered as the ultimate combination vaccine for routine immunization. This product review evaluates potential hexavalent vaccine candidates by composition, probable time to market, expected cost of goods, presentation, and technical feasibility and offers suggestions for development of low-cost hexavalent combination vaccines. Because there are significant technical challenges facing wP-based hexavalent vaccine development, this review also discusses other alternative approaches to hexavalent that could also ensure a timely and reliable supply of low-cost IPV based combination vaccines. PMID:23787559

Hexavalent IPV-based combination vaccines for public-sector markets of low-resource countries.

PubMed

Mahmood, Kutub; Pelkowski, Sonia; Atherly, Deborah; Sitrin, Robert D; Donnelly, John J

2013-09-01

In anticipation of the successful eradication of wild polio virus, alternative vaccination strategies for public-sector markets of low-resource countries are extremely important, but are still under development. Following polio eradication, inactivated polio vaccine (IPV) would be the only polio vaccine available, and would be needed for early childhood immunization for several years, as maintenance of herd immunity will be important for sustaining polio eradication. Low-cost combination vaccines containing IPV could provide reliable and continuous immunization in the post-polio eradication period. Combination vaccines can potentially simplify complex pediatric routine immunization schedules, improve compliance, and reduce costs. Hexavalent vaccines containing Diphtheria (D), Tetanus (T), whole cell pertussis (wP), Hepatitis B (HBV), Haemophilus b (Hib) and the three IPV serotype antigens have been considered as the ultimate combination vaccine for routine immunization. This product review evaluates potential hexavalent vaccine candidates by composition, probable time to market, expected cost of goods, presentation, and technical feasibility and offers suggestions for development of low-cost hexavalent combination vaccines. Because there are significant technical challenges facing wP-based hexavalent vaccine development, this review also discusses other alternative approaches to hexavalent that could also ensure a timely and reliable supply of low-cost IPV based combination vaccines.

Fully immunized child: coverage, timing and sequencing of routine immunization in an urban poor settlement in Nairobi, Kenya.

PubMed

Mutua, Martin Kavao; Kimani-Murage, Elizabeth; Ngomi, Nicholas; Ravn, Henrik; Mwaniki, Peter; Echoka, Elizabeth

2016-01-01

More efforts have been put in place to increase full immunization coverage rates in the last decade. Little is known about the levels and consequences of delaying or vaccinating children in different schedules. Vaccine effectiveness depends on the timing of its administration, and it is not optimal if given early, delayed or not given as recommended. Evidence of non-specific effects of vaccines is well documented and could be linked to timing and sequencing of immunization. This paper documents the levels of coverage, timing and sequencing of routine childhood vaccines. The study was conducted between 2007 and 2014 in two informal urban settlements in Nairobi. A total of 3856 children, aged 12-23 months and having a vaccination card seen were included in analysis. Vaccination dates recorded from the cards seen were used to define full immunization coverage, timeliness and sequencing. Proportions, medians and Kaplan-Meier curves were used to assess and describe the levels of full immunization coverage, vaccination delays and sequencing. The findings indicate that 67 % of the children were fully immunized by 12 months of age. Missing measles and third doses of polio and pentavalent vaccine were the main reason for not being fully immunized. Delays were highest for third doses of polio and pentavalent and measles. About 22 % of fully immunized children had vaccines in an out-of-sequence manner with 18 % not receiving pentavalent together with polio vaccine as recommended. Results show higher levels of missed opportunities and low coverage of routine childhood vaccinations given at later ages. New strategies are needed to enable health care providers and parents/guardians to work together to increase the levels of completion of all required vaccinations. In particular, more focus is needed on vaccines given in multiple doses (polio, pentavalent and pneumococcal conjugate vaccines).

Challenges in Estimating Vaccine Coverage in Refugee and Displaced Populations: Results From Household Surveys in Jordan and Lebanon

PubMed Central

Roberton, Timothy; Weiss, William; Doocy, Shannon

2017-01-01

Ensuring the sustained immunization of displaced persons is a key objective in humanitarian emergencies. Typically, humanitarian actors measure coverage of single vaccines following an immunization campaign; few measure routine coverage of all vaccines. We undertook household surveys of Syrian refugees in Jordan and Lebanon, outside of camps, using a mix of random and respondent-driven sampling, to measure coverage of all vaccinations included in the host country’s vaccine schedule. We analyzed the results with a critical eye to data limitations and implications for similar studies. Among households with a child aged 12–23 months, 55.1% of respondents in Jordan and 46.6% in Lebanon were able to produce the child’s EPI card. Only 24.5% of Syrian refugee children in Jordan and 12.5% in Lebanon were fully immunized through routine vaccination services (having received from non-campaign sources: measles, polio 1–3, and DPT 1–3 in Jordan and Lebanon, and BCG in Jordan). Respondents in Jordan (33.5%) and Lebanon (40.1%) reported difficulties obtaining child vaccinations. Our estimated immunization rates were lower than expected and raise serious concerns about gaps in vaccine coverage among Syrian refugees. Although our estimates likely under-represent true coverage, given the additional benefit of campaigns (not captured in our surveys), there is a clear need to increase awareness, accessibility, and uptake of immunization services. Current methods to measure vaccine coverage in refugee and displaced populations have limitations. To better understand health needs in such groups, we need research on: validity of recall methods, links between campaigns and routine immunization programs, and improved sampling of hard-to-reach populations. PMID:28805672

Modeling the impact of the 7-valent pneumococcal conjugate vaccine in Chinese infants: an economic analysis of a compulsory vaccination.

PubMed

Che, Datian; Zhou, Hua; He, Jinchun; Wu, Bin

2014-02-07

The purpose of this study was to compare, from a Chinese societal perspective, the projected health benefits, costs, and cost-effectiveness of adding pneumococcal conjugate heptavalent vaccine (PCV-7) to the routine compulsory child immunization schedule. A decision-tree model, with data and assumptions adapted for relevance to China, was developed to project the health outcomes of PCV-7 vaccination (compared with no vaccination) over a 5-year period as well as a lifetime. The vaccinated birth cohort included 16,000,000 children in China. A 2 + 1 dose schedule at US$136.51 per vaccine dose was used in the base-case analysis. One-way sensitivity analysis was used to test the robustness of the model. The impact of a net indirect effect (herd immunity) was evaluated. Outcomes are presented in terms of the saved disease burden, costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio. In a Chinese birth cohort, a PCV-7 vaccination program would reduce the number of pneumococcus-related infections by at least 32% and would prevent 2,682 deaths in the first 5 years of life, saving $1,190 million in total costs and gaining an additional 9,895 QALYs (discounted by 3%). The incremental cost per QALY was estimated to be $530,354. When herd immunity was taken into account, the cost per QALY was estimated to be $95,319. The robustness of the model was influenced mainly by the PCV-7 cost per dose, effectiveness herd immunity and incidence of pneumococcal diseases. With and without herd immunity, the break-even costs in China were $29.05 and $25.87, respectively. Compulsory routine infant vaccination with PCV-7 is projected to substantially reduce pneumococcal disease morbidity, mortality, and related costs in China. However, a universal vaccination program with PCV-7 is not cost-effective at the willingness-to-pay threshold that is currently recommended for China by the World Health Organization.

Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo.

PubMed

Doshi, Reena H; Eckhoff, Philip; Cheng, Alvan; Hoff, Nicole A; Mukadi, Patrick; Shidi, Calixte; Gerber, Sue; Wemakoy, Emile Okitolonda; Muyembe-Tafum, Jean-Jacques; Kominski, Gerald F; Rimoin, Anne W

2017-10-27

One of the goals of the Global Measles and Rubella Strategic Plan is the reduction in global measles mortality, with high measles vaccination coverage as one of its core components. While measles mortality has been reduced more than 79%, the disease remains a major cause of childhood vaccine preventable disease burden globally. Measles immunization requires a two-dose schedule and only countries with strong, stable immunization programs can rely on routine services to deliver the second dose. In the Democratic Republic of Congo (DRC), weak health infrastructure and lack of provision of the second dose of measles vaccine necessitates the use of supplementary immunization activities (SIAs) to administer the second dose. We modeled three vaccination strategies using an age-structured SIR (Susceptible-Infectious-Recovered) model to simulate natural measles dynamics along with the effect of immunization. We compared the cost-effectiveness of two different strategies for the second dose of Measles Containing Vaccine (MCV) to one dose of MCV through routine immunization services over a 15-year time period for a hypothetical birth cohort of 3 million children. Compared to strategy 1 (MCV1 only), strategy 2 (MCV2 by SIA) would prevent a total of 5,808,750 measles cases, 156,836 measles-related deaths and save U.S. $199 million. Compared to strategy 1, strategy 3 (MCV2 by RI) would prevent a total of 13,232,250 measles cases, 166,475 measles-related deaths and save U.S. $408 million. Vaccination recommendations should be tailored to each country, offering a framework where countries can adapt to local epidemiological and economical circumstances in the context of other health priorities. Our results reflect the synergistic effect of two doses of MCV and demonstrate that the most cost-effective approach to measles vaccination in DRC is to incorporate the second dose of MCV in the RI schedule provided that high enough coverage can be achieved. Published by Elsevier Ltd.

Co-administration of a novel Haemophilus influenzae type b and Neisseria meningitidis serogroups C and Y-tetanus toxoid conjugate vaccine does not interfere with the immune response to antigens contained in infant vaccines routinely used in the United States.

PubMed

Marshall, Gary S; Marchant, Colin D; Blatter, Mark; Friedland, Leonard R; Aris, Emmanuel; Miller, Jacqueline M

2011-02-01

An investigational combined Haemophilus influenzae type b (Hib) and Neisseria meningitidis serogroups C and Y tetanus toxoid conjugate vaccine (HibMenCY-TT) has been developed to protect infants from invasive disease caused by Hib and these meningococcal serogroups without adding injections to the immunization schedule. Incorporation of this novel vaccine into the US vaccination schedule will require demonstration of a lack of immunologic interference with other routine pediatric vaccines. This study assessed the immune response to 7-valent pneumococcal conjugate vaccine (PCV7) and combined diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus vaccine (DTaP-HepB-IPV) when separately co-administered with HibMenCY-TT as compared to a US-licensed H. influenzae type b tetanus toxoid conjugate vaccine (Hib-TT) at 2, 4, 6 (N=606) and 12-15 months of age (N=366). HibMenCY-TT was non-inferior to Hib-TT in terms of antibody responses to all Streptococcus pneumoniae serotypes contained in PCV7 and the diphtheria, tetanus, pertussis, hepatitis B and poliovirus antigens contained in DTaP-HepB-IPV one month after the third vaccine dose, and the anti-tetanus geometric mean antibody concentration (GMC) was significantly higher in the HibMenCY-TT group than in the Hib-TT group. In an exploratory analysis, no significant differences in the proportion of subjects with anti-pneumococcal antibody concentrations ≥0.2 µg/ml or anti-pneumococcal GMC were seen between the two groups after the fourth vaccine dose. A schedule of HibMenCY-TT given concomitantly with PCV7 and DTaP-HepB-IPV would be expected to protect infants against all of the targeted diseases.

Immunogenicity and safety of a new hexavalent vaccine (DTaP5-IPV-HB-Hib) administered in a mixed primary series schedule with a pentavalent vaccine (DTaP5-IPV-Hib).

PubMed

Martinón-Torres, Federico; Boisnard, Florence; Thomas, Stéphane; Sadorge, Christine; Borrow, Ray

2017-06-27

DTaP5-IPV-HB-Hib vaccine is a fully-liquid, combination hexavalent vaccine. This phase III, open-label, multicentre study conducted in Spain, evaluated the immune response to all DTaP5-IPV-HB-Hib antigens when the vaccine was used in a mixed hexa/penta/hexa primary series. Infants (who had received one dose of hepatitis B vaccine at birth) received a mixed schedule including DTaP5-IPV-HB-Hib (PRP-OMP conjugate) at 2 and 6months of age, DTaP5-IPV-Hib at 4months, meningococcal serogroup C conjugate (MCC) vaccine at 2 and 4months, and routine rotavirus and pneumococcal vaccination. One month post-dose 3 of the mixed schedule, response rates were considered acceptable if the lower bound of the two-sided 95% confidence interval around the post-vaccination response rate was >90% for hepatitis B and >80% for Haemophilus influenzae type b (Hib). Secondary immunogenicity objectives included description of the antibody response to all hexavalent antigens one month after completion of the mixed schedule, and to MCC antigen one month after the second MCC dose. The safety profile after each dose of study vaccine was described. Of 385 healthy infants enrolled, 384 completed the study. The primary objective was achieved for both hepatitis B and Hib; the lower bound of the 2-sided 95% CI of the response rates (97.2% and 99.0%, respectively) were greater than the pre-specified acceptability thresholds. One month post-dose 3 of the mixed schedule, all participants were seroprotected against diphtheria, tetanus and polio. The mixed schedule induced a robust immune response to all hexavalent antigens. The co-administration of the hexavalent vaccine in a mixed schedule with MCC vaccine did not reduce the immune response to vaccine antigens. Vaccines were well tolerated. In conclusion, the acceptability of response rates against Hib and hepatitis B were demonstrated one month post-dose 3 of the mixed schedule; robust immune responses against all other hexavalent antigens were observed. clinicaltrial.gov: NCT01839188; EudraCT: 2012-004221-25. Copyright © 2017 Elsevier Ltd. All rights reserved.

Seroprevalence of rubella in school girls and pregnant women.

PubMed

Karakoc, Gulbin Bingol; Altintas, Derya Ufuk; Kilinc, Banu; Karabay, Aysun; Mungan, Neslihan Onenli; Yilmaz, Mustafa; Evliyaoglu, Nurdan

2003-01-01

Many studies have been assigned to investigate the surveillance of congenital rubella syndrome, acquired rubella and seroprevalence in different countries to determine the new vaccination program and national vaccination schedules. Seroprevalence of rubella in Turkey is still insufficient and national immunization schedules do not include routine rubella vaccination. In this study we aimed to investigate the seroprevalence of rubella at child bearing age in an unvaccinated population in Adana, southern Turkey, to help determine whether routine rubella vaccination is necessary, if so when it should be administered. Ninety-four school girls aged 12-18 years living in Adana were selected for the study and stratified according to the socioeconomic status of their parents and evaluated for rubella antibodies. One hundred pregnant women aged 18-25 years and 100 pregnant women aged 26-35 years were sampled rubella antibodies. Rubella specific IgG antibody was measured qualitatively and quantitatively by using microparticule enzyme immune assay technology. Rubella specific IgG antibody was positive in 87-94 school girls (92.5%). The geometric mean rubella specific IgG antibody value was found be 148.14 IU/ml. No correlation was found between socioeconomic status and rubella seropositivity (p = 0.6521). In all pregnant women rubella specific IgG antibody was found to be positive. In conclusion rubella vaccination should be considered carefully in developing countries. Because of the high seropositivity to rubella in our region we do not recommend rubella vaccination in early childhood. Yet this is a preliminary study and further studies with larger population size are needed to determine the national immunization policy for rubella.

Lessons Learned From the Introduction of Inactivated Poliovirus Vaccine in Bangladesh.

PubMed

Estivariz, Concepcion F; Snider, Cynthia J; Anand, Abhijeet; Hampton, Lee M; Bari, Tajul I; Billah, Mallick M; Chai, Shua J; Wassilak, Steven G; Heffelfinger, James D; Zaman, K

2017-07-01

We assessed programmatic adaptations and infants' uptake of inactivated poliovirus vaccine (IPV) after its introduction into the routine immunization schedule in Bangladesh. Using convenience and probability sampling, we selected 23 health facilities, 36 vaccinators, and 336 caregivers, within 5 districts and 3 city corporations. We collected data during August-October 2015 by conducting interviews, reviewing vaccination records, and observing activities. Knowledge about IPV was high among vaccinators (94%). No problems with IPV storage, transport, or waste disposal were detected, but shortages were reported in 20 health facilities (87%). Wastage per 5-dose vaccine vial was above the recommended 30% in 20 health facilities (87%); all were related to providing <5 doses per open vial. Among eligible infants, 87% and 86% received the third dose of pentavalent and oral poliovirus vaccine, respectively, but only 65% received IPV at the same visit. Among 73 infants not vaccinated with IPV, 58% of caregivers reported that vaccine was unavailable. Bangladesh successfully introduced IPV, but shortages related to insufficient global supply and high vaccine wastage in small outreach immunization sessions might reduce its impact on population immunity. Minimizing wastage and use of a 2-dose fractional-IPV schedule could extend IPV immunization to more children. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Factors Associated With Pediatrician Responses to Alternative Immunization Schedule Requests.

PubMed

Mohanty, Salini; Feemster, Kristen A; Buttenheim, Alison; Moser, Charlotte A; Field, Robert I; Mayer, Whitney; Carroll-Scott, Amy

2018-02-01

We conducted a cross-sectional online survey among 4 chapters of the American Academy of Pediatrics from July through October 2014 to describe characteristics of pediatricians and practices associated with practice-level responses to alternative immunization schedule requests. Among 374 pediatricians, 58% reported frequent alternative immunization schedule requests and 24% reported feeling comfortable using them. Pediatricians who work in practices that accommodate alternative immunization schedule requests have increased odds of having a high frequency of alternative immunization schedule requests, and beliefs that relationships with families would be negatively affected if they refused requests. Practices that discontinue care to families who request alternative immunization schedules have increased odds of being a private group practice and having a formal office vaccine policy. Pediatricians are frequently asked to use alternative immunization schedules and many are not comfortable using them. Practice-level responses to alternative immunization schedules are associated with characteristics of pediatricians and practices.

Successful polio eradication in Uttar Pradesh, India: the pivotal contribution of the Social Mobilization Network, an NGO/UNICEF collaboration

PubMed Central

Coates, Ellen A; Waisbord, Silvio; Awale, Jitendra; Solomon, Roma; Dey, Rina

2013-01-01

ABSTRACT In Uttar Pradesh, India, in response to low routine immunization coverage and ongoing poliovirus circulation, a network of U.S.-based CORE Group member and local nongovernmental organizations partnered with UNICEF, creating the Social Mobilization Network (SMNet). The SMNet's goal was to improve access and reduce family and community resistance to vaccination. The partners trained thousands of mobilizers from high-risk communities to visit households, promote government-run child immunization services, track children's immunization history and encourage vaccination of children missing scheduled vaccinations, and mobilize local opinion leaders. Creative behavior change activities and materials promoted vaccination awareness and safety, household hygiene, sanitation, home diarrheal-disease control, and breastfeeding. Program decision-makers at all levels used household-level data that were aggregated at community and district levels, and senior staff provided rapid feedback and regular capacity-building supervision to field staff. Use of routine project data and targeted research findings offered insights into and informed innovative approaches to overcoming community concerns impacting immunization coverage. While the SMNet worked in the highest-risk, poorly served communities, data suggest that the immunization coverage in SMNet communities was often higher than overall coverage in the district. The partners' organizational and resource differences and complementary technical strengths posed both opportunities and challenges; overcoming them enhanced the partnership's success and contributions. PMID:25276518

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2018.

PubMed

Robinson, Candice L; Romero, José R; Kempe, Allison; Pellegrini, Cynthia; Szilagyi, Peter

2018-02-09

In October 2017, the Advisory Committee on Immunization Practices (ACIP) approved the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2018. The 2018 child and adolescent immunization schedule summarizes ACIP recommendations, including several changes from the 2017 immunization schedules, in three figures and footnotes to the figures. These documents can be found on the CDC immunization schedule website (https://www.cdc.gov/vaccines/schedules/index.html). These immunization schedules are approved by ACIP (https://www.cdc.gov/vaccines/acip/index.html), the American Academy of Pediatrics (https://www.aap.org), the American Academy of Family Physicians (https://www.aafp.org), and the American College of Obstetricians and Gynecologists (https://www.acog.org). Health care providers are advised to use the figures and the footnotes together. The full ACIP recommendations for each vaccine, including contraindications and precautions, can be found at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. Providers should be aware that changes in recommendations for specific vaccines can occur between annual updates to the childhood/adolescent immunization schedules. If errors or omissions are discovered within the child and adolescent schedule, CDC posts revised versions on the CDC immunization schedule website.

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2017.

PubMed

Robinson, Candice L; Romero, José R; Kempe, Allison; Pellegrini, Cynthia

2017-02-10

In October 2016, the Advisory Committee on Immunization Practices (ACIP) approved the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger-United States, 2017. The 2017 child and adolescent immunization schedule summarizes ACIP recommendations, including several changes from the 2016 immunization schedules, in three figures, and footnotes for the figures. These documents can be found on the CDC immunization schedule website (https://www.cdc.gov/vaccines/schedules/index.html). These immunization schedules are approved by ACIP (https://www.cdc.gov/vaccines/acip/index.html), the American Academy of Pediatrics (https://www.aap.org), the American Academy of Family Physicians (https://www.aafp.org), and the American College of Obstetricians and Gynecologists (http://www.acog.org). Health care providers are advised to use the figures and the combined footnotes together. The full ACIP recommendations for each vaccine, including contraindications and precautions, can be found at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. Providers should be aware that changes in recommendations for specific vaccines can occur between annual updates to the childhood/adolescent immunization schedules. If errors or omissions are discovered within the child and adolescent schedule, CDC posts revised versions on the CDC immunization schedule website.

Knowledge, Attitudes and Perceptions About Routine Childhood Vaccinations Among Jewish Ultra-Orthodox Mothers Residing in Communities with Low Vaccination Coverage in the Jerusalem District.

PubMed

Stein Zamir, Chen; Israeli, Avi

2017-05-01

Background and aims Childhood vaccinations are an important component of primary prevention. Maternal and Child Health (MCH) clinics in Israel provide routine vaccinations without charge. Several vaccine-preventable-diseases outbreaks (measles, mumps) emerged in Jerusalem in the past decade. We aimed to study attitudes and knowledge on vaccinations among mothers, in communities with low immunization coverage. Methods A qualitative study including focus groups and semi-structured interviews. Results Low immunization coverage was defined below the district's mean (age 2 years, 2013) for measles-mumps-rubella-varicella 1st dose (MMR1\\MMRV1) and diphtheria-tetanus-pertussis 4th dose (DTaP4), 96 and 89%, respectively. Five communities were included, all were Jewish ultra-orthodox. The mothers' (n = 87) median age was 30 years and median number of children 4. Most mothers (94%) rated vaccinations as the main activity in the MCH clinics with overall positive attitudes. Knowledge about vaccines and vaccination schedule was inadequate. Of vaccines scheduled at ages 0-2 years (n = 13), the mean number mentioned was 3.9 ± 2.8 (median 4, range 0-9). Vaccines mentioned more often were outbreak-related (measles, mumps, polio) and HBV (given to newborns). Concerns about vaccines were obvious, trust issues and religious beliefs were not. Vaccination delay was very common and timeliness was considered insignificant. Practical difficulties in adhering to the recommended schedule prevailed. The vaccinations visits were associated with pain and stress. Overall, there was a sense of self-responsibility accompanied by inability to influence others. Conclusion Investigating maternal knowledge and attitudes on childhood vaccinations provides insights that may assist in planning tailored intervention programs aimed to increase both vaccination coverage and timeliness.

Progress in global measles control and mortality reduction, 2000-2007.

PubMed

2008-12-05

Despite the availability of a safe and effective vaccine since 1963, measles has been a major killer of children in developing countries (causing an estimated 750,000 deaths as recently as 2000), primarily because of underutilization of the vaccine. At the World Health Assembly in 2008, all World Health Organization (WHO) member states reaffirmed their commitment to achieving a 90% reduction in measles mortality by 2010 compared with 2000, a goal that was established in 2005 as part of the Global Immunization Vision and Strategy (2). This WHO-UNICEF comprehensive strategy for measles mortality reduction (1) focuses on 47 priority countries. The strategy's components include 1) achieving and maintaining high coverage (>90%) with the routinely scheduled first dose of measles-containing vaccine (MCV1) among children aged 1 year; 2) ensuring that all children receive a second opportunity for measles immunization (either through a second routine dose or through periodic supplementary immunization activities [SIAs]); 3) implementing effective laboratory-supported disease surveillance; and 4) providing appropriate clinical management for measles cases. This report updates previously published reports and describes immunization and surveillance activities implemented during 2007. Increased routine measles vaccine coverage and SIAs implemented during 2000--2007 resulted in a 74% decrease in the estimated number of measles deaths globally. An estimated 197,000 deaths from measles occurred in 2007; of these, 136,000 (69%) occurred in the WHO South-East Asian Region. Achievement of the 2010 goal will require full implementation of measles mortality reduction strategies, especially in the WHO South-East Asian Region.

Human rotavirus vaccine is highly efficacious when coadministered with routine expanded program of immunization vaccines including oral poliovirus vaccine in Latin America.

PubMed

Tregnaghi, Miguel W; Abate, Héctor J; Valencia, Alejandra; Lopez, Pio; Da Silveira, Themis Reverbel; Rivera, Luis; Rivera Medina, Doris Maribel; Saez-Llorens, Xavier; Gonzalez Ayala, Silvia Elena; De León, Tirza; Van Doorn, Leen-Jan; Pilar Rubio, Maria Del; Suryakiran, Pemmaraju Venkata; Casellas, Javier M; Ortega-Barria, Eduardo; Smolenov, Igor V; Han, Htay-Htay

2011-06-01

The efficacy of a rotavirus vaccine against severe rotavirus gastroenteritis when coadministered with routine Expanded Program on Immunization (EPI) vaccines including oral polio vaccine (OPV) was evaluated in this study. Double-blind, randomized (2:1), placebo-controlled study conducted across 6 Latin American countries. Healthy infants (N = 6568) 6 to 12 weeks of age received 2 doses of RIX4414 vaccine or placebo following a 0, 1- to 2-month schedule. Routine vaccines including OPV were coadministered according to local EPI schedule. Vaccine efficacy (VE) against severe rotavirus gastroenteritis caused by circulating wild-type rotavirus from 2 weeks post-Dose 2 until 1 year of age was calculated with 95% confidence interval [CI]. Safety was assessed during the entire study period. Immunogenicity of RIX4414 and OPV was also assessed. During the efficacy follow-up period (mean duration = 7.4 months), 7 and 19 cases of severe rotavirus gastroenteritis were reported in the vaccine and placebo groups, respectively, with a VE of 81.6% (95% CI: 54.4-93.5). VE against severe rotavirus gastroenteritis caused by G1 type was 100% (95% CI: <0-100) and 80.6% (95% CI: 51.4-93.2) against the pooled non-G1 rotavirus types, respectively. There was no difference (P = 0.514) in the incidence of serious adverse events reported in the 2 groups. Antirotavirus IgA seropositivity rate at 1 to 2 months post-Dose 2 was 61.4% (95% CI: 53.7-68.6) in the RIX4414 group; similar seroprotection rates (≥96.0%) against the 3 antipoliovirus types was observed 1 month post-Dose 3 of OPV in both groups. RIX4414 was highly efficacious against severe rotavirus gastroenteritis caused by the circulating wild-type rotavirus (G1 and non-G1) when coadministered with routine EPI vaccines including OPV.

Instant Childhood Immunization Schedule

MedlinePlus

... Recommendations Why Immunize? Vaccines: The Basics Instant Childhood Immunization Schedule Recommend on Facebook Tweet Share Compartir Get ... date. See Disclaimer for additional details. Based on Immunization Schedule for Children 0 through 6 Years of ...

Clinical and Microbiological Characteristics of Invasive Group A Streptococcal Infections Before and After Implementation of a Universal Varicella Vaccine Program.

PubMed

Frère, Julie; Bidet, Philippe; Tapiéro, Bruce; Rallu, Fabien; Minodier, Philippe; Bonacorsi, Stephane; Bingen, Edouard; Ovetchkine, Philippe

2016-01-01

Since the introduction of the varicella vaccine to the routine immunization schedule, we have observed a 70% reduction in the rate of varicella-associated invasive group A streptococcal infections (IGASI). In the mean time, the clinical presentation of IGASI and microbiological characteristics of GAS strains have changed significantly. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Predictors of administration and attitudes about pneumococcal, Haemophilus influenzae type b and rotavirus vaccines among pediatricians in India: a national survey.

PubMed

Gargano, Lisa M; Thacker, Naveen; Choudhury, Panna; Weiss, Paul S; Pazol, Karen; Bahl, Sunil; Jafari, Hamid S; Arora, Manisha; Orenstein, Walter A; Hughes, James M; Omer, Saad B

2012-05-21

According to the World Health Organization in 2008, pneumonia accounted for 20% of deaths and diarrheal diseases accounted for 13% of deaths among children under 5 in India. Vaccines are available for Streptococcus pneumoniae (pneumococcal conjugate vaccine (PCV)), Haemophilus influenzae type b (Hib vaccine), and rotavirus. Barriers to including these vaccines in routine immunization schedule in India include potential negative impacts on fragile existing immunization programs and cost. Pediatricians who are members of the Indian Academy of Pediatrics (IAP) are important stakeholders for vaccine delivery and maintaining public confidence in vaccines. A random sample of 785 pediatricians belonging to IAP was selected for the survey conducted from June 2009 to June 2010. Descriptive analyses using sampling weights were performed to evaluate the distributions of variables assessing vaccine-related attitudes and behaviors among pediatricians. Logistic regression was used to assess factors associated with routine vaccine use. The majority of pediatricians reported administering PCV (85.6%), Hib (95.9%), and rotavirus (80.2%) vaccine selectively or routinely. Pediatricians who had high perceived disease susceptibility were 2.42 times more likely to report routine administration of Hib vaccine (OR 2.42, 95% CI 1.24, 4.74). Pediatricians who had high perceived Hib vaccine efficacy were 4.74 times more likely to administer Hib vaccine routinely (OR 4.74, 95% CI 2.09, 10.74). Perceptions of disease susceptibility and severity or of vaccine safety and efficacy were not associated with routine administration of PCV or rotavirus vaccine. Understanding predictors of routine use of a new vaccine could help focus interventions to improve the routine use of other vaccines. The importance of perceived susceptibility to and severity of diseases caused by S. pneumoniae, Hib, and rotavirus and perceived efficacy and safety of the vaccines by pediatricians presents an opportunity to design strategies to build support for new vaccine introduction and may have important implications for national immunization policy in India. Copyright © 2012 Elsevier Ltd. All rights reserved.

[Knowledge, and attitudes of Civil Society Organizations in the implementation of the Expanded Program on Immunization in Côte d'Ivoire].

PubMed

Yao, Gnissan Henri Auguste; Aka, Lepri Bernadin Nicaise; Manouan, Nogbou Jean Marc; Effi, Odile Angbo; Douba, Alfred; Zengbé-Acray, Pétronille; Traoré, Youssouf; Soumahoro, Sory Ibrahim; Ak, Koko Aude; Dagnan, N'Cho Simplice

2014-01-01

The objective of this study was to assess the level of involvement of leaders of Civil Society Organizations (CSOs) in implementation of routine EPI activities. This was a cross-sectional descriptive study of the knowledge and attitudes of CSOs concerning implementation of routine EPI activities in the health district of Adiaké (Côte d'Ivoire). This study shows that 77.1% of CSO leaders were literate and 92.9% of them were practicing Catholics or Muslims. They had a good knowledge of the existence of EPI (97.1%) and EPI target diseases, but were ignorant about the immunization schedule (82%). 90% of CSO leaders considered EPI to be an important activity for the prevention of childhood diseases. They considered the reception in immunization units to be satisfactory (60%) and believed that rumours about the sterility of women were the cause of refusal of vaccination by communities. Although 41.4% of leaders had participated in social mobilization activities, none had participated in the mobilization of resources. Vaccination was not rejected by CSO leaders, but their lack of participation in implementation of EPI could induce errors and lead them to believe the rumours and refuse vaccination of their community. The effective integration of the socio-cultural bases of communities in which immunization programmes are conducted will promote the adhesion of the people responsible for these programmes.

HPV Vaccination of Boys in Primary Care Practices

PubMed Central

Allison, Mandy A.; Dunne, Eileen F.; Markowitz, Lauri E.; O’Leary, Sean T.; Crane, Lori A.; Hurley, Laura P.; Stokley, Shannon; Babbel, Christine I.; Brtnikova, Michaela; Beaty, Brenda L.; Kempe, Allison

2018-01-01

OBJECTIVE In October 2011, the Advisory Committee on Immunization Practices (ACIP) recommended the quadrivalent human papillomavirus vaccine (HPV4) for the routine immunization schedule for 11- to 12-year-old boys. Before October 2011, HPV4 was permissively recommended for boys. We conducted a study in 2010 to provide data that could guide efforts to implement routine HPV4 immunization in boys. Our objectives were to describe primary care physicians’: 1) knowledge and attitudes about human papillomavirus (HPV)-related disease and HPV4, 2) recommendation and administration practices regarding HPV vaccine in boys compared to girls, 3) perceived barriers to HPV4 administration in boys, and 4) personal and practice characteristics associated with recommending HPV4 to boys. METHODS We conducted a mail and Internet survey in a nationally representative sample of pediatricians and family medicine physicians from July 2010 to September 2010. RESULTS The response rate was 72% (609 of 842). Most physicians thought that the routine use of HPV4 in boys was justified. Although it was permissively recommended, 33% recommended HPV4 to 11- to 12-year-old boys and recommended it more strongly to older male adolescents. The most common barriers to HPV4 administration were related to vaccine financing. Physicians who reported recommending HPV4 for 11- to 12-year-old boys were more likely to be from urban locations, perceive that HPV4 is efficacious, perceive that HPV-related disease is severe, and routinely discuss sexual health with 11- to 12-year-olds. CONCLUSIONS Although most physicians support HPV4 for boys, physician education and evidence-based tools are needed to improve implementation of a vaccination program for males in primary care settings. PMID:24011749

Immune Response And Anamnestic Immune Response In Children After A 3-Dose Primary Hepatitis B Vaccination.

PubMed

Afzal, Muhammad Faheem; Sultan, Muhammad Ashraf; Saleemi, Ahmad Imran

2016-01-01

Diseases caused by Hepatitis B virus (HBV) have a worldwide distribution. Pakistan adopted the recommendations of World Health Organization (WHO) for routine universal infant vaccination against hepatitis B in 2002, currently being administered at 6, 10, and 14 weeks of age in a combination vaccine. This study was conducted to determine the immune response & anamnestic immune response in children, 9 months-10 years of age, after a 3dose primary Hepatitis B vaccination. This cross sectional study was conducted in the Department of Paediatrics, King Edward Medical University/Mayo Hospital, Lahore, Pakistan, from January to June, 2014. A total of 200 children of either sex between the ages of 9 months to 10 years, documented to have received 3 doses of hepatitis B vaccines according to Expanded Program of Immunization (6,10,14 weeks) schedule in infancy, were recruited by consecutive sampling. The level of serum antiHBsAb by ELIZA was measured. Children with antiHBs titers ≥10 mIU/mL were considered to be immune. Those with anti HBsAb levels <10 mIU/mL were offered a booster dose of infant recombinant hepatitis B vaccine. The second serum sample was obtained 21-28 days following the administration of the booster dose and the anamnestic immune response was measured. Data was analysed using SPSS 17 to determine the relation between time interval since last vaccination and antibody titer. Chi square test was applied. Of the 200 children, protective antibody response was found in 58%. Median serological response was 18.60 (range 2.82 - 65.15). Antibody levels were found to have a statistically significant ( pvalue 0.019) negative correlation with the time since last administration of vaccine. A booster dose of Hepatitis B vacci ne was administered to all nonresponders, with each registering a statistically significant (pvalue 0.00) anamnestic response. The vaccination schedule with short dosage interval was unable to provide protection to 42% of the study population. Introduction of birth dose of Hepatitis B vaccine to the existing schedule is recommended.

Cross-sectional Serologic Assessment of Immunity to Poliovirus in Differential Risk Areas of India: India Seroprevalence Survey - 2014.

PubMed

Ahmad, Mohammad; Bahl, Sunil; Kunwar, Abhishek

2016-08-07

To assess the seroprevalence against all three poliovirus serotypes in traditional high risk areas in Bihar, lowest routine immunization coverage areas in Madhya Pradesh and migrant population living in Mumbai urban slums. Cross-sectional Survey. Subjects selected by house to house visit (community based) and transported to government health facilities for further study procedures. 1137 randomly selected healthy infants 6-11 months of age residing in the selected high-risk areas. Serum samples from the study site were shipped to Enterovirus Research Centre (ERC), Mumbai to determine the neutralizing antibodies against all three poliovirus serotypes. Children with a reciprocal antibody titer ≥1:8 were considered seropositive to the specific poliovirus. Overall, seroprevalence in all the three study areas was 98%, 98% and 91% against poliovirus type-1, type-2 and type-3, respectively. Bihar had a seroprevalence of 99%, 99% and 92% against type-1, type-2 and type-3 respectively. Corresponding figures for Madhya Pradesh and Mumbai were 98%, 99% and 88% and 98%, 97% and 94%, respectively. The study found high seroprevalence against all three poliovirus types not only in the traditional high-risk areas for polio in India, but even in the areas known to have low routine immunization coverage and among the migratory clusters living in Mumbai urban slums. Type-2 seroprevalence was found to be high. These findings are reassuring against the threat of emergence of circulating vaccine derived polioviruses (cVDPVs) in the country subsequent to switch from trivalent oral polio vaccine to bivalent oral polio vaccine in the routine immunization schedule from April 2016.

Shots by STFM: value of immunization software to family medicine residency directors: a CERA study.

PubMed

Nowalk, Mary Patricia; Clinch, C Randall; Tarn, Derjung M; Chang, Tammy; Ncube, Collette N; Troy, Judith A; Zimmerman, Richard K

2012-01-01

The Group on Immunization Education (GIE) of the Society of Teachers of Family Medicine (STFM) has developed Shots by STFM immunization software, which is available free of charge for a variety of platforms. It is routinely updated with the Center for Disease Control and Prevention's (CDC's) most recent immunization schedules. Successful development and marketing of teaching resources requires periodic evaluation of their use and value to their target audience. This study was undertaken to evaluate the 2011 version of Shots by STFM. Family medicine residency directors were surveyed about their use of Shots by STFM for teaching residents and their ratings of its features. The response rate for the survey was 38% (172/452). While awareness of Shots by STFM among responding residency directors was low (57%), ratings by those using the resource were excellent. Thirty percent of respondents recommend or require their residents to use Shots by STFM. Better marketing of Shots by STFM to family medicine residency directors seems to be indicated.

The RTS,S/AS01 malaria vaccine in children 5 to 17 months of age at first vaccination.

PubMed

Vandoolaeghe, Pascale; Schuerman, Lode

2016-12-01

The RTS,S/AS01 malaria vaccine received a positive scientific opinion from the European Medicines Agency in July 2015. The World Health Organization recommended pilot implementation of the vaccine in children at least 5 months of age according to an initial 3-dose schedule given at least 1 month apart, and a 4th dose 15-18 months post-dose 3. Clinical trials and mathematical modeling demonstrated that the partial protection provided by RTS,S/AS01 against malaria has the potential to provide substantial public health benefit when used in parallel with other malaria interventions, especially in highly endemic regions. The highest impact was seen with 4 vaccine doses in children aged 5 months or older. The vaccine will be evaluated in real-life settings to further assess its impact on mortality, vaccine safety in the context of routine immunization, and programmatic feasibility of delivering a 4-dose vaccination schedule requiring new immunization contacts. If successful, this will pave the way for larger-scale implementation.

Controversies in chicken-pox immunization.

PubMed

Bhave, Swati Y

2003-06-01

Chicken-pox is one more newer vaccine in our armamentarium against infectious diseases. Due to its extremely contagious nature, varicella is experienced by almost every child or young adult in the world. Each year from 1990 to 1994, prior to availability of varicella vaccine, about 4 million cases of varicella occurred in the United States. Of these cases approximately 10,000 required hospitalization and 100 died. Although varicella is not commonly perceived as an important public health problem, the socioeconomic consequences in industrialized countries of a disease that affects practically every child and causes the carrier absence from work should not be underestimated. The varicella vaccines available in the market are safe and effective. A recent cost-benefit analysis in USA showed that routine chicken-pox vaccination is likely to save five times the investment. Even when only direct costs were considered, benefits almost balanced the costs. At present similar studies from developing countries are not available. The public health impact of varicella and zoster may be increasing in regions with high endemic rates of HIV infection. Varicella vaccine may be used either at an individual level to protect susceptible adolescents and adults, or at a population level, to cover all children as part of a national immunization programme. Vaccination of adolescents and adults will protect at-risk individuals, but will not have a significant impact on the epidemiology of the disease on a population basis. On the other hand, extensive use as a routine vaccine in children will have a significant impact on the epidemiology of the disease. If sustained high coverage can be achieved, the disease may virtually disappear. If only partial coverage can be obtained, the epidemiology may shift, leading to an increase in the number of cases in older children and adults. Hence, routine childhood varicella immunization programmes should emphasize high, sustained coverage. At present, this vaccine will have a lower priority in the National Immunization Schedule that does not have MMR and typhoid, which have a greater socioeconomic impact. Hence, at the present time WHO does not recommend the inclusion of varicella vaccination into the routine immunization programmes of developing countries.

MeNZB vaccine and epidemic control: when do you stop vaccinating?

PubMed

Loring, Belinda J; Turner, Nikki; Petousis-Harris, Helen

2008-11-05

New Zealand developed a strain-specific group B meningococcal vaccine to control an epidemic. Following a mass vaccination campaign of three doses to the population under 20 years of age, commencing in July 2004, the vaccine continued to be offered routinely as a four-dose schedule from 6 weeks of age. There is little international data on when to cease epidemic vaccination campaigns. The decision to stop using this vaccine needed to take into account a range of factors. These included epidemiology, vaccine effectiveness and duration of immunity, vaccine coverage, concomitant use with other vaccinations being added to the infant schedule, vaccine supply and cost-benefit criteria. This paper discusses these issues, along with the potential challenges for communication to both health professionals and the public.

Childhood Immunizations: First-Time Expectant Mothers' Knowledge, Beliefs, Intentions, and Behaviors.

PubMed

Weiner, Judith L; Fisher, Allison M; Nowak, Glen J; Basket, Michelle M; Gellin, Bruce G

2015-12-01

This study focused on how first-time mothers decide or intend to decide with respect to the recommended childhood immunization schedule. This was the baseline survey of a larger longitudinal survey. Data were collected between June and September 2014 from 200 first-time mothers in their second trimester of pregnancy to examine vaccine-related knowledge, perceptions, intentions, and information-seeking behavior. Data were analyzed between January and June 2015. Seventy-five percent planned to have their child receive all the vaccinations consistent with the recommended childhood immunization schedule. Although participants expressed interest in childhood vaccine information, most had not received information directly from a primary care provider. One third reported receiving such information from their obstetrician/gynecologist but only about half of those were "very satisfied" with the information they received. About 70% indicated they were not familiar with the recommended vaccination schedule and number of routinely recommended vaccines. Familiarity with common vaccine education messages varied widely. Women who indicated they were planning to delay one or more recommended vaccinations were most likely to rely on Internet searches for childhood vaccine information. Overall, respondents had relatively positive beliefs and perceptions regarding childhood vaccines, which were associated with intentions to get their newborn vaccinated as recommended. However, most who were planning to delay recommended vaccinations or were undecided relied primarily on socially available sources of vaccine information, rather than information provided by a healthcare professional. Improved access to vaccine information from healthcare professionals could foster better vaccine-related knowledge and favorably impact vaccination decisions. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

[Toward a New Immunization Schedule in Spain, 2016 (Part 1)].

PubMed

Limia-Sánchez, Aurora; Andreu, María Mar; Torres de Mier, María de Viarce; Navarro-Alonso, José Antonio

2016-03-08

The immunization Schedule is a dynamic public health tool that has incorporated different changes over the years influenced by the epidemiologic situation and the scientific evidence. The Immunization Advisory Committee [Ponencia de Programa y Registro de Vacunaciones], as the Interterritorial Council scientific and technical advisory body, carries out assessments of different programmes and vaccines and proposes changes that after approval will be introduced in the Regions schedule. This article is divided into two parts presenting the rationale followed to propose a new schedule for the immunization against diphtheria, tetanus, pertussis, hepatitis B and invasive disease by Haemophilus influenzae type b. This first part is focused in the reasoning to undertake the assessment, the review of the immunization policy and the impact of immunization in Spain, as well as a review of the immunization schedules in similar countries.

The effect of immunization on measles incidence in the Democratic Republic of Congo: Results from a model of surveillance data.

PubMed

Doshi, Reena H; Shidi, Calixte; Mulumba, Audry; Eckhoff, Philip; Nguyen, Catherine; Hoff, Nicole A; Gerber, Sue; Okitolonda, Emile; Ilunga, Benoit Kebela; Rimoin, Anne W

2015-11-27

Measles continues to be a leading cause of vaccine-preventable disease mortality among children under five despite a safe and efficacious vaccine being readily available. While global vaccination coverage has improved tremendously, measles outbreaks persist throughout sub-Saharan Africa. Since 2010, the Democratic Republic of Congo (DRC) has seen a resurgence of measles outbreaks affecting all 11 provinces. These outbreaks are mainly attributed to gaps in routine immunization (RI) coverage compounded with missed supplementary immunization activities (SIAs). We utilized national passive surveillance data from DRC's Integrated Disease Surveillance and Response (IDSR) system to estimate the effect of immunization on measles incidence in DRC. We investigated the decline in measles incidence post-immunization with one dose of measles containing vaccine (MCV1) with and without the addition of supplementary immunization activities (SIAs) and outbreak response immunization (ORI) campaigns. Measles case counts by health zone were obtained from the IDSR system between January 1, 2010 and December 31, 2013. The impact of measles immunization was modeled using a random effects multi-level model for count data with RI coverage levels and mass campaign activities from one year prior. The presence of an SIA (aIRR [95% CI] 0.86 [0.60-1.25]) and ORI (0.28 [0.20-0.39]) in the year prior were both associated with a decrease in measles incidence. When interaction terms were included, our results suggested that the high levels of MCV1 reported in the year prior and the presence of either mass campaign was associated with a decrease in measles incidence. Our results highlight the importance of a two-dose measles vaccine schedule and the need for a strong routine immunization program coupled with frequent SIAs. Repeated occurrences of large-scale outbreaks in DRC suggest that vaccination coverage rates are grossly overestimated and signify the importance of the evaluation and modification of measles prevention and control strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Acute bacterial meningitis in infants and children: epidemiology and management.

PubMed

Agrawal, Shruti; Nadel, Simon

2011-12-01

Acute bacterial meningitis (ABM) continues to be associated with high mortality and morbidity, despite advances in antimicrobial therapy. The causative organism varies with age, immune function, immunization status, and geographic region, and empiric therapy for meningitis is based on these factors. Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis cause the majority of cases of ABM. Disease epidemiology is changing rapidly due to immunization practices and changing bacterial resistance patterns. Hib was the leading cause of meningitis in children prior to the introduction of an effective vaccination. In those countries where Hib vaccine is a part of the routine infant immunization schedule, Hib has now been virtually eradicated as a cause of childhood meningitis. Vaccines have also been introduced for pneumococcal and meningococcal diseases, which have significantly changed the disease profile. Where routine pneumococcal immunization has been introduced there has been a reported increase in invasive pneumococcal disease due to non-vaccine serotypes. In those parts of the world that have introduced conjugate meningococcal vaccines, there has been a significant change in the epidemiology of meningococcal meningitis. As a part of the United Nations Millennium Development Goal 4, the WHO has introduced a new vaccine policy to improve vaccine availability in resource poor countries. In addition, antibiotic resistance is an increasing problem, especially with pneumococcal infection. Effective treatment focuses on early recognition and use of effective antibiotics. This review will attempt to focus on the changing epidemiology of ABM in pediatric patients due to vaccination, the changing patterns of infecting bacterial serotypes due to vaccination, and on antibiotic resistance and its impact on current management strategies.

Business travelers: vaccination considerations for this population.

PubMed

Chen, Lin H; Leder, Karin; Wilson, Mary E

2013-04-01

Illness in business travelers is associated with reduced productivity on the part of the employee as well as the employer. Immunizations offer a reliable method of preventing infectious diseases for international business travelers. The authors review the travel patterns of business travelers, available data on illnesses they encounter, their potential travel-associated risks for vaccine-preventable diseases and recommendations on immunizations for this population. Routine vaccines (e.g., measles, tetanus and influenza) should be reviewed to assure that they provide current coverage. The combined hepatitis A and hepatitis B vaccine with a rapid schedule offers options for those with time constraints. Other vaccine recommendations for business travelers need to focus on their destinations and activities and underlying health, taking into account the concept of cumulative risk for those with frequent travel, multiple trips or long stays.

Uptake of oral rotavirus vaccine and timeliness of routine immunization in Brazil’s National Immunization Program

PubMed Central

Flannery, Brendan; Samad, Samia; de Moraes, José Cássio; Tate, Jacqueline E.; Danovaro-Holliday, M. Carolina; de Oliveira, Lúcia Helena; Rainey, Jeanette J.

2015-01-01

Introduction In March, 2006, oral rotavirus vaccine was added to Brazil’s infant immunization schedule with recommended upper age limits for initiating (by age 14 weeks) and completing (by age 24 weeks) the two-dose series to minimize age-specific risk of intussusception following rotavirus vaccination. Several years after introduction, estimated coverage with rotavirus vaccine (83%) was lower compared to coverage for other recommended childhood immunizations (≥94%). Methods We analyzed data from Brazil’s national immunization program on uptake of oral rotavirus vaccine by geographic region and compared administrative coverage estimates for first and second doses of oral rotavirus vaccine (Rota1 and Rota2) with first and second doses of diphtheria-tetanus-pertussis-Haemophilus influenzae type b vaccine (DTP-Hib1 and DTP-Hib2). For 27 Brazilian cities, we compared differences between estimated rotavirus and DTP-Hib coverage in 2010 with delayed receipt of DTP-Hib vaccine among a cohort of children surveyed before rotavirus introduction. Results In 2010, infant vaccination coverage was 99.0% for DTP-Hib1 versus 95.2% for Rota1 (3.8% difference), and 98.4% for DTP-Hib2 versus 83.0% for Rota2 (15.4% difference), with substantial regional variation. Differences between DTP-Hib and rotavirus vaccination coverage in Brazilian cities correlated with delay in DTP-Hib vaccination among children surveyed. Age restrictions for initiating and completing the rotavirus vaccination series likely contributed to lower coverage with rotavirus vaccine in Brazil. Conclusion To maximize benefits of rotavirus vaccination, strategies are needed to improve timeliness of routine immunizations; monitoring rotavirus vaccine uptake and intussusception risk is needed to guide further recommendations for rotavirus vaccination. PMID:23313652

Vaccinations in pediatric kidney transplant recipients.

PubMed

Fox, Thomas G; Nailescu, Corina

2018-04-18

Pediatric kidney transplant (KT) candidates should be fully immunized according to routine childhood schedules using age-appropriate guidelines. Unfortunately, vaccination rates in KT candidates remain suboptimal. With the exception of influenza vaccine, vaccination after transplantation should be delayed 3-6 months to maximize immunogenicity. While most vaccinations in the KT recipient are administered by primary care physicians, there are specific schedule alterations in the cases of influenza, hepatitis B, pneumococcal, and meningococcal vaccinations; consequently, these vaccines are usually administered by transplant physicians. This article will focus on those deviations from the normal vaccine schedule important in the care of pediatric KT recipients. The article will also review human papillomavirus vaccine due to its special importance in cancer prevention. Live vaccines are generally contraindicated in KT recipients. However, we present a brief review of live vaccines in organ transplant recipients, as there is evidence that certain live virus vaccines may be safe and effective in select groups. Lastly, we review vaccination of pediatric KT recipients prior to international travel.

Issues and considerations in the use of serologic biomarkers for classifying vaccination history in household surveys.

PubMed

MacNeil, Adam; Lee, Chung-Won; Dietz, Vance

2014-09-03

Accurate estimates of vaccination coverage are crucial for assessing routine immunization program performance. Community based household surveys are frequently used to assess coverage within a country. In household surveys to assess routine immunization coverage, a child's vaccination history is classified on the basis of observation of the immunization card, parental recall of receipt of vaccination, or both; each of these methods has been shown to commonly be inaccurate. The use of serologic data as a biomarker of vaccination history is a potential additional approach to improve accuracy in classifying vaccination history. However, potential challenges, including the accuracy of serologic methods in classifying vaccination history, varying vaccine types and dosing schedules, and logistical and financial implications must be considered. We provide historic and scientific context for the potential use of serologic data to assess vaccination history and discuss in detail key areas of importance for consideration in the context of using serologic data for classifying vaccination history in household surveys. Further studies are needed to directly evaluate the performance of serologic data compared with use of immunization cards or parental recall for classification of vaccination history in household surveys, as well assess the impact of age at the time of sample collection on serologic titers, the predictive value of serology to identify a fully vaccinated child for multi-dose vaccines, and the cost impact and logistical issues on outcomes associated with different types of biological samples for serologic testing. Published by Elsevier Ltd.

Maternal determinants of timely vaccination coverage among infants in rural Bangladesh.

PubMed

Vasudevan, Lavanya; Labrique, Alain B; Mehra, Sucheta; Wu, Lee; Levine, Orin; Feikin, Danny; Klemm, Rolf; Christian, Parul; West, Keith P

2014-09-22

Timely vaccination, i.e., the receipt of all scheduled vaccinations in an age-appropriate fashion, is critical for the prevention of deadly diseases in infants and achievement of the UN Millennium Development Goal to reduce infant mortality. Infants, especially in rural or underprivileged settings often receive delayed vaccinations leaving them susceptible to vaccine-preventable illnesses early in the first year of life. In this study, we examined rates of timely vaccination among 24,435 infants born in Gaibandha and Rangpur rural districts of Bangladesh from 2001 to 2007. Vaccinations due by 14 weeks of age and administered through routine government immunization services were assessed using interviews with enrolled mothers between 11 and 18 weeks postpartum. We created a Timely Vaccination (TV) score to classify infants as vaccinated fully and on schedule (TV=1) or not (TV=0), and used multivariable logistic regression to identify maternal characteristics associated with infant's timely vaccination status. Our results suggest that only 19% of infants in this cohort received scheduled vaccinations on time by 11-18 weeks postpartum. Mothers' engagement in paid employment [OR=1.13, 95% CI: 1.03-1.23], receipt of tetanus toxoid vaccination [OR=1.24, 95% CI: 1.11-1.38], history of antenatal care [OR=1.22, 95% CI: 1.12-1.32], or higher socioeconomic status [OR=1.07, 95% CI: 1.03-1.11] were positively associated with timely vaccination of their infants. Mother's perception of small infant size at birth was negatively associated with timely vaccination [OR=0.89, 95% CI: 0.82-0.97]. Timely vaccination coverage of infants in rural Gaibandha and Rangpur districts is extremely low. This analysis identifies important shortcomings associated with the 1-year vaccination benchmark of routine immunization performance and suggests the need for specific interventions based on potential maternal determinants as well as known system and programmatic barriers of timely vaccination among infants in rural Bangladesh. Copyright © 2014 Elsevier Ltd. All rights reserved.

An Immunization Education Program for Childcare Providers

ERIC Educational Resources Information Center

Hayney, Mary S.; Bartell, Julie C.

2005-01-01

The childhood immunization schedule includes at least 17 scheduled immunizations prior to the age of 24 months. Immunization laws require childcare centers to maintain immunization records and enforce immunization standards for children who attend these centers. Childcare providers generally receive little formal education about infectious…

Geometric Distribution-Based Readers Scheduling Optimization Algorithm Using Artificial Immune System.

PubMed

Duan, Litian; Wang, Zizhong John; Duan, Fu

2016-11-16

In the multiple-reader environment (MRE) of radio frequency identification (RFID) system, multiple readers are often scheduled to interrogate the randomized tags via operating at different time slots or frequency channels to decrease the signal interferences. Based on this, a Geometric Distribution-based Multiple-reader Scheduling Optimization Algorithm using Artificial Immune System (GD-MRSOA-AIS) is proposed to fairly and optimally schedule the readers operating from the viewpoint of resource allocations. GD-MRSOA-AIS is composed of two parts, where a geometric distribution function combined with the fairness consideration is first introduced to generate the feasible scheduling schemes for reader operation. After that, artificial immune system (including immune clone, immune mutation and immune suppression) quickly optimize these feasible ones as the optimal scheduling scheme to ensure that readers are fairly operating with larger effective interrogation range and lower interferences. Compared with the state-of-the-art algorithm, the simulation results indicate that GD-MRSOA-AIS could efficiently schedules the multiple readers operating with a fairer resource allocation scheme, performing in larger effective interrogation range.

Geometric Distribution-Based Readers Scheduling Optimization Algorithm Using Artificial Immune System

PubMed Central

Duan, Litian; Wang, Zizhong John; Duan, Fu

2016-01-01

In the multiple-reader environment (MRE) of radio frequency identification (RFID) system, multiple readers are often scheduled to interrogate the randomized tags via operating at different time slots or frequency channels to decrease the signal interferences. Based on this, a Geometric Distribution-based Multiple-reader Scheduling Optimization Algorithm using Artificial Immune System (GD-MRSOA-AIS) is proposed to fairly and optimally schedule the readers operating from the viewpoint of resource allocations. GD-MRSOA-AIS is composed of two parts, where a geometric distribution function combined with the fairness consideration is first introduced to generate the feasible scheduling schemes for reader operation. After that, artificial immune system (including immune clone, immune mutation and immune suppression) quickly optimize these feasible ones as the optimal scheduling scheme to ensure that readers are fairly operating with larger effective interrogation range and lower interferences. Compared with the state-of-the-art algorithm, the simulation results indicate that GD-MRSOA-AIS could efficiently schedules the multiple readers operating with a fairer resource allocation scheme, performing in larger effective interrogation range. PMID:27854342

Performance and determinants of routine immunization coverage within the context of intensive polio eradication activities in Uttar Pradesh, India: Social Mobilization Network (SM Net) and Core Group Polio Project (CGPP)

PubMed Central

2013-01-01

Background Studies that have looked at the effect of polio eradication efforts in India on routine immunization programs have provided mixed findings. One polio eradication project, funded by US Agency for International Development (USAID) and carried out by the CORE Group Polio Project (CGPP) in the state of Uttar Pradesh of India, has included the strengthening of routine immunization systems as a core part of its polio eradication strategy. This paper explores the performance of routine immunization services in the CGPP intervention areas concurrent with intensive polio eradication activities. The paper also explores determinants of routine immunization performance such as caretaker characteristics and CGPP activities to strengthen routine immunization services. Methods We conduct secondary data analysis of the latest project household immunization survey in 2011 and compare these findings to reports of past surveys in the CGPP program area and at the Uttar Pradesh state level (as measured by children’s receipt of DPT vaccinations). This is done to judge if there is any evidence that routine immunization services are being disrupted. We also model characteristics of survey respondents and respondents’ exposure to CGPP, communication activities against their children’s receipt of key vaccinations in order to identify determinants of routine immunization coverage. Results Routine immunization coverage has increased between the first survey (2005 for state level estimates, 2008 for the CGPP program) and the latest (2011 for both state level and CGPP areas), as measured by children’s receipt of DPT vaccination. This increase occurred concurrent with polio eradication efforts intensive enough to result in interruption of transmission. In addition, a mothers’ exposure to specific communication materials, her religion and education were associated with whether or not her children receive one or more doses of DPT. Conclusions A limitation of the analysis is the absence of a controlled comparison. It is possible routine immunization coverage would have increased even more in the absence of polio eradication efforts. At the same time, however, there is no evidence that routine immunization services were disrupted by polio eradication efforts. Targeted health communications are helpful in improving routine immunization performance. Strategies to address other determinants of routine immunization, such as religion and education, are also needed to maximize coverage. PMID:23680228

Migration and child immunization in Nigeria: individual- and community-level contexts

PubMed Central

2010-01-01

Background Vaccine-preventable diseases are responsible for severe rates of morbidity and mortality in Africa. Despite the availability of appropriate vaccines for routine use on infants, vaccine-preventable diseases are highly endemic throughout sub-Saharan Africa. Widespread disparities in the coverage of immunization programmes persist between and within rural and urban areas, regions and communities in Nigeria. This study assessed the individual- and community-level explanatory factors associated with child immunization differentials between migrant and non-migrant groups. Methods The proportion of children that received each of the eight vaccines in the routine immunization schedule in Nigeria was estimated. Multilevel multivariable regression analysis was performed using a nationally representative sample of 6029 children from 2735 mothers aged 15-49 years and nested within 365 communities. Odds ratios with 95% confidence intervals were used to express measures of association between the characteristics. Variance partition coefficients and Wald statistic i.e. the ratio of the estimate to its standard error were used to express measures of variation. Results Individual- and community contexts are strongly associated with the likelihood of receiving full immunization among migrant groups. The likelihood of full immunization was higher for children of rural non-migrant mothers compared to children of rural-urban migrant mothers. Findings provide support for the traditional migration perspectives, and show that individual-level characteristics, such as, migrant disruption (migration itself), selectivity (demographic and socio-economic characteristics), and adaptation (health care utilization), as well as community-level characteristics (region of residence, and proportion of mothers who had hospital delivery) are important in explaining the differentials in full immunization among the children. Conclusion Migration is an important determinant of child immunization uptake. This study stresses the need for community-level efforts at increasing female education, measures aimed at alleviating poverty for residents in urban and remote rural areas, and improving the equitable distribution of maternal and child health services. PMID:20211034

Schools as potential vaccination venue for vaccines outside regular EPI schedule: results from a school census in Pakistan.

PubMed

Soofi, Sajid Bashir; Haq, Inam-Ul; Khan, M Imran; Siddiqui, Muhammad Bilal; Mirani, Mushtaq; Tahir, Rehman; Hussain, Imtiaz; Puri, Mahesh K; Suhag, Zamir Hussain; Khowaja, Asif R; Lasi, Abdul Razzaq; Clemens, John D; Favorov, Michael; Ochiai, R Leon; Bhutta, Zulfiqar A

2012-01-06

Vaccines are the most effective public health intervention. Expanded Program on Immunization (EPI) provides routine vaccination in developing countries. However, vaccines that cannot be given in EPI schedule such as typhoid fever vaccine need alternative venues. In areas where school enrolment is high, schools provide a cost effective opportunity for vaccination. Prior to start of a school-based typhoid vaccination program, interviews were conducted with staff of educational institutions in two townships of Karachi, Pakistan to collect baseline information about the school system and to plan a typhoid vaccination program. Data collection teams administered a structured questionnaire to all schools in the two townships. The administrative staff was requested information on school fee, class enrolment, past history of involvement and willingness of parents to participate in a vaccination campaign. A total of 304,836 students were enrolled in 1,096 public, private, and religious schools (Madrasahs) of the two towns. Five percent of schools refused to participate in the school census. Twenty-five percent of schools had a total enrolment of less than 100 students whereas 3% had more than 1,000 students. Health education programs were available in less than 8% of public schools, 17% of private schools, and 14% of Madrasahs. One-quarter of public schools, 41% of private schools, and 43% of Madrasahs had previously participated in a school-based vaccination campaign. The most common vaccination campaign in which schools participated was Polio eradication program. Cost of the vaccine, side effects, and parents' lack of information were highlighted as important limiting factors by school administration for school-based immunization programs. Permission from parents, appropriateness of vaccine-related information, and involvement of teachers were considered as important factors to improve participation. Health education programs are not part of the regular school curriculum in developing countries including Pakistan. Many schools in the targeted townships participated in immunization activities but they were not carried out regularly. In the wake of low immunization coverage in Pakistan, schools can be used as a potential venue not only for non-EPI vaccines, but for a catch up vaccination of routine vaccines.

Will dengue vaccines be used in the public sector and if so, how? Findings from an 8-country survey of policymakers and opinion leaders.

PubMed

Douglas, Don L; DeRoeck, Denise A; Mahoney, Richard T; Wichmann, Ole

2013-01-01

A face-to-face survey of 158 policymakers and other influential professionals was conducted in eight dengue-endemic countries in Asia (India, Sri Lanka, Thailand, Vietnam) and Latin America (Brazil, Colombia, Mexico, Nicaragua) to provide an indication of the potential demand for dengue vaccination in endemic countries, and to anticipate their research and other requirements in order to make decisions about the introduction of dengue vaccines. The study took place in anticipation of the licensure of the first dengue vaccine in the next several years. Semi-structured interviews were conducted on an individual or small group basis with government health officials, research scientists, medical association officers, vaccine producers, local-level health authorities, and others considered to have a role in influencing decisions about dengue control and vaccines. Most informants across countries considered dengue a priority disease and expressed interest in the public sector use of dengue vaccines, with a major driver being the political pressure from the public and the medical community to control the disease. There was interest in a vaccine that protects children as young as possible and that can fit into existing childhood immunization schedules. Dengue vaccination in most countries surveyed will likely be targeted to high-risk areas and begin with routine immunization of infants and young children, followed by catch-up campaigns for older age groups, as funding permits. Key data requirements for decision-making were additional local dengue surveillance data, vaccine cost-effectiveness estimates, post-marketing safety surveillance data and, in some countries vaccine safety and immunogenicity data in the local population. The lookout for the public sector use of dengue vaccines in the eight countries appears quite favorable. Major determinants of whether and when countries will introduce dengue vaccines include whether WHO recommends the vaccines, their price, the availability of external financing for lower income countries, and whether they can be incorporated into countries' routine immunization schedules.

Timeliness and risk factors associated with delay for pneumococcal conjugate 10-valent routine immunization in Brazilian children.

PubMed

Sartori, Ana Lucia; Minamisava, Ruth; Afonso, Eliane Terezinha; Policena, Gabriela Moreira; Pessoni, Grécia Carolina; Bierrenbach, Ana Luiza; Andrade, Ana Lucia

2017-02-15

Vaccination coverage is the usual metrics to evaluate the immunization programs performance. For the 10-valent pneumococcal conjugate (PCV10) vaccine, measuring the delay of vaccination is also important, particularly as younger children are at increased risk of disease. Routinely collected administrative data was used to assess the timeliness of PCV10 vaccination, and the factors associated with delay to receive the first and second doses, and the completion of the PCV10 3+1 schedule. A population-based retrospective cohort study was conducted with children born in 2012 in Central Brazil. Children who received the PCV10 first dose in public health services were followed-up until 23months of age. Timeliness of receiving each PCV10 dose at any given age was defined as receiving the dose within 28days grace period from the recommended age by the National Immunization Program. Log-binomial regression models were used to examine risk factors for delays of the first dose and the completion PCV10 3+1 schedule. In total, 14,282 children were included in the cohort of study. Delayed vaccination occurred in 9.4%, 23.8%, 36.8% and 39.9% children for the first, second, third and the booster doses, respectively. A total of 1912 children (12.8% of the cohort) were not adequately vaccinated at the 6months of life; 1,071 (7%) received the second dose after 6months of age, 784 (5.4%) did not receive the second dose, and 57 (0.4%) received the first dose after six months of life. A considerable delay was found in PCV10 third and booster doses. Almost 2 thousand children had not received the recommended PCV10 doses at 6months of age. Timeliness of vaccination is an issue in Brazil although high vaccination coverages. Copyright © 2017 Elsevier Ltd. All rights reserved.

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2017.

PubMed

Kim, David K; Riley, Laura E; Harriman, Kathleen H; Hunter, Paul; Bridges, Carolyn B

2017-02-10

In October 2016, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Adults Aged 19 Years or Older-United States, 2017. The 2017 adult immunization schedule summarizes ACIP recommendations in two figures, footnotes for the figures, and a table of contraindications and precautions for vaccines recommended for adults. These documents are available at https://www.cdc.gov/vaccines/schedules. The full ACIP recommendations for each vaccine can be found at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2017 adult immunization schedule was also reviewed and approved by the American College of Physicians (https://www.acponline.org), the American Academy of Family Physicians (https://www.aafp.org), the American College of Obstetricians and Gynecologists (http://www.acog.org), and the American College of Nurse-Midwives (http://www.midwife.org).

Investigating socio-economic inequity in access to and expenditures on routine immunization services in Anambra state.

PubMed

Sibeudu, Florence T; Uzochukwu, Benjamin S C; Onwujekwe, Obinna E

2017-02-01

Addressing existing inequities in the utilization of priority health services such as routine immunization is a current public health priority. Increasing access to routine immunization from the current low levels amongst all socio-economic status groups in Nigeria is challenging. However, little is known on the level of SES inequity in utilization of routine immunization services and such information which will inform the development of strategies for ensuring equitable provision of routine immunization services in the country. The study was a cross sectional household survey, which was undertaken in two randomly selected communities in Anambra State, southeast Nigeria. A pre-tested interviewer administered questionnaire was used to collect data on levels of access to RI by children under-2 years from randomly selected households. In each household, data was collected from the primary care givers or their representative (in their absence). The relationship between access to routine immunization and socio-economic status of households and other key variables was explored in data analysis. Households from high socio-economic status (well-off) groups utilized routine immunization services more than those that belong to low socio-economic status (poor) groups (X 2  = 9.97, p < 0.002). It was found that higher percentage of low socio-economic status households compared to the high socio-economic status households received routine immunization services at public health facilities. Households that belong to low socio-economic status groups had to travel longer distance to get to health facilities consequently incurring some transportation cost. The mean expenditures on service charge for routine immunization services (mostly informal payments) and transportation were US$1.84 and US$1.27 respectively. Logistic regression showed that access to routine immunization was positively related to socio-economic status and negatively related to distant of a household to a health facility. Ability to pay affects access to services, even when such services are free at point of consumption with lower socio-economic status groups having less access to services and also having other constraints such as transportation. Hence, innovative provision methods that will bring routine immunization services closer to the people and eliminate all formal and informal user fees for routine immunization will help to increase and improve equitable coverage with routine immunization services.

Intermittent Metronomic Drug Schedule Is Essential for Activating Antitumor Innate Immunity and Tumor Xenograft Regression12

PubMed Central

Chen, Chong-Sheng; Doloff, Joshua C; Waxman, David J

2014-01-01

Metronomic chemotherapy using cyclophosphamide (CPA) is widely associated with antiangiogenesis; however, recent studies implicate other immune-based mechanisms, including antitumor innate immunity, which can induce major tumor regression in implanted brain tumor models. This study demonstrates the critical importance of drug schedule: CPA induced a potent antitumor innate immune response and tumor regression when administered intermittently on a 6-day repeating metronomic schedule but not with the same total exposure to activated CPA administered on an every 3-day schedule or using a daily oral regimen that serves as the basis for many clinical trials of metronomic chemotherapy. Notably, the more frequent metronomic CPA schedules abrogated the antitumor innate immune and therapeutic responses. Further, the innate immune response and antitumor activity both displayed an unusually steep dose-response curve and were not accompanied by antiangiogenesis. The strong recruitment of innate immune cells by the 6-day repeating CPA schedule was not sustained, and tumor regression was abolished, by a moderate (25%) reduction in CPA dose. Moreover, an ∼20% increase in CPA dose eliminated the partial tumor regression and weak innate immune cell recruitment seen in a subset of the every 6-day treated tumors. Thus, metronomic drug treatment must be at a sufficiently high dose but also sufficiently well spaced in time to induce strong sustained antitumor immune cell recruitment. Many current clinical metronomic chemotherapeutic protocols employ oral daily low-dose schedules that do not meet these requirements, suggesting that they may benefit from optimization designed to maximize antitumor immune responses. PMID:24563621

Childhood immunizations: First-time expectant mothers' knowledge, beliefs, intentions, and behaviors.

PubMed

Weiner, Judith L; Fisher, Allison M; Nowak, Glen J; Basket, Michelle M; Gellin, Bruce G

2015-11-27

This study focused on how first-time mothers decide or intend to decide with respect to the recommended childhood immunization schedule. This was the baseline survey of a larger longitudinal survey. Data were collected between June and September 2014 from 200 first-time mothers in their second trimester of pregnancy to examine vaccine-related knowledge, perceptions, intentions, and information-seeking behavior. Data were analyzed between January and June 2015. Seventy-five percent planned to have their child receive all the vaccinations consistent with the recommended childhood immunization schedule. Although participants expressed interest in childhood vaccine information, most had not received information directly from a primary care provider. One third reported receiving such information from their obstetrician/gynecologist but only about half of those were "very satisfied" with the information they received. About 70% indicated they were not familiar with the recommended vaccination schedule and number of routinely recommended vaccines. Familiarity with common vaccine education messages varied widely. Women who indicated they were planning to delay one or more recommended vaccinations were most likely to rely on Internet searches for childhood vaccine information. Overall, respondents had relatively positive beliefs and perceptions regarding childhood vaccines, which were associated with intentions to get their newborn vaccinated as recommended. However, most who were planning to delay recommended vaccinations or were undecided relied primarily on socially available sources of vaccine information, rather than information provided by a healthcare professional. Improved access to vaccine information from healthcare professionals could foster better vaccine-related knowledge and favorably impact vaccination decisions. Copyright © 2015 American Journal of Preventive Medicine and Elsevier Ltd. Published by Elsevier Ltd.. All rights reserved.

Immunization with the 7-valent conjugate pneumococcal vaccine: impact evaluation, continuing surveillance and future perspectives.

PubMed

Bechini, Angela; Boccalini, Sara; Bonanni, Paolo

2009-05-26

The 7-valent Pneumococcal Conjugate Vaccine (PCV) showed high efficacy against invasive pneumococcal diseases caused by vaccine serotypes in children less than 2 years-old. Its effectiveness was confirmed under routine use in the US, Canada and several European countries. Disease surveillance and several studies showed that population indirect protection outweighs direct protection of immunized subjects. A substantial impact was also confirmed on pneumonia and acute otitis media. A limited increase in IPD caused by non-vaccine serotypes was registered to date, but far below the magnitude of the beneficial reduction in IPD due to vaccine serotypes. This fact underpins the need for ongoing improved surveillance. New tests based on PCR for the identification and typing of pneumococci represent a very interesting alternative to traditional cultural tests that should be evaluated in the near future. The World Health Organization has recognized the priority to introduce PCV into the routine infant immunization schedule in all countries, due to the extremely high yearly mortality toll for pneumococcal diseases in the world (1.6 million deaths estimated). Conjugate vaccines with additional serotypes are in advanced stage of development or under evaluation. These new products need to be compared with the existing vaccine, following WHO recommendations regarding correlates of protection, in order to show their possibility to substitute the current vaccine obtaining the same impressive level of efficacy and effectiveness.

Polio Endgame, Information Gaps Related to Vaccines and Immunity.

PubMed

Ahmad, Mohammad; Bahl, Sunil; Kunwar, Abhishek

2016-08-07

Evidence generated through research studies has guided programmatic actions and fine-tuned strategies for the Global Polio Eradication Initiative (GPEI). However, many gaps still persist in the understanding of a risk-free implementation of the polio endgame. Immediate concerns relate to the introduction of inactivated polio vaccine (IPV) and switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV) in routine immunization schedule. A comprehensive understanding of mucosal immunity in populations and best response options against circulating vaccine derived poliovirus (cVDPV) outbreaks in post tOPV-bOPV switch is essential to mitigate the risks of wild and vaccine-derived poliovirus importations and emergence of cVDPVs in polio-free countries. A clearer picture is also needed on few operational issues, interference between polio vaccines and other EPI vaccines and products related to polio endgame. It is also extremely important to develop mechanisms to identify and manage long-term poliovirus excretors who may pose a risk of reintroduction into the population after global eradication of poliovirus.

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2018.

PubMed

Kim, David K; Riley, Laura E; Hunter, Paul

2018-02-09

In October 2017, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2018. The 2018 adult immunization schedule summarizes ACIP recommendations in two figures and a table of contraindications and precautions for vaccines recommended for adults, and is intended is to assist health care providers in implementing the current ACIP recommendations for vaccinating adults. The schedule can be found at https://www.cdc.gov/vaccines/schedules.* The full ACIP recommendations for each vaccine are available at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2018 adult immunization schedule has also been approved by the American College of Physicians (https://www.acponline.org), the American Academy of Family Physicians (https://www.aafp.org), the American College of Obstetricians and Gynecologists (https://www.acog.org), and the American College of Nurse-Midwives (http://www.midwife.org). The ACIP-recommended use of each vaccine is developed after an in-depth review of vaccine-related data, including data on disease epidemiology, vaccine efficacy and effectiveness, vaccine safety, feasibility of program implementation, and economic aspects of immunization policy (1).

Metronomic cyclophosphamide schedule-dependence of innate immune cell recruitment and tumor regression in an implanted glioma model

PubMed Central

Wu, Junjie; Waxman, David J.

2014-01-01

Metronomic cyclophosphamide (CPA) treatment activates robust innate anti-tumor immunity and induces major regression of large, implanted brain tumor xenografts when administered on an intermittent, every 6-day schedule, but not on a daily low-dose or a maximum-tolerated dose CPA schedule. Here, we used an implanted GL261 glioma model to compare five intermittent metronomic CPA schedules to elucidate the kinetics and schedule dependence of innate immune cell recruitment and tumor regression. Tumor-recruited natural killer cells induced by two every 6-day treatment cycles were significantly ablated one day after a third CPA treatment, but largely recovered several days later. Natural killer and other tumor-infiltrating innate immune cells peaked 12 days after the last CPA treatment on the every 6-day schedule, suggesting that drug-free intervals longer than 6 days may show increased efficacy. Metronomic CPA treatments spaced 9 or 12 days apart, or on an alternating 6 and 9 day schedule, induced extensive tumor regression, similar to the 6-day schedule, however, the tumor-infiltrating natural killer cell responses were not sustained, leading to rapid resumption of tumor regrowth after day 24, despite ongoing metronomic CPA treatment. Increasing the CPA dose prolonged the period of tumor regression on the every 9-day schedule, but natural killer cell activation was markedly decreased. Thus, while several intermittent metronomic CPA treatment schedules can activate innate immune cell recruitment leading to major tumor regression, sustained immune and anti-tumor responses are only achieved on the 6-day schedule. However, even with this schedule, some tumors eventually relapse, indicating a need for further improvements in immunogenic metronomic therapies. PMID:25069038

Lot-to-lot consistency, safety and immunogenicity of 3 lots of Haemophilus influenzae type b conjugate vaccine: results from a phase III randomized, multicenter study in infants.

PubMed

Klein, Nicola P; Abu-Elyazeed, Remon; Cornish, Matthew; Leonardi, Michael L; Weiner, Leonard B; Silas, Peter E; Grogg, Stanley E; Varman, Meera; Frenck, Robert W; Cheuvart, Brigitte; Baine, Yaela; Miller, Jacqueline M; Leyssen, Maarten; Mesaros, Narcisa; Roy-Ghanta, Sumita

2017-06-16

Vaccination against Haemophilus influenzae type b (Hib) is included in routine pediatric immunization schedule in the United States. Previous vaccine shortages have created the need for additional options for Hib vaccination. This phase III, randomized, multi-centered study (NCT01000974) evaluated the safety and immunogenicity of a monovalent tetanus toxoid-conjugate Hib vaccine (Hib-TT) compared to a monovalent (Hib-TT control) and a combination Hib-TT vaccine. We hierarchically assessed lot-to-lot consistency of 3 Hib-TT lots and non-inferiority of Hib-TT to Hib-TT control. We co-administered routine pediatric vaccines with Hib-TT vaccines at 2, 4, 6months (primary vaccination) and 15-18months of age (booster vaccination). We recorded adverse events (AEs) for 4 (solicited) and 31days (unsolicited) post-vaccination and serious AEs (SAEs) throughout the study. Of 4009 enrolled children, 3086 completed booster phase. Lot-to-lot consistency was not demonstrated. The study met statistical criteria for non-inferiority of Hib-TT to Hib-TT control in terms of immune responses to Hib and co-administered vaccines' antigens, but not in terms of participants achieving post-primary vaccination anti-PRP levels ≥1µg/mL. Because of the hierarchical nature of the objectives, non-inferiority could not be established. In all groups, 92.5-96.7% and 99.6-100% of participants achieved anti-PRP levels ≥0.15µg/mL, while 78.3-89.8% and 97.9-99.1% had anti-PRP levels ≥1µg/mL, post-primary and post-booster vaccination, respectively. Immune responses to co-administered vaccines and reported incidence of AEs were comparable among groups. We recorded SAEs for 107/2963 (3.6%), 24/520 (4.6%), and 21/520 (4.0%) children post-primary vaccination, and 29/2337 (1.2%), 4/435 (0.9%), and 2/400 (0.5%) children post-booster vaccination with Hib-TT, Hib-TT control and combination Hib-TT vaccine, respectively; 6/5330 (0.1%) SAEs in the Hib-TT groups were considered vaccine-related. Hib-TT induced seroprotective antibody concentrations in the majority of participants and was well-tolerated when co-administered with routine pediatric vaccines according to a 3+1 schedule. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

SMS-reminder for vaccination in Africa: research from published, unpublished and grey literature

PubMed Central

Manakongtreecheep, Kasidet

2017-01-01

Immunization for children against vaccine-preventable diseases is one of the most important health intervention method in the world, both in terms of its health impact and cost-effectiveness. Through EPI and various other programs such as the Decades of Vaccines, immunization has been improving the health of children around the world. However, this progress falls short of global immunization targets of the Global Vaccine Action Plan (GVAP). Furthermore, the African region still lags behind in immunization, and suffers from a high proportion of vaccine preventable diseases as a result. Reminders and recall for vaccination have been shown to improve health care-seeking behaviours, and have been recommended for application in routine and supplemental measles immunization activities. With mobile phones becoming more accessible in Africa, SMS vaccine reminder system has been proposed as a convenient and easily scalable way to inform caregivers of the disease and the importance of immunization, to address any concerns related to immunization safety, and to remind them of vaccination schedules and campaigns. There have been 6 published articles and 1 unpublished article on the effect of SMS reminder system for immunization in Africa. The studies done has shown that SMS vaccination reminder has led to improvements in vaccination uptakes in various metrics, whether is through the increase in vaccination coverage, decrease in dropout rates, increase in completion rate, or decrease in delay for vaccination. PMID:29296158

SMS-reminder for vaccination in Africa: research from published, unpublished and grey literature.

PubMed

Manakongtreecheep, Kasidet

2017-01-01

Immunization for children against vaccine-preventable diseases is one of the most important health intervention method in the world, both in terms of its health impact and cost-effectiveness. Through EPI and various other programs such as the Decades of Vaccines, immunization has been improving the health of children around the world. However, this progress falls short of global immunization targets of the Global Vaccine Action Plan (GVAP). Furthermore, the African region still lags behind in immunization, and suffers from a high proportion of vaccine preventable diseases as a result. Reminders and recall for vaccination have been shown to improve health care-seeking behaviours, and have been recommended for application in routine and supplemental measles immunization activities. With mobile phones becoming more accessible in Africa, SMS vaccine reminder system has been proposed as a convenient and easily scalable way to inform caregivers of the disease and the importance of immunization, to address any concerns related to immunization safety, and to remind them of vaccination schedules and campaigns. There have been 6 published articles and 1 unpublished article on the effect of SMS reminder system for immunization in Africa. The studies done has shown that SMS vaccination reminder has led to improvements in vaccination uptakes in various metrics, whether is through the increase in vaccination coverage, decrease in dropout rates, increase in completion rate, or decrease in delay for vaccination.

Artificial Immune Algorithm for Subtask Industrial Robot Scheduling in Cloud Manufacturing

NASA Astrophysics Data System (ADS)

Suma, T.; Murugesan, R.

2018-04-01

The current generation of manufacturing industry requires an intelligent scheduling model to achieve an effective utilization of distributed manufacturing resources, which motivated us to work on an Artificial Immune Algorithm for subtask robot scheduling in cloud manufacturing. This scheduling model enables a collaborative work between the industrial robots in different manufacturing centers. This paper discussed two optimizing objectives which includes minimizing the cost and load balance of industrial robots through scheduling. To solve these scheduling problems, we used the algorithm based on Artificial Immune system. The parameters are simulated with MATLAB and the results compared with the existing algorithms. The result shows better performance than existing.

Immunization Schedules for Preteens and Teens

MedlinePlus

... Immunization Schedule for Preteens and Teens (7 through 18 Years) Recommend on Facebook Tweet Share Compartir On ... a Catch-Up or Accelerated Schedule Birth through 18 Years In three easy steps, you can use ...

Effects of polio eradication activities on routine immunization: lessons from the 2013 outbreak response in Somali region of Ethiopia.

PubMed

Tafesse, Belete; Tekle, Ephrem; Wondwossen, Liya; Bogale, Mengistu; Fiona, Braka; Nsubuga, Peter; Tomas, Karengera; Kassahun, Aron; Kathleen, Gallagher; Teka, Aschalew

2017-01-01

Ethiopia experienced several WPV importations with a total of 10 WPV1 cases confirmed during the 2013 outbreak alone before it is closed in 2015. We evaluated supplemental immunization activities (SIAs), including lessons learned for their effect on the routine immunization program during the 2013 polio outbreak in Somali regional state. We used descriptive study to review documents and analyse routine health information system reports from the polio outbreak affected Somali regional state. All data and technical reports of the 15 rounds of polio SIAs from June 2013 through June 2015 and routine immunization coverages for DPT-Hib-HepB 3 and measles were observed. More than 93% of the SIAs were having administrative coverage above 95%. The trend of routine immunization for the two antigens, over the five years (2011 through 2015) did not show a consistent pattern against the number of SIAs. Documentations showed qualitative positive impacts of the SIAs strengthening the routine immunization during all courses of the campaigns. The quantitative impact of polio SIAs on routine immunization remained not so impressive in this study. Clear planning, data consistencies and completeness issues need to be cleared for the impact assessment in quantitative terms, in polio legacy planning as well as for the introduction of injectable polio vaccine through the routine immunization.

[Immunisation schedule of the Spanish Association of Paediatrics: 2015 recommendations].

PubMed

Moreno-Pérez, D; Álvarez García, F J; Arístegui Fernández, J; Cilleruelo Ortega, M J; Corretger Rauet, J M; García Sánchez, N; Hernández Merino, A; Hernández-Sampelayo Matos, T; Merino Moína, M; Ortigosa Del Castillo, L; Ruiz-Contreras, J

2015-01-01

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain. Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months). The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries. The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies. It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Copyright © 2014. Published by Elsevier Espana.

[The effect of aluminum adjuvant and immunization schedule on immunogenicity of Sabin inactivated poliovirus vaccine].

PubMed

Wang, Fang; Zhang, Ming; Xie, Bing-Feng; Cao, Han; Tong, Shao-Yong; Wang, Jun-Rong; Yu, Xiao-Ping; Tang, Yang; Yang, Jing-Ran; Sun, Ming-Bo

2013-04-01

To study the effect of aluminume adjuvant and immunization schedule on immunogenicity of Sabin inactivated poliovirus vaccine. Four batches of Sabin IPV were produced by different concentrations of type 1, 2, and 3 poliovirus and administrated on three-dose schedule at 0, 1, 2 months and 0, 2, 4 months on rats. Serum samples were collected one month after each dose and neutralizing antibody titers against three types poliovirus were determined by micro-neutralization assay. The GMTs of neutralizing antibodies against three types poliovirus increased significantly and the seropositivity rates were 100% in all groups after 3 doses. There was no significant difference between two immunization schedules, and the 0, 2, 4 month schedule could induce higher level neutralizing antibody compared to the 0, 1, 2 month schedule. The groups with aluminum adjuvant could induce higher level neutralizing antibody compared to the groups without adjuvant. Aluminum djuvant and immunization schedule could improve the immunogenicity of Sabin IPV.

Immunizations and autism: a review of the literature.

PubMed

Doja, Asif; Roberts, Wendy

2006-11-01

Because of a temporal correlation between the first notable signs and symptoms of autism and the routine childhood vaccination schedule, many parents have become increasingly concerned regarding the possible etiologic role vaccines may play in the development of autism. In particular, some have suggested an association between the Measles-Mumps-Rubella vaccine and autism. Our literature review found very few studies supporting this theory, with the overwhelming majority showing no causal association between the Measles-Mumps-Rubella vaccine and autism. The vaccine preservative thimerosal has alternatively been hypothesized to have a possible causal role in autism. Again, no convincing evidence was found to support this claim, nor for the use of chelation therapy in autism. With decreasing uptake of immunizations in children and the inevitable occurrence of measles outbreaks, it is important that clinicians be aware of the literature concerning vaccinations and autism so that they may have informed discussions with parents and caregivers.

Progress toward measles elimination in the People's Republic of China, 2000-2009.

PubMed

Ma, Chao; An, Zhijie; Hao, Lixin; Cairns, K Lisa; Zhang, Yan; Ma, Jing; Cao, Lei; Wen, Ning; Xu, Wenbo; Liang, Xiaofeng; Yang, Weizhong; Luo, Huiming

2011-07-01

In 2006, China set a goal of measles elimination by 2012. To describe progress toward this goal, we reviewed relevant policies and strategies and analyzed national data for 2000-2009. In response to implementation of these strategies, including increased routine measles vaccination coverage and province-specific supplementary immunization activities (SIAs), reported measles incidence decreased to a historically low level of 39.5 cases per million in 2009. A synchronized nationwide SIA was scheduled in 2010 to further decrease susceptibility to measles. However, reaching and maintaining measles elimination will require strong political commitment and efforts for strengthening surveillance, increasing 2-dose vaccine coverage to >95%, stricter enforcement of the requirement to check immunization status at school entry, and careful attention to measles susceptibility in those aged ≥15 years. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

Recommended Immunization Schedules for Persons Aged 0 through 18 Years--United States, 2010. Morbidity and Mortality Weekly Report QuickGuide. Volume 58, Number 51 & 52

ERIC Educational Resources Information Center

Centers for Disease Control and Prevention, 2010

2010-01-01

The Advisory Committee on Immunization Practices (ACIP) annually publishes an immunization schedule for persons aged 0 through 18 years that summarizes recommendations for currently licensed vaccines for children aged 18 years and younger and includes recommendations in effect as of December 15, 2009. The changes to the previous schedule are…

Evidence of Mumps Infection Among Children in the Democratic Republic of Congo.

PubMed

Doshi, Reena H; Alfonso, Vivian H; Hoff, Nicole A; Mukadi, Patrick; Gerber, Sue; Bwaka, Ado; Higgins, Stephen G; Mwamba, Guillaume Ngoie; Okitolonda, Emile; Muyembe, Jean-Jacques; Rimoin, Anne W

2017-05-01

Mumps is an acute viral infection and while the infection is usually mild, complications can lead to permanent sequelae including brain damage and deafness. The burden of mumps is currently unknown the Democratic Republic of Congo (DRC), we therefore assessed susceptibility to mumps infection among children 6-59 months of age. In collaboration with the 2013-2014 DRC Demographic and Health Survey, we conducted a serosurvey to assess population immunity to vaccine preventable diseases. Dried blood spot samples were collected from children 6 to 59 months of age and processed at the UCLA-DRC laboratory in Kinshasa, DRC using the Dynex Technologies Multiplier FLEX chemiluminescent immunoassay platform (Dynex multiplex assay, Chantilly, VA). Logistic multivariate analyses were used to determine risk factors for mumps seropositivity. Serologic and survey data were matched for 7195, 6-59 month-old children, among whom 22% were positive and 3% indeterminate for mumps antibodies in weighted analyses. In multivariate analyses, the odds of seropositivity increased with increasing age, female gender, number of children in household, increasing socioeconomic status and province (Kinshasa with the highest odds of positive test result compared with all other provinces). These data suggest that mumps virus is circulating in DRC and risk of exposure increases with age. At present, the introduction of a combined measles-mumps-rubella vaccine remains unlikely, as the capacity to maintain adequate vaccine coverage levels for routine immunization must be improved before additional antigens can be considered for the routine immunization schedule.

Impact of the introduction of the pneumococcal conjugate vaccine in the Brazilian routine childhood national immunization program.

PubMed

Moreira, Marta; Cintra, Otavio; Harriague, Julie; Hausdorff, William P; Hoet, Bernard

2016-05-27

Brazil introduced the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV, Synflorix™, GSK Vaccines) in the routine childhood immunization program in 2010 with a 3+1 schedule (with catch-up for children <2 years-old). This review represents the first analysis of the overall impact of a second-generation pneumococcal conjugate vaccine on nasopharyngeal carriage and all the major pneumococcal disease manifestations in a single, pneumococcal conjugate vaccine-naïve, developing country. A total of 15 published articles and 13 congress abstracts were included in the analysis. In children <5 years-old, studies showed a positive impact of PHiD-CV on the incidence of vaccine-type and any-type invasive pneumococcal disease (including decreases in pneumococcal meningitis morbidity and mortality), on pneumonia incidence and mortality, and on otitis media. Nasopharyngeal carriage of vaccine-type and any-type pneumococci decreased after the primary doses, with no early signs of replacement with other pathogens. Finally, herd protection against vaccine-type invasive pneumococcal disease and pneumonia in unvaccinated subjects was shown in some studies for some age groups. In conclusion, pneumococcal disease decreased after the introduction of PHiD-CV into the Brazilian national immunization program. Further follow-up is needed to evaluate the long-term overall impact of PHiD-CV in the Brazilian population. Copyright © 2016 GlaxoSmithKline Biologicals SA. Published by Elsevier Ltd.. All rights reserved.

Introduction of a second dose of measles in national immunization program in India: a major step towards eradication.

PubMed

Verma, Ramesh; Khanna, Pardeep; Bairwa, Mohan; Chawla, Suraj; Prinja, Shankar; Rajput, Meena

2011-10-01

Measles is a highly infectious, acute respiratory illness that is caused by a virus of the genus Morbillivirus. The disease infects nearly 30 million children each year, and deaths usually occur from complications related to pneumonia, diarrhea and malnutrition. A systematic review of published Indian literature depicts the median case fatality ratio (CFR) of measles to be 1.6%. Through immunization, measles deaths dropped a remarkable 78% from 733,000 in 2000 to 164,000 in 2008. As of 2008, 192 of 193 Member States of WHO use 2 doses of measles vaccine in their national immunization programs, India being the only exception. The Millennium Development Goal (MDG) 4 aims to reduce by two-thirds between 1990 and 2015 the under-five mortality rate (U5MR) in the world. Per the draft comprehensive Multi Year Strategic Plan (cMYP, 2010–17) for immunization of India, the country aims to reduce measles-related mortality by 90% by 2013 when compared to 2000. As recommended by the National Technical Advisory Group on Immunization (NTAGI), the implementation strategy of the second dose of measles vaccine at the state level is determined by the underlying performance of the routine immunization program. The second dose in the national immunization schedule gives extra immunity against measles infection that renders children more susceptible to secondary pneumonia and diarrheal diseases, which are the primary causes of under-5 child mortality in India.

Assessing the Evidence for Maternal Pertussis Immunization: A Report From the Bill & Melinda Gates Foundation Symposium on Pertussis Infant Disease Burden in Low- and Lower-Middle-Income Countries

PubMed Central

Sobanjo-ter Meulen, Ajoke; Duclos, Philippe; McIntyre, Peter; Lewis, Kristen D. C.; Van Damme, Pierre; O'Brien, Katherine L.; Klugman, Keith P.

2016-01-01

Implementation of effective interventions has halved maternal and child mortality over the past 2 decades, but less progress has been made in reducing neonatal mortality. Almost 45% of under-5 global mortality now occurs in infants <1 month of age, with approximately 86% of neonatal deaths occurring in low- and lower-middle-income countries (LMICs). As an estimated 23% of neonatal deaths globally are due to infectious causes, maternal immunization (MI) is one intervention that may reduce mortality in the first few months of life, when direct protection often relies on passively transmitted maternal antibodies. Despite all countries including pertussis-containing vaccines in their routine childhood immunization schedules, supported through the Expanded Programme on Immunization, pertussis continues to circulate globally. Although based on limited robust epidemiologic data, current estimates derived from modeling implicate pertussis in 1% of under-5 mortality, with infants too young to be vaccinated at highest risk of death. Pertussis MI programs have proven effective in reducing infant pertussis mortality in high-income countries using tetanus-diphtheria-acellular pertussis (Tdap) vaccines in their maternal and infant programs; however, these vaccines are cost-prohibitive for routine use in LMICs. The reach of antenatal care programs to deliver maternal pertussis vaccines, particularly with respect to infants at greatest risk of pertussis, needs to be further evaluated. Recognizing that decisions on the potential impact of pertussis MI in LMICs need, as a first step, robust contemporary mortality data for early infant pertussis, a symposium of global key experts was held. The symposium reviewed current evidence and identified knowledge gaps with respect to the infant pertussis disease burden in LMICs, and discussed proposed strategies to assess the potential impact of pertussis MI. PMID:27838664

Case control study of rotavirus vaccine effectiveness in Portugal during 6 years of private market use.

PubMed

Marlow, Robin; Ferreira, Muriel; Cordeiro, Eugénio; Trotter, Caroline; Januário, Luis; Finn, Adam; Rodrigues, Fernanda

2015-05-01

Although recommended by the vaccine committee of the Portuguese Paediatric Society, rotavirus vaccines have not been included in the routine immunization schedule. They have been available privately since 2006 with estimated coverage reaching approximately 30%. However, unlike other European countries using the vaccine, sentinel surveillance has detected fluctuations but no clear trends in the rate of gastrointestinal disease presentations. In this study, we set out to establish the real world effectiveness of rotavirus immunization in this low vaccine coverage setting. We carried out a test-negative case control study on a population of children attending a regional pediatric hospital, between 2006 and 2012, with symptoms of acute gastroenteritis and producing a stool sample for routine rotavirus testing. We calculated exposure odds ratio (ratio of odds of antecedent vaccination among cases compared with controls) to derive vaccine effectiveness ([1 - adjusted odds ratio]/100) against both hospital attendance and admission. Vaccine effectiveness against attendance with rotavirus acute gastroenteritis was 83.7% (95% confidence interval: 73.9-89.8) and against hospital admission was 96.1% (95% confidence interval: 83.8-99.1). No significant difference between the 2 available vaccines was detected. Both rotavirus vaccines offer a high degree of individual protection in this population.

Endogenous Circadian Regulation of Pro-inflammatory Cytokines and Chemokines in the Presence of Bacterial Lipopolysaccharide in Humans

PubMed Central

Rahman, Shadab A.; Castanon-Cervantes, Oscar; Scheer, Frank A.J.L.; Shea, Steven A.; Czeisler, Charles A.; Davidson, Alec J.; Lockley, Steven W.

2015-01-01

Various aspects of immune response exhibit 24-hour variations suggesting that infection susceptibility and treatment efficacy may vary by time of day. Whether these 24-hour variations are endogenous or evoked by changes in environmental or behavioral conditions is not known. We assessed the endogenous circadian control and environmental and behavioral influences on ex-vivo lipopolysaccharide stimulation of whole blood in thirteen healthy participants under 48 hours of baseline conditions with standard sleep-wake schedules and 40–50 hours of constant environmental and behavioral (constant routine; CR) conditions. Significant 24-hour rhythms were observed under baseline conditions in Monocyte Chemotactic Protein, Granulocyte-Macrophage Colony-Stimulating Factor and Interleukin 8 but not Tumor Necrosis Factor alpha whereas significant 24-hour rhythms were observed in all four immune factors under CR conditions. The rhythm amplitudes, expressed as a percentage of mean, were comparable between immune factors and across conditions. In contrast, the acrophase time (time of the fitted peak) was different between immune factors, and included daytime and nighttime peaks and changes across behavioral conditions. These results suggest that the endogenous circadian system underpins the temporal organization of immune responses in humans with additional effects of external environmental and behavioral cycles. These findings have implications for understanding the adverse effects of recurrent circadian disruption and sleep curtailment on immune function. PMID:25452149

[Toward a New Immunization Schedule in Spain, 2016 (Part 2)].

PubMed

Navarro-Alonso, José Antonio; Taboada-Rodríguez, José Antonio; Limia-Sánchez, Aurora

2016-03-08

Immunization schedules are intrinsically dynamic in order to embed the immunologic and epidemiologic changes in any specific geographic Region. According to this, the current study addresses a proposal to modify the Childhood Immunization Schedule in Spain. In order to move from a three plus one schema to a two plus one, we undertake a review of the available literature to explore the immunological and clinical rationale behind this change, including an overview of the potential impact on this schedule of premature infants. Additionally, some recommendations are made regarding those Spanish regions which start hepatitis B vaccination at the newborn period.

[Childhood immunization schedule 2001-2002. Advisory Committee on Vaccines of the Spanish Association of Pediatrics].

PubMed

2001-07-01

In 1994 the Spanish Association of Pediatrics founded the Advisory Committee on Vaccines with the aim of providing advice on matters related to childhood immunizations and of implementing vaccination schedules. The latest recommendations concern the immunization schedule for 2001-2002, in which indications for the inactivated poliovirus vaccine instead of the attenuated poliovirus vaccine are of prime importance. The advisability of including the vaccine against chicken pox in healthy children is stressed.

Factors and misperceptions of routine childhood immunization service uptake in Ethiopia: findings from a nationwide qualitative study

PubMed Central

Tadesse, Tefera; Getachew, Kinde; Assefa, Tersit; Ababu, Yohannes; Simireta, Tesfaye; Birhanu, Zewdie; Hailemichael, Yohannes

2017-01-01

Introduction While the routine childhood immunization program might be affected by several factors, its identification using qualitative evidence of caretakers is generally minimal. This article explores the various factors and misperceptions of routine childhood immunization service uptake in Ethiopia and provides possible recommendations to mitigate them. Methods In this study, we used a qualitative multiple case study design collecting primary data from 63 focus group discussions (FGDs) conducted with a purposefully selected sample of children's caretakers (n = 630). Results According to the results of this study, the use of routine childhood immunization is dependent on four major factors: caretakers' behavior, family characteristics, information and communication and immunization service system. In addition, the participants had some misperceptions about routine childhood immunization. For example, immunization should be taken when the child gets sick and a single dose vaccine is enough for a child. These factors and misperceptions are complex and sometimes context-specific and vary between categories of caretakers. Conclusion Our interpretations suggest that no single factor affects immunization service uptake alone in a unique way. Rather, it is the synergy among the factors that has a collective influence on the childhood immunization system. Therefore, intervention efforts should target these multiple factors simultaneously. Importantly, this study recommends improving the quality of existing childhood immunization services and building awareness among caretakers as crucial components. PMID:29675124

White Paper on studying the safety of the childhood immunization schedule in the Vaccine Safety Datalink.

PubMed

Glanz, Jason M; Newcomer, Sophia R; Jackson, Michael L; Omer, Saad B; Bednarczyk, Robert A; Shoup, Jo Ann; DeStefano, Frank; Daley, Matthew F

2016-02-15

While the large majority of parents in the U.S. vaccinate their children according to the recommended immunization schedule, some parents have refused or delayed vaccinating, often citing safety concerns. In response to public concern, the U.S. Institute of Medicine (IOM) evaluated existing research regarding the safety of the recommended immunization schedule. The IOM concluded that although available evidence strongly supported the safety of the currently recommended schedule as a whole, additional observational research was warranted to compare health outcomes between fully vaccinated children and those on a delayed or alternative schedule. In addition, the IOM identified the Vaccine Safety Datalink (VSD) as an important resource for conducting this research. Guided by the IOM findings, the Centers for Disease Control and Prevention (CDC) commissioned a White Paper to assess how the VSD could be used to study the safety of the childhood immunization schedule. Guided by subject matter expert engagement, the resulting White Paper outlines a 4 stage approach for identifying exposure groups of undervaccinated children, presents a list of health outcomes of highest priority to examine in this context, and describes various study designs and statistical methods that could be used to analyze the safety of the schedule. While it appears feasible to study the safety of the recommended immunization schedule in settings such as the VSD, these studies will be inherently complex, and as with all observational studies, will need to carefully address issues of confounding and bias. In light of these considerations, decisions about conducting studies of the safety of the schedule will also need to assess epidemiological evidence of potential adverse events that could be related to the schedule, the biological plausibility of an association between an adverse event and the schedule, and public concern about the safety of the schedule. Copyright © 2015 Elsevier Ltd. All rights reserved.

Economic impact of routine opt-out antenatal human immune deficiency virus screening: A systematic review.

PubMed

Ibekwe, Everistus; Haigh, Carol; Duncan, Fiona; Fatoye, Francis

2017-12-01

To evaluate the economic impact of routine testing of human immune deficiency virus in antenatal settings. Many children are being infected with human immune deficiency virus through mother-to-child transmission of the virus. Most of these infections are preventable if the mothers' human immune deficiency virus status is identified in a timely manner and appropriate interventions put in place. Routine human immune deficiency virus testing is widely acclaimed as a strategy for universal access to human immune deficiency virus testing and is being adopted by developed and developing poor income countries without recourse to the economic impact. A systematic review of published articles. Extensive electronic searches for relevant journal articles published from 1998-2015 when countries began to implement routine antenatal HIV testing on their own were conducted in the following databases: Science Direct, MEDLINE, SCOPUS, JSTOR, CINAHL and PubMed with search terms as listed in Box 2. Manual searches were also performed to complement the electronic identification of high-quality materials. There were no geographical restrictions, but language was limited to English. Fifty-five articles were retrieved; however, ten were eligible and included in the review. The findings showed that many programmes involving routine human immune deficiency virus testing for pregnant women compared to the alternatives were cost-effective and cost saving. Data from the reviewed studies showed cost savings between $5,761.20-$3.69 million per case of previously undiagnosed maternal human immune deficiency virus-positive infection prevented. Overall, cost-effectiveness was strongly associated with the prevalence rate of human immune deficiency virus in the various settings. Routine human immune deficiency virus testing is both cost-effective and cost saving compared to the alternatives. However, there are wide variations in the methodological approaches to the studies. Adopting standard reporting format would facilitate comparison between studies and generalisability of economic evaluations. (i) Healthcare decision-makers should understand that routine antenatal screening for human immune deficiency virus is both cost-effective and cost saving. (ii) Addressing late identification of prenatal human immune deficiency virus is crucial to reducing mother-to-child transmission at minimal healthcare spending. © 2017 John Wiley & Sons Ltd.

Administering Multiple Injectable Vaccines During a Single Visit-Summary of Findings From the Accelerated Introduction of Inactivated Polio Vaccine Globally.

PubMed

Dolan, Samantha B; Patel, Manish; Hampton, Lee M; Burnett, Eleanor; Ehlman, Daniel C; Garon, Julie; Cloessner, Emily; Chmielewski, Elizabeth; Hyde, Terri B; Mantel, Carsten; Wallace, Aaron S

2017-07-01

In 2013, the World Health Organization's (WHO's) Strategic Advisory Group of Experts (SAGE) recommended that all 126 countries using only oral polio vaccine (OPV) introduce at least 1 dose of inactivated polio vaccine (IPV) into their routine immunization schedules by the end of 2015. In many countries, the addition of IPV would necessitate delivery of multiple injectable vaccines (hereafter, "multiple injections") during a single visit, with infants receiving IPV alongside pentavalent vaccine (which covers diphtheria, tetanus, and whole-cell pertussis; hepatitis B; and Haemophilus influenzae type b) and pneumococcal vaccine. Unanticipated concerns emerged from countries over acceptability of multiple injections, sites of administration, and safety. We contextualized the issues surrounding multiple injections by documenting concerns associated with administration of ≥3 injections, existing evidence in the published literature, and findings of a systematic review on administration practices and techniques. Concerns associated with multiple-injection visits were documented from meetings and personal communications with immunization program managers. Published literature on the acceptability of multiple injections by providers and caregivers was summarized, and a systematic review of the literature on administration practices was completed on the following topics: spacing between injection sites (ie, vaccine spacing), site of injection, route of injection, and procedural preparedness. WHO and United Nations Children's Fund data from 2013-2015 were used to assess multiple-injection visits included in national immunization schedules. Healthcare provider and caregiver attitudes and practices indicated concerns about infant pain, potential adverse effects, and uncertainty about vaccine effectiveness with multiple-injection visits. Published literature reinforced the record of safety and acceptance of the recommended schedule of IPV by the SAGE, but the evidence was largely from developed countries. Parental acceptance of multiple injections was associated with a positive provider recommendation to the caregiver. Findings of the systematic review identified that the intramuscular route is preferred over the subcutaneous route for vaccine administration and that the vastus lateralis muscle is preferred over the deltoid muscle for intramuscular injections. Recommendations on vaccine spacing and procedural preparedness were based on practical necessities, but comparative evidence was not identified. During 2013-2015, 85 countries added IPV to their immunization schedules, 46 (55%) of which adopted a schedule resulting in 3 injectable vaccines being administered in a single visit. The multiple-injection experience identified gaps in guidance for future vaccine introductions. Global partner organizations quickly mobilized to assess, document, and communicate the existing global experience on multiple-injection visits. This evidence-based approach provided reassurance to opinion leaders, health workers, and professional societies, thus encouraging uptake of IPV as a second or third injection in an accelerated manner globally. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Administering Multiple Injectable Vaccines During a Single Visit—Summary of Findings From the Accelerated Introduction of Inactivated Polio Vaccine Globally

PubMed Central

Patel, Manish; Hampton, Lee M.; Burnett, Eleanor; Ehlman, Daniel C.; Garon, Julie; Cloessner, Emily; Chmielewski, Elizabeth; Hyde, Terri B.; Mantel, Carsten; Wallace, Aaron S.

2017-01-01

Abstract Background. In 2013, the World Health Organization’s (WHO’s) Strategic Advisory Group of Experts (SAGE) recommended that all 126 countries using only oral polio vaccine (OPV) introduce at least 1 dose of inactivated polio vaccine (IPV) into their routine immunization schedules by the end of 2015. In many countries, the addition of IPV would necessitate delivery of multiple injectable vaccines (hereafter, “multiple injections”) during a single visit, with infants receiving IPV alongside pentavalent vaccine (which covers diphtheria, tetanus, and whole-cell pertussis; hepatitis B; and Haemophilus influenzae type b) and pneumococcal vaccine. Unanticipated concerns emerged from countries over acceptability of multiple injections, sites of administration, and safety. We contextualized the issues surrounding multiple injections by documenting concerns associated with administration of ≥3 injections, existing evidence in the published literature, and findings of a systematic review on administration practices and techniques. Methods. Concerns associated with multiple-injection visits were documented from meetings and personal communications with immunization program managers. Published literature on the acceptability of multiple injections by providers and caregivers was summarized, and a systematic review of the literature on administration practices was completed on the following topics: spacing between injection sites (ie, vaccine spacing), site of injection, route of injection, and procedural preparedness. WHO and United Nations Children’s Fund data from 2013–2015 were used to assess multiple-injection visits included in national immunization schedules. Results. Healthcare provider and caregiver attitudes and practices indicated concerns about infant pain, potential adverse effects, and uncertainty about vaccine effectiveness with multiple-injection visits. Published literature reinforced the record of safety and acceptance of the recommended schedule of IPV by the SAGE, but the evidence was largely from developed countries. Parental acceptance of multiple injections was associated with a positive provider recommendation to the caregiver. Findings of the systematic review identified that the intramuscular route is preferred over the subcutaneous route for vaccine administration and that the vastus lateralis muscle is preferred over the deltoid muscle for intramuscular injections. Recommendations on vaccine spacing and procedural preparedness were based on practical necessities, but comparative evidence was not identified. During 2013–2015, 85 countries added IPV to their immunization schedules, 46 (55%) of which adopted a schedule resulting in 3 injectable vaccines being administered in a single visit. Conclusion. The multiple-injection experience identified gaps in guidance for future vaccine introductions. Global partner organizations quickly mobilized to assess, document, and communicate the existing global experience on multiple-injection visits. This evidence-based approach provided reassurance to opinion leaders, health workers, and professional societies, thus encouraging uptake of IPV as a second or third injection in an accelerated manner globally. PMID:28838188

The present situation of prophylactic vaccination in Japan for travel abroad.

PubMed

Nakano, Takashi

2008-11-01

The current situation of vaccination in Japan is reviewed from a viewpoint of overseas travelers. Vaccinations before travel to developing countries, where the risk of infection is high, are recommended for two reasons: "individual protection" and "prevention of communicable disease importation". However, there are problems in Japan; some vaccines available commonly in foreign nations are not approved in Japan and the vaccination schedule is not convenient for travelers. Vaccination is sometimes needed also for travel to Europe and North America. This is because certain vaccinations are required for entering school or studying abroad. In Japan, there is no regulation which recommends vaccination as an entrance requirement. Compared with other nations, Japanese children receive fewer vaccines routinely. On the other hand, there are different features from other industrialized nations, such as routine childhood BCG vaccination and immunization against Japanese encephalitis in Japan. Compared with foreign nations, awareness as regards "travel medicine" is lower in Japan. Recognizing this situation will lead to improvement of vaccination of travelers.

The role of routine polio immunization in the post-certification era.

PubMed Central

Sutter, Roland W.; Cáceres, Victor M.; Mas Lago, Pedro

2004-01-01

The role of routine vaccination against poliomyelitis for the post-certification era remains an important area for policy decision-making. Two critical decisions need to be taken: first, to continue or discontinue vaccination with the live attenuated oral poliovirus vaccine (OPV); and second, if OPV is to be discontinued, whether vaccination with inactivated poliovirus vaccine (IPV) is needed. Four potential vaccination scenarios can be constructed: stop all polio vaccination; continue with current vaccination policies (OPV, IPV, or sequential schedule); discontinue OPV, but continue IPV universally; or discontinue OPV, but continue IPV in selected countries. All possible scenarios require continued investments in a surveillance and response strategy, including a stockpile of polio vaccine. Continuing vaccination would limit the savings that could be applied to the control of other health priorities. This report reviews the key issues associated with each scenario, highlights the advantages and disadvantages of each scenario, and outlines the major challenges for policy decision-making. PMID:15106298

Factors that affect voluntary vaccination of children in Japan.

PubMed

Shono, Aiko; Kondo, Masahide

2015-03-10

Some important vaccinations are not included in the routine childhood immunization schedule in Japan. Voluntary vaccinations are usually paid as an out-of-pocket expense. Low voluntary vaccination coverage rates and high target disease incidence are assumed to be a consequence of voluntary vaccination. Therefore, this study aimed to explore factors associated with voluntary vaccination patterns in children. We conducted an online survey of 1243 mothers from a registered survey panel who had at least one child 2 months to <3 years of age. The voluntary vaccination mainly correlated positively with annual household income and mothers' positive opinions about voluntary vaccinations, but negatively with number of children. Financial support, especially for low income households and households with more than one child, may motivate parents to vaccinate their children. Communication is also an important issue. More opportunities for education and information about voluntary vaccinations should be provided to mothers without distinguishing between voluntary and routine vaccination. Copyright © 2014 Elsevier Ltd. All rights reserved.

Combinations of Quality and Frequency of Immunization Activities to Stop and Prevent Poliovirus Transmission in the High-Risk Area of Northwest Nigeria

PubMed Central

Duintjer Tebbens, Radboud J.; Pallansch, Mark A.; Wassilak, Steven G. F.; Cochi, Stephen L.; Thompson, Kimberly M.

2015-01-01

Background Frequent supplemental immunization activities (SIAs) with the oral poliovirus vaccine (OPV) represent the primary strategy to interrupt poliovirus transmission in the last endemic areas. Materials and Methods Using a differential-equation based poliovirus transmission model tailored to high-risk areas in Nigeria, we perform one-way and multi-way sensitivity analyses to demonstrate the impact of different assumptions about routine immunization (RI) and the frequency and quality of SIAs on population immunity to transmission and persistence or emergence of circulating vaccine-derived polioviruses (cVDPVs) after OPV cessation. Results More trivalent OPV use remains critical to avoid serotype 2 cVDPVs. RI schedules with or without inactivated polio vaccine (IPV) could significantly improve population immunity if coverage increases well above current levels in under-vaccinated subpopulations. Similarly, the impact of SIAs on overall population immunity and cVDPV risks depends on their ability to reach under-vaccinated groups (i.e., SIA quality). Lower SIA coverage in the under-vaccinated subpopulation results in a higher frequency of SIAs needed to maintain high enough population immunity to avoid cVDPVs after OPV cessation. Conclusions National immunization program managers in northwest Nigeria should recognize the benefits of increasing RI and SIA quality. Sufficiently improving RI coverage and improving SIA quality will reduce the frequency of SIAs required to stop and prevent future poliovirus transmission. Better information about the incremental costs to identify and reach under-vaccinated children would help determine the optimal balance between spending to increase SIA and RI quality and spending to increase SIA frequency. PMID:26068928

Combinations of Quality and Frequency of Immunization Activities to Stop and Prevent Poliovirus Transmission in the High-Risk Area of Northwest Nigeria.

PubMed

Duintjer Tebbens, Radboud J; Pallansch, Mark A; Wassilak, Steven G F; Cochi, Stephen L; Thompson, Kimberly M

2015-01-01

Frequent supplemental immunization activities (SIAs) with the oral poliovirus vaccine (OPV) represent the primary strategy to interrupt poliovirus transmission in the last endemic areas. Using a differential-equation based poliovirus transmission model tailored to high-risk areas in Nigeria, we perform one-way and multi-way sensitivity analyses to demonstrate the impact of different assumptions about routine immunization (RI) and the frequency and quality of SIAs on population immunity to transmission and persistence or emergence of circulating vaccine-derived polioviruses (cVDPVs) after OPV cessation. More trivalent OPV use remains critical to avoid serotype 2 cVDPVs. RI schedules with or without inactivated polio vaccine (IPV) could significantly improve population immunity if coverage increases well above current levels in under-vaccinated subpopulations. Similarly, the impact of SIAs on overall population immunity and cVDPV risks depends on their ability to reach under-vaccinated groups (i.e., SIA quality). Lower SIA coverage in the under-vaccinated subpopulation results in a higher frequency of SIAs needed to maintain high enough population immunity to avoid cVDPVs after OPV cessation. National immunization program managers in northwest Nigeria should recognize the benefits of increasing RI and SIA quality. Sufficiently improving RI coverage and improving SIA quality will reduce the frequency of SIAs required to stop and prevent future poliovirus transmission. Better information about the incremental costs to identify and reach under-vaccinated children would help determine the optimal balance between spending to increase SIA and RI quality and spending to increase SIA frequency.

[Childhood immunization schedule of the Spanish Association of Pediatrics 2003].

PubMed

2003-03-01

In this document the Advisory Committee on Vaccines of the Spanish Association of Pediatrics provides recommendations for the immunization schedule for the 2003-2004 season. The use of inactivated poliovirus vaccine is again stressed for children of any age. Moreover, the introduction of the varicella vaccine and the pneumococcal conjugated vaccine, as well as the option of dTpa in adolescents, is highly recommended due to the availability of safe and effective products. Because of the increasing number of new vaccines in the immunization schedule, strategies with combined vaccines must be used.

Polio endgame: the global switch from tOPV to bOPV.

PubMed

Garon, Julie; Seib, Katherine; Orenstein, Walter A; Ramirez Gonzalez, Alejandro; Chang Blanc, Diana; Zaffran, Michel; Patel, Manish

2016-06-01

Globally, polio cases have reached an all-time low, and type 2 poliovirus (one of three) is eradicated. Oral polio vaccine (OPV) has been the primary tool, however, in rare cases, OPV induces paralysis. In 2013, the World Health Assembly endorsed the phased withdrawal of OPV and introduction of inactivated poliovirus vaccine (IPV) into childhood routine immunization schedules. Type 2 OPV will be withdrawn through a globally synchronized "switch" from trivalent OPV (all three types) to bivalent OPV (types 1 and 3). The switch will happen in 155 OPV-using countries between April 17(th) and May 1(st), 2016. Planned activities to reduce type 2 outbreak risks post-switch include the following: tOPV campaigns to increase type 2 immunity prior to the switch, monovalent OPV2 stockpiling to respond to outbreaks should they occur, containment of both wild and vaccine type 2 viruses, enhanced acute flaccid paralysis (AFP) and environmental surveillance, outbreak response protocols, and ensured access to IPV and bivalent OPV.

Epidemiology and medical cost of hospitalization due to rotavirus gastroenteritis among children under 5 years of age in the central-east of Tunisia.

PubMed

Soltani, M S; Salah, A Ben; Bouanene, I; Trabelsi, A; Sfar, M T; Harbi, A; Gueddiche, M N; Farhat, E Ben

2015-09-28

Data on the economic burden of rotavirus infection in Tunisia are needed to inform the decision to include rotavirus in routine childhood immunizations. This study aimed to describe the epidemiological profile of rotavirus disease in central-east Tunisia and to estimate its hospital cost. In the first stage - the prospective collection of epidemiological data - we enrolled all patients < 5 years old who were hospitalized for acute diarrhoea at 5 university paediatric departments in central-east Tunisia during the period 2009-2011. Rotavirus was responsible for 65 (23.3%) of the 279 cases enrolled. In the second stage, cost data were collected retrospectively using an activity-based costing method from the medical records of the children who were positively diagnosed with rotavirus. The average cost of care per child was TD 433 (SD 134). This is a significant economic burden in Tunisia, where a safe and effective vaccine is available but not yet introduced to the immunization schedule.

Maintaining high rates of measles immunization in Africa.

PubMed

Lessler, J; Moss, W J; Lowther, S A; Cummings, D A T

2011-07-01

Supplementary immunization activities (SIAs) are important in achieving high levels of population immunity to measles virus. Using data from a 2006 survey of measles vaccination in Lusaka, Zambia, we developed a model to predict measles immunity following routine vaccination and SIAs, and absent natural infection. Projected population immunity was compared between the current programme and alternatives, including supplementing routine vaccination with a second dose, or SIAs at 1-, 2-, 3-, 4- and 5-year intervals. Current routine vaccination plus frequent SIAs could maintain high levels of population immunity in children aged <5 years, even if each frequent SIA has low coverage (e.g. ≥ 72% for bi-annual 60% coverage SIAs vs. ≥ 69% for quadrennial 95% coverage SIAs). A second dose at 12 months with current coverage could achieve 81% immunity. Circulating measles virus will only increase population immunity. Public health officials should consider frequent SIAs when resources for a two-dose strategy are unavailable.

Attitudes of Swiss Health Care Providers Toward Childhood Immunizations.

PubMed

Schuler, Marianne; Schaedelin, Sabine; Aebi, Christoph; Berger, Christoph; Crisinel, Pierre-Alex; Diana, Alessandro; Niederer-Loher, Anita; Siegrist, Claire-Anne; Vaudaux, Bernard; Heininger, Ulrich

2017-06-01

INFOVAC is a network providing information about immunization issues to health professionals. The aim of this study was to assess the attitude of INFOVAC subscribers toward the current Swiss immunization schedule, potential modifications, and current and hypothetical immunization practices regarding their own children. In March 2015, a Web-based survey was sent to 4260 physicians and pharmacists subscribed to INFOVAC. Participation was anonymous and voluntary. The following information was obtained: (1) current immunization status of own children; (2) which immunizations would currently be accepted for a hypothetical own child and (3) attitudes toward potential modifications of the Swiss immunization schedule. Descriptive methods and multivariate models to correct for covariables were used for data analysis. Nine hundred and fifty-five valid questionnaires were received: 886/3704 (23.9%) from physicians and 69/556 (12.4%) from pharmacists. Current (>95%) and hypothetical (>99%) immunization rates were high for diphtheria, tetanus, pertussis, poliomyelitis and measles-mumps-rubella. Most pediatricians (61%) would support more vaccines for their children than currently recommended by the Swiss immunization advisory committee, whereas about 50% of other physicians and pharmacists would decline at least one of the recommended immunizations, most frequently varicella, pneumococcal or meningococcal C conjugate vaccines. Strong general support was expressed for the expansion of human papillomavirus immunization to males, acceleration of the measles-mumps-rubella schedule and a 2 + 1 instead of 3 + 1 diphtheria-tetanus-pertussis, acellular-inactivated poliomyelitis vaccine (DTPa-IPV)/Haemophilus influenzae type b ± hepatitis B virus (HBV) schedule. Survey participants generally demonstrated a positive attitude toward immunization, with pediatricians being the most progressive subgroup with the largest percentage of participants (63.1%) neither declining nor postponing any recommended immunization.

Seroepidemiology of Rubella in Mozambique, 2006-2014: Implications for Rubella Immunization in Settings With High Fertility Rates.

PubMed

Amade, Nádia Alves; Sultane, Thebora; Augusto, Orvalho; Ali, Sádia; Jani, Ilesh V; Gudo, Eduardo Samo

2016-10-01

Rubella and congenital rubella syndrome are highly underreported and neglected in most sub-Saharan countries and vaccination has not yet been incorporated into their national immunization schedules. In this study, we investigated the frequency of immunoglobulin M antibodies against rubella and examined correlations with fertility rates during the period from 2006 to 2014 in Mozambique. We conducted a retrospective analysis of data collected through the routine case-based surveillance system for measles in Mozambique. A total of 7312 serum samples from suspected cases of measles were tested between 2006 and 2014. The median age was 4 years (interquartile range: 1-8 years). Of these, 1331 (18.2%) were positive for immunoglobulin M anti-rubella. The highest frequency of rubella was observed within the 5-9-year-old age group (32.6%). The frequency in the age groups <1 years old, 1-4, 10-14, 15-19, 20-29 and ≥30 were 4.5%, 13.1%, 28.7%,18.7%, 5.2% and 5.1%, respectively. Our data show that rubella is frequent among women of childbearing age in Mozambique. Considering that early pregnancy is common in Mozambique, this suggests that, in settings such as ours, the introduction of routine rubella vaccination in children should be accompanied by repeated vaccination campaigns targeting older children and adolescents.

Impact of rotavirus vaccines in low and middle-income countries.

PubMed

Sindhu, Kulandaipalayam Natarajan Chella; Babji, Sudhir; Ganesan, Santhosh Kumar

2017-10-01

Rotavirus vaccines are playing a pivotal role in improving lives of infants and young children in low and middle-income countries (LMICs). Many of these countries have adopted the vaccine into their routine immunization, whereas others are considering introduction. This article provides an update on the impact of rotavirus vaccines in LMICs on morbidity and mortality in children aged less than 5 years, and their cost-effectiveness. The WHO, in 2013, updated its recommendation to prioritize introduction of rotavirus vaccines in the routine immunization schedule, without age restrictions. Despite the decreased efficacy of the vaccines in LMICs, data from Sub-Saharan Africa have demonstrated a decrease in rotavirus-related morbidity, with some sites reporting an indirect protective effect on children age ineligible to receive the vaccine. Even with improvements in sanitation, nutritional status in children, and other health-related indices in LMICs, the use of rotavirus vaccines will play an important role in preventing rotavirus-related gastroenteritis. Economic models predict a reduction in economic burden because of rotavirus-related health costs, making vaccine introduction cost-effective in resource-constrained settings. Increasing evidence from impact studies shows the significant impact of rotavirus vaccination on hospitalizations and economic burden because of rotavirus gastroenteritis in LMICs. Universal rotavirus vaccination is recommended, and introductions should be monitored by robust surveillance systems to measure effectiveness and impact.

Accelerating measles elimination and strengthening routine immunization services in Guizhou Province, China, 2003-2009.

PubMed

Zuo, Shuyan; Cairns, Lisa; Hutin, Yvan; Liang, Xiaofeng; Tong, Yibing; Zhu, Qing; Zhang, Dayong; Lee, Lisa A; Strebel, Peter; Quick, Linda

2015-04-21

To develop a successful model for accelerating measles elimination in poor areas of China, we initiated a seven-year project in Guizhou, one of the poorest provinces, with reported highest measles incidence of 360 per million population in 2002. Project strategies consisted of strengthening routine immunization services, enforcement of school entry immunization requirements at kindergarten and school, conducting supplemental measles immunization activities (SIAs), and enhancing measles surveillance. We measured coverage of measles containing vaccines (MCV) by administrative reporting and population-based sample surveys, systematic random sampling surveys, and convenience sampling surveys for routine immunization services, school entry immunization, and SIAs respectively. We measured impact using surveillance based measles incidence. Routine immunization coverage of the 1st dose of MCV (MCV1) increased from 82% to 93%, while 2nd dose of MCV (MCV2) coverage increased from 78% to 91%. Enforcement of school entry immunization requirements led to an increase in MCV2 coverage from 36% on primary school entry in 2004 to 93% in 2009. Province-wide SIAs achieved coverage greater than 90%. The reported annual incidence of measles dropped from 200 to 300 per million in 2003 to 6 per million in 2009, and sustained at 0.9-2.2 per million in 2010-2013. This project found that a package of strategies including periodic SIAs, strengthened routine immunization, and enforcing school entry immunization requirements, was an effective approach toward achieving and sustaining measles elimination in less-developed area of China. Copyright © 2015. Published by Elsevier Ltd.

Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older - United States, 2014.

PubMed

Bridges, Carolyn B; Coyne-Beasley, Tamera

2014-02-07

Vaccines are recommended for adults on the basis of their age, prior vaccinations, health conditions, lifestyle, occupation, and travel. Reasons for current low levels of vaccination coverage for adult vaccines are multifactorial and include limited awareness among the public about vaccines for adults and gaps in incorporation of regular assessments of vaccine needs and vaccination into routine medical care. Updated standards for immunization of adults were approved by the National Vaccine Advisory Committee (NVAC) in September 2013. These standards acknowledge the current low levels of vaccination coverage among adults and the role that all health-care providers, including those who do not offer all recommended adult vaccines in their practices, have in ensuring that their patients are up-to-date on recommended vaccines. NVAC recommends that providers assess vaccination needs for their patients at each visit, recommend needed vaccines, and then, ideally, offer the vaccine or, if the provider does not stock the needed vaccines, refer the patient to a provider who does vaccinate. Vaccinating providers should also ensure that patients and their referring health-care providers have documentation of the vaccination.

15 CFR 716.1 - General information on the conduct of initial and routine inspections.

Code of Federal Regulations, 2011 CFR

2011-01-01

... WEAPONS CONVENTION REGULATIONS INITIAL AND ROUTINE INSPECTIONS OF DECLARED FACILITIES § 716.1 General... is subject to inspection if it produced in excess of 100 grams aggregate of Schedule 1 chemicals in the previous calendar year or anticipates producing in excess of 100 grams aggregate of Schedule 1...

The Role of Childhood Infections and Immunizations on Childhood Rhabdomyosarcoma: A Report from the Children's Oncology Group

PubMed Central

Sankaran, Hari; Danysh, Heather E.; Scheurer, Michael E.; Okcu, M. Fatih; Skapek, Stephen X.; Hawkins, Douglas S.; Spector, Logan G.; Erhardt, Erik B.; Grufferman, Seymour; Lupo, Philip J.

2016-01-01

Background Rhabdomyosarcoma (RMS) is a rare, highly malignant tumor arising from primitive mesenchymal cells that differentiate into skeletal muscle. Relatively little is known about RMS susceptibility. Based on growing evidence regarding the role of early immunologic challenges on RMS development, we evaluated the role of infections and immunizations on this clinically significant pediatric malignancy Procedure RMS cases (n=322) were enrolled from the third trial coordinated by the Intergroup Rhabdomyosarcoma Study Group. Population-based controls (n=322) were pair matched to cases on race, sex, and age. The following immunizations were assessed: diphtheria-pertussis-tetanus (DPT), measles-mumps-rubella (MMR), and oral polio vaccine (OPV). We also evaluated if immunizations were complete vs. incomplete. We examined selected infections including chickenpox, mumps, pneumonia, scarlet fever, rubella, rubeola, pertussis, mononucleosis, and lung infections. Conditional logistic regression models were used to calculate an odds ratio (OR) and 95% confidence interval (CI) for each exposure, adjusted for maternal education and total annual income Results Incomplete immunization schedules (OR=5.30, 95% CI: 2.47-11.33) and incomplete DPT immunization (OR=1.56, 95% CI: 1.06-2.29) were positively associated with childhood RMS. However, infections did not appear to be associated with childhood RMS. Conclusions This is the largest study of RMS to date demonstrating a possible protective effect of immunizations against development of childhood RMS. Further studies are needed to validate our findings. Our findings add to the growing body of literature suggesting a protective role of routine vaccinations in childhood cancer and specifically in childhood RMS. PMID:27198935

The Role of Childhood Infections and Immunizations on Childhood Rhabdomyosarcoma: A Report From the Children's Oncology Group.

PubMed

Sankaran, Hari; Danysh, Heather E; Scheurer, Michael E; Okcu, M Fatih; Skapek, Stephen X; Hawkins, Douglas S; Spector, Logan G; Erhardt, Erik B; Grufferman, Seymour; Lupo, Philip J

2016-09-01

Rhabdomyosarcoma (RMS) is a rare, highly malignant tumor arising from primitive mesenchymal cells that differentiate into skeletal muscle. Relatively little is known about RMS susceptibility. Based on growing evidence regarding the role of early immunologic challenges on RMS development, we evaluated the role of infections and immunizations on this clinically significant pediatric malignancy. RMS cases (n = 322) were enrolled from the third trial coordinated by the Intergroup Rhabdomyosarcoma Study Group. Population-based controls (n = 322) were pair matched to cases on race, sex, and age. The following immunizations were assessed: diphtheria, pertussis, and tetanus (DPT); measles, mumps, and rubella; and oral polio vaccine. We also evaluated if immunizations were complete versus incomplete. We examined selected infections including chickenpox, mumps, pneumonia, scarlet fever, rubella, rubeola, pertussis, mononucleosis, and lung infections. Conditional logistic regression models were used to calculate an odds ratio (OR) and 95% confidence interval (CI) for each exposure, adjusted for maternal education and total annual income. Incomplete immunization schedules (OR = 5.30, 95% CI: 2.47-11.33) and incomplete DPT immunization (OR = 1.56, 95% CI: 1.06-2.29) were positively associated with childhood RMS. However, infections did not appear to be associated with childhood RMS. This is the largest study of RMS to date demonstrating a possible protective effect of immunizations against the development of childhood RMS. Further studies are needed to validate our findings. Our findings add to the growing body of literature, suggesting a protective role of routine vaccinations in childhood cancer and specifically in childhood RMS. © 2016 Wiley Periodicals, Inc.

Decreasing inventory of a cement factory roller mill parts using reliability centered maintenance method

NASA Astrophysics Data System (ADS)

Witantyo; Rindiyah, Anita

2018-03-01

According to data from maintenance planning and control, it was obtained that highest inventory value is non-routine components. Maintenance components are components which procured based on maintenance activities. The problem happens because there is no synchronization between maintenance activities and the components required. Reliability Centered Maintenance method is used to overcome the problem by reevaluating maintenance activities required components. The case chosen is roller mill system because it has the highest unscheduled downtime record. Components required for each maintenance activities will be determined by its failure distribution, so the number of components needed could be predicted. Moreover, those components will be reclassified from routine component to be non-routine component, so the procurement could be carried out regularly. Based on the conducted analysis, failure happens in almost every maintenance task are classified to become scheduled on condition task, scheduled discard task, schedule restoration task and no schedule maintenance. From 87 used components for maintenance activities are evaluated and there 19 components that experience reclassification from non-routine components to routine components. Then the reliability and need of those components were calculated for one-year operation period. Based on this invention, it is suggested to change all of the components in overhaul activity to increase the reliability of roller mill system. Besides, the inventory system should follow maintenance schedule and the number of required components in maintenance activity so the value of procurement will be decreased and the reliability system will increase.

[Review of the 2016 Swiss immunization schedule and technology update for improving vaccine management].

PubMed

Diana, Alessandro

2016-05-11

The 2016 immunization schedule published by the Swiss Federal Office of Public Health includes three new clauses: reimbursement of the additional Human Papillomavirus (HPV) vaccination in young males (11-26 years) as recommended by local canton programs, the end of franchise exemption for the measles, mumps and rubella (MMR) vaccination, and the creation of a new system of indemnities and moral compensation in the event of personal injury resulting from vaccinations. This article presents the main features of the 2016 immunization schedule with details of the technology available to physicians to improve vaccine management.

Introduction of Inactivated Poliovirus Vaccine and Impact on Vaccine-Associated Paralytic Poliomyelitis - Beijing, China, 2014-2016.

PubMed

Zhao, Dan; Ma, Rui; Zhou, Tao; Yang, Fan; Wu, Jin; Sun, Hao; Liu, Fang; Lu, Li; Li, Xiaomei; Zuo, Shuyan; Yao, Wei; Yin, Jian

2017-12-15

When included in a sequential polio vaccination schedule, inactivated polio vaccine (IPV) reduces the risk for vaccine-associated paralytic poliomyelitis (VAPP), a rare adverse event associated with receipt of oral poliovirus vaccine (OPV). During January 2014, the World Health Organization (WHO) recommended introduction of at least 1 IPV dose into routine immunization schedules in OPV-using countries (1). The Polio Eradication and Endgame Strategic Plan 2013-2018 recommended completion of IPV introduction in 2015 and globally synchronized withdrawal of OPV type 2 in 2016 (2). Introduction of 1 dose of IPV into Beijing's Expanded Program on Immunization (EPI) on December 5, 2014 represented China's first province-wide IPV introduction. Coverage with the first dose of polio vaccine was maintained from 96.2% to 96.9%, similar to coverage with the first dose of diphtheria and tetanus toxoids and pertussis vaccine (DTP) (96.5%-97.2%); the polio vaccine dropout rate (the percentage of children who received the first dose of polio vaccine but failed to complete the series) was 1.0% in 2015 and 0.4% in 2016. The use of 3 doses of private-sector IPV per child decreased from 18.1% in 2014, to 17.4% in 2015, and to 14.8% in 2016. No cases of VAPP were identified during 2014-2016. Successful introduction of IPV into the public sector EPI program was attributed to comprehensive planning, preparation, implementation, robust surveillance for adverse events after immunization (AEFI), and monitoring of vaccination coverage. This evaluation provided information that helped contribute to the expansion of IPV use in China and in other OPV-using countries.

Increasing Completion of Classroom Routines through the Use of Picture Activity Schedules

ERIC Educational Resources Information Center

Watson, Kamille J.; DiCarlo, Cynthia F.

2016-01-01

Teachers spend the first few days of school teaching routines to children that will help transitions in the classroom between different activities. When children have difficulty, they move more slowly and/or require teacher prompting. A picture activity schedule intervention (Breitfelder in Teach Except Child Plus 4(5):2-15, 2008; Bryan and Gast…

Economics of an adolescent meningococcal conjugate vaccination catch-up campaign in the United States.

PubMed

Ortega-Sanchez, Ismael R; Meltzer, Martin I; Shepard, Colin; Zell, Elizabeth; Messonnier, Mark L; Bilukha, Oleg; Zhang, Xinzhi; Stephens, David S; Messonnier, Nancy E

2008-01-01

In June 2005, the Advisory Committee on Immunization Practices recommended the newly licensed quadrivalent meningococcal conjugate vaccine for routine use among all US children aged 11 years. A 1-time catch-up vaccination campaign for children and adolescents aged 11-17 years, followed by routine annual immunization of each child aged 11 years, could generate immediate herd immunity benefits. The objective of our study was to analyze the cost-effectiveness of a catch-up vaccination campaign with quadrivalent meningococcal conjugate vaccine for children and adolescents aged 11-17 years. We built a probabilistic model of disease burden and economic impacts for a 10-year period with and without a program of adolescent catch-up meningococcal vaccination, followed by 9 years of routine immunization of children aged 11 years. We used US age- and serogroup-specific surveillance data on incidence and mortality. Assumptions related to the impact of herd immunity were drawn from experience with routine meningococcal vaccination in the United Kingdom. We estimated costs per case, deaths prevented, life-years saved, and quality-adjusted life-years saved. With herd immunity, the catch-up and routine vaccination program for adolescents would prevent 8251 cases of meningococcal disease in a 10-year period (a 48% decrease). Excluding program costs, this catch-up and routine vaccination program would save US$551 million in direct costs and $920 million in indirect costs, including costs associated with permanent disability and premature death. At $83 per vaccinee, the catch-up vaccination would cost society approximately $223,000 per case averted, approximately $2.6 million per death prevented, approximately $127,000 per life-year saved, and approximately $88,000 per quality-adjusted life-year saved. Targeting counties with a high incidence of disease decreased the cost per life-year saved by two-thirds. Although costly, catch-up and routine vaccination of adolescents can have a substantial impact on meningococcal disease burden. Because of herd immunity, catch-up and routine vaccination cost per life-year saved could be up to one-third less than that previously assessed for routine vaccination of children aged 11 years.

Assessing the Evidence for Maternal Pertussis Immunization: A Report From the Bill & Melinda Gates Foundation Symposium on Pertussis Infant Disease Burden in Low- and Lower-Middle-Income Countries.

PubMed

Sobanjo-Ter Meulen, Ajoke; Duclos, Philippe; McIntyre, Peter; Lewis, Kristen D C; Van Damme, Pierre; O'Brien, Katherine L; Klugman, Keith P

2016-12-01

Implementation of effective interventions has halved maternal and child mortality over the past 2 decades, but less progress has been made in reducing neonatal mortality. Almost 45% of under-5 global mortality now occurs in infants <1 month of age, with approximately 86% of neonatal deaths occurring in low- and lower-middle-income countries (LMICs). As an estimated 23% of neonatal deaths globally are due to infectious causes, maternal immunization (MI) is one intervention that may reduce mortality in the first few months of life, when direct protection often relies on passively transmitted maternal antibodies. Despite all countries including pertussis-containing vaccines in their routine childhood immunization schedules, supported through the Expanded Programme on Immunization, pertussis continues to circulate globally. Although based on limited robust epidemiologic data, current estimates derived from modeling implicate pertussis in 1% of under-5 mortality, with infants too young to be vaccinated at highest risk of death. Pertussis MI programs have proven effective in reducing infant pertussis mortality in high-income countries using tetanus-diphtheria-acellular pertussis (Tdap) vaccines in their maternal and infant programs; however, these vaccines are cost-prohibitive for routine use in LMICs. The reach of antenatal care programs to deliver maternal pertussis vaccines, particularly with respect to infants at greatest risk of pertussis, needs to be further evaluated. Recognizing that decisions on the potential impact of pertussis MI in LMICs need, as a first step, robust contemporary mortality data for early infant pertussis, a symposium of global key experts was held. The symposium reviewed current evidence and identified knowledge gaps with respect to the infant pertussis disease burden in LMICs, and discussed proposed strategies to assess the potential impact of pertussis MI. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Understanding Internal Accountability in Nigeria’s Routine Immunization System: Perspectives From Government Officials at the National, State, and Local Levels

PubMed Central

Erchick, Daniel J.; George, Asha S.; Umeh, Chukwunonso; Wonodi, Chizoba

2017-01-01

Background: Routine immunization coverage in Nigeria has remained low, and studies have identified a lack of accountability as a barrier to high performance in the immunization system. Accountability lies at the heart of various health systems strengthening efforts recently launched in Nigeria, including those related to immunization. Our aim was to understand the views of health officials on the accountability challenges hindering immunization service delivery at various levels of government. Methods: A semi-structured questionnaire was used to interview immunization and primary healthcare (PHC) officials from national, state, local, and health facility levels in Niger State in north central Nigeria. Individuals were selected to represent a range of roles and responsibilities in the immunization system. The questionnaire explored concepts related to internal accountability using a framework that organizes accountability into three axes based upon how they drive change in the health system. Results: Respondents highlighted accountability challenges across multiple components of the immunization system, including vaccine availability, financing, logistics, human resources, and data management. A major focus was the lack of clear roles and responsibilities both within institutions and between levels of government. Delays in funding, especially at lower levels of government, disrupted service delivery. Supervision occurred less frequently than necessary, and the limited decision space of managers prevented problems from being resolved. Motivation was affected by the inability of officials to fulfill their responsibilities. Officials posited numerous suggestions to improve accountability, including clarifying roles and responsibilities, ensuring timely release of funding, and formalizing processes for supervision, problem solving, and data reporting. Conclusion: Weak accountability presents a significant barrier to performance of the routine immunization system and high immunization coverage in Nigeria. As one stakeholder in ensuring the performance of health systems, routine immunization officials reveal critical areas that need to be prioritized if emerging interventions to improve accountability in routine immunization are to have an effect. PMID:28812836

Invasive meningococcal disease epidemiology and control measures: a framework for evaluation.

PubMed

Caro, J Jaime; Möller, Jörgen; Getsios, Denis; Coudeville, L; El-Hadi, Wissam; Chevat, Catherine; Nguyen, Van Hung; Caro, Ingrid

2007-06-29

Meningococcal disease can have devastating consequences. As new vaccines emerge, it is necessary to assess their impact on public health. In the absence of long-term real world data, modeling the effects of different vaccination strategies is required. Discrete event simulation provides a flexible platform with which to conduct such evaluations. A discrete event simulation of the epidemiology of invasive meningococcal disease was developed to quantify the potential impact of implementing routine vaccination of adolescents in the United States with a quadrivalent conjugate vaccine protecting against serogroups A, C, Y, and W-135. The impact of vaccination is assessed including both the direct effects on individuals vaccinated and the indirect effects resulting from herd immunity. The simulation integrates a variety of epidemiologic and demographic data, with core information on the incidence of invasive meningococcal disease and outbreak frequency derived from data available through the Centers for Disease Control and Prevention. Simulation of the potential indirect benefits of vaccination resulting from herd immunity draw on data from the United Kingdom, where routine vaccination with a conjugate vaccine has been in place for a number of years. Cases of disease are modeled along with their health consequences, as are the occurrence of disease outbreaks. When run without a strategy of routine immunization, the simulation accurately predicts the age-specific incidence of invasive meningococcal disease and the site-specific frequency of outbreaks in the Unite States. 2,807 cases are predicted annually, resulting in over 14,000 potential life years lost due to invasive disease. In base case analyses of routine vaccination, life years lost due to infection are reduced by over 45% (to 7,600) when routinely vaccinating adolescents 12 years of age at 70% coverage. Sensitivity analyses indicate that herd immunity plays an important role when this population is targeted for vaccination. While 1,100 cases are avoided annually when herd immunity effects are included, in the absence of any herd immunity, the number of cases avoided with routine vaccination falls to 380 annually. The duration of vaccine protection also strongly influences results. In the absence of appropriate real world data on outcomes associated with large-scale vaccination programs, decisions on optimal immunization strategies can be aided by discrete events simulations such as the one described here. Given the importance of herd immunity on outcomes associated with routine vaccination, published estimates of the economic efficiency of routine vaccination with a quadrivalent conjugate vaccine in the United States may have considerably underestimated the benefits associated with a policy of routine immunization of adolescents.

How supportive supervision influences immunization session site practices: a quasi-experimental study in Odisha, India.

PubMed

Panda, Bhuputra; Pati, Sanghamitra; Nallala, Srinivas; Chauhan, Abhimanyu S; Anasuya, Anita; Som, Meena; Zodpey, Sanjay

2015-01-01

Routine immunization (RI) is a key child survival intervention. Ensuring acceptable standards of RI service delivery is critical for optimal outcomes. Accumulated evidences suggest that 'supportive supervision' improves the quality of health care services in general. During 2009-2010, the Government of Odisha and UNICEF jointly piloted this strategy in four districts to improve RI program outcomes. The present study aims to assess the effect of this strategy on improvement of skills and practices at immunization session sites. A quasi-experimental 'post-test only' study design was adopted to compare the opinion and practices of frontline health workers and their supervisors in four intervention districts (IDs) with two control districts (CDs). Altogether, we interviewed 111 supervisor-supervisee (health worker) pairs using semi-structured interview schedules and case vignettes. We also directly observed health workers' practices during immunization sessions at 111 sites. Data were analyzed with SPSS version 16.0. The mean knowledge score of supervisors in CDs was significantly higher than in intervention groups. Variegated responses were obtained on case vignettes. The control group performed better in solving certain hypothetically asked problems, whereas the intervention group scored better in others. Health workers in IDs gave a lower rating to their respective supervisors' knowledge, skill, and frequency of supervision. Logistics and vaccine availability were better in CDs. Notwithstanding other limitations, supportive supervision may not have independent effects on improving the quality of immunization services. Addressing systemic issues, such as the availability of essential logistics, supply chain management, timely indenting, and financial resources, could complement the supportive supervision strategy in improving immunization service delivery.

Haemophilus influenzae type b (Hib) vaccine: an effective control strategy in India.

PubMed

Verma, Ramesh; Khanna, Pardeep; Chawla, Suraj; Bairwa, Mohan; Prinja, Shankar; Rajput, Meena

2011-11-01

Haemophilus influenzae type b (Hib) is an encapsulated, non-motile and non-spore-forming Gram-negative coccobacillus which causes severe pneumonia, meningitis and other life threatening illnesses. Hib disease affects almost exclusively (95%) children aged less than 5 years throughout the world. The mean age of onset is 6-24 months after which it declines gradually until age 5 years. The World Health Organization (WHO) estimates that Hib is responsible for 3 million cases of serious illnesses and approximately 386,000 deaths worldwide each year in children aged under 5 years. In the latest position paper on Hib vaccine, WHO recommended the inclusion of Hib conjugate vaccines in all routine infant immunization programs without waiting for local disease-burden data. The WHO and the Global Alliance for Vaccine Immunization (GAVI) have been working to expand supplies of Hib vaccine, reduce vaccine cost, and assist especially low-income countries with vaccine introduction. Hib vaccine is safe, highly effective and readily available in the market. Hib vaccine has been shown to be > 95% efficacious in diverse populations around the world. Globally, hundreds of millions of doses of Hib vaccine have been administered in the last 2 decades. More than 160 countries are using Hib vaccine in national immunization programmes and around 25 countries planning to introduce. Hib vaccination fits into the India's national immunization schedule.

The role of the China Experts Advisory Committee on Immunization Program.

PubMed

Zheng, Jingshan; Zhou, Yuqing; Wang, Huaqing; Liang, Xiaofeng

2010-04-19

The Experts Advisory Committee on Immunization Program (EACIP) of China was founded in 1982, and currently consists of 33 experts in immunization and related fields, selected by the Ministry of Health, to provide advice and guidance on the control of vaccine-preventable diseases. The main tasks of the EACIP are to advise on the national immunization schedule, to participate in the drafting and review of technical documents, and to participate in field supervision and staff training. In 2007, the EACIP used evidence-based methods to formulate a revised national immunization schedule. The EACIP has played and is playing an increasingly important role in guiding immunization policy in China. Copyright © 2010. Published by Elsevier Ltd.

Examining the cost of delivering routine immunization in Honduras.

PubMed

Janusz, Cara Bess; Castañeda-Orjuela, Carlos; Molina Aguilera, Ida Berenice; Felix Garcia, Ana Gabriela; Mendoza, Lourdes; Díaz, Iris Yolanda; Resch, Stephen C

2015-05-07

Many countries have introduced new vaccines and expanded their immunization programs to protect additional risk groups, thus raising the cost of routine immunization delivery. Honduras recently adopted two new vaccines, and the country continues to broaden the reach of its program to adolescents and adults. In this article, we estimate and examine the economic cost of the Honduran routine immunization program for the year 2011. The data were gathered from a probability sample of 71 health facilities delivering routine immunization, as well as 8 regional and 1 central office of the national immunization program. Data were collected on vaccinations delivered, staff time dedicated to the program, cold chain equipment and upkeep, vehicle use, infrastructure, and other recurrent and capital costs at each health facility and administrative office. Annualized economic costs were estimated from a modified societal perspective and reported in 2011 US dollars. With the addition of rotavirus and pneumococcal conjugate vaccines, the total cost for routine immunization delivery in Honduras for 2011 was US$ 32.5 million. Vaccines and related supplies accounted for 23% of the costs. Labor, cold chain, and vehicles represented 54%, 4%, and 1%, respectively. At the facility level, the non-vaccine system costs per dose ranged widely, from US$ 25.55 in facilities delivering fewer than 500 doses per year to US$ 2.84 in facilities with volume exceeding 10,000 doses per year. Cost per dose was higher in rural facilities despite somewhat lower wage rates for health workers in these settings; this appears to be driven by lower demand for services per health worker in sparsely populated areas, rather than increased cost of outreach. These more-precise estimates of the operational costs to deliver routine immunizations provide program managers with important information for mobilizing resources to help sustain the program and for improving annual planning and budgeting as well as longer-term resource allocation decisions. Copyright © 2015. Published by Elsevier Ltd.

What have we learned on costs and financing of routine immunization from the comprehensive multi-year plans in GAVI eligible countries?

PubMed

Brenzel, Logan

2015-05-07

Immunization is one of the most cost-effective health interventions, but as countries introduce new vaccines and scale-up immunization coverage, costs will likely increase. This paper updates estimates of immunization costs and financing based on information from comprehensive multi-year plans (cMYPs) from GAVI-eligible countries during a period when countries planned to introduce a range of new vaccines (2008-2016). The analysis database included information from baseline and 5-year projection years for each country cMYP, resulting in a total sample size of 243 observations. Two-thirds were from African countries. Cost data included personnel, vaccine, injection, transport, training, maintenance, cold chain and other capital investments. Financing from government and external sources was evaluated. All estimates were converted to 2010 US Dollars. Statistical analysis was performed using STATA, and results were population-weighted. Results pertain to country planning estimates. Average annual routine immunization cost was $62 million. Vaccines continued to be the major cost driver (51%) followed by immunization-specific personnel costs (22%). Non-vaccine delivery costs accounted for almost half of routine program costs (44%). Routine delivery cost per dose averaged $0.61 and the delivery cost per infant was $10. The cost per DTP3 vaccinated child was $27. Routine program costs increased with each new vaccine introduced. Costs accounted for 5% of government health expenditures. Governments accounted for 67% of financing. Total and average costs of routine immunization programs are rising as coverage rates increase and new vaccines are introduced. The cost of delivering vaccines is nearly equivalent to the cost of vaccines. Governments are financing greater proportions of the immunization program but there may be limits in resource scarce countries. Price reductions for new vaccines will help reduce costs and the burden of financing. Strategies to improve efficiency in service delivery should be pursued. Copyright © 2015 Elsevier Ltd. All rights reserved.

Progress in measles control--Kenya 2002-2007.

PubMed

2007-09-21

In 2000, countries represented by the World Health Organization (WHO) Regional Office for Africa established a goal to reduce, by the end of 2005, measles mortality to 50% of the 506,000 deaths from measles estimated in 1999. Strategies adopted included strengthening routine vaccination, providing a second opportunity for measles vaccination through supplemental immunization activities (SIAs), monitoring disease trends, and improving measles case management. In Kenya, an east African country with a population estimated at 33.4 million in 2005, the Kenya Expanded Programme on Immunization (KEPI) in the Ministry of Health began implementing these strategies in 2002 with a wide age range catch-up SIA and reduced the number of reported measles cases by >99%, from 11,304 in 2001 to 20 in 2004. A follow-up SIA, initially scheduled for July 2005, was postponed to 2006 to include concurrent distribution of long-lasting insecticide-treated bednets (LLINs). This report documents progress made in reducing measles morbidity and mortality in Kenya and describes the consequences of a large measles outbreak, beginning in September 2005, on the integrated measles follow-up SIA.

Oral iodine supplementation does not reduce neutralizing antibody responses to oral poliovirus vaccine.

PubMed Central

Taffs, R. E.; Enterline, J. C.; Rusmil, K.; Muhilal; Suwardi, S. S.; Rustama, D.; Djatnika; Cobra, C.; Semba, R. D.; Cohen, N.; Asher, D. M.

1999-01-01

Iodine deficiency is a major cause of impaired mental development, goitre, and cretinism in many parts of the world. Because existing immunization programmes can be used to deliver oral iodized oil (OIO) to infants at risk, it was important to know whether OIO could adversely affect the antibody response to vaccines, such as trivalent oral poliovirus vaccine (OPV). A randomized, double-blind, placebo-controlled clinical trial was conducted in Subang, West Java, Indonesia, in which 617 eight-week-old infants received either OIO or a placebo (poppy-seed oil) during a routine visit for their first dose of OPV as part of the Expanded Programme on Immunization (EPI). The infants received two boosters of OPV at 4-week intervals after the first dose, and were followed up when 6 months old. Neutralizing antibody titres to poliovirus serotypes 1, 2, and 3 were compared in serum samples that were taken from 478 of these infants just before the first dose of OPV and at 6 months. It was found that oral iodized oil did not reduce the antibody responses to any of the three serotypes of OPV. These results indicate that oral iodine may safely be delivered to infants at the same time as oral poliovirus vaccine according to current EPI immunization schedules. PMID:10427933

Understanding Internal Accountability in Nigeria's Routine Immunization System: Perspectives From Government Officials at the National, State, and Local Levels.

PubMed

Erchick, Daniel J; George, Asha S; Umeh, Chukwunonso; Wonodi, Chizoba

2016-12-10

Routine immunization coverage in Nigeria has remained low, and studies have identified a lack of accountability as a barrier to high performance in the immunization system. Accountability lies at the heart of various health systems strengthening efforts recently launched in Nigeria, including those related to immunization. Our aim was to understand the views of health officials on the accountability challenges hindering immunization service delivery at various levels of government. A semi-structured questionnaire was used to interview immunization and primary healthcare (PHC) officials from national, state, local, and health facility levels in Niger State in north central Nigeria. Individuals were selected to represent a range of roles and responsibilities in the immunization system. The questionnaire explored concepts related to internal accountability using a framework that organizes accountability into three axes based upon how they drive change in the health system. Respondents highlighted accountability challenges across multiple components of the immunization system, including vaccine availability, financing, logistics, human resources, and data management. A major focus was the lack of clear roles and responsibilities both within institutions and between levels of government. Delays in funding, especially at lower levels of government, disrupted service delivery. Supervision occurred less frequently than necessary, and the limited decision space of managers prevented problems from being resolved. Motivation was affected by the inability of officials to fulfill their responsibilities. Officials posited numerous suggestions to improve accountability, including clarifying roles and responsibilities, ensuring timely release of funding, and formalizing processes for supervision, problem solving, and data reporting. Weak accountability presents a significant barrier to performance of the routine immunization system and high immunization coverage in Nigeria. As one stakeholder in ensuring the performance of health systems, routine immunization officials reveal critical areas that need to be prioritized if emerging interventions to improve accountability in routine immunization are to have an effect. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Toddlers' Adjustment to the Stress of Immunization in Function of Mothers' General and Specific Coping Tendencies

ERIC Educational Resources Information Center

Favez, N.; Reicherts, M.

2008-01-01

The aim of this research is to assess the relative influence of mothers' coping strategies in everyday life and mothers' specific coping acts on toddlers' adjustment behavior to pain and distress during a routine immunization. The population is 41 mothers with toddlers (23 girls, 18 boys; mean age, 22.7 months) undergoing a routine immunization in…

77 FR 58843 - Advisory Committee on Immunization Practices (ACIP)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-24

..., hepatitis B vaccine, meningococcal vaccines, influenza, measles-mumps-rubella vaccine, pertussis and vaccine...-rubella vaccine, hepatitis B vaccine, child/adolescent immunization schedule, and the adult immunization...

Prolonged intervals during Mycobacterium tuberculosis subunit vaccine boosting contributes to eliciting immunity mediated by central memory-like T cells.

PubMed

Bai, Chunxiang; He, Juanjuan; Niu, Hongxia; Hu, Lina; Luo, Yanping; Liu, Xun; Peng, Liang; Zhu, Bingdong

2018-05-01

It is believed that central memory T cells (T CM ) provide long-term protection against tuberculosis (TB). However, the effects of TB subunit vaccine immunization schedule, especially the vaccination intervals, on T cell immune memory is still unclear. In this study, mice were immunized with fusion protein ESAT6-Ag85B-MPT64 (190-198)-Mtb8.4-Rv2626c (LT70) based subunit vaccine three times according to the following schedules: ① 0, 3rd and 6th week respectively (0-3-6w), ② 0, 4th and 12th week (0-4-12w), and ③ 0, 4th and 24th week (0-4-24w). We found that both schedules of 0-4-12w and 0-4-24w induced higher level of antigen specific IL-2, IFN-γ and TNF-α than 0-3-6w immunization. Among them, 0-4-12w induced the highest level of IL-2, which is a key cytokine mainly produced by T CM . Moreover, by cultured IFN-γ ELISPOT and cell proliferation assay etc., we found that the vaccination schedule of 0-4-12w elicited higher numbers of T CM like cells, stronger T CM - mediated immune responses and higher protective efficacy against M. bovis BCG challenge than 0-3-6w did. It suggests that prolonging the vaccination interval of TB subunit vaccine to some extent contributes to inducing more abundant T CM like cells and providing stronger immune protection against mycobacteria infection. Copyright © 2018. Published by Elsevier Ltd.

Immunization Schedule

MedlinePlus

... third dose may be needed, depending on the brand of vaccine used in previous Hib immunizations. PCV ... third dose may be needed, depending on the brand of vaccine used in previous RV immunizations. 6 ...

The cost structure of routine infant immunization services: a systematic analysis of six countries

PubMed Central

Geng, Fangli; Suharlim, Christian; Brenzel, Logan; Resch, Stephen C; Menzies, Nicolas A

2017-01-01

Abstract Little information exists on the cost structure of routine infant immunization services in low- and middle-income settings. Using a unique dataset of routine infant immunization costs from six countries, we estimated how costs were distributed across budget categories and programmatic activities, and investigated how the cost structure of immunization sites varied by country and site characteristics. The EPIC study collected data on routine infant immunization costs from 319 sites in Benin, Ghana, Honduras, Moldova, Uganda, Zambia, using a standardized approach. For each country, we estimated the economic costs of infant immunization by administrative level, budget category, and programmatic activity from a programme perspective. We used regression models to describe how costs within each category were related to site operating characteristics and efficiency level. Site-level costs (incl. vaccines) represented 77–93% of national routine infant immunization costs. Labour and vaccine costs comprised 14–69% and 13–69% of site-level cost, respectively. The majority of site-level resources were devoted to service provision (facility-based or outreach), comprising 48–78% of site-level costs across the six countries. Based on the regression analyses, sites with the highest service volume had a greater proportion of costs devoted to vaccines, with vaccine costs per dose relatively unaffected by service volume but non-vaccine costs substantially lower with higher service volume. Across all countries, more efficient sites (compared with sites with similar characteristics) had a lower cost share devoted to labour. The cost structure of immunization services varied substantially between countries and across sites within each country, and was related to site characteristics. The substantial variation observed in this sample suggests differences in operating model for otherwise similar sites, and further understanding of these differences could reveal approaches to improve efficiency and performance of immunization sites. PMID:28575193

The cost structure of routine infant immunization services: a systematic analysis of six countries.

PubMed

Geng, Fangli; Suharlim, Christian; Brenzel, Logan; Resch, Stephen C; Menzies, Nicolas A

2017-10-01

Little information exists on the cost structure of routine infant immunization services in low- and middle-income settings. Using a unique dataset of routine infant immunization costs from six countries, we estimated how costs were distributed across budget categories and programmatic activities, and investigated how the cost structure of immunization sites varied by country and site characteristics. The EPIC study collected data on routine infant immunization costs from 319 sites in Benin, Ghana, Honduras, Moldova, Uganda, Zambia, using a standardized approach. For each country, we estimated the economic costs of infant immunization by administrative level, budget category, and programmatic activity from a programme perspective. We used regression models to describe how costs within each category were related to site operating characteristics and efficiency level. Site-level costs (incl. vaccines) represented 77-93% of national routine infant immunization costs. Labour and vaccine costs comprised 14-69% and 13-69% of site-level cost, respectively. The majority of site-level resources were devoted to service provision (facility-based or outreach), comprising 48-78% of site-level costs across the six countries. Based on the regression analyses, sites with the highest service volume had a greater proportion of costs devoted to vaccines, with vaccine costs per dose relatively unaffected by service volume but non-vaccine costs substantially lower with higher service volume. Across all countries, more efficient sites (compared with sites with similar characteristics) had a lower cost share devoted to labour. The cost structure of immunization services varied substantially between countries and across sites within each country, and was related to site characteristics. The substantial variation observed in this sample suggests differences in operating model for otherwise similar sites, and further understanding of these differences could reveal approaches to improve efficiency and performance of immunization sites. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Wild poliovirus circulation among healthy children immunized with oral polio vaccine in Antananarivo, Madagascar.

PubMed

Andrianarivelo, M R; Rabarijaona, L; Boisier, P; Chezzi, C; Zeller, H G

1999-01-01

From July 1995 to December 1996, 3185 stool specimens from healthy children aged 6-59 months attending 6 dispensaries in the Antananarivo area were examined for poliovirus. The children had been routinely immunized according to the Expanded Programme on Immunization (EPI) schedule and received the last dose of oral polio vaccine (OPV) more than 1 month before stool collection. 99.4% of the children were immunized with at least 3 doses of OPV. HEp-2 cell culture revealed virus infections in 192 stools (6.0%), including 9 poliovirus (0.3%) and 183 nonpolio enterovirus isolates (5.7%). Infections occurred throughout the year, but incidence was higher during the hot and rainy season (P=0.01). Using a neutralization test with monoclonal antibodies and PCR-RFLP in two genomic regions coding for the VP1 capsid and RNA polymerase, 4 wild polioviruses (3 type 1 and 1 type 3) and 5 vaccine-related polioviruses (2 Sabin 1-like variants, 1 Sabin 2-like and 2 Sabin 3-like) strains were identified. The wild polioviruses were isolated at the beginning and the end of the dry season. Similar RFLP patterns were observed for the 3 wild type 1 polioviruses. Comparison of partial genomic sequences in the VP1/2 A region of 1 of the wild type 1 isolates with 2 wild type strains isolated in Antananarivo in 1992 and 1993 showed a divergence of at least 10% between the strains, suggesting at least two different pathways of transmission during this period. Our findings demonstrate that immunization with 3 doses of OPV did not prevent intestinal carriage of wild poliovirus strains, and that there is a risk of wild poliovirus transmission to susceptible children in the area. Multiple strategies are required to improve immunization coverage in Madagascar.

EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010-11.

PubMed

Brenzel, Logan; Schütte, Carl; Goguadze, Keti; Valdez, Werner; Le Gargasson, Jean-Bernard; Guthrie, Teresa

2016-02-01

Governments in resource-poor settings have traditionally relied on external donor support for immunization. Under the Global Vaccine Action Plan, adopted in 2014, countries have committed to mobilizing additional domestic resources for immunization. Data gaps make it difficult to map how well countries have done in spending government resources on immunization to demonstrate greater ownership of programs. This article presents findings of an innovative approach for financial mapping of routine immunization applied in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. This approach uses modified System of Health Accounts coding to evaluate data collected from national and subnational levels and from donor agencies. We found that government sources accounted for 27-95 percent of routine immunization financing in 2011, with countries that have higher gross national product per capita better able to finance requirements. Most financing is channeled through government agencies and used at the primary care level. Sustainable immunization programs will depend upon whether governments have the fiscal space to allocate additional resources. Ongoing robust analysis of routine immunization should be instituted within the context of total health expenditure tracking. Project HOPE—The People-to-People Health Foundation, Inc.

78 countries: immunization financing in developing and transitional countries.

PubMed

Deroeck, D; Levin, A

1999-01-01

The Special Initiative on Immunization Financing is a project that reviews available information on immunization costs and financing in developing countries in order to inform planned field-based activities to increase sustainability of immunization programs. While routine immunization costs just pennies a dose, newer vaccines such as hepatitis B vaccine cost much more; the full cost of making them routine are not yet known. However, a growing number of governments are paying for these vaccines. Three-quarters of the countries responding to the survey have immunization and vaccination programs in their national budgets. Moreover, international organizations have set up fund and procurement mechanisms to aid countries purchase low-cost, high-quality vaccines.

Generically Used Expert Scheduling System (GUESS): User's Guide Version 1.0

NASA Technical Reports Server (NTRS)

Liebowitz, Jay; Krishnamurthy, Vijaya; Rodens, Ira

1996-01-01

This user's guide contains instructions explaining how to best operate the program GUESS, a generic expert scheduling system. GUESS incorporates several important features for a generic scheduler, including automatic scheduling routines to generate a 'first' schedule for the user, a user interface that includes Gantt charts and enables the human scheduler to manipulate schedules manually, diagnostic report generators, and a variety of scheduling techniques. The current version of GUESS runs on an IBM PC or compatible in the Windows 3.1 or Windows '95 environment.

Polio vaccines: WHO position paper, January 2014--recommendations.

PubMed

2014-07-16

This article presents the World Health Organizations (WHO) evidence and recommendations for the use of polio vaccination from the WHO position paper on polio vaccines - January 2014 recently published in the Weekly Epidemiological Record [1]. This position paper summarizes the WHO position on the introduction of at least one dose of inactivated polio vaccine (IPV) into routine immunization schedules as a strategy to mitigate the potential risk of re-emergence of type 2 polio following the withdrawal of Sabin type 2 strains from oral polio vaccine (OPV). The current document replaces the position paper on the use of polio vaccines published in 2010 [2]. Footnotes to this paper provide a number of core references. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO's Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its November 2013 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html. Copyright © 2014 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

Risk factors for incomplete immunization in children with HIV infection.

PubMed

Bhattacharya, Sangeeta Das; Bhattacharyya, Subhasish; Chatterjee, Devlina; Niyogi, Swapan Kumar; Chauhan, Nageshwar; Sudar, A

2014-09-01

To document the immunization rates, factors associated with incomplete immunization, and missed opportunities for immunizations in children affected by HIV presenting for routine outpatient follow-up. A cross-sectional study of immunization status of children affected by HIV presenting for routine outpatient care was conducted. Two hundred and six HIV affected children were enrolled. The median age of children in this cohort was 6 y. One hundred ninety seven of 206 children were HIV infected, nine were HIV exposed, but indeterminate. Fifty (25 %) children had incomplete immunizations per the Universal Immunization Program (UIP) of India. Hundred percent of children had received OPV. Ninety three percent of children got their UIP vaccines from a government clinic. Children with incomplete immunization were older, median age of 8 compared to 5 (p = 0.003). Each year of maternal education increased the odds of having a child with complete UIP immunizations by 1.18 (p = 0.008)-children of mothers with 6 y of education compared to those with no education were seven times more likely to have complete UIP vaccine status. The average number of visits to the clinic by an individual child in a year was 4. This represents 200 missed opportunities for immunizations. HIV infected children are at risk for incomplete immunization coverage though they regularly access medical care. Including routine immunizations, particularly catch-up immunizations in programs for HIV infected children maybe an effective way of protecting these children from vaccine preventable disease.

Safety and Immunogenicity of Sequential Rotavirus Vaccine Schedules

PubMed Central

Libster, Romina; McNeal, Monica; Walter, Emmanuel B.; Shane, Andi L.; Winokur, Patricia; Cress, Gretchen; Berry, Andrea A.; Kotloff, Karen L.; Sarpong, Kwabena; Turley, Christine B.; Harrison, Christopher J.; Pahud, Barbara A.; Marbin, Jyothi; Dunn, John; El-Khorazaty, Jill; Barrett, Jill

2016-01-01

BACKGROUND AND OBJECTIVES: Although both licensed rotavirus vaccines are safe and effective, it is often not possible to complete the schedule by using the same vaccine formulation. The goal of this study was to investigate the noninferiority of the immune responses to the 2 licensed rotavirus vaccines when administered as a mixed schedule compared with administering a single vaccine formulation alone. METHODS: Randomized, multicenter, open-label study. Healthy infants (6–14 weeks of age) were randomized to receive rotavirus vaccines in 1 of 5 different schedules (2 using a single vaccine for all doses, and 3 using mixed schedules). The group receiving only the monovalent rotavirus vaccine received 2 doses of vaccine and the other 4 groups received 3 doses of vaccine. Serum for immunogenicity testing was obtained 1 month after the last vaccine dose and the proportion of seropositive children (rotavirus immunoglobulin A ≥20 U/mL) were compared in all the vaccine groups. RESULTS: Between March 2011 and September 2013, 1393 children were enrolled and randomized. Immune responses to all the sequential mixed vaccine schedules were shown to be noninferior when compared with the 2 single vaccine reference groups. The proportion of children seropositive to at least 1 vaccine antigen at 1 month after vaccination ranged from 77% to 96%, and was not significantly different among all the study groups. All schedules were well tolerated. CONCLUSIONS: Mixed schedules are safe and induced comparable immune responses when compared with the licensed rotavirus vaccines given alone. PMID:26823540

41 CFR 51-9.304-5 - Reproduction fee schedule.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Reproduction fee schedule... RULES 9.3-Individual Access to Records § 51-9.304-5 Reproduction fee schedule. (a) The fee for... physical characteristics do not permit reproduction by routine electrostatic copying shall be the direct...

41 CFR 51-9.304-5 - Reproduction fee schedule.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 1 2011-07-01 2009-07-01 true Reproduction fee schedule... RULES 9.3-Individual Access to Records § 51-9.304-5 Reproduction fee schedule. (a) The fee for... physical characteristics do not permit reproduction by routine electrostatic copying shall be the direct...

Progress toward measles elimination--Eastern Mediterranean Region, 2008-2012.

PubMed

Teleb, Nadia; Lebo, Emmaculate; Ahmed, Hinda; Hossam, Abdel Rahman; El Sayed, El Tayeb; Dabbagh, Alya; Strebel, Peter; Rota, Paul; Alexander, James

2014-06-13

In 1997, the 22 countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) adopted a goal of measles elimination by 2010. To achieve this goal, the WHO Regional Office for the Eastern Mediterranean Region (EMRO) developed a four-pronged strategy: 1) achieve ≥ 95% vaccination coverage of children with the first dose of measles-containing vaccine (MCV1) in every district of each country through routine immunization services, 2) achieve ≥ 95% vaccination coverage with the second dose of measles-containing vaccine (MCV2) in every district of each country either through a routine 2-dose vaccination schedule or through supplementary immunization activities (SIAs), 3) conduct high-quality, case-based surveillance in all countries, and 4) provide optimal clinical case management, including supplementing diets with vitamin A. Although significant progress was made toward measles elimination in the EMR during 1997-2007, the measles elimination goal was not reached by the target date of 2010, and the date was revised to 2015. This report updates previous reports and summarizes the progress made toward measles elimination in EMR during 2008-2012. From 2008 to 2012, large outbreaks occurred in countries with a high incidence of measles, and reported annual measles cases in EMR increased from 12,186 to 36,456. To achieve measles elimination in EMR, efforts are needed to increase 2-dose vaccination coverage, especially in countries with high incidence of measles and in conflict-affected countries, and to implement innovative strategies to reach populations at high risk in areas with poor access to vaccination services or with civil strife.

The National Immunization Information Hotline.

PubMed

Gust, D A; Gangarosa, P; Hibbs, B; Wilkins, C; Ford, K; Stuart, M; Brown-Bryant, R; Wallach, G; Chen, R T

2004-01-01

The National Immunization Information Hotline (NIIH) has been providing information regarding immunizations to the public and to health care professionals since March 1997. We describe the operations of the NIIH, its experience over the first two and a half years of operation and lessons learned for other immunization hotlines. From 1998-2000, the hotline answered 246,859 calls. Calls concerning immunization information requests totaled 175,367; data about the calls were collected from 35,102. Approximately a third of the 35,102 calls were from health care providers. Of the remaining calls from the public, the greatest number of calls concerned childhood immunizations. Immunization schedule queries from the public increased 323.0% from 1998 to 2000. While the major goal of the NIIH is to provide accurate and reliable information to the public and to health care providers, data from the hotline can be used to monitor changes over time in calls concerning inquiries about the immunization schedule in addition to other variables of interest.

Compliance with the vaccination schedule in children hospitalized with pneumonia and associated factors

PubMed Central

da Silva, Amanda Tabosa Pereira; Lima, Eduardo Jorge da Fonseca; Caminha, Maria de Fátima Costa; da Silva, Andresa Tabosa Pereira; Rodrigues, Edil de Albuquerque; dos Santos, Carmina Silva

2018-01-01

ABSTRACT OBJECTIVE: To verify the adequacy and factors associated with compliance with the immunization schedule (BCG, DTP-Hib, MMR, PCV-10) in children hospitalized with pneumonia at a pediatric referral hospital in Northeast Brazil. METHODS: This is a cross-sectional, descriptive study with an analytical component, with a sample of 452 children hospitalized with pneumonia at the Instituto de Medicina Integral Prof. Fernando Figueira, between 2010 and 2013. The inclusion criterion was children aged from one month to less than five years of age with proof in the immunization record. The exclusion criterion was the presence of hospital-acquired pneumonia or concomitant disease. We have evaluated the adequacy of the immunization schedule for the BCG, tetravalent, MMR, and 10-valent pneumococcal conjugate (PCV-10) vaccines. We used the chi-square test and Fisher's exact test followed by multivariate Poisson regression, estimating the crude and adjusted prevalence ratios and respective 95% confidence intervals. The variables with p < 0.20 in the univariate analysis were included in the multivariate analysis. RESULTS: There was good adequacy in the immunization schedule, except for PCV-10, which presented a percentage lower than 85%. We have observed an association between adequate compliance with the immunization schedule and education level of the mother (89.9% complete high school), sex of the child (87.2% female), age of the child (94.2% younger than six months), and breastfeeding (84.3% breastfed). CONCLUSIONS: Given the high rate of education level of the mother and the high percentage of breastfeeding, we can understand that there is a better understanding of the health of the child by the mothers studied in this study, showing the effectiveness of public policies for infant feeding. However, children did not have good adequacy of the immunization schedule of PCV-10, one of the main vaccines against pneumonia, which can be one of the main factors in the causes of hospitalization, with no influence on the classification of the severity of the disease. In this way, we emphasize that the causes of pneumonia morbidity are not associated with a single factor. PMID:29668816

Haemophilus influenzae type B meningitis: Is there a re-emergence? 24 years of experience in a children's hospital.

PubMed

Gentile, Angela; Martínez, Ana C; Juarez, María Del V; Lución, María F; Burgo, Candela; Della Latta, María P; Rapapor, Solana; Romanin, Viviana; Turco, Marisa

2017-06-01

Haemophilus influenzae type B (Hib) used to be the main cause of bacterial meningitis in children younger than 5 years old. Following the introduction of the Hib vaccine in the immunization schedule (1998), its incidence reduced significantly but it has increased over the last years. The objectives of this study included describing the characteristics and analyzing the epidemic curve of Haemophilus influenzae type B (Hib) meningitis by comparing the pre- and postimmunization periods. Time-series study. All patients hospitalized with Hib meningitis at Hospital de Niños "R. Gutiérrez" (January 1992-May 2016). Hospitalization rates were compared before (pre-immunization) and after (post-immunization) the introduction of the Hib vaccine. The post-immunization period was divided into three similar periods. Eighty-five patients with Hib meningitis were admitted (73.3% in the pre-immunization period). No differences were observed in relation to the clinical and sociodemographic characteristics of cases in both periods. Pre-immunization: 10.5 cases/year; postimmunization: 0.7 cases/year. As of 2014, the rate has increased. Lethality rate: 4.8% (all preimmunization). Post-immunization data (n= 15): 40% had completed their primary immunization schedule, 40% were delayed on the immunization schedule for their age. Overall reduction in the hospital rate of Hib meningitis by 89.8% (95% confidence interval: -82.79-93.96%, p < 0.001) in the post-immunization period. The analysis of the different post-immunization periods shows a decline in reduction over time. A very significant reduction in hospitalizations due to Hib meningitis was observed after the Hib vaccine was introduced; however, over the past years, the number of cases has increased although no changes have been observed in patient characteristics.

A phase III, randomized controlled study to assess the safety and immunogenicity of a semi-synthetic diphtheria, tetanus and whole-cell pertussis vaccine in Indian infants.

PubMed

Sharma, Hitt; Patil, Vishwanath; Sharma, Dharambhushan; Kapre, Subhash; Jadhav, Suresh; Ravetkar, Satish; Kumar, Rakesh; Bahl, Sunil; Parekh, Sameer; Chakravarty, Anita

2012-09-21

Reactions to DTwP vaccine are well known and are a matter of great concern, much for the development of next generation combination vaccines. To avoid such reactions which occur from foreign compounds, WHO suggested manufacture of DTwP vaccine using semi-synthetic medium. The phase III trial reported here was conducted to assess the immunogenicity, tolerability and safety of a new DTwP vaccine manufactured using semi-synthetic medium for both tetanus and diphtheria toxoids in comparison with the routinely manufactured DTwP vaccine. In all, 331 infants aged 6-8 weeks were enrolled, out of which 308 completed the study. The vaccination was done at 6-10-14 weeks following EPI/WHO recommended immunization schedule. Blood samples were collected prior to the administration of first dose and one month after the third dose. Postvaccination, geometric mean titres for each component did not differ significantly amongst the two study groups. Though, the immunogenicity results were comparable between the two vaccines, the incidence of adverse events was comparatively low in semi-synthetic vaccine as against the routine vaccine group for all the three doses. The semi-synthetic DTwP vaccine was immunogenic and showed a significant lower incidence of local adverse events in comparison to the routine vaccine. This vaccine is now being used in the routine vaccination programme both as a triple antigen (DTwP alone) as well as a combination with Hepatitis B and/or Haemophilus influenzae type b vaccine. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effect of introduction of pentavalent vaccine as replacement for Diphtheria-Tetanus-Pertussis and Hepatitis B vaccines on vaccination uptake in a health facility in Nigeria.

PubMed

Sadoh, Ayebo Evawere; Nwaneri, Damian Uchechukwu; Ogboghodo, Bamidele Charity; Sadoh, Wilson Ehidiamen

2016-05-23

The introduction of a new vaccine into an immunization programme may affect the immunization system negatively or positively. The aim of this study is to determine the effect of the introduction of the pentavalent vaccine as replacement for DTP and Hepatitis B vaccines on timeliness, completion of the schedule and dropout rates among children attending a health facility. This was a retrospective cohort study which involved extracting immunization records of children attending the Institute of Child Health Child Welfare Clinic between June 2011 and May 2013. Pentavalent vaccine was introduced as a replacement for DTP and Hepatitis B vaccines in June 2012. The uptake, timeliness and dropout rates of different vaccines in the immunization schedule were determined for children who commenced immunization in the pre, peri and post introduction phases. A total of 1110 children were studied - 190, 410 and 510 who commenced vaccination in the pre, peri and post introduction phases of the pentavalent vaccine respectively. Uptake was significantly higher for all vaccines in the post introduction phase compared to pre and peri introduction phases (p<0.001). Completion of the immunization schedule by 60.2% of the children who commenced vaccination in the post introduction phase was higher than the 31.6% and 41.7% for the pre and peri introduction phases respectively (p<0.001). Significantly more visits were required to complete the schedule in the peri introduction phase compared to the pre and post introduction phases p<0.001. Delay in receipt of the three doses of DTP/PENTA was significantly longer in the peri introduction phase compared to pre and post introduction phases. The introduction of pentavalent vaccine significantly improved uptake of vaccines and completion of the schedule but resulted in prolonged delay in receipt of vaccines during the introduction period. Copyright © 2016 Elsevier Ltd. All rights reserved.

Impact of an Intervention to Use a Measles, Rubella, and Polio Mass Vaccination Campaign to Strengthen Routine Immunization Services in Nepal.

PubMed

Wallace, Aaron S; Bohara, Rajendra; Stewart, Steven; Subedi, Giri; Anand, Abhijeet; Burnett, Eleanor; Giri, Jagat; Shrestha, Jagat; Gurau, Suraj; Dixit, Sameer; Rajbhandari, Rajesh; Schluter, W William

2017-07-01

The potential to strengthen routine immunization (RI) services through supplementary immunization activities (SIAs) is an important benefit of global measles and rubella elimination and polio eradication strategies. However, little evidence exists on how best to use SIAs to strengthen RI. As part the 2012 Nepal measles-rubella and polio SIA, we developed an intervention package designed to improve RI processes and evaluated its effect on specific RI process measures. The intervention package was incorporated into existing SIA activities and materials to improve healthcare providers' RI knowledge and practices throughout Nepal. In 1 region (Central Region) we surveyed the same 100 randomly selected health facilities before and after the SIA and evaluated the following RI process measures: vaccine safety, RI planning, RI service delivery, vaccine supply chain, and RI data recording practices. Data collection included observations of vaccination sessions, interviews with the primary healthcare provider who administered vaccines at each facility, and administrative record reviews. Pair-matched analytical methods were used to determine whether statistically significant changes in the selected RI process measures occurred over time. After the SIA, significant positive changes were measured in healthcare provider knowledge of adverse events following immunization (11% increase), availability of RI microplans (+17%) and maps (+12%), and awareness of how long a reconstituted measles vial can be used before it must be discarded (+14%). For the SIA, 42% of providers created an SIA high-risk villages list, and >50% incorporated this information into RI outreach session site planning. Significant negative changes occurred in correct knowledge of measles vaccination contraindications (-11%), correct definition for a measles outbreak (-21%), and how to treat a child with a severe adverse event following immunization (-10%). Twenty percent of providers reported cancelling ≥1 RI sessions during the SIA. Many RI process measures were at high proportions (>90%) before the SIA and remained high afterward, including proper vaccine administration techniques, proper vaccine waste management, and availability of vaccine carriers and vaccine registers. Focusing on activities that are easily linked between SIAs and RI services, such as using SIA high-risk village list to strengthen RI microplanning and examining ways to minimize the impact of an SIA on RI session scheduling, should be prioritized when implementing SIAs. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies.

PubMed

Menzies, Nicolas A; Suharlim, Christian; Geng, Fangli; Ward, Zachary J; Brenzel, Logan; Resch, Stephen C

2017-10-06

Evidence on immunization costs is a critical input for cost-effectiveness analysis and budgeting, and can describe variation in site-level efficiency. The Expanded Program on Immunization Costing and Financing (EPIC) Project represents the largest investigation of immunization delivery costs, collecting empirical data on routine infant immunization in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. We developed a pooled dataset from individual EPIC country studies (316 sites). We regressed log total costs against explanatory variables describing service volume, quality, access, other site characteristics, and income level. We used Bayesian hierarchical regression models to combine data from different countries and account for the multi-stage sample design. We calculated output elasticity as the percentage increase in outputs (service volume) for a 1% increase in inputs (total costs), averaged across the sample in each country, and reported first differences to describe the impact of other predictors. We estimated average and total cost curves for each country as a function of service volume. Across countries, average costs per dose ranged from $2.75 to $13.63. Average costs per child receiving diphtheria, tetanus, and pertussis ranged from $27 to $139. Within countries costs per dose varied widely-on average, sites in the highest quintile were 440% more expensive than those in the lowest quintile. In each country, higher service volume was strongly associated with lower average costs. A doubling of service volume was associated with a 19% (95% interval, 4.0-32) reduction in costs per dose delivered, (range 13% to 32% across countries), and the largest 20% of sites in each country realized costs per dose that were on average 61% lower than those for the smallest 20% of sites, controlling for other factors. Other factors associated with higher costs included hospital status, provision of outreach services, share of effort to management, level of staff training/seniority, distance to vaccine collection, additional days open per week, greater vaccination schedule completion, and per capita gross domestic product. We identified multiple features of sites and their operating environment that were associated with differences in average unit costs, with service volume being the most influential. These findings can inform efforts to improve the efficiency of service delivery and better understand resource needs.

Polio Eradication Initiative contribution in strengthening immunization and integrated disease surveillance data management in WHO African region, 2014.

PubMed

Poy, Alain; Minkoulou, Etienne; Shaba, Keith; Yahaya, Ali; Gaturuku, Peter; Dadja, Landoh; Okeibunor, Joseph; Mihigo, Richard; Mkanda, Pascal

2016-10-10

The PEI Programme in the WHO African region invested in recruitment of qualified staff in data management, developing data management system and standards operating systems since the revamp of the Polio Eradication Initiative in 1997 to cater for data management support needs in the Region. This support went beyond polio and was expanded to routine immunization and integrated surveillance of priority diseases. But the impact of the polio data management support to other programmes such as routine immunization and disease surveillance has not yet been fully documented. This is what this article seeks to demonstrate. We reviewed how Polio data management area of work evolved progressively along with the expansion of the data management team capacity and the evolution of the data management systems from initiation of the AFP case-based to routine immunization, other case based disease surveillance and Supplementary immunization activities. IDSR has improved the data availability with support from IST Polio funded data managers who were collecting them from countries. The data management system developed by the polio team was used by countries to record information related to not only polio SIAs but also for other interventions. From the time when routine immunization data started to be part of polio data management team responsibility, the number of reports received went from around 4000 the first year (2005) to >30,000 the second year and to >47,000 in 2014. Polio data management has helped to improve the overall VPD, IDSR and routine data management as well as emergency response in the Region. As we approach the polio end game, the African Region would benefit in using the already set infrastructure for other public health initiative in the Region. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Influence of host related factors on the antibody response to trivalent oral polio vaccine in Tunisian infants.

PubMed

Triki, H; Abdallah, M V; Ben Aissa, R; Bouratbine, A; Ben Ali Kacem, M; Bouraoui, S; Koubaa, C; Zouari, S; Mohsni, E; Crainic, R; Dellagi, K

1997-07-01

The low efficiency of trivalent oral polio vaccine (TOPV) in inducing protective antibody titres to polio3 is a problem of great importance in many regions of the world. A prospective study was conducted in 121 Tunisian infants aged 3 months during routine immunization with TOPV under carefully controlled conditions. Seroconversion rates to polio1, polio2 and polio3, one month after the third dose, were 94.7, 100 and 89.5%, respectively. The kinetics of the antibody response showed delayed and more difficult responses to polio3 compared to polio2 and polio1. The following host related factors, previously suggested to interfere with the immune response, were assessed: maternal antibodies; breast-feeding; concurrent enteric infections; and other illnesses. The main factor associated with the lack of seroconversion was concurrent infection with non-polio enteroviruses (NPE) which was found in 50% of non-responders to polio1 and/or to polio3 during the vaccination protocol whereas no NPE was isolated in vaccine responders. The other studied factors seemed not to interfere in the infants according to the locally adopted vaccination schedule and to the specific socio-economic conditions.

A comparative study of the incidence of aseptic meningitis in symptomatic natural mumps patients and monovalent mumps vaccine recipients in Japan.

PubMed

Nagai, Takao; Okafuji, Teruo; Miyazaki, Chiaki; Ito, Yuhei; Kamada, Makoto; Kumagai, Takuji; Yuri, Kenji; Sakiyama, Hiroshi; Miyata, Akiko; Ihara, Toshiaki; Ochiai, Hitoshi; Shimomura, Kunihisa; Suzuki, Eitaro; Torigoe, Sadayoshi; Igarashi, Masahiro; Kase, Tetsuo; Okuno, Yoshinobu; Nakayama, Tetsuo

2007-03-30

To compare the incidence of aseptic meningitis associated with symptomatic natural mumps infection and in mumps vaccine recipients, we conducted a prospective comparative study. Consecutive samples of 1051 children with mumps were enrolled by 10 pediatricians and 21,465 vaccine recipients by 143 pediatric primary care practitioners, from January 1, 2000 to January 1, 2003. Parents used a daily diary to record symptoms during the period of illness (15 days) or 30-day period following immunization. Mumps infection was confirmed by virus isolation and/or detection of mumps virus genome in salivary and CSF samples. The incidence of aseptic meningitis was 13/1051 (1.24%) in patients with symptomatic natural mumps infection and was estimated to be 0.7-1.1% of overall infection in considering asymptomatic infection, and 10/21,465 (0.05%) in vaccine recipients. Although aseptic meningitis is a clear side effect of the mumps vaccine, the incidence is considerably lower than among those with symptomatic natural infection. Our results provide an informative data for consideration to resume mumps vaccine as a part of routine immunization schedule for Japanese children.

Access to Routine Immunization: A Comparative Analysis of Supply-Side Disparities between Northern and Southern Nigeria

PubMed Central

Eboreime, Ejemai; Abimbola, Seye; Bozzani, Fiammetta

2015-01-01

Background The available data on routine immunization in Nigeria show a disparity in coverage between Northern and Southern Nigeria, with the former performing worse. The effect of socio-cultural differences on health-seeking behaviour has been identified in the literature as the main cause of the disparity. Our study analyses the role of supply-side determinants, particularly access to services, in causing these disparities. Methods Using routine government data, we compared supply-side determinants of access in two Northern states with two Southern states. The states were identified using criteria-based purposive selection such that the comparisons were made between a low-coverage state in the South and a low-coverage state in the North as well as between a high-coverage state in the South and a high-coverage state in the North. Results Human resources and commodities at routine immunization service delivery points were generally insufficient for service delivery in both geographical regions. While disparities were evident between individual states irrespective of regional location, compared to the South, residents in Northern Nigeria were more likely to have vaccination service delivery points located within a 5km radius of their settlements. Conclusion Our findings suggest that regional supply-side disparities are not apparent, reinforcing the earlier reported socio-cultural explanations for disparities in routine immunization service uptake between Northern and Southern Nigeria. Nonetheless, improving routine immunisation coverage services require that there are available human resources and that health facilities are equitably distributed. PMID:26692215

Access to Routine Immunization: A Comparative Analysis of Supply-Side Disparities between Northern and Southern Nigeria.

PubMed

Eboreime, Ejemai; Abimbola, Seye; Bozzani, Fiammetta

2015-01-01

The available data on routine immunization in Nigeria show a disparity in coverage between Northern and Southern Nigeria, with the former performing worse. The effect of socio-cultural differences on health-seeking behaviour has been identified in the literature as the main cause of the disparity. Our study analyses the role of supply-side determinants, particularly access to services, in causing these disparities. Using routine government data, we compared supply-side determinants of access in two Northern states with two Southern states. The states were identified using criteria-based purposive selection such that the comparisons were made between a low-coverage state in the South and a low-coverage state in the North as well as between a high-coverage state in the South and a high-coverage state in the North. Human resources and commodities at routine immunization service delivery points were generally insufficient for service delivery in both geographical regions. While disparities were evident between individual states irrespective of regional location, compared to the South, residents in Northern Nigeria were more likely to have vaccination service delivery points located within a 5 km radius of their settlements. Our findings suggest that regional supply-side disparities are not apparent, reinforcing the earlier reported socio-cultural explanations for disparities in routine immunization service uptake between Northern and Southern Nigeria. Nonetheless, improving routine immunisation coverage services require that there are available human resources and that health facilities are equitably distributed.

RadNet Sampling and Analyses Schedules

EPA Pesticide Factsheets

RadNet air monitors operate continuously and samples of air, precipitation and drinking water and analyzed on a routine schedule. RadNet can send deployable monitors to any U.S. location in the case of a radiological emergency.

Factors associated with seasonal influenza vaccine uptake among children in Japan.

PubMed

Shono, Aiko; Kondo, Masahide

2015-02-18

Seasonal influenza vaccine was once part of the routine immunization schedule that is routinely offered to all children in Japan, but it is now excluded from the schedule. This study aimed to investigate factors influential to parents' decision to have their children receive seasonal influenza vaccine, as well as types of seasonal influenza vaccine information that is given to parents. We conducted a cross-sectional online survey of 555 participants who have at least one child younger than 13 years of age. Respondents were asked to categorize the history of influenza vaccination of their youngest child as either 'annual' , 'sometimes' , or 'never'. Participants were also asked about potentially influential factors in their decision to have their children receive a seasonal influenza vaccine. A total of 75% of respondents answered that their youngest child had received a seasonal influenza vaccine, and 57% of respondents answered that their child receives the vaccine every year. The higher income group was more likely than the lowest income group to have a history of influenza vaccine uptake. A recommendation from a pediatrician or school/nursery to have their child vaccinated was also positively associated with a history of influenza vaccine uptake. The most common reason for a pediatrician's recommendation was 'it leads to milder symptoms if infected'. The main finding of the study is a significant association between household income and influenza vaccination of the youngest child in the household. We also found that cost could be a barrier to vaccinating children in low income households and that information from pediatricians and schools/nurseries could motivate parents to have their children vaccinated.

[Pneumococcal vaccines in children: an update].

PubMed

Potin, Marcela

2014-08-01

Conjugated pneumococal vaccines had a notable impact on prevention of invasive pneumococcal disease (IPD) in vacccinated and non vaccinated (herd immunity) populations. In Chile a 10 valent conjugated vaccine (PCV10) was introduced in the Nacional Immunization Program (NIP) in 2011, initially in a 3+1 schedule at 2, 4, 6 and 12 months of age, and since 2012 in a 2+1 schedule (2, 4 and 12 months). In prematures schedule 3+1 was maintained. No catch up or high risk groups vaccination strategies were used. The inclusion of PCV10 has reduced the rates of IPD; 66% in infants less than 12 months old and a 60% in 12-24 months old. After 3 years of the introduction of PCV10, no herd immunity has been seen. Serotype replacement shows an increase of ST 3 but not ST19A. Surveillance shows that another vaccine with 13 serotypes (PCV13) would cover an additional 5 to 10% of cases. The nule herd immunity and more extense coverage of PCV13, suggests that NIP should switch from PCV10 to PCV13.

A Brief History of Vaccines Against Polio.

PubMed

Vashishtha, Vipin M; Kamath, Sachidanand

2016-08-07

Poliomyelitis, a dreaded disease of the last century that had already crippled millions of people across the globe, is now on the verge of eradication thanks mainly to two polio vaccines, inactivated polio vaccine (IPV) and oral polio vaccine (OPV). Ever since their development in late 1950s and early 1960s, the journey of their early development process, clinical trials, licensure and ultimately widespread clinical use in different countries provide a fascinating tale of events. Oral polio vaccine has been the mainstay of global polio eradication initiative (GPEI) in most of the countries. With the advent of 'polio endgame', the focus has now shifted back to IPV. However, there are certain issues associated with global cessation of OPV use and universal implementation of IPV in routine immunization schedules across the globe that need to be dealt with some urgency, before proclaiming the global victory over polio.

Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis.

PubMed

Driessen, Julia; Olson, Zachary D; Jamison, Dean T; Verguet, Stéphane

2015-08-01

Vaccination coverage rates often mask wide variation in access, uptake, and cost of providing vaccination. Financial incentives have been effective at creating demand for social services in a variety of settings. Using methods of extended cost-effectiveness analysis, we compare the health and economic implications of three different vaccine delivery strategies for measles vaccination in Ethiopia: i) routine immunization, ii) routine immunization with financial incentives, and iii) mass campaigns, known as supplemental immunization activities (SIAs). We examine annual birth cohorts of almost 3,000,000 births over a ten year period, exploring variation in these outcomes based on economic status to understand how various options may improve equity. SIAs naturally achieve higher levels of vaccine coverage, but at higher costs. Routine immunization combined with financial incentives bolsters demand among more economically vulnerable households. The relative appeal of routine immunization with financial incentives and SIAs will depend on the policy environment, including short-term financial limitations, time horizons, and the types of outcomes that are desired. While the impact of financial incentives has been more thoroughly studied in other policy arenas, such as education, consideration of this approach alongside standard vaccination models such as SIAs is timely given the dialog around measles eradication. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Design of a Real Time Operating System for a Fault Tolerant Microcomputer

DTIC Science & Technology

1986-12-01

Scheduler then enqueues all the new jobs for the new frame. Upon completion of the Purge and Task Scheduler routines the Cycle Interrupt Handler returns...the scheduling of new tasks in a new minor cycle to make room for the new jobs . The purge operation will usually not remove the same number of jobs each

Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations

PubMed Central

Webb, Heather; Street, Jackie; Marshall, Helen

2014-01-01

Immunization against pertussis, influenza, and rubella reduces morbidity and mortality in pregnant women and their offspring. Health care professionals (HCPs) caring for women perinatally are uniquely placed to reduce maternal vaccine preventable diseases (VPDs). Despite guidelines recommending immunization during the perinatal period, maternal vaccine uptake remains low. This qualitative study explored the role of obstetricians, general practitioners, and midwives in maternal vaccine uptake. Semi-structured interviews (n = 15) were conducted with perinatal HCPs at a tertiary maternity hospital in South Australia. HCPs were asked to reflect on their knowledge, beliefs, and practice relating to immunization advice and vaccine provision. Interviews were transcribed and coded using thematic analysis. Data collection and analysis was an iterative process, with collection ceasing with theoretical saturation. Participants unanimously supported maternal vaccination as an effective way of reducing risk of disease in this vulnerable population, however only rubella immunity detection and immunization is embedded in routine care. Among these professionals, delegation of responsibility for maternal immunization was unclear and knowledge about maternal immunization was variable. Influenza and pertussis vaccine prevention measures were not included in standard pregnancy record documentation, information provision to patients was “ad hoc” and vaccinations not offered on-site. The key finding was that the incorporation of maternal vaccinations into standard care through a structured process is an important facilitator for immunization uptake. Incorporating vaccine preventable disease management measures into routine obstetric care including incorporation into the Pregnancy Record would facilitate HCPs in implementing recommendations. Rubella prevention provides a useful “template” for other vaccines. PMID:24509790

Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations.

PubMed

Webb, Heather; Street, Jackie; Marshall, Helen

2014-01-01

Immunization against pertussis, influenza, and rubella reduces morbidity and mortality in pregnant women and their offspring. Health care professionals (HCPs) caring for women perinatally are uniquely placed to reduce maternal vaccine preventable diseases (VPDs). Despite guidelines recommending immunization during the perinatal period, maternal vaccine uptake remains low. This qualitative study explored the role of obstetricians, general practitioners, and midwives in maternal vaccine uptake. Semi-structured interviews (n = 15) were conducted with perinatal HCPs at a tertiary maternity hospital in South Australia. HCPs were asked to reflect on their knowledge, beliefs, and practice relating to immunization advice and vaccine provision. Interviews were transcribed and coded using thematic analysis. Data collection and analysis was an iterative process, with collection ceasing with theoretical saturation. Participants unanimously supported maternal vaccination as an effective way of reducing risk of disease in this vulnerable population, however only rubella immunity detection and immunization is embedded in routine care. Among these professionals, delegation of responsibility for maternal immunization was unclear and knowledge about maternal immunization was variable. Influenza and pertussis vaccine prevention measures were not included in standard pregnancy record documentation, information provision to patients was "ad hoc" and vaccinations not offered on-site. The key finding was that the incorporation of maternal vaccinations into standard care through a structured process is an important facilitator for immunization uptake. Incorporating vaccine preventable disease management measures into routine obstetric care including incorporation into the Pregnancy Record would facilitate HCPs in implementing recommendations. Rubella prevention provides a useful 'template' for other vaccines.

Strengthening Routine Immunization in Areas of Northern Nigeria at High Risk for Polio Transmission During 2012–2014

PubMed Central

Ali, Daniel; Banda, Richard; Mohammed, Abdulaziz; Adagadzu, Julie; Murele, Bolatito; Seruyange, Rachel; Makam, Jeevan; Mkanda, Pascal; Okpessen, Bassey; Tegegne, Sisay G.; Folorunsho, Adeboye S.; Erbeto, Tesfaye B.; Yehualashet, Yared G.; Vaz, Rui G.

2016-01-01

Background. Following the 2012 declaration by World Health Organization (WHO) Regional Director for Africa and the WHO Executive Board to ramp up routine immunization (RI) activities, began to intensify activities to strengthen RI. This study assessed how the intensification of RI helped strengthen service delivery in local government areas (LGAs) of northern Nigeria at high risk for polio transmission. Methods. A retrospective study was performed by analyzing RI administrative data and findings from supportive supervisory visits in 107 high-risk LGAs. Results. Our study revealed that administrative coverage with 3rd dose of diphtheria-pertussis-tetanus vaccine in the 107 high-risk LGAs improved from a maximum average coverage of 33% during the preintensification period of 2009–2011 to 74% during the postintensification period of 2012–2014. Conclusions. Routine immunization could be strengthened in areas where coverage is low, and RI has been identified to be weak when certain key routine activities are intensified. PMID:26917576

Immunization Schedules for Infants and Children

MedlinePlus

... a Catch-Up or Accelerated Schedule Birth through 18 Years In three easy steps, you can use ... See Vaccines Your Child May Need Birth through 18 Years Take the Childhood Vaccine Quiz to create ...

Measles prevention in adolescents: lessons learnt from implementing a high school catch-up vaccination programme in New South Wales, Australia, 2014–2015

PubMed Central

Seale, Holly; Sheppeard, Vicky; Campbell-Lloyd, Sue

2016-01-01

Introduction In response to a significant increase of measles cases and a high percentage of unvaccinated adolescents in New South Wales, Australia, a measles high school catch-up vaccination programme was implemented between August and December 2014. This study aimed to explore the factors affecting school-based supplementary immunization activities (SIAs) and to inform future SIA and routine school-based vaccination programme implementation and service provision. Methods Focus group analysis was conducted among public health unit (PHU) staff responsible for implementing the SIA catch-up programme. Key areas discussed were pre-programme planning, implementation, resources, consent materials, media activity and future directions for school vaccination programme delivery. Sessions were audio recorded, transcribed verbatim and reviewed. Thematic analysis was conducted to identify the major themes. Results Two independent focus groups with 32 participants were conducted in January 2015. Barriers to the SIA implementation included lead time, consent processes, interagency collaboration, access to the targeted cohort and the impact of introducing a SIA to an already demanding curriculum and school programme immunization schedule. A positive PHU school coordinator rapport and experience of PHU staff facilitated the implementation. Consideration of different approaches for pre-clinic vaccination status checks, student involvement in the vaccination decision, online consent, workforce sharing between health districts and effective programme planning time were identified for improving future SIA implementation. Conclusion Although many barriers to school programme implementation have been identified in this study, with adequate resourcing and lead time, SIAs implemented via a routine school vaccination programme are an appropriate model to target adolescents. PMID:27757258

Primary vaccine failure to routine vaccines: Why and what to do?

PubMed

Wiedermann, Ursula; Garner-Spitzer, Erika; Wagner, Angelika

2016-01-01

There are 2 major factors responsible for vaccine failures, the first is vaccine-related such as failures in vaccine attenuation, vaccination regimes or administration. The other is host-related, of which host genetics, immune status, age, health or nutritional status can be associated with primary or secondary vaccine failures. The first describes the inability to respond to primary vaccination, the latter is characterized by a loss of protection after initial effectiveness. Our studies concentrate on the evaluation of immunological characteristics responsible for primary vaccine failures in different (risk) populations for which the underlying mechanisms are currently unknown. Here we summarise current knowledge and findings from our studies. About 2-10% of healthy individuals fail to mount antibody levels to routine vaccines. Comparing the immune responses to different vaccines in non-responder and high-responder vaccinees revealed that hypo-responsiveness is antigen/vaccine-specific at the humoral but not at the cellular level. We found that T-regulatory as well as B-regulatory cells and the production of IL-10 are involved in non/hypo-responsiveness. Non-responsiveness increases with age and in particular vaccination to a novel vaccine in persons > 65 years is associated with a high low/non-responder rate, indicating that vaccine schedules and doses (at least for primary vaccination) should be adapted according to age. In light of the growing number of allergic but also obese people, our current studies concentrate on these risk groups to reveal whether different vaccination approaches are necessary for optimal protection compared to healthy individuals. These studies are in line with the significant paradigm shift taking place in many fields of medical research and care, and will extend the concept of personalised medicine into the field of vaccinology.

Effectiveness of different vaccine schedules for heptavalent and 13-valent conjugate vaccines against pneumococcal disease in the Community of Madrid.

PubMed

Latasa, P; Ordobás, M; Garrido-Estepa, M; Gil de Miguel, A; Sanz, J C; Barranco, M D; Insúa, E; García-Comas, L

2017-09-25

The heptavalent pneumococcal conjugate vaccine (PCV-7) was added to the childhood routine vaccination program in the Community of Madrid in November of 2006 with 3+1 recommended doses and a catch-up for those under 2years old. In June 2010, PCV-7 was replaced by 13-valent vaccine (PCV-13) with 2+1 recommended doses. In July of 2012, the PCV-13 was removed from the funded program and reintroduced again (2+1 recommended doses) in December 2014. In between, children were vaccinated privately with 3+1 recommended doses of PCV-13. The aim of this study was to evaluate the effectiveness of each vaccination schedule used in the Community of Madrid. We included all cases of invasive pneumococcal disease (IPD) reported between 2007 and 2015 to the Notifiable Diseases Surveillance System. Vaccination information was obtained from the Immunization Registry. Vaccine effectiveness (VE) was estimated using the indirect cohort design for cases with serotype information. A total 779 cases were included in the study. Among them 47.6% of the cases were primo-vaccinated with booster, 20% primo-vaccinated, 15.9% incompletely primo-vaccinated and 16.5% not vaccinated. The VE for ≥1 doses of any PCV was 82% (CI 95%: 67.8-89.9%): 91.9% (CI 95%: 76.5-97.2%) for PCV-7 and 77.2% (48.6-89.9%) for PCV-13. VE in those receiving the full 2+1 or 3+1 schedules was 100% for both vaccines. A high number of vaccine failures were reported in children before they had the opportunity to receive the booster dose, especially due to PCV-13-non-PCV-7 serotypes. VE was higher for PCV-7 compared to PCV-13, except for those that received the complete schedule with booster that achieved 100% of VE, which shows the relevance of the vaccines and complying with all doses scheduled. Copyright © 2017 Elsevier Ltd. All rights reserved.

Health Check Tools

MedlinePlus

... Breastfeeding Daily Food Plan for Moms (Department of Agriculture) C Calcium Calcium Calculator (International Osteoporosis Foundation) Cancer ... Center) Child Nutrition Food-A-Pedia (Department of Agriculture) Childhood Immunization Instant Childhood Immunization Schedule (Centers for ...

An analysis of government immunization program expenditures in lower and lower middle income countries 2006-12.

PubMed

Nader, Alice Abou; de Quadros, Ciro; Politi, Claudio; McQuestion, Michael

2015-04-01

Financing is becoming increasingly important as the cost of immunizing the world's children continues to rise. By 2015, that cost will likely exceed US$60 per infant as new vaccines are introduced into national immunization programs. In 2006, 51 lower and lower middle income countries reported spending a mean US$12 per surviving infant on routine immunization. By 2012, the figure had risen to $20, a 67% increase. This study tests the hypothesis that lower and lower middle income countries will spend more on their routine immunization programs as their economies grow. A panel data regression approach is used. Expenditures reported by governments annually (2006-12) through the World Health Organization/UNICEF Joint Reporting Form are regressed on lagged annual per capita gross national income (GNI), controlling for prevailing mortality levels, immunization program performance, corruption control efforts, geographical region and correct reporting. Results show the expenditures increased with GNI. Expressed as an elasticity, the countries spent approximately $6.32 on immunization for every $100 in GNI increase from 2006 to 2012. Projecting forward and assuming continued annual GNI growth rates of 10.65%, countries could be spending $60 per infant by 2020 if national investment functions increase 4-fold. Given the political will, this result implies countries could fully finance their routine immunization programs without cutting funding for other programs. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Immunizations for Preterm Babies

MedlinePlus

... preterm babies with a minimum birth weight of 2000 grams (about 4 lbs., 6 oz.) be treated ... immunization schedule. If birth weight is less than 2000 g, the AAP recommends administering the hepatitis B ...

Recommended vaccines for international travelers to India.

PubMed

Verma, Ramesh; Khanna, Pardeep; Chawla, Suraj

2014-06-18

India's tourism industry generated 6.6% of the nation's Gross Domestic Product (GDP) during 2012. International travel to India is predicted to grow at an average annual rate of ~8% over the next decade. The number of foreign tourists has increased by 9% to 5.8 million. Approximately 8% of travelers to developing countries require medical care during or after travel; the main diagnoses are vaccine-preventable diseases. Travelers to India can be exposed to various infectious diseases; water-borne, water-related, and zoonotic diseases may be imported to India where the disease is not endemic. The World Health Organization (WHO) emphasizes that all international travelers should be up to date with routine vaccinations. The recommended vaccinations for travelers to India vary according to the traveler's age, immunization history, existing medical conditions, duration, legal requirements for entry into countries being visited, travelers preferences, and values. Travelers should consult with a doctor so that there is sufficient time for completion of optimal vaccination schedules. No matter where traveling, one should be aware of potential exposure to certain organisms that can cause severely illnesses, even death. There is no doubt that vaccines have reduced or virtually eliminated many diseases that killed or severely disabled children and adults just a few generations ago. Thus, travelers must take recommended vaccines per schedule before traveling to India.

Recommended vaccines for international travelers to India.

PubMed

Verma, Ramesh; Khanna, Pardeep; Chawla, Suraj

2015-01-01

India's tourism industry generated 6.6% of the nation's Gross Domestic Product (GDP) during 2012. International travel to India is predicted to grow at an average annual rate of ∼ 8% over the next decade. The number of foreign tourists has increased by 9% to 5.8 million. Approximately 8% of travelers to developing countries require medical care during or after travel; the main diagnoses are vaccine-preventable diseases. Travelers to India can be exposed to various infectious diseases; water-borne, water-related, and zoonotic diseases may be imported to India where the disease is not endemic. The World Health Organization (WHO) emphasizes that all international travelers should be up to date with routine vaccinations. The recommended vaccinations for travelers to India vary according to the traveler's age, immunization history, existing medical conditions, duration, legal requirements for entry into countries being visited, travelers preferences, and values. Travelers should consult with a doctor so that there is sufficient time for completion of optimal vaccination schedules. No matter where traveling, one should be aware of potential exposure to certain organisms that can cause severely illnesses, even death. There is no doubt that vaccines have reduced or virtually eliminated many diseases that killed or severely disabled children and adults just a few generations ago. Thus, travelers must take recommended vaccines per schedule before traveling to India.

Acceptability of meningococcal serogroup B vaccine among parents and health care workers in Italy: A survey

PubMed Central

Mameli, Chiara; Faccini, Marino; Mazzali, Cristina; Picca, Marina; Colella, Giacomo; Duca, Pier Giorgio; Zuccotti, Gian Vincenzo

2014-01-01

A new meningococcal serogroup B vaccine (4CMenB) has recently been licensed. This study assessed the acceptability of 4CMenB vaccine among parents and healthcare workers (HCWs). From May to July 2013 in Milan, Italy, self-administered questionnaires were distributed to 2050 parents of infants presenting at immunization clinics for the mandatory hexavalent vaccination and submitted to 350 HCWs involved in immunization practices. 1842 parents (89.1%) responded to the survey; 64.4% of parents wanted their child to receive the 4CMenB vaccine and 5.1% would not vaccinate their children. Multivariate analysis showed that recognition of the severity of meningitis [a life threatening vs a mild or unthreatening disease (Odds ratio (OR): 2.3; confidence interval (CI): 1.4–3.6], awareness of vaccination as a beneficial preventive measure (very beneficial vs not beneficial OR = 6.4; CI 3.0–13.7) and knowledge of the Meningococcal C vaccine (OR = 1.4; CI 1.1–1.8) were strongly associated to willingness to receive 4CMenB vaccine. On the contrary, level of education was associated with refusal of immunization (university vs education level lower than middle school OR = 0.68; CI 0.47–0.97). Among the parents who were willing to immunize their children, 66.9% would agree with three injections to be administered during the same visit. A total of 291 HCWs (83.1%) agreed to participate in the survey; 73% considered 4CMenB vaccine a priority in infants’ immunization schedule; 26.8% of HCWs suggested the concomitant administration with routine infant immunization. Parental and HCWs acceptability of 4CMenB vaccine was high. Increasing knowledge about meningitis and vaccine prevention might further increase the acceptability of this vaccine. PMID:25483638

The costs of future polio risk management policies.

PubMed

Tebbens, Radboud J Duintjer; Sangrujee, Nalinee; Thompson, Kimberly M

2006-12-01

Decisionmakers need information about the anticipated future costs of maintaining polio eradication as a function of the policy options under consideration. Given the large portfolio of options, we reviewed and synthesized the existing cost data relevant to current policies to provide context for future policies. We model the expected future costs of different strategies for continued vaccination, surveillance, and other costs that require significant potential resource commitments. We estimate the costs of different potential policy portfolios for low-, middle-, and high-income countries to demonstrate the variability in these costs. We estimate that a global transition from routine immunization with oral poliovirus vaccine (OPV) to inactivated poliovirus vaccine (IPV) would increase the costs of managing polio globally, although routine IPV use remains less costly than routine OPV use with supplemental immunization activities. The costs of surveillance and a stockpile, while small compared to routine vaccination costs, represent important expenditures to ensure adequate response to potential outbreaks. The uncertainty and sensitivity analyses highlight important uncertainty in the aggregated costs and demonstrates that the discount rate and uncertainty in price and administration cost of IPV drives the expected incremental cost of routine IPV vs. OPV immunization.

Predictors of childhood immunization completion in a rural population.

PubMed

Gore, P; Madhavan, S; Curry, D; McClung, G; Castiglia, M; Rosenbluth, S A; Smego, R A

1999-04-01

Despite the availability of effective vaccines, immunization rates among two-year old children continue to be low in many areas of the United States including rural West Virginia. The goal of this study was to identify barriers to childhood immunization in rural West Virginia and determine factors that were important in the completion of the childhood immunization schedule. A telephone survey was used to collect data from a randomly selected sample of 316 mothers, of two-year olds, from 18 rural counties of West Virginia. Results indicated that two-thirds or 65% of the children in the study sample had completed their recommended immunizations by two years of age. Immunization barriers identified in this study include: living in health professional shortage areas, lack of health insurance, negative beliefs and attitudes regarding childhood immunizations, problems accessing the immunization clinic, and a perception of inadequate support from the immunization clinic. Results of the structural equation modeling, using LISREL-8, indicated that 20% of the variation in immunization completion (R2 = 0.197) was explained by attitude towards immunization and perceived support received from the immunization clinic. Furthermore, 42% of the variation in attitude towards immunization (R2 = 0.419) was explained by immunization-related beliefs, and 28% of the variation in immunization-related beliefs (the R2 = 0.277) was explained by general problems faced during immunization and perceived clinic support. The study concluded that positive immunization-related beliefs and attitudes, support from the immunization clinic, and ease of the immunization seeking process are important factors in the timely completion of the childhood immunization schedule.

Well-Child-Care - A Check-Up for Success

MedlinePlus

... Size Email Print Share AAP Schedule of Well-Child Care Visits Page Content Parents know who they ... old 21 years old The Benefits of Well-Child Visits: Prevention . Your child gets scheduled immunizations to ...

Hanford Site Environmental Surveillance Master Sampling Schedule for Calendar Year 2007

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bisping, Lynn E.

2007-01-31

This document contains the calendar year 2007 schedule for the routine collection of samples for the Surface Environmental Surveillance Project and Drinking Water Monitoring Project. Each section includes sampling locations, sampling frequencies, sample types, and analyses to be performed. In some cases, samples are scheduled on a rotating basis and may not be collected in 2007 in which case the anticipated year for collection is provided. Maps showing approximate sampling locations are included for media scheduled for collection in 2007.

Prevention of group B streptococcal disease in the first 3 months of life: would routine maternal immunization during pregnancy be cost-effective?

PubMed

Oster, Gerry; Edelsberg, John; Hennegan, Kalin; Lewin, Clement; Narasimhan, Vas; Slobod, Karen; Edwards, Morven S; Baker, Carol J

2014-08-20

A vaccine against group B streptococcus (GBS) that is intended for routine maternal immunization during pregnancy is in clinical development. Addition of vaccination to screening and intrapartum antibiotic prophylaxis (IAP) may further reduce the burden of GBS disease in infancy; its potential cost-effectiveness is unknown, however. We evaluated the cost-effectiveness of routine immunization at week 28 of pregnancy with the trivalent GBS (serotypes Ia, Ib and III) vaccine that is in clinical development. The vaccine was assumed to be used in addition to screening and IAP, and reduce the risk of invasive infection in infancy due to covered serotypes. We estimated the effectiveness of immunization in terms of additional cases of GBS disease prevented, deaths averted, life-years saved, and quality-adjusted life-years (QALYs) gained; potential reductions in prematurity and stillbirths were not considered. Costs considered included those of acute care for infants with GBS disease, and chronic care for those with long-term disability. The cost of immunization was assumed to be $100 per person. Assuming 85% coverage, routine maternal immunization against GBS added to screening and IAP would prevent an additional 899 cases of GBS disease and an additional 35 deaths among infants in the US. The total annual cost of immunization would be $362.7 million; estimated cost savings from prevention of GBS disease in infancy would be $43.5 million. The cost-effectiveness of immunization was estimated to be $91,321 per QALY gained. Findings were sensitive to assumptions regarding vaccine efficacy and cost. Addition of a trivalent GBS maternal vaccine to screening and IAP might further reduce the burden of GBS disease among infants in the US, and may be comparable in cost-effectiveness to other vaccines recently approved for use in children and adolescents. Copyright © 2014 Elsevier Ltd. All rights reserved.

NASA's Software Bank (CLIPS)

NASA Technical Reports Server (NTRS)

1992-01-01

C Language Integrated Production System (CLIPS) was used by Esse Systems to develop an expert system for clients who want to automate portions of their operations. The resulting program acts as a scheduling expert and automates routine, repetitive scheduling decisions, allowing employees to spend time on more creative projects.

Development of pediatric vaccine recommendations and policies.

PubMed

Pickering, Larry K; Orenstein, Walter A

2002-07-01

A significant decrease in each vaccine-preventable disease has occurred since the introduction of the respective immunizations now included in the recommended childhood immunization schedule. The process through which a vaccine must travel from development to approval and implementation is complex. Hurdles include receiving approval from several advisory committees, government agencies, and professional organizations. At each step in the process, data regarding safety, immunogenicity, and efficacy are evaluated continuously and rigorously. Once a vaccine is approved by the Food and Drug Administration (FDA) and incorporated into the recommended childhood immunization schedule, continuing issues include those that deal with supply, safety, effectiveness, and financing. The logistics of development and implementation of pediatric vaccine recommendations and policies are reviewed.

Evaluation of the immunogenicity of the quadrivalent HPV vaccine using 2 versus 3 doses at month 21: An epidemiological surveillance mechanism for alternate vaccination schemes

PubMed Central

Hernández-Ávila, Mauricio; Torres-Ibarra, Leticia; Stanley, Margaret; Salmerón, Jorge; Cruz-Valdez, Aurelio; Muñoz, Nubia; Herrero, Rolando; Villaseñor-Ruíz, Ignacio F; Lazcano-Ponce, Eduardo

2016-01-01

The cost of HPV vaccines and the need for 3 doses remains a barrier for their inclusion in routine vaccination schedules for girls in low and middle income countries. In a non-inferiority study, we aimed to compare the immunogenicity of a standard 3 doses and a 2 doses schedule. We enrolled 450 participants in an open-label non-randomized clinical trial to evaluate the immunogenicity induced at different ages by the licensed HPV6/11/16/18 quadrivalent vaccine in a 2 doses schedule (0–6 months, n = 150 girls aged 9–10 y) and 3 doses schedule (0, 2, and 6 months; n = 150 girls aged 9–10 y and n=150 women aged 18 to 24 years). To assess the antibody response, blood samples were obtained at Month 7 and 21 after the first vaccination from participants in all study groups. cLIA testing was performed at Merck Research Laboratories. Antibody levels were expressed as milli-Merck units (mMU) per ml. Primary outcome was non-inferiority (95% CI, lower bound >0.5) of the geometric mean titers (GMT) ratios for HPV6, HPV11, HPV16 and HPV18 antibodies 7 and 21 months after the first dose among girls receiving 2 doses compared with young women and girls receiving 3 doses. All vaccinees were seropositive for both HPV16 and HPV18 antibodies at month 7. At month 21, 98.5 and 56.6% of women 18–24 y old were seropositive for HPV16 and 18, respectively. For girls in the three doses group, seropositivity rates were 99.3 and 86.3% for HPV16 and 18, respectively. For girls in the two doses group rates were 99.3 and 70.2% for HPV16 and 18, respectively. The two doses schedule was non-inferior compared to the 3 doses schedule in same-age girls and to the group of adult women after 21 months of the first vaccine dose. Our results are in agreement with similar trials evaluating the immune response of a 2 doses schedule of both HPV vaccines, supporting the recent WHO recommendation as well as the Mexican policy to incorporate the 2 doses schedule for girls aged 9–11 y. PMID:26211489

Modeling options to manage type 1 wild poliovirus imported into Israel in 2013.

PubMed

Kalkowska, Dominika A; Duintjer Tebbens, Radboud J; Grotto, Itamar; Shulman, Lester M; Anis, Emilia; Wassilak, Steven G F; Pallansch, Mark A; Thompson, Kimberly M

2015-06-01

After 25 years without poliomyelitis cases caused by circulating wild poliovirus (WPV) in Israel, sewage sampling detected WPV type 1 (WPV1) in April 2013, despite high vaccination coverage with only inactivated poliovirus vaccine (IPV) since 2005. We used a differential equation-based model to simulate the dynamics of poliovirus transmission and population immunity in Israel due to past exposure to WPV and use of oral poliovirus vaccine (OPV) in addition to IPV. We explored the influences of various immunization options to stop imported WPV1 circulation in Israel. We successfully modeled the potential for WPVs to circulate without detected cases in Israel. Maintaining a sequential IPV/OPV schedule instead of switching to an IPV-only schedule in 2005 would have kept population immunity high enough in Israel to prevent WPV1 circulation. The Israeli response to WPV1 detection prevented paralytic cases; a more rapid response might have interrupted transmission more quickly. IPV-based protection alone might not provide sufficient population immunity to prevent poliovirus transmission after an importation. As countries transition to IPV in immunization schedules, they may need to actively manage population immunity and consider continued use of OPV, to avoid the potential circulation of imported live polioviruses before globally coordinated cessation of OPV use. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Indian Academy of Pediatrics (IAP) recommended immunization schedule for children aged 0 through 18 years--India, 2014 and updates on immunization.

PubMed

Vashishtha, Vipin M; Choudhury, Panna; Kalra, Ajay; Bose, Anuradha; Thacker, Naveen; Yewale, Vijay N; Bansal, C P; Mehta, Pravin J

2014-10-01

There is a need to review/revise recommendations about existing vaccines in light of recent developments in the field of vaccinology. Following an IAP ACVIP meeting on April 19 and 20, 2014, a draft of revised recommendations for the year 2014 and updates on certain vaccine formulations was prepared and circulated among the meeting participants to arrive at a consensus. To review and revise recommendations for 2014 Immunization timetable for pediatricians in office practice and issue statements on certain new and existing vaccine formulations. The major changes in the 2014 Immunization Timetable include two doses of MMR vaccine at 9 and 15 months of age, single dose recommendation for administration of live attenuated H2 strain hepatitis A vaccine, inclusion of two new situations in high-risk category of children in context with pre-exposure prophylaxis of rabies, creation of a new slot at 9-12 months of age for typhoid conjugate vaccine for primary immunization, and recommendation of two doses of human papilloma virus vaccines with a minimum interval of 6 months between doses for primary schedule of adolescent/preadolescent girls aged 9-14 years. There would not be any change to the committee's last year's (2013) recommendations on pertussis vaccination and administration schedule of monovalent human rotavirus vaccine. There is no need of providing additional doses of whole-cell pertussis vaccine to children who have earlier completed their primary schedule with acellular pertussis vaccine-containing products. A brief update on the new Indian Rotavirus vaccine, 116E is also provided. The committee has reviewed and offered its recommendations on the currently available pentavalent vaccine (DTwP+Hib+Hepatitis-B) combinations in Indian market. The comments and footnotes for several vaccines are also updated and revised.

On-Line Data Reconstruction in Redundant Disk Arrays.

DTIC Science & Technology

1994-05-01

each sale, - file servers that support a large number of clients with differing work schedules , and * automated teller networks in banking systems...24KB Head scheduling : FIFO User data layout: Sequential in address space of array Disk spindles: Synchronized Table 2.2: Default array parameters for...package and a set of scheduling and queueing routines. 2.3.3. Default workload This dissertation reports on many performance evaluations. In order to

Effect of vaccination schedule on immune response of Macaca mulatta to cell culture-grown Rocky Mountain spotted fever vaccine.

PubMed Central

Sammons, L S; Kenyon, R H; Pedersen, C E

1976-01-01

The effect of vaccination schedule on the immune response of Macaca mulatta to formalin-inactivated chicken embryo cell culture (CEC)-grown Rickettsia rickettsii vaccine was studied. Schedules consisted of inoculation on day 1 only, on days 1 and 15, on days 1 and 30, on days 1, 8, and 15, or on days 1, 15, and 45. Humoral antibody measured by microagglutination and indirect immunofluorescence and resistance to challenge with 10(4) plaque-forming units of yolk sac-grown R. rickettsii were assessed. Seroconversion was noted in all monkeys after the first dose of vaccine. A second dose administered 8 or 15 days after the primary infection, or a third given 7 or 30 days after the second, produced no long-term effect on antibody titer. Only monkeys given two doses of vaccine at a 30-day interval showed an increase in antibody titer during the period before challenge. Vaccination with one, two, or three doses of CEC vaccine prevented development of rash and rickettsemia after challenge. The two-dose schedules appeared to induce the highest degree of resistance to challenge, as indicated by unaltered hematological parameters and body temperature in monkeys. The one- and three-dose schedules were somewhat less effective, in that some challenged monkeys within each group displayed febrile and leukocyte responses associated with Rocky Mountain spotted fever infection. Our data suggest that administration of two doses of CEC vaccine at 15- or 30-day intervals is the immunization schedule of choice. PMID:823173

Your Baby's First Vaccines

MedlinePlus

... Link Vaccines & Immunizations Immunization Schedules Your Child's First Vaccines Format: Select One PDF [336K] RTF [260K] Recommend ... child will get one or more of these vaccines today: DTaP Hib Hepatitis B Polio PCV13 Why ...

Factors associated with routine immunization coverage of children under one year old in Lao People's Democratic Republic.

PubMed

Phoummalaysith, Bounfeng; Yamamoto, Eiko; Xeuatvongsa, Anonh; Louangpradith, Viengsakhone; Keohavong, Bounxou; Saw, Yu Mon; Hamajima, Nobuyuki

2018-05-03

Routine vaccination is administered free of charge to all children under one year old in Lao People's Democratic Republic (Lao PDR) and the national goal is to achieve at least 95% coverage with all vaccines included in the national immunization program by 2025. In this study, factors related to the immunization system and characteristics of provinces and districts in Lao PDR were examined to evaluate the association with routine immunization coverage. Coverage rates for Bacillus Calmette-Guerin (BCG), Diphtheria-Tetanus-Pertussis-Hepatitis B (DTP-HepB), DTP-HepB-Hib (Haemophilus influenzae type B), polio (OPV), and measles (MCV1) vaccines from 2002 to 2014 collected through regular reporting system, were used to identify the immunization coverage trends in Lao PDR. Correlation analysis was performed using immunization coverage, characteristics of provinces or districts (population, population density, and proportion of poor villages and high-risk villages), and factors related to immunization service (including the proportions of the following: villages served by health facility levels, vaccine session types, and presence of well-functioning cold chain equipment). To determine factors associated with low coverage, provinces were categorized based on 80% of DTP-HepB-Hib3 coverage (<80% = low group; ≥80% = high group). Coverages of BCG, DTP-HepB3, OPV3 and MCV1 increased gradually from 2007 to 2014 (82.2-88.3% in 2014). However, BCG coverage showed the least improvement from 2002 to 2014. The coverage of each vaccine correlated with the coverage of the other vaccines and DTP-HepB-Hib dropout rate in provinces as well as districts. The provinces with low immunization coverage were correlated with higher proportions of poor villages. Routine immunization coverage has been improving in the last 13 years, but the national goal is not yet reached in Lao PDR. The results of this study suggest that BCG coverage and poor villages should be targeted to improve nationwide coverage. Copyright © 2018 Elsevier Ltd. All rights reserved.

Contribution of Global Polio Eradication Initiative–Funded Personnel to the Strengthening of Routine Immunization Programs in the 10 Focus Countries of the Polio Eradication and Endgame Strategic Plan

PubMed Central

Swift, Rachel D.; Anaokar, Sameer; Hegg, Lea Anne; Eggers, Rudolf; Cochi, Stephen L.

2017-01-01

Abstract Background. The Polio Eradication and Endgame Strategic Plan (PEESP) established a target that at least 50% of the time of personnel receiving funding from the Global Polio Eradication Initiative (GPEI) for polio eradication activities (hereafter, “GPEI-funded personnel”) should be dedicated to the strengthening of immunization systems. This article describes the self-reported profile of how GPEI-funded personnel allocate their time toward immunization goals and activities beyond those associated with polio, the training they have received to conduct tasks to strengthen routine immunization systems, and the type of tasks they have conducted. Methods. A survey of approximately 1000 field managers of frontline GPEI-funded personnel was conducted by Boston Consulting Group in the 10 focus countries of the PEESP during 2 phases, in 2013 and 2014, to determine time allocation among frontline staff. Country-specific reports on the training of GPEI-funded personnel were reviewed, and an analysis of the types of tasks that were reported was conducted. Results. A total of 467 managers responded to the survey. Forty-seven percent of the time (range, 23%–61%) of GPEI-funded personnel was dedicated to tasks related to strengthening immunization programs, other than polio eradication. Less time was spent on polio-associated activities in countries that had already interrupted wild poliovirus (WPV) transmission, compared with findings for WPV-endemic countries. All countries conducted periodic trainings of the GPEI-funded personnel. The types of non–polio-related tasks performed by GPEI-funded personnel varied among countries and included surveillance, microplanning, newborn registration and defaulter tracing, monitoring of routine immunization activities, and support of district immunization task teams, as well as promotion of health behaviors, such as clean-water use and good hygiene and sanitation practices. Conclusion. In all countries, GPEI-funded personnel perform critical tasks in the strengthening of routine immunization programs and the control of measles and rubella. In certain countries with very weak immunization systems, GPEI-funded personnel provide critical support for the immunization programs, and sudden discontinuation of their employment would potentially disrupt the immunization programs in their countries and create a setback in capacity and effectiveness that would put children at higher risk for vaccine-preventable diseases. PMID:28838165

Contribution of Global Polio Eradication Initiative-Funded Personnel to the Strengthening of Routine Immunization Programs in the 10 Focus Countries of the Polio Eradication and Endgame Strategic Plan.

PubMed

van den Ent, Maya M V X; Swift, Rachel D; Anaokar, Sameer; Hegg, Lea Anne; Eggers, Rudolf; Cochi, Stephen L

2017-07-01

The Polio Eradication and Endgame Strategic Plan (PEESP) established a target that at least 50% of the time of personnel receiving funding from the Global Polio Eradication Initiative (GPEI) for polio eradication activities (hereafter, "GPEI-funded personnel") should be dedicated to the strengthening of immunization systems. This article describes the self-reported profile of how GPEI-funded personnel allocate their time toward immunization goals and activities beyond those associated with polio, the training they have received to conduct tasks to strengthen routine immunization systems, and the type of tasks they have conducted. A survey of approximately 1000 field managers of frontline GPEI-funded personnel was conducted by Boston Consulting Group in the 10 focus countries of the PEESP during 2 phases, in 2013 and 2014, to determine time allocation among frontline staff. Country-specific reports on the training of GPEI-funded personnel were reviewed, and an analysis of the types of tasks that were reported was conducted. A total of 467 managers responded to the survey. Forty-seven percent of the time (range, 23%-61%) of GPEI-funded personnel was dedicated to tasks related to strengthening immunization programs, other than polio eradication. Less time was spent on polio-associated activities in countries that had already interrupted wild poliovirus (WPV) transmission, compared with findings for WPV-endemic countries. All countries conducted periodic trainings of the GPEI-funded personnel. The types of non-polio-related tasks performed by GPEI-funded personnel varied among countries and included surveillance, microplanning, newborn registration and defaulter tracing, monitoring of routine immunization activities, and support of district immunization task teams, as well as promotion of health behaviors, such as clean-water use and good hygiene and sanitation practices. In all countries, GPEI-funded personnel perform critical tasks in the strengthening of routine immunization programs and the control of measles and rubella. In certain countries with very weak immunization systems, GPEI-funded personnel provide critical support for the immunization programs, and sudden discontinuation of their employment would potentially disrupt the immunization programs in their countries and create a setback in capacity and effectiveness that would put children at higher risk for vaccine-preventable diseases. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Factors influencing HPV vaccine delivery by healthcare professionals at public health posts in São Paulo, Brazil.

PubMed

Figueroa-Downing, Daniella; Baggio, Maria Luiza; Baker, Misha L; Dias De Oliveira Chiang, Ellen; Villa, Luisa L; Eluf Neto, Jose; Evans, Dabney P; Bednarczyk, Robert A

2017-01-01

To assess the association between Brazilian healthcare providers' characteristics and their knowledge, perceptions, and practices regarding the HPV vaccine. An observational cross-sectional study was conducted at five public health posts in São Paulo between July 28 and August 8, 2014. Healthcare professionals directly involved in patient care were asked to complete a written survey. Factors associated with routine verification of HPV vaccination status were evaluated using Poisson regression. Among 200 participants included, 74 (38.5%) reported never and 70 (36.5%) reported always asking about HPV immunization status. Doctors were significantly less likely to report always asking than were community health agents (5/39 [12.8%] vs 32/60 [53.3%]; adjusted prevalence ratio [aPR] 0.25 [95% confidence interval (CI) 0.07-0.91]). Knowledge about the correct dosing schedule was associated with always rather than never verifying vaccination status (aPR 2.46 [95% CI 1.06-5.70]). Knowledge and attitude played secondary roles in influencing HPV vaccine verification. Community health agents were crucial for vaccine promotion; continued education and support of this group is essential for the sustained success of HPV immunization efforts in Brazil. © 2016 International Federation of Gynecology and Obstetrics.

[Inactivated poliovirus vaccines: an inevitable choice for eliminating poliomyelitis].

PubMed

Vidor, J D; Jean-Denis, Shu

2016-12-06

The inactivated poliovirus vaccine (IPV) is a very old tool in the fight against poliomyelitis. Though supplanted by oral poliovirus vaccine (OPV) in the 1960s and 1970s, the IPV has now become an inevitable choice because of the increasingly recognized risks associated with continuous use of OPVs. Following the pioneering work of Jonas Salk, who established key principles for the IPV, considerable experience has accumulated over the years. This work has led to modern Salk IPV-containing vaccines, based on the use of inactivated wildtype polioviruses, which have been deployed for routine use in many countries. Very good protection against paralysis is achieved with IPV through the presence of circulating antibodies able to neutralize virus infectivity toward motor neurons. In addition, with IPV, a variable degree of protection against mucosal infection (and therefore transmission) through mucosal antibodies and immune cells is achieved, depending on previous exposure of subjects to wildtype or vaccine polioviruses. The use of an IPV-followed-by-OPV sequential immunization schedule has the potential advantage of eliminating the vaccine-associated paralytic poliomyelitis (VAPP) risk, while limiting the risks of vaccine-derived poliovirus (VDPVs). Sabin strain-derived IPVs are new tools, only recently beginning to be deployed, and data are being generated to document their performance. IPVs will play an irreplaceable role in global eradication of polio.

Community Engagement in Liberia: Routine Immunization Post-Ebola.

PubMed

Bedford, Juliet; Chitnis, Ketan; Webber, Nance; Dixon, Phil; Limwame, Ken; Elessawi, Rania; Obregon, Rafael

2017-01-01

A national integrated polio, measles, and deworming campaign was implemented across Liberia May 8-14, 2015. The community engagement and social mobilization component of the campaign was based on structures that had been invested in during the Ebola response. This article provides an overview of the community engagement and social mobilization activities that were conducted and reports the key findings of a rapid qualitative assessment conducted immediately after the campaign that focused on community perceptions of routine immunization in the post-Ebola context. Focus group discussions and interviews were conducted across four counties in Liberia (Montserrado, Nimba, Bong, and Margibi). Thematic analysis identified the barriers preventing and drivers leading to the utilization of routine immunization. Community members also made recommendations and forwarded community-based solutions to encourage engagement with future health interventions, including uptake in vaccination campaigns. These should be incorporated in the development and implementation of future interventions and programs.

75 FR 999 - Records Schedules; Availability and Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-07

... temporary items). Claims, allowances, and individual trusts relating to the World War I alien property... process is available on request. Schedules Pending 1. Department of Agriculture, Agency-wide (N1-16-10-4, 1 item, 1 temporary item). Routine surveillance recordings, which were previously approved for...

Dutch national immunization schedule: compliance and associated characteristics for the primary series.

PubMed

Scheepers, Elsemieke D; van Lier, Alies; Drijfhout, Ingrid H; Berbers, Guy; van der Maas, Nicoline A T; de Melker, Hester E; Knol, Mirjam J

2017-06-01

In the Netherlands, the recommended priming immunization schedule for diphtheria, tetanus, pertussis and polio (DTaP-IPV) is at 2, 3 and 4 months of age. We evaluated the compliance with the recommended schedule, as well as its characteristics. We included all infants born between 2007 and 2012 who received minimally one DTaP-IPV vaccination (n = 1,061,578). Infants complied with the schedule if they received the first vaccination between 6 and 9 weeks of age, and the second and third vaccination 2-6 weeks after the first and second vaccination. We examined associations between compliance and several characteristics using log-binomial regression. Compliance for the first, second and third vaccination was 81.6, 88.3 and 84.2%, respectively. Compliance with the total recommended schedule was 64.5%, and increased from 60.1% for 2007 to 68.5% for 2012. Compliance was higher for full-term infants (65.9%), infants with normal birth weight (66.0%) and when both parents were born in the Netherlands (66.8%). Delayed vaccination during the primary vaccination schedule occurs in one sixth of the Dutch children. Efforts to improve compliance should be focused in particular on preterm infants, infants with low birth weight and infants whose parents are not born in the Netherlands. What is Known: • A delayed start of vaccination leads to a longer period at risk for infectious diseases, e.g. pertussis • Delayed vaccination is associated with several factors including prematurity, low birth weight, family size, birth order, low socioeconomic status and health status of the child What is New: • Compliance with the recommended priming immunization schedule for diphtheria, tetanus, pertussis and polio was 64.5%, and increased from 60.1% for 2007 to 68.5% for 2012 • If the first vaccination was delayed, there was a higher chance that the following vaccinations were administered 'out-of-schedule' as well, resulting in even a higher age at second and third vaccination.

Metronomic cyclophosphamide eradicates large implanted GL261 gliomas by activating antitumor Cd8+ T-cell responses and immune memory

PubMed Central

Wu, Junjie; Waxman, David J

2015-01-01

Cancer chemotherapy using cytotoxic drugs can induce immunogenic tumor cell death; however, dosing regimens and schedules that enable single-agent chemotherapy to induce adaptive immune-dependent ablation of large, established tumors with activation of long-term immune memory have not been identified. Here, we investigate this issue in a syngeneic, implanted GL261 glioma model in immune-competent mice given cyclophosphamide on a 6-day repeating metronomic schedule. Two cycles of metronomic cyclophosphamide treatment induced sustained upregulation of tumor-associated CD8+ cytotoxic T lymphocyte (CTL) cells, natural killer (NK) cells, macrophages, and other immune cells. Expression of CTL- and NK–cell-shared effectors peaked on Day 6, and then declined by Day 9 after the second cyclophosphamide injection and correlated inversely with the expression of the regulatory T cell (Treg) marker Foxp3. Sustained tumor regression leading to tumor ablation was achieved after several cyclophosphamide treatment cycles. Tumor ablation required CD8+ T cells, as shown by immunodepletion studies, and was associated with immunity to re-challenge with GL261 glioma cells, but not B16-F10 melanoma or Lewis lung carcinoma cells. Rejection of GL261 tumor re-challenge was associated with elevated CTLs in blood and increased CTL infiltration in tumors, consistent with the induction of long-term, specific CD8+ T-cell anti-GL261 tumor memory. Co-depletion of CD8+ T cells and NK cells did not inhibit tumor regression beyond CD8+ T-cell depletion alone, suggesting that the metronomic cyclophosphamide-activated NK cells function via CD8a+ T cells. Taken together, these findings provide proof-of-concept that single-agent chemotherapy delivered on an optimized metronomic schedule can eradicate large, established tumors and induce long-term immune memory. PMID:26137402

Polio immunity and the impact of mass immunization campaigns in the Democratic Republic of the Congo.

PubMed

Voorman, Arend; Hoff, Nicole A; Doshi, Reena H; Alfonso, Vivian; Mukadi, Patrick; Muyembe-Tamfum, Jean-Jacques; Wemakoy, Emile Okitolonda; Bwaka, Ado; Weldon, William; Gerber, Sue; Rimoin, Anne W

2017-10-09

In order to prevent outbreaks from wild and vaccine-derived poliovirus, maintenance of population immunity in non-endemic countries is critical. We estimated population seroprevalence using dried blood spots collected from 4893 children 6-59months olds in the 2013-2014 Demographic and Health Survey in the Democratic Republic of the Congo (DRC). Population immunity was 81%, 90%, and 70% for poliovirus types 1, 2, and 3, respectively. Among 6-59-month-old children, 78% reported at least one dose of polio in routine immunization, while only 15% had three doses documented on vaccination cards. All children in the study had been eligible for at least two trivalent oral polio vaccine campaigns at the time of enrollment; additional immunization campaigns seroconverted 5.0%, 14%, and 5.5% of non-immune children per-campaign for types 1, 2, and 3, respectively, averaged over relevant campaigns for each serotype. Overall polio immunity was high at the time of the study, though pockets of low immunity cannot be ruled out. The DRC still relies on supplementary immunization campaigns, and this report stresses the importance of the quality and coverage of those campaigns over their quantity, as well as the importance of routine immunization. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Childhood immunization: one HMO's experience in benchmarking and improving plan performance.

PubMed

Keitel, C

1995-01-01

In 1994, Health Net initiated a childhood immunization campaign and research project to improve health plan member immunization rates by motivating and educating parents of children 20-32 months old as to the importance of fully immunizing their child. The findings indicate that 88 percent of those parents with children who were not fully immunized believed their child had been fully immunized by age two. This lack of awareness may explain the unreliability of self-reported immunization status. Future immunization campaigns must include ongoing member reminder systems, educate members as to the immunization schedule, and must take into consideration the barriers, real and perceived, that block full immunization.

Impact of meningococcal C conjugate vaccination four years after introduction of routine childhood immunization in Brazil.

PubMed

Andrade, Ana Lucia; Minamisava, Ruth; Tomich, Lisia Moura; Lemos, Ana Paula; Gorla, Maria Cecilia; de Cunto Brandileone, Maria Cristina; Domingues, Carla Madga S; de Moraes, Camile; Policena, Gabriela; Bierrenbach, Ana Luiza

2017-04-11

Routine infant immunization with meningococcal C conjugate (MCC) vaccination started in Brazil in November 2010, scheduled at three and five months plus a booster at 12-15months of age. No catch-up was implemented. We assessed the impact of vaccination on meningococcal C disease (MenC) four years after vaccination start in the National Immunization Program. We performed an ecological quasi-experimental design from 2008 to 2014 using a deterministic linkage between the National Notification and the National Reference Laboratory databases for meningitis. We conducted an interrupted time-series analysis considering Brazil except for Salvador municipality, because an epidemic of serogroup C disease occurred in this city, which prompted a mass vaccination campaign with catch-up for adolescents in 2010. Observed MenC rates in the post-vaccination period were compared to expected rates calculated from the pre-vaccination years. Results for Salvador were presented as descriptive data. An additional time-series analysis was performed for the state of São Paulo. A total of 18,136 MenC cases were analyzed. The highest incidence rates were observed for infants aged <12months and no second incident peak was observed for adolescents. For Brazil, MenC rates were reduced by 67.2% (95%CI 43.0-91.4%) for infants <12months of age, 92.0% (77.3-106.8%) for the age-group 12-23months, and 64.6% (24.6-104.5%) for children aged 2-4years. For children 5-9years old, MenC rates reduced 19.2% (9.5-28.9%). Overall, 955 MenC cases were averted in Brazil in individuals aged <40years after MCC vaccination. Results from São Paulo State, mirror the patterns seen in Brazil. After four years of infants and toddlers vaccination start, MenC invasive disease reduced in the target population. This investigation provide a robust baseline to ascertain how much the upcoming catch-up dose in 12-13years of age will accelerate the decrease in MenC incidence rates among youths in Brazil. Copyright © 2017. Published by Elsevier Ltd.

The composition of demand for newly launched vaccines: results from the pneumococcal and rotavirus vaccine introductions in Ethiopia and Malawi

PubMed Central

Kidane, Teklay; Chirwa, Geoffrey; Tesfaye, Neghist; Prescott, Marta R; Scotney, Soleine T; Valle, Moussa; Abebe, Sintayehu; Tambuli, Adija; Malewezi, Bridget; Mohammed, Tahir; Kobayashi, Emily; Wootton, Emily; Wong, Renee; Dosani, Rahima; Subramaniam, Hamsa; Joseph, Jessica; Yavuz, Elif; Apple, Aliza; Le Tallec, Yann; Kang’ethe, Alice

2016-01-01

Understanding post-launch demand for new vaccines can help countries maximize the benefits of immunization programmes. In particular, low- and middle-income countries (LMICs) should ensure adequate resource planning with regards to stock consumption and service delivery for new vaccines, whereas global suppliers must produce enough vaccines to meet demand. If a country underestimates the number of children seeking vaccination, a stock-out of commodities will create missed opportunities for saving lives. We describe the post-launch demand for the first dose of pneumococcal conjugate vaccine (PCV1) in Ethiopia and Malawi and the first dose of rotavirus vaccine (Rota1) in Malawi, with focus on the new birth cohort and the ‘backlog cohort’, comprised of older children who are still eligible for vaccination at the time of launch. PCV1 and Rota1 uptake were compared with the demand for the first dose of pentavalent vaccine (Penta1), a routine immunization that targets the same age group and immunization schedule. In the first year, the total demand for PCV1 was 37% greater than that of Penta1 in Ethiopia and 59% greater in Malawi. In the first 6 months, the demand of Rota1 was only 5.9% greater than Penta1 demand in Malawi. Over the first three post-introduction months, 70.7% of PCV1 demand in Ethiopia and 71.5% of demand in Malawi came from children in the backlog cohort, whereas only 28.0% of Rota1 demand in Malawi was from the backlog cohort. The composition of demand was impacted by time elapsed since vaccine introduction and age restrictions. Evidence suggests that countries’ plans should account for the impact of backlog demand, especially in the first 3 months post-introduction. LMICs should request for higher stock volumes when compared with routine needs, plan social mobilization activities to reach the backlog cohort and allocate human resources and cold chain capacity to accommodate high demand following vaccine introduction. PMID:26856361

[Comparative immunogenicity of 2 antirabies vaccines in a 2-1-1 post-exposure vaccination schedule].

PubMed

Landry, P; Lazzaro, M; Darioli, R

1998-09-09

Few trials have compared the Purified Duck Embryo Vaccine (PDEV) and the Human Diploid Cell Vaccine (HDCV) in a post-exposure immunization schedule of 4 shots (2 on day 0 and 1 each on day 7 and 21, or 2-1-1 schedule). A retrospective analysis compared 10 patients with PEDV and 20 with HDCV, who had received the 2-1-1 schedule as well as 20 UI mg/kg of immune globulins on day 0. The median neutralizing antibody titers on day 21 (after 3 doses) and the median of maximum titers until day 90 were higher for HDCV than for PEDV (0.6 IU/ml versus 3.5 IU/ml [p < 0.04] and 2.5 IU/ml versus 5.8 IU/ml [p < 0.03] respectively). Seven patients had not reached the seroconversion titer of 0.5 IU/ml after 3 doses (day 21). These results differ from previous studies showing a 100% seroconversion rate on day 21, and suggest that more studies are required before these 2 vaccines can be used in the 2-1-1 schedule after severe exposure.

Tracking financial flows for immunization in Honduras.

PubMed

Valdés, Werner; Janusz, Cara Bess; Molina Aguilera, Ida Berenice; Mendoza, Lourdes; Díaz, Iris Yolanda; Resch, Stephen

2015-05-07

In Honduras, until 2008, vaccine and injection supplies were financed with domestic resources. With the introduction of rotavirus vaccine in 2009 and pneumococcal conjugate in 2011, the country's Expanded Program on Immunization required an influx of resources to support not only vaccine procurement but also investments in cold chain infrastructure and programmatic strategies. This paper examines the origin, allocation, and use of resources for immunization in 2011 in Honduras, with the aim of identifying gaps in financing. An adaptation of the System of Health Accounts (2011) codes was used to specifically track resources for immunization services in Honduras for 2011. All financial flows were entered into an Excel database, and each transfer of resources was coded with a financing source and a financing agent. These coded financing sources were then distributed by provider, health care function (activity), health care provision (line item or resource input), and beneficiary (geographic, population, and antigen). All costs were calculated in 2011 United States dollars. In 2011, financing for routine immunization in Honduras amounted to US$ 49.1 million, which is equal to 3.3% of the total health spending of US$ 1.49 billion and 0.29% of the GDP. Of the total financing, 64% originate from domestic sources. The other 36% is external financing, most importantly Gavi support for introducing new vaccines. This analysis identified potential financing gaps for many immunization-related activities besides procuring vaccines, such as expanding the cold chain, training, social mobilization, information systems, and research. The funding for Honduras' immunization program is a small share of total public spending on health. However, new vaccines recently added to the schedule with financial support from Gavi have increased the financing requirements by more than 30% in comparison to 2008. The Honduran government and its partners are developing sustainability plans to cover a financing gap that will occur when the country graduates from Gavi support in 2016. Access to lower vaccine prices will make the existing and future program, including the planned introduction of HPV vaccine to adolescent girls, more affordable. Copyright © 2015. Published by Elsevier Ltd.

Too little but not too late: Results of a literature review to improve routine immunization programs in developing countries

PubMed Central

Ryman, Tove K; Dietz, Vance; Cairns, K Lisa

2008-01-01

Background Globally, immunization services have been the center of renewed interest with increased funding to improve services, acceleration of the introduction of new vaccines, and the development of a health systems approach to improve vaccine delivery. Much of the credit for the increased attention is due to the work of the GAVI Alliance and to new funding streams. If routine immunization programs are to take full advantage of the newly available resources, managers need to understand the range of proven strategies and approaches to deliver vaccines to reduce the incidence of diseases. In this paper, we present strategies that may be used at the sub-national level to improve routine immunization programs. Methods We conducted a systematic review of studies and projects reported in the published and gray literature. Each paper that met our inclusion criteria was rated based on methodological rigor and data were systematically abstracted. Routine-immunization – specific papers with a methodological rigor rating of greater than 60% and with conclusive results were reported. Results Greater than 11,000 papers were identified, of which 60 met our inclusion criteria and 25 papers were reported. Papers were grouped into four strategy approaches: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccination (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7). Conclusion Immunization programs are at a historical crossroads in terms of developing new funding streams, introducing new vaccines, and responding to the global interest in the health systems approach to improving immunization delivery. However, to complement this, actual service delivery needs to be strengthened and program managers must be aware of proven strategies. Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level. However it was startling to see how few papers were identified and in particular how few were of strong scientific quality. Further well-designed and well-conducted scientific research is warranted. Proposed areas of additional research include integration of additional services with immunization delivery, collaboration of immunization programs with new partners, best approaches to new vaccine introduction, and how to improve service delivery. PMID:18570677

Too little but not too late: results of a literature review to improve routine immunization programs in developing countries.

PubMed

Ryman, Tove K; Dietz, Vance; Cairns, K Lisa

2008-06-21

Globally, immunization services have been the center of renewed interest with increased funding to improve services, acceleration of the introduction of new vaccines, and the development of a health systems approach to improve vaccine delivery. Much of the credit for the increased attention is due to the work of the GAVI Alliance and to new funding streams. If routine immunization programs are to take full advantage of the newly available resources, managers need to understand the range of proven strategies and approaches to deliver vaccines to reduce the incidence of diseases. In this paper, we present strategies that may be used at the sub-national level to improve routine immunization programs. We conducted a systematic review of studies and projects reported in the published and gray literature. Each paper that met our inclusion criteria was rated based on methodological rigor and data were systematically abstracted. Routine-immunization - specific papers with a methodological rigor rating of greater than 60% and with conclusive results were reported. Greater than 11,000 papers were identified, of which 60 met our inclusion criteria and 25 papers were reported. Papers were grouped into four strategy approaches: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccination (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7). Immunization programs are at a historical crossroads in terms of developing new funding streams, introducing new vaccines, and responding to the global interest in the health systems approach to improving immunization delivery. However, to complement this, actual service delivery needs to be strengthened and program managers must be aware of proven strategies. Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level. However it was startling to see how few papers were identified and in particular how few were of strong scientific quality. Further well-designed and well-conducted scientific research is warranted. Proposed areas of additional research include integration of additional services with immunization delivery, collaboration of immunization programs with new partners, best approaches to new vaccine introduction, and how to improve service delivery.

Space shuttle maintenance program planning document

NASA Technical Reports Server (NTRS)

Brown, D. V.

1972-01-01

A means for developing a space shuttle maintenance program which will be acceptable to the development centers, the operators (KSC and AF), and the manufacturer is presented. The general organization and decision processes for determining the essential scheduled maintenance requirements for the space shuttle orbiter are outlined. The development of initial scheduled maintenance programs is discussed. The remaining maintenance, that is non-scheduled or non-routine maintenance, is directed by the findings of the scheduled maintenance program and the normal operation of the shuttle. The remaining maintenance consists of maintenance actions to correct discrepancies noted during scheduled maintenance tasks, nonscheduled maintenance, normal operation, or condition monitoring.

Assessing age-dependent susceptibility to measles in Japan.

PubMed

Kinoshita, Ryo; Nishiura, Hiroshi

2017-06-05

Routine vaccination against measles in Japan started in 1978. Whereas measles elimination was verified in 2015, multiple chains of measles transmission were observed in 2016. We aimed to reconstruct the age-dependent susceptibility to measles in Japan so that future vaccination strategies can be elucidated. An epidemiological model was used to quantify the age-dependent immune fraction using datasets of vaccination coverage and seroepidemiological survey. The second dose was interpreted in two different scenarios, i.e., booster and random shots. The effective reproduction number, the average number of secondary cases generated by a single infected individual, and the age at infection were explored using the age-dependent transmission model and the next generation matrix. While the herd immunity threshold of measles likely ranges from 90% to 95%, assuming that the basic reproductive number ranges from 10 to 20, the estimated immune fraction in Japan was below those thresholds in 2016, despite the fact that the estimates were above 80% for all ages. If the second dose completely acted as the booster shot, a proportion immune above 90% was achieved only among those aged 5years or below in 2016. Alternatively, if the second dose was randomly distributed regardless of primary vaccination status, a proportion immune over 90% was achieved among those aged below 25years. The effective reproduction number was estimated to range from 1.50 to 3.01 and from 1.50 to 3.00, respectively, for scenarios 1 and 2 in 2016; if the current vaccination schedule were continued, the reproduction number is projected to range from 1.50 to 3.01 and 1.39 to 2.78, respectively, in 2025. Japan continues to be prone to imported cases of measles. Supplementary vaccination among adults aged 20-49years would be effective if the chains of transmission continue to be observed in that age group. Copyright © 2017 Elsevier Ltd. All rights reserved.

An effective hybrid immune algorithm for solving the distributed permutation flow-shop scheduling problem

NASA Astrophysics Data System (ADS)

Xu, Ye; Wang, Ling; Wang, Shengyao; Liu, Min

2014-09-01

In this article, an effective hybrid immune algorithm (HIA) is presented to solve the distributed permutation flow-shop scheduling problem (DPFSP). First, a decoding method is proposed to transfer a job permutation sequence to a feasible schedule considering both factory dispatching and job sequencing. Secondly, a local search with four search operators is presented based on the characteristics of the problem. Thirdly, a special crossover operator is designed for the DPFSP, and mutation and vaccination operators are also applied within the framework of the HIA to perform an immune search. The influence of parameter setting on the HIA is investigated based on the Taguchi method of design of experiment. Extensive numerical testing results based on 420 small-sized instances and 720 large-sized instances are provided. The effectiveness of the HIA is demonstrated by comparison with some existing heuristic algorithms and the variable neighbourhood descent methods. New best known solutions are obtained by the HIA for 17 out of 420 small-sized instances and 585 out of 720 large-sized instances.

Human papillomavirus vaccination coverage using two-dose or three-dose schedule criteria.

PubMed

Lin, Xia; Rodgers, Loren; Zhu, Liping; Stokley, Shannon; Meites, Elissa; Markowitz, Lauri E

2017-10-13

In October 2016, the Advisory Committee on Immunization Practices (ACIP) updated the human papillomavirus (HPV) vaccination recommendation to include a 2-dose schedule for U.S. adolescents initiating the vaccine series before their 15th birthday. We analyzed records for >4million persons aged 9-17years receiving any HPV vaccine by the end of each quarter during January 1, 2014-September 30, 2016 from six Immunization Information Systems Sentinel Sites, and reclassified HPV vaccination up-to-date coverage according to the updated recommendations. Compared with HPV vaccination up-to-date coverage by the 3-dose schedule only, including criteria for either a 2-dose or 3-dose schedule increased up-to-date coverage in 11-12, 13-14, and 15-17 year-olds by 4.5-8.5 percentage points. The difference between 3-dose up-to-date coverage and 2- or 3-dose up-to-date coverage was greatest in late 2016. These data provide baseline HPV vaccination coverage using current ACIP recommendations. Published by Elsevier Ltd.

15 CFR Supplement No. 1 to Part 716 - Notification, Duration and Frequency of Inspections

Code of Federal Regulations, 2012 CFR

2012-01-01

... Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL... Schedule 3 Unscheduled discrete organic chemicals Notice of initial or routine inspection to USNA 72 hours... Inspection Team at the point of entry (routine) 48 hours prior to arrival of Inspection Team at the plant...

15 CFR Supplement No. 1 to Part 716 - Notification, Duration and Frequency of Inspections

Code of Federal Regulations, 2014 CFR

2014-01-01

... Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL... Schedule 3 Unscheduled discrete organic chemicals Notice of initial or routine inspection to USNA 72 hours... Inspection Team at the point of entry (routine) 48 hours prior to arrival of Inspection Team at the plant...

Priorities for early hearing detection and intervention in sub-Saharan Africa.

PubMed

Olusanya, Bolajoko O

2008-01-01

Sub-Saharan Africa not only has the highest rates of neonatal, infant, and child mortality worldwide but also accounts for a significant proportion of the global burden of permanent congenital and early-onset hearing loss (PCEHL). This article explores the diverse psychosocial, educational, and economic consequences of PCEHL in the region and highlights the interrelationships between this condition and the crucial domains of early childhood development. It also examines relevant levels of prevention and current practices within the context of the birthing patterns and routine immunization schedules in the first three months of life. It presents practical options for addressing the needs of children with PCEHL and their parents against the backdrop of the prevailing health and socioeconomic conditions. It concludes by underscoring the crucial dimensions of culturally-sensitive interventions as well as the need for ear-care professionals in each country to take advantage of the growing global initiatives for hearing impairment prevention within a multidisciplinary framework to advance the best interests of the affected children and their families.

Haemophilus influenzae type b meningitis in a vaccinated and immunocompetent child.

PubMed

Almeida, Ana F; Trindade, Eunice; B Vitor, Artur; Tavares, Margarida

Invasive Haemophilus influenzae type b (Hib) disease decreased dramatically after the introduction of conjugate vaccine in routine immunization schedules. We report a case of a fifteen-months-old girl, previously healthy and vaccinated, admitted in the emergency room with fever and vomiting. She was irritable and the Brudzinski's sign was positive. The cerebrospinal fluid (CSF) analysis showed pleocytosis and high protein level. Empiric intravenous antibiotics (ceftriaxone and vancomycin) were administered for suspected bacterial meningitis during 10 days. Serotyping of the Haemophilus influenzae strain found in CSF revealed a serotype b. After one year of follow-up no Hib meningitis sequelae were noted. Despite vaccination compliance and absence of risk factors, invasive Hib disease can occur due to vaccine failure. Efforts to keep the low incidence of invasive Hib disease should be directed to the maintenance of high vaccination coverage rates, combined with the notification and surveillance strategies already implemented in each country. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Systematic literature review comparing rapid 3-dose administration of the GSK tick-borne encephalitis vaccine with other primary immunization schedules.

PubMed

Galgani, Ilaria; Bunge, Eveline M; Hendriks, Lisa; Schludermann, Christopher; Marano, Cinzia; De Moerlooze, Laurence

2017-09-01

Tick-borne encephalitis (TBE), which is endemic across large regions of Europe and Asia, is most effectively prevented through vaccination. Three-dose primary TBE vaccination schedules are either rapid (0,7,21-days) or conventional (0,28-84-days, 9-12-months). The second dose can also be administered at 14 days for faster priming and sero-protection). Areas covered: We used a three-step selection process to identify 21 publications comparing the immunogenicity and/or safety of different schedules. Expert commentary: Priming with two or three TBE vaccine doses was highly immunogenic. After conventional priming (0-28 days), 95% adults and ≥95% children had neutralization test (NT) titers ≥10 at 14 days post-dose-2 compared with 92% adults and 99% children at 21 days post-dose-3 (rapid schedule). Most subjects retained NT titers ≥10 at day 300. A single booster dose induced a strong immune response in all subjects irrespective of primary vaccination schedule or elapsed time since priming. GMT peaked at 42 days post-dose-1 (i.e., 21 days post-dose 3 [rapid-schedule], or 14-28 days post-dose-2 [conventional-schedule]), and declined thereafter. Adverse events were generally rare and declined with increasing doses. In the absence of data to recommend one particular schedule, the regimen choice will remain at the physician's discretion, based on patient constraints and availability.

Budget impact analysis of vaccination against Haemophilus influenzae type b as a part of a Pentavalent vaccine in the childhood immunization schedule of Iran.

PubMed

Teimouri, Fatemeh; Kebriaeezadeh, Abbas; Zahraei, Seyed Mohsen; Gheiratian, MohammadMahdi; Nikfar, Shekoufeh

2017-01-14

Health decision makers need to know the impact of the development of a new intervention on the public health and health care costs so that they can plan for economic and financial objectives. The aim of this study was to determine the budget impact of adding Haemophilus influenzae type b (Hib) as a part of a Pentavalent vaccine (Hib-HBV-DTP) to the national childhood immunization schedule of Iran. An excel-based model was developed to determine the costs of including the Pentavalent vaccine in the national immunization program (NIP), comparing the present schedule with the previous one (including separate DTP and hepatitis B vaccines). The total annual costs included the cost of vaccination (the vaccine and syringe) and the cost of Hib treatment. The health outcome was the estimated annual cases of the diseases. The net budget impact was the difference in the total annual cost between the two schedules. Uncertainty about the vaccine effectiveness, vaccination coverage, cost of the vaccine, and cost of the diseases were handled through scenario analysis. The total cost of vaccination during 5 years was $18,060,463 in the previous program and $67,774,786 in the present program. Inclusion of the Pentavalent vaccine would increase the vaccination cost about $49 million, but would save approximately $6 million in the healthcare costs due to reduction of disease cases and treatment costs. The introduction of the Pentavalent vaccine resulted in a net increase in the healthcare budget expenditure across all scenarios from $43.4 million to $50.7 million. The results of this study showed that the inclusion of the Pentavalent vaccine in the NIP of Iran had a significant impact on the health care budget and increased the financial burden on the government. Budget impact of including Pentavalent vaccine in the national immunization schedule of Iranᅟ.

Evaluation of intradermal vaccination at the anti rabies vaccination OPD.

PubMed

Mankeshwar, R; Silvanus, V; Akarte, S

2014-09-01

Rabies is a virtually 100% fatal acute viral encephalitis caused by an RNA virus belonging to family Rhabdoviridae and genus Lyssavirus. The virus can infect all warm blooded animals. The disease is transmitted to humans by the bite, lick or scratch of an infected animal. More than 99% of all human rabies deaths occur in the developing world. It is preventable with timely and proper usage of modern immunobiologicals (vaccines and immunoglobulins). Once exposure occurs, modern prophylaxis entails immediate wound care, local infiltration of rabies immune globulin and parenteral administration of modern cell culture vaccines in multiple doses. The annual medicinal (vaccines and other drugs) cost for animal bite treatment is Rs. 2 billion approximately (2004). The objective of the present study is to evaluate the performance of the Intradermal (i.d.) route visa vis the Intramuscular (i.m.) route in our clinical setting the Antirabies Vaccination (ARV) OPD, Sir J.J. Hospital, Mumbai. A total of 1460 patients were administered the Antirabies vaccine by the Intradermal route over the 1 year period as compared to 1075 patients who were administered the Antirabies vaccine by the Intramuscular route in the previous year. 1230 (84.2) of the patients who were administered the vaccine by the i.d. route completed the schedule and 230 (15.8%) partially completed the schedule. Four hundred thirty two (40%) of the patients who were administered the vaccine by the Intramuscular route completed the schedule and 643 (59.8%) partially completed the schedule. The vaccine cost for i.d. was Rs. 2,80,600. The vaccine cost for the intramuscular (i.m.) assuming 84% compliance was estimated as Rs. 15, 64, 000. Assuming 40% compliance the cost was estimated as Rs. 7, 82, 230. Thus a saving of Rs. 5, 01, 630 to Rs. 12, 83, 400 was effected. In our setting, the Intradermal regime was cost effective and increased patient adherence and enrolment. It has now been routinely adopted at the clinic.

Country specific predictions of the cost-effectiveness of malaria vaccine RTS,S/AS01 in endemic Africa.

PubMed

Galactionova, Katya; Tediosi, Fabrizio; Camponovo, Flavia; Smith, Thomas A; Gething, Peter W; Penny, Melissa A

2017-01-03

RTS,S/AS01 is a safe and moderately efficacious vaccine considered for implementation in endemic Africa. Model predictions of impact and cost-effectiveness of this new intervention could aid in country adoption decisions. The impact of RTS,S was assessed in 43 countries using an ensemble of models of Plasmodium falciparum epidemiology. Informed by the 32months follow-up data from the phase 3 trial, vaccine effectiveness was evaluated at country levels of malaria parasite prevalence, coverage of control interventions and immunization. Benefits and costs of the program incremental to routine malaria control were evaluated for a four dose schedule: first dose administered at six months, second and third - before 9months, and fourth dose at 27months of age. Sensitivity analyses around vaccine properties, transmission, and economic inputs were conducted. If implemented in all 43 countries the vaccine has the potential to avert 123 (117;129) million malaria episodes over the first 10years. Burden averted averages 18,413 (range of country median estimates 156-40,054) DALYs per 100,000 fully vaccinated children with much variation across settings primarily driven by differences in transmission intensity. At a price of $5 per dose program costs average $39.8 per fully vaccinated child with a median cost-effectiveness ratio of $188 (range $78-$22,448) per DALY averted; the ratio is lower by one third - $136 (range $116-$220) - in settings where parasite prevalence in children aged 2-10years is at or above 10%. RTS,S/AS01has the potential to substantially reduce malaria burden in children across Africa. Conditional on assumptions on price, coverage, and vaccine properties, adding RTS,S to routine malaria control interventions would be highly cost-effective. Implementation decisions will need to further consider feasibility of scaling up existing control programs, and operational constraints in reaching children at risk with the schedule. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Simulated Night Shift Disrupts Circadian Rhythms of Immune Functions in Humans.

PubMed

Cuesta, Marc; Boudreau, Philippe; Dubeau-Laramée, Geneviève; Cermakian, Nicolas; Boivin, Diane B

2016-03-15

Recent research unveiled a circadian regulation of the immune system in rodents, yet little is known about rhythms of immune functions in humans and how they are affected by circadian disruption. In this study, we assessed rhythms of cytokine secretion by immune cells and tested their response to simulated night shifts. PBMCs were collected from nine participants kept in constant posture over 24 h under a day-oriented schedule (baseline) and after 3 d under a night-oriented schedule. Monocytes and T lymphocytes were stimulated with LPS and PHA, respectively. At baseline, a bimodal rhythmic secretion was detected for IL-1β, IL-6, and TNF-α: a night peak was primarily due to a higher responsiveness of monocytes, and a day peak was partly due to a higher proportion of monocytes. A rhythmic release was also observed for IL-2 and IFN-γ, with a nighttime peak due to a higher cell count and responsiveness of T lymphocytes. Following night shifts, with the exception of IL-2, cytokine secretion was still rhythmic but with peak levels phase advanced by 4.5-6 h, whereas the rhythm in monocyte and T lymphocyte numbers was not shifted. This suggests distinct mechanisms of regulation between responsiveness to stimuli and cell numbers of the human immune system. Under a night-oriented schedule, only cytokine release was partly shifted in response to the change in the sleep-wake cycle. This led to a desynchronization of rhythmic immune parameters, which might contribute to the increased risk for infection, autoimmune diseases, cardiovascular and metabolic disorders, and cancer reported in shift workers. Copyright © 2016 by The American Association of Immunologists, Inc.

Do infant behaviors following immunization predict attachment? An exploratory study.

PubMed

Horton, Rachel; Pillai Riddell, Rebecca; Moran, Greg; Lisi, Diana

2016-01-01

The relationship between infant behaviors during routine immunization, pre- and post-needle, and infant attachment was explored. A total of 130 parent-infant dyads were recruited from a larger longitudinal study and videotaped during routine immunization at 12 months and the Strange Situation Procedure (SSP) at 14 months. Six infant behaviors were coded for 1-minute pre-needle and 3-minutes post-needle. Attachment was operationalized according to the secure/avoidant/resistant/disorganized categories. As expected, none of the pre-needle behaviors predicted attachment. Proximity-seeking post-needle significantly discriminated attachment categorizations. Secure infants were more likely to seek proximity to caregivers post-needle in comparison with avoidant and disorganized infants. Proximity-seeking following immunization was positively correlated with proximity-seeking during the SSP and negatively correlated with avoidance and disorganization during the SSP. Infant proximity-seeking during immunization is associated with attachment security and parallels behaviors observed during the SSP. More research is needed to identify behavioral markers of disorganization.

Poliomyelitis eradication in China: 1953-2012.

PubMed

Yu, Wen-Zhou; Wen, Ning; Zhang, Yong; Wang, Hai-Bo; Fan, Chun-Xiang; Zhu, Shuang-Li; Xu, Wen-Bo; Liang, Xiao-Feng; Luo, Hui-Ming; Li, Li

2014-11-01

Poliomyelitis has historically been endemic in China and has been considered an important cause of disability and death. We reviewed strategies and measures of poliomyelitis control and eradication from 1953 to 2012. Data from notifiable disease and routine immunization reporting systems and acute flaccid paralysis (AFP) surveillance were analyzed. About 20 000 poliomyelitis cases were reported annually in the prevaccine era. During 1965-1977, live, attenuated oral poliomyelitis vaccine (OPV) was administered to children through annual mass campaigns in the winter, and the number of poliomyelitis cases started to decline. A cold chain system was established during 1982, and OPV coverage increased during the early stage of the Expanded Programme on Immunization, from 1978 to 1988. Between 1989 and 1999, routine immunization was strengthened, supplementary immunization activities (SIAs) were conducted, and the AFP surveillance system was established. China reported a last indigenous poliomyelitis case in 1994 and was certified as free of polio in 2000. To maintain its polio-free status, China kept >90% coverage of 3 doses of OPV, conducted SIAs in high-risk areas, and maintained high-quality of AFP surveillance. China succeeded in stopping the outbreak in Xinjiang in 2011. China's polio-free status was achieved and maintained through strengthening routine immunization and implementing SIAs and AFP surveillance. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Family Characteristics Associated with Likelihood of Varicella Vaccination.

PubMed

Weinmann, Sheila; Mullooly, John P; Drew, Lois; Chun, Colleen S

2016-01-01

The introduction of the varicella vaccine as a routine pediatric immunization in the US, in 1995, provided an opportunity to assess factors associated with uptake of new vaccines in the member population of the Kaiser Permanente Northwest (KPNW) Health Plan. Identify factors associated with varicella vaccination in the KPNW population in the first five years after varicella vaccine was introduced. A retrospective cohort of children under age 13 years between June 1995 and December 1999, without a history of varicella disease was identified using KPNW automated data. Membership records were linked to vaccine databases. Cox regression was used to estimate likelihood of varicella vaccination during the study period in relation to age, sex, primary clinician's specialty, and Medicaid eligibility. For a subset whose parents answered a behavioral health survey, additional demographic and behavioral characteristics were evaluated. Varicella vaccination. We identified 88,646 children under age 13 years without a history of varicella; 22% were vaccinated during the study period. Varicella vaccination was more likely among children who were born after 1995, were not Medicaid recipients, or had pediatricians as primary clinicians. In the survey-linked cohort, positively associated family characteristics included smaller family size; higher socioeconomic status; and parents who were older, were college graduates, reported excellent health, and received influenza vaccination. Understanding predictors of early varicella vaccine-era vaccine acceptance may help in planning for introduction of new vaccines to routine schedules.

Uptake of Meningococcal Vaccine in Arizona Schoolchildren After Implementation of School-Entry Immunization Requirements

PubMed Central

Hills, Rebecca A.; Allwes, Deborah; Rasmussen, Lisa

2013-01-01

Objectives Meningitis and bacteremia due to Neisseria meningitidis are rare but potentially deadly diseases that can be prevented with immunization. Beginning in 2008, Arizona school immunization requirements were amended to include immunization of children aged 11 years or older with meningococcal vaccine before entering the sixth grade. We describe patterns in meningococcal vaccine uptake surrounding these school-entry requirement changes in Arizona. Methods We used immunization records from the Arizona State Immunization Information System (ASIIS) to compare immunization rates in 11- and 12-year-olds. We used principal component analysis and hierarchical cluster analysis to identify and analyze demographic variables reported by the 2010 U.S. Census. Results Adolescent meningococcal immunization rates in Arizona increased after implementation of statewide school-entry immunization requirements. The increase in meningococcal vaccination rates among 11- and 12-year-olds from 2007 to 2008 was statistically significant (p<0.0001). All demographic groups had significantly higher odds of on-schedule vaccination after the school-entry requirement change (odds ratio range = 5.57 to 12.81, p<0.0001). County demographic factors that were associated with lower odds of on-schedule vaccination included higher poverty, more children younger than 18 years of age, fewer high school graduates, and a higher proportion of Native Americans. Conclusions This analysis suggests that implementation of school immunization requirements resulted in increased meningococcal vaccination rates in Arizona, with degree of response varying by demographic profile. ASIIS was useful for assessing changes in immunization rates over time. Further study is required to identify methods to control for population overestimates in registry data. PMID:23277658

Usefulness of routine preoperative testing in a developing country: a prospective study

PubMed Central

Bordes, Julien; Cungi, Pierre-Julien; Savoie, Pierre-Henry; Bonnet, Stéphane; Kaiser, Eric

2015-01-01

Introduction The assessment of anesthetic risks is an essential component of preoperative evaluation. In developing world, preanesthesia evaluation may be challenging because patient's medical history and records are scare, and language barrier limits physical examination. Our objective was to evaluate the impact of routine preoperative testing in a low-resources setting. Methods Prospective observational study performed in a French forward surgical unit in Abidjan, Ivory Coast. 201 patients who were scheduled for non urgent surgery were screened with routine laboratory exams during preoperative evaluation. Changes in surgery were assessed (delayed or scheduled). Results Abnormal hemoglobin findings were reported in 35% of patients, abnormal WBC count in 11,1% of patients, abnormal platelets in 15,3% of patients. Positive HIV results were found in 8,3% of cases. Routine tests represented 43,6% of changes causes. Conclusion Our study showed that in a developing country, routine preoperative tests showed abnormal results up to 35% of cases, and represented 43,5% of delayed surgery causes. The rate of tests leading to management changes varied widely, from 0% to 8,3%. These results suggested that selected tests would be useful to diagnose diseases that required treatment before non urgent surgery. However, larger studies are needeed to evaluate the cost/benefit ratio and the clinical impact of such a strategy. PMID:26516395

Researching routine immunization-do we know what we don't know?

PubMed

Clements, C John; Watkins, Margaret; de Quadros, Ciro; Biellik, Robin; Hadler, James; McFarland, Deborah; Steinglass, Robert; Luman, Elizabeth; Hennessey, Karen; Dietz, Vance

2011-11-03

The Expanded Programme on Immunization (EPI), launched in 1974, has developed and implemented a range of strategies and practices over the last three decades to ensure that children and adults receive the vaccines they need to help protect them against vaccine-preventable diseases. Many of these strategies have been implemented, resulting in immunization coverage exceeding 80% among children one year of age in many countries. Yet millions of infants remain under-immunized or unimmunized, particularly in poorer countries. In November 2009, a panel of external experts met at the United States Centers for Disease Control and Prevention (CDC) to review and identify areas of research required to strengthen routine service delivery in developing countries. Research opportunities were identified utilizing presentations emphasizing existing research, gaps in knowledge and key questions. Panel members prioritized the topics, as did other meeting participants. Several hundred research topics covering a wide range were identified by the panel members and participants. However there were relatively few topics for which there was a consensus that immediate investment in research is warranted. The panel identified 28 topics as priorities. 18 topics were identified as priorities by at least 50% of non-panel participants; of these, five were also identified as priorities by the panel. Research needs included identifying the best ways to increase coverage with existing vaccines and introduce new vaccines, integrate other services with immunizations, and finance immunization programmes. There is an enormous range of research that could be undertaken to support routine immunization. However, implementation of strategic plans, rather than additional research will have the greatest impact on raising immunization coverage and preventing disease, disability, and death from vaccine-preventable diseases. The panel emphasized the importance of tying operational research to programmatic needs, with a focus on efforts to scale up proven best practices in each country, facilitating the full implementation of immunization strategies. Copyright © 2011. Published by Elsevier Ltd.. All rights reserved.

Multitasking scheduler works without OS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Howard, D.M.

1982-09-15

Z80 control applications requiring parallel execution of multiple software tasks can use the executive routine described and listed in this article when multitasking is not available via an operating system (OS). Although the routine is not as capable or as transparent to software as the multitasking in a full-scale OS, it is simple to understand and use.

Rationale and methods of a randomized controlled trial of immunogenicity, safety and impact on carriage of pneumococcal conjugate and polysaccharide vaccines in infants in Papua New Guinea.

PubMed

Lehmann, Deborah; Kirarock, Wendy; van den Biggelaar, Anita H J; Passey, Megan; Jacoby, Peter; Saleu, Gerard; Masiria, Geraldine; Nivio, Birunu; Greenhill, Andrew; Orami, Tilda; Francis, Jacinta; Ford, Rebecca; Kirkham, Lea-Ann; Solomon, Vela; Richmond, Peter C; Pomat, William S

2017-01-01

Children in third-world settings including Papua New Guinea (PNG) experience early onset of carriage with a broad range of pneumococcal serotypes, resulting in a high incidence of severe pneumococcal disease and deaths in the first 2 years of life. Vaccination trials in high endemicity settings are needed to provide evidence and guidance on optimal strategies to protect children in these settings against pneumococcal infections. This report describes the rationale, objectives, methods, study population, follow-up and specimen collection for a vaccination trial conducted in an endemic and logistically challenging setting in PNG. The trial aimed to determine whether currently available pneumococcal conjugate vaccines (PCV) are suitable for use under PNG's accelerated immunization schedule, and that a schedule including pneumococcal polysaccharide vaccine (PPV) in later infancy is safe and immunogenic in this high-risk population. This open randomized-controlled trial was conducted between November 2011 and March 2016, enrolling 262 children aged 1 month between November 2011 and April 2014. The participants were randomly allocated (1:1) to receive 10-valent PCV (10vPCV) or 13-valent PCV (13vPCV) in a 1-2-3-month schedule, with further randomization to receive PPV or no PPV at age 9 months, followed by a 1/5 th PPV challenge at age 23 months. A total of 1229 blood samples were collected to measure humoral and cellular immune responses and 1238 nasopharyngeal swabs to assess upper respiratory tract colonization and carriage load. Serious adverse events were monitored throughout the study. Of the 262 children enrolled, 87% received 3 doses of PCV, 79% were randomized to receive PPV or no PPV at age 9 months, and 67% completed the study at 24 months of age with appropriate immunization and challenge. Laboratory testing of the many samples collected during this trial will determine the impact of the different vaccine schedules and formulations on nasopharyngeal carriage, antibody production and function, and immune memory. The final data will inform policy on pneumococcal vaccine schedules in countries with children at high risk of pneumococcal disease by providing direct comparison of an accelerated schedule of 10vPCV and 13vPCV and the potential advantages of PPV following PCV immunization. ClinicalTrials.gov CTN NCT01619462, retrospectively registered on May 28, 2012.

Irregular tick-borne encephalitis vaccination schedules: the effect of a single catch-up vaccination with FSME-IMMUN. A prospective non-interventional study.

PubMed

Schosser, Rudolf; Reichert, Anja; Mansmann, Ulrich; Unger, Bernd; Heininger, Ulrich; Kaiser, Reinhard

2014-04-25

Intervals longer than recommended are frequently encountered between doses of tick borne encephalitis virus (TBE) vaccines in both residents of and travelers to endemic regions. In clinical practice the management of individuals with lapsed TBE vaccination schedules varies widely and has in common that the underlying immunological evidence is scarce. The aim of this study was to generate data reliable enough to derive practical recommendations on how to continue vaccination with FSME-IMMUN in subjects with an irregular TBE vaccination history. Antibody response to a single catch-up dose of FSME-IMMUN was assessed in 1115 adults (age ≥16 years) and 125 children (age 6-15 years) with irregular TBE vaccination histories. Subjects of all age groups developed a substantial increase in geometric mean antibody concentration after a single catch-up TBE vaccination which was consistently lower in subjects with only one previous TBE vaccination compared to subjects with two or more vaccinations. Overall, >94% of young adults and children, and >93% of elderly subjects with an irregular TBE vaccination history achieved antibody levels ≥25U/ml irrespective of the number of previous TBE vaccinations. We conclude that TBE vaccination of subjects with irregular vaccination histories should be continued as if the previous vaccinations had been administered in a regular manner, with the stage of the vaccination schedule being determined by the number of previous vaccinations. Although lapsed vaccination schedules may leave subjects temporarily with inadequate protection against TBE infection, adequate protection can quickly be re-established in >93% of the subjects by a single catch-up dose of FSME-IMMUN, irrespective of age, number of previous vaccinations, and time interval since the last vaccination. Copyright © 2014 Anja Reichert. Published by Elsevier Ltd.. All rights reserved.

Flight and Operational Medicine Clinic (FOMC) Workflow Analysis

DTIC Science & Technology

2014-03-14

Flight Medicine, Optometry, and Dental ) Base 4 MSME schedules all appointments required in the IFC (i.e., Flight Medicine, Optometry, and Dental ...IT Note: Base 1 Examinee completes Optometry, Dental , and Immunizations on the day of the Flight Medicine appointment Base 2 Examinee...completes Optometry and Immunizations prior to being seen in Flight Medicine Base 4 Examinee completes Optometry, Dental , and Immunizations on the day of

Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies

PubMed Central

LaFond, Anne; Kanagat, Natasha; Steinglass, Robert; Fields, Rebecca; Sequeira, Jenny; Mookherji, Sangeeta

2015-01-01

There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria–tetanus–pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement—four direct drivers and two enabling drivers—that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance. PMID:24615431

Travel immunization update for older adults.

PubMed

Spain, Margaret P; Edlund, Barbara J

2010-04-01

Older Americans are among the most widely traveled group in our society. Recent trends point to more international travel, more travel to Third World countries, and more travel by older adults with significant health problems. Regardless of the reason for travel, older adults need to plan for healthy travel. Primary care providers need to inquire at routine visits if patients have plans for international travel. If travel to other countries or regions is being considered, patients must be advised of the importance of early travel preparation. To begin with, older adults should be up to date on all routine immunizations. Those planning on international travel may need additional required and/or recommended immunizations, depending on the individual's health status, travel itinerary, length of stay, and health risks associated with destination sites. Primary care providers should be knowledgeable about travel medicine resources in the community to make referrals for travelers requiring additional immunizations and health information. Copyright 2010, SLACK Incorporated.

Artificial immune algorithm for multi-depot vehicle scheduling problems

NASA Astrophysics Data System (ADS)

Wu, Zhongyi; Wang, Donggen; Xia, Linyuan; Chen, Xiaoling

2008-10-01

In the fast-developing logistics and supply chain management fields, one of the key problems in the decision support system is that how to arrange, for a lot of customers and suppliers, the supplier-to-customer assignment and produce a detailed supply schedule under a set of constraints. Solutions to the multi-depot vehicle scheduling problems (MDVRP) help in solving this problem in case of transportation applications. The objective of the MDVSP is to minimize the total distance covered by all vehicles, which can be considered as delivery costs or time consumption. The MDVSP is one of nondeterministic polynomial-time hard (NP-hard) problem which cannot be solved to optimality within polynomial bounded computational time. Many different approaches have been developed to tackle MDVSP, such as exact algorithm (EA), one-stage approach (OSA), two-phase heuristic method (TPHM), tabu search algorithm (TSA), genetic algorithm (GA) and hierarchical multiplex structure (HIMS). Most of the methods mentioned above are time consuming and have high risk to result in local optimum. In this paper, a new search algorithm is proposed to solve MDVSP based on Artificial Immune Systems (AIS), which are inspirited by vertebrate immune systems. The proposed AIS algorithm is tested with 30 customers and 6 vehicles located in 3 depots. Experimental results show that the artificial immune system algorithm is an effective and efficient method for solving MDVSP problems.

Application of mobile technology for improving expanded program on immunization among highland minority and stateless populations in northern Thailand border.

PubMed

Kaewkungwal, Jaranit; Apidechkul, Tawatchai; Jandee, Kasemsak; Khamsiriwatchara, Amnat; Lawpoolsri, Saranath; Sawang, Surasak; Sangvichean, Aumnuyphan; Wansatid, Peerawat; Krongrungroj, Sarinya

2015-01-14

Studies of undervaccinated children of minority/stateless populations have highlighted significant barriers at individual, community, and state levels. These include geography-related difficulties, poverty, and social norms/beliefs. The objective of this study was to assess project outcomes regarding immunization coverage, as well as maternal attitudes and practices toward immunization. The "StatelessVac" project was conducted in Thailand-Myanmar-Laos border areas using cell phone-based mechanisms to increase immunization coverage by incorporating phone-to-phone information sharing for both identification and prevention. With limitation of the study among vulnerable populations in low-resource settings, the pre/post assessments without comparison group were conducted. Immunization coverage was collected from routine monthly reports while behavior-change outcomes were from repeat surveys. This study revealed potential benefits of the initiative for case identification; immunization coverage showed an improved trend. Prevention strategies were successfully integrated into the routine health care workflows of immunization activities at point-of-care. A behavior-change-communication package contributes significantly in raising both concern and awareness in relation to child care. The mobile technology has proven to be an effective mechanism in improving a children's immunization program among these hard-to-reach populations. Part of the intervention has now been revised for use at health centers across the country.

U.S. vaccine and immune globulin product shortages, 2001-15.

PubMed

Ziesenitz, Victoria C; Mazer-Amirshahi, Maryann; Zocchi, Mark S; Fox, Erin R; May, Larissa S

2017-11-15

Trends in shortages of vaccines and immune globulin products from 2001 through 2015 in the United States are described. Drug shortage data from January 2001 through December 2015 were obtained from the University of Utah Drug Information Service. Shortage data for vaccines and immune globulins were analyzed, focusing on the type of product, reason for shortage, shortage duration, shortages requiring vaccine deferral, and whether the drug was a single-source product. Inclusion of the product into the pediatric vaccination schedule was also noted. Of the 2,080 reported drug shortages, 59 (2.8%) were for vaccines and immune globulin products. Of those, 2 shortages (3%) remained active at the end of the study period. The median shortage duration was 16.8 months. The most common products on shortage were viral vaccines (58%), especially hepatitis A, hepatitis B, rabies, and varicella vaccines (4 shortages each). A vaccine deferral was required for 21 shortages (36%), and single-source products were on shortage 30 times (51%). The most common reason for shortage was manufacturing problems (51%), followed by supply-and-demand issues (7%). Thirty shortages (51%) were for products on the pediatric schedule, with a median duration of 21.7 months. Drug shortages of vaccines and immune globulin products accounted for only 2.8% of reported drug shortages within a 15-year period, but about half of these shortages involved products on the pediatric vaccination schedule, which may have significant public health implications. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Repurposing Ospemifene for Potentiating an Antigen-Specific Immune Response

PubMed Central

Kao, Chiao-Jung; Wurz, Gregory T.; Lin, Yi-Chen; Vang, Daniel P.; Phong, Brian; DeGregorio, Michael W.

2016-01-01

Objective Ospemifene, an estrogen receptor agonist/antagonist approved for treatment of dyspareunia and vaginal dryness in postmenopausal women, has potential new indications as an immune modulator. The overall objective of the present series of preclinical studies was to evaluate the immunomodulatory activity of ospemifene in combination with a peptide cancer vaccine. Methods Immune regulating effects, mechanism of action and structure activity relationships of ospemifene and related compounds were evaluated by examining expression of T cell activating cytokines in vitro, and antigen-specific immune response and cytotoxic T-lymphocyte activity in vivo. The effects of ospemifene (OSP) on the immune response to a peptide cancer vaccine (PV) were evaluated following chronic [control (n=22); OSP 50 mg/kg (n=16); PV (n=6); OSP+PV (n=11)], intermittent [control (n=10); OSP 10 and 50 mg/kg (n=11); PV (n=11); combination treatment (n=11 each dose)] and pretreatment [control; OSP 100 mg/kg; PV 100 µg; combination treatment (n=8 all groups)] ospemifene oral dosing schedules in a total of 317 mixed-sex tumor-bearing and non-tumor-bearing mice. Results The results showed that ospemifene induced expression of the key TH1 cytokines interferon gamma and interleukin-2 in vitro, which may be mediated by stimulating T cells through phosphoinositide 3-kinase and calmodulin signaling pathways. In combination with an antigen-specific peptide cancer vaccine, ospemifene increased antigen-specific immune response and increased cytotoxic T-lymphocyte activity in tumor-bearing and non-tumor-bearing mice. The pretreatment, intermittent, and chronic dosing schedules of ospemifene activate naïve T cells, modulate antigen-induced tolerance and reduce tumor-associated, pro-inflammatory cytokines, respectively. Conclusions Taken together, ospemifene’s dose response and schedule-dependent immune modulating activity offers a method of tailoring and augmenting the efficacy of previously failed antigen-specific cancer vaccines for a wide range of malignancies. PMID:27922937

Levels of Antibodies Specific to Tetanus Toxoid, Haemophilus influenzae Type b, and Pneumococcal Capsular Polysaccharide in Healthy Children and Adults

PubMed Central

Schauer, Uwe; Stemberg, Frank; Rieger, Christian H. L.; Büttner, Wolfgang; Borte, Michael; Schubert, Simone; Möllers, Helga; Riedel, Frank; Herz, Udo; Renz, Harald; Herzog, Wilhelm

2003-01-01

Antibody levels specific for capsular polysaccharides of Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) and for tetanus toxoid were measured in serum samples of 386 age-stratified subjects. The study group consists of healthy adult blood donors and hospitalized children undergoing elective surgery, excluding individuals with a history of infection. In children, anti-tetanus toxoid antibody levels displayed two peaks of 1.20 IU/ml (20.4 mg/liter) and 1.65 IU/ml (28.1 mg/liter) related to the schedule of routine childhood immunization in the first year and at 8 years of age. Eighty percent of the antibodies are of the immunoglobulin G1 (IgG1) isotype. For pneumococcal capsular polysaccharide (PCP), the specific antibody levels represent the acquisition of natural immunity. The initial concentration of 9.2 mg/liter was low in infancy (0.5 to 1 years of age) and remained low until 3 to 4 years of age (14.6 mg/liter). During this period PCP antibodies were almost 100% of the IgG2 subclass. Thereafter, IgG anti-PCP antibody titers increased steadily to adult levels (59.5 mg/liter). The data are intended to provide reference ranges to aid in the interpretation of specific antibody determinations in the clinical setting. PMID:12626443

Exceptional Financial Support for Introduction of Inactivated Polio Vaccine in Middle-Income Countries.

PubMed

Blankenhorn, Anne-Line; Cernuschi, Tania; Zaffran, Michel J

2017-07-01

In May 2012, the World Health Assembly declared the completion of poliovirus eradication a programmatic emergency for global public health and called for a comprehensive polio endgame strategy. The Polio Eradication and Endgame Strategic Plan 2013-2018 was developed in response to this call and demands that all countries using Oral Polio Vaccine (OPV) only introduce at least 1 dose of Inactivated Polio Vaccine (IPV) into routine immunization schedules by the end of 2015. In November 2013, the Board of Gavi (the Vaccine Alliance) approved the provision of support for IPV introduction in the 72 Gavi-eligible countries. Following analytical work and stakeholder consultations, the IPV Immunization Systems Management Group (IMG) presented a proposal to provide exceptional financial support for IPV introduction to additional OPV-only using countries not eligible for Gavi support and that would otherwise not be able to mobilize the necessary financial resources within the Polio Eradication and Endgame Strategic Plan timelines. In June 2014, the Polio Oversight Board (POB) agreed to make available a maximum envelope of US $45 million toward supporting countries not eligible for Gavi funding. This article describes the design of the funding mechanism that was developed, its implementation and the lessons learned through this process. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Antigen-specific antibody response in juvenile-onset SLE patients following routine immunization with tetanus toxoid.

PubMed

Kashef, Sara; Ghazizadeh, Farid; Derakhshan, Ali; Farjadian, Shirin; Alyasin, Soheila

2008-09-01

Infection is now the most common cause of morbidity in Systemic Lupus Erythematosus (SLE). There is lack of information regarding the specific antibody formation in response to vaccines in young SLE patients. To determine the efficacy of anti-tetanus antibody response in young patients with SLE. Forty SLE patients with mean age of 14.1 years (range: 7-21) and 60 age and sex matched normal controls were enrolled in this study over a period of one year. Diagnosis was made according to the ACR criteria and disease activity was determined based on SLE Disease Activity Index (SLEDAI). All patients and controls had received the complete schedule of tetanus vaccinations consisting of three primary doses and two boosters by the age of six. Serum immunoglobulins and anti-tetanus antibody titers were determined by Nephelometry and ELISA. Anti-tetanus antibody levels greater than 0.1 IU/ml have been suggested as protective. In all of the patients and controls anti-tetanus antibody titer was > 0.1 IU/ml. IgG, IgA, and IgM levels were in the normal range for their age. Mean disease activity score was 4.9 (range: 0-16). There was no association between SLEDAI score and anti-tetanus antibody response. School age onset and immunosuppressive therapy does not seem to interfere with development of consistent immunity to tetanus vaccine in young SLE patients.

Persuasive messages. Development of persuasive messages may help increase mothers' compliance of their children's immunization schedule.

PubMed

Gore, P; Madhavan, S; Curry, D; McClurg, G; Castiglia, M; Rosenbluth, S A; Smego, R A

1998-01-01

Effective immunization campaigns can be designed by determining which persuasion strategy is most effective in attracting the attention of mothers of preschoolers. The authors assess the impact of three persuasional strategies: fear-arousal, motherhood-arousal, and rational messages, on mothers of preschoolers who are late for their immunizations. The fear-arousal message was found to be most effective, followed by the motherhood-arousal, and then the rational message, in attracting mothers' attention to their child's immunization status.

Introducing auto-disable syringes to the national immunization programme in Madagascar.

PubMed Central

Drain, Paul K.; Ralaivao, Josoa S.; Rakotonandrasana, Alexander; Carnell, Mary A.

2003-01-01

OBJECTIVE: To evaluate the safety and coverage benefits of auto-disable (AD) syringes, weighed against the financial and logis- tical costs, and to create appropriate health policies in Madagascar. METHODS: Fifteen clinics in Madagascar, trained to use AD syringes, were randomized to implement an AD syringe only, mixed (AD syringes used only on non-routine immunization days), or sterilizable syringe only (control) programme. During a five-week period, data on administered vaccinations were collected, interviews were conducted, and observations were recorded. FINDINGS: The use of AD syringes improved coverage rates by significantly increasing the percentage of vaccines administered on non-routine immunization days (AD-only 4.3%, mixed 5.7%, control 1.1% (P<0.05)). AD-only clinics eliminated sterilization sessions for vaccinations, whereas mixed clinics reduced the number of sterilization sessions by 64%. AD syringes were five times more expensive than sterilizable syringes, which increased AD-only and mixed clinics' projected annual injection costs by 365% and 22%, respectively. However, introducing AD syringes for all vaccinations would only increase the national immunization budget by 2%. CONCLUSION: The use of AD syringes improved vaccination coverage rates by providing ready-to-use sterile syringes on non-routine immunization days and decreasing the number of sterilization sessions, thereby improving injection safety. The mixed programme was the most beneficial approach to phasing in AD syringes and diminishing logistical complications, and it had minimal costs. AD syringes, although more expensive, can feasibly be introduced into a developing country's immunization programme to improve vaccination safety and coverage. PMID:14576886

Timeliness of Childhood Primary Immunization and Risk Factors Related with Delays: Evidence from the 2014 Zhejiang Provincial Vaccination Coverage Survey.

PubMed

Hu, Yu; Li, Qian; Chen, Yaping

2017-09-20

Background: this study aimed to assess both immunization coverage and timeliness, as well as reasons for non-vaccination, and identity the risk factors of delayed immunization, for the vaccines scheduled during the first year of life, in Zhejiang province, east China. Methods: A cluster survey among children aged 24-35 months was conducted. Demographic information and socio-economic characteristics of the selected child, the mother, and the household were collected. Immunization data were transcribed from immunization cards. Timeliness was assessed with Kaplan-Meier analysis for each vaccine given before 12 months of age, based on the time frame stipulated by the expanded program on immunization of China. Cox proportional hazard regression was applied to identify risk factors of delayed immunization. Results: A total of 2772 eligible children were surveyed. The age-appropriate coverage ranged from 25.4% (95% CI: 23.7-27.0%) for Bacillus Calmette-Guerin (BCG) to 91.3% (95% CI: 90.2-92.3%) for the first dose of oral poliomyelitis vaccine (OPV1). The most frequent reason for non-vaccination was parent's fear of adverse events of immunization. Delayed immunizations were associated with mother having a lower education level, mother having a job, delivery at home, increasing number of children per household, and having a lower household income. Conclusions: Although the timeliness of immunization has improved since 2011, necessary steps are still needed to achieve further improvement. Timeliness of immunization should be considered as another important indicator of expanded program on immunization (EPI) performance. Future interventions on vaccination coverage should take into consideration demographic and socio-economic risk factors identified in this study. The importance of adhering to the recommended schedule should be explained to parents.

Timeliness of Childhood Primary Immunization and Risk Factors Related with Delays: Evidence from the 2014 Zhejiang Provincial Vaccination Coverage Survey

PubMed Central

Hu, Yu; Li, Qian; Chen, Yaping

2017-01-01

Background: this study aimed to assess both immunization coverage and timeliness, as well as reasons for non-vaccination, and identity the risk factors of delayed immunization, for the vaccines scheduled during the first year of life, in Zhejiang province, east China. Methods: A cluster survey among children aged 24–35 months was conducted. Demographic information and socio-economic characteristics of the selected child, the mother, and the household were collected. Immunization data were transcribed from immunization cards. Timeliness was assessed with Kaplan–Meier analysis for each vaccine given before 12 months of age, based on the time frame stipulated by the expanded program on immunization of China. Cox proportional hazard regression was applied to identify risk factors of delayed immunization. Results: A total of 2772 eligible children were surveyed. The age-appropriate coverage ranged from 25.4% (95% CI: 23.7–27.0%) for Bacillus Calmette–Guerin (BCG) to 91.3% (95% CI: 90.2–92.3%) for the first dose of oral poliomyelitis vaccine (OPV1). The most frequent reason for non-vaccination was parent’s fear of adverse events of immunization. Delayed immunizations were associated with mother having a lower education level, mother having a job, delivery at home, increasing number of children per household, and having a lower household income. Conclusions: Although the timeliness of immunization has improved since 2011, necessary steps are still needed to achieve further improvement. Timeliness of immunization should be considered as another important indicator of expanded program on immunization (EPI) performance. Future interventions on vaccination coverage should take into consideration demographic and socio-economic risk factors identified in this study. The importance of adhering to the recommended schedule should be explained to parents. PMID:28930165

15 CFR 716.7 - Samples.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS INITIAL AND ROUTINE... will be restricted to verifying the absence of undeclared scheduled chemicals, unless otherwise agreed...

15 CFR 716.7 - Samples.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS INITIAL AND ROUTINE... will be restricted to verifying the absence of undeclared scheduled chemicals, unless otherwise agreed...

Immunogenicity and reactogenicity of the human rotavirus vaccine, RIX4414 oral suspension, when co-administered with routine childhood vaccines in Chinese infants.

PubMed

Li, Rong-Cheng; Huang, Teng; Li, Yanping; Wang, Lao-Hong; Tao, Junhui; Fu, Botao; Si, Guoai; Nong, Yi; Mo, Zhaojun; Liao, XueYan; Luan, Ivy; Tang, Haiwen; Rathi, Niraj; Karkada, Naveen; Han, Htay Htay

2016-03-03

This study evaluated the immunogenicity of the human rotavirus (RV) vaccine (RIX4414) when co-administered with routine childhood vaccines in Chinese infants (NCT01171963). Healthy infants aged 6-16 weeks received 2 doses of either RIX4414 or placebo according to a 0, 1-month schedule. Infants received routine diphtheria-tetanus-acellular pertussis (DTPa) and oral poliovirus (OPV) vaccines either separately from or concomitantly with RIX4414/placebo (separate and co-administration cohorts, respectively). Anti-RV IgA seroconversion rates (one month post-dose-2) and seropositivity rates (at one year of age) were measured using ELISA. Immune responses against the DTPa and OPV antigens were measured one month post-DTPa dose-3 in the co-administration cohort. Solicited local and general symptoms were recorded for 8-days post-vaccination (total cohort). The according-to-protocol immunogenicity population included 511 infants in the separate cohort and 275 in the co-administration cohort. One month post-RIX4414 dose-2, anti-RV IgA seroconversion rates were 74.7% (95% confidence interval [CI]: 68.9-79.9) and 64.2% (95% CI: 55.4-72.3) in the separate and co-administration cohorts; seropositivity rates at one year of age were 71.5% (95% CI: 65.5-77.1) and 50.0% (95% CI: 40.9-59.1), respectively. One month post-DTPa dose-3, all infants in the co-administration cohort were seroprotected against diphtheria and tetanus, and seropositive for pertussis toxoid, pertactin and filamentous haemaglutinin. Two months post-OPV dose-3, seroprotection rates against anti-poliovirus types 1, 2 and 3 were >99% in the co-administration cohort. Reactogenicity profiles were similar in both cohorts. RIX4414 was immunogenic and well-tolerated in Chinese infants and did not appear to interfere with the immunogenicity and reactogenicity of co-administered routine childhood vaccines.

Immunogenicity and reactogenicity of the human rotavirus vaccine, RIX4414 oral suspension, when co-administered with routine childhood vaccines in Chinese infants

PubMed Central

Li, Rong-cheng; Huang, Teng; Li, Yanping; Wang, Lao-Hong; Tao, Junhui; Fu, Botao; Si, Guoai; Nong, Yi; Mo, Zhaojun; Liao, XueYan; Luan, Ivy; Tang, Haiwen; Rathi, Niraj; Karkada, Naveen; Han, Htay Htay

2016-01-01

Abstract This study evaluated the immunogenicity of the human rotavirus (RV) vaccine (RIX4414) when co-administered with routine childhood vaccines in Chinese infants (NCT01171963). Healthy infants aged 6–16 weeks received 2 doses of either RIX4414 or placebo according to a 0, 1-month schedule. Infants received routine diphtheria-tetanus-acellular pertussis (DTPa) and oral poliovirus (OPV) vaccines either separately from or concomitantly with RIX4414/placebo (separate and co-administration cohorts, respectively). Anti-RV IgA seroconversion rates (one month post-dose-2) and seropositivity rates (at one year of age) were measured using ELISA. Immune responses against the DTPa and OPV antigens were measured one month post-DTPa dose-3 in the co-administration cohort. Solicited local and general symptoms were recorded for 8-days post-vaccination (total cohort). The according-to-protocol immunogenicity population included 511 infants in the separate cohort and 275 in the co-administration cohort. One month post-RIX4414 dose-2, anti-RV IgA seroconversion rates were 74.7% (95% confidence interval [CI]: 68.9–79.9) and 64.2% (95% CI: 55.4–72.3) in the separate and co-administration cohorts; seropositivity rates at one year of age were 71.5% (95% CI: 65.5–77.1) and 50.0% (95% CI: 40.9–59.1), respectively. One month post-DTPa dose-3, all infants in the co-administration cohort were seroprotected against diphtheria and tetanus, and seropositive for pertussis toxoid, pertactin and filamentous haemaglutinin. Two months post-OPV dose-3, seroprotection rates against anti-poliovirus types 1, 2 and 3 were >99% in the co-administration cohort. Reactogenicity profiles were similar in both cohorts. RIX4414 was immunogenic and well-tolerated in Chinese infants and did not appear to interfere with the immunogenicity and reactogenicity of co-administered routine childhood vaccines. PMID:27149266

Environmental surveillance master sampling schedule

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bisping, L.E.

This document contains the planned 1994 schedules for routine collection of samples for the Surface Environmental Surveillance Project (SESP), Drinking Water Project, and Ground-Water Surveillance Project. Samples are routinely collected for the SESP and analyzed to determine the quality of air, surface water, soil, sediment, wildlife, vegetation, foodstuffs, and farm products at Hanford Site and surrounding communities. The responsibility for monitoring the onsite drinking water falls outside the scope of the SESP. The Hanford Environmental Health Foundation is responsible for monitoring the nonradiological parameters as defined in the National Drinking Water Standards while PNL conducts the radiological monitoring of themore » onsite drinking water. PNL conducts the drinking water monitoring project concurrent with the SESP to promote efficiency and consistency, utilize the expertise developed over the years, and reduce costs associated with management, procedure development, data management, quality control and reporting. The ground-water sampling schedule identifies ground-water sampling events used by PNL for environmental surveillance of the Hanford Site.« less

Universal immunization in urban areas: Calcutta's success story.

PubMed

Chaudhuri, E R

1990-01-01

The Central Government of Calcutta, India aimed to immunize 85% (85,262) of the city's 12 month old infants against polio, diphtheria, measles, tuberculosis, pertussis and tetanus. The Universal Immunization Program (UIP) achieved this target 3 months earlier than intended. In fact, at the end of December 1990, it achieved 110.6% for DPT3, 142.16% for OPV3, 151.96% for BCG, and 97% for measles. UIP was able to surpass its targets by emphasizing team work. Government, the private sector, UNICEF, and the voluntary sector made up the Apex Coordination Committee on Immunization headed up by the mayor. The committee drafted an action plan which included routine immunization sessions on a fixed day and intensive immunization drives. Further the involved organizations pooled together cold chain equipment. In addition, the District Family Welfare Bureau was the distribution center for vaccines, syringes, immunization cards, report formats, vaccine carriers, and ice packs. Health workers administered immunizations from about 300 centers generally on Wednesday, National Immunization Day. Intensive immunization drives focused on measles immunizations. UIP leaders encouraged all center to routinely record coverage and submit monthly progress reports to the District Family Welfare Bureau. The Calcutta Municipal Corporation coordinated promotion activities and social mobilization efforts. Promotion included radio and TV announcements, newspaper advertisements, cinema slides, billboards, and posters. The original UIP plan to use professional communicators to mobilize communities was ineffective, so nongovernmental organizations entered the slums to encourage people to encourage their neighbors to immunize their children. Further Islamic, Protestant, and Catholic leaders encouraged the faithful to immunize their children. A UNICEF officer noted that this success must be sustained, however.

Sick and tired: how molecular regulators of human sleep schedules and duration impact immune function.

PubMed

Kurien, Philip A; Chong, S Y Christin; Ptáček, Louis J; Fu, Ying-Hui

2013-10-01

Why do we need to sleep? What regulates when we sleep? And what dictates the number of hours we require? These are often viewed as three separate biological questions. Here, we propose they share molecular etiologies, whereby regulators of sleep schedules and sleep duration also govern the physiological purposes of sleep. To support our hypothesis, we review Mendelian human genetic variants sufficient to advance sleep-wake onset (PER2) and shorten sleep length (DEC2), and evaluate their emerging roles in immune responses that may rely on a sound night of slumber. Copyright © 2013 Elsevier Ltd. All rights reserved.

Post-immunization leucocytosis and its implications for the management of febrile infants.

PubMed

Prentice, Sarah; Kamushaaga, Zephyrian; Nash, Stephen B; Elliott, Alison M; Dockrell, Hazel M; Cose, Stephen

2018-05-11

Clinical guidelines for management of infants with fever but no evident focus of infection recommend that those aged 1-3 months with a white cell count >15 × 10 9 /l have a full septic screen and be admitted for parenteral antibiotics. However, there is limited information about leucocyte changes following routine immunization, a common cause of fever. We investigated white cell counts shortly after routine immunization in Ugandan infants under 3 months of age. White cell counts were measured in 212 healthy infants following routine immunizations (DTwP-HepB-Hib, oral polio and pneumococcal conjugate 7 vaccines) received prior to 3 months of age. Mean leucocyte counts increased from 9.03 × 10 9 /l (95% confidence interval 8.59-9.47 × 10 9 /l) pre-immunizations to 16.46 × 10 9 /l (15.4-17.52 × 10 9 /l) at one-day post-immunizations at 6 weeks of age, and 15.21 × 10 9 /l (14.07-16.36 × 10 9 /l) at one-day post-immunizations at 10 weeks of age. The leucocytosis was primarily a neutrophilia, with neutrophil percentages one-day post-immunization of 49% at 6 weeks of age and 46% at 10 weeks of age. White cell parameters returned to baseline by two-days post-immunization. No participant received antibiotics when presenting with isolated fever post-immunization and all remained well at follow-up. In our study almost half the children <3 months old presenting with fever but no evident focus of infection at one-day post-immunization met commonly used criteria for full septic screen and admission for parenteral antibiotics, despite having no serious bacterial infection. These findings add to the growing body of literature that questions the utility of white blood cell measurement in identification of young infants at risk of serious bacterial infections, particularly in the context of recent immunizations, and suggest that further exploration of the effect of different immunization regimes on white cell counts is needed. This observational work was nested within a clinical trial, registration number ISRCTN59683017. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Use of Dedicated Mobile Teams and Polio Volunteer Community Mobilizers to Increase Access to Zero-Dose Oral Poliovirus Vaccine and Routine Childhood Immunizations in Settlements at High Risk for Polio Transmission in Northern Nigeria.

PubMed

Ongwae, Kennedy M; Bawa, Samuel B; Shuaib, Faisal; Braka, Fiona; Corkum, Melissa; Isa, Hammanyero K

2017-07-01

The Polio Eradication Initiative in Nigeria, which started >20 years ago, faced many challenges, including initial denial, resistance from communities, and prolonged regional safety concerns. These challenges led into the structuring of the response including the development of the National Emergency Action Plan, improved partner coordination and government engagement, and the establishment of a Polio Emergency Operations Centre. Although monthly supplementary immunization activities (SIAs) continued, the targeting of settlements at high risk for polio transmission with routine immunization (RI) and other selected primary healthcare (PHC) services using dedicated mobile teams and volunteer community mobilizers (VCMs) became a key strategy for interrupting polio transmission in the high-risk areas. These efforts could have contributed to the wild poliovirus-free 2-year period between 24 July 2014 and 11 August 2016, when 2 cases of the virus were reported from Borno State, Northern Nigeria. A narrative analysis of polio-related program and other official documents was conducted to identify the relevant human resources and their role in the Polio Eradication Initiative and in RI. The data used in the article was obtained from United Nations Children's Fund (UNICEF) and World Health Organization project reports and a draft evaluation report of the dedicated mobile teams approach in Northern Nigeria. The data from 6 of the states that commenced the provision of polio, RI, and other selected PHC services using the dedicated mobile teams approach in 2014 showed an overall increase in the percentage of children aged 12-23 months in the settlements at high risk for polio transmission with a RI card seen, from 23% to 56%, and an overall increase in fully immunized children aged 12-23 months, from 19% to 55%. The number of newborns given the first dose of oral poliovirus vaccine (OPV) according to the RI schedule and the number of children given zero-dose OPV with the assistance of the VCMs similarly increased between 2013 and 2015. In 2015, VCMs helped track 167 092 newborns and also linked 156 537 infants aged <1 year to RI services in the 6 states. The analysis illustrates that polio personnel in Northern Nigeria are used in increasing access to zero-dose OPV, RI, and selected PHC services. The increase in the services generated represented the increasing role of the dedicated mobile teams and polio VCMs in strengthening RI. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Use of Dedicated Mobile Teams and Polio Volunteer Community Mobilizers to Increase Access to Zero-Dose Oral Poliovirus Vaccine and Routine Childhood Immunizations in Settlements at High Risk for Polio Transmission in Northern Nigeria

PubMed Central

Bawa, Samuel B.; Shuaib, Faisal; Braka, Fiona; Corkum, Melissa; Isa, Hammanyero K.

2017-01-01

Abstract Background The Polio Eradication Initiative in Nigeria, which started >20 years ago, faced many challenges, including initial denial, resistance from communities, and prolonged regional safety concerns. These challenges led into the structuring of the response including the development of the National Emergency Action Plan, improved partner coordination and government engagement, and the establishment of a Polio Emergency Operations Centre. Although monthly supplementary immunization activities (SIAs) continued, the targeting of settlements at high risk for polio transmission with routine immunization (RI) and other selected primary healthcare (PHC) services using dedicated mobile teams and volunteer community mobilizers (VCMs) became a key strategy for interrupting polio transmission in the high-risk areas. These efforts could have contributed to the wild poliovirus–free 2-year period between 24 July 2014 and 11 August 2016, when 2 cases of the virus were reported from Borno State, Northern Nigeria. Methods A narrative analysis of polio-related program and other official documents was conducted to identify the relevant human resources and their role in the Polio Eradication Initiative and in RI. The data used in the article was obtained from United Nations Children's Fund (UNICEF) and World Health Organization project reports and a draft evaluation report of the dedicated mobile teams approach in Northern Nigeria. Results The data from 6 of the states that commenced the provision of polio, RI, and other selected PHC services using the dedicated mobile teams approach in 2014 showed an overall increase in the percentage of children aged 12–23 months in the settlements at high risk for polio transmission with a RI card seen, from 23% to 56%, and an overall increase in fully immunized children aged 12–23 months, from 19% to 55%. The number of newborns given the first dose of oral poliovirus vaccine (OPV) according to the RI schedule and the number of children given zero-dose OPV with the assistance of the VCMs similarly increased between 2013 and 2015. In 2015, VCMs helped track 167 092 newborns and also linked 156 537 infants aged <1 year to RI services in the 6 states. Conclusions The analysis illustrates that polio personnel in Northern Nigeria are used in increasing access to zero-dose OPV, RI, and selected PHC services. The increase in the services generated represented the increasing role of the dedicated mobile teams and polio VCMs in strengthening RI. PMID:28838155

The Use and Effectiveness of a Question Exploration Routine in Secondary-Level English Language Arts Classrooms

ERIC Educational Resources Information Center

Bulgren, Janis A.; Marquis, Janet G.; Deshler, Donald D.; Lenz, B. Keith; Schumaker, Jean B.

2013-01-01

This purpose of the study was to determine the effects of teachers using the Question Exploration Routine (QER) in regularly scheduled secondary-level English Language Arts classes to help students answer questions about the development and use of main ideas in Shakespeare's "Romeo and Juliet." Questions were posed in both…

Digital immunization registry: evidence for the impact of mHealth on enhancing the immunization system and improving immunization coverage for children under one year old in Vietnam.

PubMed

Nguyen, Nga Tuyet; Vu, Huong Minh; Dao, Sang Dinh; Tran, Hieu Trung; Nguyen, Tu Xuan Cam

2017-01-01

The Vietnam National Expanded Program on Immunization (NEPI) has been successfully implementing a nationwide immunization system since 1985. From the start, the program has increased the immunization coverage rate; however, data on immunization coverage in Vietnam are gathered and aggregated from commune health centers in routine, paper-based reports, which have shortcomings. Also, calculations of coverage are inconsistent at subnational levels, which lead to uncertainty about the size of the target population used as the denominator in coverage calculations. The growth of mobile networks in Vietnam provides an opportunity to apply mHealth to improve the immunization program. In 2012, PATH and the Vietnam NEPI developed and piloted a digital immunization registry, ImmReg, to overcome the challenges of the paper system. A final evaluation was conducted in 2015 to assess the impact of ImmReg, including its use of SMS reminders, on improving the immunization program. The study population comprised all children born in Ben Tre province in September and October of 2013, 2014, and 2015, representing pre-intervention, post-intervention, and one year post-intervention, respectively. Data exported from ImmReg were used to compare the immunization rate, dropout rate, and timeliness of vaccination before and after the intervention. Additionally, a rapid survey was conducted to understand the willingness of parents with children due for vaccination to pay for SMS reminder messages on the immunization schedule. Timely administration of oral polio vaccine, Quinvaxem, and measles 1 vaccine significantly increased over time from baseline to post-intervention to one year post-intervention. In particular, the timeliness of vaccination with the third dose of Quinvaxem increased from 53.6% to 65.8% to 77.2%. For measles 1 vaccine, the rate increased from 70.4% to 76.2% to 92.3%. In addition, the dropout rate from Quinvaxem 1 to Quinvaxem 3 declined from 4.2% in 2013 to 0% in 2015, and the dropout rate from Bacillus Calmette-Guérin (BCG) to measles 1 fell from 12.8% in 2013 to 0% in 2015. Full immunization coverage of children under one year old increased significantly from 75.4% in 2013 to 81.7% in 2014 to 99.2% in 2015. Also, survey results indicated that 93.3% of interviewees were willing to pay for SMS reminders for immunization. A digital immunization registry that includes SMS reminders can improve immunization coverage and timeliness of vaccination, thereby strengthening the quality and effectiveness of immunization programs. Integrating this system into the national health information system and leveraging it for other health programs, such as maternal and child health and nutrition as well as infectious disease control, can bring more benefits to the health care system in Vietnam.

Immunotoxicant screening and prioritization in the 21st century

EPA Science Inventory

Current immunotoxicity testing guidance for drugs, high production volume chemicals and pesticides specifies the use of animal models that measure immune function or evaluation of general indicators of immune system health generated in routine toxicity testing. The assays are ...

Immunotoxicant screening and prioritization in the 21st century*

EPA Science Inventory

Current immunotoxicity testing guidance for drugs, high production volume chemicals and pesticides specifies the use of animal models that measure immune function or evaluation of general indicators of immune system health generated in routine toxicity testing. The assays are r...

Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature.

PubMed

Nelson, Kristin N; Wallace, Aaron S; Sodha, Samir V; Daniels, Danni; Dietz, Vance

2016-11-04

Immunization programs in developing countries increasingly face challenges to ensure equitable delivery of services within cities where rapid urban growth can result in informal settlements, poor living conditions, and heterogeneous populations. A number of strategies have been utilized in developing countries to ensure high community demand and equitable availability of urban immunization services; however, a synthesis of the literature on these strategies has not previously been undertaken. We reviewed articles published in English in peer-reviewed journals between 1990 and 2013 that assessed interventions for improving routine immunization coverage in urban areas in low- and middle-income countries. We categorized the intervention in each study into one of three groups: (1) interventions aiming to increase utilization of immunization services; (2) interventions aiming to improve availability of immunization services by healthcare providers, or (3) combined availability and utilization interventions. We summarized the main quantitative outcomes from each study and effective practices from each intervention category. Fifteen studies were identified; 87% from the African, Eastern Mediterranean and Southeast Asian regions of the World Health Organization (WHO). Six studies were randomized controlled trials, eight were pre- and post-intervention evaluations, and one was a cross-sectional study. Four described interventions designed to improve availability of routine immunization services, six studies described interventions that aimed to increase utilization, and five studies aiming to improve both availability and utilization of services. All studies reported positive change in their primary outcome indicator, although seven different primary outcomes indicators were used across studies. Studies varied considerably with respect to the type of intervention assessed, study design, and length of intervention assessment. Few studies have assessed interventions designed explicitly for the unique challenges facing immunization programs in urban areas. Further research on sustainability, scalability, and cost-effectiveness of interventions is needed to fill this gap. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature

PubMed Central

Nelson, Kristin N.; Wallace, Aaron S.; Sodha, Samir V.; Daniels, Danni; Dietz, Vance

2016-01-01

Introduction Immunization programs in developing countries increasingly face challenges to ensure equitable delivery of services within cities where rapid urban growth can result in informal settlements, poor living conditions, and heterogeneous populations. A number of strategies have been utilized in developing countries to ensure high community demand and equitable availability of urban immunization services; however, a synthesis of the literature on these strategies has not previously been undertaken. Methods We reviewed articles published in English in peer-reviewed journals between 1990 and 2013 that assessed interventions for improving routine immunization coverage in urban areas in low- and middle-income countries. We categorized the intervention in each study into one of three groups: (1) interventions aiming to increase utilization of immunization services; (2) interventions aiming to improve availability of immunization services by healthcare providers, or (3) combined availability and utilization interventions. We summarized the main quantitative outcomes from each study and effective practices from each intervention category. Results Fifteen studies were identified; 87% from the African, Eastern Mediterranean and Southeast Asian regions of the World Health Organization (WHO). Six studies were randomized controlled trials, eight were pre- and post-intervention evaluations, and one was a cross-sectional study. Four described interventions designed to improve availability of routine immunization services, six studies described interventions that aimed to increase utilization, and five studies aiming to improve both availability and utilization of services. All studies reported positive change in their primary outcome indicator, although seven different primary outcomes indicators were used across studies. Studies varied considerably with respect to the type of intervention assessed, study design, and length of intervention assessment. Conclusion Few studies have assessed interventions designed explicitly for the unique challenges facing immunization programs in urban areas. Further research on sustainability, scalability, and cost-effectiveness of interventions is needed to fill this gap. PMID:27692772

Utilization of outreach immunization services among children in Hoima District, Uganda: a cluster survey.

PubMed

Oryema, Paul; Babirye, Juliet N; Baguma, Charles; Wasswa, Peter; Guwatudde, David

2017-02-27

The global vaccine action plan 2011-2020 was endorsed by 194 states to equitably extend the benefits of immunization to all people. However, gaps in vaccination coverage remain in developing countries such as Uganda. One of the strategies used to tackle existing inequities is implementation of outreach immunization services to deliver services to those with poor geographical access. However, reports of inconsistent use of these services prevail; therefore understanding the factors associated with use of these services is critical for improving service delivery. This study examined the factors associated with utilization of outreach immunization services among children aged 10-23 months in Hoima District, Uganda. Overall, 87.4% (416/476) of the children had ever utilized outreach immunization services. Of these, 3.6% (15/416) had completed their entire immunization schedules from outreach immunization sessions. Use of outreach services was associated with reports that the time of outreach sessions was convenient [adjusted odds ratio (AOR) 2.9, 95% confidence interval (CI) 1.32-6.51], community mobilization was done prior to outreach sessions (AOR 4.9, 95% CI 1.94-12.61), the caretaker knew the benefits of childhood immunizations (AOR 2.1, 95% CI 1.30-4.42), and the caretaker was able to name at least four vaccine preventable diseases (AOR 3.0, 95% CI 1.13-7.88). Utilization of outreach immunization services in Hoima District was high but reduced with subsequent vaccine doses. Therefore, strategies targeted at retaining service users for the entire immunization schedule need to be developed and implemented. Such strategies could include health education emphasizing the benefits of childhood immunization.

Effects of Parent Implemented Visual Schedule Routines for African American Children with ASD in Low-Income Home Settings

ERIC Educational Resources Information Center

Goldman, Samantha E.; Glover, Carrie A.; Lloyd, Blair P.; Barton, Erin E.; Mello, Maria P.

2018-01-01

Low-income, minority families are underrepresented in the literature on parent training for school-aged children with autism spectrum disorder (ASD). Although the use of visual supports, such as visual schedules, is considered to be an evidence-based practice for children with ASD in school, it is not known whether this strategy is effective for…

Factors associated with the immune response to hepatitis A vaccination in HIV-infected patients in the era of highly active antiretroviral therapy.

PubMed

Mena, Guillermo; García-Basteiro, Alberto L; Llupià, Anna; Díez, Consolación; Costa, Josep; Gatell, Josep-María; García, Felipe; Bayas, José-María

2013-08-12

HIV seropositivity is considered a risk factor for complications in hepatitis A virus (HAV) infection. HAV vaccination schedules are widely implemented in HIV-infected patients, but the immune response remains impaired. We analysed the response to vaccination (antiHAV titres ≥20IU/l) in 282 HIV-infected patients included in a standard (1440 Elisa Units (EU) at 0, 6 months) or rapidly accelerated schedule (720 EU at 0, 7, 21 days and 6 months) between 1997 and 2009. Factors associated with the response to vaccination were analysed using logistic regression. The overall response rate was 73.4%. Male sex (OR: 0.16, 95% CI 0.05-0.51) and hepatitis C virus co-infection (OR: 0.30, 95% CI 0.14-0.74) were associated with a lower probability of response. Protective antibody response was associated with a higher CD4/CD8 ratio (OR: 3.69, 95% CI 1.3-10.5) and having received two doses of standard schedule (compared with patients receiving only one dose of the same schedule) (OR: 2.51, 95% CI 1.22-5.15). Three doses of the rapidly accelerated schedule were not more effective than a single dose of 1440 EU (OR: 1.32, 95% CI 0.48-3.63). The low responses observed in patients receiving a single dose suggest the need to emphasize adhesion to vaccination protocols to avoid failure. The CD4/CD8 ratio may be considered as an immune status marker which could help to better choose the moment of vaccination. Our findings underscore the importance of identifying strategies that optimize the timing and effectiveness of hepatitis A vaccination in HIV-infected patients and of the need for further studies on individual factors such as sex and hepatitis C co-infection that may affect the response to vaccination. Likewise, the sub-optimal effectiveness of three doses of 720 EU in the rapidly accelerated schedule, if confirmed in future studies, might lead to a revision of the current schedule recommended for HIV-infected travellers. Copyright © 2013 Elsevier Ltd. All rights reserved.

Polio vaccines: WHO position paper, March 2016-recommendations.

PubMed

World Health Organization

2017-03-01

This article presents the World Health Organization's (WHO) recommendations on the use of polio vaccine excerpted from the WHO position paper on polio vaccines - March 2016, published in the Weekly Epidemiological Record [1]. This position paper on polio vaccines replaces the 2014 WHO position paper [2]. The position paper summarizes the WHO position on the introduction of at least one dose of inactivated polio vaccine (IPV) into routine immunization schedules as a strategy to mitigate the potential risk of re-emergence of type 2 polio following the withdrawal of Sabin type 2 strains from oral polio vaccine (OPV) [3]. Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation table. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This position paper reflects the global switch from trivalent to bivalent OPV which took place in April 2016. Recommendations on the use of polio vaccines have been discussed on multiple occasions by SAGE, most recently in October 2016; evidence presented at these meetings can be accessed at: http://www.who.int/immunization/sage/previous/en/index.html. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Primary care follow-up of newborns with sickle cell disease detected in neonatal screening in the Community of Madrid].

PubMed

Rodríguez-Moldes, B; Carbajo, A J; Sánchez, B; Fernández, M; Garí, M; Fernández, M C; Álvarez, J; García, A; Cela, E

2015-04-01

The main aim of the study was to assess the effects of the recommended preventive program in the population affected with Sickle Cell Disease in Primary Care. The program included, antibiotic prophylaxis, immunizations and health education, following the introduction of universal neonatal screening program for Sickle Cell Disease in the Community of Madrid. A cross-sectional observational study was performed with retrospective data collected from a cohort of newborns with Sickle Cell Disease diagnosed by neonatal screening test in the Community of Madrid. From the data obtained from a sample of 20 patients, it was found that 95% had been diagnosed by the newborn screening test performed between 5 and 13 days of life. The mean age was 39 months when the study was conducted. During follow-up, from Primary Care Paediatric clinic, it was observed that the compliance for antibiotic prophylaxis was 90%, and the coverage for the official vaccination schedule was 85%. Specific vaccine coverage as a risk population was highly variable (85% for pneumococcal 23V, 50% for influenza, and 15% for hepatitis A). Health education only reached one in every four families. Acceptable compliance with antibiotic prophylaxis was observed during the follow-up of patients with sickle cell disease in Primary Care, but a low coverage of routine immunization, as well as specific immunizations. Coverage of health education was very low. Improving these parameters would require greater coordination and involvement of Primary Care Professionals so that these patients were followed up appropriately, and could be translated into a reduction of disease complications and an improvement in the quality of life of these patients. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Monitoring Results in Routine Immunization: Development of Routine Immunization Dashboard in Selected African Countries in the Context of the Polio Eradication Endgame Strategic Plan.

PubMed

Poy, Alain; van den Ent, Maya M V X; Sosler, Stephen; Hinman, Alan R; Brown, Sidney; Sodha, Samir; Ehlman, Daniel C; Wallace, Aaron S; Mihigo, Richard

2017-07-01

To monitor immunization-system strengthening in the Polio Eradication Endgame Strategic Plan 2013-2018 (PEESP), the Global Polio Eradication Initiative identified 1 indicator: 10% annual improvement in third dose of diphtheria- tetanus-pertussis-containing vaccine (DTP3) coverage in polio high-risk districts of 10 polio focus countries. A multiagency team, including staff from the African Region, developed a comprehensive list of outcome and process indicators measuring various aspects of the performance of an immunization system. The development and implementation of the dashboard to assess immunization system performance allowed national program managers to monitor the key immunization indicators and stratify by high-risk and non-high-risk districts. Although only a single outcome indicator goal (at least 10% annual increase in DTP3 coverage achieved in 80% of high-risk districts) initially existed in the endgame strategy, we successfully added additional outcome indicators (eg, decreasing the number of DTP3-unvaccinated children) as well as program process indicators focusing on cold chain, stock availability, and vaccination sessions to better describe progress on the pathway to raising immunization coverage. When measuring progress toward improving immunization systems, it is helpful to use a comprehensive approach that allows for measuring multiple dimensions of the system. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Application of Mobile Technology for Improving Expanded Program on Immunization Among Highland Minority and Stateless Populations in Northern Thailand Border

PubMed Central

Apidechkul, Tawatchai; Jandee, Kasemsak; Khamsiriwatchara, Amnat; Lawpoolsri, Saranath; Sawang, Surasak; Sangvichean, Aumnuyphan; Wansatid, Peerawat; Krongrungroj, Sarinya

2015-01-01

Background Studies of undervaccinated children of minority/stateless populations have highlighted significant barriers at individual, community, and state levels. These include geography-related difficulties, poverty, and social norms/beliefs. Objective The objective of this study was to assess project outcomes regarding immunization coverage, as well as maternal attitudes and practices toward immunization. Methods The “StatelessVac” project was conducted in Thailand-Myanmar-Laos border areas using cell phone-based mechanisms to increase immunization coverage by incorporating phone-to-phone information sharing for both identification and prevention. With limitation of the study among vulnerable populations in low-resource settings, the pre/post assessments without comparison group were conducted. Immunization coverage was collected from routine monthly reports while behavior-change outcomes were from repeat surveys. Results This study revealed potential benefits of the initiative for case identification; immunization coverage showed an improved trend. Prevention strategies were successfully integrated into the routine health care workflows of immunization activities at point-of-care. A behavior-change-communication package contributes significantly in raising both concern and awareness in relation to child care. Conclusions The mobile technology has proven to be an effective mechanism in improving a children’s immunization program among these hard-to-reach populations. Part of the intervention has now been revised for use at health centers across the country. PMID:25589367

Update on vaccine-derived polioviruses - worldwide, July 2012-December 2013.

PubMed

Diop, Ousmane M; Burns, Cara C; Wassilak, Steven G; Kew, Olen M

2014-03-21

In 1988, the World Health Assembly resolved to eradicate poliomyelitis worldwide. One of the main tools used in polio eradication efforts has been live, attenuated oral poliovirus vaccine (OPV), an inexpensive vaccine easily administered by trained volunteers. OPV might require several doses to induce immunity, but then it provides long-term protection against paralytic disease through durable humoral immunity. Rare cases of vaccine-associated paralytic poliomyelitis can occur among immunologically normal OPV recipients, their contacts, and persons who are immunodeficient. In addition, vaccine-derived polioviruses (VDPVs) can emerge in areas with low OPV coverage to cause polio outbreaks and can replicate for years in persons who have primary, B-cell immunodeficiencies. This report updates previous surveillance summaries and describes VDPVs detected worldwide during July 2012-December 2013. Those include a new circulating VDPV (cVDPV) outbreak identified in Pakistan in 2012, with spread to Afghanistan; an outbreak in Afghanistan previously identified in 2009 that continued into 2013; a new outbreak in Chad that spread to Cameroon, Niger, and northeastern Nigeria; and an outbreak that began in Somalia in 2008 that continued and spread to Kenya in 2013. A large outbreak in Nigeria that was identified in 2005 was nearly stopped by the end of 2013. Additionally, 10 newly identified persons in eight countries were found to excrete immunodeficiency-associated VDPVs (iVDPVs), and VDPVs were found among immunocompetent persons and environmental samples in 13 countries. Because the majority of VDPV isolates are type 2, the World Health Organization has developed a plan for coordinated worldwide replacement of trivalent OPV (tOPV) with bivalent OPV (bOPV; types 1 and 3) by 2016, preceded by introduction of at least 1 dose of inactivated poliovirus vaccine (IPV) containing all three poliovirus serotypes into routine immunization schedules worldwide to ensure high population immunity to all polioviruses.

An assessment of routine primary care health information system data quality in Sofala Province, Mozambique

PubMed Central

2011-01-01

Background Primary health care is recognized as a main driver of equitable health service delivery. For it to function optimally, routine health information systems (HIS) are necessary to ensure adequate provision of health care and the development of appropriate health policies. Concerns about the quality of routine administrative data have undermined their use in resource-limited settings. This evaluation was designed to describe the availability, reliability, and validity of a sample of primary health care HIS data from nine health facilities across three districts in Sofala Province, Mozambique. HIS data were also compared with results from large community-based surveys. Methodology We used a methodology similar to the Global Fund to Fight AIDS, Tuberculosis and Malaria data verification bottom-up audit to assess primary health care HIS data availability and reliability. The quality of HIS data was validated by comparing three key indicators (antenatal care, institutional birth, and third diptheria, pertussis, and tetanus [DPT] immunization) with population-level surveys over time. Results and discussion The data concordance from facility clinical registries to monthly facility reports on five key indicators--the number of first antenatal care visits, institutional births, third DPT immunization, HIV testing, and outpatient consults--was good (80%). When two sites were excluded from the analysis, the concordance was markedly better (92%). Of monthly facility reports for immunization and maternity services, 98% were available in paper form at district health departments and 98% of immunization and maternity services monthly facility reports matched the Ministry of Health electronic database. Population-level health survey and HIS data were strongly correlated (R = 0.73), for institutional birth, first antenatal care visit, and third DPT immunization. Conclusions Our results suggest that in this setting, HIS data are both reliable and consistent, supporting their use in primary health care program monitoring and evaluation. Simple, rapid tools can be used to evaluate routine data and facilitate the rapid identification of problem areas. PMID:21569533

An assessment of prime‐boost vaccination schedules with AS03A‐adjuvanted prepandemic H5N1 vaccines: a randomized study in European adults

PubMed Central

Gillard, Paul; Caplanusi, Adrian; Knuf, Markus; Roman, François; Walravens, Karl; Moris, Philippe; Dramé, Mamadou; Schwarz, Tino F.

2012-01-01

Please cite this paper as: Gillard et al. (2012) An assessment of prime‐boost vaccination schedules with AS03A‐adjuvanted prepandemic H5N1 vaccines: a randomized study in European adults. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2012.00349.x. Background  Long‐term persistence of immune response and safety of an H5N1 prepandemic influenza vaccine adjuvanted with AS03 (an α‐tocopherol oil‐in‐water emulsion‐based adjuvant system) was evaluated using various prime‐boost schedules that mimicked potential pandemic scenarios (NCT00430521). Methods  Five hundred and twelve healthy adults aged 18–60 years received primary vaccination with one or two doses (0, 21 days schedule) of the A/Vietnam/1194/2004 H5N1 vaccine followed by a booster dose (A/Vietnam/1194/2004 or A/Indonesia/05/2005 strain) six or twelve months later across eight randomized groups. Immunogenicity results by hemagglutination inhibition [HI] assay, microneutralization assay, and the cell‐mediated immune response (CMI) are reported here for the four groups boosted at Month 12. Results  A one‐dose‐adjuvanted primary administration followed 12 months later by a single‐adjuvanted booster dose containing a heterologous vaccine strain met or exceeded all US and European criteria for both strains. Increasing the interval between the first and second dose (from 21 days to 12 months) resulted in stronger cross‐reactive immune responses against the A/Indonesia/05/2005 strain. The HI antibody response against the two strains persisted for 6 months after the booster dose irrespective of the booster vaccine’s strain. The neutralizing antibody responses and the CMI observed in the study population paralleled the HI immune response. Overall, the vaccine had a clinically acceptable safety profile. Conclusion  The H5N1 vaccine in this study allowed for flexibility in the time interval between primary and booster vaccination and the use of a heterologous strain without impacting the strength of the humoral and cellular immune response to both vaccine strains. PMID:22405557

Legacy of Polio—Use of India’s Social Mobilization Network for Strengthening of the Universal Immunization Program in India

PubMed Central

Deutsch, Nicole; Singh, Vivek; Curtis, Rod; Siddique, Anisur Rahman

2017-01-01

Abstract The Social Mobilization Network (SMNet) has been lauded as one of the most successsful community engagement strategies in public health for its role in polio elimination in India. The UNICEF-managed SMNet was created as a strategy to eradicate polio by engaging >7000 frontline social mobilizers to advocate for vaccination in some of the most underserved, marginalized, and at-risk communities in India. This network focused initially on generating demand for polio vaccination but later expanded its messaging to promote routine immunization and other health and sanitation interventions related to maternal and children’s health. As an impact of the network’s interventions, in collaboration with other eradication efforts, these high-risk pockets witnessed an increase in full routine immunization coverage. The experience of the SMNet offers lessons for health-system strengthening for social mobilization and promoting positive health behaviors for other priority health programs like the Universal Immunization Program. PMID:28838190

Immunity to tetanus and diphtheria in the UK in 2009.

PubMed

Wagner, Karen S; White, Joanne M; Andrews, Nick J; Borrow, Ray; Stanford, Elaine; Newton, Emma; Pebody, Richard G

2012-11-19

This study aimed to estimate the immunity of the UK population to tetanus and diphtheria, including the potential impact of new glycoconjugatate vaccines, and the addition of diphtheria to the school leaver booster in 1994. Residual sera (n=2697) collected in England in 2009/10 were selected from 18 age groups and tested for tetanus and diphtheria antibody. Results were standardised by testing a panel of sera (n=150) to enable comparison with a previously (1996) published serosurvey. Data were then standardised to the UK population. In 2009, 83% of the UK population were protected (≥0.1 IU/mL) against tetanus compared to 76% in 1996 (p=0.079), and 75% had at least basic protection against diphtheria (≥0.01 IU/mL) in 2009 compared to 60% in 1996 (p<0.001). Higher antibody levels were observed in those aged 1-3 years in 2009 compared to 1996 for both tetanus and diphtheria. Higher diphtheria immunity was observed in those aged 16-34 years in 2009 compared to 1996 (geometric mean concentration [GMC] 0.15 IU/mL vs. 0.03 IU/mL, p<0.001). Age groups with the largest proportion of susceptible individuals to both tetanus and diphtheria in 2009 were <1 year old (>29% susceptible), 45-69 years (>20% susceptible) and 70+ years (>32% susceptible). Low immunity was observed in those aged 10-11 years (>19% susceptible), between the scheduled preschool and school leaver booster administration. The current schedule appears to induce protective levels; increases in the proportions protected/GMCs were observed for the ages receiving vaccinations according to UK policy. Glycoconjugate vaccines appear to have increased immunity, in particular for diphtheria, in preschool age groups. Diphtheria immunity in teenagers and young adults has increased as a result of the addition of diphtheria to the school leaver booster. However, currently older adults remain susceptible, without any further opportunities for immunisations planned according to the present schedule. Copyright © 2012 Elsevier Ltd. All rights reserved.

Predictors of incompletion of immunization among children residing in the slums of Kathmandu valley, Nepal: a case-control study.

PubMed

Shrestha, Sumina; Shrestha, Monika; Wagle, Rajendra Raj; Bhandari, Gita

2016-09-13

Immunization is one of the most effective health interventions averting an estimated 2-3 million deaths every year. In Nepal, as in most low-income countries, infants are immunized with standard WHO recommended vaccines. However, 16.4 % of children did not receive complete immunization by 12 months of age in Nepal in 2011. Studies from different parts of the world showed that incomplete immunization is even higher in slums. The objective of this study was to identify the predictors of incompletion of immunization among children aged 12-23 months living in the slums of Kathmandu Valley, Nepal. The unmatched case-control study was conducted in 22 randomly selected slums of Kathmandu Valley. The sampling frame was first identified by complete enumeration of entire households of the study area from which 59 incompletely immunized children as cases and 177 completely immunized children as controls were chosen randomly in 1:3 ratio. Data were collected from the primary caretakers of the children. Backward logistic regression with 95 % confidence interval and adjusted odds ratio (AOR) were applied to assess the factors independently associated with incomplete immunization. Twenty-six percent of the children were incompletely vaccinated. The coverage of BCG vaccine was 95.0 % while it was 80.5 % for measles vaccine. The significant predictors of incomplete immunization were the home delivery of a child, the family residing on rent, a primary caretaker with poor knowledge about the schedule of vaccination and negative perception towards vaccinating a sick child, conflicting priorities, and development of abscess following immunization. Reduction of abscess formation rate can be a potential way to improve immunization rates. Community health volunteers should increase their follow-up on children born at home and those living in rent. Health institutions and volunteers should be influential in creating awareness about immunization, its schedule, and post-vaccination side effects.

Interactive experimenters' planning procedures and mission control

NASA Technical Reports Server (NTRS)

Desjardins, R. L.

1973-01-01

The computerized mission control and planning system routinely generates a 24-hour schedule in one hour of operator time by including time dimensions into experimental planning procedures. Planning is validated interactively as it is being generated segment by segment in the frame of specific event times. The planner simply points a light pen at the time mark of interest on the time line for entering specific event times into the schedule.

Recommendations for NRC policy on shift scheduling and overtime at nuclear power plants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lewis, P.M.

1985-07-01

This report contains the Pacific Northwest Laboratory's (PNL's) recommendations to the US Nuclear Regulatory Commission (NRC) for an NRC policy on shift scheduling and hours of work (including overtime) for control room operators and other safety-related personnel in nuclear power plants. First, it is recommended that NRC make three additions to its present policy on overtime: (1) limit personnel to 112 hours of work in a 14-day period, 192 hours in 28 days, and 2260 hours in one year; exceeding these limits would require plant manager approval; (2) add a requirement that licensees obtain approval from NRC if plant personnelmore » are expected to exceed 72 hours of work in a 7-day period, 132 hours in 14 days, 228 hours in 28 days, and 2300 hours in one year; and (3) make the policy a requirement, rather than a nonbinding recommendation. Second, it is recommended that licensees be required to obtain NRC approval to adopt a routine 12-hour/day shift schedule. Third, it is recommended that NRC add several nonbinding recommendations concerning routine 8-hour/day schedules. Finally, because additional data can strengthen the basis for future NRC policy on overtime, five methods are suggested for collecting data on overtime and its effects. 44 refs., 10 tabs.« less

Risk of fever and sepsis evaluations after routine immunizations in the neonatal intensive care unit.

PubMed

Navar-Boggan, A M; Halsey, N A; Golden, W C; Escobar, G J; Massolo, M; Klein, N P

2010-09-01

Premature infants can experience cardiorespiratory events such as apnea after immunization in the neonatal intensive care unit (NICU). These changes in clinical status may precipitate sepsis evaluations. This study evaluated whether sepsis evaluations are increased after immunizations in the NICU. We conducted a retrospective cohort study of infants older than 53 days who were vaccinated in the NICU at the KPMCP (Kaiser Permanente Medical Care Program). Chart reviews were carried out before and after all immunizations were administered and for all sepsis evaluations after age 53 days. The clinical characteristics of infants on the day before receiving a sepsis evaluation were compared between children undergoing post-immunization sepsis evaluations and children undergoing sepsis evaluation at other times. The incidence rate of sepsis evaluations in the post-immunization period was compared with the rate in a control time period not following immunization using Poisson regression. A total of 490 infants met the inclusion criteria. The rate of fever was increased in the 24 h period after vaccination (2.3%, P<0.05). The incidence rate of sepsis evaluations was 40% lower after immunization than during the control period, although this was not statistically significant (P=0.09). Infants undergoing a sepsis evaluation after immunization were more likely to have an apneic, bradycardic or moderate-to-severe cardiorespiratory event in the day before the evaluation than were infants undergoing sepsis evaluations at other times (P<0.05). Despite an increase in fever and cardiorespiratory events after immunization in the NICU, routine vaccination was not associated with increased risk of receiving sepsis evaluations. Providers may be deferring immunizations until infants are clinically stable, or may have a higher threshold for initiating sepsis evaluations after immunization than at other times.

Are we doing enough? Evaluation of the Polio Eradication Initiative in a district of Pakistan's Punjab province: a LQAS study

PubMed Central

2010-01-01

Background The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. The aim of the study was to establish valid and reliable estimate for: routine oral polio vaccine (OPV) coverage, logistics management and the quality of monitoring systems in health facilities, NIDs OPV coverage, the quality of NIDs service delivery in static centers and mobile teams, and to ultimately provide scientific evidence for tailoring future interventions. Methods A cross-sectional study using lot quality assessment sampling was conducted in the District Nankana Sahib of Pakistan's Punjab province. Twenty primary health centers and their catchment areas were selected randomly as 'lots'. The study involved the evaluation of 1080 children aged 12-23 months for routine OPV coverage, 20 health centers for logistics management and quality of monitoring systems, 420 households for NIDs OPV coverage, 20 static centers and 20 mobile teams for quality of NIDs service delivery. Study instruments were designed according to WHO guidelines. Results Five out of twenty lots were rejected for unacceptably low routine immunization coverage. The validity of coverage was questionable to extent that all lots were rejected. Among the 54.1% who were able to present immunization cards, only 74.0% had valid immunization. Routine coverage was significantly associated with card availability and socioeconomic factors. The main reasons for routine immunization failure were absence of a vaccinator and unawareness of need for immunization. Health workers (96.9%) were a major source of information. All of the 20 lots were rejected for poor compliance in logistics management and quality of monitoring systems. Mean compliance score and compliance percentage for logistics management were 5.4 ± 2.0 (scale 0-9) and 59.4% while those for quality of monitoring systems were 3.3 ± 1.2 (scale 0-6) and 54.2%. The 15 out of 20 lots were rejected for unacceptably low NIDs coverage by finger-mark. All of the 20 lots were rejected for poor NIDs service delivery (mean compliance score = 11.7 ± 2.1 [scale 0-16]; compliance percentage = 72.8%). Conclusion Low coverage, both routine and during NIDs, and poor quality of logistics management, monitoring systems and NIDs service delivery were highlighted as major constraints in polio eradication and these should be considered in prioritizing future strategies. PMID:20144212

Are we doing enough? Evaluation of the Polio Eradication Initiative in a district of Pakistan's Punjab province: a LQAS study.

PubMed

Mushtaq, Muhammad Umair; Majrooh, Muhammad Ashraf; Ullah, Mohsin Zia Sana; Akram, Javed; Siddiqui, Arif Mahmood; Shad, Mushtaq Ahmad; Waqas, Muhammad; Abdullah, Hussain Muhammad; Ahmad, Waqar; Shahid, Ubeera; Khurshid, Usman

2010-02-09

The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. The aim of the study was to establish valid and reliable estimate for: routine oral polio vaccine (OPV) coverage, logistics management and the quality of monitoring systems in health facilities, NIDs OPV coverage, the quality of NIDs service delivery in static centers and mobile teams, and to ultimately provide scientific evidence for tailoring future interventions. A cross-sectional study using lot quality assessment sampling was conducted in the District Nankana Sahib of Pakistan's Punjab province. Twenty primary health centers and their catchment areas were selected randomly as 'lots'. The study involved the evaluation of 1080 children aged 12-23 months for routine OPV coverage, 20 health centers for logistics management and quality of monitoring systems, 420 households for NIDs OPV coverage, 20 static centers and 20 mobile teams for quality of NIDs service delivery. Study instruments were designed according to WHO guidelines. Five out of twenty lots were rejected for unacceptably low routine immunization coverage. The validity of coverage was questionable to extent that all lots were rejected. Among the 54.1% who were able to present immunization cards, only 74.0% had valid immunization. Routine coverage was significantly associated with card availability and socioeconomic factors. The main reasons for routine immunization failure were absence of a vaccinator and unawareness of need for immunization. Health workers (96.9%) were a major source of information. All of the 20 lots were rejected for poor compliance in logistics management and quality of monitoring systems. Mean compliance score and compliance percentage for logistics management were 5.4 +/- 2.0 (scale 0-9) and 59.4% while those for quality of monitoring systems were 3.3 +/- 1.2 (scale 0-6) and 54.2%. The 15 out of 20 lots were rejected for unacceptably low NIDs coverage by finger-mark. All of the 20 lots were rejected for poor NIDs service delivery (mean compliance score = 11.7 +/- 2.1 [scale 0-16]; compliance percentage = 72.8%). Low coverage, both routine and during NIDs, and poor quality of logistics management, monitoring systems and NIDs service delivery were highlighted as major constraints in polio eradication and these should be considered in prioritizing future strategies.

Family Characteristics Associated with Likelihood of Varicella Vaccination

PubMed Central

Weinmann, Sheila; Mullooly, John P; Drew, Lois; Chun, Colleen S

2016-01-01

Context: The introduction of the varicella vaccine as a routine pediatric immunization in the US, in 1995, provided an opportunity to assess factors associated with uptake of new vaccines in the member population of the Kaiser Permanente Northwest (KPNW) Health Plan. Objective: Identify factors associated with varicella vaccination in the KPNW population in the first five years after varicella vaccine was introduced. Design: A retrospective cohort of children under age 13 years between June 1995 and December 1999, without a history of varicella disease was identified using KPNW automated data. Membership records were linked to vaccine databases. Cox regression was used to estimate likelihood of varicella vaccination during the study period in relation to age, sex, primary clinician’s specialty, and Medicaid eligibility. For a subset whose parents answered a behavioral health survey, additional demographic and behavioral characteristics were evaluated. Main Outcome Measure: Varicella vaccination. Results: We identified 88,646 children under age 13 years without a history of varicella; 22% were vaccinated during the study period. Varicella vaccination was more likely among children who were born after 1995, were not Medicaid recipients, or had pediatricians as primary clinicians. In the survey-linked cohort, positively associated family characteristics included smaller family size; higher socioeconomic status; and parents who were older, were college graduates, reported excellent health, and received influenza vaccination. Conclusion: Understanding predictors of early varicella vaccine-era vaccine acceptance may help in planning for introduction of new vaccines to routine schedules. PMID:27104589

Safety and Immunogenicity of a Quadrivalent Meningococcal Conjugate Vaccine and Commonly Administered Vaccines After Coadministration.

PubMed

Gasparini, Roberto; Tregnaghi, Miguel; Keshavan, Pavitra; Ypma, Ellen; Han, Linda; Smolenov, Igor

2016-01-01

Given the broad age range across which the quadrivalent meningococcal conjugate vaccine MenACWY-CRM is used, coadministration with routine vaccines should be evaluated across age groups for possible immunologic interference and impact on vaccine reactogenicity and safety. We summarize data from a large population of infants, adolescents and international travelers from 10 phase 3 or 4 clinical studies to evaluate coadministration of MenACWY-CRM with commonly administered vaccines. Noninferiority analyses of immune responses were performed across studies and age groups for each vaccine. Reactogenicity and safety were also assessed. In infants, MenACWY-CRM coadministered with routine vaccines did not reduce immune responses to diphtheria, tetanus, poliovirus, hepatitis B, Haemophilus influenzae type b, pneumococcal conjugate, measles-mumps-rubella, varicella or pertussis antigens. Noninferiority criteria were not met for some pneumococcal conjugate serotypes at 7 months of age, but no consistent trends were observed. In adolescents, coadministration did not reduce immune responses to tetanus, diphtheria and human papilloma virus vaccine antigens. Noninferiority criteria for pertussis antigens were not uniformly met in infant and adolescent studies, although the clinical relevance is unclear. In adults, coadministration did not reduce immune responses to hepatitis A/B, typhoid fever, yellow fever, Japanese encephalitis and rabies antigens. Immune responses to MenACWY-CRM were not impacted by coadministration of commonly administered vaccines. Coadministration did not increase frequencies of postvaccination adverse events in any age group. With no clinically relevant vaccine interactions or impact on vaccine reactogenicity or safety, these results support the coadministration of MenACWY-CRM with routine vaccines in all age groups.

Analytics for vaccine economics and pricing: insights and observations.

PubMed

Robbins, Matthew J; Jacobson, Sheldon H

2015-04-01

Pediatric immunization programs in the USA are a successful and cost-effective public health endeavor, profoundly reducing mortalities caused by infectious diseases. Two important issues relate to the success of the immunization programs, the selection of cost-effective vaccines and the appropriate pricing of vaccines. The recommended childhood immunization schedule, published annually by the CDC, continues to expand with respect to the number of injections required and the number of vaccines available for selection. The advent of new vaccines to meet the growing requirements of the schedule results: in a large, combinatorial number of possible vaccine formularies. The expansion of the schedule and the increase in the number of available vaccines constitutes a challenge for state health departments, large city immunization programs, private practices and other vaccine purchasers, as a cost-effective vaccine formulary must be selected from an increasingly large set of possible vaccine combinations to satisfy the schedule. The pediatric vaccine industry consists of a relatively small number of pharmaceutical firms engaged in the research, development, manufacture and distribution of pediatric vaccines. The number of vaccine manufacturers has dramatically decreased in the past few decades for a myriad of reasons, most notably due to low profitability. The contraction of the industry negatively impacts the reliable provision of pediatric vaccines. The determination of appropriate vaccine prices is an important issue and influences a vaccine manufacturer's decision to remain in the market. Operations research is a discipline that applies advanced analytical methods to improve decision making; analytics is the application of operations research to a particular problem using pertinent data to provide a practical result. Analytics provides a mechanism to resolve the challenges facing stakeholders in the vaccine development and delivery system, in particular, the selection of cost-effective vaccines and the appropriate pricing of vaccines. A review of applicable analytics papers is provided.

Demonstration of the Use of Remote Temperature Monitoring Devices in Vaccine Refrigerators in Haiti.

PubMed

Cavallaro, Kathleen F; Francois, Jeannot; Jacques, Roody; Mentor, Derline; Yalcouye, Idrissa; Wilkins, Karen; Mueller, Nathan; Turner, Rebecca; Wallace, Aaron; Tohme, Rania A

After the 2010 earthquake, Haiti committed to introducing 4 new antigens into its routine immunization schedule, which required improving its cold chain (ie, temperature-controlled supply chain) and increasing vaccine storage capacity by installing new refrigerators. We tested the feasibility of using remote temperature monitoring devices (RTMDs) in Haiti in a sample of vaccine refrigerators fueled by solar panels, propane gas, or electricity. We analyzed data from 16 RTMDs monitoring 24 refrigerators in 15 sites from March through August 2014. Although 5 of the 16 RTMDs exhibited intermittent data gaps, we identified typical temperature patterns consistent with refrigerator door opening and closing, propane depletion, thermostat insufficiency, and overstocking. Actual start-up, annual maintenance, and annual electricity costs for using RTMDs were $686, $179, and $9 per refrigerator, respectively. In Haiti, RTMD use was feasible. RTMDs could be prioritized for use with existing refrigerators with high volumes of vaccines and new refrigerators to certify their functionality before use. Vaccine vial monitors could provide additional useful information about cumulative heat exposure and possible vaccine denaturation.

The burden of rotavirus hospitalizations among Medicaid and non-Medicaid children younger than 5 years old.

PubMed

Ma, Liyuan; El Khoury, Antoine C; Itzler, Robbin F

2009-10-01

We sought to compare the burden of hospitalizations associated with rotavirus gastroenteritis (RGE) in children younger than 5 years in US Medicaid and non-Medicaid populations in 2000 and 2003. We used the Kids' Inpatient Database (KID) to examine the burden of RGE-associated hospitalizations in terms of numbers and rates of hospitalizations, lengths of stay, and hospital charges. Two indirect methods were also used to estimate RGE-associated hospitalizations, because rotavirus testing is not routinely performed. Approximately 40% of children younger than 5 years were enrolled in Medicaid in 2003, but this population accounted for nearly 50% of all RGE-associated hospitalizations and 60% of total charges. Children enrolled in Medicaid had significantly greater hospitalization rates, average lengths of stay, and average charges per stay than did those not enrolled. Although RGE affects all socioeconomic groups, the Medicaid population accounted for a disproportionate number of the hospitalizations. With the inclusion of rotavirus vaccines in the pediatric immunization schedule, it is important that US children, especially those enrolled in Medicaid programs, are vaccinated to reduce the burden of RGE.

Interactive Dynamic Mission Scheduling for ASCA

NASA Astrophysics Data System (ADS)

Antunes, A.; Nagase, F.; Isobe, T.

The Japanese X-ray astronomy satellite ASCA (Advanced Satellite for Cosmology and Astrophysics) mission requires scheduling for each 6-month observation phase, further broken down into weekly schedules at a few minutes resolution. Two tools, SPIKE and NEEDLE, written in Lisp and C, use artificial intelligence (AI) techniques combined with a graphic user interface for fast creation and alteration of mission schedules. These programs consider viewing and satellite attitude constraints as well as observer-requested criteria and present an optimized set of solutions for review by the planner. Six-month schedules at 1 day resolution are created for an oversubscribed set of targets by the SPIKE software, originally written for HST and presently being adapted for EUVE, XTE and AXAF. The NEEDLE code creates weekly schedules at 1 min resolution using in-house orbital routines and creates output for processing by the command generation software. Schedule creation on both the long- and short-term scale is rapid, less than 1 day for long-term, and one hour for short-term.

Shift Work in Rats Results in Increased Inflammatory Response after Lipopolysaccharide Administration: A Role for Food Consumption.

PubMed

Guerrero-Vargas, Natalí N; Guzmán-Ruiz, Mara; Fuentes, Rebeca; García, Joselyn; Salgado-Delgado, Roberto; Basualdo, María del Carmen; Escobar, Carolina; Markus, Regina P; Buijs, Ruud M

2015-08-01

The suprachiasmatic nucleus (SCN) drives circadian rhythms in behavioral and physiological variables, including the inflammatory response. Shift work is known to disturb circadian rhythms and is associated with increased susceptibility to develop disease. In rodents, circadian disruption due to shifted light schedules (jet lag) induced increased innate immune responses. To gain more insight into the influence of circadian disruption on the immune response, we characterized the inflammatory response in a model of rodent shift work and demonstrated that circadian disruption affected the inflammatory response to lipopolysaccharide (LPS) both in vivo and in vitro. Since food consumption is a main disturbing element in the shift work schedule, we also evaluated the inflammatory response to LPS in a group of rats that had no access to food during their working hours. Our results demonstrated that the shift work schedule decreased basal TNF-α levels in the liver but not in the circulation. Despite this, we observed that shift work induced increased cytokine response after LPS stimulation in comparison to control rats. Also, Kupffer cells (liver macrophages) isolated from shift work rats produced more TNF-α in response to in vitro LPS stimulation, suggesting important effects of circadian desynchronization on the functionality of this cell type. Importantly, the effects of shift work on the inflammatory response to LPS were prevented when food was not available during the working schedule. Together, these results show that dissociating behavior and food intake from the synchronizing drive of the SCN severely disturbs the immune response. © 2015 The Author(s).

Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage.

PubMed

Mugali, Raveesha R; Mansoor, Farooq; Parwiz, Sardar; Ahmad, Fazil; Safi, Najibullah; Higgins-Steele, Ariel; Varkey, Sherin

2017-04-04

Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births. The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12-23 months. Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%), not aware of the need of vaccination (17%), no faith in vaccination (16%), mother was too busy (15%), and fear of side effects (11%). The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.

Effectiveness of Muskaan Ek Abhiyan (the smile campaign) for strengthening routine immunization in bihar, India.

PubMed

Goel, Sonu; Dogra, Vishal; Gupta, Satish Kumar; Lakshmi, P Vm; Varkey, Sherin; Pradhan, Narottam; Krishna, Gopal; Kumar, Rajesh

2012-02-01

In Bihar State, proportion of fully immunized children was only 19% ;in Coverage Evaluation Survey of 2005. In October 2007, a special campaign called Muskaan Ek Abhiyan (The Smile Campaign) was launched under National Rural Health Mission to give a fillip to the immunization program. To evaluate improvement in the performance and coverage of the Routine Immunization Program consequent to the launch of Muskaan Ek Abhiyan The main strategies of the Muskaan campaign were reviewing and strengthening immunization micro-plans, enhanced inter-sectoral coordination between the Departments of Health, and Women and Child Development, increased involvement of women groups in awareness generation, enhanced political commitment and budgetary support, strengthening of monitoring and supervision mechanisms, and provision of performance based incentive to service providers. Immunization Coverage Evaluation Surveys conducted in various states of India during 2005 and 2009 were used for evaluation of the effect of Muskaan campaign by measuring the increase in immunization coverage in Bihar in comparison to other Empowered Action Group (EAG) states using the difference-in-difference method. Interviews of the key stakeholders were also done to substantiate the findings. The proportion of fully immunized 12-23 month old children in Bihar has increased significantly from 19% ;in 2005 to 49% ;in 2009. The coverage of BCG also increased significantly from 52.8% to 82.3%, DPT-3 from 36.5 to 59.3%, OPV-3 from 27.1% ;to 61.6% ;and measles from 28.4 to 58.2%. In comparison to other states, the coverage of fully immunized children increased significantly from 16 to 26% ;in Bihar. There was a marked improvement in immunization coverage after the launch of the Campaign in Bihar. Therefore, best practices of the Campaign may be replicated in other areas where full immunization coverage is low.

SUPPRESSION OF IMMUNE FUNCTION AND SUSCEPTIBILITY TO INFECTIONS IN HUMANS: ASSOCIATION OF IMMUNE FUNCTION WITH CLINICAL DISEASE

EPA Science Inventory

ABSTRACT
A number of regulatory agencies in western Europe, Japan and the US now include guidelines for evaluating the potential immunotoxicity of chemicals, including drugs, as part of routine toxicity testing. Most testing guidelines recommend observational or functional as...

Childhood Immunization: A Key Component of Early Childhood Development

ERIC Educational Resources Information Center

Messonnier, Nancy

2017-01-01

Physical health is a key component of early childhood development and school readiness. By keeping children healthy and decreasing the chances of disease outbreaks, immunizations help early childhood programs create a safe environment for children. While overall vaccination rates are high nationally for most vaccines routinely recommended for…

Statistics on Diphtheria

MedlinePlus

... and diseases Global Vaccine Action Plan WHO policy recommendations SAGE Immunization schedules Position papers Advisory committees National programmes and systems Policy and strategies Service delivery Linking with other ...

Preflight and In-Flight Exercise Conditions for Astronauts on the International Space Station

NASA Technical Reports Server (NTRS)

Guilliams, Mark E.; Nieschwitz, Bruce; Hoellen, David; Loehr, Jim

2011-01-01

The physiological demands of spaceflight require astronauts to have certain physical abilities. They must be able to perform routine and off-nominal physical work during flight and upon re-entry into a gravity environment to ensure mission success, such as an Extra Vehicular Activity (EVA) or emergency egress. To prepare the astronauts for their mission, a Wyle Astronaut Strength Conditioning and Rehabilitation specialist (ASCR) works individually with the astronauts to prescribe preflight strength and conditioning programs and in-flight exercise, utilizing Countermeasure Systems (CMS) exercise hardware. PURPOSE: To describe the preflight and in-flight exercise programs for ISS crewmembers. METHODS: Approximately 2 years before a scheduled launch, an ASCR is assigned to each astronaut and physical training (PT) is routinely scheduled. Preflight PT of astronauts consists of carrying out strength, aerobic and general conditioning, employing the principles of periodization. Exercise programs are prescribed to the astronauts to account for their individual fitness levels, planned mission-specific tasks, areas of concern, and travel schedules. Additionally, astronauts receive instruction on how to operate CMS exercise hardware and receive training for microgravity-specific conditions. For example, astronauts are scheduled training sessions for the International Space Station (ISS) treadmill (TVIS) and cycle ergometer (CEVIS), as well as the Advanced Resistive Exercise Device (ARED). In-flight programs are designed to maintain or even improve the astronauts pre-flight levels of fitness, bone health, muscle strength, power and aerobic capacity. In-flight countermeasure sessions are scheduled in 2.5 h blocks, six days a week, which includes 1.5 h for resistive training and 1 h for aerobic exercise. CONCLUSIONS: Crewmembers reported the need for more scheduled time for preflight training. During flight, crewmembers have indicated that the in-flight exercise is sufficient, but would like more reliable and capable hardware.

Quality of vaccination services and social demand for vaccinations in Africa and Asia.

PubMed Central

Streefland, P. H.; Chowdhury, A. M.; Ramos-Jimenez, P.

1999-01-01

For immunization to be effective in the long run as a major global disease control intervention it is important to provide good quality vaccination services. Studies carried out in three countries in Asia (Bangladesh, India, and the Philippines) and two countries in Africa (Ethiopia and Malawi), and reported on in this article, document the fact that parents are willing to invest considerable effort in having their children vaccinated; however, there are a number of serious shortcomings in the quality of the routine vaccination services and strains are apparent at the interface between the vaccination providers and the users. These shortcomings are detracting from the sustainability of routine vaccination programmes and are promoting the growth of pools of nonimmunized and partially immunized children. To safeguard the continued operation and to enhance the coverage of routine vaccination programmes it is crucial that these difficulties be addressed. PMID:10534895

Characteristics of wild polio virus outbreak investigation and response in Ethiopia in 2013-2014: implications for prevention of outbreaks due to importations.

PubMed

Tegegne, Ayesheshem Ademe; Braka, Fiona; Shebeshi, Meseret Eshetu; Aregay, Aron Kassahun; Beyene, Berhane; Mersha, Amare Mengistu; Ademe, Mohammed; Muhyadin, Abdulahi; Jima, Dadi; Wyessa, Abyot Bekele

2018-01-05

Ethiopia joined the Global Polio Eradication Initiative (GPEI) in 1996, and by the end of December 2001 circulation of indigenous Wild Polio Virus (WPV) had been interrupted. Nonetheless, the country experienced multiple importations during 2004-2008, and in 2013. We characterize the 2013 outbreak investigations and response activities, and document lessons learned. The data were pulled from different field investigation reports and from the national surveillance database for Acute Flaccid Paralysis (AFP). In 2013, a WPV1 outbreak was confirmed following importation in Dollo zone of the Somali region, which affected three Woredas (Warder, Geladi and Bokh). Between July 10, 2013, and January 5, 2014, there were 10 children paralyzed due to WPV1 infection. The majorities (7 of 10) were male and below 5 years of age, and 7 of 10 cases was not vaccinated, and 72% (92/129) of < 5 years of old children living in close proximity with WPV cases had zero doses of oral polio vaccine (OPV). The travel history of the cases showed that seven of the 10 cases had contact with someone who had traveled or had a travel history prior to the onset of paralysis. Underserved and inaccessibility of routine immunization service, suboptimal surveillance sensitivity, poor quality and inadequate supplemental immunization were the most crucial gaps identified during the outbreak investigations. Prior to the 2013 outbreak, Ethiopia experienced multiple imported polio outbreaks following the interruption of indigenous WPV in December 2001. The 2013 outbreak erupted due to massive population movement and was fueled by low population immunity as a result of low routine immunization and supplemental Immunization coverage and quality. In order to avert future outbreaks, it is critical that surveillance sensitivity be improved by establishing community-based surveillance systems and by assigning surveillance focal points at all level particularly in border areas. In addition, it is vital to set up in hard to reach areas a functional immunization service delivery system using the "Reaching Every Child" approach, including periodic routine immunization intensification and supplemental immunization activities.

[Complete immunization coverage and reasons for non-vaccination in a periurban area of Abidjan].

PubMed

Sackou, K J; Oga, A S S; Desquith, A A; Houenou, Y; Kouadio, K L

2012-10-01

An immunization coverage survey was conducted among children aged 12-59 months in a suburban neighbourhood in Abidjan. The objective was to determine the complete immunization coverage, the reasons for non-vaccination and factors influencing the immunization status of children. The method of exhaustive sampling enabled us to interview the mothers of 669 children using a questionnaire. Overall vaccination coverage was 68.6% with 1.2%, with 1.2% of children never having received vaccine. The logistic regression analysis showed that the level of education, knowledge of the immunization schedule and the marital status of mothers, as well as the type of habitat, were associated with full immunization of children. These determinants must be taken into account to improve vaccination coverage.

Tetanus toxoid immunization campaign in West Nusa Tenggara, Indonesia.

PubMed

1985-01-01

A tetanus toxoid (TT) immunization campaign was carried out in Central Lombok district of Indonesia in the province of West Nusa Tenggara (NTB) from January to April 1985. A coverage rate of 93% for 2 doses was obtained among women of childbearing age. This paper summarizes the major components of the activity, discussing some of the strengths and weaknesses of the campaign. The major objective of this crash campaign was to raise the tetanus immunity level throughout the fertile age group and thus to achieve a marked reduction in the incidence of neonatal tetanus. A draft protocol for the campaign was developed by national and provincial health staff. The governor of NTB pledged the full support of the provincial administrative apparatus, and funds, equipment, and vaccine were guaranteed at the national level. Commitments of support were received from all relevant sectoral departments at provincial and district levels. About 2 weeks before the vaccination activities began, PKK cadres -- about 6000 women in Central Lombok district -- were provided with forms to take a census of all fertile women in their respective areas. This information was consolidated at the village level, where a serial number was assigned to each name. The enumeration forms were later used as vaccination registers. The number of women identified in each village was reported to the appropriate health center for use in planning vaccine requirements and the deployment of manpower. 2 or 3 days prior to the scheduled vaccination session, PKK cadres again visited all women on their census list to inform them of the place and time of the vaccinator's visit and to distribute appointment cards which carried serial numbers matching those on the census list. The 31 vaccinators were newly qualified nursing school graduates awaiting their 1st government postings. They were given a 2-day orientation course on campaign strategy and methods, and their work schedule was explained. First-line technical supervision was the responsibility of the rural health center doctor in each subdistrict, supported by the district chief of health services and his staff. The campaign was officially opened on January 7, 1986. Each of the 9 subdistricts was completely covered before vaccinators moved on to the next one. A total of 1086 vaccination posts were required. Vaccine was shipped from Jakarta in 3 batches during the course of the campaign to avoid overloading storage facilities in the province. It then was transferred to the district as required. The campaign achieved remarkably good results. It is important to monitor the extent to which the TT campaign experience contributes to improved performance of the routine immunization delivery system in NTB.

Cost-effectiveness of pneumococcal conjugate vaccination in Georgia.

PubMed

Komakhidze, T; Hoestlandt, C; Dolakidze, T; Shakhnazarova, M; Chlikadze, R; Kopaleishvili, N; Goginashvili, K; Kherkheulidze, M; Clark, A D; Blau, J

2015-05-07

Financial support from the Global Alliance for Vaccines and Immunization (GAVI) to introduce the 10-valent pneumococcal conjugate vaccine (PCV10) into the routine childhood immunization schedule in Georgia is ending in 2015. As a result, the Interagency Coordination Committee (ICC) decided to carry out a cost-effectiveness analysis to gather additional evidence to advocate for an appropriate evidence-based decision after GAVI support is over. The study also aimed to strengthen national capacity to conduct cost-effectiveness studies, and to introduce economic evaluations into Georgia's decision-making process. A multidisciplinary team of national experts led by a member of the ICC carried out the analysis that compared two scenarios: introducing PCV10 vs no vaccination. The TRIVAC model was used to evaluate 10 cohorts of children over the period 2014-2023. National data was used to inform demographics, disease burden, vaccine coverage, health service utilization, and costs. Evidence from clinical trials and the scientific literature was used to estimate the impact of the vaccine. A 3+0 schedule and a vaccine price increasing to US$ 3.50 per dose was assumed for the base-case scenario. Alternative univariate and multivariate scenarios were evaluated. Over the 10-year period, PCV10 was estimated to prevent 7170 (8288 undiscounted) outpatient visits due to all-cause acute otitis media, 5325 (6154 undiscounted) admissions due to all-cause pneumonia, 87 (100 undiscounted) admissions due to pneumococcal meningitis, and 508 (588 undiscounted) admissions due to pneumococcal non-pneumonia and non-meningitis (NPNM). In addition, the vaccine was estimated to prevent 41 (48 undiscounted) deaths. This is equivalent to approximately 5 deaths and 700 admissions prevented each year in Georgia. Over the 10-year period, PCV10 would cost the government approximately US$ 4.4 million ($440,000 per year). However, about half of this would be offset by the treatment costs prevented. The discounted cost-effectiveness ratio was estimated to be US$ 1599 per DALY averted with scenarios ranging from US$ 286 to US$ 7787. This study led to better multi-sectoral collaboration and improved national capacity to perform economic evaluations. Routine infant vaccination against Streptococcus pneumoniae would be highly cost-effective in Georgia. The decision to introduce PCV10 was already made some time before the study was initiated but it provided important economic evidence in support of that decision. There are several uncertainties around many of the parameters used, but a multivariate scenario analysis with several conservative assumptions (including no herd effect in older individuals) shows that this recommendation is robust. This study supports the decision to introduce PCV10 in Georgia. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina.

PubMed

Urueña, Analía; Pippo, Tomás; Betelu, María Sol; Virgilio, Federico; Giglio, Norberto; Gentile, Angela; Jimenez, Salvador García; Jáuregui, Bárbara; Clark, Andrew D; Diosque, Máximo; Vizzotti, Carla

2011-07-12

Since the 10-valent pneumococcal conjugate vaccine (PCV-10) and 13-valent pneumococcal conjugate vaccine (PCV-13) were recently licensed for use in Argentina, both vaccines were evaluated to estimate the costs, health benefits and cost-effectiveness of adding a PCV to the routine child immunization schedule. The integrated TRIVAC vaccine cost-effectiveness model from Pan American Health Organization's ProVac Initiative (Version 1.0.65) was used to assess the health outcomes of 20 successive cohorts from birth to 5 years of age. PCV-10 and PCV-13 were each compared to a scenario assuming no PCV vaccination. A 3+1 (three doses+booster) schedule and a vaccination price of US$ 20.75 per dose was assumed in the base case for both vaccines. Introduction of PCV-13 rather than PCV-10 would increase the number of life years gained (LYG) by at least 10%. The number of LYG (and LYG after adjustment for DALY morbidity weights) was 56,882 (64,252) for PCV-10 compared to 65,038 (71,628) for PCV-13. From the health system perspective, the cost per DALY averted was US$ 8973 and US$ 10,948 for PCV-10 and PCV-13 respectively, and US$ 8546 and US$ 10,510 respectively, after incorporating costs saved by households. When PCV13 was compared to PCV10 directly, the additional benefits of PCV-13 was conferred at a cost of US$ 28,147 per DALY averted. Cost-effectiveness was influenced mainly by vaccine price, serotype replacement, pneumonia mortality and discount rate. Routine vaccination against S. pneumoniae in Argentina would be cost-effective with either PCV-10 or PCV-13. PCV-13, with higher coverage of local serotypes, would prevent more cases of pneumonia, invasive pneumococcal disease, sequelae and deaths with a higher number of LYG and DALYs averted, but PCV-10, due its higher impact in the prevention of AOM, would save more costs to the healthcare system. Copyright © 2011 Elsevier Ltd. All rights reserved.

Immunization coverage in India for areas served by the Integrated Child Development Services programme. The Integrated Child Development Services Consultants.

PubMed

Tandon, B N; Gandhi, N

1992-01-01

The Integrated Child Development Services (ICDS) programme was launched by the Indian government in October 1975 to provide a package of health, nutrition and informal educational services to mothers and children. In 1988 we studied the impact of ICDS on the immunization coverage of children aged 12-24 months and of mothers of infants in 19 rural, 8 tribal, and 9 urban ICDS projects that had been operational for more than 5 years. Complete coverage with BCG, diphtheria-pertussis-tetanus (DPT) and poliomyelitis vaccines was recorded for 65%, 63%, and 64% of children, respectively, in the ICDS population. By comparison, the coverage in the non-ICDS group was only 22% for BCG, 28% for DPT, and 27% for poliomyelitis. Complete immunization with tetanus toxoid was recorded for 68% of the mothers in the ICDS group and for 40% in the non-ICDS group. Coverage was greater in the urban and lower in the tribal projects. Scheduled castes, scheduled tribes, backward communities, and minorities (groups that have a high priority for social services) had immunization coverages in ICDS projects that were similar to those of higher castes.

Childhood immunization: when physicians and parents disagree.

PubMed

Gilmour, Joan; Harrison, Christine; Asadi, Leyla; Cohen, Michael H; Vohra, Sunita

2011-11-01

Persistent fears about the safety and efficacy of vaccines, and whether immunization programs are still needed, have led a significant minority of parents to refuse vaccination. Are parents within their rights when refusing to consent to vaccination? How ought physicians respond? Focusing on routine childhood immunization, we consider the ethical, legal, and clinical issues raised by 3 aspects of parental vaccine refusal: (1) physician counseling; (2) parental decision-making; and (3) continuing the physician-patient relationship despite disagreement. We also suggest initiatives that could increase confidence in immunization programs.

A comparison of 2 influenza vaccine schedules in 6- to 23-month-old children.

PubMed

Englund, Janet A; Walter, Emmanuel B; Fairchok, Mary P; Monto, Arnold S; Neuzil, Kathleen M

2005-04-01

Trivalent inactivated influenza vaccine (TIV) is recommended for all children ages 6 to 23 months. Delivering 2 doses of TIV at least 4 weeks apart to young children receiving this vaccine for the first time is challenging. We compared the immunogenicity and reactogenicity of the standard 2-dose regimen of TIV administered in the fall with an early schedule of a single spring dose followed by a fall dose of the same vaccine in healthy toddlers 6 to 23 months of age. Children were recruited in the spring to be randomized into either the standard or early schedule. An additional group was also enrolled in the fall as part of a nonrandomized standard comparison group. The 2002-2003 licensed TIV was administered in the spring; the fall 2003-2004 vaccine contained the same 3 antigenic components. Reactogenicity was assessed by parental diaries and telephone surveillance. Blood was obtained after the second dose of TIV for all children. The primary outcome measure was antibody response to influenza A/H1N1, A/H3N2, and B after 2 doses of vaccine, as determined by hemagglutination-inhibition titers > or =1:32 and geometric mean titer (GMT). Two hundred nineteen children were randomized to receive either the standard or early TIV schedule; 40 additional children were enrolled in the fall in the nonrandomized standard group. Response rates in the combined standard versus early groups were similar overall: 78% (GMT: 48) vs 76% (GMT: 57) to H1N1, 89% (GMT: 115) vs 88% (GMT: 129) to H3N2, and 52% (GMT: 24) vs 60% (GMT: 28) to B. Reactogenicity after TIV in both groups of children was minimal and did not differ by dose, age, or time between doses. Reaction rates were higher in those receiving TIV and concomitant vaccines compared with those receiving TIV alone. Overall rates of fever >38 degrees C axillary and injection-site pain, redness, or swelling were 5.4%, 3.1%, 0.9%, and 1.1%, respectively. When the spring and fall influenza vaccines had the same 3 antigenic components, the early vaccine schedule resulted in similar immunogenicity and reactogenicity compared with the standard schedule. When the vaccine components do not change between years, initiating influenza vaccine in the spring at the time of routine office visits would facilitate full immunization of children against influenza earlier in the season.

Immunogenicity and safety of a quadrivalent meningococcal polysaccharide CRM conjugate vaccine in infants and toddlers.

PubMed

Tregnaghi, Miguel; Lopez, Pio; Stamboulian, Daniel; Graña, Gabriela; Odrljin, Tatjana; Bedell, Lisa; Dull, Peter M

2014-09-01

This phase III study assessed the safety and immunogenicity of MenACWY-CRM, a quadrivalent meningococcal conjugate vaccine, administered with routine vaccines starting at 2 months of age. Healthy infants received MenACWY-CRM in a two- or three-dose primary infant series plus a single toddler dose. In addition, a two-dose toddler catch-up series was evaluated. Immune responses to MenACWY-CRM were assessed for serum bactericidal activity with human complement (hSBA). Reactogenicity and safety results were collected systematically. After a full infant/toddler series or two-dose toddler catch-up series, MenACWY-CRM elicited immune responses against the four serogroups in 94-100% of subjects. Noninferiority of the two- versus three-dose MenACWY-CRM infant dosing regimen was established for geometric mean titers for all serogroups. Following the three-dose infant primary series, 89-98% of subjects achieved an hSBA ≥ 8 across all serogroups. Immune responses to concomitant routine vaccines given with MenACWY-CRM were noninferior to responses to routine vaccines alone, except for pertactin after the two-dose infant series. Noninferiority criteria were met for all concomitant antigens after the three-dose infant series. MenACWY-CRM vaccination regimens in infants and toddlers were immunogenic and well tolerated. No clinically meaningful effects of concomitant administration with routine infant and toddler vaccines were observed. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Missed opportunities for immunization.

PubMed

Verma, J; Sachar, R K; Prakash, V; Jain, G D; Sehgal, R

1990-01-01

A survey conducted in the outpatient departments of Dayanand Medical College and Hospital in Ludhiana, India, found that 13.4% of children aged 0-23 months and 33.0% of pregnant women were not being given due immunization. Maximum advantage, however, should be taken of every contact between health workers and clients to provide all available and required health interventions. 80% immunization coverage could be achieved if all children who are brought to clinics for whatever purpose were screened and immunized if necessary. Missed opportunities occur because immunization is not available on all days; there is no uniform contraindication policy; doctors schedule as they please, with only one or two vaccines given to children who are eligible for more; there is an unwillingness to combine vaccines; weak excuses prevent the administration of vaccines; due antigens are not given on discharge from hospitals following recovery; pregnancy of less than 16 weeks is supposed to be a contraindication to tetanus toxoid; there is vaccinator reluctance to open multi-dose BCG/measles vaccine vials for a small number of children for fear of wasting the vaccine; and vaccines may be out of stock. The following suggestions may help minimize missed opportunities for immunization: review of the immunization schedule to provide optimal protection at the earliest age, review of the policy on contraindications to avoid false contraindications, ensuring that all women and children receive all vaccines for which they are eligible, issuing immunization cards to all women and children and checking them on all subsequent visits, making vaccines available in all clinics, educating health care personnel on these issues, packing vaccines in smaller quantities to avoid wastage, and exploiting all contacts with the people to provide maximum health care interventions.

Intracellular Fixation Buffer Inactivates Newcastle Disease Virus in Chicken Allantoic Fluid, Macrophages and Splenocytes for Immune Assessment During Infection

USDA-ARS?s Scientific Manuscript database

Inactivation of Newcastle disease virus (NDV) has been routinely achieved with heat, ß-propiolactone, binary ethylenimine, ultraviolet light and formalin, however these strategies have not been validated for cell surface ligand or receptor phenotype in viral-infected chicken immune cells. To study ...

Vaccine Safety Resources for Nurses

PubMed Central

Shimabukuro, Tom T.; Hibbs, Beth F.; Moro, Pedro L.; Broder, Karen R.; Vellozzi, Claudia

2015-01-01

Overview Nurses are on the front lines of health care delivery, and many of them routinely administer immunizations. The authors describe the Centers for Disease Control and Prevention’s (CDC) vaccine safety monitoring systems, explaining how nurses can access inquiry channels and other immunization information resources. Examples of recent vaccine safety inquiries are also provided. PMID:26222474

Assessing providers' vaccination behaviors during routine immunization in India.

PubMed

Cohen, Megan A; Gargano, Lisa M; Thacker, Naveen; Choudhury, Panna; Weiss, Paul S; Arora, Manisha; Orenstein, Walter A; Omer, Saad B; Hughes, James M

2015-08-01

Progress has been made toward improving routine immunization coverage in India, but universal coverage has not been achieved. Little is known about how providers' vaccination behaviors affect coverage rates. The purpose of this study was to identify provider behaviors that served as barriers to vaccination that could lead to missed opportunities to vaccinate. We conducted a study of health-care providers' vaccination behaviors during clinic visits for children <3 years of age. Information on provider behaviors was collected through parent report and direct observation. Compared with illness visits, parents were eight times more likely to report vaccination status was verified (p < 0.001) and three times more likely to report receiving counseling on immunization (p = 0.022) during vaccination visits. Training of all vaccination practitioners should focus on behaviors such as the necessity of verifying vaccination status regardless of visit type, stressing the importance of counseling parents on immunization and emphasizing what is a valid contraindication to vaccination. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Outbreak of Type 2 Vaccine-Derived Poliovirus in Nigeria: Emergence and Widespread Circulation in an Underimmunized Population

PubMed Central

Pate, Muhammad Ali; Wannemuehler, Kathleen; Jenks, Julie; Burns, Cara; Chenoweth, Paul; Abanida, Emmanuel Ade; Adu, Festus; Baba, Marycelin; Gasasira, Alex; Iber, Jane; Mkanda, Pascal; Williams, A. J.; Shaw, Jing; Pallansch, Mark; Kew, Olen

2011-01-01

Wild poliovirus has remained endemic in northern Nigeria because of low coverage achieved in the routine immunization program and in supplementary immunization activities (SIAs). An outbreak of infection involving 315 cases of type 2 circulating vaccine-derived poliovirus (cVDPV2; >1% divergent from Sabin 2) occurred during July 2005–June 2010, a period when 23 of 34 SIAs used monovalent or bivalent oral poliovirus vaccine (OPV) lacking Sabin 2. In addition, 21 “pre-VDPV2” (0.5%–1.0% divergent) cases occurred during this period. Both cVDPV and pre-VDPV cases were clinically indistinguishable from cases due to wild poliovirus. The monthly incidence of cases increased sharply in early 2009, as more children aged without trivalent OPV SIAs. Cumulative state incidence of pre-VDPV2/cVDPV2 was correlated with low childhood immunization against poliovirus type 2 assessed by various means. Strengthened routine immunization programs in countries with suboptimal coverage and balanced use of OPV formulations in SIAs are necessary to minimize risks of VDPV emergence and circulation. PMID:21402542

Maternal influenza immunization in Malawi: Piloting a maternal influenza immunization program costing tool by examining a prospective program

PubMed Central

Pecenka, Clint; Munthali, Spy; Chunga, Paul; Levin, Ann; Morgan, Win; Lambach, Philipp; Bhat, Niranjan; Neuzil, Kathleen M.; Ortiz, Justin R.

2017-01-01

Background This costing study in Malawi is a first evaluation of a Maternal Influenza Immunization Program Costing Tool (Costing Tool) for maternal immunization. The tool was designed to help low- and middle-income countries plan for maternal influenza immunization programs that differ from infant vaccination programs because of differences in the target population and potential differences in delivery strategy or venue. Methods This analysis examines the incremental costs of a prospective seasonal maternal influenza immunization program that is added to a successful routine childhood immunization and antenatal care program. The Costing Tool estimates financial and economic costs for different vaccine delivery scenarios for each of the major components of the expanded immunization program. Results In our base scenario, which specifies a donated single dose pre-filled vaccine formulation, the total financial cost of a program that would reach 2.3 million women is approximately $1.2 million over five years. The economic cost of the program, including the donated vaccine, is $10.4 million over the same period. The financial and economic costs per immunized pregnancy are $0.52 and $4.58, respectively. Other scenarios examine lower vaccine uptake, reaching 1.2 million women, and a vaccine purchased at $2.80 per dose with an alternative presentation. Conclusion This study estimates the financial and economic costs associated with a prospective maternal influenza immunization program in a low-income country. In some scenarios, the incremental delivery cost of a maternal influenza immunization program may be as low as some estimates of childhood vaccination programs, assuming the routine childhood immunization and antenatal care systems are capable of serving as the platform for an additional vaccination program. However, purchasing influenza vaccines at the prices assumed in this analysis, instead of having them donated, is likely to be challenging for lower-income countries. This result should be considered as a starting point to understanding the costs of maternal immunization programs in low- and middle-income countries. PMID:29281710

Maternal influenza immunization in Malawi: Piloting a maternal influenza immunization program costing tool by examining a prospective program.

PubMed

Pecenka, Clint; Munthali, Spy; Chunga, Paul; Levin, Ann; Morgan, Win; Lambach, Philipp; Bhat, Niranjan; Neuzil, Kathleen M; Ortiz, Justin R; Hutubessy, Raymond

2017-01-01

This costing study in Malawi is a first evaluation of a Maternal Influenza Immunization Program Costing Tool (Costing Tool) for maternal immunization. The tool was designed to help low- and middle-income countries plan for maternal influenza immunization programs that differ from infant vaccination programs because of differences in the target population and potential differences in delivery strategy or venue. This analysis examines the incremental costs of a prospective seasonal maternal influenza immunization program that is added to a successful routine childhood immunization and antenatal care program. The Costing Tool estimates financial and economic costs for different vaccine delivery scenarios for each of the major components of the expanded immunization program. In our base scenario, which specifies a donated single dose pre-filled vaccine formulation, the total financial cost of a program that would reach 2.3 million women is approximately $1.2 million over five years. The economic cost of the program, including the donated vaccine, is $10.4 million over the same period. The financial and economic costs per immunized pregnancy are $0.52 and $4.58, respectively. Other scenarios examine lower vaccine uptake, reaching 1.2 million women, and a vaccine purchased at $2.80 per dose with an alternative presentation. This study estimates the financial and economic costs associated with a prospective maternal influenza immunization program in a low-income country. In some scenarios, the incremental delivery cost of a maternal influenza immunization program may be as low as some estimates of childhood vaccination programs, assuming the routine childhood immunization and antenatal care systems are capable of serving as the platform for an additional vaccination program. However, purchasing influenza vaccines at the prices assumed in this analysis, instead of having them donated, is likely to be challenging for lower-income countries. This result should be considered as a starting point to understanding the costs of maternal immunization programs in low- and middle-income countries.

76 FR 70664 - Policy Statement on Grant Stamp Procedure in Routine Director Orders

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-15

... grant stamp unopposed motions for an extension of time or requests for a procedural schedule to which..., Vice Chairman Begeman, and Commissioner Mulvey. Jeffrey Herzig, Clearance Clerk. Appendix [GRAPHIC...

13-valent pneumococcal conjugate vaccine given with meningococcal C-tetanus toxoid conjugate and other routine pediatric vaccinations: immunogenicity and safety.

PubMed

Martinón-Torres, Federico; Gimenez-Sanchez, Francisco; Gurtman, Alejandra; Bernaola, Enrique; Diez-Domingo, Javier; Carmona, Alfonso; Sidhu, Mohinder; Sarkozy, Denise A; Gruber, William C; Emini, Emilio A; Scott, Daniel A

2012-04-01

As multiple vaccines are administered concomitantly during routine pediatric immunizations, it is important to ascertain the potential interference of any new vaccine on the immune response to the concomitantly administered vaccines. Immune responses to meningococcal serogroup C-tetanus toxoid conjugate vaccine (MnCC-TT) and the diphtheria and tetanus antigens in routine pediatric vaccines (diphtheria, tetanus, acellular pertussis-hepatitis B virus-inactivated poliovirus/Haemophilus influenza type b [DTaP-HBV-IPV/Hib] and DTaP-IPV+Hib) when given concomitantly with the 13-valent pneumococcal conjugate vaccine (PCV13) were compared with responses when given with PCV7. In addition, the immunogenicity and safety of PCV13 were assessed. Healthy infants were randomized to receive PCV13 or PCV7 (ages 2, 4, 6 and 15 months), concomitant with MnCC-TT (2, 4 and 15 months), DTaP-HBV-IPV/Hib (2, 4 and 6 months), and DTaP-IPV+Hib (15 months). Immune responses to MnCC-TT and to the diphtheria and tetanus antigens administered with PCV13 were noninferior to the responses observed when the vaccines were administered with PCV7; ≥96.6 (postinfant) and ≥99.4% (posttoddler) subjects achieved prespecified immune response levels to each antigen in each group. After the infant series, ≥93.0% of subjects receiving PCV13 achieved pneumococcal anticapsular immunoglobulin G concentrations ≥0.35 µg/mL for all serotypes except serotype 3 (86.2%), increasing to 98.1-100% for most serotypes (serotype 3: 93.6%) after the toddler dose. Local and systemic reactions were similar between groups. Immune responses to MnCC-TT, and other childhood vaccines (DTaP-HBV-IPV/Hib, DTaP-IPV+Hib) were noninferior when concomitantly administered with PCV13 compared with PCV7. PCV13 does not interfere with MnCC-TT. PCV13 is highly immunogenic with a favorable safety profile.

78 FR 27392 - Advisory Committee on Immunization Practices (ACIP)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-10

... discussions on: General recommendations, influenza, Japanese encephalitis vaccine, pertussis vaccine, Herpes... votes are scheduled for influenza and Japanese encephalitis vaccine. Time will be available for public...

76 FR 60500 - Advisory Committee on Immunization Practices (ACIP)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-29

... schedule; human papillomavirus vaccine; hepatitis B vaccine; meningococcal vaccines; influenza; 13-valent... subject to change as priorities dictate. Contact Person for More Information: Stephanie B. Thomas...

Immunogenicity, reactogenicity and safety of the human rotavirus vaccine RIX4414 (Rotarix™) oral suspension (liquid formulation) when co-administered with expanded program on immunization (EPI) vaccines in Vietnam and the Philippines in 2006-2007.

PubMed

Anh, D D; Carlos, C C; Thiem, D V; Hutagalung, Y; Gatchalian, S; Bock, H L; Smolenov, I; Suryakiran, P V; Han, H H

2011-03-03

Evaluation of immunogenicity and safety of a 2-dose liquid formulation of human rotavirus vaccine, RIX4414 following WHO's Expanded Program on Immunization (EPI) schedule (0, 1, and 2 months; Month 0 indicates day of enrollment) in Vietnam and the Philippines. Infants aged 6-10 (mean=8.7 ± 1.07 weeks Vietnam) and 5-10 weeks (mean=6.6 ± 1.03 weeks Philippines) received two doses of RIX4414 vaccine (V) and one dose of placebo (PL) or three placebo doses concomitantly with commercially available diphtheria-tetanus-whole-cell pertussis, hepatitis B and oral poliovirus vaccines. The vaccination schedules were: V-V-PL, V-PL-V and PL-PL-PL (Vietnam); PL-V-V, V-PL-V and PL-PL-PL (Philippines). Anti-rotavirus seroconversion rate was assessed pre-vaccination and post-vaccination (ELISA cut-off=20 U/ml). 375 infants were enrolled in each country. Seroconversion rates at one month post-Dose 2 of RIX4414 were Vietnam 63.3% (95% CI: 54.3-71.6) in V-V-PL group and 81.5% (95% CI: 73.4-88) in V-PL-V group; Philippines 70% (95% CI: 61-78) in PL-V-V group and 59.2% (95% CI: 49.8-68) in V-PL-V group. Frequencies of solicited (8-day post-each dose) and unsolicited symptoms (31-day post-each dose) were similar. Two-doses of rotavirus vaccine administered within the WHO EPI offer flexibility in existing schedule, though both schedules provides good immune responses. Copyright © 2011 Elsevier Ltd. All rights reserved.

Predictors of Early-Onset Permanent Hearing Loss in Malnourished Infants in Sub-Saharan Africa

ERIC Educational Resources Information Center

Olusanya, Bolajoko O.

2011-01-01

The objective of this study was to determine the predictors of early-onset permanent hearing loss (EPHL) among undernourished infants in a low-income country where routine screening for developmental disabilities in early childhood is currently unattainable. All infants attending four community-based clinics for routine immunization who met the…

Sero-prevalence and vaccination status of hepatitis A and hepatitis B among adults with cirrhosis in Sri Lanka: a hospital based cohort study.

PubMed

Niriella, Madunil Anuk; Kobbegala, Vipuli Jayendra; Karalliyadda, Hasnatha Nuwan; Ranawaka, Chamila Kumara; de Silva, Arjuna Priyadarshin; Dassanayake, Anuradha Supun; de Silva, Hithanadura Janaka

2017-07-21

As acute viral hepatitis can be fatal in patients with cirrhosis, vaccination against hepatitis A (HAV) and hepatitis B (HBV) is recommended for non-immune patients. With increasing affluence the incidence of hepatitis A in childhood has decreased leading to a significant proportion of non-immune adults. As part of their routine investigation, hepatitis A IgG antibodies (anti-HAV IgG), hepatitis B surface antigen (HBsAg) and anti-HCV antibodies was checked and immunization status was assessed among consenting newly diagnosed cirrhotic patients presenting to a tertiary referral center. Out of 135 patients, 107 [79.3%; males 91; mean age (SD) at presentation: 55.5 (11.6) years] with complete data were included for analysis. Most patients had either cryptogenic cirrhosis (62.6%) or alcoholic cirrhosis (29.9%); 2 (1.9%) had HBV cirrhosis, none had hepatitis C (HCV) cirrhosis. None of the patients had received vaccination against hepatitis A, while 71 (67.6%) had been vaccinated against HBV. The majority [62 (58%)] were negative for anti-HAV IgG. Most cirrhotic patients in this cohort were not immune to hepatitis A. None had been vaccinated against HAV, while a third of patients had not been vaccinated against HBV. Cirrhotic patients should be routinely investigated for immunity against HAV and HBV, and vaccination offered to those found to be non-immune.

Factors associated with routine childhood vaccine uptake and reasons for non-vaccination in India: 1998-2008.

PubMed

Francis, Mark Rohit; Nohynek, Hanna; Larson, Heidi; Balraj, Vinohar; Mohan, Venkata Raghava; Kang, Gagandeep; Nuorti, J Pekka

2017-08-24

Despite almost three decades of the Universal Immunization Program in India, a little more than half the children aged 12-23months receive the full schedule of routine vaccinations. We examined socio-demographic factors associated with partial-vaccination and non-vaccination and the reasons for non-vaccination among Indian children during 1998 and 2008. Data from three consecutive, nationally-representative, District Level Household and Facility Surveys (1998-99, 2002-04 and 2007-08) were pooled. Multinomial logistic regression was used to identify individual and household level socio-demographic variables associated with the child's vaccination status. The mother's reported reasons for non-vaccination were analyzed qualitatively, adapting from a previously published framework. The pooled dataset contained information on 178,473 children 12-23months of age; 53%, 32% and 15% were fully vaccinated, partially vaccinated and unvaccinated respectively. Compared with the 1998-1999 survey, children in the 2007-2008 survey were less likely to be unvaccinated (Adjusted Prevalence Odds Ratio (aPOR): 0.92, 95%CI=0.86-0.98) but more likely to be partially vaccinated (aPOR: 1.58, 95%CI=1.52-1.65). Vaccination status was inversely associated with female gender, Muslim religion, lower caste, urban residence and maternal characteristics such as lower educational attainment, non-institutional delivery, fewer antenatal care visits and non-receipt of maternal tetanus vaccination. The mother's reported reasons for non-vaccination indicated gaps in awareness, acceptance and affordability (financial and non-financial costs) related to routine vaccinations. Persisting socio-demographic disparities related to partial-vaccination and non-vaccination were associated with important childhood, maternal and household characteristics. Further research investigating the causal pathways through which maternal and social characteristics influence decision-making for childhood vaccinations is needed to improve uptake of routine vaccination in India. Also, efforts to increase uptake should address parental fears related to vaccination to improve trust in government health services as part of ongoing social mobilization and communication strategies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Private-sector vaccine purchase costs and insurer payments: a disincentive for using combination vaccines?

PubMed

Clark, Sarah J; Cowan, Anne E; Freed, Gary L

2011-04-01

Combination vaccines have been endorsed as a means to decrease the number of injections needed to complete the childhood immunization schedule, yet anecdotal reports suggest that private providers lose money on combination vaccines. The objective of this study was to determine whether practices purchasing combination vaccines had significantly different vaccine costs and reimbursement compared to practices that were not purchasing combination vaccines. Using cross-sectional purchase and insurer payment data collected from a targeted sample of private practices in five US states, we calculated the average total vaccine cost and reimbursement across the childhood immunization schedule. The average vaccine purchase cost across the childhood schedule was significantly higher for practices using a combined vaccine with diphtheria, tetanus, acellular pertussis vaccine, inactivated polio vaccine, and Hepatitis B vaccine (DTaP-IPV-HepB) than for practices using either separate vaccine products or a combined vaccine with Haemophilus influenzae, type b vaccine and Hepatitis B vaccine (Hib-HepB). The average insurer payment for vaccine administration across the childhood schedule was significantly lower for practices using DTaP-IPV-HepB combination vaccine than for practices using separate vaccine products. This study appears to validate anecdotal reports that vaccine purchase costs and insurer payment for combination vaccines can have a negative financial impact for practices that purchase childhood vaccines.

Medicines and You: A Guide for Older Adults

MedlinePlus

... re taking the right medicine at the right time. Before you travel , ask your doctor or pharmacist how to adjust your medicine schedule to account for changes in time, routine, and diet. Bring the phone numbers of ...

Determinants of routine immunization costing in Benin and Ghana in 2011.

PubMed

Ahanhanzo, Césaire Damien; Huang, Xiao Xian; Le Gargasson, Jean-Bernard; Sossou, Justin; Nyonator, Frank; Colombini, Anais; Gessner, Bradford D

2015-05-07

Existing tools to evaluate costs do not always capture the heterogeneity of costs at the facility level. This study seeks to address this issue through an analysis of determinants of health facility immunization costs. A statistical analysis on facility routine delivery and vaccine costs was conducted using ordinary least squares regression. Explanatory variables included the number of doses administered; proportion of time spent by facility staff on immunization; average staff wage; whether the health facility had enough staff; presence of cold chain equipment; distance to a vaccine collection point; and, facility ownership. Data were drawn from representative samples of primary care facilities in Benin and Ghana (46 and 50 facilities, respectively) collected as part of the EPIC studies. Weighted average RI immunization facility cost was US$ 16,459 in Ghana and US$ 14,994 in Benin. The regression found total doses administered to be positively and significantly associated with facility cost in both countries. A 10% increase in doses resulted in a 4% increase in cost in Ghana, and a 7.5% increase in Benin. In Ghana, the proportion of immunization time, presence of cold chain, and sufficiency of staff were positively and significantly associated with total cost. In Benin, facility cost was negatively and significantly related to distance to the vaccine collection point. In the pooled sample, facilities in capital cities were associated with significantly higher costs. This study provides evidence on the importance of the level of scale in determining facility immunization cost, as well as the role of availability of health workers and time they spend on immunization in Ghana and Benin. This type of analysis can provide insights into the costs of scaling up immunization services, and can assist with development of more efficient immunization strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Physician impressions of using text message technology to increase vaccination compliance.

PubMed

Hart, Traci; Ahlers-Schmidt, Carolyn R; Chesser, Amy; Jones, Jordan; Williams, Katherine S; Wittler, Robert R

2011-01-01

Immunization schedules are complicated and difficult for parents to remember. Parents are willing to receive text message reminders. However, it is unknown whether physicians are willing to implement such a system. The purpose of this study was to evaluate the feasibility of a text messaging reminder system from the physician's perspective. Surveys were distributed in the winter of 2009-2010 by e-mail, facsimile, and telephone interview to 149 family physicians and pediatricians who provide immunizations in Sedgwick County, Kansas. A 69% response rate was achieved. Nearly all (92%) respondents reported that they currently communicate information about immunization schedules to parents using traditional methods such as verbal reminders or appointment cards; however, none (0%) currently use text or email to generate reminders to parents. Even when asked to assume they had all of the necessary resources, almost one-third (31%) reported that they were "very unwilling" or "unwilling" to use a general text-messaging program, 43% were "neutral" or "undecided," and only 27% were "willing" or "very willing." Physician willingness to use a text-messaging program was not related to their reported gender (χ²(2)=0.224, p=0.894), specialization (χ² (2)=4.363, p=0.113), years in practice (F(2, 91)=0.435, p=0.149), or comfort level with technology (χ²(4)=1.861, p=0.761). There is a hesitancy to implement a text message reminder system for childhood vaccine schedules. This may be due to the lack of empirical evidence supporting the use of this technology for health reminders or the lack of willingness to implement another system. Further investigation is needed to determine why few physicians are willing to implement text messaging for immunization reminders.

Development of immunity following financial incentives for hepatitis B vaccination among people who inject drugs: A randomized controlled trial.

PubMed

Day, Carolyn A; Shanahan, Marian; Wand, Handan; Topp, Libby; Haber, Paul S; Rodgers, Craig; Deacon, Rachel; Walsh, Nick; Kaldor, John; van Beek, Ingrid; Maher, Lisa

2016-01-01

People who inject drugs (PWID) are at risk of hepatitis B virus (HBV) but have low rates of vaccination completion. The provision of modest financial incentives increases vaccination schedule completion, but their association with serological protection has yet to be determined. To investigate factors associated with vaccine-induced immunity among a sample of PWID randomly allocated to receive AUD$30 cash following receipt of doses two and three ('incentive condition') or standard care ('control condition') using an accelerated 3-dose (0,7,21 days) HBV vaccination schedule. A randomised controlled trial among PWID attending two inner-city health services and a field site in Sydney, Australia, assessing vaccine-induced immunity measured by hepatitis B surface antibodies (HBsAb ≥ 10 mIU/ml) at 12 weeks. The cost of the financial incentives and the provision of the vaccine program are also reported. Just over three-quarters of participants - 107/139 (77%)--completed the vaccination schedule and 79/139 (57%) were HBsAb ≥ 10 mIU/ml at 12 weeks. Vaccine series completion was the only variable significantly associated with vaccine-induced immunity in univariate analysis (62% vs 41%, p<0.035) but was not significant in multivariate analysis. There was no statistically discernible association between group allocation and series completion (62% vs 53%). The mean costs were AUD$150.5, (95% confidence interval [CI]: 142.7-158.3) and AUD$76.9 (95% CI: 72.6-81.3) for the intervention and control groups respectively. Despite increasing HBV vaccination completion, provision of financial incentives was not associated with enhanced serological protection. Further research into factors which affect response rates and the optimal vaccination regimen and incentive schemes for this population are needed. Copyright © 2015 Elsevier B.V. All rights reserved.

[Immunisation schedule of the Spanish Association of Paediatrics: 2013 recommendations].

PubMed

Moreno-Pérez, D; Álvarez García, F J; Arístegui Fernández, J; Barrio Corrales, F; Cilleruelo Ortega, M J; Corretger Rauet, J M; González-Hachero, J; Hernández-Sampelayo Matos, T; Merino Moína, M; Ortigosa Del Castillo, L; Ruiz-Contreras, J

2013-01-01

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded as routine vaccinations those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunisation schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, CAV-AEP follows the innovations proposed in the last year's schedule, such as the administration of the first dose of the MMR and the varicella vaccines at age 12 months and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age, preferably at 11-12 years. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years, preferably at 11-12 years, must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier España, S.L. All rights reserved.

Proceedings of Joint RL/AFOSR Workshop on Intelligent Information Systems Held at Griffiss AFB, New York on October 22-23, 1991

DTIC Science & Technology

1992-04-01

AND SCHEDULING" TIM FINN, UNIVERSITY OF MARYLAND, BALTIMORE COUNTY E. " EXTRACTING RULES FROM SOFTWARE FOR KNOWLEDGE-BASES" NOAH S. PRYWES, UNIVERSITY...Databases for Planning and Scheduling" Tim Finin, Unisys Corporation 8:30 - 9:00 " Extracting Rules from Software for Knowledge Baseso Noah Prywes, U. of...Space Requirements are Tractable E.G.: FEM, Multiplication Routines, Sorting Programs Lebmwmy fo Al Roseew d. The Ohio Male Unlversity A-2 Type 2

A current and historical perspective on disparities in US childhood pneumococcal conjugate vaccine adherence and in rates of invasive pneumococcal disease: Considerations for the routinely-recommended, pediatric PCV dosing schedule in the United States

PubMed Central

McLaughlin, John M; Utt, Eric A; Hill, Nina M; Welch, Verna L; Power, Edward; Sylvester, Gregg C

2016-01-01

Previous research has suggested that reducing the US 4-dose PCV13 schedule to a 3-dose schedule may provide cost savings, despite more childhood pneumococcal disease. The study also stressed that dose reduction should be coupled with improved PCV adherence, however, US PCV uptake has leveled-off since 2008. An estimated 24–36% of US children aged 5–19 months are already receiving a reduced PCV schedule (i.e., missing ≥1 dose). This raises a practical concern that, under a reduced, 3-dose schedule, a similar proportion of children may receive ≤2 doses. It is also unknown if a reduced, 3-dose PCV schedule in the United States will afford the same disease protection as 3-dose schedules used elsewhere, given lower US PCV adherence. Finally, more assurance is needed that, under a reduced schedule, racial, socioeconomic, and geographic disparities in PCV adherence will not correspond with disproportionately higher rates of pneumococcal disease among poor or minority children. PMID:26376039

Sustainability of National Immunization Programme (NIP) performance and financing following Global Alliance for Vaccines and Immunization (GAVI) support to the Democratic Republic of the Congo (DRC).

PubMed

Le Gargasson, Jean-Bernard; Breugelmans, J Gabrielle; Mibulumukini, Benoît; Da Silva, Alfred; Colombini, Anaïs

2013-04-08

The Global Alliance for Vaccines and Immunization (GAVI) is a public-private global health partnership aiming to increase access to immunisation in poor countries. The Democratic Republic of the Congo (DRC) is the third largest recipient of GAVI funds in terms of cumulative disbursed support. We provided a comprehensive assessment of GAVI support and analysed trends in immunisation performance and financing in the DRC from 2002 to 2010. The scope of the analysis includes GAVI's total financial support and the value of vaccines and syringes purchased by GAVI for the DRC from 2002 to 2010. Data were collected through a review of published and grey literature and interviews with key stakeholders in the DRC. We assessed the allocation and use of GAVI funds for each of GAVI's support areas, as well as trends in immunisation performance and financing. DTP3 coverage increased from 2002 (38%) to 2007 (72%) but had decreased to a level below 70% in 2008 (68%) and 2010 (63%). The overall funding for vaccines increased from US$5.4 million in 2006 to US$30.5 million in 2010 (mostly from GAVI support for new vaccines). However, during the same period, the funding from national (government) and international (GAVI and other donors) sources for routine immunisation services (except vaccines) decreased from US$36.4 million to US$24.4 million. This drop in overall funding (33%) primarily affected surveillance, transport, and cold chain equipment. GAVI support to DRC has enhanced significant progress in routine immunisation performance and financing during 2002-2010. Although progress has been partly sustained, the initial observed increase in DTP3 coverage and available funding for routine immunisation halted towards the end of the analysis period, coinciding with tetravalent and pentavalent vaccine introduction. These findings highlight the need for additional efforts to ensure the sustainability of routine immunization program performance and financing. Copyright © 2013 Elsevier Ltd. All rights reserved.

Comparing health outcomes and costs of general vaccination with pneumococcal conjugate vaccines in Sweden: a Markov model.

PubMed

By, Asa; Sobocki, Patrik; Forsgren, Arne; Silfverdal, Sven-Arne

2012-01-01

Two new pneumococcal conjugate vaccines were licensed to immunize infants and young children against pneumococcal disease. The objective of this study was to estimate the expected health benefits, costs, and incremental cost-effectiveness of routine vaccination with the 10-valent pneumococcal nontypeable hemophilus influenza protein-D conjugate vaccine (PHiD-CV) compared with the 13-valent pneumococcal conjugate vaccine (PCV13) in Sweden. A Markov cohort model was used to estimate the effect of vaccination at vaccine steady state, taking a societal perspective and using a 2+1 vaccination schedule. Price parity was assumed between the vaccines. Outcomes were measured by reduction in disease burden, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio. The results predicted that PCV13 would prevent 3 additional cases of invasive pneumococcal disease and 34 additional cases of pneumonia, whereas PHiD-CV would avoid 3 additional cases of mastoiditis, 1010 tube insertions, and 10,420 cases of ambulatory acute otitis media compared with PCV13. By combining morbidity and mortality benefits of all clinical outcomes, PHiD-CV would generate 45.3 additional QALYs compared with PCV13 and generate savings of an estimated 62 million Swedish kronors. The present study predicted lower costs and better health outcome (QALYs) gained by introducing PHiD-CV compared with PCV13 in routine vaccination. Our results indicated that PHiD-CV is cost-effective compared with PCV13 in Sweden. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Treatment of a Circadian Rhythm Disturbance in a 2-Year-Old Blind Child.

ERIC Educational Resources Information Center

Mindell, J. A.; And Others

1996-01-01

The use of sleep scheduling and a daytime routine for the treatment of circadian rhythm disorder was found helpful in decreasing a blind 2-year old's nighttime wake periods and daytime sleepiness. (DB)

A double-dose hepatitis B vaccination schedule in travelers presenting for late consultation.

PubMed

Wong, Jason; Payne, Michael; Hollenberg, Susan

2014-01-01

Vaccination against hepatitis B virus (HBV) is recommended for all travelers visiting HBV-endemic countries. However, travelers often present with insufficient time for the standard HBV vaccine schedule (SVS). We examined seroprotection against HBV following an alternative two-visit vaccination schedule (TVS) with currently available vaccine products, and completion rates with this TVS. A retrospective cohort study was conducted in three travel clinics in British Columbia, Canada. Adults ≥20 years old traveling to an HBV-endemic country, and unable to complete the standard or rapid HBV vaccination schedule before departure, were offered a TVS that consisted of a double dose of HBV vaccine at day 0, followed by a single dose in 4 to 12 months. Immunity to HBV [anti-HBV surface antigen (HBs) ≥10 mIU/mL] was determined 1 to 6 months following the final dose of HBV vaccine. Logistic regression modeling was used to assess correlates of seroprotection. We also determined completion rate with this TVS at two clinics. In total, 117 participants (age range, 21-81 years, median age 57) met the inclusion criteria. Of these, 97 (82.9%) were immune after the TVS. Immunity was demonstrated in 93.1% of patients <50 years old and 79.5% of patients ≥50 years old. Increasing age was associated with reduced odds of developing immunity to HBV using the TVS [adjusted odds ratio = 0.954, 95% confidence interval (CI): 0.904, 1.008]. The completion rate of the TVS was 32.6% over a 12-month period. Completion rates varied between clinics (23.5% vs 48.4%, p < 0.001), suggesting that clinic-specific follow-up policies were important. Seroprotection with completion of this TVS was similar to or exceeded that published in the literature for the SVS by age. However, even with a TVS, completion rates were low, underscoring the importance of follow-up. Further research is needed to determine whether travelers are protected prior to completion of this TVS. © 2014 International Society of Travel Medicine.

Adverse Events After Routine Immunization of Extremely Low Birth Weight Infants

PubMed Central

DeMeo, Stephen D.; Raman, Sudha R.; Hornik, Christoph P.; Wilson, Catherine C.; Clark, Reese; Smith, P. Brian

2015-01-01

Importance Immunization of extremely low birth weight (ELBW) infants in the neonatal intensive care unit (NICU) is associated with adverse events including fever and apnea/bradycardia in the immediate post-immunization period. This presents a diagnostic dilemma for clinicians, leading to the potential for immunization delay and sepsis evaluations. Objective To compare the incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death among immunized ELBW infants in the 3 days pre- and post-immunization. Design Multicenter retrospective cohort study. Setting 348 NICUs managed by the Pediatrix Medical Group. Participants 13,926 ELBW infants ≤28 weeks gestation who were discharged between 2007 and 2012. Exposure At least one immunization between day of life 53 and 110. Main Outcomes and Measures Incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death. Results Most (91%) of the infants received 3 or more immunizations. The incidence of sepsis evaluations increased from 5.4/1000 patient days in the pre-immunization period to 19.3/1000 patient days post-immunization (adjusted rate ratio [ARR], 3.7; 95% CI, 3.2–4.4). The need for increased respiratory support increased from 6.6/1000 patient days in the pre-immunization period to 14.0/1000 patient days post-immunization (ARR, 2.1; 95% CI, 1.9–2.5), and intubation increased from 2.0/1000 patient days to 3.6/1000 patient days (ARR, 1.7; 95% CI, 1.3–2.2). The post-immunization incidence of adverse events was similar across immunization types, including combination vaccines when compared to single-dose vaccines. Infants who were 23–24 weeks gestation had a higher risk of sepsis evaluation and intubation post-immunization. A prior history of sepsis was associated with higher risk of sepsis evaluation post-immunization. Conclusion ELBW infants in the NICU had an increased incidence of sepsis evaluations as well as increased respiratory support and intubation after routine immunization. Our findings provide no evidence to suggest that clinicians should not use combination vaccines in ELBW infants. Further studies are needed to determine whether timing or spacing of immunization administrations confers risk for the developing adverse events and whether a prior history of sepsis confers risk for an altered immune response in ELBW infants. PMID:26030302

The interplay of immunotherapy and chemotherapy: harnessing potential synergies.

PubMed

Emens, Leisha A; Middleton, Gary

2015-05-01

Although cancer chemotherapy has historically been considered immune suppressive, it is now accepted that certain chemotherapies can augment tumor immunity. The recent success of immune checkpoint inhibitors has renewed interest in immunotherapies, and in combining them with chemotherapy to achieve additive or synergistic clinical activity. Two major ways that chemotherapy promotes tumor immunity are by inducing immunogenic cell death as part of its intended therapeutic effect and by disrupting strategies that tumors use to evade immune recognition. This second strategy, in particular, is dependent on the drug, its dose, and the schedule of chemotherapy administration in relation to antigen exposure or release. In this Cancer Immunology at the Crossroads article, we focus on cancer vaccines and immune checkpoint blockade as a forum for reviewing preclinical and clinical data demonstrating the interplay between immunotherapy and chemotherapy. ©2015 American Association for Cancer Research.

The 2016 Lifetime Immunization Schedule, approved by the Italian scientific societies: A new paradigm to promote vaccination at all ages

PubMed Central

Chiamenti, Giampietro; Conforti, Giorgio; Maio, Tommasa; Odone, Anna; Russo, Rocco; Scotti, Silvestro; Signorelli, Carlo; Villani, Alberto

2017-01-01

ABSTRACT Medical scientific societies have the core mission of producing, pooling and disseminating solid and updated scientific information. We report the successful experience of the partnership of four national Medical Scientific Societies active in Italy in producing scientific advice on vaccines and vaccination. In particular, i) the Italian Society of Hygiene, Preventive Medicine and Public Health; SitI, ii) the Italian Society of Paediatrics; SIP, iii) the “Italian Federation of General Practitioners”; FIMP, and iv) the Italian Federation of General Medicine FIMMG) have worked together since 2012 to produce shared evidence-based recommendations on vaccination schedules, namely the “Lifetime Immunization Schedule” which introduced for the first time in Italy a life-course approach to vaccination. The 2014 edition of the “Lifetime Immunization Schedule” was used as a basis to develop the 2017–2019 Italian National Prevention Plan, approved by The Italian Ministry of Health in February 2017. In this report, we present the structure, content and supporting evidence of the new 2016 “Lifetime Immunization Schedule” and we expand on the influential role of medical scientific societies in researching and advocating for effective and safe vaccination programmes’ implementation at the national level. PMID:29048980

A case study using the United Republic of Tanzania: costing nationwide HPV vaccine delivery using the WHO Cervical Cancer Prevention and Control Costing Tool.

PubMed

Hutubessy, Raymond; Levin, Ann; Wang, Susan; Morgan, Winthrop; Ally, Mariam; John, Theopista; Broutet, Nathalie

2012-11-13

The purpose, methods, data sources and assumptions behind the World Health Organization (WHO) Cervical Cancer Prevention and Control Costing (C4P) tool that was developed to assist low- and middle-income countries (LMICs) with planning and costing their nationwide human papillomavirus (HPV) vaccination program are presented. Tanzania is presented as a case study where the WHO C4P tool was used to cost and plan the roll-out of HPV vaccines nationwide as part of the national comprehensive cervical cancer prevention and control strategy. The WHO C4P tool focuses on estimating the incremental costs to the health system of vaccinating adolescent girls through school-, health facility- and/or outreach-based strategies. No costs to the user (school girls, parents or caregivers) are included. Both financial (or costs to the Ministry of Health) and economic costs are estimated. The cost components for service delivery include training, vaccination (health personnel time and transport, stationery for tally sheets and vaccination cards, and so on), social mobilization/IEC (information, education and communication), supervision, and monitoring and evaluation (M&E). The costs of all the resources used for HPV vaccination are totaled and shown with and without the estimated cost of the vaccine. The total cost is also divided by the number of doses administered and number of fully immunized girls (FIGs) to estimate the cost per dose and cost per FIG. Over five years (2011 to 2015), the cost of establishing an HPV vaccine program that delivers three doses of vaccine to girls at schools via phased national introduction (three regions in year 1, ten regions in year 2 and all 26 regions in years 3 to 5) in Tanzania is estimated to be US$9.2 million (excluding vaccine costs) and US$31.5 million (with vaccine) assuming a vaccine price of US$5 (GAVI 2011, formerly the Global Alliance for Vaccines and Immunizations). This is equivalent to a financial cost of US$5.77 per FIG, excluding the vaccine cost. The most important costs of service delivery are social mobilization/IEC and service delivery operational costs. When countries expand their immunization schedules with new vaccines such as the HPV vaccine, they face initial costs to fund critical pre-introduction activities, as well as incremental system costs to deliver the vaccines on an ongoing basis. In anticipation, governments need to plan ahead for non-vaccine costs so they will be financed adequately. Existing human resources need to be re-allocated or new staff need to be recruited for the program to be implemented successfully in a sustainable and long-term manner.Reaching a target group not routinely served by national immunization programs previously with three doses of vaccine requires new delivery strategies, more transport of vaccines and health workers and more intensive IEC activities leading to new delivery costs for the immunization program that are greater than the costs incurred when a new infant vaccine is added to the existing infant immunization schedule. The WHO C4P tool is intended to help LMICs to plan ahead and estimate the programmatic and operational costs of HPV vaccination.

A case study using the United Republic of Tanzania: costing nationwide HPV vaccine delivery using the WHO Cervical Cancer Prevention and Control Costing Tool

PubMed Central

2012-01-01

Background The purpose, methods, data sources and assumptions behind the World Health Organization (WHO) Cervical Cancer Prevention and Control Costing (C4P) tool that was developed to assist low- and middle-income countries (LMICs) with planning and costing their nationwide human papillomavirus (HPV) vaccination program are presented. Tanzania is presented as a case study where the WHO C4P tool was used to cost and plan the roll-out of HPV vaccines nationwide as part of the national comprehensive cervical cancer prevention and control strategy. Methods The WHO C4P tool focuses on estimating the incremental costs to the health system of vaccinating adolescent girls through school-, health facility- and/or outreach-based strategies. No costs to the user (school girls, parents or caregivers) are included. Both financial (or costs to the Ministry of Health) and economic costs are estimated. The cost components for service delivery include training, vaccination (health personnel time and transport, stationery for tally sheets and vaccination cards, and so on), social mobilization/IEC (information, education and communication), supervision, and monitoring and evaluation (M&E). The costs of all the resources used for HPV vaccination are totaled and shown with and without the estimated cost of the vaccine. The total cost is also divided by the number of doses administered and number of fully immunized girls (FIGs) to estimate the cost per dose and cost per FIG. Results Over five years (2011 to 2015), the cost of establishing an HPV vaccine program that delivers three doses of vaccine to girls at schools via phased national introduction (three regions in year 1, ten regions in year 2 and all 26 regions in years 3 to 5) in Tanzania is estimated to be US$9.2 million (excluding vaccine costs) and US$31.5 million (with vaccine) assuming a vaccine price of US$5 (GAVI 2011, formerly the Global Alliance for Vaccines and Immunizations). This is equivalent to a financial cost of US$5.77 per FIG, excluding the vaccine cost. The most important costs of service delivery are social mobilization/IEC and service delivery operational costs. Conclusions When countries expand their immunization schedules with new vaccines such as the HPV vaccine, they face initial costs to fund critical pre-introduction activities, as well as incremental system costs to deliver the vaccines on an ongoing basis. In anticipation, governments need to plan ahead for non-vaccine costs so they will be financed adequately. Existing human resources need to be re-allocated or new staff need to be recruited for the program to be implemented successfully in a sustainable and long-term manner. Reaching a target group not routinely served by national immunization programs previously with three doses of vaccine requires new delivery strategies, more transport of vaccines and health workers and more intensive IEC activities leading to new delivery costs for the immunization program that are greater than the costs incurred when a new infant vaccine is added to the existing infant immunization schedule. The WHO C4P tool is intended to help LMICs to plan ahead and estimate the programmatic and operational costs of HPV vaccination. PMID:23146319

Impact of Louisiana's HPV Vaccine Awareness Policy on HPV Vaccination among 13- to 17-Year-Old Females

ERIC Educational Resources Information Center

Pierre-Victor, Dudith; Trepka, Mary Jo; Page, Timothy F.; Li, Tan; Stephens, Dionne P.; Madhivanan, Purnima

2017-01-01

The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) immunization for 11- to 12-year-old adolescents. In 2008, Louisiana required the school boards to distribute HPV vaccine information to parents or guardian of students in Grades 6 to 12. This article investigates the impact of this policy on HPV…

Recommendations for pneumococcal immunization outside routine childhood immunization programs in Western Europe.

PubMed

Castiglia, Paolo

2014-10-01

The global burden of pneumococcal diseases is high, with young children and adults≥50 years of age at highest risk of infection. Two types of vaccine are available for the prevention of pneumococcal diseases caused by specific Streptococcus pneumoniae serotypes: the pneumococcal polysaccharide vaccine (PPV23) and the pneumococcal conjugate vaccine (PCV7, PCV10, and PCV13). Despite pneumococcal immunization programs in adults and children, the burden in adults has remained high. Most European countries have national or local/regional vaccination recommendations. The objective of this review was to provide an overview of the government recommendations for pneumococcal vaccination outside routine childhood vaccination programs for 16 Western European countries as of August 2014. We found that recommendations for pneumococcal immunization across Europe are complex and vary greatly among countries in terms of age groups and risk groups recommended for vaccination, as well as which vaccine should be administered. Clarifying or simplifying these recommendations and improving their dissemination could help to increase pneumococcal vaccine uptake and decrease the high burden of pneumococcal diseases in adults, both through a direct effect of the vaccine and via a herd effect in unvaccinated individuals.

What do parents learn by reading a DPT vaccine information form?

PubMed Central

Gold, Ronald; Bjornson, Gordean L

1994-01-01

Objective: Information forms are commonly used to inform parents about childhood vaccination. This study assessed the knowledge of mothers about pertussis and pertussis vaccine before and after reading a form about diphtheria-pertussis-tetanus (dpt) vaccine. Design: A test was administered to mothers before and after the first vaccination of their infant. By random allocation, one-half of the mothers received the form (study group) in addition to the routine counselling by a public health nurse given to the others (control group). Setting: Public health immunization clinics in suburban Vancouver, British Columbia. Subjects: One hundred and fifty-one mothers who were scheduled to bring their infant for the first dpt immunization were recruited, of whom 145 (96%) completed the study. Interventions: A test consisting of 20 true/false questions was administered by telephone two weeks before and two weeks after the first dpt vaccination. Additional data about sources of vaccine information, maternal education, number of children and maternal age were obtained. Outcome Measures: Mean scores and mean change in scores on test. Results: The mean changes in scores between tests 1 and 2 in study and control groups were +22.2% and +6.9%, respectively, on the disease-related questions (P<0.001) and +14.6% and +10.7%, respectively, on the vaccine-related questions (P=0.16). The forms were considered to be very useful by the mothers and clearly enabled them to score higher on a test of their knowledge of pertussis and pertussis vaccine. Conclusions: Reading a dpt vaccine form enabled mothers to improve their knowledge of pertussis and pertussis vaccine. PMID:22451768

Risk of Dengue for Tourists and Teams during the World Cup 2014 in Brazil

PubMed Central

van Panhuis, Willem G.; Hyun, Sangwon; Blaney, Kayleigh; Marques, Ernesto T. A.; Coelho, Giovanini E.; Siqueira, João Bosco; Tibshirani, Ryan; da Silva, Jarbas B.; Rosenfeld, Roni

2014-01-01

Abstract Background This year, Brazil will host about 600,000 foreign visitors during the 2014 FIFA World Cup. The concern of possible dengue transmission during this event has been raised given the high transmission rates reported in the past by this country. Methodology/Principal Findings We used dengue incidence rates reported by each host city during previous years (2001–2013) to estimate the risk of dengue during the World Cup for tourists and teams. Two statistical models were used: a percentile rank (PR) and an Empirical Bayes (EB) model. Expected IR's during the games were generally low (<10/100,000) but predictions varied across locations and between models. Based on current ticket allocations, the mean number of expected symptomatic dengue cases ranged from 26 (PR, 10th–100th percentile: 5–334 cases) to 59 (EB, 95% credible interval: 30–77 cases) among foreign tourists but none are expected among teams. These numbers will highly depend on actual travel schedules and dengue immunity among visitors. Sensitivity analysis for both models indicated that the expected number of cases could be as low as 4 or 5 with 100,000 visitors and as high as 38 or 70 with 800,000 visitors (PR and EB, respectively). Conclusion/Significance The risk of dengue among tourists during the World Cup is expected to be small due to immunity among the Brazil host population provided by last year's epidemic with the same DENV serotypes. Quantitative risk estimates by different groups and methodologies should be made routinely for mass gathering events. PMID:25079960

Vaccination coverage among children in Germany estimated by analysis of health insurance claims data

PubMed Central

Rieck, Thorsten; Feig, Marcel; Eckmanns, Tim; Benzler, Justus; Siedler, Anette; Wichmann, Ole

2014-01-01

In Germany, the national routine childhood immunization schedule comprises 12 vaccinations. Primary immunizations should be completed by 24 mo of age. However, nationwide monitoring of vaccination coverage (VC) is performed only at school entry. We utilized health insurance claims data covering ~85% of the total population with the objectives to (1) assess VC of all recommended childhood vaccinations in birth-cohorts 2004–2009, (2) analyze cross-sectional (at 24 and 36 mo) and longitudinal trends, and (3) validate the method internally and externally. Counting vaccine doses in a retrospective cohort fashion, we assembled individual vaccination histories and summarized VC to nationwide figures. For most long-established vaccinations, VC at 24 mo was at moderate levels (~73–80%) and increased slightly across birth-cohorts. One dose measles VC was high (94%), but low (69%) for the second dose. VC with a full course of recently introduced varicella, pneumococcal, and meningococcal C vaccines increased across birth-cohorts from below 10% above 60%, 70%, and 80%, respectively. At 36 mo, VC had increased further by up to 15 percentage points depending on vaccination. Longitudinal analysis suggested a continued VC increase until school entry. Validation of VC figures with primary data showed an overall good agreement. In conclusion, analysis of health insurance claims data allows for the estimation of VC among children in Germany considering completeness and timeliness of vaccination series. This approach provides valid nationwide VC figures for all currently recommended pediatric vaccinations and fills the information gap between early infancy and late assessment at school entry. PMID:24192604

Rotavirus vaccine RIX4414 (Rotarix): a review of its use in the prevention of rotavirus gastroenteritis.

PubMed

McCormack, Paul L; Keam, Susan J

2009-01-01

Rotavirus vaccine RIX4414 is an oral vaccine composed of a monovalent, live, attenuated, human rotavirus strain of G1P[8] type. RIX4414 vaccination in infants aged 6-17 weeks at enrolment provided protection against rotavirus gastroenteritis (RVGE) of any severity and high-level protection against severe RVGE requiring hospitalization in large, randomized clinical trials conducted in a wide range of geographic regions. Protective efficacy was evident over the period (2 months) between the first and second doses of vaccine, and the protection afforded by the full two-dose course was sustained for at least 2 years, the limit to which efficacy was assessed. RIX4414 displayed protective efficacy against the common rotavirus G, P[8] types (G1P[8], G3P[8], G4P[8], and G9P[8]) and the fully heterotypic G2P[4] type. RIX4414 did not interfere with other common childhood injectable immunizations when administered concomitantly, suggesting that it should be possible to integrate the vaccine into most routine childhood vaccination schedules, including those still using oral poliovirus vaccine. RIX4414 was generally well tolerated and there was no evidence of an increased risk of intussusception. Although dependent on many factors, including prevalent infecting strains, efficacy rates, and vaccine costs, pharmacoeconomic analyses suggest that mass immunization with RIX4414 would be cost effective in many countries, especially when assessed from the societal perspective. Therefore, rotavirus vaccine RIX4414 offers a highly effective control strategy for reducing the burden of RVGE in infants.

Chickenpox, chickenpox vaccination, and shingles

PubMed Central

Welsby, P D

2006-01-01

Chickenpox in the United Kingdom, where vaccination is not undertaken, has had a stable epidemiology for decades and is a routine childhood illness. Because of vaccination, chickenpox is now a rarity in the USA. In the UK vaccination is not done because introduction of a routine childhood vaccination might drive up the age at which those who are non‐immune get the illness (chickenpox tends to be more severe the older you are), and the incidence of shingles may increase. The United Kingdom is waiting to see what happens in countries where vaccination is routine. PMID:16679476

Controversies in rabies vaccination.

PubMed

Ghosh, Tapan Kr

2003-06-01

Rabies is a cent per cent fatal disease and there should not be any controversy in giving rabies vaccine to the victims. WHO has fixed schedules for doses for both pre and post-exposure in different category of cases, which also help us to avoid all controversies. But controversies arise in five main areas, which are related to the strategies of rabies prevention. These are: (i) Replacing use of NTV by MTCV. (ii) Intradermal schedule of MTCV, in place of Essen protocol of 5 i.m. doses to reduce the cost. (iii) Acceptability and inclusion of pre-exposure doses of MTCV in the immunization schedule of children as additional vaccine (iv) Schedule for re-exposure in already post-exposure vaccinated cases and schedule for exposure in pre-exposure vaccinated cases. (v) Uses of RIG in WHO category III cases. If these controversial issues are considered scientifically, rabies prophylaxis will see the light of success.

Immunization Schedules for Adults

MedlinePlus

... color [2 pages] PDF black & white [2 pages] Spanish Version (en español) Vacunas recomendadas para adultos según ... easy-to-read format in English and/or Spanish on your website. See examples of how the ...

Communicating the benefits of combination vaccines to parents and health care providers.

PubMed

Koslap-Petraco, Mary Beth; Parsons, Tamra

2003-01-01

Infants may receive as many as 5 separate injections at an office visit in order to comply with the 2002 childhood immunization schedule. Many parents and healthcare providers disagree with administering 4 or 5 injections at one visit, and therefore may delay some injections until another visit. This practice may lead to decreased compliance and can increase costs for the parent. New combination vaccines will help to simplify the immunization schedule, and health care providers will need to be able to address parental concerns regarding these vaccines. Nurses are often responsible for administering vaccines in the office setting, and therefore are also influential in deciding which vaccines should be ordered. The purpose of this article is to educate nurses on communicating the benefits of combination vaccines to parents and other healthcare providers.

Drug scheduling of cancer chemotherapy based on natural actor-critic approach.

PubMed

Ahn, Inkyung; Park, Jooyoung

2011-11-01

Recently, reinforcement learning methods have drawn significant interests in the area of artificial intelligence, and have been successfully applied to various decision-making problems. In this paper, we study the applicability of the NAC (natural actor-critic) approach, a state-of-the-art reinforcement learning method, to the drug scheduling of cancer chemotherapy for an ODE (ordinary differential equation)-based tumor growth model. ODE-based cancer dynamics modeling is an active research area, and many different mathematical models have been proposed. Among these, we use the model proposed by de Pillis and Radunskaya (2003), which considers the growth of tumor cells and their interaction with normal cells and immune cells. The NAC approach is applied to this ODE model with the goal of minimizing the tumor cell population and the drug amount while maintaining the adequate population levels of normal cells and immune cells. In the framework of the NAC approach, the drug dose is regarded as the control input, and the reward signal is defined as a function of the control input and the cell populations of tumor cells, normal cells, and immune cells. According to the control policy found by the NAC approach, effective drug scheduling in cancer chemotherapy for the considered scenarios has turned out to be close to the strategy of continuing drug injection from the beginning until an appropriate time. Also, simulation results showed that the NAC approach can yield better performance than conventional pulsed chemotherapy. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Durability of Vaccine-Induced Immunity Against Tetanus and Diphtheria Toxins: A Cross-sectional Analysis

PubMed Central

Hammarlund, Erika; Thomas, Archana; Poore, Elizabeth A.; Amanna, Ian J.; Rynko, Abby E.; Mori, Motomi; Chen, Zunqiu; Slifka, Mark K.

2016-01-01

Background. Many adult immunization schedules recommend that tetanus and diphtheria vaccination be performed every 10 years. In light of current epidemiological trends of disease incidence and rates of vaccine-associated adverse events, the 10-year revaccination schedule has come into question. Methods. We performed cross-sectional analysis of serum antibody titers in 546 adult subjects stratified by age or sex. All serological results were converted to international units after calibration with international serum standards. Results. Approximately 97% of the population was seropositive to tetanus and diphtheria as defined by a protective serum antibody titer of ≥0.01 IU/mL. Mean antibody titers were 3.6 and 0.35 IU/mL against tetanus and diphtheria, respectively. Antibody responses to tetanus declined with an estimated half-life of 14 years (95% confidence interval, 11–17 years), whereas antibody responses to diphtheria were more long-lived and declined with an estimated half-life of 27 years (18–51 years). Mathematical models combining antibody magnitude and duration predict that 95% of the population will remain protected against tetanus and diphtheria for ≥30 years without requiring further booster vaccination. Conclusions. These studies demonstrate that durable levels of protective antitoxin immunity exist in the majority of vaccinated individuals. Together, this suggests that it may no longer be necessary to administer booster vaccinations every 10 years and that the current adult vaccination schedule for tetanus and diphtheria should be revisited. PMID:27060790

Measles outbreak investigation in Guji zone of Oromia Region, Ethiopia.

PubMed

Belda, Ketema; Tegegne, Ayesheshem Ademe; Mersha, Amare Mengistu; Bayenessagne, Mekonnen Getahun; Hussein, Ibrahim; Bezabeh, Belay

2017-01-01

Despite the increase of immunization coverage (administrative) of measles in the country, there are widespread outbreaks of measles. In this respect, we investigated one of the outbreaks that occurred in hard to reach kebeles of Guji Zone, Oromia region, to identify the contributing factors that lead to the protracted outbreak of measles. We used a cross-sectional study design to investigate a measles outbreak in Guji zone, Oromia region. Data entry and analysis was performed using EPI-Info version 7.1.0.6 and MS-Microsoft Excel. In three months' time a total of 1059 suspected cases and two deaths were reported from 9 woredas affected by a measles outbreak in Guji zone. The cumulative attack rate of 81/100,000 population and case fatality ratio of 0.2% was recorded. Of these, 821 (77.5%) cases were < 15 years of age, and 742 (70%) were zero doses of measles vaccine. Although, all age groups were affected under five years old were more affected 495 (48%) than any other age groups. In response to the outbreak, an outbreak response immunization was organized at the 11th week of the epidemic, when the epidemic curve started to decline. 6 months to14 years old were targeted for outbreak response immunization and the overall coverage was 97 % (range: 90-103%). Case management with vitamin A supplementation, active case search, and health education was some of the activities carried out to curb the outbreak. We conclude that low routine immunization coverage in conjunction with low access to routine immunization in hard to reach areas, low community awareness in utilization of immunization service, inadequate cold chain management and delivery of a potent vaccine in hard to reach woredas/kebeles were likely contributed to the outbreak that's triggered a broad spread epidemic affecting mostly children without any vaccination. We also figured that the case-based surveillance lacks sensitivity and timely confirmation of the outbreak, which as a result outbreak response immunization were delayed. We recommend establishing reaching every child (REC) strategy in Guji zone with particular emphasis too hard reach areas to enhance the current immunization service, and furthermore to conduct data quality self-assessment or cluster coverage survey to verify the reported high vaccination coverage in some kebeles. We also recommend conducting the second opportunity as a form of supplemental immunization activities in 2-3 year interval or consider the national second dose introduction in the routine immunization system to improve population immunity. We further recommend that there is a need to boost the sensitivity of case-based surveillance system to be able to early detect, confirm and react to future epidemics.

Meningococcal vaccine introduction in Mali through mass campaigns and its impact on the health system

PubMed Central

Mounier-Jack, Sandra; Burchett, Helen Elizabeth Denise; Griffiths, Ulla Kou; Konate, Mamadou; Diarra, Kassibo Sira

2014-01-01

Objective: To evaluate the impact of the meningococcal A (MenA) vaccine introduction in Mali through mass campaigns on the routine immunization program and the wider health system. Methods: We used a mixed-methods case-study design, combining semi-structured interviews with 31 key informants, a survey among 18 health facilities, and analysis of routine health facility data on number of routine vaccinations and antenatal consultations before, during, and after the MenA vaccine campaign in December 2010. Survey and interview data were collected at the national level and in 2 regions in July and August 2011, with additional interviews in January 2012. Findings: Many health system functions were not affected—either positively or negatively—by the MenA vaccine introduction. The majority of effects were felt on the immunization program. Benefits included strengthened communication and social mobilization, surveillance, and provider skills. Drawbacks included the interruption of routine vaccination services in the majority of health facilities surveyed (67%). The average daily number of children receiving routine vaccinations was 79% to 87% lower during the 10-day campaign period than during other periods of the month. Antenatal care consultations were also reduced during the campaign period by 10% to 15%. Key informants argued that, with an average of 14 campaigns per year, mass campaigns would have a substantial cumulative negative effect on routine health services. Many also argued that the MenA campaign missed potential opportunities for health systems strengthening because integration with other health services was lacking. Conclusion: The MenA vaccine introduction interrupted routine vaccination and other health services. When introducing a new vaccine through a campaign, coverage of routine health services should be monitored alongside campaign vaccine coverage to highlight where and how long services are disrupted and to mitigate risks to routine services. PMID:25276567

Immunogenicity and safety of a live attenuated shingles (herpes zoster) vaccine (Zostavax®) in individuals aged ≥ 70 years: a randomized study of a single dose vs. two different two-dose schedules.

PubMed

Vesikari, Timo; Hardt, Roland; Rümke, Hans C; Icardi, Giancarlo; Montero, Jordi; Thomas, Stéphane; Sadorge, Christine; Fiquet, Anne

2013-04-01

Disease protection provided by herpes zoster (HZ) vaccination tends to reduce as age increases. This study was designed to ascertain whether a second dose of the HZ vaccine, Zostavax(®), would increase varicella zoster virus (VZV)-specific immune response among individuals aged ≥ 70 y. Individuals aged ≥ 70 y were randomized to receive HZ vaccine in one of three schedules: a single dose (0.65 mL), two doses at 0 and 1 mo, or two doses at 0 and 3 mo. VZV antibody titers were measured at baseline, 4 weeks after each vaccine dose, and 12 mo after the last dose. In total, 759 participants (mean age 76.1 y) were randomized to receive vaccination. Antibody responses were similar after a single dose or two doses of HZ vaccine [post-dose 2/post-dose 1 geometric mean titer (GMT) ratios for the 1-mo or 3-mo schedules were 1.11, 95% confidence interval (CI) 1.02-1.22 and 0.78, 95% CI 0.73-0.85], respectively). The 12-mo post-dose 2/12-mo post-dose 1 GMT ratio was similar for the 1-mo schedule and for the 3-mo schedule (1.06, 95% CI 0.96-1.17 and 1.08, 95% CI 0.98-1.19, respectively). Similar immune responses were observed in participants aged 70-79 y and those aged ≥ 80 y. HZ vaccine was generally well tolerated, with no evidence of increased adverse event incidence after the second dose with either schedule. Compared with a single-dose regimen, two-dose vaccination did not increase VZV antibody responses among individuals aged ≥ 70 y. Antibody persistence after 12 mo was similar with all three schedules.

[Mechanism of action of intravesical BCG. Biological bases and clinical applicability.

PubMed

Carballido, Joaquín A; Rodríguez Monsalve, María

2018-05-01

The therapeutic approaches developed around immune system modulation find the therapeutic contribution of intravesical Bacillus Calmette Guerin (BCG) for transitional cell bladder cancer an unquestionable example as a proof of concept of antitumor immunotherapy since more than 30 years ago. Intravesical immunotherapy for urothelial carcinomas is considered with periodic intravesical instillations schedules, and the one with longer historic development and wider diffusion is BCG in the form of suspension. BCG is a unique strain obtained from Mycobacterium bovis at the end of the first third of the XX century and represents the historically most successful immunotherapeutic modality of all tumors with a high level body of evidence. Currently, we even see an unpredictable development potential of this therapeutic modality based on immunomodulation related with activation or suppression of T lymphocytes by blocking the immune system checkpoints. This option is at this time a decisive step in the treatment of chemotherapy refractory metastatic urothelial carcinoma. Over the last years, there have been advances in the intimate mechanism of action of intravesical BCG, but there are many open questions that will only be answered from complex basic and translational research platforms. The objective of this review article is to try to translate the basic mechanisms currently implicated in the different phases of antitumor response of BCG in its routine use in clinical practice. Also, to analyze the future lines already active under clinical research with and without implications of the mechanisms of action of BCG. We describe the role of interactions basally established between urothelial tumor cells and cellular and molecular elements of the immune system of the patients with ulterior antitumor effector capacity. After intravesical BCG therapy and its interaction, we describe the various phases of its mechanism of action, namely fixation, internalization and triggering of the lytic cytotoxic antitumor response, and its integration in the current intravesical treatment regimens The implication of all these mechanisms in the varied capacity of clinical response observed in patients, reviewing the current status of knowledge of BCG mechanisms of action, leads unavoidably to the search of better clinical efficacy through eventual immune response markers and to set the approach to the knowledge of the individual reactivity of the immune system of each patient as a determinant factor to be able to adopt adjusted therapeutic patterns.

Immunization dropout rate and data quality among children 12-23 months of age in Ghana.

PubMed

Baguune, Benjamin; Ndago, Joyce Aputere; Adokiya, Martin Nyaaba

2017-01-01

Immunization against diseases is one of the most important public health interventions with cost effective means to preventing childhood morbidity, mortality and disability. However, a proportion of children particularly in Africa are not fully immunized with the recommended vaccines. Thus, many children are still susceptible to the Expanded Program on Immunization (EPI) targeted diseases. The objective of this study was to determine the immunization dropout rate and data quality among children aged 12-23 months in Techiman Municipality, Ghana. A cross-sectional cluster survey was conducted among 600 children. Data was collected using semi-structured questionnaire through face-to-face interviews. Before the main data collection, the tools were pre-tested in three different communities in the Municipality. The mothers/caregivers were interviewed, extracted information from the child immunization cards and observation employed to confirm the presence of Bacillus Calmette-Guerin (BCG) scar on each child. Routine immunization data was also extracted from immunization registers and annual reports in the Municipality. I mmunization coverage for each of the fifteen vaccines doses is above 90.0% while full childhood immunized status is 89.5%. Immunization dropout rate was 5.6% (using BCG and Measles as proxy vaccines). This is lower than the 10.0% cutoff point by World Health Organization. However, routine administrative data was characterized by some discrepancies (e.g. > 100.0% immunization coverage for each of the vaccines) and high dropout rate (BCG - Measles = 31.5%). Binary regression was performed to determine predictors of dropout rate. The following were statistically significant: married (OR = 0.31; 95% = CI 0.15-0.62; and p  = 0.001), Christianity (OR = 0.27; 95% CI = 0.13-0.91; and p  < 0.001), female child (OR = 0.50; 95% CI = 0.26-0.91; and p  = 0.024) and possession of immunization card (OR = 50.3; 95% CI = 14.40-175.92; and p  < 0.001) were found to be associated with immunization dropout. Childhood full immunized status (89.5%) and immunization coverages (>90%) are high while dropout rate is lower than the recommended cutoff point by WHO. However, immunization data quality remains inadequate. Thus, health education and orientation of service providers is urgently needed. In addition, immunization registers and data quality are issues that require attention.

Progress in vaccination towards hepatitis B control and elimination in the Region of the Americas.

PubMed

Ropero Álvarez, Alba Maria; Pérez-Vilar, Silvia; Pacis-Tirso, Carmelita; Contreras, Marcela; El Omeiri, Nathalie; Ruiz-Matus, Cuauhtémoc; Velandia-González, Martha

2017-04-17

Over recent decades, the Region of the Americas has made significant progress towards hepatitis B elimination. We summarize the countries/territories' efforts in introducing and implementing hepatitis B (HB) vaccination and in evaluating its impact on HB virus seroprevalence. We collected information about HB vaccination schedules, coverage estimates, and year of vaccine introduction from countries/territories reporting to the Pan American Health Organization/World Health Organization (PAHO/WHO) through the WHO/UNICEF Joint Reporting Form on Immunization. We obtained additional information regarding countries/territories vaccination recommendations and strategies through communications with Expanded Program on Immunization (EPI) managers and national immunization survey reports. We identified vaccine impact studies conducted and published in the Americas. As of October 2016, all 51 countries/territories have included infant HB vaccination in their official immunization schedule. Twenty countries, whose populations represent over 90% of the Region's births, have included nationwide newborn HB vaccination. We estimated at 89% and 75%, the regional three-dose series and the birth dose HB vaccination coverage, respectively, for 2015. The impact evaluations of infant HB immunization programs in the Region have shown substantial reductions in HB surface antigen (HBsAg) seroprevalence. The achievements of vaccination programs in the Americas suggest that the elimination of perinatal and early childhood HB transmission could be feasible in the short-term. Moreover, the data gathered indicate that the Region may have already achieved the 2020 WHO goal for HB control.

Morphologic evaluations of Q-switched Nd:YAG laser injury of human retina

NASA Astrophysics Data System (ADS)

Scales, David K.; Schuschereba, Steven T.; Lund, David J.; Stuck, Bruce E.

1997-05-01

Depiction of the cellular and immune responses in the human model is critical to design rational therapies preventing/limiting cellular destruction and ultimately functional visual loss following acute laser injuries. We report the light and electron microscopy histologic findings in a controlled ocular human laser exposure. Following informed consent, the normal eye of a patient scheduled to undergo exenteration for invasive carcinoma of the orbit was exposed to both continuous wave and Q-switched lasers. Four hours prior to exenteration, argon G lesions were placed in the superior/temporal quadrant and Nd:YAG lesions were placed in the inferior/temporal quadrant. After enucleation, the retina was prepared for routine light and transmission electron microscopy. Histology of the argon G lesions showed primarily photoreceptor and RPE photocoagulation damage. Neutrophil adhesion was limited within the choroid and no neutrophils were observed in the subretinal space. In contrast, the 4 hr Nd:YAG lesions showed extensive retinal disruption, hemorrhage within subretinal and intraretinal spaces, neutrophil accumulation in the retina, and an extensive neutrophil chemotaxic and emigration response in the choroid. Severe laser injuries elicit a significant neutrophil response by 4 hr, suggesting that neutrophils should be an early stage therapeutic target.

The Burden of Rotavirus Hospitalizations Among Medicaid and Non-Medicaid Children Younger Than 5 Years Old

PubMed Central

El Khoury, Antoine C.; Itzler, Robbin F.

2009-01-01

Objectives. We sought to compare the burden of hospitalizations associated with rotavirus gastroenteritis (RGE) in children younger than 5 years in US Medicaid and non-Medicaid populations in 2000 and 2003. Methods. We used the Kids' Inpatient Database (KID) to examine the burden of RGE-associated hospitalizations in terms of numbers and rates of hospitalizations, lengths of stay, and hospital charges. Two indirect methods were also used to estimate RGE-associated hospitalizations, because rotavirus testing is not routinely performed. Results. Approximately 40% of children younger than 5 years were enrolled in Medicaid in 2003, but this population accounted for nearly 50% of all RGE-associated hospitalizations and 60% of total charges. Children enrolled in Medicaid had significantly greater hospitalization rates, average lengths of stay, and average charges per stay than did those not enrolled. Conclusions. Although RGE affects all socioeconomic groups, the Medicaid population accounted for a disproportionate number of the hospitalizations. With the inclusion of rotavirus vaccines in the pediatric immunization schedule, it is important that US children, especially those enrolled in Medicaid programs, are vaccinated to reduce the burden of RGE. PMID:19797754

Safety and immunogenicity of a novel quadrivalent meningococcal CRM-conjugate vaccine given concomitantly with routine vaccinations in infants.

PubMed

Klein, Nicola P; Reisinger, Keith S; Johnston, William; Odrljin, Tatjana; Gill, Christopher J; Bedell, Lisa; Dull, Peter

2012-01-01

In phase II studies, MenACWY-CRM elicited robust immunologic responses in young infants. We now present results from our pivotal phase III infant immunogenicity/safety study. In this open-label phase III study, we randomized full-term 2-month-old infants to 4 doses of MenACWY-CRM coadministered with routine vaccines at 2, 4, 6, and 12 months of age or with routine vaccines alone. We monitored for local and systemic reactions and serious adverse events among all study participants and evaluated for sufficiency of the immune responses to MenACWY-CRM through serum bactericidal activity assay with human complement. Bactericidal antibodies were present in 94% to 100% of subjects against each of the serogroups in MenACWY-CRM after the 4-dose series and were 67% to 97% after the first 3 doses. Geometric mean titers were higher after the fourth dose of MenACWY-CRM compared with a single dose of MenACWY-CRM at 12 months of age for all serogroups (range of ratios, 4.5-38). Responses to 3 doses of routine vaccines coadministered with MenACWY-CRM were noninferior to routine vaccinations alone, except for small differences in pneumococcal serotype 6B responses after dose 3 but not dose 4 and pertactin after dose 3. Inclusion of MenACWY-CRM did not affect the safety or reactogenicity profiles of the routine infant vaccine series. A 4-dose series of MenACWY-CRM was highly immunogenic and well tolerated in young infants, and it can be coadministered with routine infant vaccines. Substantial immunity was conferred after the first 3 doses administered at 2, 4, and 6 months of age.

Systematic review of reporting rates of adverse events following immunization: an international comparison of post-marketing surveillance programs with reference to China.

PubMed

Guo, Biao; Page, Andrew; Wang, Huaqing; Taylor, Richard; McIntyre, Peter

2013-01-11

China is the most populous country in the world, with an annual birth cohort of approximately 16 million, requiring an average of 500 million vaccine doses administered annually. In China, over 30 domestic and less than 10 overseas vaccine manufacturers supply over 60 licensed vaccine products, representing a growing vaccine market mainly due to recent additions to the national immunization schedule, but data on post-marketing surveillance for adverse events following immunization (AEFI) are sparse. To compare reporting rates for various categories of AEFI from China with other routine post-marketing surveillance programs internationally. Systematic review of published studies reporting rates of AEFI by vaccine, category of reaction and age from post-marketing surveillance systems in English and Chinese languages. Overall AEFI reporting rates (all vaccines, all ages) in Chinese studies were consistent with those from similar international studies elsewhere, but there was substantial heterogeneity in regional reporting rates in China (range 2.3-37.8/100,000 doses). The highest AEFI reporting rates were for diphtheria-tetanus-pertussis whole-cell (DTwP) and acellular (DTaP) vaccines (range 3.3-181.1/100,000 doses for DTwP; range 3.5-92.6/100,000 doses for DTaP), with higher median rates for DTwP than DTaP, and higher than expected rates for DTaP vaccine. Similar higher rates for DTwP and DTaP containing vaccines, and relatively lower rates for vaccines against hepatitis B virus, poliovirus, and Japanese encephalitis virus were found in China and elsewhere in the world. Overall AEFI reporting rates in China were consistent with similar post-marketing surveillance systems in other countries. Sources of regional heterogeneity in AEFI reporting rates, and their relationships to differing vaccine manufacturers versus differing surveillance practices, require further exploration. Copyright © 2012 Elsevier Ltd. All rights reserved.

Costs and financing of routine immunization: Approach and selected findings of a multi-country study (EPIC).

PubMed

Brenzel, Logan; Young, Darwin; Walker, Damian G

2015-05-07

Few detailed facility-based costing studies of routine immunization (RI) programs have been conducted in recent years, with planners, managers and donors relying on older information or data from planning tools. To fill gaps and improve quality of information, a multi-country study on costing and financing of routine immunization and new vaccines (EPIC) was conducted in Benin, Ghana, Honduras, Moldova, Uganda and Zambia. This paper provides the rationale for the launch of the EPIC study, as well as outlines methods used in a Common Approach on facility sampling, data collection, cost and financial flow estimation for both the routine program and new vaccine introduction. Costing relied on an ingredients-based approach from a government perspective. Estimating incremental economic costs of new vaccine introduction in contexts with excess capacity are highlighted. The use of more disaggregated System of Health Accounts (SHA) coding to evaluate financial flows is presented. The EPIC studies resulted in a sample of 319 primary health care facilities, with 65% of facilities in rural areas. The EPIC studies found wide variation in total and unit costs within each country, as well as between countries. Costs increased with level of scale and socio-economic status of the country. Governments are financing an increasing share of total RI financing. This study provides a wealth of high quality information on total and unit costs and financing for RI, and demonstrates the value of in-depth facility approaches. The paper discusses the lessons learned from using a standardized approach, as well as proposes further areas of methodology development. The paper discusses how results can be used for resource mobilization and allocation, improved efficiency of services at the country level, and to inform policies at the global level. Efforts at routinizing cost analysis to support sustainability efforts would be beneficial. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reduced schedules of 4CMenB vaccine in infants and catch-up series in children: Immunogenicity and safety results from a randomised open-label phase 3b trial.

PubMed

Martinón-Torres, Federico; Safadi, Marco Aurelio P; Martinez, Alfonso Carmona; Marquez, Pilar Infante; Torres, Juan Carlos Tejedor; Weckx, Lily Yin; Moreira, Edson Duarte; Mensi, Ilhem; Calabresi, Marco; Toneatto, Daniela

2017-06-16

This study evaluated the immunogenicity and safety of a licensed meningococcal serogroup B vaccine (4CMenB) administered alone according to reduced schedules in infants or catch-up series in children. In this open-label, multicentre, phase 3b study (NCT01339923), infants randomised 1:1:1 received 4CMenB: 2+1 doses at 3½-5-11months or 6-8-11months of age, 3+1 doses at ages 2½-3½-5-11months. Children aged 2-10years received 2 catch-up doses administered 2months apart. Immune responses were measured by hSBA assays against 4 strains specific for vaccine components fHbp, NadA, PorA and NHBA. Sufficiency of immune responses was defined in groups with 2+1 doses schedules as a lower limit ≥70% for the 97.5% confidence interval of the percentage of infants with hSBA titres ≥4, 1month post-dose 2 for fHbp, NadA, PorA. Adverse events were collected for 7days post-vaccination; serious adverse events (SAEs) throughout the study. 754 infants and 404 children were enrolled. Post-primary vaccination, 98-100% of infants across all groups developed hSBA titres ≥4 for fHbp, NadA, PorA, and 48-77% for NHBA. Sufficiency of immune responses in infants receiving 2+1 schedules was demonstrated for fHbp, NadA, PorA after 2 doses of 4CMenB, as pre-specified criteria were met. Following receipt of 2 catch-up doses, 95-99% of children developed hSBA titres ≥4 for 4CMenB components. Similar safety profiles were observed across groups. A total of 45 SAEs were reported, 3 of which were related to vaccination. Reduced infant schedules and catch-up series in children were immunogenic and safe, having the potential to widen 4CMenB vaccine coverage. GlaxoSmithKline Biologicals SA. Copyright © 2017. Published by Elsevier Ltd.

Eating routines: Embedded, value based, modifiable, and reflective

PubMed Central

Jastran, Margaret; Bisogni, Carole A.; Sobal, Jeffery; Blake, Christine; Devine, Carol M.

2009-01-01

Eating routines are a compelling issue because recurring eating behaviors influence nutrition and health. As non-traditional and individualized eating patterns have become more common, new ways of thinking about routine eating practices are needed. This study sought to gain conceptual understanding of working adults' eating routines. Forty-two purposively sampled US adults reported food intake and contextual details about eating episodes in qualitative 24-hour dietary recalls conducted over 7 consecutive days. Using the constant comparative method, researchers analyzed interview transcripts for recurrent ways of eating that were either explicitly reported by study participants as “routines” or emergent in the data. Participants' eating routines included repetition in food consumption as well as eating context, and also involved sequences of eating episodes. Eating routines were embedded in daily schedules for work, family, and recreation. Participants maintained purposeful routines that helped balance tension between demands and values, but they modified routines as circumstances changed. Participants monitored and reflected upon their eating practices and tended to assess their practices in light of their personal identities. These findings provide conceptual insights for food choice researchers and present a perspective from which practitioners who work with individuals seeking to adopt healthful eating practices might usefully approach their tasks. PMID:18835305

Acceptability of coupling intermittent preventive treatment in infants with the expanded programme on immunization in three francophone countries in Africa.

PubMed

de Sousa, Alexandra; Rabarijaona, Leon P; Ndiaye, Jean L; Sow, Doudou; Ndyiae, Mouhamed; Hassan, Jacques; Lambo, Nilda; Adovohekpe, Paul; Guidetti, Flavia; Recht, Judith; Affo, Alphonse

2012-03-01

Intermittent preventive treatment in infants (IPTi) is a malaria control strategy currently recommended by WHO for implementation at scale in Africa, consisting of administration of sulphadoxine-pyrimethamine (SP) coupled with routine immunizations offered to children under 1 year. In this study, we analysed IPTi acceptability by communities and health staff. Direct observation, in-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in Benin, Madagascar and Senegal during IPTi pilot implementation. Villages were stratified by immunization coverage. Data were transcribed and analysed using NVivo7 software. Communities' knowledge of malaria aetiology and diagnosis was good, although generally villagers did not seek treatment at health centres as their first choice. Perceptions and attitudes towards IPTi were very positive among communities and health workers. A misconception that SP was an antipyretic that prevents post-vaccinal fever contributed to IPTi's acceptability. No refusals or negative rumours related to IPTi coupling with immunizations were identified, and IPTi did not negatively influence attitudes towards other malaria control strategies. Healthcare decisions about children, normatively made by the father, are starting to shift to educated and financially independent mothers. Intermittent preventive treatment in infants is well accepted by providers and communities, showing a synergic acceptability when coupled with routine immunizations. However, a misconception that SP alleviates fever should be addressed when scaling up implementation. © 2011 Blackwell Publishing Ltd.

Antibody titers against vaccine and contemporary wild poliovirus type 1 in children immunized with IPV+OPV and young adults immunized with OPV.

PubMed

Lukashev, Alexander N; Yarmolskaya, Maria S; Shumilina, Elena Yu; Sychev, Daniil A; Kozlovskaya, Liubov I

2016-02-02

In 2010, a type 1 poliovirus outbreak in Congo with 445 lethal cases was caused by a virus that was neutralized by sera of German adults vaccinated with inactivated polio vaccine with a reduced efficiency. This seroprevalence study was done in two cohorts immunized with other vaccination schedules. Russian children aged 3-6 years immunized with a combination of inactivated and live polio vaccines were reasonably well protected against any wild type poliovirus 1, including the Congolese isolate. Adults aged 20-29 years immunized only with live vaccine were apparently protected against the vaccine strain (92% seropositive), but only 50% had detectable antibodies against the Congo-2010 isolate. Both waning immunity and serological divergence of the Congolese virus could contribute to this result. Copyright © 2015 Elsevier B.V. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Russell, J.S.

Several factors in the development of the East Wilmington oil field by THUMS Long Beach Co. are described. These include: critical path scheduling, complex stratigraphy, reservoir engineering, drilling program, production methods, pressure maintenance, crude oil processing, automation, transportation facilities, service lines, and electrical facilities. The complexity and closely scheduled operational events interwoven in the THUMS project demands a method for the carefully planned sequence of jobs to be done, beginning with island construction up through routine production and to the LACT system. These demanding requirements necessitated the use of a critical path scheduling program. It was decided to use themore » program evaluation technique. This technique is used to assign responsibilities for individual assignments to time assignments, and to keep the overall program on schedule. The stratigraphy of East Wilmington complicates all engineering functions associated with recovery methods and reservoir evaluation. At least 5 major faults are anticipated.« less

Ultrastructural study of electron dense deposits in renal tubular basement membrane: prevalence and relationship to epithelial atrophy.

PubMed

Yong, Jim L C; Killingsworth, Murray C

2014-08-01

This study reports the prevalence of immune deposits associated with the proximal and distal tubules in a series of routine renal biopsies received in our department during a single calendar year. From 87 cases, 65 (74%) were found to have glomerular immune deposits by immunofluorescence. Tubular immune deposits were found in 12 cases (18%), 3 of which had no glomerular deposits. By transmission electron microscopy (EM), 58 cases (66%) were found to have deposits of granular or vesicular material associated with the tubular basement membranes (TBM). Finely granular electron dense deposits appeared to correspond to the immune deposits seen by immunofluorescence microscopy (IF) and may be a sensitive marker of immune deposition.

Ultrastructural Study of Electron Dense Deposits in Renal Tubular Basement Membrane: Prevalence and Relationship to Epithelial Atrophy

PubMed Central

Killingsworth, Murray C.

2014-01-01

This study reports the prevalence of immune deposits associated with the proximal and distal tubules in a series of routine renal biopsies received in our department during a single calendar year. From 87 cases, 65 (74%) were found to have glomerular immune deposits by immunofluorescence. Tubular immune deposits were found in 12 cases (18%), 3 of which had no glomerular deposits. By transmission electron microscopy (EM), 58 cases (66%) were found to have deposits of granular or vesicular material associated with the tubular basement membranes (TBM). Finely granular electron dense deposits appeared to correspond to the immune deposits seen by immunofluorescence microscopy (IF) and may be a sensitive marker of immune deposition. PMID:24933115

Genital Warts

MedlinePlus

... that they can't be seen with the naked eye. Sometimes, however, genital warts may multiply into ... on Immunization Practices recommends routine HPV vaccination for girls and boys ages 11 and 12. If not ...

Optimization of HAART with genetic algorithms and agent-based models of HIV infection.

PubMed

Castiglione, F; Pappalardo, F; Bernaschi, M; Motta, S

2007-12-15

Highly Active AntiRetroviral Therapies (HAART) can prolong life significantly to people infected by HIV since, although unable to eradicate the virus, they are quite effective in maintaining control of the infection. However, since HAART have several undesirable side effects, it is considered useful to suspend the therapy according to a suitable schedule of Structured Therapeutic Interruptions (STI). In the present article we describe an application of genetic algorithms (GA) aimed at finding the optimal schedule for a HAART simulated with an agent-based model (ABM) of the immune system that reproduces the most significant features of the response of an organism to the HIV-1 infection. The genetic algorithm helps in finding an optimal therapeutic schedule that maximizes immune restoration, minimizes the viral count and, through appropriate interruptions of the therapy, minimizes the dose of drug administered to the simulated patient. To validate the efficacy of the therapy that the genetic algorithm indicates as optimal, we ran simulations of opportunistic diseases and found that the selected therapy shows the best survival curve among the different simulated control groups. A version of the C-ImmSim simulator is available at http://www.iac.cnr.it/~filippo/c-ImmSim.html

Application of smart phone in "Better Border Healthcare Program": a module for mother and child care.

PubMed

Kaewkungwal, Jaranit; Singhasivanon, Pratap; Khamsiriwatchara, Amnat; Sawang, Surasak; Meankaew, Pongthep; Wechsart, Apisit

2010-11-03

To assess the application of cell phone integrating into the healthcare system to improve antenatal care (ANC) and expanded programme on immunization (EPI) services for the under-served population in border area. A module combining web-based and mobile technology was developed to generate ANC/EPI visit schedule dates in which the healthcare personnel can cross-check, identify and update the mother's ANC and child's EPI status at the healthcare facility or at the household location when performing home visit; with additional feature of sending appointment reminder directly to the scheduled mother in the community. The module improved ANC/EPI coverage in the study area along the country border including for both Thai and non-Thai mothers and children who were either permanent resident or migrants; numbers of ANC and EPI visit on-time as per schedule significantly increased; there was less delay of antenatal visits and immunizations. The module integrated and functioned successfully as part of the healthcare system; it is proved for its feasibility and the extent to which community healthcare personnel in the low resource setting could efficiently utilize it to perform their duties.

A simple provider-based educational intervention to boost infant immunization rates: a controlled trial.

PubMed

Stille, C J; Christison-Lagay, J; Bernstein, B A; Dworkin, P H

2001-07-01

We sought to determine if a simple educational intervention initiated at the first well-child care visit, with reinforcement at subsequent visits, can improve inner-city infant immunization rates. We conducted a controlled trial involving 315 newborn infants and their primary caregivers in 3 inner-city primary care centers. Child health care providers gave caregivers in the intervention group an interactive graphic card with verbal reinforcement. At later visits, stickers were applied to the card when immunizations were given. Routine information was given to controls. After the trial, age-appropriate immunization rates at 7 months were 58% in each group. Intervention infants had 50% fewer missed opportunities to immunize (p=0.01) but cancelled 77% more appointments (p=0.04) than controls. We conclude that a brief educational intervention at the first well-child care visit did not boost 7-month immunization rates, although it was associated with fewer missed opportunities to immunize.

Should cell-free DNA testing be used to target antenatal rhesus immune globulin administration?

PubMed

Ma, Kimberly K; Rodriguez, Maria I; Cheng, Yvonne W; Norton, Mary E; Caughey, Aaron B

2016-01-01

To compare the rates of alloimmunization with the use of cell-free DNA (cfDNA) screening to target antenatal rhesus immune globulin (RhIG) prenatally, versus routine administration of RhIG in rhesus D (RhD)-negative pregnant women in a theoretic cohort using a decision-analytic model. A decision-analytic model compared cfDNA testing to routine antenatal RhIG administration. The primary outcome was maternal sensitization to RhD antigen. Sensitivity and specificity of cfDNA testing were assumed to be 99.8% and 95.3%, respectively. Univariate and bivariate sensitivity analyses, Monte Carlo simulation, and threshold analyses were performed. In a cohort of 10,000 RhD-negative women, 22.6 sensitizations would occur with utilization of cfDNA, while 20 sensitizations would occur with routine RhIG. Only when the sensitivity of the cfDNA test reached 100%, the rate of sensitization was equal for both cfDNA and RhIG. Otherwise, routine RhIG minimized the rate of sensitization, especially given RhIG is readily available in the United States. Adoption of cfDNA testing would result in a 13.0% increase in sensitization among RhD-negative women in a theoretical cohort taking into account the ethnic diversity of the United States' population.

Five Strategies of Successful Part-Time Work.

ERIC Educational Resources Information Center

Corwin, Vivien; Lawrence, Thomas B.; Frost, Peter J.

2001-01-01

Identifies commonalities in the approaches of successful part-time professionals. Discusses five strategies for success: (1) communicating work-life priorities and schedules to the organization; (2) making the business case for part-time arrangements; (3) establishing time management routines; (4) cultivating advocates in senior management; and…

Mothers' Perspectives on the Development of Their Preschoolers' Dietary and Physical Activity Behaviors and Parent-Child Relationship: Implications for Pediatric Primary Care Physicians.

PubMed

Pratt, Keeley J; Van Fossen, Catherine; Cotto-Maisonet, Jennifer; Palmer, Elizabeth N; Eneli, Ihuoma

2017-07-01

The study explores female caregivers' reflections on their relationship with their child (2-5 years old) and the development of their child's dietary and physical activity behaviors. Five, 90-minute semistructured focus groups were conducted to inquire about children's growth, eating behaviors and routines, physical activity, personality, and the parent-child relationship. Nineteen female caregivers diverse in race/ethnicity, age, and educational attainment participated. Participants reported that they maintained a schedule, but needed to be flexible to accommodate daily responsibilities. Family, social factors, and day care routines were influences on their children's behaviors. The main physical activity barriers were safety and time constraints. Guidance from pediatric primary care providers aimed at supporting female caregivers to build a positive foundation in their parent-child relationship, and to adopt and model healthy diet and physical activity behaviors that are respectful of schedules and barriers should be a priority for childhood obesity prevention.

Maintenance of the Hanford cone penetrometer platform during fiscal year 1999

DOE Office of Scientific and Technical Information (OSTI.GOV)

IWATATE, D.F.

This SOW describes services requested of Applied Research and Associates, Inc. (ARA), as a commercial provider of cone penetrometer equipment and services, to provide routine inspection and minimum preventive maintenance on the Hanford CP Platform (CPP) during Fiscal Year 1999. This SOW specifically pertains to the maintenance of the CPP and associated support equipment and is limited in scope to routine preventive maintenance and identification of any deficiencies. ARA is the original manufacturer of the CPP and will conduct this work following the vendor-prepared maintenance schedule.

78 FR 43281 - Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-19

..., Independent Laboratory, Pathology, Radiation Oncology, and Radiation Therapy Centers are projected to have a... Mass immunization roster biller. 74 Radiation therapy centers. 87 All other suppliers (e.g., drug and...

Polio and the Vaccine (Shot) to Prevent It

MedlinePlus

... Resources Related Links Vaccines & Immunizations Polio and the Vaccine (Shot) to Prevent It Language: English (US) Español ( ... schedule. Fact Sheets for Parents Diseases and the Vaccines that Prevent Them Chickenpox Diphtheria Flu (Influenza) Hepatitis ...

Introduction of Inactivated Polio Vaccine, Withdrawal of Type 2 Oral Polio Vaccine, and Routine Immunization Strengthening in the Eastern Mediterranean Region.

PubMed

Fahmy, Kamal; Hampton, Lee M; Langar, Houda; Patel, Manish; Mir, Tahir; Soloman, Chandrasegarar; Hasman, Andreas; Yusuf, Nasir; Teleb, Nadia

2017-07-01

The Global Polio Eradication Initiative has reduced the global incidence of polio by 99% and the number of countries with endemic polio from 125 to 3 countries. The Polio Eradication and Endgame Strategic Plan 2013-2018 (Endgame Plan) was developed to end polio disease. Key elements of the endgame plan include strengthening immunization systems using polio assets, introducing inactivated polio vaccine (IPV), and replacing trivalent oral polio vaccine with bivalent oral polio vaccine ("the switch"). Although coverage in the Eastern Mediterranean Region (EMR) with the third dose of a vaccine containing diphtheria, tetanus, and pertussis antigens (DTP3) was ≥90% in 14 countries in 2015, DTP3 coverage in EMR dropped from 86% in 2010 to 80% in 2015 due to civil disorder in multiple countries. To strengthen their immunization systems, Pakistan, Afghanistan, and Somalia developed draft plans to integrate Polio Eradication Initiative assets, staff, structure, and activities with their Expanded Programmes on Immunization, particularly in high-risk districts and regions. Between 2014 and 2016, 11 EMR countries introduced IPV in their routine immunization program, including all of the countries at highest risk for polio transmission (Afghanistan, Pakistan, Somalia, and Yemen). As a result, by the end of 2016 all EMR countries were using IPV except Egypt, where introduction of IPV was delayed by a global shortage. The switch was successfully implemented in EMR due to the motivation, engagement, and cooperation of immunization staff and decision makers across all national levels. Moreover, the switch succeeded because of the ability of even the immunization systems operating under hardship conditions of conflict to absorb the switch activities. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Use of the nonavalent HPV vaccine in individuals previously fully or partially vaccinated with bivalent or quadrivalent HPV vaccines.

PubMed

Van Damme, Pierre; Bonanni, Paolo; Bosch, F Xavier; Joura, Elmar; Kjaer, Susanne Krüger; Meijer, Chris J L M; Petry, Karl-Ulrich; Soubeyrand, Benoit; Verstraeten, Thomas; Stanley, Margaret

2016-02-03

With the availability of the nonavalent human papillomavirus (HPV) vaccine, vaccinees, parents and healthcare providers need guidance on how to complete an immunization course started with the bi- or quadrivalent vaccine and whether to revaccinate individuals who have completed a full immunization course with the bi- or quadrivalent vaccine. To answer these questions three parameters should be considered: age at the start of vaccination (9 to 14 years of age versus 15 years and older, the cut-off for 2 or 3 doses schedule), the number of doses already received and the time interval between doses. Based on a number of scenarios, we propose that the 9-valent vaccine can be used to complete an incomplete vaccination regimen or might be added to a previous completed schedule to extend protection. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Assessment of safety and immunogenicity of two different lots of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b vaccine manufactured using small and large scale manufacturing process.

PubMed

Sharma, Hitt J; Patil, Vishwanath D; Lalwani, Sanjay K; Manglani, Mamta V; Ravichandran, Latha; Kapre, Subhash V; Jadhav, Suresh S; Parekh, Sameer S; Ashtagi, Girija; Malshe, Nandini; Palkar, Sonali; Wade, Minal; Arunprasath, T K; Kumar, Dinesh; Shewale, Sunil D

2012-01-11

Hib vaccine can be easily incorporated in EPI vaccination schedule as the immunization schedule of Hib is similar to that of DTP vaccine. To meet the global demand of Hib vaccine, SIIL scaled up the Hib conjugate manufacturing process. This study was conducted in Indian infants to assess and compare the immunogenicity and safety of DTwP-HB+Hib (Pentavac(®)) vaccine of SIIL manufactured at large scale with the 'same vaccine' manufactured at a smaller scale. 720 infants aged 6-8 weeks were randomized (2:1 ratio) to receive 0.5 ml of Pentavac(®) vaccine from two different lots one produced at scaled up process and the other at a small scale process. Serum samples obtained before and at one month after the 3rd dose of vaccine from both the groups were tested for IgG antibody response by ELISA and compared to assess non-inferiority. Neither immunological interference nor increased reactogenicity was observed in either of the vaccine groups. All infants developed protective antibody titres to diphtheria, tetanus and Hib disease. For hepatitis B antigen, one child from each group remained sero-negative. The response to pertussis was 88% in large scale group vis-à-vis 87% in small scale group. Non-inferiority was concluded for all five components of the vaccine. No serious adverse event was reported in the study. The scale up vaccine achieved comparable response in terms of the safety and immunogenicity to small scale vaccine and therefore can be easily incorporated in the routine childhood vaccination programme. Copyright © 2011 Elsevier Ltd. All rights reserved.

Role of National Immunization Technical Advisory Group on improvement of immunization programmes in the Islamic Republic of Iran.

PubMed

Zahraei, Seyed Mohsen; Marandi, Alireza; Sadrizadeh, Bijan; Gouya, Mehdi Mohammad; Rezaei, Parviz; Vazirian, Parviz; Yaghini, Fatheme

2010-04-19

The National Immunization Technical Advisory Group (NITAG) was established in Iran in 1982 and has made many important technical recommendations (e.g., regarding polio eradication, introduction of new vaccines, organizing special studies) that have contributed to a dramatic decline in vaccine preventable disease burden. The NITAG consists of experts from the Ministry of Health and Medical Education (MOHME), vaccine manufacturers, and medical universities with national Expanded Program of Immunization (EPI) staff serving as the secretariat. It is not completely independent from MOHME or EPI. It meets on a quarterly basis, and publishes national guidelines and immunization schedules that are updated regularly. Although primarily an advisory body, representation from MOHME members, including the EPI manager, ensures almost universal implementation of NITAG recommendations. Copyright © 2010 Elsevier Ltd. All rights reserved.

The challenge of changing the inactivated poliomyelitis vaccine in Latin America: declaration of the Latin American Society of Pediatric Infectious Diseases (SLIPE).

PubMed

Falleiros-Arlant, Luiza Helena; Avila-Agüero, María Luisa; Brea del Castillo, José; Mariño, Cristina

2014-10-01

Even though we have already covered 99% of the path to eradicate poliomyelitis from the world, this disease is still causing paralysis in children. Its eradication means not only the end of wild poliovirus circulation, but vaccine-derived poliovirus circulation as well. Taking into account different factors such as: current epidemiological data, adverse events of the attenuated oral poliomyelitis vaccine (OPV), the availability of an injectable inactivated vaccine (IPV) without the potential of causing the severe adverse events of the oral vaccine (OPV), the efficacy and effectiveness of the IPV in several countries of the world where it has been used for several years, the rationale of changing the vaccination schedule in different Latin American countries; the Latin American Society of Pediatric Infectious Diseases (SLIPE) announces its recommendation of switching to IPV in Latin America, by this Declaration, with an Action Plan for 2014-2015 period as regards vaccination against polio policies in Latin America. 1. The optimal proposed schedule consists of four IPV doses (three doses in the primary schedule plus a booster dose), whether IPV is combined or not with other indicated vaccines in the immunization program of the country. During the OPV to IPV transition phase, an alternative schedule is acceptable; 2. Countries should set optimal strategies in order to maintain and improve vaccination coverage, and implement a nominal immunization registry; 3. Improving the Epidemiological Surveillance of Acute Flaccid Paralysis (AFP) and setting up an environmental surveillance program; 4. Setting up strategies for introducing IPV in National Immunization Programs, such as communicating properly with the population, among others; 5. Bringing scientific societies closer to decision makers; 6. Ensuring optimal supply and prices for IPV introduction; 7. Training vaccination teams; 8. Enhancing the distribution and storing logistics of vaccines. In addition to the scientific evidence, the countries that have not yet decided to switch to IPV should consider the implications of equity and social justice.

Barriers to immunization among children of HIV-infected mothers in Kolkata, India: a qualitative study.

PubMed

Sensarma, Pinaki; Bhandari, Subhasis; Kutty, V Raman

2015-03-01

More than one fourth of children of HIV-infected mothers living in Kolkata city are not completely immunized by 12 months of age. This qualitative study aims to explore the barriers to immunization of these children as perceived by their caregivers and the local health care service providers. In-depth interviews were conducted after obtaining written informed consent. Audio recording and hand-recorded notes were used with permission. The transcripts were coded and analyzed using grounded theory. Deteriorating socioeconomic status, tightening of time schedule of caregivers due to illness in the family, stigma, discrimination, and lack of awareness about immunization prove to be major barriers for immunization of the HIV-exposed children. Interplay of these factors coupled with harassment and negative attitudes of service providers toward HIV-affected/HIV-infected people also impede immunization. The intervention efforts need to address these social barriers and adverse life events to improve immunization coverage. © 2013 APJPH.

Deciphering the Adaptive Immune Response to Ovarian Cancer

DTIC Science & Technology

2014-10-01

of 10 mg/mL. Wells containing anti-CD3/ anti-CD28 coated beads (bead-to-cell ratio of 1:1) or human cytomegalovirus, Epstein - Barr virus , and...Waldenstrom’s Macroglobulinemia (MYD88L265P). CONCLUSION: Overall, this study is progressing on schedule and on budget. We have developed the...apart from T-cell–medi- ated control of virus -induced cancers (3). More obvious in humans is the influence of the immune system on cancer progression and

Protection against vaccine preventable diseases in children treated for acute lymphoblastic leukemia.

PubMed

de de la Fuente Garcia, Isabel; Coïc, Léna; Leclerc, Jean-Marie; Laverdière, Caroline; Rousseau, Céline; Ovetchkine, Philippe; Tapiéro, Bruce

2017-02-01

The objective of this retrospective study was to assess protection against vaccine preventable diseases (VPDs) in children treated for acute lymphoblastic leukemia (ALL). Clinical characteristics and vaccination records were collected. Antibodies against VPDs were measured after completion of chemotherapy and after a booster dose of vaccine. Immunization status of household members was evaluated. Sixty children were included. Median interval between the end of chemotherapy and enrolment in the study was 13 months (range 1-145). At ALL diagnosis, 81.3% of the children were up to date with their vaccination schedule. This proportion decreased to 52.9% at enrolment. Among the parents, 21% were up to date with their immunization schedule and 42% had received seasonal influenza vaccination. After chemotherapy, less than 50% of the patients were seroprotected against tetanus, diphtheria, polio 3, Haemophilus influenzae type b (Hib), and mumps and no more than 80% were seroprotected against polio 1 and 2, measles, rubella, and varicella. After a booster dose of vaccine, the rate of protection increased to over 90% for each of the following antigens: TT, DT, polio 1, Hib, measles, and rubella. Nevertheless, polio 3, mumps, and varicella-zoster virus antibodies titers/concentrations remained below seroprotective thresholds in over 20% of the patients. After chemotherapy for ALL, most of the children were not protected against VPDs. As the majority mounted a robust response to booster vaccines, efforts need to be done to improve protection against VPDs by implementing a systematic vaccine booster schedule. This could also be helped by reinforcing household members' immunization. © 2016 Wiley Periodicals, Inc.

Methods for addressing "innocent bystanders" when evaluating safety of concomitant vaccines.

PubMed

Wang, Shirley V; Abdurrob, Abdurrahman; Spoendlin, Julia; Lewis, Edwin; Newcomer, Sophia R; Fireman, Bruce; Daley, Matthew F; Glanz, Jason M; Duffy, Jonathan; Weintraub, Eric S; Kulldorff, Martin

2018-04-01

The need to develop methods for studying the safety of childhood immunization schedules has been recognized by the Institute of Medicine and Department of Health and Human Services. The recommended childhood immunization schedule includes multiple vaccines in a visit. A key concern is safety of concomitant (same day) versus separate day vaccination. This paper addresses a methodological challenge for observational studies using a self-controlled design to investigate the safety of concomitant vaccination. We propose a process for distinguishing which of several concomitantly administered vaccines is responsible for increased risk of an adverse event while adjusting for confounding due to relationships between effect modifying risk factors and concomitant vaccine combinations. We illustrate the approach by re-examining the known increase in risk of seizure 7 to 10 days after measles-mumps-rubella (MMR) vaccination and evaluating potential independent or modifying effects of other vaccines. Initial analyses suggested that DTaP had both an independent and potentiating effect on seizure. After accounting for the relationship between age at vaccination and vaccine combination, there was little evidence for increased risk of seizure with same day administration of DTaP and MMR; incidence rate ratio, 95% confidence interval 1.2 (0.9-1.6), P value = θ.226. We have shown that when using a self-controlled design to investigate safety of concomitant vaccination, it can be critically important to adjust for time-invariant effect modifying risk factors, such as age at time of vaccination, which are structurally related to vaccination patterns due to recommended immunization schedules. Copyright © 2018 John Wiley & Sons, Ltd.

Travelers' Health: International Adoption

MedlinePlus

... current on their routine immunizations. Protection against measles, varicella, tetanus, diphtheria, pertussis, hepatitis A, hepatitis B, and ... for all people born in or after 1957. Varicella vaccine should be given to those without a ...

Expanding specificity of class 1 restricted CD8+ T cells for viral epitopes following multiple inoculations of swine with a human adenivorus vectored foot-and-mouth disease virus (FMDV) vaccine

USDA-ARS?s Scientific Manuscript database

The immune response to the highly acute foot-and-mouth disease virus (FMDV) is routinely reported as a measure of serum antibody. However, a critical effector function of immune responses combating viral infection of mammals is the cytotoxic T lymphocyte (CTL) response, mediated by virus specific ...

Routine Immunization Service Delivery Through the Basic Package of Health Services Program in Afghanistan: Gaps, Challenges, and Opportunities.

PubMed

Mbaeyi, Chukwuma; Kamawal, Noor Shah; Porter, Kimberly A; Azizi, Adam Khan; Sadaat, Iftekhar; Hadler, Stephen; Ehrhardt, Derek

2017-07-01

The Basic Package of Health Services (BPHS) program has increased access to immunization services for children living in rural Afghanistan. However, multiple surveys have indicated persistent immunization coverage gaps. Hence, to identify gaps in implementation, an assessment of the BPHS program was undertaken, with specific focus on the routine immunization (RI) component. A cross-sectional survey was conducted in 2014 on a representative sample drawn from a sampling frame of 1858 BPHS health facilities. Basic descriptive analysis was performed, capturing general characteristics of survey respondents and assessing specific RI components, and χ2 tests were used to evaluate possible differences in service delivery by type of health facility. Of 447 survey respondents, 27% were health subcenters (HSCs), 30% were basic health centers, 32% were comprehensive health centers, and 12% were district hospitals. Eighty-seven percent of all respondents offered RI services, though only 61% of HSCs did so. Compared with other facility types, HSCs were less likely to have adequate stock of vaccines, essential cold-chain equipment, or proper documentation of vaccination activities. There is an urgent need to address manpower and infrastructural deficits in RI service delivery through the BPHS program, especially at the HSC level. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Specific immunization of mice against Leishmania mexicana amazonensis using solubilized promastigotes

NASA Technical Reports Server (NTRS)

Barral-Netto, M.; Sadigursky, M.; Reed, S. G.; Sonnenfeld, G.

1987-01-01

In this work, it was demonstrated that mice (BALB/c strain) highly susceptible to Leishmania mexicana amazonensis can be protected against infection by this parasite by being preimmunized with whole solubilized (in a buffer that contained EDTA, NP-40, and SDS) promastigotes; the use of adjuvant or intact inactivated parasite cells is shown to be not necessary. The best immunization schedule consisted of three intravenous injections of 5 x 10 to the 7th parasite equivalents, administered one to eight weeks before infection. Immunized mice exhibited a marked inhibition of primary lesion development, reduced numbers of parasites in the spleen, and reduced death rate.

Influenza seasonality goes south in the Yucatan Peninsula: The case for a different influenza vaccine calendar in this Mexican region.

PubMed

Ayora-Talavera, Guadalupe; Flores, Gerardo Montalvo-Zurbia; Gómez-Carballo, Jesus; González-Losa, Refugio; Conde-Ferraez, Laura; Puerto-Solís, Marylin; López-Martínez, Irma; Díaz-Quiñonez, Alberto; Barrera-Badillo, Gisela; Acuna-Soto, Rodolfo; Livinski, Alicia A; Alonso, Wladimir J

2017-08-24

While vaccination may be relatively straightforward for regions with a well-defined winter season, the situation is quite different for tropical regions. Influenza activity in tropical regions might be out of phase with the dynamics predicted for their hemispheric group thereby impacting the effectiveness of the immunization campaign. To investigate how the climatic diversity of Mexico hinders its existing influenza immunization strategy and to suggest that the hemispheric vaccine recommendations be tailored to the regional level in order to optimize vaccine effectiveness. We studied the seasonality of influenza throughoutMexico by modeling virological and mortality data.De-trended time series of each Mexican state were analyzed by Fourier decomposition to describe the amplitude and timing of annual influenza epidemic cycles and to compare with each the timing of the WHO's Northern and Southern Hemispheric vaccination schedule. The timings of the primary (major) peaks of both virological and mortality data for most Mexican states are well aligned with the Northern Hemisphere winter (December-February) and vaccine schedule. However, influenza peaks in September in the three states of the Yucatan Peninsula. Influenza-related mortality also peaks in September in Quintana Roo and Yucatan whereas it peaks in May in Campeche. As the current timing of vaccination in Mexico is between October and November, more than half of the annual influenza cases have already occurred in the Yucatan Peninsula states by the time the Northern Hemispheric vaccine is delivered and administered. The current Northern Hemispheric influenza calendar adopted for Mexico is not optimal for the Yucatan Peninsula states thereby likely reducing the effectiveness of the immunization of the population. We recommend that Mexico tailor its immunization strategy to better reflect its climatologic and epidemiological diversity and adopt the WHO Southern Hemisphere influenza vaccine and schedule for the Yucatan Peninsula. Copyright © 2017 Elsevier Ltd. All rights reserved.

Burden of rotavirus in India--is rotavirus vaccine an answer to it?

PubMed

Taneja, Davendra K; Malik, Akash

2012-01-01

Rotavirus is currently by far the most common cause of severe diarrhea in infants and young children worldwide and of diarrheal deaths in developing countries. Worldwide Rotavirus is responsible for 611,000 childhood deaths out of which more than 80% occur in low-income countries. The resistance of rotavirus to commonly used disinfectants and ineffectiveness of oral rehydration therapy due to severe vomiting indicates that if an effective vaccine is the preferred option. WHO has recommended inclusion of rotavirus vaccine in the National Schedules where under 5 mortality due to diarrheal diseases is ≥ 10%. Currently two vaccines are available against rotavirus. Rotarix (GlaxoSmithKline) is a monovalent vaccine recommended to be orally administered in two doses at 6-12 weeks. Rota Teq (Merck) is a pentavalent vaccine recommended to be orally administered in three doses starting at 6-12 weeks of age. Serodiversity of rotavirus in India and its regional variation favor either a monovalent vaccine that can induce heterotypic immunity or a polyvalent vaccine incorporating majority of serotypes prevalent in the country. However, the efficacy of available rotavirus vaccines is less in low-income countries. Both the candidate vaccines when coadministered with OPV, immune response to first dose of these vaccines is reduced. However, immune responses to subsequent rotavirus vaccine doses are not affected. In view of this, WHO recommends three doses of either vaccine to be given to children in developing countries to produce the optimum response. Indigenous vaccine, 116E (Bharat Biotech) based on human rotavirus of serotype G9P [11] is still under Phase 2 trials. Another multivalent vaccine is being developed by Shantha Biotechnics in India. The cost effectiveness of the three dose schedule of the available and the rsults of the field trials of the indigenous vaccines should be assessed before inclusion of rotavirus vaccine in the National Immunization Schedule.

Immunogenicity and Safety of Three Doses of a Bivalent (B:4:P1.19,15 and B:4:P1.7-2,4) Meningococcal Outer Membrane Vesicle Vaccine in Healthy Adolescents▿

PubMed Central

Boutriau, Dominique; Poolman, Jan; Borrow, Ray; Findlow, Jamie; Domingo, Javier Diez; Puig-Barbera, Joan; Baldó, José María; Planelles, Victoria; Jubert, Angels; Colomer, Julia; Gil, Angel; Levie, Karin; Kervyn, Anne-Diane; Weynants, Vincent; Dominguez, Francisco; Barberá, Ramon; Sotolongo, Franklin

2007-01-01

An experimental bivalent meningococcal outer membrane vesicle (OMV) vaccine (B:4:P1.19,15 and B:4:P1.7-2,4) has been developed to provide wide vaccine coverage particularly of the circulating strains in Europe. A randomized, controlled phase II study (study identification number, 710158/002; ClinicalTrials.gov identifier number, NCT00137917) to evaluate the immunogenicity and safety of three doses of the OMV vaccine when given to healthy 12- to 18-year-olds on a 0-2-4 month (n = 162) or 0-1-6 month schedule (n = 159). A control group received two doses of hepatitis A and one of conjugated meningococcal serogroup C vaccine on a 0-1-6 month schedule (n = 157). Immune response, defined as a fourfold increase in serum bactericidal titer using a range of vaccine-homologous or PorA-related and heterologous strains, was determined for samples taken before and 1 month after vaccination; assays were performed at two laboratories. As measured at the GlaxoSmithKline (GSK) laboratory, the OMV vaccine induced an immune response against homologous or PorA-related strains (in at least 51% of subjects against strains of serosubtype P1.19,15 and at least 66% against strains of serosubtype P1.7-2,4) and against a set of three heterologous strains (in 28% to 46% of subjects). Both laboratories showed consistent results for immune response rates. The OMV vaccine had a similar reactogenicity profile for each schedule. Pain preventing normal activities occurred in approximately one-fifth of the subjects; this was significantly higher than in the control group. The immune responses induced by the bivalent OMV vaccine demonstrated the induction of bactericidal antibodies against the vaccine-homologous/PorA-related strains but also against heterologous strains, indicating the presence of protective antigens in OMVs and confirming the potential of clinical cross-protection. PMID:17065257

Management Tools for Bus Maintenance: Current Practices and New Methods. Final Report.

ERIC Educational Resources Information Center

Foerster, James; And Others

Management of bus fleet maintenance requires systematic recordkeeping, management reporting, and work scheduling procedures. Tools for controlling and monitoring routine maintenance activities are in common use. These include defect and fluid consumption reports, work order systems, historical maintenance records, and performance and cost…

78 FR 18630 - Records Schedules; Availability and Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-27

... speeches, program files, records of senior-level boards, and substantive working papers. 11. Office of the... reference materials, non-substantive drafts, routine briefings and speeches, staff level working groups, Web... speeches, drafts, non-substantive working papers, reference files, and the internal Web site. Proposed for...

NASA occupational medicine programs: Our obligation to management

NASA Technical Reports Server (NTRS)

Arnoldt, L. B.; Mockbee, J.

1975-01-01

Factors to be considered in forming policies for managing NASA's health maintenance program to provide optimum arrangement for quality medical care are discussed. Topics include scheduling routine physical examinations, job related stress, prevalence of chronic diseases, additions to the PROM data system, and disease trends among personnel.

Custodial Methods and Procedures Manual. Third Edition.

ERIC Educational Resources Information Center

Johnson, Donald R.

This manual discusses school facility cleaning and maintenance from the expanded perspective of work management, physical assets management, and resource management. Work management encompasses the organization of work and personnel, scheduling of daily or routine duties and tasks, and handling of demand work. Physical asset management includes…

Computer Applications in Assessment and Counseling.

ERIC Educational Resources Information Center

Veldman, Donald J.; Menaker, Shirley L.

Public school counselors and psychologists can expect valuable assistance from computer-based assessment and counseling techniques within a few years, as programs now under development become generally available for the typical computers now used by schools for grade-reporting and class-scheduling. Although routine information-giving and gathering…

Library Binding Manual. Revised Edition.

ERIC Educational Resources Information Center

Lakhanpal, S. K.

This procedural manual is designed to be used in bindery sections in public, university and special libraries. It briefly discusses these general matters: administrative control; selection of a binder; when and what to bind; conventional binding; routines; missing issues; schedule for shipments; temporary binding; rare books, maps and newspapers;…

[A seroconversion study of the measles component of the MMR vaccine in adolescents of the town of Sabrosa].

PubMed

Gonçalves, G; Tavares, F; de Andrade, H R

1998-12-01

The Portuguese national programme of vaccination has instituted a two-dose MMR vaccine schedule. The second dose of MMR (measles-mumps-rubella combined vaccine) is given at 11-13 years of age, for both sexes. This study was conducted to evaluate the duration of immunity of the monovalent measles vaccine, and the efficacy of a second dose given as MMR. MMR (Triviraten Berna with the strain Edmonston-Zagreb) was given to the 38 participants. Blood samples were collected before and after vaccination. Thirty-six participants had been vaccinated with measles monovalent vaccine during childhood. To measure anti-measles IgG (mIgG), an enzyme immunoassay was used. Participants were classified as "susceptible" or "immune", using 200 mIU/ml (milli international units per millilitre) as the threshold for "immune". Geometric mean concentration (GMC) of mIgG was 1401 mIU/ml in prevaccination sera (n = 38). Thirty-five (92%) of the adolescents were "immune". Only the two unvaccinated had a positive measles history. GMC in the sera of the 36 vaccinated participants was 1301 mIU/ml. Neither the time since measles vaccination nor age at vaccination were correlated with the levels of mIgG. After receiving MMR, all adolescents became "immune". GMC of mIgG was 2879 mIU/ml in postvaccination sera (n = 38). In 28 (74%) participants, mIgG levels increased after receiving MMR. Mean concentration increase was 1082 mIU/ml. For measles, results support the use of a two-dose MMR vaccine schedule in Portugal.

Immunologic effects of hydroxyurea in sickle cell anemia.

PubMed

Lederman, Howard M; Connolly, Margaret A; Kalpatthi, Ram; Ware, Russell E; Wang, Winfred C; Luchtman-Jones, Lori; Waclawiw, Myron; Goldsmith, Jonathan C; Swift, Andrea; Casella, James F

2014-10-01

Susceptibility to encapsulated bacteria is well known in sickle cell disease (SCD). Hydroxyurea use is common in adults and children with SCD, but little is known about hydroxyurea's effects on immune function in SCD. Because hydroxyurea inhibits ribonucleotide reductase, causing cell cycle arrest at the G1-S interface, we postulated that hydroxyurea might delay transition from naive to memory T cells, with inhibition of immunologic maturation and vaccine responses. T-cell subsets, naive and memory T cells, and antibody responses to pneumococcal and measles, mumps, and rubella vaccines were measured among participants in a multicenter, randomized, double-blind, placebo-controlled trial of hydroxyurea in infants and young children with SCD (BABY HUG). Compared with placebo, hydroxyurea treatment resulted in significantly lower total lymphocyte, CD4, and memory T-cell counts; however, these numbers were still within the range of historical healthy controls. Antibody responses to pneumococcal vaccination were not affected, but a delay in achieving protective measles antibody levels occurred in the hydroxyurea group. Antibody levels to measles, mumps, and rubella showed no differences between groups at exit, indicating that effective immunization can be achieved despite hydroxyurea use. Hydroxyurea does not appear to have significant deleterious effects on the immune function of infants and children with SCD. Additional assessments of lymphocyte parameters of hydroxyurea-treated children may be warranted. No changes in current immunization schedules are recommended; however, for endemic disease or epidemics, adherence to accelerated immunization schedules for the measles, mumps, and rubella vaccine should be reinforced. Copyright © 2014 by the American Academy of Pediatrics.

Immunologic Effects of Hydroxyurea in Sickle Cell Anemia

PubMed Central

Lederman, Howard M.; Connolly, Margaret A.; Kalpatthi, Ram; Ware, Russell E.; Wang, Winfred C.; Luchtman-Jones, Lori; Waclawiw, Myron; Goldsmith, Jonathan C.; Swift, Andrea

2014-01-01

BACKGROUND AND OBJECTIVE: Susceptibility to encapsulated bacteria is well known in sickle cell disease (SCD). Hydroxyurea use is common in adults and children with SCD, but little is known about hydroxyurea’s effects on immune function in SCD. Because hydroxyurea inhibits ribonucleotide reductase, causing cell cycle arrest at the G1–S interface, we postulated that hydroxyurea might delay transition from naive to memory T cells, with inhibition of immunologic maturation and vaccine responses. METHODS: T-cell subsets, naive and memory T cells, and antibody responses to pneumococcal and measles, mumps, and rubella vaccines were measured among participants in a multicenter, randomized, double-blind, placebo-controlled trial of hydroxyurea in infants and young children with SCD (BABY HUG). RESULTS: Compared with placebo, hydroxyurea treatment resulted in significantly lower total lymphocyte, CD4, and memory T-cell counts; however, these numbers were still within the range of historical healthy controls. Antibody responses to pneumococcal vaccination were not affected, but a delay in achieving protective measles antibody levels occurred in the hydroxyurea group. Antibody levels to measles, mumps, and rubella showed no differences between groups at exit, indicating that effective immunization can be achieved despite hydroxyurea use. CONCLUSIONS: Hydroxyurea does not appear to have significant deleterious effects on the immune function of infants and children with SCD. Additional assessments of lymphocyte parameters of hydroxyurea-treated children may be warranted. No changes in current immunization schedules are recommended; however, for endemic disease or epidemics, adherence to accelerated immunization schedules for the measles, mumps, and rubella vaccine should be reinforced. PMID:25180279

Cost-effectiveness of a national enterovirus 71 vaccination program in China.

PubMed

Wang, Wenjun; Song, Jianwen; Wang, Jingjing; Li, Yaping; Deng, Huiling; Li, Mei; Gao, Ning; Zhai, Song; Dang, Shuangsuo; Zhang, Xin; Jia, Xiaoli

2017-09-01

Enterovirus 71 (EV71) has caused great morbidity, mortality, and use of health service in children younger than five years in China. Vaccines against EV71 have been proved effective and safe by recent phase 3 trials and are now available in China. The purpose of this study was to evaluate the health impact and cost-effectiveness of a national EV71 vaccination program in China. Using Microsoft Excel, a decision model was built to calculate the net clinical and economic outcomes of EV71 vaccination compared with no EV71 vaccination in a birth cohort of 1,000,000 Chinese children followed for five years. Model parameters came from published epidemiology, clinical and cost data. In the base-case, vaccination would annually avert 37,872 cases of hand, foot and mouth disease (HFMD), 2,629 herpangina cases, 72,900 outpatient visits, 6,363 admissions to hospital, 29 deaths, and 945 disability adjusted life years. The break-even price of the vaccine was $5.2/dose. When the price was less than $8.3 or $14.6/dose, the vaccination program would be highly cost-effective or cost-effective, respectively (incremental cost-effectiveness ratio less than or between one to three times China GDP per capita, respectively). In one-way sensitivity analyses, the HFMD incidence was the only influential parameter at the price of $5/dose. Within the price range of current routine vaccines paid by the government, a national EV71 vaccination program would be cost-saving or highly cost-effective to prevent EV71 related morbidity, mortality, and use of health service among children younger than five years in China. Policy makers should consider including EV71 vaccination as part of China's routine childhood immunization schedule.

Impact of routine hepatitis B immunization on the prevalence of chronic hepatitis B virus infection in the marshall islands and the federated States of micronesia.

PubMed

Bialek, Stephanie R; Helgenberger, Louisa; Fischer, Gayle E; Bower, William A; Konelios, Mailynn; Chaine, Jean-Paul; Armstrong, Gregory; Williams, Ian T; Bell, Beth P

2010-01-01

To evaluate the impact of routine hepatitis B (HB) vaccination on the prevalence of chronic hepatitis B virus (HBV) infection among children in Pacific Island countries where HBV infection was highly endemic, we conducted HB serosurveys during 2000 to 2007 among women of childbearing age born before implementation of HB vaccination and among children born after its implementation. Serum specimens were collected from children aged 2 to 6 years and their mothers in Chuuk, Federated States of Micronesia in 2000, children aged 2 to 9 years and their mothers in Pohnpei, Federated States of Micronesia in 2005, and 5- to 9-year-old children and prenatal clinic patients in 2007 in Republic of the Marshall Islands (RMI). Specimens were tested for HB surface antigen (HBsAg) and antibodies to HB core antigen (total anti-HBc). HB vaccination coverage was determined from health department vaccination registries. We defined chronic HBV infection as the presence of HBsAg. Birthdose and 3 dose HB vaccination coverage was 48% and 87%, respectively, in Chuuk, 87% and 90% in Pohnpei, and 49% and 93% in RMI. Chronic HBV infection prevalence among children was 2.5% (9/362) in Chuuk, 1.5% (7/478) in Pohnpei and 1.8% (6/331) in RMI. Chronic HBV infection prevalence among women was 9.2% (21/229) in Chuuk, 4.4% (10/229) in Pohnpei, and 9.5% (11/116) in RMI. Hepatitis B vaccination has resulted in a substantial decline in chronic infection in children in the Pacific Islands. HB vaccine effectiveness is high in this region, despite challenges in providing HB vaccine at birth and completing vaccination series on schedule.

A Supply and Demand Management Perspective on the Accelerated Global Introductions of Inactivated Poliovirus Vaccine in a Constrained Supply Market

PubMed Central

Ottosen, Ann; Rubin, Jennifer; Blanc, Diana Chang; Zipursky, Simona; Wootton, Emily

2017-01-01

Abstract A total of 105 countries have introduced IPV as of September 2016 of which 85 have procured the vaccine through UNICEF. The Global Eradication and Endgame Strategic Plan 2013-2018 called for the rapid introduction of at least one dose of IPV into routine immunization schedules in 126 all OPV-using countries by the end of 2015. At the time of initiating the procurement process, demand was estimated based on global modeling rather than individual country indications. In its capacity as procurement agency for the Global Polio Eradication Initiative and Gavi, the Vaccine Alliance, UNICEF set out to secure access to IPV supply for around 100 countries. Based on offers received, sufficient supply was awarded to two manufacturers to meet projected routine requirements. However, due to technical issues scaling up vaccine production and an unforecasted demand for IPV use in campaigns to interrupt wild polio virus and to control type 2 vaccine derived polio virus outbreaks, IPV supplies are severely constrained. Activities to stretch supplies and to suppress demand have been ongoing since 2014, including delaying IPV introduction in countries where risks of type 2 reintroduction are lower, implementing the multi-dose vial policy, and encouraging the use of fractional dose delivered intradermally. Despite these efforts, there is still insufficient IPV supply to meet demand. The impact of the supply situation on IPV introduction timelines in countries are the focus of this article, and based on lessons learned with the IPV introductions, it is recommended for future health programs with accelerated scale up of programs, to take a cautious approach on supply commitments, putting in place clear allocation criteria in case of shortages or delays and establishing a communication strategy vis a vis beneficiaries. PMID:28838159

Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial.

PubMed

Sege, Robert; Preer, Genevieve; Morton, Samantha J; Cabral, Howard; Morakinyo, Oluwatomisin; Lee, Vonne; Abreu, Catarina; De Vos, Edward; Kaplan-Sanoff, Margot

2015-07-01

Changes in health care delivery create opportunities to improve systems to better meet the needs of low-income families while achieving quality benchmarks. Families of healthy newborns receiving primary care at a single large urban safety-net hospital participated. Intervention families were randomly assigned a family specialist who provided support until the 6-month routine health care visit. The Developmental Understanding and Legal Collaboration for Everyone (DULCE) intervention is based on the Strengthening Families approach and incorporated components of the Healthy Steps and Medical-Legal Partnership models. Medical record reviews determined use of preventive and emergency care. Surveys conducted at baseline, postintervention (6 months), and follow-up (12 months) were used to determine hardship and attainment of concrete supports. Three hundred thirty families participated in the study. At baseline, 73% of families reported economic hardships. Intervention parents had an average of 14 contacts with the family specialist, and 5 hours of total contact time. Intervention infants were more likely to have completed their 6-month immunization schedule by age 7 months (77% vs 63%, P < .005) and by 8 months (88% vs 77%, P < .01). Intervention infants were more likely to have 5 or more routine preventive care visits by age 1 year (78% vs 67%, P < .01) and were less likely to have visited the emergency department by age 6 months (37% vs 49.7%, P < .03). The DULCE intervention accelerated access to concrete resources (P = .029). Assignment to the Project DULCE intervention led to improvements in preventive health care delivery and utilization and accelerated access to concrete supports among low-income families. Copyright © 2015 by the American Academy of Pediatrics.

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study.

PubMed

Hoest, Christel; Seidman, Jessica C; Lee, Gwenyth; Platts-Mills, James A; Ali, Asad; Olortegui, Maribel Paredes; Bessong, Pascal; Chandyo, Ram; Babji, Sudhir; Mohan, Venkata Raghava; Mondal, Dinesh; Mahfuz, Mustafa; Mduma, Estomih R; Nyathi, Emanuel; Abreu, Claudia; Miller, Mark A; Pan, William; Mason, Carl J; Knobler, Stacey L

2017-01-11

Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings. The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered. Coverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87-100%, whereas measles vaccination rates ranged widely, 73-100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific. Our findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Parents' concerns about vaccine scheduling in Shanghai, China.

PubMed

Wagner, Abram L; Boulton, Matthew L; Sun, Xiaodong; Huang, Zhuoying; Harmsen, Irene A; Ren, Jia; Zikmund-Fisher, Brian J

2017-08-03

Several new vaccines have been introduced into China in recent years, but some parents in China have shown concerns about the scheduling of vaccinations for young infants. This study explores caregiver concerns about children receiving multiple vaccines during a single visit and about vaccine administration in infants <6months, and assesses the degree to which these concerns are associated with ratings of the importance of different sources of vaccine information in Shanghai. Caregivers of children 8months to 7years presenting at immunization clinics in Shanghai completed a survey about vaccine co-administration and vaccine administration <6months of age. Respondents provided ratings of information from different sources (Internet, family/friends, other parents) and trust in doctors. We analyzed vaccine concerns using linear regression analyses that included these information sources after adjusting for socioeconomic variables. Among 618 caregivers, 64% were concerned about vaccine co-administration and 31% were concerned about vaccine administration to infants <6months of age. Higher ratings of Internet as an important source of information were associated with greater concern about co-administration (β=0.11, 95% CI: 0.00, 0.22) and concern about administration at <6months of age (β=0.17, 95% CI: 0.05, 0.28). Higher ratings given to information from other parents corresponded to 0.24 points greater concern about vaccine co-administration (95% CI: 0.04, 0.44). More trust in doctors and ratings of information from friends and family were not associated with vaccine concerns. Caregiver concerns about vaccine scheduling may limit China's flexibility to add vaccines to its official immunization schedule. Reporting information about vaccine safety on the Internet and bringing groups of parents together to discuss vaccines might help to ameliorate concerns about vaccine scheduling. Copyright © 2017 Elsevier Ltd. All rights reserved.

Update on invasive meningococcal vaccination for Canadian children and youth.

PubMed

Robinson, Joan L

2018-02-01

Invasive meningococcal disease (IMD) is serious, often resulting in fulminant sepsis or meningitis. IMD in Canada is primarily attributable to serogroups B and C. There are routine programs for serogroup C vaccine at 12 months of age, with some jurisdictions routinely providing additional earlier doses. Adolescents routinely receive a booster dose of serogroup C vaccine or of a quadrivalent (serogroups A, C, W and Y) vaccine. Serogroup B vaccines are not recommended for routine use pending further data on the efficacy and duration of protection from the available vaccine. However, children at increased risk for IMD should start immunization for serogroups B and C as soon as possible, assuming that they are at least 2 months of age.

The impact of a preloaded intraocular lens delivery system on operating room efficiency in routine cataract surgery.

PubMed

Jones, Jason J; Chu, Jeffrey; Graham, Jacob; Zaluski, Serge; Rocha, Guillermo

2016-01-01

The aim of this study was to evaluate the operational impact of using preloaded intraocular lens (IOL) delivery systems compared with manually loaded IOL delivery processes during routine cataract surgeries. Time and motion data, staff and surgery schedules, and cost accounting reports were collected across three sites located in the US, France, and Canada. Time and motion data were collected for manually loaded IOL processes and preloaded IOL delivery systems over four surgery days. Staff and surgery schedules and cost accounting reports were collected during the 2 months prior and after introduction of the preloaded IOL delivery system. The study included a total of 154 routine cataract surgeries across all three sites. Of these, 77 surgeries were performed using a preloaded IOL delivery system, and the remaining 77 surgeries were performed using a manual IOL delivery process. Across all three sites, use of the preloaded IOL delivery system significantly decreased mean total case time by 6.2%-12.0% (P<0.001 for data from Canada and the US and P<0.05 for data from France). Use of the preloaded delivery system also decreased surgeon lens time, surgeon delays, and eliminated lens touches during IOL preparation. Compared to a manual IOL delivery process, use of a preloaded IOL delivery system for cataract surgery reduced total case time, total surgeon lens time, surgeon delays, and eliminated IOL touches. The time savings provided by the preloaded IOL delivery system provide an opportunity for sites to improve routine cataract surgery throughput without impacting surgeon or staff capacity.

Chandra mission scheduling on-orbit experience

NASA Astrophysics Data System (ADS)

Bucher, Sabina; Williams, Brent; Pendexter, Misty; Balke, David

2008-07-01

Scheduling observatory time to maximize both day-to-day science target integration time and the lifetime of the observatory is a formidable challenge. Furthermore, it is not a static problem. Of course, every schedule brings a new set of observations, but the boundaries of the problem change as well. As spacecraft ages, its capabilities may degrade. As in-flight experience grows, capabilities may expand. As observing programs are completed, the needs and expectations of the science community may evolve. Changes such as these impact the rules by which a mission scheduled. In eight years on orbit, the Chandra X-Ray Observatory Mission Planning process has adapted to meet the challenge of maximizing day-to-day and mission lifetime science return, despite a consistently evolving set of scheduling constraints. The success of the planning team has been achieved, not through the use of complex algorithms and optimization routines, but through processes and home grown tools that help individuals make smart short term and long term Mission Planning decisions. This paper walks through the processes and tools used to plan and produce mission schedules for the Chandra X-Ray Observatory. Nominal planning and scheduling, target of opportunity response, and recovery from on-board autonomous safing actions are all addressed. Evolution of tools and processes, best practices, and lessons learned are highlighted along the way.

Vectorization of a penalty function algorithm for well scheduling

NASA Technical Reports Server (NTRS)

Absar, I.

1984-01-01

In petroleum engineering, the oil production profiles of a reservoir can be simulated by using a finite gridded model. This profile is affected by the number and choice of wells which in turn is a result of various production limits and constraints including, for example, the economic minimum well spacing, the number of drilling rigs available and the time required to drill and complete a well. After a well is available it may be shut in because of excessive water or gas productions. In order to optimize the field performance a penalty function algorithm was developed for scheduling wells. For an example with some 343 wells and 15 different constraints, the scheduling routine vectorized for the CYBER 205 averaged 560 times faster performance than the scalar version.

The drivers of facility-based immunization performance and costs. An application to Moldova.

PubMed

Maceira, Daniel; Goguadze, Ketevan; Gotsadze, George

2015-05-07

This paper identifies factors that affect the cost and performance of the routine immunization program in Moldova through an analysis of facility-based data collected as part of a multi-country costing and financing study of routine immunization (EPIC). A nationally representative sample of health care facilities (50) was selected through multi-stage, stratified random sampling. Data on inputs, unit prices and facility outputs were collected during October 3rd 2012-January 14th 2013 using a pre-tested structured questionnaire. Ordinary least square (OLS) regression analysis was performed to determine factors affecting facility outputs (number of doses administered and fully immunized children) and explaining variation in total facility costs. The study found that the number of working hours, vaccine wastage rates, and whether or not a doctor worked at a facility (among other factors) were positively and significantly associated with output levels. In addition, the level of output, price of inputs and share of the population with university education were significantly associated with higher facility costs. A 1% increase in fully immunized child would increase total cost by 0.7%. Few costing studies of primary health care services in developing countries evaluate the drivers of performance and cost. This exercise attempted to fill this knowledge gap and helped to identify organizational and managerial factors at a primary care district and national level that could be addressed by improved program management aimed at improved performance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Meningococcal Vaccines: What You Need to Know

MedlinePlus

... Life Family Life Family Life Medical Home Family Dynamics Media Work & Play Getting Involved in Your Community ... with certain medical conditions that affect the immune system Microbiologists who routinely work with isolates of N. ...

Alienation from Learning: School Effects on Students.

ERIC Educational Resources Information Center

Travis, Jon E.

1995-01-01

During their elementary school years, many students develop a dislike for school. Their alienation is due partly to the school environment and discouraging educator behaviors. Children sense they are overly assessed and classified, arbitrarily promoted, confined to large groups, and bound to a routine work schedule that values competition and…

Clonal Selection Based Artificial Immune System for Generalized Pattern Recognition

NASA Technical Reports Server (NTRS)

Huntsberger, Terry

2011-01-01

The last two decades has seen a rapid increase in the application of AIS (Artificial Immune Systems) modeled after the human immune system to a wide range of areas including network intrusion detection, job shop scheduling, classification, pattern recognition, and robot control. JPL (Jet Propulsion Laboratory) has developed an integrated pattern recognition/classification system called AISLE (Artificial Immune System for Learning and Exploration) based on biologically inspired models of B-cell dynamics in the immune system. When used for unsupervised or supervised classification, the method scales linearly with the number of dimensions, has performance that is relatively independent of the total size of the dataset, and has been shown to perform as well as traditional clustering methods. When used for pattern recognition, the method efficiently isolates the appropriate matches in the data set. The paper presents the underlying structure of AISLE and the results from a number of experimental studies.

Designing pediatric vaccine formularies and pricing pediatric combination vaccines using operations research models and algorithms.

PubMed

Jacobson, Sheldon H; Sewell, Edward C; Allwine, Daniel A; Medina, Enrique A; Weniger, Bruce G

2003-02-01

The National Immunization Program, housed within the Centers for Disease Control and Prevention in the USA, has identified several challenges that must be faced in childhood immunization programs to deliver and procure vaccines that immunize children from the plethora of childhood diseases. The biomedical issues cited include how drug manufacturers can combine and formulate vaccines, how such vaccines are scheduled and administered and how economically sound vaccine procurement can be achieved. This review discusses how operations research models can be used to address the economics of pediatric vaccine formulary design and pricing, as well as how such models can be used to address a new set of pediatric formulary problems that will surface with the introduction of pediatric combination vaccines into the US pediatric immunization market.

An Adaptive Immune Genetic Algorithm for Edge Detection

NASA Astrophysics Data System (ADS)

Li, Ying; Bai, Bendu; Zhang, Yanning

An adaptive immune genetic algorithm (AIGA) based on cost minimization technique method for edge detection is proposed. The proposed AIGA recommends the use of adaptive probabilities of crossover, mutation and immune operation, and a geometric annealing schedule in immune operator to realize the twin goals of maintaining diversity in the population and sustaining the fast convergence rate in solving the complex problems such as edge detection. Furthermore, AIGA can effectively exploit some prior knowledge and information of the local edge structure in the edge image to make vaccines, which results in much better local search ability of AIGA than that of the canonical genetic algorithm. Experimental results on gray-scale images show the proposed algorithm perform well in terms of quality of the final edge image, rate of convergence and robustness to noise.

Efficacy of Rhodotorula glutinis and Spirulina platensis carotenoids in immunopotentiation of mice infected with Candida albicans SC5314 and Pseudomonas aeruginosa 35.

PubMed

El-Sheekh, M M; Mahmoud, Y A-G; Abo-Shady, A M; Hamza, W

2010-01-01

Enhancement of the immune response leading to protection against bacterial and fungal infections was shown using different schedules of immunization with microbial pigments and a polysaccharide. The group of mice given carotenoids of Rhodotorula glutinis (preparation I) and polysaccharide of Spitulina platensis (IV) survived for 2 weeks after Pseudomonas aeruginosa infection. The groups of mice given carotenoids (I), polysaccharide (IV), I+IV and with the crude phycocyanin of S. platensis (III)+IV survived for 2 weeks after Candida albicans infection. All other groups recorded a maximum level of mortality reaching 2 mice per group either after immunization or post-infection. Adding the carotenoids, phycocyanin and polysaccharides to food as additives might therefore enhance the human immune response against microbial infections.

Evaluation of a time efficient immunization strategy for anti-PAH antibody development

PubMed Central

Li, Xin; Kaattari, Stephen L.; Vogelbein, Mary Ann; Unger, Michael A.

2016-01-01

The development of monoclonal antibodies (mAb) with affinity to small molecules can be a time-consuming process. To evaluate shortening the time for mAb production, we examined mouse antisera at different time points post-immunization to measure titer and to evaluate the affinity to the immunogen PBA (pyrene butyric acid). Fusions were also conducted temporally to evaluate antibody production success at various time periods. We produced anti-PBA antibodies 7 weeks post-immunization and selected for anti-PAH reactivity during the hybridoma screening process. Moreover, there were no obvious sensitivity differences relative to antibodies screened from a more traditional 18 week schedule. Our results demonstrate a more time efficient immunization strategy for anti-PAH antibody development that may be applied to other small molecules. PMID:27282486

32 CFR 199.18 - Uniform HMO Benefit.

Code of Federal Regulations, 2012 CFR

2012-07-01

... schedule, including frequency or age specifications for: (i) Laboratory and x-ray tests, including blood lead, rubella, cholesterol, fecal occult blood testing, and mammography; (ii) Pap smears; (iii) Eye exams; (iv) Immunizations; (v) Periodic health promotion and disease prevention exams; (vi) Blood...

32 CFR 199.18 - Uniform HMO Benefit.

Code of Federal Regulations, 2011 CFR

2011-07-01

... schedule, including frequency or age specifications for: (i) Laboratory and x-ray tests, including blood lead, rubella, cholesterol, fecal occult blood testing, and mammography; (ii) Pap smears; (iii) Eye exams; (iv) Immunizations; (v) Periodic health promotion and disease prevention exams; (vi) Blood...

32 CFR 199.18 - Uniform HMO Benefit.

Code of Federal Regulations, 2013 CFR

2013-07-01

... schedule, including frequency or age specifications for: (i) Laboratory and x-ray tests, including blood lead, rubella, cholesterol, fecal occult blood testing, and mammography; (ii) Pap smears; (iii) Eye exams; (iv) Immunizations; (v) Periodic health promotion and disease prevention exams; (vi) Blood...

Cost-effectiveness of HPV vaccination in Belize.

PubMed

Walwyn, Leslie; Janusz, Cara Bess; Clark, Andrew David; Prieto, Elise; Waight, Eufemia; Largaespada, Natalia

2015-05-07

Among women in Belize, cervical cancer is both the leading cancer and the leading cause of cancer deaths. Both the quadrivalent and bivalent human papillomavirus (HPV) vaccines are licensed in Belize. The Ministry of Health of Belize convened a multidisciplinary team to estimate the costs, health benefits, and cost-effectiveness of adding an HPV vaccine to the national immunization schedule. The CERVIVAC cost-effectiveness model (Version 1.123) was used to assess the lifetime health and economic outcomes of vaccinating one cohort of girls aged 10 years against HPV. The comparator was no HPV vaccination. The PAHO Revolving Fund negotiated price of US$ 13.79 per dose was used (for the quadrivalent vaccine) and national data sources were used to define demography, cervical cancer incidence and mortality, cervical cancer treatment costs, and vaccine delivery costs. Estimates from international agencies were used in scenario analysis. In a cohort of ∼4000 Belizean girls tracked over a lifetime, HPV vaccination is estimated to prevent 69 new cases of cervical cancer (undiscounted), and 51 cervical cancer deaths (undiscounted). Considering the potential cervical cancer treatment costs and lost wages avoided by households (societal perspective), the cost per disability-adjusted life year (DALY) averted was estimated to be US$ 429. This increased to US$ 1320 when cervical cancer treatment costs and lost wages were excluded from the analysis. Both estimates are far below the gross domestic product (GDP) per capita of Belize (US$ 4795). The lifetime health care costs saved by the women and their families represent more than 60% of the investment cost needed by the Government for the vaccine. Routine HPV vaccination would be highly cost-effective in Belize. If affordable, efforts should be made to expedite the introduction of this vaccine into the Belizean national immunization program. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effectiveness of short message services reminder on childhood immunization programme in Kadoma, Zimbabwe - a randomized controlled trial, 2013.

PubMed

Bangure, Donewell; Chirundu, Daniel; Gombe, Notion; Marufu, Tawanda; Mandozana, Gibson; Tshimanga, Mufuta; Takundwa, Lucia

2015-02-12

Globally, non-attendance for immunization appointments remains a challenge to healthcare providers. A review of the 2011 immunization coverage for Kadoma City, Zimbabwe was 74% for Oral Polio Vaccine (OPV), Pneumococcal and Pentavalent antigens. The immunization coverage was less than 90%, which is the target for Kadoma City. Adoption of short message services (SMS) reminders has been shown to enhance attendance in some medical settings. The study was conducted to determine the effectiveness of SMS reminders on immunization programme for Kadoma City. A randomized controlled trial was conducted at Kadoma City clinics in Zimbabwe. Women who delivered and were residents of Kadoma City were recruited into the study. In the intervention group, SMS reminders were sent at 6, 10 and 14 weeks in addition to routine health education. In the non-intervention no SMS reminders were used, however routine health education was offered. Data were collected using interviewer administered questionnaire. Data were analyzed using Epi Info 7™, where frequencies, means, risk ratios and risk differences were generated. A total of 304 participants were recruited, 152 for the intervention group and 152 for the non-intervention group. The immunization coverage at 6 weeks was 97% in the intervention group and 82% in the non-intervention group (p < 0.001). At 14 weeks immunization coverage was 95% for intervention and 75% for non-intervention group (p < 0.001). Those who did not delay receiving immunization at 14 weeks was 82% for the intervention and 8% for non-intervention group. Median delay for intervention was 0 days (Q1 = 0; Q3 = 0) and 10 days (Q1 = 6; Q3 = 17) for non-intervention group. The risk difference (RD) for those who received SMS reminders than those in the non intervention group was 16.3% (95% CI: 12.5-28.0) at 14 weeks. Immunization coverage in the intervention group was significantly higher than in non-intervention group. Overall increase in immunization coverage can be attributed to use of SMS. ISRCTN70918594 . Registration Date: 28 August 2014.

DTaP5-IPV-Hib-HepB, a hexavalent vaccine for infants and toddlers.

PubMed

Lee, Andrew W; Jordanov, Emilia; Boisnard, Florence; Marshall, Gary S

2017-02-01

Combination vaccines reduce the 'shot burden' and simplify the childhood immunization schedule. Only 5-valent DTaP-based vaccines are licensed in the U.S. Areas covered: A new combination vaccine - DTaP5-IPV-Hib-HepB - is described, which induces antibody responses in infants (given in different schedules, including a 2, 4, and 6-month schedule) that are similar to the respective component vaccines. The vaccine appears to be safe and would be expected to protect against six diseases: diphtheria, tetanus, pertussis, hepatitis B, H influenzae type b, and polio. Administration is associated with higher rates of mild fever, but without significant safety signals. Expert commentary: Incorporation of this hexavalent vaccine into the U.S. schedule could improve coverage rates and timeliness, and addition to the E.U. market would add depth to the available repertoire of combination vaccines.

Routine postoperative CT-scans after burr hole trepanation for chronic subdural hematoma - better before or after drainage removal?

PubMed

Brokinkel, Benjamin; Ewelt, Christian; Holling, Markus; Hesselmann, Volker; Heindel, Walter Leonard; Stummer, Walter; Fischer, Bernhard Robert

2013-01-01

To evaluate timing of scheduled CT-scans after burr hole trepanation for chronic subdural hematoma (cSDH). 131 patients with primary cSDH were included. Scheduled CT-scans were performed after burr hole trepanation and placement of a subdural drain. The influence of CT-scanning with or without indwelling drain was analysed regarding subsequent surgery and CT-scans, duration of hospitalization, short- and middle-term follow up by single factor analyses. Subgroup analyses were performed for patients receiving anticoagulant drugs. Median age was 74 years. Routine CT-scans with indwelling drainage were not shown to be beneficial regarding subsequent burr hole trepanations (p=0.243), craniotomies (p=1.000) and outcome at discharge (p=0.297). Mean duration of hospitalization (11 vs. 8 days, p=0.013) was significantly longer and number of subsequent CT-scans was higher when CT scan was performed with indwelling drain (2.3 vs. 1.4, p=0.001). In middle-term follow-up, beneficial effects of CT-scanning with inlaying drainage could neither be shown. Moreover, advantageous effects of CT-scans with indwelling drains could neither be shown for patients receiving anticoagulant drugs. Scheduled postoperative cranial imaging with indwelling drains was not shown to be beneficial and misses information of intracranial damage inflicted by removal of drains. We thus recommend CT-scanning after drainage removal.

Use of the Microparticle Nanoscale Silicon Dioxide as an Adjuvant To Boost Vaccine Immune Responses against Influenza Virus in Neonatal Mice.

PubMed

Russell, Ryan F; McDonald, Jacqueline U; Lambert, Laura; Tregoning, John S

2016-05-01

Neonates are at a high risk of infection, but vaccines are less effective in this age group; tailored adjuvants could potentially improve vaccine efficacy. Increased understanding about danger sensing by the innate immune system has led to the rational design of novel adjuvants. But differences in the neonatal innate immune response, for example, to Toll-like receptor (TLR) agonists, can reduce the efficacy of these adjuvants in early life. We therefore targeted alternative danger-sensing pathways, focusing on a range of compounds described as inflammasome agonists, including nanoscale silicon dioxide (NanoSiO2), calcium pyrophosphate dihydrate (CPPD) crystals, and muramyl tripeptide (M-Tri-DAP), for their ability to act as adjuvants.In vitro, these compounds induced an interleukin 1-beta (IL-1β) response in the macrophage-like cell line THP1.In vivo, adult CB6F1 female mice were immunized intramuscularly with H1N1 influenza vaccine antigens in combination with NanoSiO2, CPPD, or M-Tri-DAP and subsequently challenged with H1N1 influenza virus (A/England/195/2009). The adjuvants boosted anti-hemagglutinin IgG and IgA antibody levels. Both adult and neonatal animals that received NanoSiO2-adjuvanted vaccines lost significantly less weight and recovered earlier after infection than control animals treated with antigen alone. Administration of the adjuvants led to an influx of activated inflammatory cells into the muscle but to little systemic inflammation measured by serum cytokine levels. Blocking IL-1β or caspase 1 in vivo had little effect on NanoSiO2 adjuvant function, suggesting that it may work through pathways other than the inflammasome. Here we demonstrate that NanoSiO2 can act as an adjuvant and is effective in early life. Vaccines can fail to protect the most at-risk populations, including the very young, the elderly, and the immunocompromised. There is a gap in neonatal immunity between the waning of maternal protection and routine infant immunization schedules, exacerbated by the failure of vaccines to work in the first months of life. One approach is to design age-specific formulations, with more-effective adjuvants, based on our understanding of the nature of the neonatal immune response. We chose to target the inflammasome, a molecular complex capable of detecting infection and cell damage and of triggering IL-1β-driven inflammation. We screened a range of compounds in vitro and in vivo and identified three lead candidates: NanoSiO2, CPPD, and M-Tri-DAP. Of these, NanoSiO2 was the most effective and boosted the anti-influenza virus response in both adult and neonatal mice. This finding is important for the development of age-specific vaccines, designed using our knowledge of the neonatal immune response. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Immunogenicity, reactogenicity and safety of 2 doses of an adjuvanted herpes zoster subunit vaccine administered 2, 6 or 12 months apart in older adults: Results of a phase III, randomized, open-label, multicenter study.

PubMed

Lal, Himal; Poder, Airi; Campora, Laura; Geeraerts, Brecht; Oostvogels, Lidia; Vanden Abeele, Carline; Heineman, Thomas C

2018-01-02

In phase III trials, 2 doses of a herpes zoster (HZ) subunit vaccine (HZ/su; 50 µg varicella-zoster virus glycoprotein E [gE] and AS01 B Adjuvant System) administered 2-months apart in older adults (≥50 and ≥70 years) demonstrated >90% efficacy in preventing HZ and had a clinically acceptable safety profile. Here we report immunogenicity, reactogenicity and safety following administration of 2 HZ/su doses at intervals longer than 2 months. In this Phase III, open-label trial conducted in the US and Estonia, 354 adults ≥50 years were randomized 1:1:1 to receive 2 HZ/su doses 2, 6, or 12 months apart. gE-specific humoral immune responses were evaluated at pre-vaccination, 1 and 12 months post-dose 2. Co-primary objectives were to compare immune responses to HZ/su 1 month post-dose 2 when given 6-months or 12-months apart to those administered 2-months apart. For each participant, safety information was collected from dose 1 to 12 months post-dose 2. 346 participants completed the study and 343 were included in the according-to-protocol cohort for immunogenicity. One month post-dose 2, vaccine response rates were 96.5% (97.5% confidence interval [CI]: 90.4; 99.2) and 94.5% (97.5% CI: 87.6; 98.3) for the 0, 6- and 0, 12-month schedules, respectively, both schedules meeting the pre-defined criterion. Non-inferiority of anti-gE geometric mean concentrations was demonstrated for HZ/su administered on 0, 6-month compared to a 0, 2-month schedule; however, HZ/su administered on a 0, 12-month schedule did not meet the non-inferiority criterion. Injection site pain was the most commonly reported solicited adverse event (AE). 26 participants each reported at least 1 serious AE; none were assessed as related to vaccination. Immune responses to HZ/su administered at 0, 6-month were non-inferior to those elicited by a 0, 2-month schedule. HZ/su exhibited a clinically acceptable safety profile for all dosing intervals. Clinicaltrials.gov (NCT01751165). Copyright © 2017. Published by Elsevier Ltd.

Check-off logs for routine equipment maintenance.

PubMed

Brewster, M A; Carver, P H; Randolph, B

1995-12-01

The regulatory requirement for appropriate routine instrument maintenance documentation is approached by laboratories in numerous ways. Standard operating procedures (SOPs) may refer to maintenance listed in instrument manuals, may indicate "periodic" performance of an action, or may indicate specific tasks to be performed at certain frequencies. The Quality Assurance Unit (QAU) task of assuring the performance of these indicated maintenance tasks can be extremely laborious if these records are merged with other analysis records. Further, the lack of written maintenance schedules often leads to omission of infrequently performed tasks. We recommend creation of routine maintenance check-off logs for instruments with tasks grouped by frequency of expected performance. Usage of such logs should result in better laboratory compliance with SOPs and the compliance can be readily monitored by QAU or by regulatory agencies.

Visual Schedule System in Dental Care for Patients with Autism: A Pilot Study.

PubMed

Mah, Janet Wt; Tsang, Phoebe

A pilot study to test whether a visual schedule system using picture communication symbols can help children with autism have successful routine dental cleaning visits. 14 boys with autism between three- to eight-years-old presented to the dental clinic for four weekly consecutive dental appointments. Patients were randomly assigned to either the control group who received the tell-show-do method (i.e., standard of care), or the test group who received the tell-show-do method plus the visual schedule system. Patients in the test group completed an average of 1.38 more steps, at 35.52 seconds per step faster, and with 18.7% lower levels of behavioral distress than those in the control group. The use of a visual schedule system, along with repeated weekly visits, showed some promise in helping children with autism successfully complete more steps, progress at a quicker rate, and exhibit lower levels of behavioral distress within a dental appointment, compared to a traditional tell-show-do approach.

Religious Expression in Coastal Area of Muslim Society West Papua

NASA Astrophysics Data System (ADS)

Mutia Faradillah Tukwain, Sitti; Fatimah, Fatimah; Suardi Wekke, Ismail

2018-05-01

This research focuses on da’i (Muslim preacher) absence during Ramadhan at Darussalam Mosque Kampung Pisang that ffects its da’wah (preaching) activity schedule. The activity meant here is a routine Islamic preaching which is scheduled every night during Ramdhan by Sorong Ministry of Religious Affair. The researcher appoints three problems to discuss: what are the reasons behind da’i absence during Ramadhan at Darussalam Mosque Kampung Pisang, how the attendees (mad’u) respond to the absence and how Ministry of Religious Affair deals with it. The type of this research is qualitative research. The data are collected from researcher interview with subjected primary informants; they are Darussalam Mosque Kampung Pisang committee, the listed da’i/mubaligh on schedule, the attendants (mad’u) and Ministry of Religious Affair for scheduling matters. The researcher also conducts a direct observation on the primary informants. This research finding is significant enough to base any related party who attempt to cope with similar problem.

Maternal nutritional status during pregnancy and infant immune response to routine childhood vaccinations.

PubMed

Obanewa, Olayinka; Newell, Marie-Louise

2017-09-01

To systematically review the association between maternal nutritional status in pregnancy and infant immune response to childhood vaccines. We reviewed literature on maternal nutrition during pregnancy, fetal immune system and vaccines and possible relationships. Thereafter, we undertook a systematic review of the literature of maternal nutritional status and infant vaccine response, extracted relevant information, assessed quality of the nine papers identified and present findings in a narrative format. From limited evidence of average quality, intrauterine nutrition deficiency could lead to functional deficit in the infant's immune function; child vaccine response may thus be negatively affected by maternal malnutrition. Response to childhood vaccination may be associated with fetal and early life environment; evaluation of programs should take this into account.

Immunogenicity and safety of two doses of catch-up immunization with Haemophilus influenzae type b conjugate vaccine in Indian children living with HIV.

PubMed

Arya, Bikas K; Bhattacharya, Sangeeta Das; Sutcliffe, Catherine G; Saha, Malay K; Bhattacharyya, Subhasish; Niyogi, Swapan Kumar; Moss, William J; Panda, Samiran; Das, Ranjan Saurav; Mallick, Mausom; Mandal, Sutapa

2016-04-27

Children living with HIV are at increased risk of disease from Haemophilus influenzae type b (Hib). Data are limited on the immunogenicity of a two-dose, catch-up schedule for Hib conjugate vaccine (HibCV) among HIV-infected children accessing antiretroviral therapy (ART) late. The objectives of the study were to: (1) evaluate baseline immunity to Hib and the immunogenicity and safety of two doses of HibCV among HIV-infected Indian children; and (2) document the threshold antibody level required to prevent Hib colonization among HIV-infected children following immunization. We conducted a prospective cohort study among HIV-infected children 2-15 years of age and HIV-uninfected children 2-5 years of age. HIV-infected children received two doses of HibCV and uninfected children received one. Serum anti-Hib PRP IgG antibodies were measured at baseline and two months after immunization in the HIV-infected children. Nasopharyngeal (NP) swabs were collected at baseline and follow-up. 125 HIV-infected and 44 uninfected children participated. 40% of HIV-infected children were receiving ART and 26% had a viral load >100,000 copies/mL. The geometric mean concentration of serum anti-Hib PRP antibody increased from 0.25 μg/mL at baseline to 2.65 μg/mL after two doses of HibCV, representing a 10.6-fold increase (p<0.0001). 76% percent of HIV-infected children mounted an immune response. Moderate or severe immune suppression, trimethoprim/sulfamethoxazole prophylaxis, and lower baseline antibody levels were associated with lower post-vaccine serum anti-Hib PRP IgG antibodies. A serum anti-Hib PRP IgG antibody level ≥ 3.3 μg/mL was protective against Hib NP colonization. There were no differences in adverse events between HIV-infected and uninfected children. Including a catch-up immunization schedule for older HIV infected children in countries introducing Hib vaccines is important. Older HIV-infected children with delayed access to ART and without suppressed viral loads mounted an adequate immune response following two doses of HibCV. Copyright © 2016 Elsevier Ltd. All rights reserved.

38 CFR 4.88 - [Reserved

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false [Reserved] 4.88 Section 4.88 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings Infectious Diseases, Immune Disorders and Nutritional Deficiencies § 4.88...

38 CFR 4.88 - [Reserved

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false [Reserved] 4.88 Section 4.88 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings Infectious Diseases, Immune Disorders and Nutritional Deficiencies § 4.88...

38 CFR 4.88 - [Reserved

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false [Reserved] 4.88 Section 4.88 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings Infectious Diseases, Immune Disorders and Nutritional Deficiencies § 4.88...

38 CFR 4.88 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false [Reserved] 4.88 Section 4.88 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings Infectious Diseases, Immune Disorders and Nutritional Deficiencies § 4.88...

38 CFR 4.88 - [Reserved

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false [Reserved] 4.88 Section 4.88 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings Infectious Diseases, Immune Disorders and Nutritional Deficiencies § 4.88...

[THE SYSTEMIC IMMUNITY CELLULAR LINK REACTION IN PATIENTS WITH TRAUMATIC ILLNESS].

PubMed

Plehutsa, I M; Sydorchuk, R I; Plehutsa, O M

2015-01-01

The effect of trauma on parameters of cellular immunity changes is studied. The study includes 52 patients with various forms of traumatic illness, aged 18-69 years (37.91-4.28). The control group consisted of 16 patients who underwent routine surgery not related to the pathology of musculoskeletal system. All patients of the main group were divided into 3 groups according to severity of the condition. Analysis of parameters of cellular link of immune system was performed by defining subpopulations of T-lymphocytes in indirect immunofluorescence method using a panel of monoclonal antibodies for CD3, CD4, CD8, CD22 lymphocytes' receptors and calculation of integrated indicators. The highest expression (immune disorders of II-III grades) of changes of cellular immunity observed in patients with severe traumatic: illness (expand clinical picture). Surgical intervention, even without traumatic injury significantly impact cellular immunity, but in patients with traumatic illness immunity violation were significantly higher than in comparison groups patients except immunoregulatory index.

Suppressive influences in the immune response to cancer.

PubMed

Bronte, Vincenzo; Mocellin, Simone

2009-01-01

Although much evidence has been gathered demonstrating that immune effectors can play a significant role in controlling tumor growth under natural conditions or in response to therapeutic manipulation, it is clear that malignant cells do evade immune surveillance in most cases. Considering that anticancer active specific immunotherapy seems to have reached a plateau of results and that currently no vaccination regimen is indicated as a standard anticancer therapy, the dissection of the molecular events underlying tumor immune escape is the necessary condition to make anticancer vaccines a therapeutic weapon effective enough to be implemented in the routine clinical setting. Recent years have witnessed significant advances in our understanding of the molecular mechanisms underlying tumor immune escape. These mechanistic insights are fostering the development of rationally designed therapeutics aimed to revert the immunosuppressive circuits that undermine an effective antitumor immune response. In this review, the best characterized mechanisms that allow cancer cells to evade immune surveillance are overviewed and the most debated controversies constellating this complex field are highlighted.

A new challenge for the world: the eradication of polio.

PubMed

Gentile, Ángela; Abate, Héctor

2016-12-01

Poliovirus infects 100% of susceptible individuals and causes acute flaccid paralysis in one out of200 infections. Type 1 causes epidemic poliomyelitis; type 2 has been eradicated worldwide; and type 3 is close to being eradicated. In this region, the last case of wild poliovirus occurred in Peru in 1991. There are still two endemic countries: Afghanistan and Pakistan, but countries where there is no circulation of the wild poliovirus have also reported imported cases of polio. In May 2012, the World Health Assembly declared the polio eradication a programmatic emergency for global public health and, as a result, developed the Polio Eradication and Endgame Strategic Plan 2013-2018. The Plan has four objectives: 1) Detect and interrupt all poliovirus transmission and maintain surveillance of acute flaccid paralysis in children < 15 years. 2) Strengthen immunization systems and withdraw oral polio vaccine by the first trimester of 2016. Replace the trivalent oral polio vaccine with the bivalent oral vaccine, containing serotypes 1 and 3, and introduce the inactivated polio vaccine in all immunization schedules to maintain immunity against poliovirus type 2. 3) Contain poliovirus and certify interruption of transmission. 4) Plan the exploitation of the fight against polio and its impact on public health. The plan is expected to reach its goals by 2018; all use of the oral polio vaccine will be interrupted thereafter. Change in immunization schedules will require pediatricians to provide advice and guidance to families depending on the varied situations of everyday practice. Sociedad Argentina de Pediatría.

Reasons for non-immunization of children in an urban, low income group in North India.

PubMed

Mathew, Joseph L; Babbar, Harsh; Yadav, Sangita

2002-07-01

A study was undertaken on 500 children under the age of 5 years belonging to a low income group. All were attending the paediatrics outpatient department of a large teaching hospital in New Delhi, India. Only 25% were found to have received complete primary immunization as per the National Immunization Schedule (bacille Calmette-Guérin at birth, three doses of diphtheria, pertussis and tetanus and oral poliovirus vaccine at 6,10 and 14 weeks and measles vaccine at 9 months). The major reasons for non-immunization of the children were: migration to a native village (26.4%); domestic problems (9.6%); the immunization centre was located too far from their home (9.6%); and the child was unwell when the vaccination was due (9%). Twelve per cent of mothers could not give any reason for non-immunization. In addition to the migration of children to rural areas, the other significant finding was an indirect effect of intensive OPV administration as part of polio eradication initiative. The lack of awareness and fear of side effects constituted a small minority of reasons for non-immunization.

The cost of doing business: cost structure of electronic immunization registries.

PubMed

Fontanesi, John M; Flesher, Don S; De Guire, Michelle; Lieberthal, Allan; Holcomb, Kathy

2002-10-01

To predict the true cost of developing and maintaining an electronic immunization registry, and to set the framework for developing future cost-effective and cost-benefit analysis. Primary data collected at three immunization registries located in California, accounting for 90 percent of all immunization records in registries in the state during the study period. A parametric cost analysis compared registry development and maintenance expenditures to registry performance requirements. Data were collected at each registry through interviews, reviews of expenditure records, technical accomplishments development schedules, and immunization coverage rates. The cost of building immunization registries is predictable and independent of the hardware/software combination employed. The effort requires four man-years of technical effort or approximately $250,000 in 1998 dollars. Costs for maintaining a registry were approximately $5,100 per end user per three-year period. There is a predictable cost structure for both developing and maintaining immunization registries. The cost structure can be used as a framework for examining the cost-effectiveness and cost-benefits of registries. The greatest factor effecting improvement in coverage rates was ongoing, user-based administrative investment.

Immunization of Health-Care Providers: Necessity and Public Health Policies

PubMed Central

Maltezou, Helena C.; Poland, Gregory A.

2016-01-01

Health-care providers (HCPs) are at increased risk for exposure to vaccine-preventable diseases (VPDs) in the workplace. The rationale for immunization of HCPs relies on the need to protect them and, indirectly, their patients from health-care-associated VPDs. Published evidence indicates significant immunity gaps for VPDs of HCPs globally. Deficits in knowledge and false perceptions about VPDs and vaccines are the most common barriers for vaccine uptake and may also influence communication about vaccines between HCPs and their patients. Most countries have immunization recommendations for HCPs; however, there are no universal policies and significant heterogeneity exists between countries in terms of vaccines, schedules, frame of implementation (recommendation or mandatory), and target categories of HCPs. Mandatory influenza immunization policies for HCPs have been implemented with high vaccine uptake rates. Stronger recommendations for HCP immunization and commitment at the level of the health-care facility are critical in order to achieve high vaccine coverage rates. Given the importance to health, mandatory immunization policies for VPDs that can cause serious morbidity and mortality to vulnerable patients should be considered. PMID:27490580

Measles immunity gaps and the progress towards elimination: a multi-country modelling analysis.

PubMed

Trentini, Filippo; Poletti, Piero; Merler, Stefano; Melegaro, Alessia

2017-10-01

The persistent circulation of measles in both low-income and high-income countries requires a better characterisation of present epidemiological trends and existing immunity gaps across different sociodemographic settings. Serological surveys, which provide direct measures of population protection against the infection, are underexploited and often supply fragmentary estimates of population immunity. This study aims to investigate how measles immunity has changed over time across different socioeconomic settings, as a result of demographic changes and past immunisation policies. For this multi-country modelling analysis, we developed a transmission model to simulate measles circulation during the past 65 years in nine countries with distinct demographic and vaccination histories. The model was calibrated on historical serological data and used to estimate the reduction of disease burden as a result of vaccination and present age-specific residual susceptibility. Our model shows that estimated residual susceptibility to measles ranges from 3% in the UK to more than 10% in Kenya and Ethiopia. In high-income countries, such as Italy, Singapore, and South Korea, where routine first-dose administration produced more than 90% of immunised individuals, only about 20% of susceptible individuals are younger than 5 years. We also observed that the reduction in fertility that has occurred during the past decades in high-income countries has contributed to almost half of the reduction in measles incidence. In low-income countries, where fertility is high, the population is younger and routine vaccination has been suboptimum. Susceptible individuals are concentrated in early childhood, with about 60% of susceptible individuals in Ethiopia younger than 10 years. In these countries, Supplementary Immunization Activities (SIAs) were responsible for more than 25% of immunised individuals (up to 45% in Ethiopia), mitigating the consequences of suboptimum routine vaccination coverage. Future vaccination strategies in high-fertility countries should focus on increasing childhood immunisation rates, either by raising first-dose coverage or by making erratic SIAs more frequent and regular. Immunisation campaigns targeting adolescents and adults are required in low-fertility countries, where the susceptibility in these age groups will otherwise sustain measles circulation. European Research Council. Copyright © 2017 Elsevier Ltd. All rights reserved.

Families Experiencing Housing Instability: The Effects of Housing Programs on Family Routines and Rituals

PubMed Central

Mayberry, Lindsay S.; Shinn, Marybeth; Benton, Jessica Gibbons; Wise, Jasmine

2013-01-01

Maintenance of family processes can protect parents, children, and families from the detrimental effects of extreme stressors, such as homelessness. When families cannot maintain routines and rituals, the stressors of poverty and homelessness can be compounded for both caregivers and children. However, characteristics of living situations common among families experiencing homelessness present barriers to the maintenance of family routines and rituals. We analyzed 80 in-depth interviews with parents who were experiencing or had recently experienced an instance of homelessness. We compared their assessments of challenges to family schedules, routines, and rituals across various living situations, including shelter, transitional housing programs, doubled up (i.e. living temporarily with family/friend), and independent housing. Rules common across shelters and transitional housing programs impeded family processes, and parents felt surveilled and threatened with child protective service involvement in these settings. In doubled up living situations, parents reported adapting their routines to those of the household and having parenting interrupted by opinions of friends and family members. Families used several strategies to maintain family rituals and routines in these living situations and ensure consistency and stability for their children during an otherwise unstable time. PMID:24826832

Families experiencing housing instability: the effects of housing programs on family routines and rituals.

PubMed

Mayberry, Lindsay Satterwhite; Shinn, Marybeth; Benton, Jessica Gibbons; Wise, Jasmine

2014-01-01

Maintenance of family processes can protect parents, children, and families from the detrimental effects of extreme stressors, such as homelessness. When families cannot maintain routines and rituals, the stressors of poverty and homelessness can be compounded for both caregivers and children. However, characteristics of living situations common among families experiencing homelessness present barriers to the maintenance of family routines and rituals. We analyzed 80 in-depth interviews with parents who were experiencing or had recently experienced an instance of homelessness. We compared their assessments of challenges to family schedules, routines, and rituals across various living situations, including shelter, transitional housing programs, doubled-up (i.e., living temporarily with family or friends), and independent housing. Rules common across shelters and transitional housing programs impeded family processes, and parents felt surveilled and threatened with child protective service involvement in these settings. In doubled-up living situations, parents reported adapting their routines to those of the household and having parenting interrupted by opinions of friends and family members. Families used several strategies to maintain family routines and rituals in these living situations and ensure consistency and stability for their children during an otherwise unstable time. (c) 2014 APA, all rights reserved.

Thimerosal Exposure and the Role of Sulfation Chemistry and Thiol Availability in Autism

PubMed Central

Kern, Janet K.; Haley, Boyd E.; Geier, David A.; Sykes, Lisa K.; King, Paul G.; Geier, Mark R.

2013-01-01

Autism spectrum disorder (ASD) is a neurological disorder in which a significant number of the children experience a developmental regression characterized by a loss of previously acquired skills and abilities. Typically reported are losses of verbal, nonverbal, and social abilities. Several recent studies suggest that children diagnosed with an ASD have abnormal sulfation chemistry, limited thiol availability, and decreased glutathione (GSH) reserve capacity, resulting in a compromised oxidation/reduction (redox) and detoxification capacity. Research indicates that the availability of thiols, particularly GSH, can influence the effects of thimerosal (TM) and other mercury (Hg) compounds. TM is an organomercurial compound (49.55% Hg by weight) that has been, and continues to be, used as a preservative in many childhood vaccines, particularly in developing countries. Thiol-modulating mechanisms affecting the cytotoxicity of TM have been identified. Importantly, the emergence of ASD symptoms post-6 months of age temporally follows the administration of many childhood vaccines. The purpose of the present critical review is provide mechanistic insight regarding how limited thiol availability, abnormal sulfation chemistry, and decreased GSH reserve capacity in children with an ASD could make them more susceptible to the toxic effects of TM routinely administered as part of mandated childhood immunization schedules. PMID:23965928

Modeling the Transmission of Measles and Rubella to Support Global Management Policy Analyses and Eradication Investment Cases.

PubMed

Thompson, Kimberly M; Badizadegan, Nima D

2017-06-01

Policy makers responsible for managing measles and rubella immunization programs currently use a wide range of different vaccines formulations and immunization schedules. With endemic measles and rubella transmission interrupted in the region of the Americas, all five other regions of the World Health Organization (WHO) targeting the elimination of measles transmission by 2020, and increasing adoption of rubella vaccine globally, integrated dynamic disease, risk, decision, and economic models can help national, regional, and global health leaders manage measles and rubella population immunity. Despite hundreds of publications describing models for measles or rubella and decades of use of vaccines that contain both antigens (e.g., measles, mumps, and rubella vaccine or MMR), no transmission models for measles and rubella exist to support global policy analyses. We describe the development of a dynamic disease model for measles and rubella transmission, which we apply to 180 WHO member states and three other areas (Puerto Rico, Hong Kong, and Macao) representing >99.5% of the global population in 2013. The model accounts for seasonality, age-heterogeneous mixing, and the potential existence of preferentially mixing undervaccinated subpopulations, which create heterogeneity in immunization coverage that impacts transmission. Using our transmission model with the best available information about routine, supplemental, and outbreak response immunization, we characterize the complex transmission dynamics for measles and rubella historically to compare the results with available incidence and serological data. We show the results from several countries that represent diverse epidemiological situations to demonstrate the performance of the model. The model suggests relatively high measles and rubella control costs of approximately $3 billion annually for vaccination based on 2013 estimates, but still leads to approximately 17 million disability-adjusted life years lost with associated costs for treatment, home care, and productivity loss costs of approximately $4, $3, and $47 billion annually, respectively. Combined with vaccination and other financial cost estimates, our estimates imply that the eradication of measles and rubella could save at least $10 billion per year, even without considering the benefits of preventing lost productivity and potential savings from reductions in vaccination. The model should provide a useful tool for exploring the health and economic outcomes of prospective opportunities to manage measles and rubella. Improving the quality of data available to support decision making and modeling should represent a priority as countries work toward measles and rubella goals. © 2017 Society for Risk Analysis.

Guidelines for Creating a Transition Routine: Changing from One Room to Another

ERIC Educational Resources Information Center

McCoy, Kathleen M.; Mathur, Sarup. R.; Czoka, Andrea

2010-01-01

Research strongly suggests that visual supports, such as pictures, prompts, cue cards, story boards, graphic schedules, and diagrams, have been effective for providing instructional structure for a wide variety of children and for multiple activities. Making successful transitions from one activity to another is difficult for many children,…

Managing Highway Maintenance: Standards for Maintenance Work, Part 1, Unit 8, Level 2.

ERIC Educational Resources Information Center

Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

Part of the series "Managing Highway Maintenance," the unit is about maintenance standards and is designed for superintendents and senior foremen who are responsible for scheduling and controlling routine maintenance. It describes different kinds of standards, why and how standards are developed, and how standards are to be used and…

Playtime Is Science: Implementing a Parent/Child Activity Program.

ERIC Educational Resources Information Center

Sprung, Barbara; And Others

A program of science activities for children in the early childhood years and their parents is offered. The three different formats of the Playtime Is Science program are adaptable to a variety of settings and schedules. The Parent/Child Activity Program includes one parents-only session in which participants learn that routine chores involve…

Training Teachers at a School for the Handicapped in Quezaltenango, Guatemala.

ERIC Educational Resources Information Center

Lasky, Beth

A 5 day course was developed to train teachers at the Instituto Neurologico (Guatemala), a day school for about 50 children (aged 3 to 16) considered to be learning handicapped and educationally or trainably retarded. The course addressed five topics (one each day): special education, class routines and schedules, classroom management, evaluating…

15 CFR 716.1 - General information on the conduct of initial and routine inspections.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Schedule 3 chemical at all declared plants on the plant site exceeds 200 metric tons. (4) Unscheduled discrete organic chemical plant sites. Your declared plant site is subject to inspection if it produced by... chemicals containing phosphorus, sulfur or fluorine in the calculation of your plant site's aggregate...

15 CFR 716.1 - General information on the conduct of initial and routine inspections.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Schedule 3 chemical at all declared plants on the plant site exceeds 200 metric tons. (4) Unscheduled discrete organic chemical plant sites. Your declared plant site is subject to inspection if it produced by... chemicals containing phosphorus, sulfur or fluorine in the calculation of your plant site's aggregate...

15 CFR 716.1 - General information on the conduct of initial and routine inspections.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Schedule 3 chemical at all declared plants on the plant site exceeds 200 metric tons. (4) Unscheduled discrete organic chemical plant sites. Your declared plant site is subject to inspection if it produced by... chemicals containing phosphorus, sulfur or fluorine in the calculation of your plant site's aggregate...

40 CFR 53.4 - Applications for reference or equivalent method determinations.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) Required or recommended routine, periodic, and preventative maintenance and maintenance schedules. (J) Any... methods for PM 2.5 and PM 10-2,5 must be described in sufficient detail, based on the elements described... Table A-1 to this subpart) will be met throughout the warranty period and that the applicant accepts...

40 CFR 53.4 - Applications for reference or equivalent method determinations.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) Required or recommended routine, periodic, and preventative maintenance and maintenance schedules. (J) Any... methods for PM 2.5 and PM 10-2.5 must be described in sufficient detail, based on the elements described... Table A-1 to this subpart) will be met throughout the warranty period and that the applicant accepts...

The Trifold Display Board: A Visual and Portable Way to Present Physical Education Class Information

ERIC Educational Resources Information Center

Lavay, Barry; Alexander, Susan; Lawrence, Barbara

2008-01-01

Physical educators at all grade levels often provide instruction in open environments and classrooms without walls, such as gymnasiums, school playgrounds and athletic fields. Open teaching environments present unique challenges when it comes to implementing and displaying class information such as class schedules, routines and procedures, rules…

Anamnestic responses in pigs to the Taenia solium TSOL18 vaccine and implications for control strategies.

PubMed

Lightowlers, Marshall W; Donadeu, Meritxell; Elaiyaraja, M; Maithal, Kapil; Kumar, K Anand; Gauci, Charles G; Firestone, Simon M; Sarasola, Patxi; Rowan, Tim G

2016-04-01

Specific antibody responses were assessed in pigs immunized with the Taenia solium vaccine TSOL18. Anti-TSOL18 responses were compared 2 weeks after secondary immunization, where the interval between primary and secondary immunization was 4, 8, 12, 16 or 20 weeks. All animals responded to the vaccine and there was no diminution in antibody responses in animals receiving their second injection after an interval up to 20 weeks. Pigs receiving vaccinations at an interval of 12 weeks developed significantly increased antibody responses compared with animals receiving immunizations 4 weeks apart (P = 0.046). The ability to deliver TSOL18 vaccination effectively where the revaccination schedule can be delayed for up to 12-16 weeks in pigs increases the options available for designing T. solium control interventions that incorporate TSOL18 vaccination.

Maximizing protection from use of oral cholera vaccines in developing country settings

PubMed Central

Desai, Sachin N; Cravioto, Alejandro; Sur, Dipika; Kanungo, Suman

2014-01-01

When oral vaccines are administered to children in lower- and middle-income countries, they do not induce the same immune responses as they do in developed countries. Although not completely understood, reasons for this finding include maternal antibody interference, mucosal pathology secondary to infection, malnutrition, enteropathy, and previous exposure to the organism (or related organisms). Young children experience a high burden of cholera infection, which can lead to severe acute dehydrating diarrhea and substantial mortality and morbidity. Oral cholera vaccines show variations in their duration of protection and efficacy between children and adults. Evaluating innate and memory immune response is necessary to understand V. cholerae immunity and to improve current cholera vaccine candidates, especially in young children. Further research on the benefits of supplementary interventions and delivery schedules may also improve immunization strategies. PMID:24861554

38 CFR 4.88a - Chronic fatigue syndrome.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Chronic fatigue syndrome. 4.88a Section 4.88a Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings Infectious Diseases, Immune Disorders and Nutritional...

Cost-effectiveness of a herpes zoster vaccination program among the French elderly people.

PubMed

Belchior, Emmanuel; Lévy-Bruhl, Daniel; Le Strat, Yann; Herida, Magid

2016-09-01

A vaccine against herpes zoster (HZ) and its complications has already proven safe and effective against infection and pain and against the related deterioration of quality of life in the elderly. In order to inform the vaccination decision-making process regarding inclusion of this vaccine in the French immunization schedule, we assessed the cost-effectiveness of several vaccination scenarios, compared to no vaccination. We chose to use a previously published Markov model. Starting vaccination in elderly individuals aged 65, 70 and 75 y old appears more cost-effective than vaccination for those aged 60 y old, with a cost-effectiveness ratio between 30,000 and 35,000 euros per quality-adjusted-life year (QALY) gained for the first 3 age groups versus 54,500 €; for the latter group. These results largely contributed to the recommendation to include the HZ vaccination in the French immunization schedule for people aged between 65 and 74 y old in France.

[Vaccination schedule of the Spanish Association of Pediatrics: recommendations 2005].

PubMed

2005-02-01

The Advisory Committee on Vaccines of the Spanish Association of Pediatrics provides information and comments on the new developments in vaccines that have taken place in 2004 and recommends a few modifications to the Immunization Schedule for 2005. Concerning the meningococcal C vaccine, no change is made to the possibility of administering two doses for the first vaccination with one of the available formulations. The existence of immunization failure in children who have received a first vaccination with three vaccine doses before the age of 12 months is discussed, and the health authorities will probably include a booster dose in the second year of life throughout 2005. The recommendations of the European Medicines Evaluation Agency (EMEA) on hexavalent vaccines continue to be valid and consequently the use of these vaccines should not be stopped. This year the need for adolescents to receive a booster dose of the pertussis vaccine, with administration of an acellular, low antigenic load preparation together with the adult diphtheria and tetanus vaccine is stressed.

Duration of protection against hepatitis A for the current two-dose vaccine compared to a three-dose vaccine schedule in children

PubMed Central

Raczniak, Gregory A.; Thomas, Timothy K.; Bulkow, Lisa R.; Negus, Susan E.; Zanis, Carolyn L.; Bruce, Michael G.; Spradling, Philip R.; Teshale, Eyasu H.; McMahon, Brian J.

2015-01-01

Background Hepatitis A is mostly a self-limiting disease but causes substantial economic burden. Consequently, United States Advisory Committee for Immunization Practices recommends inactivated hepatitis A vaccination for all children beginning at age 1 year and for high risk adults. The hepatitis A vaccine is highly effective but the duration of protection is unknown. Methods We examined the proportion of children with protective hepatitis A antibody levels (anti-HAV ≥20 mIU/mL) as well as the geometric mean concentration (GMC) of anti-HAV in a cross sectional convenience sample of individuals aged 12–24 years, who had been vaccinated with a two-dose schedule in childhood, with the initial dose at least 5 years ago. We compared a subset of data from persons vaccinated with two-doses (720 EL.U.) at age 3–6 years with a demographically similar prospective cohort that received a three-dose (360 EL.U.) schedule and have been followed for 17 years. Results No significant differences were observed when comparing GMC between the two cohorts at 10 (P = 0.467), 12 (P = 0.496), and 14 (P = 0.175) years post-immunization. For the three-dose cohort, protective antibody levels remain for 17 years and have leveled-off over the past 7 years. Conclusion The two- and three-dose schedules provide similar protection >14 years after vaccination, indicating a booster dose is not needed at this time. Plateauing anti-HAV GMC levels suggest protective antibody levels may persist long-term. PMID:23470239

Effectiveness of Using Mobile Phone Image Capture for Collecting Secondary Data: A Case Study on Immunization History Data Among Children in Remote Areas of Thailand.

PubMed

Jandee, Kasemsak; Kaewkungwal, Jaranit; Khamsiriwatchara, Amnat; Lawpoolsri, Saranath; Wongwit, Waranya; Wansatid, Peerawat

2015-07-20

Entering data onto paper-based forms, then digitizing them, is a traditional data-management method that might result in poor data quality, especially when the secondary data are incomplete, illegible, or missing. Transcription errors from source documents to case report forms (CRFs) are common, and subsequently the errors pass from the CRFs to the electronic database. This study aimed to demonstrate the usefulness and to evaluate the effectiveness of mobile phone camera applications in capturing health-related data, aiming for data quality and completeness as compared to current routine practices exercised by government officials. In this study, the concept of "data entry via phone image capture" (DEPIC) was introduced and developed to capture data directly from source documents. This case study was based on immunization history data recorded in a mother and child health (MCH) logbook. The MCH logbooks (kept by parents) were updated whenever parents brought their children to health care facilities for immunization. Traditionally, health providers are supposed to key in duplicate information of the immunization history of each child; both on the MCH logbook, which is returned to the parents, and on the individual immunization history card, which is kept at the health care unit to be subsequently entered into the electronic health care information system (HCIS). In this study, DEPIC utilized the photographic functionality of mobile phones to capture images of all immunization-history records on logbook pages and to transcribe these records directly into the database using a data-entry screen corresponding to logbook data records. DEPIC data were then compared with HCIS data-points for quality, completeness, and consistency. As a proof-of-concept, DEPIC captured immunization history records of 363 ethnic children living in remote areas from their MCH logbooks. Comparison of the 2 databases, DEPIC versus HCIS, revealed differences in the percentage of completeness and consistency of immunization history records. Comparing the records of each logbook in the DEPIC and HCIS databases, 17.3% (63/363) of children had complete immunization history records in the DEPIC database, but no complete records were reported in the HCIS database. Regarding the individual's actual vaccination dates, comparison of records taken from MCH logbook and those in the HCIS found that 24.2% (88/363) of the children's records were absolutely inconsistent. In addition, statistics derived from the DEPIC records showed a higher immunization coverage and much more compliance to immunization schedule by age group when compared to records derived from the HCIS database. DEPIC, or the concept of collecting data via image capture directly from their primary sources, has proven to be a useful data collection method in terms of completeness and consistency. In this study, DEPIC was implemented in data collection of a single survey. The DEPIC concept, however, can be easily applied in other types of survey research, for example, collecting data on changes or trends based on image evidence over time. With its image evidence and audit trail features, DEPIC has the potential for being used even in clinical studies since it could generate improved data integrity and more reliable statistics for use in both health care and research settings.

[Modification of pertussis vaccination schedule in Chile, immunization of special groups and control strategies: Commentary from the Consultive Committee of Immunizations of The Chilean Society of Infectious Diseases].

PubMed

Potin, Marcela; Cerda, Jaime; Contreras, Lily; Muñoz, Alma; Ripoll, Erna; Vergara, Rodrigo

2012-06-01

In Chile, an increased number of notifications of cases of whooping cough was detected at the beginning of October 2010, and maintained through 2012. Accumulated cases during 2011 were 2,581 (15.0 per 100,000), which is greater than the number of cases registered during the period 2008-2010 (2,460 cases). On the other hand, the local sanitary authority introduced a modification of pertussis vaccination schedule (starting 2012), which consists in the replacement of the second booster of pertussis vaccine (DTwP, administered to 4-year-old children) as well as diphtheria-tetanus toxoid (dT, administered to second grade scholars) for an acellular pertussis vaccine with reduced antigenic content (dTpa), which will be administrated to first grade scholars. The Consultive Committee of Immunizations considers that the modification is adequate, since it extends the age of protection, reducing at least in theory the infection in older scholars and adolescents -who are significant sources of transmission of Bordetella pertussis to infants- using an adequate vaccine formulation (acellular pertussis vaccine). The available evidence regarding vaccination in special groups (adolescents and adults, health-care workers and pregnant women) and cocooning strategy are commented.

Assessing the Contributions of Private Health Facilities in a Pioneer Private-Public Partnership in Childhood Immunization in Nigeria

PubMed Central

Oluoha, Chukwuemeka; Ahaneku, Hycienth

2014-01-01

The vision of Nigeria’s immunization program is to reach and sustain routine immunization coverage of greater than 90% for all vaccines by 2020. In order to achieve this, Abia state embarked on a unique private-public partnership (PPP) between private health facilities and the Abia state ministry of health. The aim of this partnership was to collaborate with private health facilities to provide free childhood immunization services in the state - the first of its kind in Nigeria. This is a retrospective study of the 2011 Abia state, Nigeria monthly immunization data. In the 4 local governments operating the PPP, 45% (79/175) of the health facilities that offered immunization services in 2011 were private health facilities and 55% (96/175) were public health facilities. However, 21% of the immunization services took place in private health facilities while 79% took place in public health facilities. Private health facilities were shown to have a modest contribution to immunization in the 4 local governments involved in the PPP. Efforts should be made to expand PPP in immunization nationally to improve immunization services in Nigeria. PMID:28299112

Immune Monitoring for CMV in Transplantation.

PubMed

Yong, Michelle K; Lewin, Sharon R; Manuel, Oriol

2018-03-14

Immune monitoring to determine when and how the recovery of cytomegalovirus (CMV)-specific T-cells occurs post-transplantation may help clinicians to risk stratify individuals at risk of complications from CMV. We aimed to review all recent clinical studies using CMV immune monitoring in the pre- and post-transplant setting including the use of recently developed standardized assays (Quantiferon-CMV and the CMV ELISPOT) to better understand in whom, when, and how immune monitoring is best used. Pre-transplant assessment of CMV immunity in solid-organ transplant recipients where CMV seropositive recipients had undetectable cell-mediated responses despite past immunity has shown that they are at a much higher risk of developing CMV reactivation. Post-transplant CMV immune monitoring can guide (shorten or prolong) the duration of antiviral prophylaxis, identify recipients at risk of post-prophylaxis CMV disease, and predict recurrent CMV reactivation. Thus, CMV immune monitoring, in addition to current clinical and DNA-based monitoring for CMV, has the potential to be incorporated into routine clinical care to better improve CMV management in both the stem and solid-organ transplant population.

Immunizations for foreign travel.

PubMed Central

Hill, D. R.

1992-01-01

One of the most important aspects of preparing travelers for destinations throughout the world is providing them with immunizations. Before administering any vaccines, however, a careful health and immunization history and travel itinerary should be obtained in order to determine vaccine indications and contraindications. There are three categories of immunizations for foreign travel. The first category includes immunizations which are routinely recommended whether or not the individual is traveling. Many travelers are due for primary vaccination or boosting against tetanus-diphtheria, measles-mumps-rubella, pneumococcal pneumonia, and influenza, for example, and the pre-travel visit is an ideal time to administer these. The second category are immunizations which might be required by a country as a condition for entry; these are yellow fever and cholera. The final category contains immunizations which are recommended because there is a risk of acquiring a particular disease during travel. Typhoid fever, meningococcal disease, rabies, and hepatitis are some examples. Travelers who are pregnant or who are infected with the human immunodeficiency virus require special consideration. Provision of appropriate immunizations for foreign travel is an important aspect of preventing illness in travelers. PMID:1337807

Meta-analysis of vaccine effectiveness of mumps-containing vaccine under different immunization strategies in China.

PubMed

Wang, Huaqing; Hu, Yongmei; Zhang, Guomin; Zheng, Jingshan; Li, Li; An, Zhijie

2014-08-20

To evaluate vaccine effectiveness (VE) of mumps-containing vaccine (MuV) under different immunization strategies. We conducted Medline, Embase, China National Knowledge Internet (CNKI), and Wan Fang Database (WF) searches for Chinese and English language articles describing studies of mumps VE in a Chinese population. Evaluated articles were scored on quality using the Newcastle-Ottawa Scale. Meta-analysis was conducted using random effects models. Sensitivity analysis, subgroup analysis and meta-regression were conducted to explore heterogeneity. A total of 32 studies in 19 papers were included; 14 were case-control studies, and 18 were cohort studies. Half of the studies were of high quality; 41% were of moderate quality. The overall VE for mumps containing vaccine (either one dose or two doses) was 85% (95% CI 76-90%) for cohort studies and 88% (95% CI 82-92%) for case-control studies. Using random effects meta-regression we found significant differences in some study covariates; for instance, VE varied by population (VE=88% in day care versus 69% in pupil, p=0.008) and emergency versus routine immunization (VE=80% for routine immunization versus 95% for emergency immunization, p=0.041). However, these results must be interpreted with caution due to the low number of studies in subgroups, with the permutation test giving non-significant results that indicated that the results may be due to chance. MuV provides good protection from mumps infection. Further studies of mumps VE with larger sample sizes enabling subgroup analyses will be needed to confirm our findings. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Effectiveness, population-level effects, and heath economics of measles and rubella vaccination].

PubMed

Wichmann, O; Ultsch, B

2013-09-01

Vaccination against measles and rubella has been included in national immunization programs worldwide for several decades. In this article, we present the evidence related to the effectiveness of measles and rubella vaccination based on published systematic reviews, and we describe the epidemiological and health economic effects of vaccination at a population level. Several observational studies demonstrate the high effectiveness (> 90 %) of both measles and rubella vaccination. The global measles mortality reduction and the dramatic decrease in rubella and measles incidences after introduction of routine immunization contribute to the very high quality of evidence. The countries of the Americas have proved that it is feasible to eliminate measles and rubella by strengthening infant immunization through routine vaccination services and by conducting supplemental immunization activities in other childhood age groups so as to close immunity gaps. An economic evaluation of measles and rubella vaccination specifically for the healthcare system in Germany does not exist. However, we conducted a systematic review and identified 11 health-economic studies from other industrialized countries and one for a hypothetical industrialized country. Results indicate that vaccination against measles and rubella had either a cost-effective or even a cost-saving potential, which could be assumed with some limitations also for the German setting. In conclusion, there is compelling evidence that the available vaccines are very effective and that measles and rubella elimination is feasible if adequate vaccination strategies are implemented. In Germany, catch-up vaccination programs are urgently needed for children, adolescents, and young adults specifically in the western federal states.

Immunogenicity of a 7-valent pneumococcal conjugate vaccine (PCV7) and impact on carriage in Venezuelan children at risk of invasive pneumococcal diseases.

PubMed

Rivera-Olivero, Ismar A; Del Nogal, Berenice; Fuentes, Mariana; Cortez, Rossana; Bogaert, Debby; Hermans, Peter W M; Waard, Jacobus H de

2014-06-30

We evaluated the immunogenicity of the 7-valent pneumococcal conjugate vaccine (PCV7), and its impact on pneumococcal carriage in Venezuelan children at high risk for invasive pneumococcal disease (IPD). 82 children (age 2-59 months) with sickle cell anemia (n=22), chronic heart disease (n=19), HIV infection (n=12), immune-suppressive therapy (n=11) and other IPD-predisposing conditions (n=18) were vaccinated with PCV7 according to CDC-recommended age-related immunization schedules. Blood samples were taken to determine the concentration of IgG antibody, and nasopharyngeal swabs were obtained to isolate Streptococcus pneumoniae, before the first vaccine dose and 1 month after completion of the vaccination schedule. Pneumococcal carriage prior to the first immunization was 27% (n=22), with the most frequently carried serotypes being vaccine serotypes 6B (22%) and 14 (13%). One month after completion of the vaccination scheme pneumococcal carriage was 22% (n=17), dominated by non-vaccine serotypes 19A (24%) and 7F (12%). Before immunization, 65% of the subjects had IgG antibody titers >0.35 μg/mL for five serotypes tested. Post-vaccination, 100% of the subjects showed titers >1.0 μg/mL for all PCV7 serotypes with geometric mean concentrations (GMC) ranging from 1.75 μg/mL (serotype 23F) to 17.16 μg/mL (serotype 14). Children previously colonized with serotype 6B had a significantly lower GMC to this serotype following immunization than children not carrying 6B prior to the first PCV dose (p<0.05). PCV7 is highly immunogenic in Venezuelan children at high-risk for IPD. Vaccination was associated with an immediate shift in nasopharyngeal carriage toward non-PCV7 serotypes. Finally, we observed serotype-specific hyporesponsiveness to immunization after natural carriage with the same serotype in high-risk children. Copyright © 2014 Elsevier Ltd. All rights reserved.

Safety and Immunological Efficacy of a DNA Vaccine Encoding the Androgen Receptor Ligand-Binding Domain (AR-LBD).

PubMed

Olson, Brian M; Bradley, Eric S; Sawicki, Thomas; Zhong, Weixiong; Ranheim, Erik A; Bloom, Jordan E; Colluru, Viswa T; Johnson, Laura E; Rekoske, Brian T; Eickhoff, Jens C; McNeel, Douglas G

2017-05-01

The androgen receptor (AR) is a key oncogenic driver of prostate cancer, and has been the primary focus of prostate cancer treatment for several decades. We have previously demonstrated that the AR is also an immunological target antigen, recognized in patients with prostate cancer, and targetable by means of vaccines in rodent models with delays in prostate tumor growth. The current study was performed to determine the safety and immunological efficacy of a GMP-grade plasmid DNA vaccine encoding the ligand-binding domain (LBD) of the AR, pTVG-AR. Groups of male mice (n = 6-10 per group) were evaluated after four or seven immunizations, using different schedules and inclusion of GM-CSF as a vaccine adjuvant. Animals were assessed for toxicity using gross observations, pathological analysis, and analysis of serum chemistries. Animals were analyzed for evidence of vaccine-augmented immunity by tetramer analysis. Survival studies using different immunization schedules and inclusion of GM-CSF were conducted in an autochthonous genetically engineered mouse model. No significant toxicities were observed in terms of animal weights, histopathology, hematological changes, or changes in serum chemistries, although there was a trend to lower serum glucose in animals treated with the vaccine. There was specifically no evidence of toxicity in other tissues that express AR, including liver, muscle, hematopoietic, and brain. Vaccination was found to elicit AR LBD-specific CD8+ T cells. In a subsequent study of tumor-bearing animals, animals treated with vaccine had prolonged survival compared with control-immunized mice. These studies demonstrate that, in immunocompetent mice expressing the target antigen, immunization with the pTVG-AR vaccine was both safe and effective in eliciting AR-specific cellular immune responses, and prolonged the survival of prostate tumor-bearing mice. These findings support the clinical evaluation of pTVG-AR in patients with recurrent prostate cancer. Prostate 77:812-821, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

The Texas Children's Hospital immunization forecaster: conceptualization to implementation.

PubMed

Cunningham, Rachel M; Sahni, Leila C; Kerr, G Brady; King, Laura L; Bunker, Nathan A; Boom, Julie A

2014-12-01

Immunization forecasting systems evaluate patient vaccination histories and recommend the dates and vaccines that should be administered. We described the conceptualization, development, implementation, and distribution of a novel immunization forecaster, the Texas Children's Hospital (TCH) Forecaster. In 2007, TCH convened an internal expert team that included a pediatrician, immunization nurse, software engineer, and immunization subject matter experts to develop the TCH Forecaster. Our team developed the design of the model, wrote the software, populated the Excel tables, integrated the software, and tested the Forecaster. We created a table of rules that contained each vaccine's recommendations, minimum ages and intervals, and contraindications, which served as the basis for the TCH Forecaster. We created 15 vaccine tables that incorporated 79 unique dose states and 84 vaccine types to operationalize the entire United States recommended immunization schedule. The TCH Forecaster was implemented throughout the TCH system, the Indian Health Service, and the Virginia Department of Health. The TCH Forecast Tester is currently being used nationally. Immunization forecasting systems might positively affect adherence to vaccine recommendations. Efforts to support health care provider utilization of immunization forecasting systems and to evaluate their impact on patient care are needed.

Immune activity elevates energy expenditure of house sparrows: a link between direct and indirect costs?

PubMed Central

Martin, Lynn B; Scheuerlein, Alex; Wikelski, Martin

2003-01-01

The activation of an immune response is beneficial for organisms but may also have costs that affect fitness. Documented immune costs include those associated with acquisition of special nutrients, as well as immunopathology or autoimmunity. Here, we test whether an experimental induction of the immune system with a non-pathological stimulant can elevate energy turnover in passerine birds. We injected phytohaemagglutinin (PHA), a commonly used mitogen that activates the cell-mediated immune response, into the wing web of house sparrows, Passer domesticus. We then examined energetic costs resulting from this immune activity and related those costs to other physiological activities. We found that PHA injection significantly elevated resting metabolic rate (RMR) of challenged sparrows relative to saline controls. We calculated the total cost of this immune activity to be ca. 4.20 kJ per day (29% RMR), which is equivalent to the cost of production of half of an egg (8.23 kJ egg(-1)) in this species. We suggest that immune activity in wild passerines increases energy expenditure, which in turn may influence important life-history characteristics such as clutch size, timing of breeding or the scheduling of moult. PMID:12590753

Immunological considerations regarding parental concerns on pediatric immunizations.

PubMed

Nicoli, Francesco; Appay, Victor

2017-05-25

Despite the fundamental role of vaccines in the decline of infant mortality, parents may decide to decline vaccination for their own children. Many factors may influence this decision, such as the belief that the infant immune system is weakened by vaccines, and concerns have been raised about the number of vaccines and the early age at which they are administered. Studies focused on the infant immune system and its reaction to immunizations, summarized in this review, show that vaccines can overcome those suboptimal features of infant immune system that render them more at risk of infections and of their severe manifestations. In addition, many vaccines have been shown to improve heterologous innate and adaptive immunity resulting in lower mortality rates for fully vaccinated children. Thus, multiple vaccinations are necessary and not dangerous, as infants can respond to several antigens as well as when responding to single stimuli. Current immunization schedules have been developed and tested to avoid vaccine interference, improve benefits and reduce side effects compared to single administrations. The infant immune system is therefore capable, early after birth, of managing several antigenic challenges and exploits them to prompt its development. Copyright © 2017 Elsevier Ltd. All rights reserved.

Perspectives on polio and immunization in Northern Nigeria.

PubMed

Renne, Elisha

2006-10-01

Through the efforts of the global campaign to eradicate poliomyelitis, polio cases have declined worldwide, from 35,251 cases in 1988, to 1449 cases as of 28 October 2005. However, confirmed cases of wild polio virus continue to be reported from Northern Nigeria. This paper examines the reasons for the difficulties in eradicating polio in Northern Nigeria from the perspective of residents of one town, Zaria, in northern Kaduna State. Research methods included participant observation, open-ended interviews and the collection of polio-related documents. While some people believed that the vaccine was contaminated by anti-fertility substances, others questioned the focus on polio when measles and malaria were considered more harmful. Some also distrusted claims about the safety of Western biomedicine. These concerns relate to questions about the appropriateness of vertical health interventions, where levels of routine immunization are low. While the Polio Eradication Initiative was considered to be cost-effective by Western donors, from the perspective of some people in Zaria it was seen as undermining primary health care, suggesting that a collaborative, community-based framework for primary health care, which includes routine immunization, would be a more acceptable approach.

Detection of hepatitis B surface antigen in pregnant women attending a public hospital for delivery: implication for vaccination strategy in Bangladesh.

PubMed

Rumi, M A; Begum, K; Hassan, M S; Hasan, S M; Azam, M G; Hasan, K N; Shirin, M; Khan, A K

1998-08-01

Routine antenatal hepatitis B surface antigen (HBsAg) screening and immunization of risk babies is very effective in preventing perinatal transmission of hepatitis B virus (HBV). We studied 1,800 parturients attending a public hospital to assess the rationale for such vaccination in Bangladesh. In one in every 29 deliveries (63 of 1,800 or 3.5%), the mother was found to be HBsAg positive. All were asymptomatic and many (41 of 63 or 65%) without risk factors would remain undetected if HBsAg screening were performed on selected groups. Most of the HBsAg-positive mothers (54 of 63 or 85.7%) were found to be chronic carriers and 30.2% (19 of 63) were also hepatitis B e antigen (HBeAg) positive, indicating high infectivity. Although 23 cord blood were positive for HBsAg or HBeAg, none were positive for IgM antibody to hepatitis B core antigen (IgM anti-HBc), suggesting transplacental transmission of the antigens rather than intrauterine infection. These findings are discussed in relation to the cost-effectiveness of routine prenatal screening and immunization of risk babies compared with universal infant immunization.

Recommendations of 2nd National Consultative Meeting of Indian Academy of Pediatrics (IAP) on polio eradication and improvement of routine immunization.

PubMed

Vashishtha, Vipin M; Kalra, Ajay; John, T Jacob; Thacker, Naveen; Agarwal, R K

2008-05-01

Persistence of intense wild poliovirus (WPV) transmission, particularly type 3 in northern India necessitated the Indian Academy of Pediatrics (IAP) to convene a National Consultative Meeting to review its earlier recommendations on polio eradication and improvement of routine immunization. More than thirty experts were invited and intense deliberations were held over two days to draw consensus statements on various issues related with polio eradication. To review the ongoing strategy, identify the existing challenges, and suggest modifications to the current strategy for eradication of poliomyelitis in India. IAP reiterates its support to ongoing efforts on polio eradication but demand some flexibility in the strategy. The immediate challenges identified include persistent WPV type 1 transmission in Uttar Pradesh (UP) and Bihar, intense type 3 transmission also in UP and Bihar, and maintaining polio-free status of all other states. Circulating vaccine derived poliovirus (cVDPV), particularly type 2, was identified as a great future threat. Neglect of routine immunization (RI), poor efficacy of oral polio vaccine (OPV), operational issues, and inadequate uptake of OPV in the 2 endemic states are the main reasons of failure to interrupt transmission of WPV 1 and 3. However, for the first time in history the intensity of WPV 1 circulation is very low in western UP. IAP suggests that high-quality, uniform and consistent performance of supplementary immunization activities (SIAs) in all districts of western UP, particularly using mOPV1(monovalent OPV1) should be maintained to avoid reestablishment of circulation of type 1 poliovirus. A judicious mix of mOPV1 and mOPV3, given sequentially or even simultaneously (after validating the efficacies) will be necessary to address the upsurge of WPV3. Re-establishing routine immunization should be the foremost priority. IAP strongly recommends to Government of India (GOI) to take urgent measures to attain coverage of a minimum of 90% against all UIP antigens in all the states by the end of 2008. In view of the need to simultaneously raise immunity levels to protect against WPVs 1, 3 and cVDPV2, IPV may be given immediate consideration as an additional tool. IPV will be essential in the postWPVeradication phase; it can play a useful role even in the current WPV eradication phase. IAP urges the GOI to urgently sort out various issues associated with implementation of the proposal to use IPV. More transparency is needed on cases of vaccine associated paralytic poliomyelitis (VAPP). Further improvement in stool collection rates is also warranted to minimize the tally of compatible cases. IAP urges the social mobilization network to address the issues of waning interest and shifting focus and negative media coverage. Alternate tactics like reduced numbers of SIAs applied in the low transmission season, along with IPVDTP combination vaccine in RI can also be considered. IAP believes it will be risky to stop vaccination against poliomyelitis in postWPV eradication phase. The best option is to gradually introduce IPV starting now, so that a switch to IPV following high-performance national immunization days (NIDs) can be made to ensure sustained high immunity against all polioviruses, wild and vaccine derived. IAP requests the global polio eradication initiative (GPEI) to continue relevant research to inform on various aspects related to polio eradication, defined as zero incidence of any poliovirus infection. IAP also urges GOI to take immediate measures for improvement of environmental sanitation.

Effectiveness of Haemophilus influenzae type b conjugate vaccine introduction into routine childhood immunization in Kenya

PubMed Central

Cowgill, Karen D.; Ndiritu, Moses; Nyiro, Joyce; Slack, Mary P. E.; Chiphatsi, Salome; Ismail, Amina; Kamau, Tatu; Mwangi, Isaiah; English, Mike; Newton, Charles R. J. C.; Feikin, Daniel R.; Scott, J. Anthony G.

2006-01-01

Context Haemophilus influenzae type b (Hib) conjugate vaccine is not perceived as a public health priority in Africa because data on Hib disease burden and vaccine effectiveness are scarce. Hib immunization was introduced in Kenyan infants in 2001. Objective to define invasive Hib disease incidence and Hib vaccine program effectiveness. Design, Setting, Patients culture-based surveillance for invasive Hib disease at Kilifi District Hospital from 2000 to 2005 was linked to demographic surveillance of 38,000 children aged <5 years in Kilifi District, Kenya. HIV infection and Hib vaccination status were determined for children with Hib disease admitted 2002–2005. Interventions Conjugate Hib vaccine within the routine childhood immunization program at ages 6, 10 and 14 weeks from November 2001 Main outcome measures Incidence of culture-proven Hib invasive disease before and after vaccine introduction and vaccine program effectiveness (1-incidence rate ratio) Results Prior to vaccine introduction the median age of Hib cases was 8 months; case fatality was 23%. Among children aged <5 years the annual incidence of invasive Hib disease 1 year before and 1 and 3 years after vaccine introduction was 66, 47 and 7.6 per 100,000, respectively. For children <2 years, incidence was 119, 82 and 16, respectively. In 2004–2005 vaccine effectiveness was 88% (95% CI 73–96%) among children <5 years and 87% (95% CI 66–96%) among children <2 years. Of 53 Hib cases admitted during 2002–2005, 29 (55%) were age-ineligible to have received vaccine, 12 (23%) had not been vaccinated despite being eligible, and 12 (23%) had received ≥2 doses of vaccine (2 were HIV-positive). Conclusions In Kenya, introduction of Hib vaccine into the routine childhood immunization program reduced Hib disease incidence among children aged <5 years to 12% of its baseline level. This impact was not observed until the third year after vaccine introduction. PMID:16896110

Variation in the costs of delivering routine immunization services in Peru.

PubMed

Walker, D; Mosqueira, N R; Penny, M E; Lanata, C F; Clark, A D; Sanderson, C F B; Fox-Rushby, J A

2004-09-01

Estimates of vaccination costs usually provide only point estimates at national level with no information on cost variation. In practice, however, such information is necessary for programme managers. This paper presents information on the variations in costs of delivering routine immunization services in three diverse districts of Peru: Ayacucho (a mountainous area), San Martin (a jungle area) and Lima (a coastal area). We consider the impact of variability on predictions of cost and reflect on the likely impact on expected cost-effectiveness ratios, policy decisions and future research practice. All costs are in 2002 prices in US dollars and include the costs of providing vaccination services incurred by 19 government health facilities during the January-December 2002 financial year. Vaccine wastage rates have been estimated using stock records. The cost per fully vaccinated child ranged from 16.63-24.52 U.S. Dollars in Ayacucho, 21.79-36.69 U.S. Dollars in San Martin and 9.58-20.31 U.S. Dollars in Lima. The volume of vaccines administered and wastage rates are determinants of the variation in costs of delivering routine immunization services. This study shows there is considerable variation in the costs of providing vaccines across geographical regions and different types of facilities. Information on how costs vary can be used as a basis from which to generalize to other settings and provide more accurate estimates for decision-makers who do not have disaggregated data on local costs. Future studies should include sufficiently large sample sizes and ensure that regions are carefully selected in order to maximize the interpretation of cost variation.

Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance.

PubMed

2016-09-01

Routine childhood immunizations against infectious diseases are an integral part of our public health infrastructure. They provide direct protection to the immunized individual and indirect protection to children and adults unable to be immunized via the effect of community immunity. All 50 states, the District of Columbia, and Puerto Rico have regulations requiring proof of immunization for child care and school attendance as a public health strategy to protect children in these settings and to secondarily serve as a mechanism to promote timely immunization of children by their caregivers. Although all states and the District of Columbia have mechanisms to exempt school attendees from specific immunization requirements for medical reasons, the majority also have a heterogeneous collection of regulations and laws that allow nonmedical exemptions from childhood immunizations otherwise required for child care and school attendance. The American Academy of Pediatrics (AAP) supports regulations and laws requiring certification of immunization to attend child care and school as a sound means of providing a safe environment for attendees and employees of these settings. The AAP also supports medically indicated exemptions to specific immunizations as determined for each individual child. The AAP views nonmedical exemptions to school-required immunizations as inappropriate for individual, public health, and ethical reasons and advocates for their elimination. Copyright © 2016 by the American Academy of Pediatrics.

SOFIA's Choice: Automating the Scheduling of Airborne Observations

NASA Technical Reports Server (NTRS)

Frank, Jeremy; Norvig, Peter (Technical Monitor)

1999-01-01

This paper describes the problem of scheduling observations for an airborne telescope. Given a set of prioritized observations to choose from, and a wide range of complex constraints governing legitimate choices and orderings, how can we efficiently and effectively create a valid flight plan which supports high priority observations? This problem is quite different from scheduling problems which are routinely solved automatically in industry. For instance, the problem requires making choices which lead to other choices later, and contains many interacting complex constraints over both discrete and continuous variables. Furthermore, new types of constraints may be added as the fundamental problem changes. As a result of these features, this problem cannot be solved by traditional scheduling techniques. The problem resembles other problems in NASA and industry, from observation scheduling for rovers and other science instruments to vehicle routing. The remainder of the paper is organized as follows. In 2 we describe the observatory in order to provide some background. In 3 we describe the problem of scheduling a single flight. In 4 we compare flight planning and other scheduling problems and argue that traditional techniques are not sufficient to solve this problem. We also mention similar complex scheduling problems which may benefit from efforts to solve this problem. In 5 we describe an approach for solving this problem based on research into a similar problem, that of scheduling observations for a space-borne probe. In 6 we discuss extensions of the flight planning problem as well as other problems which are similar to flight planning. In 7 we conclude and discuss future work.

CMV-specific immune reconstitution following allogeneic stem cell transplantation

PubMed Central

Blyth, Emily; Withers, Barbara; Clancy, Leighton; Gottlieb, David

2016-01-01

ABSTRACT Cytomegalovirus (CMV) remains a major contributor to morbidity and mortality following allogeneic haemopoietic stem cell transplant (HSCT) despite widespread use of viraemia monitoring and pre-emptive antiviral therapy. Uncontrolled viral replication occurs primarily in the first 100 d post transplant but this high risk period can extend to many months if immune recovery is delayed. The re-establishment of a functional population of cellular effectors is essential for control of virus replication and depends on recipient and donor serostatus, the stem cell source, degree of HLA matching and post-transplant factors such as CMV antigen exposure, presence of GVHD and ongoing use of immune suppression. A number of immune monitoring assays exist but have not yet become widely accessible for routine clinical use. Vaccination, adoptive transfer of CMV specific T cells and a number of graft engineering processes are being evaluated to enhance of CMV specific immune recovery post HSCT. PMID:27580355

Mainstreaming implementation science into immunization systems in the decade of vaccines: a programmatic imperative for the African Region.

PubMed

Adamu, Abdu A; Adamu, Aishatu L; Dahiru, Abdulkarim I; Uthman, Olalekan A; Wiysonge, Charles S

2018-05-17

Several innovations that can improve immunization systems already exist. Some interventions target service consumers within communities to raise awareness, build trust, improve understanding, remind caregivers, reward service users, and improve communication. Other interventions target health facilities to improve access and quality of vaccination services among others. Despite available empirical evidence, there is a delay in translating innovations into routine practice by immunization programmes. Drawing on an existing implementation science framework, we propose an interactive, and multi-perspective model to improve uptake and utilization of available immunization-related innovations in the African region. It is important to stress that our framework is by no means prescriptive. The key intention is to advocate for the entire immunization system to be viewed as an interconnected system of stakeholders, so as to foster better interaction, and proactive transfer of evidence-based innovation into policy and practice.

Evaluation of impact of measles rubella campaign on vaccination coverage and routine immunization services in Bangladesh.

PubMed

Uddin, Md Jasim; Adhikary, Gourab; Ali, Md Wazed; Ahmed, Shahabuddin; Shamsuzzaman, Md; Odell, Chris; Hashiguchi, Lauren; Lim, Stephen S; Alam, Nurul

2016-08-12

Like other countries in Asia, measles-rubella (MR) vaccine coverage in Bangladesh is suboptimal whereas 90-95 % coverage is needed for elimination of these diseases. The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh implemented MR campaign in January-February 2014 to increase MR vaccination coverage. Strategically, the MOHFW used both routine immunization centres and educational institutions for providing vaccine to the children aged 9 months to <15 years. The evaluation was carried out to assess the impact of the campaign on MR vaccination and routine immunization services. Both quantitative and qualitative evaluations were done before and after implementation of the campaign. Quantitative data were presented with mean (standard deviation, SD) for continuous variables and with proportion for categorical variables. The overall and age- and sex-specific coverage rates were calculated for each region and then combined. Categorical variables were compared by chi-square statistics. Multiple logistic regression analysis were performed to estimate odds ratios (OR) and 95 % confidence intervals (CI) of coverage associated with covariates, with adjustment for other covariates. Qualitative data were analyzed using content analysis. The evaluations found MR coverage was very low (<13 %) before the campaign and it rose to 90 % after the campaign. The pre-post campaign difference in MR coverage in each stratum was highly significant (p < 0.001). The campaign achieved high coverage despite relatively low level (23 %) of interpersonal communication with caregivers through registration process. Child registration was associated with higher MR coverage (OR 2.91, 95 % CI 1.91-4.44). Children who attended school were more likely to be vaccinated (OR 8.97, 95 % CI 6.17-13.04) compared to those who did not attend school. Children of caregivers with primary or secondary or higher education had higher coverage compared to children of caregivers with no formal education. Most caregivers mentioned contribution of the campaign in vaccination for the children not previously vaccinated. The results of the evaluation indicated that the campaign was successful in terms of improving MR coverage and routine immunization services. The evaluation provided an important guideline for future evaluation of similar efforts in Bangladesh and elsewhere.

Dosing Schedules for Pneumococcal Conjugate Vaccine

PubMed Central

2014-01-01

Since second generation pneumococcal conjugate vaccines (PCVs) targeting 10 and 13 serotypes became available in 2010, the number of national policy makers considering these vaccines has steadily increased. An important consideration for a national immunization program is the timing and number of doses—the schedule—that will best prevent disease in the population. Data on disease epidemiology and the efficacy or effectiveness of PCV schedules are typically considered when choosing a schedule. Practical concerns, such as the existing vaccine schedule, and vaccine program performance are also important. In low-income countries, pneumococcal disease and deaths typically peak well before the end of the first year of life, making a schedule that provides PCV doses early in life (eg, a 6-, 10- and 14-week schedule) potentially the best option. In other settings, a schedule including a booster dose may address disease that peaks in the second year of life or may be seen to enhance a schedule already in place. A large and growing body of evidence from immunogenicity studies, as well as clinical trials and observational studies of carriage, pneumonia and invasive disease, has been systematically reviewed; these data indicate that schedules of 3 or 4 doses all work well, and that the differences between these regimens are subtle, especially in a mature program in which coverage is high and indirect (herd) effects help enhance protection provided directly by a vaccine schedule. The recent World Health Organization policy statement on PCVs endorsed a schedule of 3 primary doses without a booster or, as a new alternative, 2 primary doses with a booster dose. While 1 schedule may be preferred in a particular setting based on local epidemiology or practical considerations, achieving high coverage with 3 doses is likely more important than the specific timing of doses. PMID:24336059

Vaccine chronicle in Japan.

PubMed

Nakayama, Tetsuo

2013-10-01

The concept of immunization was started in Japan in 1849 when Jenner's cowpox vaccine seed was introduced, and the current immunization law was stipulated in 1948. There have been two turning points for amendments to the immunization law: the compensation remedy for vaccine-associated adverse events in 1976, and the concept of private vaccination in 1994. In 1992, the regional Court of Tokyo, not the Supreme Court, decided the governmental responsibility on vaccine-associated adverse events, which caused the stagnation of vaccine development. In 2010, many universal vaccines became available as the recommended vaccines, but several vaccines, including mumps, zoster, hepatitis B, and rota vaccines, are still voluntary vaccines, not universal routine applications. In this report, immunization strategies and vaccine development are reviewed for each vaccine item and future vaccine concerns are discussed.

Employees' work responses to episodes of illness: evidence from the American time use survey.

PubMed

Gifford, Brian; Jinnett, Kimberly

2014-02-01

To better understand presenteeism and absenteeism on the basis of the choices employees make about working when they experience episodes of illness. We examine nationally representative data to describe employees' work responses to episodes of illness and how different leave policies contribute to their decisions. Illness episodes typically result in absence from work rather than working a normal or adjusted routine. Employees adjust their routine when ill primarily to save leave or because they have too much work. Paid sick leave and scheduling flexibility influence the likelihood of absence in different ways. Although flexibility to adjust work routines can reduce absences, it is not known to what extent productivity suffers when this occurs. Measures of both short- and long-term presenteeism are necessary to understand the full productivity costs of illness in the workforce.

Impact of inactivated poliovirus vaccine on mucosal immunity: implications for the polio eradication endgame

PubMed Central

Parker, Edward PK; Molodecky, Natalie A; Pons-Salort, Margarita; O’Reilly, Kathleen M; Grassly, Nicholas C

2015-01-01

The polio eradication endgame aims to bring transmission of all polioviruses to a halt. To achieve this aim, it is essential to block viral replication in individuals via induction of a robust mucosal immune response. Although it has long been recognized that inactivated poliovirus vaccine (IPV) is incapable of inducing a strong mucosal response on its own, it has recently become clear that IPV may boost immunity in the intestinal mucosa among individuals previously immunized with oral poliovirus vaccine. Indeed, mucosal protection appears to be stronger following a booster dose of IPV than oral poliovirus vaccine, especially in older children. Here, we review the available evidence regarding the impact of IPV on mucosal immunity, and consider the implications of this evidence for the polio eradication endgame. We conclude that the implementation of IPV in both routine and supplementary immunization activities has the potential to play a key role in halting poliovirus transmission, and thereby hasten the eradication of polio. PMID:26159938

[Vaccination schedule of the Spanish Association of Pediatrics: recommendations 2004].

PubMed

2004-05-01

The Vaccine Assessment Committee of the Spanish Association of Pediatrics discusses vaccine developments in 2003 and recommends some modifications to the vaccination schedule. The recommendation of substituting the oral polio vaccine for the inactivated polio vaccine, suppressing the fifth dose, is maintained. The introduction of the conjugate pneumococcal vaccine and the varicella vaccine is stressed. Concerning the meningococcal C vaccine, the improvement introduced by being able to immunize with just two doses is discussed. In agreement with the information received from the European Medicines Agency, there appear to be no well-founded reasons to abandon hexavalent preparations.

Physician Attitudes Toward Adult Vaccines and Other Preventive Practices, United States, 2012.

PubMed

Hurley, Laura P; Bridges, Carolyn B; Harpaz, Rafael; Allison, Mandy A; O' Leary, Sean T; Crane, Lori A; Brtnikova, Michaela; Stokley, Shannon; Beaty, Brenda L; Jimenez-Zambrano, Andrea; Kempe, Allison

2016-01-01

We described the following among U.S. primary care physicians: (1) perceived importance of vaccines recommended by the Advisory Committee on Immunization Practices relative to U.S. Preventive Services Task Force (USPSTF) preventive services, (2) attitudes toward the U.S. adult immunization schedule, and (3) awareness and use of Medicare preventive service visits. We conducted an Internet and mail survey from March to June 2012 among national networks of general internists and family physicians. We received responses from 352 of 445 (79%) general internists and 255 of 409 (62%) family physicians. For a 67-year-old hypothetical patient, 540/606 (89%, 95% confidence interval [CI] 87, 92) of physicians ranked seasonal influenza vaccine and 487/607 (80%, 95% CI 77, 83) ranked pneumococcal vaccine as very important, whereas 381/604 (63%, 95% CI 59, 67) ranked Tdap/Td vaccine and 288/607 (47%, 95% CI 43, 51) ranked herpes zoster vaccine as very important (p<0.001). All Grade A USPSTF recommendations were considered more important than Tdap/Td and herpes zoster vaccines. For the hypothetical patient aged 30 years, the number and percentage of physicians who reported that the Tdap/Td vaccine (377/604; 62%, 95% CI 59, 66) is very important was greater than the number and percentage who reported that the seasonal influenza vaccine (263/605; 43%, 95% CI 40, 47) is very important (p<0.001), and all Grade A and Grade B USPSTF recommendations were more often reported as very important than was any vaccine. A total of 172 of 587 physicians (29%) found aspects of the adult immunization schedule confusing. Among physicians aware of "Welcome to Medicare" and annual wellness visits, 492/514 (96%, 95% CI 94, 97) and 329/496 (66%, 95% CI 62, 70), respectively, reported having conducted fewer than 10 such visits in the previous month. Despite lack of prioritization of vaccines by ACIP, physicians are prioritizing some vaccines over others and ranking some vaccines below other preventive services. These attitudes and confusion about the immunization schedule may result in missed opportunities for vaccination. Medicare preventive visits are not being used widely despite offering a venue for delivery of preventive services, including vaccinations.

Apps for immunization: Leveraging mobile devices to place the individual at the center of care.

PubMed

Wilson, Kumanan; Atkinson, Katherine M; Westeinde, Jacqueline

2015-01-01

Mobile technology and applications (apps) have disrupted several industries including healthcare. The advantage of apps, being personally focused and permitting bidirectional communication, make them well suited to address many immunization challenges. As of April 25, 2015 searching the Android app store with the words 'immunize app' and 'immunization app' in Canada yielded 225 apps. On the Apple App Store a similar search produced 98 results. These include apps that provide immunization related information, permit vaccine tracking both for individuals and for animals, assist with the creation of customized schedules and identification of vaccine clinics and serve as sources of education. The diverse functionality of mobile apps creates the potential for transformation of immunization practice both at a personal level and a system level. For individuals, mobile apps offer the opportunity for better record keeping, assistance with the logistics of vaccination, and novel ways of communicating with and receiving information from public health officials. For the system, mobile apps offer the potential to improve the quality of information residing in immunization information systems and program evaluation, facilitate harmonization of immunization information between individuals, health care providers and public health as well as reduce vaccine hesitancy. As mobile technology continues to rapidly evolve there will emerge new ways in which apps can enhance immunization practice.

Transport networks and inequities in vaccination: remoteness shapes measles vaccine coverage and prospects for elimination across Africa.

PubMed

Metcalf, C J E; Tatem, A; Bjornstad, O N; Lessler, J; O'Reilly, K; Takahashi, S; Cutts, F; Grenfell, B T

2015-05-01

Measles vaccination is estimated to have averted 13·8 million deaths between 2000 and 2012. Persisting heterogeneity in coverage is a major contributor to continued measles mortality, and a barrier to measles elimination and introduction of rubella-containing vaccine. Our objective is to identify determinants of inequities in coverage, and how vaccine delivery must change to achieve elimination goals, which is a focus of the WHO Decade of Vaccines. We combined estimates of travel time to the nearest urban centre (⩾50 000 people) with vaccination data from Demographic Health Surveys to assess how remoteness affects coverage in 26 African countries. Building on a statistical mapping of coverage against age and geographical isolation, we quantified how modifying the rate and age range of vaccine delivery affects national coverage. Our scenario analysis considers increasing the rate of delivery of routine vaccination, increasing the target age range of routine vaccination, and enhanced delivery to remote areas. Geographical isolation plays a key role in defining vaccine inequity, with greater inequity in countries with lower measles vaccine coverage. Eliminating geographical inequities alone will not achieve thresholds for herd immunity, indicating that changes in delivery rate or age range of routine vaccination will be required. Measles vaccine coverage remains far below targets for herd immunity in many countries on the African continent and is likely to be inadequate for achieving rubella elimination. The impact of strategies such as increasing the upper age range eligible for routine vaccination should be considered.