Incidence Of Vaccine-preventable Diseases Research Articles

Vaccine-preventable disease incidence of pneumococcal conjugate vaccine in the Finnish invasive pneumococcal disease vaccine trial

Estimation of the full disease burden caused by Streptococcus pneumoniae is challenging due to the difficulties in assigning the aetiology especially in lower and upper respiratory infections. We estimated the pneumococcal disease burden by using the vaccine-preventable disease incidence (VPDI) of PHiD-CV10 vaccine (GSK) in our clinical trial setting.Finnish Invasive Pneumococcal disease (FinIP) trial was a cluster-randomized, double-blind trial in children <19 months who received PHiD-CV10 in 52 clusters or hepatitis B/A vaccine as control in 26 clusters according to 3+1 or 2+1 schedules (infants < 7 months) or catch-up schedules (children 7–18 months). Outcome data were collected using Finnish routine health-care registers, consisting of THL National Infectious Diseases Register, THL Care register, and Benefits Register of Social Insurance Institution of Finland. Blinded follow-up lasted from the date of first vaccination (trial enrolment Feb-2009 through Aug-2010) to January 31, 2012 for Invasive Pneumococcal Disease (IPD) and to end of December 2011 for four other outcomes: non-laboratory-confirmed IPD, hospital-diagnosed pneumonia, tympanostomy tube placements, and antimicrobial purchases. VPDI was estimated as difference in disease incidences between PHiD-CV10 clusters and control clusters.Altogether >47,000 children were enrolled. In 30,527 vaccinated infants <7 months at first dose, the VPDIs per 100,000 person-years were 75 for laboratory-confirmed IPD, 210 for non-laboratory-confirmed IPD, 271 for hospital-diagnosed pneumonia, 1143 for any tympanostomy tube placements and 11,381 for antimicrobial outpatient prescription, mainly due to otitis media.In a European developed-country setting, over 95% of the disease episode reductions in vaccinated children were seen in mild upper respiratory infections. The VPDIs of severe diseases are underestimated, because the majority of invasive disease goes undetected with routine blood-culture-based definitions. Evaluation of the absolute reduction achievable with vaccinations using sensitive case detection is essential for understanding the full disease burden, for valid cost-effectiveness analyses and for appropriate vaccination policy decisions.Registration: ClinicalTrials.gov, NCT00861380 and NCT00839254.

New Herpes Zoster Vaccine Close to FDA Approval

New Herpes Zoster Vaccine Close to FDA Approval

WEALTH-BASED INEQUALITY IN CHILD IMMUNIZATION IN INDIA: A DECOMPOSITION APPROACH.

Despite years of health and medical advancement, children still suffer from infectious diseases that are vaccine preventable. India reacted in 1978 by launching the Expanded Programme on Immunization in an attempt to reduce the incidence of vaccine-preventable diseases (VPDs). Although the nation has made remarkable progress over the years, there is significant variation in immunization coverage across different socioeconomic strata. This study attempted to identify the determinants of wealth-based inequality in child immunization using a new, modified method. The present study was based on 11,001 eligible ever-married women aged 15-49 and their children aged 12-23 months. Data were from the third District Level Household and Facility Survey (DLHS-3) of India, 2007-08. Using an approximation of Erreyger's decomposition technique, the study identified unequal access to antenatal care as the main factor associated with inequality in immunization coverage in India.

ESTABLISHING IMMUNIZATION SAFETY SURVEILLANCE SYSTEM IN ALBANIA

INTRODUCTION: While vaccine use increases, adverse events following immunization are becoming a public concern with the rate of adverse events following immunization (AEFI) increasing with the number of administered doses of vaccines. The safety of vaccines is ensured during clinical studies before the licensure of the vaccine. However, clinical trials have limitations, such as, rare events that cannot be detected and events occurring in specific groups of people. The consequences of AEFI influence public health policies and the incidence of vaccine-preventable diseases, although these might not be related directly to vaccines themselves.OBJECTIVES: The objective of this article is to examine the evolution of vaccine safety issues in Albania by mapping stakeholders involved in vaccine safety control and analyzing the different periods when changes in the vaccine safety system has taken placeMETHODS: A grey literature review, by searching the archive of IPH, provided a list of different stakeholders involved in vaccine safety in Albania. By reviewing all documents of the various organizations included in vaccine safety, we differentiated and characterized the roles of each in this area.RESULTS: The main stakeholders involved in AEFI and vaccine safety in Albania are; the Institute of Public Health (IPH), which manages the National Immunization Program (NIP), the Directorate of Public Health (DPH) at the Ministry of Health (MoH), the 36 District Public Health Directories each with a microbiological laboratory for the assessment of AEFI, the pharmacovigilance center and National Regulatory Authority in the National Agency for Medicines and Medical Devices (NAMMD),National Immunization Safety Expert Committee in MoH and the Secretariat that supports the national AEFI committeeCONCLUSIONS: Despite huge progress over the last decade in Albania regarding vaccine safety, much remains to be achieved. The changes in the vaccine safety system have enforced and increased public trust on vaccination, leading to a strengthened National Immunization Program.

Incidence of vaccine preventable diseases in pediatric population of Latvia

Childhood and adolescent immunizations are one of the most effective means of preventing such serious diseases as diphtheria, pertussis, rubella etc. These infectious diseases are termed as vaccine preventable diseases because vaccination continues to be the most effective strategy to reduce morbidity and mortality from these diseases. Despite this, immunization is an emotional issue for many parents. As vaccine preventable diseases become less common and parents have little familiarity with the devastating effects of vaccine preventable illnesses, the benefits of immunization may seem less important than the potential adverse effects.

Estimating the public health importance of the CYD-tetravalent dengue vaccine: Vaccine preventable disease incidence and numbers needed to vaccinate

BackgroundTo evaluate the potential public health impact of the live attenuated tetravalent Sanofi Pasteur dengue vaccine (CYD-TDV) we analyzed data from the reported clinical trials to calculate vaccine preventable disease incidence (VPDI) and number needed to vaccinate (NNV) based on the licensure indication for persons age 9 years and above. MethodsVPDI is defined as incidence in an unvaccinated population X vaccine efficacy (VE), and thus incorporates both VE and the underlying burden of disease. NNV was calculated as 100,000 divided by VPDI divided by 2-year length of study. We compared these values to data for three newer vaccines that are currently integrated into some national immunization programs in Asia and Latin America, namely pneumococcal conjugate, Haemophilus influenzae type b, and rotavirus vaccines. ResultsIn the Asian-Pacific trial, in the first 25 months after the first dose of the dengue vaccine, CYD-TDV prevented annually 2639 cases of virologically confirmed dengue for every 100,000 persons vaccinated, for an NNV of 18. In the Latin American trial, given the overall lower annual dengue incidence compared to Asia, VPDI was 1707, and NNV 28. For the Asian-Pacific and Latin American studies, the VPDIs for hospitalized virologically confirmed disease at the trials’ end were 638 and 239 per 100,000 population per year, respectively, with NNVs of 75 and 201. VPDI for confirmed dengue hospitalization was higher than that for Hib vaccine against Hib meningitis or all cause severe pneumonia while lower than that for rotavirus vaccine against severe rotavirus gastroenteritis. ConclusionsOur analysis found that the CYD-TDV dengue vaccine had favorable VPDI and NNV, also when compared to existing vaccines used in Latin America and Asia. VPDI and NNV varied by serotype distribution, extent of prior dengue exposure (baseline seroprevalence) and country. These findings will help policy-makers decide where and how to introduce this vaccine post-licensure.

Impact of State Public Health Spending on Disease Incidence in the United States from 1980 to 2009.

To understand the relationship between state-level spending by public health departments and the incidence of three vaccine preventable diseases (VPDs): mumps, pertussis, and rubella in the United States from 1980 to 2009. This study uses state-level public health spending data from The Census Bureau and annual mumps, pertussis, and rubella incidence counts from the University of Pittsburgh's project Tycho. Ordinary least squares (OLS), fixed effects, and random effects regression models were tested, with results indicating that a fixed effects model would be most appropriate model for this analysis. Model output suggests a statistically significant, negative relationship between public health spending and mumps and rubella incidence. Lagging outcome variables indicate that public health spending actually has the greatest impact on VPD incidence in subsequent years, rather than the year in which the spending occurred. Results were robust to models with lagged spending variables, national time trends, and state time trends, as well as models with and without Medicaid and hospital spending. Our analysis indicates that there is evidence of a significant, negative relationship between a state's public health spending and the incidence of two VPDs, mumps and rubella, in the United States.

Immunization Equity.

Health inequities are the unjust differences in health among different social groups. Unfortunately, inequities are the norm, both in terms of health status and access to, and use of, health services. Childhood immunizations reduce the incidence of vaccine-preventable diseases and represent a cost-effective way to foster health equity. This paper reflects a 2015 review of data from surveys conducted in developing countries from 2005 to 2011 that show significant inequities in immunization coverage and discusses several initiatives currently underway (including Gavi, the Vaccine Alliance) that are directed at increasing childhood immunizations or reducing or abolishing overall health inequities. These initiatives have already had a significant impact on disease burden and childhood mortality and give rise to optimism that health disparities may further be reduced and health equity achieved as a result of investments made in immunization.

Arguments and sources on Italian online forums on childhood vaccinations: Results of a content analysis

BackgroundDespite being committed to the immunization agenda set by the WHO, Italy is currently experiencing decreasing vaccination rates and increasing incidence of vaccine-preventable diseases. Our aim is to analyze Italian online debates on pediatric immunizations through a content analytic approach in order to quantitatively evaluate and summarize users’ arguments and information sources. MethodsThreads were extracted from 3 Italian forums. Threads had to include the keyword Vaccin* in the title, focus on childhood vaccination, and include at least 10 posts. They had to have been started between 2008 and June 2014. High inter-coder reliability was achieved. Exploratory analysis using k-means clustering was performed to identify users’ posting patterns for arguments about vaccines and sources. ResultsThe analysis included 6544 posts mentioning 6223 arguments about pediatric vaccinations and citing 4067 sources. The analysis of argument posting patterns included users who published a sufficient number of posts; they generated 85% of all arguments on the forum. Dominating patterns of three groups were identified: (1) an anti-vaccination group (n=280) posted arguments against vaccinations, (2) a general pro-vaccination group (n=222) posted substantially diverse arguments supporting vaccination and (3) a safety-focused pro-vaccination group (n=158) mainly forwarded arguments that questioned the negative side effects of vaccination. The anti-vaccination group was shown to be more active than the others. They use multiple sources, own experience and media as their cited sources of information. Medical professionals were among the cited sources of all three groups, suggesting that vaccination-adverse professionals are gaining attention. ConclusionsKnowing which information is shared online on the topic of pediatric vaccinations could shed light on why immunization rates have been decreasing and what strategies would be best suited to address parental concerns. This suggests there is a high need for developing automated approaches to detect misleading or false information on the Internet.

Immunization equity

Health inequities are the unjust differences in health among different social groups. Unfortunately, inequities are the norm, both in terms of health status and access to, and use of, health services. Childhood immunizations reduce the incidence of vaccine-preventable diseases and represent a cost-effective way to foster health equity. This paper reflects a 2015 review of data from surveys conducted in developing countries from 2005 to 2011 that show significant inequities in immunization coverage and discusses several initiatives currently underway (including Gavi, the Vaccine Alliance) that are directed at increasing childhood immunizations or reducing or abolishing overall health inequities. These initiatives have already had a significant impact on disease burden and childhood mortality and give rise to optimism that health disparities may further be reduced and health equity achieved as a result of investments made in immunization.

Needle size for vaccination procedures in children and adolescents.

Needle size for vaccination procedures in children and adolescents.

Immunization information systems to increase vaccination rates: a community guide systematic review.

Immunizations are the most effective way to reduce incidence of vaccine-preventable diseases. Immunization information systems (IISs) are confidential, population-based, computerized databases that record all vaccination doses administered by participating providers to people residing within a given geopolitical area. They facilitate consolidation of vaccination histories for use by health care providers in determining appropriate client vaccinations. Immunization information systems also provide aggregate data on immunizations for use in monitoring coverage and program operations and to guide public health action. Methods for conducting systematic reviews for the Guide to Community Preventive Services were used to assess the effectiveness of IISs. Reviewed evidence examined changes in vaccination rates in client populations or described expanded IIS capabilities related to improving vaccinations. The literature search identified 108 published articles and 132 conference abstracts describing or evaluating the use of IISs in different assessment categories. Studies described or evaluated IIS capabilities to (1) create or support effective interventions to increase vaccination rates, such as client reminder and recall, provider assessment and feedback, and provider reminders; (2) determine client vaccination status to inform decisions by clinicians, health care systems, and schools; (3) guide public health responses to outbreaks of vaccine-preventable disease; (4) inform assessments of vaccination coverage, missed vaccination opportunities, invalid dose administration, and disparities; and (5) facilitate vaccine management and accountability. Findings from 240 articles and abstracts demonstrate IIS capabilities and actions in increasing vaccination rates with the goal of reducing vaccine-preventable disease.

Thirty years of vaccination in Vietnam: Impact and cost-effectiveness of the national Expanded Programme on Immunization

IntroductionCountries like Vietnam transitioning to middle-income status increasingly bear the cost of both existing and new vaccines. However, the impact and cost-effectiveness of the Expanded Programme on Immunization (EPI) as a whole has never been assessed on a country level. MethodsData on vaccine-preventable disease incidence and mortality from Vietnam's national surveillance was analysed to estimate the likely impact that vaccination in 1980–2010 may have had. Adjustment for under-reporting was made by examining trends in reported mumps incidence and in case-fatality risks for each disease. The same data were separately analysed using the Lives Saved Tool (LiST) to give an alternative estimate of impact. The financial cost of EPI in 1996–2010 was also estimated from the perspective of service provider. ResultsNational surveillance data suggests that up to 5.7 million diseases cases and 26,000 deaths may have been prevented by EPI. Analysis using LiST suggests that even more deaths (370,000) may have been prevented by measles and pertussis vaccination alone. The cost-effectiveness of EPI is estimated to be around $1000–$27,000 per death prevented. ConclusionTwo separate approaches to assessing EPI impact in Vietnam give different quantitative results but a common conclusion: that EPI has made a substantial impact on mortality and represents good value for money.

G258(P) A twelve month review of paediatric intensive care in myanmar to guide service development

Aims Reliable healthcare statistics are limited in Myanmar. This study aims to describe the typical patient journey through a Paediatric Intensive Care Unit (PICU) and provide vital information to guide future development. Methods A retrospective review of the PICU admission records and patient medical notes was undertaken for all patients admitted to the PICU from 1st November 2011 until 31st October 2012. Patient information was anonymised and key data was extracted including basic demographics, history of presenting complaint, investigations, management and outcome on the PICU. Results The PICU had 10 beds, 7 ventilators and 1 haemodialysis machine. There was a shortage of staff with only 1 doctor and 2 nurses at night. Routine investigations were available although microbiology culture was rarely performed. 407 patients were admitted with the majority being infants (range 0–16 years). The furthest distance travelled was 907Km for a child with lead poisoning. Most patients were admitted for less than 5 days. The peak admission period was during the rainy season which corresponds to the peak incidence of dengue. 64 patients (17.5%) presented with dengue shock syndrome or dengue haemorrhagic fever. The principle reasons for admission included status epilepticus (26.5%); pneumonia (20%); dengue (17.5%); multi-organ failure (14.2%); septicaemic shock (11.7%); and encephalitis (9.5%). Other important reasons for admission were meningitis; gastroenteritis; post-measles complications; diphtheria; snake bite; Beriberi (including Wernicke’s encephalopathy); tetanus; rabies; malaria; late haemorrhagic disease of the newborn; malnutrition; tuberculosis; HIV; and poisoning (organophosphates; traditional medicine). All patients with a viper bite died of complications including shock, acute renal failure and pulmonary haemorrhage. The majority of patients with diphtheria were managed with a tracheostomy. Overall mortality on the PICU was 34%. Conclusions This study provides a unique insight into the local disease burden, resources available and challenges faced in providing paediatric intensive care. The relatively high incidence of vaccine preventable diseases is of particular concern. Key priorities include support for the development of nurse and doctor training; staff retention; evidence-based guidelines; data management including follow-up; referral pathways; access to routine investigations; and a reliable supply of essential medications and equipment.

G385(P) A twelve month review of paediatric intensive care in myanmar to guide service development

Aims Reliable healthcare statistics are limited in Myanmar. This study aims to describe the typical patient journey through a Paediatric Intensive Care Unit (PICU) and provide vital information to guide future development. Methods A retrospective review of the PICU admission records and patient medical notes was undertaken for all patients admitted to the PICU from 1st November 2011 until 31st October 2012. Patient information was anonymised and key data was extracted including basic demographics, history of presenting complaint, investigations, management and outcome on the PICU. Results The PICU had 10 beds, 7 ventilators and 1 haemodialysis machine. There was a shortage of staff with only 1 doctor and 2 nurses at night. Routine investigations were available although microbiology culture was rarely performed. 407 patients were admitted with the majority being infants (range 0–16 years). The furthest distance travelled was 907 Km for a child with lead poisoning. Most patients were admitted for less than 5 days. The peak admission period was during the rainy season which corresponds to the peak incidence of dengue. 64 patients (17.5%) presented with dengue shock syndrome or dengue haemorrhagic fever. The principle reasons for admission included status epilepticus (26.5%); pneumonia (20%); dengue (17.5%); multi-organ failure (14.2%); septicaemic shock (11.7%); and encephalitis (9.5%). Other important reasons for admission were meningitis; gastroenteritis; post-measles complications; diphtheria; snake bite; Beriberi (including Wernicke´s encephalopathy); tetanus; rabies; malaria; late haemorrhagic disease of the newborn; malnutrition; tuberculosis; HIV; and poisoning (organophosphates; traditional medicine). All patients with a viper bite died of complications including shock, acute renal failure and pulmonary haemorrhage. The majority of patients with diphtheria were managed with a tracheostomy. Overall mortality on the PICU was 34%. Conclusions This study provides a unique insight into the local disease burden, resources available and challenges faced in providing paediatric intensive care. The relatively high incidence of vaccine preventable diseases is of particular concern. Key priorities include support for the development of nurse and doctor training; staff retention; evidence-based guidelines; data management including follow-up; referral pathways; access to routine investigations; and a reliable supply of essential medications and equipment.

Conceptos generales. Calendarios de vacunación sistemática del niño y del adulto en España. Impacto de los programas de vacunación

One area of major importance in promoting health is the prevention of infectious diseases through vaccination.Vaccine is any preparation intended to generate immunity against a disease by stimulating the production of antibodies. There are two basic types: live attenuated and inactivated, with different characteristics that determine their use. The main properties of a vaccine are safety and protective efficacy.The vaccines can be administered based on individualized directions depending on various factors (personal, environmental…), or systematically as part of the immunization schedules.In Spain, the first childhood immunization schedule was implemented in 1975. The Autonomous Communities are currently responsible for establishing vaccine recommendations.The incidence of vaccine-preventable diseases and vaccination coverage are essential criteria for the evaluation of vaccination programs. In Spain the incidence of vaccine-preventable diseases is low. Vaccination coverage is high in childhood, but in adolescents, adults and groups at risk it is not always appropriate.

Determinants of vaccination coverage and adherence to the Greek national immunization program among infants aged 2-24 months at the beginning of the economic crisis (2009-2011).

BackgroundChildhood immunization has significantly reduced the incidence of vaccine preventable diseases. Parental mistrust over vaccine safety has been associated with vaccine refusal creating barriers on vaccine coverage. Recently, economic crisis has imposed additional impediment.MethodsStudy aim was to evaluate vaccine coverage among infants 2-24 months old in the Athens metropolitan area at the beginning of the economic crisis (2009-2011).ResultsOverall, 1,667 infants were enrolled (mean age 13 months). Less than 5% of parents admitted omitting or postponing vaccination secondary to their beliefs. Although vaccination coverage was acceptable for most vaccines, lower rates of immunization were found for some newer vaccines such as hepatitis A and rotavirus. Multiple regression analysis indicated that parental age, occupational, educational statuses and family size were independently associated with immunization coverage at 6 and 12 months. Interestingly, lack of insurance was not associated with missed vaccine doses.ConclusionIncomplete vaccination coverage was associated with socioeconomic factors. It becomes apparent, that reassessing vaccination priorities under the current economic situation may be needed.

Nonmedical exemptions from school immunization requirements: a systematic review.

We summarized studies describing the prevalence of, trends in, and correlates of nonmedical exemptions from school vaccination mandates and the association of these policies with the incidence of vaccine-preventable disease. We searched 4 electronic databases for empirical studies published from 1997 to 2013 to capture exemption dynamics and qualitatively abstracted and synthesized the results. Findings from 42 studies suggest that exemption rates are increasing and occur in clusters; most exemptors questioned vaccine safety, although some exempted out of convenience. Easier state-level exemption procedures increase exemption rates and both individual and community disease risk. State laws influence exemption rates, but policy implementation, exemptors' vaccination status, and underlying mechanisms of geographical clustering need to be examined further to tailor specific interventions.

Tu1176 Utilization of Influenza Immunization in Adults With Crohn's Disease -A Longitudinal, Population Based Study

BACKGROUND The incidence of vaccine-preventable disease is increasing. Several guidelines recommend annual influenza vaccination for patients with inflammatory bowel disease. METHODS Using the Business Objects database of Clalit Health Services in the Tel Aviv district we identified all patients older than 18 years with a diagnosis of Crohn's disease (CD) on December 31, 2005. This cohort was followed until December 31, 2012. Subjects without inflammatory bowel disease older than 50 years served as controls. The uptake of annual influenza vaccination was recorded. RESULTS The study included 515 patients with CD (267 [51.8%] men, age 48.9 ± 17.5 years, disease duration 142.7 ± 56.9 months) and 2960 controls (1262 [42.6%] men, P < 0.01, age 68.9 ± 11.1 years, P < 0.01). The mean number of influenza vaccines received from 2006 to 2012 was 2.08 ± 2.46 and 3.40 ± 2.71 in CD and controls, respectively (P < 0.01). Uptake was higher in patients with CD aged 50 to 59 years and 60 to 69 years, compared with controls (0.45 ± 0.04 versus 0.24 ± 0.01, P < 0.01 and 0.64 ± 0.06 versus 0.50 ± 0.01, P = 0.04, respectively). Vaccination uptake increased significantly over time in both groups (P < 0.01). Predictors of vaccination in CD included age, female sex, immunosuppression, and cardiovascular disease. CONCLUSIONS Uptake of influenza vaccination in CD has increased over the past 7 years, and among subjects older than 50 years, uptake remains higher in age-matched controls. Nevertheless, overall uptake remains low, particularly in young males.

Utilization of Influenza Immunization in Adults with Crohnʼs Disease—A Longitudinal, Population-Based Study

The incidence of vaccine-preventable disease is increasing. Several guidelines recommend annual influenza vaccination for patients with inflammatory bowel disease. Using the Business Objects database of Clalit Health Services in the Tel Aviv district we identified all patients older than 18 years with a diagnosis of Crohn's disease (CD) on December 31, 2005. This cohort was followed until December 31, 2012. Subjects without inflammatory bowel disease older than 50 years served as controls. The uptake of annual influenza vaccination was recorded. The study included 515 patients with CD (267 [51.8%] men, age 48.9 ± 17.5 years, disease duration 142.7 ± 56.9 months) and 2960 controls (1262 [42.6%] men, P < 0.01, age 68.9 ± 11.1 years, P < 0.01). The mean number of influenza vaccines received from 2006 to 2012 was 2.08 ± 2.46 and 3.40 ± 2.71 in CD and controls, respectively (P < 0.01). Uptake was higher in patients with CD aged 50 to 59 years and 60 to 69 years, compared with controls (0.45 ± 0.04 versus 0.24 ± 0.01, P < 0.01 and 0.64 ± 0.06 versus 0.50 ± 0.01, P = 0.04, respectively). Vaccination uptake increased significantly over time in both groups (P < 0.01). Predictors of vaccination in CD included age, female sex, immunosuppression, and cardiovascular disease. Uptake of influenza vaccination in CD has increased over the past 7 years, and among subjects older than 50 years, uptake remains higher in age-matched controls. Nevertheless, overall uptake remains low, particularly in young males.