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At least 19 recordsLinked to original sources
PubMed1989

Measles prevention and control in emergency settings.

Outbreaks of measles continue to be a common occurrence among refugee and famine-affected children in emergency relief camps. Extremely high measles-associated mortality rates have been reported from refugee camps--where undernutrition is common--in several countries over the past 10 years. Mortality from measles is, however, preventable, and immunization against the disease is a high priority in emergency relief programmes, second only in importance to the provision of adequate food rations. All children aged 6 months to 5 years should be immunized with measles vaccine as soon as they enter an organized camp or settlement. Should supplies of measles vaccine be inadequate, children in feeding centres, or those otherwise identified as undernourished, are the top priority for immunization. The occurrence of measles in a camp is not a contraindication to conducting an immunization campaign. Strong coordination by a designated lead agency is needed if such campaigns are to be successful; however, cooperation with the local expanded programme on immunization is essential to ensure that existing cold chain equipment, training protocols, and management manuals are used. If additional equipment is necessary, a complete immunization kit developed by the Office of the United Nations High Commissioner for Refugees, the World Health Organization, and Oxfam can be procured from Oxfam headquarters in the United Kingdom. Vitamin A supplements should be given routinely at the time of measles immunization in situations where malnutrition is severe. Mortality and morbidity in children with clinical measles can be reduced by administering high doses of vitamin A.

Child, Preschool↗
PubMed1992

Vaccination coverage before and after primary health care implementation and trend of target diseases in Al Hassa, Saudi Arabia.

There were two objectives of this study. The first was to determine the impact of vaccination coverage in the first year of life on the trend of the expanded program of immunization (EPI) target diseases in Al Hassa. The second was to determine the impact of primary health care (PHC) implementation in Al Hassa on vaccination coverage. A correlation matrex was computed for all the variables to determine the correlation between vaccination coverage by type of vaccine and reported cases of EPI target diseases. A negative correlation was noticed between Bacillus Calmette Guerin (BCG), Oral Polio Vaccine (OPV), Diphtheria, Pertussis and Tetanus (DPT) and measles vaccine and reported cases of corresponding diseases. This negative correlation was significant (P = 0.043) between measles vaccine and reported measles cases. The average vaccination coverage in the first year of life based on the total number of births significantly increased in 1988 and 1989 compared to the preceding four years (P < 0.01). It is concluded that with increased vaccination coverage in the first year of life against EPI target diseases, the number of reported corresponding diseases decreased, and that PHC implementation improved the vaccination coverage in Al Hassa.

Communicable Diseases↗
PubMed1988

Vaccination strategies in developing countries.

By 1990 it is hoped that all of the world's infants will have access to immunization services and that these services will then continue indefinitely. The link between people and health services, including immunization, can only be forged and maintained by an effective system of delivery and support to all health workers. A careful choice of strategies for this delivery system and an understanding of local cultural attitudes and behaviour is vital if this link is to be effective. Health workers will have to be trained and then supported in the field by regular contact with their supervisors. They will also need continuous, reliable, predictable and adequate supplies of equipment, drugs, vaccines, fuel and money, including salaries. Immunization is cost effective as a health intervention, but an effective programme of immunization can contribute much more than just vaccines, if it is developed in the context of primary health care (PHC) as originally proposed in 1978 at the conference in Alma Ata.

Child, Preschool↗
PubMed1991

[Vaccines and developing countries].

Infectious diseases are the main cause of mortality and morbidity in developing countries. The Expanded Programme on Immunization, initiated by WHO in 1974, now reaches 60 mill. a year at a cost of less than 2 US $ per immunized child, and saves 2.2 mill. lives annually. The present vaccines, however, have significant shortcomings. Measles vaccine is given too late to prevent the large number of deaths occurring in the first year of life. Attenuated polio vaccine has to be given three times and inherits the risk of "vaccine palsy" and revertion to virulence. Tetanus vaccine given to children does not prevent neonatal tetanus, the main cause of tetanus casualties. BCG does not control spread of tuberculosis. Vaccines given parenterally involve some risk of spread of HIV, and some potentially useful vaccines are too expensive for developing countries. By only modest investments modern gene technology could give improved and new vaccines which would potentially save 20 mill. lives a year. Particularly promising is the recent development of multi-vaccine-vectors. However, poor prospects for profit in developing countries and patent "swapping" by commercial producers severely hamper development in the vaccine field.

Developing Countries↗
PubMed1988

Trial of high-dose Edmonston-Zagreb measles vaccine in Guinea-Bissau: protective efficacy.

In a randomised study of 558 children in an urban African community, the protective effect of the Edmonston-Zagreb (EZ) measles vaccine given in a dose of 40,000 plaque forming units from the age of 4 months was compared with the effects of a standard dose (6000 tissue culture infectious units) of Schwarz measles vaccine given from the age of 9 months. During two years of follow-up, all 14 clinical cases of measles occurred in the Schwarz group; 10 of the children contracted measles before vaccination and 4 after measles vaccination. Thus the EZ vaccine provided significant protection against measles both before and after the usual age of vaccination. Among the children who were exposed to measles at home, those given EZ vaccine were better protected than either unvaccinated children or those given the Schwarz vaccine.

Age Factors↗
PubMed1988

Trial of high-dose Edmonston-Zagreb measles vaccine in the Gambia: antibody response and side-effects.

In a randomised trial, infants living in a large village in The Gambia were immunised either at 4 months of age with 40,000 plaque forming units (PFU) of the Edmonston-Zagreb (EZ) measles vaccine or at the usual age of 9 months with 6000 TCID50 of a conventional Schwarz measles vaccine. Measles developed in 2 of 119 children who received the EZ vaccine, in 1 before and in the other after 9 months of age. In the Schwarz group measles developed in 7 of 120 children--in 5 before and in 2 after 9 months of age. Serological responses measured at 5 months after vaccination and at 18 months of age were satisfactory in both groups although in the Schwarz group levels were on average 2-fold higher than in the EZ group. The frequencies of fever, cough, vomiting, and diarrhoea were no higher in the EZ vaccinees in the 3 weeks following vaccination than in age-matched non-immunised controls. Long-term morbidity as assessed by clinic attendances and weight at 18 months of age was much the same in the two groups. The EZ measles vaccine is thus safe and clinically and serologically effective when used in a high dose to immunise young Gambian infants.

Age Factors↗
PubMed1992

Low seroconversion rates to measles vaccine among children in Nigeria.

The Nigerian Expanded Programme on Immunization (EPI) was assessed with particular reference to measles immunization. Of 150 children who received measles vaccine at the Institute of Child Health, University of Ibadan, Nigeria, 82 (54.7%) seroconverted. The immune response was directly related to the titre of the vaccines used. Vaccines whose titres were 10(-1) to 10(1.7) stimulated immune responses in 0-25% of vaccinees, those with titres in the range 10(-2.1) to 10(-2.5) stimulated responses in 12-47.6%, while those with titres of 10(-2.7) to 10(-3.4) stimulated responses in 87.5-100% of vaccinees. Only one of the vaccines used had a titre that met the minimum WHO required standard of log 10(-3) TCID50 at the point of vaccination.

Antibodies, Viral↗
PubMed1992

Expanded programme on immunization (EPI). Safety of high titre measles vaccines.

Unexpected results suggesting decreased survival when compared with standard titre vaccine administered at 9 months of age have been found in some field studies evaluating the performance of high titre measles vaccine. Analytical difficulties have arisen because the studies were not specifically designed to measure survival. Nonetheless, careful analysis of the results from all of the high titre vaccine trials showed decreased survival of high titre vaccine recipients, in areas with high background mortality rates, compared with recipients of standard measles vaccines at 9 months. No systematic biases could be found in the studies to explain these differences. Statistical analysis of these data suggested that the findings were unlikely to be attributable to chance alone. The panel recommended that high titre measles vaccine derived from the original Edmonston measles vaccine isolate should no longer be recommended for use in immunization programmes. Further post-licensure field studies of new measles vaccines should take into account the results of these studies. Additional detailed epidemiological studies in populations that have received high titre vaccines and their controls were encouraged.

Child, Preschool↗
PubMed1991

Measles control in a rural area in Zimbabwe.

In the rural district of Chimanimani in Zimbabwe, the Expanded Programme on Immunisation (EPI) which started in January 1982 has achieved measles coverage of between 50 and 80% in the 12-23 months age group, from 1984 to 1988, through 65 outreach centres, and 15 static health centres serving 93985 people in 119 villages. Facility based data as well as community based surveys have failed to show serious measles transmission in children under nine months of age, a common observation in high population density urban areas in Africa. Instead there has been a reduction in measles incidence and age distribution of measles has shifted to older children. The lowest measles incidence rate of 0.8 per 100 children occurred in the 0-5 months age group and the highest incidence rate of 4.0 per 100 children in the 48-59 months of age group. Only 7.9% of measles cases occurred in children under nine months of age. The high vaccination coverage rates were made possible by the post-independence government commitment, community involvement and dedicated staff. Our observations support the current one-dose 9 months minimum age measles vaccination policy for the low density rural areas in the developing countries.

Age Factors↗
PubMed1991

Strategies to improve immunization services in urban Africa.

The urban poor constitute a rapidly increasing proportion of the population in developing countries. Focusing attention on underserved urban slums and squatter settlements will contribute greatly to immunization programme goals, because these areas account for 30-50% of urban populations, usually provide low access to health services, carry a large burden of disease mortality, and act as sources of infection for the city and surrounding rural areas. Improvement of urban immunization programmes requires intersectorial collaboration, use of all opportunities to vaccinate eligible children and mothers, identification of low-coverage neighbourhoods and execution of extra activities in these neighbourhoods, and community mobilization to identify and refer persons for vaccination. Improved disease surveillance helps to identify high-risk populations and document programme impact. New developments in vaccines, such as the high-dose Edmonston-Zagreb vaccine, will allow changes in the immunization schedule that facilitate the control of specific diseases. Finally, operational research can assist managers to conduct urban situation assessments, evaluate programme performance at the "micro" level, and design and monitor interventions.

Africa↗
PubMed1979

Measles and mumps immunization: benefit versus risk factors.

Measles and mumps are universal diseases that affect more than 90% of the population of most countries of the world. During the prevaccine era about 98% of young adults had serologic evidence of past measles infection. Although mumps infection was less prevalent, about 90% of persons were infected before they reached their 20th birthday. Before vaccines were available, measles and mumps were inevitable infections of childhood. Therefore, an assessment of the benefits and risks of immunization to prevent these diseases must also consider the consequences of naturally acquired measles and mumps infections.

Adolescent↗
PubMed1988

Uptake of immunisation in district health authorities in England.

The uptakes of immunisation in the district health authorities in England were studied for the years 1983-5. Multiple regression analysis showed that the factors significantly associated with a low uptake of immunisation were mainly related to social conditions, particularly overcrowding of households and population density. Of the service factors, high proportions of elderly and singlehanded general practitioners and high average list sizes were also associated with a low uptake of immunisation in some of the analyses. The results suggest that the measures outlined in the government's white paper on improving primary health care services are likely to lead to improved uptakes of immunisation. If, however, the uptakes of immunisation are used as a measure of standards of the services provided they should first be adjusted to control for variations in social conditions, and the quality of vaccination data would have to be improved.

Child↗