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PubMed1995

Acute epiglottitis in children: results of a large-scale anti-Haemophilus type B immunization program.

The incidence of acute epiglottitis in children is declining in the province of Quebec, Canada. In 1988, a PRP-D anti-Haemophilus type B vaccine was introduced into the routine vaccination schedule of 18-month-old children. A substantial reduction in the occurrence of acute epiglottitis was perceived by clinicians. Since 1992, improved new vaccines (PRP-T, HbOC, PRP-OMPC), given to 2-month-old infants, have been expected to increase the efficacy of the immunization program. The impact of the immunization program on preventing acute epiglottitis was verified using a provincial database system called Med-Echo. In the presumably vaccinated target population (0 to 6 years old), 15 children suffered acute epiglottitis in 1993, whereas 97 cases were reported on the average for each yearly period from 1984 to 1987, just before the program's inception. Thus, the incidence of acute epiglottitis in preschoolers was reduced to 15.4% of its former level. The overall efficacy of the immunization program in preventing acute epiglottitis, therefore, is estimated to be 84.6%.

Acute Disease↗
PubMedDate not supplied

Vaccine coverage during a school-based hepatitis B immunization program.

Ontario initiated a universal hepatitis B immunization program for grade seven students in the fall of 1994. An ecological study was conducted within seven health units of the Greater Toronto Area to assess vaccine coverage. The study population consisted of all grade seven students enrolled within schools in the participating health units, on October 1, 1994. There were 39,935 students enrolled in 604 schools eligible for inclusion in the study. Consent to receive the vaccine series was obtained for 88% (range across health units from 81.5% to 96.3%) of the students. Among students for whom consent was obtained, an average of 95% (range 88.1% to 99.5%) completed the series. Therefore, the total vaccine coverage for the study population was 84% (range 77.5% to 89.5%). Series completion varied by school board, education provider and the use of Ministry of Health educational material. A limiting factor in achieving high vaccination coverage among grade seven students was obtaining consent to receive the vaccine series.

Adolescent↗
PubMed2006

Developing a vaccination evaluation model to support evidence-based decision making on national immunization programs.

Among all public health provisions national immunization programs (NIPs) are beyond doubt one of the most effective in reducing mortality, morbidity, and costs associated with major infectious diseases. To maintain their success, NIPs have to modernize in response to many new and old demands regarding efficacy, safety, availability of new vaccines, emerging and evolving pathogens, waning immunity, altered epidemiological situations, and the public's trust in the program. In this paper we present an evaluation model in the form of a checklist that may help in collecting relevant scientific information that is necessary for evaluation and decision making when considering changes in a NIP. Such a checklist points to relevant information on the vaccine-preventable disease, the pathogen causing it, the vaccine, and the cost-effectiveness ratio of the vaccine. However, the final judgment on a potential change in the NIP cannot be based on a simple algorithm, as the relevant information reflects factors of a very different kind and magnitude, to which different value judgements may be added, and which may have certain degrees of uncertainty. Because any change in the NIP may be accompanied by more or less unforeseen changes in the vaccine's efficacy, evolutionary consequences, including the antigenic composition of the pathogen, and the vaccine's safety profile, an intensive surveillance program should accompany any NIP. Elements thereof include clinical-epidemiological surveillance, surveillance of vaccination coverage, immune surveillance, surveillance of microbial population dynamics, and surveillance of adverse events and safety issues. We emphasize that the decision to introduce a vaccine in the NIP should be taken as seriously, both scientifically and ethically, as the decision to withhold a vaccine from the NIP. In the latter case one might be responsible for vaccine-preventable disease and mortality.

Cost-Benefit Analysis↗
PubMedDate not supplied

Motivating factors influencing participation in hepatitis B immunization programs in rural populations.

The emphasis on immunization of children aged 0-2 results in a large pocket of need within the school-aged population, particularly in regard to hepatitis B immunization. After implementing a school-based hepatitis B immunization program in a rural, west central Indiana county, a study was conducted to identify the factors that motivated rural families to participate in the program. A retrospective, descriptive design using a convenience sample of 553 elementary and middle-school students was used. Survey results were received from 41 percent (227) of the sample; 95 percent of the returned questionnaires (215) was used for analysis. Approximately 82 percent of the children immunized were between 11 and 19 years old, with the largest cluster (49 percent) in the 11-13 year age group. Benefit to health, convenience of location and time, and no financial cost to the family were the top three reasons for program participation. Recommendations from health care providers and other parents were ranked as least likely to influence participation. More than 70 percent of the respondents indicated that both parents were not immunized against hepatitis B, 11.6 percent had completed the series, while 14 percent were unsure of their immunization status. These findings corroborated previously held assumptions regarding barriers to appropriate immunization status in rural America and reveal implications for future immunization, health promotion and education programs for rural residents.

Adolescent↗
PubMed1975

Tetanus and diphtheria antitoxin levels following a hospital-based adult immunization program.

A hospital-based program to immunize adults against tetanus unless specific contraindications to immunization are present has been in effect at Parkland Memorial Hospital since 1959. Adsorbed tetanus toxoid was used from 1959 to 1970, and was replaced at that time by adult type adsorbed combined tetanus/diphtheria toxoid. In the present survey, the titers of diphtheria and tetanus antitoxins were determined in sera from 97 adults admitted to the Medical Service. Titers of diphtheria antitoxin less than 0.0125 units per ml were found in only seven patients and less than 0.0125 units per ml of tetanus antitoxin in only 17 patients. This high prevalence of immunity especially to tetanus appears to reflect our practice of routine immunization of adults. Although the recommended frequency of tetanus boosters has recently been reduced for adults who have completed a full primary immunization series, susceptibility to diphtheria or tetanus or both is not uncommon among adults in the US. Unless contraindications are present, we therefore urge routine immunization of all adults seeking medical care and of all hospital personnel as a means of diminishing the risk of diphtheria and tetanus in those adult populations with a significant incidence of susceptibility to these diseases.

Adolescent↗
PubMed2001

Factors associated with student participation in a school-based hepatitis B immunization program.

This study examined the relationship between participation in a school-based hepatitis B immunization program and teacher attitudes toward school-based health care and student socioeconomic factors. A survey addressing teachers' attitudes was administered to all teachers participating in the program. Information regarding student participation in school lunch programs and scores on national standardized tests were collected. Of the 4,874 fifth-grade students targeted for the program, 3,483 (72%) consented to be vaccinated and 3,232 (93% of 3,483) received all three doses of vaccine. Socioeconomic factors were the most important predictors of student participation in this school-based immunization program. Participation was significantly lower among students in schools with a high proportion of students receiving free or reduced-price school lunch and with low test scores. The only teacher factor associated with student participation was whether the teacher had returned the questionnaire. Strategies to increase immunization coverage in school-based programs should target children of low socioeconomic status.

Adult↗
PubMedDate not supplied

Implementation of a pharmacy-based immunization program in a supermarket chain.

OBJECTIVE: To describe procedures for implementing a pharmacy-based immunization program in a supermarket chain. SETTING: Supermarket chain pharmacy. PRACTICE DESCRIPTION: Ukrop's is a local supermarket chain with 27 stores in the greater area of Richmond, Fredericksburg, and Williamsburg, Virginia, 19 of which have pharmacies. Ukrop's offers enhanced patient care services including immunizations, diabetes, asthma, hypertension, hyperlipidemia monitoring, and smoking cessation. All pharmacies offer adult immunizations and host periodic diabetes, hypertension, and hyperlipidemia screening events. PRACTICE INNOVATION: Adult immunization program. INTERVENTIONS: Each pharmacy offered influenza and pneumococcal vaccinations on a walk-up basis during pharmacy hours and during clinics held at least 3 days per week. Immunizations were also offered periodically at off-site locations. Distribution of letters and chart stickers to patients' physicians, and even partnership with a physician to establish the immunization protocol, helped increase awareness of the pharmacy immunization services. This service involved a core group of immunizing pharmacists who developed a policies and procedures manual, distributed the vaccine, and handled additional staffing requirements. MAIN OUTCOME MEASURES: Number of adult influenza and pneumococcal vaccinations administered by pharmacists. RESULTS: Between September and December 1998, Ukrop's pharmacists administered 5,137 influenza vaccinations and 613 pneumococcal vaccinations. Between September 1999 and January 2000, Ukrop's pharmacists administered 18,000 influenza vaccinations and 1,200 pneumococcal vaccinations. CONCLUSION: In addition to immunizing thousands of people in its first year, the program served as a successful marketing tool to increase awareness of enhanced pharmacy services in the community and among local physicians. Administration of vaccines increased pharmacists involvement with and enthusiasm for enhanced patient care services and generated a revenue stream for the pharmacies.

Adult↗
PubMed2000

Outbreak of aseptic meningitis associated with mass vaccination with a urabe-containing measles-mumps-rubella vaccine: implications for immunization programs.

A mass immunization campaign with a Urabe-containing measles-mumps-rubella vaccine was carried out in 1997 in the city of Salvador, northeastern Brazil, with a target population of children aged 1-11 years. There was an outbreak of aseptic meningitis following the mass campaign. Cases of aseptic meningitis were ascertained through data collected from the records of children admitted to the local referral hospital for infectious diseases between March and October of 1997, using previously defined eligibility criteria. Vaccination histories were obtained through home visits or telephone calls. Eighty-seven cases fulfilled the study criteria. Of those, 58 cases were diagnosed after the vaccination campaign. An elevated risk of aseptic meningitis was observed 3 weeks after Brazil's national vaccination day compared with the risk in the prevaccination period (relative risk = 14.3; 95% confidence interval: 7.9, 25.7). This result was confirmed by a case series analysis (relative risk = 30.4; 95% confidence interval: 11.5, 80.8). The estimated risk of aseptic meningitis was 1 in 14,000 doses. This study confirms a link between measles-mumps-rubella vaccination and aseptic meningitis. The authors discuss the implications of this for the organization and planning of mass immunization campaigns.

Brazil↗
PubMed1995

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

OBJECTIVE: To estimate the economic consequences in the United States of routine childhood immunization of children younger than 1 year of age with a rotavirus (RV) vaccine. DESIGN: Cost-effectiveness analysis of a national RV immunization program from the perspective of the health care system and the perspective of society. Estimates of disease incidence, medical expenditures, productivity costs, vaccine efficacy, and vaccine coverage rates were derived from published literature and unpublished vaccine trial reports. The impact of changes in estimates of vaccine efficacy and medical costs was determined by sensitivity analysis. MAIN OUTCOME MEASURES: Incremental cost effectiveness, expressed as savings per case of RV diarrhea prevented. RESULTS: Given a vaccine efficacy rate of 50% and a vaccine cost of $30 per dose, an RV immunization program would prevent more than 1 million cases of RV diarrhea, 58,000 hospitalizations, and 82 deaths per year. A vaccine program would cost $243 million per year but would yield net savings of $79 million from the perspective of the health care system and $466 million from the perspective of society. The incremental cost effectiveness was a savings of $459 per case prevented from the societal perspective and $78 per case prevented from the health care system perspective. Sensitivity analyses substantiated net savings over a wide range of variables, and cost effectiveness increased with greater vaccine efficacy or decreased vaccine cost. CONCLUSIONS: Economic and disease reduction benefits would be realized from the use of an RV vaccine that is partially protective against severe RV diarrhea. These findings suggest that immunization with an RV vaccine would be cost effective and cost saving.

Child, Preschool↗
PubMed1999

Use of state hospital discharge data to assess the morbidity from rotavirus diarrhea and to monitor the impact of a rotavirus immunization program: A pilot study in Connecticut.

OBJECTIVES: Now that rotavirus vaccines have been licensed and recommended for routine immunization of US infants, there is an urgent need for data to assess the morbidity from rotavirus diarrhea and to monitor the impact of a rotavirus immunization program. In a pilot study, we have assessed the usefulness of state hospital discharge data on diarrhea in children to provide this information by examining data from Connecticut. DESIGN: Retrospective analysis of discharge records from acute care, nongovernmental hospitals in Connecticut. Patients. Children 1 month through 4 years of age with a diarrhea-associated diagnosis listed on the discharge record. Setting. Connecticut, 1987 through 1996. RESULTS: During the 10-year study period, a total of 11 324 diarrhea-associated hospitalizations (49.4 hospitalizations per 10,000 children) were reported. Diarrhea-associated hospitalizations peaked during February through April, especially among children 4 to 35 months of age. The seasonality and age distribution of diarrhea-associated hospitalizations of presumed noninfectious and viral etiologies resembled those of rotavirus-associated hospitalizations. During 1993 to 1996, rotavirus was coded for 10.4% of diarrhea-associated hospitalizations increasing from 8.6% in 1993 to 14.7% in 1996. The unadjusted median cost of a diarrhea-associated hospitalization during 1987 to 1996 and 1993 to 1996 was $1,941 and $2,428, respectively. CONCLUSIONS: Diarrhea causes substantial morbidity in children from Connecticut. The winter seasonal peak of diarrhea-associated hospitalizations in children 4 to 35 months of age coinciding with the peak of rotavirus-specific hospitalizations suggests that rotavirus is an important contributor to the overall morbidity. Although our findings suggest incomplete coding of rotavirus cases, state hospital discharge data should provide sensitive and timely information to monitor the impact of a rotavirus immunization program in Connecticut.

Child, Preschool↗
PubMed1994

A "high-tech," "soft-touch" immunization program for members of a Medicaid managed care organization.

Immunization rates among the very poor are critically low. The solution to improving rates requires technological tracking of immunizations linked to extensive home visiting outreach services as well as physician and member support services to increase compliance with recommended immunization schedules. This paper describes the development and implementation of a comprehensive immunization program which incorporates these strategies for members of a Medicaid managed care organization. Analysis of preliminary data provides some indication of the value of the tracking system and the effectiveness of incentives and home visiting on member compliance with immunizations.

Accounting↗
PubMed2005

Worksite influenza immunization programs. Insight into the implementation and cost-benefit.

The most important factors in cost-benefit analyses of worksite influenza immunization programs are vaccine cost and administration, vaccine efficacy, and the assumptions used to calculate lost productivity from worker absenteeism or decreased effectiveness. Based on several models published in the literature, estimates of savings per healthy working adult employee could be anticipated to range between dollars 15 and dollars 50. Variations of this net savings are primarily based on assumptions of productivity estimates of the employee. Efficient large worksite influenza immunization programs are feasible and worthy of employer consideration for economic and employee satisfaction reasons.

Absenteeism↗
PubMedDate not supplied

Building a year-round immunization program.

Each year, an estimated 55,000 to 80,000 people die from vaccine-preventable diseases. More pharmacists are needed to advocate, facilitate, and deliver immunizations throughout the year. Pharmacists who want to develop a year-round immunization program should begin by developing a comprehensive business plan. By implementing a successful year-round immunization program, pharmacists can reduce morbidity and mortality from a range of vaccine-preventable infections.

Community Pharmacy Services↗
PubMedDate not supplied

Immunization programs and human immunodeficiency virus.

The emergence of human immunodeficiency virus (HIV) in epidemic form has implications for immunization programs. Infection with HIV, which is capable of infecting cells of the immune system and which can remain latent for many years, results in profound and progressive immunosuppression. As a consequence, vaccines may not elicit a protective response from HIV-infected individuals. Stimulation of the immune system may also be a cofactor for the progression of infection to AIDS, since stimulated lymphocytes are needed for the replication of HIV. HIV-positive individuals may also react differently to vaccines than do uninfected persons. The standard vaccines in use today are extremely safe. The possibility that the excellent safety profile of vaccines may be altered in HIV-positive patients must be considered. Since this virus can be transmitted through exposure to blood and blood products, mass immunization programs must take steps to minimize the possibility of accidental transmission of infection during a mass vaccination program. Finally, the problems and prospect for the testing and use of vaccines to prevent HIV are discussed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Cost-benefit analysis of immunizations programs in north-west Romania].

Cost/benefit analysis could be an important approach in improving the decisional process in public health. We used the direct benefit/cost analysis and clinical cases of measles, acute hepatitis B, pertussis, and tetanus notified in North-West Romania to evaluate the results of immunization programs against such diseases. The numbers of potentially occurring cases of diphtheria were evaluated based on incidence data published in literature. The Excel under Windows 2000 software has been used to process the data. The benefit/cost rates of mass immunization programs were of 5.5 for measles, 9.5 for acute hepatitis B, 5.8 for pertussis, 71.1 for tetanus and 192.5 for diphtheria. The rate was low for measles because of the occurring outbreaks, for pertussis because of prevailing mild clinical cases, and for hepatitis B because only clinical cases were counted. The immunization programs against tetanus and diphtheria had the most relevant economic advantages.

Cost-Benefit Analysis↗
PubMed2001

Using nursing students to enhance one college's immunization program.

In New York State, all college students who were born on or after January 1, 1957, are required to show proof of immunity against measles, mumps, and rubella (MMR) before the 1st day of classes. Colleges have established immunization programs so that those students who do not have the required proof can be given the necessary injections. Often, our health service office does not have enough staff to administer the MMR shots during the registration period, resulting in long lines of students waiting to be immunized. In this article, the authors describe how one college used nursing students to assist with and enhance its immunization program. The 45 nursing students who participated in this project administered 694 injections over a 5-day period, They received credit from the nursing department for clinical time and all of the participants agree that the project was a success.

Humans↗
PubMed1990

The national immunization program of The Netherlands.

After a brief explanation of the immunization policy in the Netherlands, the national immunization program is described, with special attention given to coupling of the municipal population records with a computerized database of individual immunization records at the provincial level. The Dutch program achieves coverage rates greater than 90% for all routine immunizations. Participation in the program is free of charge to every child living in the country up to the age of 13 years, but there is no obligation or requirement to be immunized. Financing of the program is also discussed.

Adolescent↗