State Department : serious problems in the anthrax vaccine immunization program : report to congressional requesters /

"GAO-01-21."

Development and testing of an analytical framework for immunization program planning in Canada

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Development and testing of an analytical framework for immunization program planning in Canada

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Iowa Immunization Program Annual Report 2013, April 30, 2014

The Bureau of Immunization is part of the Division of Acute Disease Prevention and Emergency Response (ADPER) at the Iowa Department of Public Health (IDPH). The ADPER division provides support, technical assistance and consultation to local hospitals, public health agencies, community health centers, emergency medical service programs and local health care providers regarding infectious diseases, disease prevention and control, injury prevention and public health and health care emergency preparedness and response. The division encompasses the Center for Acute Disease Epidemiology (CADE), the Bureau of Immunization and Tuberculosis (ITB), the Bureau of Emergency Medical Services (EMS), the Bureau of Communication and Planning (CAP), the Office of Health Information Technology (HIT), and the Center for Disaster Operations and Response (CDOR). The Bureau of Immunization and Tuberculosis includes the Immunization Program, the Tuberculosis Control Program, and the Refugee Health Program. The mission of the Immunization Program is to decrease vaccine‐preventable diseases through education, advocacy and partnership. While there has been major advancement in expanding immunizations to many parts of Iowa’s population, work must continue with public and private health care providers to promote the program’s vision of healthy Iowans living in communities free of vaccine‐preventable diseases. Accomplishing this goal will require achieving and maintaining high vaccination coverage levels, improving vaccination strategies among under‐vaccinated populations, prompt reporting and thorough investigation of suspected disease cases, and rapid institution of control measures. The Immunization Program is comprised of multiple programs that provide immunization services throughout the state: Adolescent Immunization Program, Adult Immunization Program, Immunization Registry Information System (IRIS), Vaccines for Children Program (VFC), Perinatal Hepatitis B Program, and Immunization Assessment Program.

Interplay of Virulence Factors in Complement Resistance of Streptococcus pneumoniae

Streptococcus pneumoniae (pneumococcus) is a normal inhabitant of the human nasopharynx. Symptoms occur in only a small proportion of those who become carriers, but the ubiquity of the organism in the human population results in a large burden of disease. S. pneumoniae is the leading bacterial cause of pneumonia, sepsis, and meningitis worldwide, causing the death of a million children each year. Middle-ear infection is the most common clinical manifestation of mucosal pneumococcal infections. In invasive disease, S. pneumoniae gains access to the bloodstream and spreads to normally sterile parts of the body. The progression from asymptomatic colonization to disease depends on factors characteristic of specific pneumococcal strains as well as the status of host defenses. The polysaccharide capsule surrounding the bacterium is considered to be the most important factor affecting the virulence of pneumococci. It protects pneumococci from phagocytosis and also may determine its affinity to the respiratory epithelium. S. pneumoniae as a species comprises more than 90 different capsular serotypes, but not all of them are equally prevalent in human diseases. Invasive serotypes are rarely isolated from healthy carriers, but relatively often cause invasive disease. Serotypes that are carried asymptomatically for a long time behave like opportunistic pathogens, causing disease in patients who have impaired immune defenses. The complement system is a collection of blood and cell surface proteins that act as a major primary defense against invading microbes. Phagocytic cells with receptors for complement proteins can engulf and destroy pneumococcal cells opsonized with these proteins. S. pneumoniae has evolved a number of ways to subvert mechanisms of innate immunity, and this is likely to contribute to its pathogenicity. The capsular serotype, proteins essential for virulence, as well the genotype, may all influence the ability of pneumococcus to resist complement and its potential to cause disease. Immunization with conjugate vaccines produces opsonic antibodies, which enhance complement deposition and clearance of the bacteria. The pneumococcal vaccine included in the Finnish national immunization program in 2010 contains the most common serotypes causing invasive disease. Clinical data suggest that protection from middle-ear infection and possibly also from invasive disease depends largely on the capsular serotype, for reasons hitherto unknown. The general aim of this thesis is to assess the relative roles of the pneumococcal capsule and virulence proteins in complement evasion and subsequent opsonophagocytic killing. The main question is whether differences between serotypes to resist complement explain the different abilities of serotypes to cause disease. The importance of particular virulence factors to the complement resistance of a strain may vary depending on its genotype. Prior studies have evaluated the effect of the capsule and virulence proteins on complement resistance of S. pneumoniae by comparing only a few strains. In this thesis, the role of pneumococcal virulence factors in the complement resistance of the bacterium was studied in several genotypically different strains. The ability of pneumococci to inhibit deposition of the complement protein C3 on the bacterial surface was found to depend on the capsular serotype as well as on other features of the bacteria. The results suggest that pneumococcal histidine triad (Pht) proteins may play a role in complement inhibition, but their contribution depends on the bacterial genotype. The capsular serotype was found to influence complement resistance more than the bacterial genotype. A higher concentration of anticapsular antibodies was required for the opsonophagocytic killing of serotypes resistant to C3 deposition. The invasive serotypes were more resistant to C3 deposition than the opportunistic serotypes, suggesting that the former are better adapted to resist immune mechanisms controlling the development of invasive disease. The different susceptibilities of serotypes to complement deposition, opsonophagocytosis, and resultant antibody-mediated protection should be taken into account when guidelines for serological correlates for vaccine efficacy evaluations are made. The results of this thesis suggest that antibodies in higher quantity or quality are needed for efficient protection against the invasive serotypes.

Stratégie de vaccination familiale contre la coqueluche (méthode de cocooning) à la maternité : analyse coût-efficacité d'un programme provincial

Le manuscrit constituant l'annexe 1 a été publié en décembre 2013 sous la référence : Vaccine. 2013 Dec 9;31(51):6087-91.

Stratégies visant à accroître la demande de vaccination infantile dans les pays en développement : révision systématique et méta-analyse

La vaccination figure parmi les interventions sanitaires les plus efficaces et les plus rentables connues. Pourtant, des inégalités de couverture persistent entre les régions et les pays. Les interventions visant à améliorer la couverture vaccinale sont généralement regroupées soit comme interventions pour améliorer l’offre ou la prestation des services de santé, soit comme interventions pour stimuler la demande pour les services de vaccination. L’objectif de cette étude est d’évaluer si les interventions du côté de la demande qui visent à améliorer la couverture vaccinale peuvent accroître la vaccination de routine des enfants dans les pays en développement. Nous avons effectué une revue systématique et une méta-analyse des essais randomisés contrôlés ainsi que d’autres types d’études scientifiques réalisées dans des pays en développement. La population ciblée comprenait les parents et les gardiens d'enfants de moins de deux ans qui sont exposés à une intervention visant à accroître la demande de vaccination de routine des enfants. La recherche des études originales dans les différentes bases de données a été limitée aux études publiées avant septembre 2013 (dernière mise à jour le 25 Mars 2014) dans 6 langues. Onze études ont été sélectionnées puis classifiées dans deux catégories: (a) éducation ou transfert de connaissances (7 études) et (b) incitations (4 études). Les résultats de la métaanalyse ont démontré un impact positif des interventions sur la demande de vaccination des enfants dans les pays en développement (RR 1.30; 95% CI 1.17, 1.44). Ces impacts positifs ont été constatés autant pour les interventions qui comprennent l’éducation ou transfert de connaissances (RR 1.40; 95% CI1.20, 1.63) que pour les interventions de type incitation (RR 1.28; 95% CI 1.12, 1.45). Les résultats suggèrent que diverses stratégies visant à accroître la demande peuvent conduire à une augmentation de la couverture vaccinale dans différents pays en développement.

Análisis económico de las vacunas 10-valente y 13-valente contra neumococo: revisión sistemática

Introducción: Las vacunas clásicamente han representado un método económico y eficaz para el control y prevención de múltiples enfermedades infecciosas. En los últimos años se han introducido nuevas vacunas contra neumococo a precios elevados, y los diferentes análisis económicos a nivel mundial de estas vacunas no muestran tendencias. El objetivo de este trabajo era resumir la evidencia existente a través de los diferentes estudios económicos evaluando las dos vacunas de segunda generación contra neumococo en la población a riesgo. Metodología: En este trabajo se realizo una revisión sistemática de la literatura en 8 bases de datos localizadas en diferentes partes del mundo y también que tuvieran literatura gris. Los artículos fueron inicialmente evaluados acorde a su titulo y resumen, posteriormente los elegidos se analizaron en su totalidad. Resultados: Se encontraron 404 artículos, de los cuales 20 fueron incluidos en el análisis final. Se encontró que la mayoría de los estudios se realizaron en áreas donde la enfermedad tiene una carga baja, como es Norte América y Europa, mientras que en los lugares del mundo donde la carga es mas alta, se realizaron pocos estudios. De igual manera se observo que la mayoría de los estudios mostraron por los menos ser costo efectivos respecto a la no vacunación, y en su totalidad las dos vacunas de segunda generación mostraron costo efectividad respecto a la vacunación con PCV-7. Los resultados de los estudios son muy heterogéneos, hasta dentro del mismo país, señalando la necesidad de guías para la conducción de este tipo de estudios. De igual manera, la mayoría de los estudios fueron financiados por farmacéuticas, mientras en un numero muy reducido por entes gubernamentales. Conclusiones: La mayoría de los estudios económicos sobre las vacunas de segunda generación contra neumococo han sido realizados en países con un alto índice de desarrollo económico y patrocinados por farmacéuticas. Dado que la mayoría de la carga de la enfermedad se encuentran en regiones con un menor nivel de desarrollo económico se deberían realizar mas en estas zonas. De igual manera, al ser la vacunación un asunto de salud publica y con un importante impacto económico los gobiernos deberían estar mas involucrados en los mismos.

Household survey of hepatitis B vaccine coverage among Brazilian children

We conducted a multi-stage household cluster survey to calculate hepatitis B vaccine coverage among children 18-30 months of age in 27 Brazilian cities. Hepatitis B vaccine is administered at birth, 1 month and 6 months of age by Brazil`s national immunization program. Among 17,749 children surveyed, 40.2% received a birth dose within one day of birth, 94.8% received at least one dose of hepatitis B vaccine, and 86.7% completed the three-dose series by 12 months of age. Increased coverage with the birth dose and administration of hepatitis B in combination with diphtheria-tetanus-pertussis-Haemophilus influenzae type b antigens could improve protection against hepatitis B. (C) 2009 Elsevier Ltd. All rights reserved.

Avaliação da prevalência de imunização contra a hepatite B nos profissionais da secretaria de saúde de Maringá

Pós-graduação em Pesquisa e Desenvolvimento (Biotecnologia Médica) - FMB

Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: Regional analyses according to the endemic context

Objective: To To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil. Methods: An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South + Southeast (low endemicity) and one for the North + Northeast + Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real). Results: A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs. Conclusions: Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program. (C) 2012 Elsevier Ltd. All rights reserved.

Prospective surveillance of varicella-zoster virus infections in an out-patient setting in Switzerland

Limited data are available on the clinical impact of varicella in the ambulatory setting. Our goal was to determine real-life data on the clinical outcomes, medical management, and resource utilization in patients with varicella in Switzerland, a country without a universal immunization program against varicella. A total of 236 patients (222 = 94% primarily healthy individuals) with a clinical diagnosis of varicella were recruited by pediatricians and general practitioners. Age range of patients was 0-47 years with a median of 5 years. The great majority of patients (179 = 76%) were immunization.

Bringing the Community into the Classroom: Teaching Immunizations Skills via a Community-based Project

Introduction or Statement of Problem Health care profession educators are challenged in their efforts to bring clinical experiences into the class room and to introduce students to community settings early in their didactic training. An immunization program directed at improving childhood immunization rates can introduce students to the community, to students of other disciplines and reinforce the knowledge and skills needed for immunization interventions. Successful interventions increase community demand for immunizations, improve access to services, and educate providers about immunization services and disease. Interventions serve to mold attitudes among health care professionals that foster commitment to universal immunization coverage and low disease rates. [See PDF for complete abstract]

Impacto da vacinação contra rotavírus nas consultas de pronto-socorro e internações por doença diarreica aguda em crianças menores de cinco anos de idade

INTRODUÇÃO: A doença diarreica aguda é a segunda causa de morte em crianças abaixo de 5 anos de idade. No Brasil, entre 2003 e 2009, a diarreia aguda foi responsável por cerca de 100.000 internações por ano, e por 4% das mortes em crianças abaixo de 5 anos de idade. O rotavírus é a principal etiologia de diarreia aguda grave no mundo todo, sendo responsável por 40% das internações por diarreia aguda, e 29% de todas as mortes por diarreia aguda. A vacina monovalente (RV1) contra o rotavírus foi introduzida no Programa Nacional de Imunizações em 2006. OBJETIVOS: Verificar o impacto da vacina monovalente contra rotavírus nas consultas de pronto-socorro e internações por doença diarreica aguda em crianças menores de 5 anos de idade, verificar a positividade do exame \"pesquisa de rotavírus nas fezes\", e verificar a presença ao ausência de imunidade de rebanho. METODOLOGIA: Foi realizado um estudo ecológico retrospectivo no Hospital Universitário da Universidade de São Paulo. O período foi dividido em pré-vacina (2003 a 2005) e pós-vacina (2007 a 2009). Foram incluídas todas as crianças abaixo de 5 anos que passaram em consulta no pronto-socorro e verificado o diagnóstico do atendimento e internação através de registro eletrônico. Foram obtidas as taxas de consultas no pronto-socorro e internações por doença diarreica aguda, foram selecionadas as crianças não vacinadas para cálculo da imunidade de rebanho, e verificado se houve coleta do exame pesquisa de rotavírus nas fezes. A redução nas taxas foi obtida através da fórmula: redução (%) = (1 - odds ratio) x 100. RESULTADOS: No período pré-vacina a taxa de consultas por diarreia aguda foi de 85,8 consultas por 1.000 consultas gerais, no período pós vacina a taxa de consultas por diarreia aguda foi 80,9 por 1.000, e a redução foi 6% (IC 95%, 4% a 9%, p < 0,001), chegando a 40% (IC 95%, 36% a 44%, p<0,001) nos meses de maio e junho. A taxa de internação por diarreia aguda era 40,8 internações por 1.000 e caiu para 24,9 por 1.000, redução de 40% (IC 95%, 22% a 54%, p < 0,001), chegando a 82% (IC 95%, 62% a 92%, p < 0,001) nos meses de maio e junho. Nas crianças não vacinadas não houve redução na taxa de consultas de pronto-socorro (IC 95%, -4% a 5%, p=0,903), e não se pode afirmar se houve redução ou aumento das internações por diarreia aguda (IC 95%, -212% a 35%, p=0,381). Houve queda da positividade do exame pesquisa de rotavírus em 2009 (redução de 70%, IC 95%, 26% a 88%, p=0,007). CONCLUSÕES: Após a introdução da vacina contra rotavírus (RV1) houve uma redução de 6% nas consultas por diarreia aguda no pronto-socorro, de 40% nas internações por diarreia aguda e de 70% na positividade do exame pesquisa de rotavírus nas fezes. Não foi detectada imunidade de rebanho