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PubMed2006

Mass immunization programs: principles and standards.

Mass immunization involves delivering immunizations to a large number of people at one or more locations in a short interval of time. Good mass immunization programs apply planning and quality standards that maximize return on resources invested and provide the greatest individual benefits when immunizing many people in a short period of time. These programs can be used to counter contagious outbreaks, adopted as a repeated means of sustained healthcare delivery, or applied where many people move through a specific place in a short interval of time. Relevant quality standards address appropriate facilities and supplies, training of professional and paraprofessional staff, education of potential vaccinees and methods to screen them for contraindications to immunization, safeguards against anaphylaxis and syncope, documentation, safety surveillance, and a quality-improvement program. Successful mass immunization programs require early planning that builds on existing competencies. As the number of available vaccines increases, prioritizing which vaccines to administer during mass campaigns requires consideration of effectiveness, safety, and a cost-benefit equation from both the individual and community perspectives. Mass immunization campaigns aim to maximize the health of a population, but such campaigns need to be customized based on individual contraindications to immunization. Mass immunization programs need to be conducted ethically, with considerations of benefit versus risk and the need for detailed education of healthcare workers and vaccinees.

Health Education↗
PubMed1998

School-based adolescent hepatitis B immunization programs in the United States: strategies and successes.

BACKGROUND: To increase hepatitis B vaccination coverage of adolescents, a public/private partnership was organized in the greater Baton Rouge area of Louisiana in 1992 to fund and implement school-based vaccination programs. METHODS: Initial programs utilized schools with existing school-based clinics and administered 2 to 3 doses of hepatitis B vaccine to up to 76% of eligible students. During 1996 to 1997, expansion from 4 schools to 68 schools was facilitated by the use of temporary clinics set up in open school space. This multifaceted program administered 3 doses of hepatitis B vaccine to 3232 students (75%) and 2 doses to 171 students (4%). Administration of the 3-dose regimen of hepatitis B vaccine was aided by the use of a dosing schedule at 0, 2 and 4 months. This accelerated dosing has been shown to provide seroprotection for greater than 95% of healthy adolescents. RESULTS: In the Baton Rouge area, the hepatitis B adolescent vaccination program has immunized approximately 5000 adolescents during a 5-year period with minimal use of financial and personnel resources. CONCLUSIONS: The success and growth of this program demonstrate that school-based vaccination programs can be highly efficient and effective.

Adolescent↗
PubMed1977

Evaluation and control of vaccines for the National Influenza Immunization Program.

The National Influenza Immunization Program of 1976 offered an ideal opportunity to test the capability of the system in the United States for production and distribution of maximal amounts of inactivated influenza virus vaccine of carefully regulated quality. The four licensed manufacturers were able to produce and distribute greater than 10 million doses of vaccine per week over a 14-week period. Assays showed that the quality of these vaccines was comparable to or exceeded that of vaccines produced in recent years under less stressful circumstances. Because of the extensive clinical trials conducted as part of the program, it was possible to make an unprecedented evaluation of the significance of various laboratory tests of vaccines in relation to their pertinence in prediction of immunogenicity and reactivity for humans. This experience demonstrated the superiority of immunodiffusion methods as compared with the standard chick cell-agglutination method for assay of vaccine potency. Qualitative differences in immunogenicity between whole-virus and disrupted-virus vaccines were recognized that are not measured by in vitro potency tests. The results also indicated that influenza viral components are responsible for most febrile reactions to the vaccine.

Evaluation Studies as Topic↗
PubMed2004

Mass smallpox immunization program in a deployed military setting.

A prospective, observational study of immunizing over 6,000 active-duty troops against smallpox in a 4-week time period was conducted. It focused on the complications of the vaccine and lost workdays. Comparison is made to the complication rates of earlier smallpox immunization programs. In direct response to elevated bioterrorism concerns, the United States military and civilian first-responders have begun a mass smallpox immunization program. This article reviews the experience with implementing such a program in a forward-deployed location while maintaining military readiness. The objectives were to assess the impact of a mass smallpox immunization program on operations in a forward-deployed military setting and to comment on lessons learned in the screening and immunization process. From January 16, 2003 through February 11, 2003 6,002 members of the United States military were immunized in a forward-deployed location. Information was obtained using data from the Air Force Complete Information Tracking Application (AFCITA) and the Global Expeditionary Medical System (GEMS) we plan to calculate the following Main Outcome Measures data: (1)Percentage of individuals eligible to receive the vaccine, (2) Vaccine take rate by CDC criteria, (3) Number of serious complications, (4) Number of life-threatening complications, and (5) Number of manpower days lost as a complication of the vaccine. A total of 6,739 individuals were screened for vaccination with 6,348 (94%) remaining eligible for the vaccine. The "take" rate for the vaccine was 98.6% as per Centers for Disease Control and Prevention (CDC) criteria. The immunization program produced an additional 156 medical visits (2.6% of patients required one visit). A total of 0.55% of immunized individuals lost one or more work days. In conclusion, a mass smallpox vaccination program can be effectively administered in a forward-deployed military setting despite high tempo military operations with minimal operational impact.

Humans↗
PubMedDate not supplied

[Immunity against hepatitis A in younger age groups and the basis for an immunization program].

The naturally acquired immunity to hepatitis A virus (HAV) in a sample of 305 children, aged up to 15 years, in the municipality of Ivanić-Grad amounted to 18.7%. The study was conducted in September 1989. Of those 305 children, 16.8% of the boys and 20.7% of the girls were positive. No statistically significant difference was observed with regard to sex (p < 0.01) (chi 2 = 1.4). Of the children aged up to two years, 47.4% were exposed to the hepatitis A virus. Seropositive for anti-HAV were 8.3% in the group from 2-3 years of age, 6.4% in those aged from 4-5 years, 15.9% in the group from 6-7 years of age, 6.8% in those aged from 8-9 years, 20.0% in the group from 10-11 years of age, 27.8% in those aged from 12-13 years, and 29.0% in the group from 14-15 years of age. The spread of the infection by contact was predominant, reflecting the socioeconomic standards of the studied community (p < 0.01) (chi 2 = 29.5). A relatively high prevalence of hepatitis A infection compared to that of the developed countries, the first peak immunity rates in first-graders, a low number of cases among infants aged up to 5 years (approximately 6.0%), availability of commercial vaccine, speak in favour of including hepatitis A vaccination into the obligatory community-wide immunization program. It appears that the target age for HAV vaccination would be the age of five.

Adolescent↗
PubMed1998

Absenteeism among employees who participated in a workplace influenza immunization program.

To assess the effectiveness of a free workplace immunization program at 3M's St. Paul, Minnesota locations, we examined the difference in sick leave hours taken from November 15, 1996, through March 15, 1997, for employees who had and did not have an influenza vaccination prior to the previous year's four-month influenza season (November 15, 1995-March 15, 1996). Among the 2,622 employees who self-reported that they were not immunized in the previous year, there were, on average, 1.2 fewer hours of sick leave taken during the 1996-1997 influenza season than the comparable time period one year earlier (P < 0.05), although the exact reason for the absenteeism was not determined. In particular, we observed that female employees younger than 50 years of age with two or more children took 3.1 hours less sick leave in the year they were immunized, compared with the preceding year (P < 0.0001). Among the 895 subjects who were immunized in both years, employees took 0.7 hours more sick leave during the 1996-1997 influenza season than the previous year (P = 0.46). Based on our findings, consideration should be given to workplace immunization programs. However, we urge caution in applying a "one-size fits all" approach to any cost-savings analysis from a company-sponsored immunization program because the workplace is not a homogeneous [corrected] environment, with regard to employees' age, gender, medical history, and home environment. All of these factors may directly or indirectly contribute to the risk of acquiring influenza and any of its complications.

Absenteeism↗
PubMed2004

An immunization program for dental practices.

Immunization helps prevent acquisition of diseases, many of which were once common in the United States. Immunity is generally achieved by administering live or dead pathogens or their components. Vaccines used for active immunization consist of live (attenuated) organisms, killed whole or split organisms, microbial components, or inactivated toxins (toxoids). Some cases require the administration of antibody-containing gamma globulin injections. According to the new Centers for Disease Control and Prevention Guideline on infection control, dental practices must develop a written, comprehensive policy on immunizing workers and refer personnel to qualified professionals for evaluation and, when necessary, for all appropriate immunizations.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

[Health sector reform in Colombia and its effects on tuberculosis control and immunization programs].

This paper analyzes the effects of health reform in Colombia on public health programs at the local level, particularly the Expanded Program of Immunization (EPI) and the tuberculosis control program. The research was developed in three health districts in two States by analysis of documents, direct observation, and longitudinal follow-up of the transition process. The health districts were unprepared for the change, resulting in insufficient technical skills among staff as well as lack of awareness of important elements in the new system, associated with a reduction in immunization coverage and tuberculosis case detection. Structural problems in the new system included loss of immunization opportunities and lack of examination of tuberculosis contacts. The potentialities of the new system were the local development of a new organizational structure and the improvement of the information system; a limiting factor was exposure of the health system to local political interests. The general conclusion is that the transition period takes far longer than anticipated and requires a much greater information flow to both the local level and the community. There are transitory but also structural maladjustments that require a political response.

Colombia↗
PubMed1983

A hospital-based influenza immunization program, 1977-78.

An influenza immunization program on General Medicine inpatient and outpatient units immunized a greater proportion of patients than did physicians on medical subspecialty units. Many patients hospitalized with influenza and other respiratory conditions had been discharged earlier in the year or seen in outpatient clinics. Previous hospital care may be a useful marker for identifying many high-risk patients who could receive influenza vaccine in organized programs for hospital-based immunization. (Am J Public Health 1983; 73:442-445.)

Disease Susceptibility↗
PubMed1997

Implementing an immunization program in the neonatal intensive care unit.

The immunization of children less than two years old is a priority with several organizations involved in health care. The infants in the intensive care nursery and their parents provide a ready population with whom to implement immunization programs. This article reviews the importance of immunizations for the newborn and their appropriateness in the intensive care setting. Suggestions are also made for implementing this concept in the normal new-born nursery, utilizing Lewin's change theory.

Humans↗
PubMed2003

Short term evaluation of a rural immunization program in Nigeria.

BACKGROUND: Immunization remains the primary strategy in both the control and prevention of common childhood diseases, particularly in the developing world. Immunization and preprimary health care services were commenced in a rural community in Nigeria in 1998, when vaccine coverage for all Expanded Program on Immunization (EPI) diseases (tuberculosis, polio, diphtheria, pertussis, tetanus, measles, and hepatitis B) was considerably low with only 43% of children fully immunized. METHODS: Children aged 0-2 years and living in a rural community were recruited into the study. Data on vaccination history was collected by both vaccination card and maternal history. Three hundred and twenty-seven children were recruited into the study. Study participants were vaccinated for EPI diseases. Hepatitis-B vaccine was administered at birth, and a combined diphtheria and tetanus toxoids, and pertussis whole cell vaccine (DTP) plus hepatitis-B vaccine was administered in a single injection after six weeks. RESULTS AND CONCLUSIONS: Two years after the program was started, immunization coverage rates were 94% for BCG, 88% for DTP (third dose), and 82% for measles. All antigens showed significant improvements from baseline values (p < 0.0001). Eighty four percent of children were fully immunized against all six diseases, compared with 43% at the commencement (p < 0.0001). Hepatitis-B coverage (three doses) was 58%. The vaccination program has significantly improved vaccination coverage and could be a model for under served, non-industrialized communities.

BCG Vaccine↗
PubMed2000

Adult immunization programs in nontraditional settings: quality standards and guidance for program evaluation.

This report provides a summary of the National Vaccine Advisory Committee's (NVAC) workshop on adult immunization programs in nontraditional settings, quality standards for such programs, and guidance for program evaluation. Throughout the United States, an increasing number of adults are receiving vaccine in nontraditional settings (e.g., pharmacies and churches). Immunization programs in nontraditional settings are often more accessible and convenient than a health-care provider's office or a public health clinic, especially for medically underserved adults (e.g., economically disadvantaged, inner city, and minority populations). Medically underserved adults might be at particular risk for undervaccination because they are often without a medical home (i.e., a regular point of contact where their health-care needs are met). Immunization programs in nontraditional settings might enhance the capacity of the health-care system to effectively deliver vaccine to adults by increasing the number and types of sites where adults can receive vaccine. NVAC has recognized that strategies need to be developed to make vaccines available to all adults and that the number of immunization programs in nontraditional settings is increasing. Therefore, the Committee issues the following report, including quality standards and guidance for program evaluation.

Adult↗
PubMed1990

Door-to-door canvassing for immunization program acceleration in Mozambique: achievements and costs.

The Expanded Program on Immunization has made remarkable progress in raising coverage in developing countries. Countries have been urged to accelerate their programs, especially in urban areas. In Mozambique, as part of program acceleration, volunteers from grassroots organizations conducted door-to-door canvassing for the Program. Concurrently, the availability of immunization was increased in health centers and in outreach visits. By 1987, over 90 percent coverage for all vaccines was achieved in the capital, Maputo; two other cities doubled their immunization coverage to over 50 percent fully immunized children, and rural areas of the pilot province achieved 60 percent coverage. Immunization costs were estimated in one city as $6.9 (U.S. dollars) per fully vaccinated child. Door-to-door canvassing accounted for more than 40 percent of personnel costs, and may have diverted attention from the quality of service in the health centers. In this article we outline the achievements and costs of door-to-door canvassing and discuss other strategies to raise coverage. The analysis of the need to balance the mobilization of demand with the capacity to respond is relevant to other countries in their efforts to develop sustainable immunization services.

Cost-Benefit Analysis↗
PubMed2000

[Achievements and challenges of the expanded immunization program in the Americas].

The Expanded Program on Immunization (EPI) was initiated in 1974 in The Americas, based on the WHA 2757 resolution passed by the World Assembly of Health. Its purpose was to improve immunization coverage and to decrease morbidity and mortality caused by vaccine preventable diseases through vaccination. Specific goals were to eradicate in determined time periods poliomyelitis, measles, neonatal tetanus, to eliminate tuberculous meningitis in children four years and younger, diphtheria, and tetanus. This article presents up to date information on vaccination coverage trends between 1990 and 1998 in 13 countries of the American Region, briefly describes implementation of surveillance programs required for appropriate monitoring of vaccine impact, and discusses the changes observed in morbidity attributable to vaccine preventable disease in these countries during four periods, 1968 before the existence of EPI, 1978, four years after its introduction, 1988 and 1998. Although much remains to be done, the impact of EPI in the Americas has been outstanding in decreasing morbidity caused by vaccine preventable diseases.

Americas↗
PubMedDate not supplied

Are state immunization programs effective? Implications for the children's immunization initiative.

Several states operate universal vaccine purchase (UVP) programs aimed at ensuring adequate immunization of children. Some of these programs have been in operation for many decades. Recently, there has been a great deal of interest in implementing a federal UVP program. It is not clear, however, that such programs can significantly increase immunization levels; many nonfinancial barriers to full immunization exist and would have to be addressed. This paper uses cross-sectional data at the state level to estimate the effect of state UVP programs on the immunization levels of preschool children. The results indicate that states with UVP programs do not have significantly higher immunization rates than do other states. Therefore, it is not likely that a federal UVP program would significantly affect immunization rates.

Child↗
PubMed1998

Cost-effectiveness analysis of a rotavirus immunization program for the United States.

CONTEXT: Rotavirus is the most common cause of severe diarrhea in children, and a live, oral vaccine may soon be licensed for prevention. OBJECTIVE: To estimate the economic impact of a national rotavirus immunization program in the United States. DESIGN: Cost-effectiveness was analyzed from the perspectives of the health care system and society. A decision tree used estimates of disease burden, costs, vaccine coverage, efficacy, and price obtained from published and unpublished sources. INTERVENTION: The proposed vaccine would be administered to infants at ages 2, 4, and 6 months as part of the routine schedule of childhood immunizations. MAIN OUTCOME MEASURES: Total costs, outcomes prevented, and incremental cost-effectiveness. RESULTS: A routine, universal rotavirus immunization program would prevent 1.08 million cases of diarrhea, avoiding 34000 hospitalizations, 95000 emergency department visits, and 227000 physician visits in the first 5 years of life. At $20 per dose, the program would cost $289 million and realize a net loss of $107 million to the health care system-$103 per case prevented. The program would provide a net savings of $296 million to society. Threshold analysis identified a break-even price per dose of $9 for the health care system and $51 for the societal perspective. Greater disease burden and greater vaccine efficacy and lower vaccine price increased cost-effectiveness. CONCLUSIONS: A US rotavirus immunization program would be cost-effective from the perspectives of society and the health care system, although the cost of the immunization program would not be fully offset by the reduction in health care cost of rotavirus diarrhea unless the price fell to $9 per dose.

Child↗
PubMed1977

Proposed calfhood immunization program for the commercial dairy herd.

Immunization programs never will usurp the central role of sound management practices and good nutrition in the disease prevention program of the commercial dairy operation. However, certain immunizations against diseases such as brucellosis, leptospirosis, and clostridial infections should be routine. Other diseases such as infectious bovine rhinotracheitis, bovine virus diarrhea, parainfluenza-3, colibacillosis, and pasteurellosis should be considered if it can be determined that the herd is infected chronically. The present knowledge of other disease conditions, vaccine effectiveness and safety makes the use of vaccines for other diseases of questionable value.

Animals↗
PubMed2000

Implications of the diphtheria epidemic in the Former Soviet Union for immunization programs.

The massive diphtheria epidemic in the former Soviet Union provides important lessons for all diphtheria immunization programs: It is important to achieve a high level of childhood immunization, maintain immunity against diphtheria in older age groups, and use anti-epidemic measures, including immunization, to control epidemics in the early phase. The immunization coverage among children should be at least 90%. Further studies are needed to elaborate the most effective strategy to maintain immunity against diphtheria in adults (periodic booster doses, immunization of selected age groups in health care settings, use of Td [tetanus-diphtheria toxoids with reduced diphtheria toxoid content] vaccine instead of monovalent tetanus toxoid whenever tetanus toxoid is indicated [e.g., in treatment of wounds or in school-based immunization programs]). Efforts should be undertaken to monitor diphtheria immunity in different groups by conducting age-specific serologic studies.

Adolescent↗