Introduction Of Universal Immunization Research Articles

No evidence of an increase in the incidence of norovirus gastroenteritis hospitalizations in young children after the introduction of universal rotavirus immunization in Israel

ABSTRACT Following the introduction of universal immunization against rotavirus, concerns were raised regarding pathogen-replacement of rotavirus by norovirus. The study aim was to examine the incidence and characteristics and norovirus gastroenteritis before and after the introduction of universal rotavirus immunization in Israel. We studied 1179 stool samples collected between November 2007 and December 2014 for a prospective hospital-based surveillance study of children aged 0–59 months hospitalized for gastroenteritis. A real-time RT-PCR assay was used to identify genogroup II (GII) norovirus in extracted fecal RNA samples. Overall, the weighted percentage of norovirus positive patients was 10.9%. Norovirus positivity was similar in the pre-universal rotavirus immunisation years (2008–2010) and the universal years (2011–2014), the respective average annual incidence of norovirus gastroenteritis was 1.6 (95% CI 0.6–2.3) per 1000 and 1.1 (95% CI 0.8–1.4) per 1000 children. Rotavirus was detected in 36.8% and 19.6% of the patients in the pre-vaccine years and the universal vaccine years, with an estimated incidence of 5.5 (95% CI 3.4–7.6) per 1000 and 2.1 (95% CI 1.6–2.7) per 1000 children, respectively. Most patients (59.1%) with norovirus gastroenteritis were infants aged 0–11 months. Norovirus was detected all year round with a significant 3-month peak from September through November. In conclusion, norovirus continues to be a leading cause of acute gastroenteritis associated with hospitalizations in young children. Future norovirus vaccines should target young infants. There was no evidence of pathogen-replacement by norovirus following the introduction of universal rotavirus immunization in Israel.

Effectiveness of rotavirus pentavalent vaccine under a universal immunization programme in Israel, 2011–2015: a case–control study

ObjectivesThe use of rotavirus pentavalent vaccine (RotaTeq®) as a sole vaccine within rotavirus universal immunization programmes remains limited. We examined the effectiveness of RotaTeq in preventing rotavirus gastroenteritis (RVGE) hospitalization in Israel, after the introduction of universal immunization against the disease. MethodsA test-negative case–control study included age-eligible children for universal RotaTeq immunization (aged 2–59 months, born in 2011–2015). Cases (n = 98) were patients who tested positive for rotavirus by immunochromatography; those who tested negative (n = 628) comprised the control group. Information on rotavirus immunization history was obtained through linkage with a national immunization registry. Vaccination status was compared between cases and controls, adjusted odds ratios (aORs) were obtained from logistic regression models, and vaccine effectiveness calculated as (1 − aOR)*100. ResultsImmunization with RotaTeq was less frequent in RVGE cases (73.5%) than in controls (90.1%), p < 0.001; this association persisted after controlling for potential confounders. Effectiveness of the complete vaccine series was estimated at 77% (95% confidence interval (CI): 49–90) in children aged 6–59 months, and 86% (95% CI: 65–94) in children aged 6–23 months; whereas for the incomplete series, the respective estimates were 72% (95% CI: 28–89) and 75% (95% CI: 30–91). Vaccine effectiveness was estimated at 79% (95% CI: 45–92) against G1P[8]-associated RVGE hospitalizations and 69% (95% CI: 11–89) against other genotype-RVGE hospitalizations. ConclusionsHigh effectiveness of RotaTeq as the sole rotavirus vaccine in a universal immunization programme was demonstrated in a high-income country. Although partial vaccination conferred protection, completing the vaccine series is warranted to maximize the benefit.

Seroprevalencia de rubeola en Colombia: un analisis por cohorte de nacimiento

OBJECTIVETo estimate the seroprevalence of rubella and associated factors.METHODSPopulation-based seroprevalence study in a random sample of 2,124 individuals, aged six to 64 years, representative by age, sex and area in Medellín, Colombia, 2009. Biological and socioeconomic variables were analyzed for their association with serum protection against rubella, according to birth-year cohort; those born before (1954-1990) and after (1991-2003) the introduction of universal immunization. Titer of IgG antibodies against the rubella virus was detected using a high sensitivity (AxSYM®Rubella IgG – Abbott Laboratories) and a high specificity test (VIDAS RUB IgG II®– BioMerieux Laboratories). Proportions and weighted averages derived from a complex sample, including a correction factor for differences in gender participation, were estimated. Association with protection for groups of biological and social variables according to birth cohort was analyzed using a logistic regression model.RESULTSTiters of IgG antibodies were higher in those born before (mean 110 UI/ml, 95%CI 100.5;120.2) compared to those born after (mean 64 UI/ml; 95%CI 54.4;72.8; p = 0.000) the introduction of mass immunization. The proportion of protection increased from 88.9% in those born 1990-1994, to 89.2% in those born 1995-1999 and to 92.1% in those born between 2000 and 2003, possibly due to boosters being administered from 1998 onwards. In those born before the introduction of the immunization, seroprotection was associated with previous contact with cases (OR 2.6; 95%CI 1.1;5.9), self- perceived health status (OR 2.5; 95%CI 1.05;6.0), educational level (OR 0.2; 95%CI 0.08;0.8) and years of residence in the neighborhood (RD 0,96; 95%CI 0.98;1.0) after adjusting for all variables. In those born after, serum protection was associated with effective sleep time (OR 1,4; 95%CI 1.09;1.8) and self-perceived health status (OR 5.5; 95%CI 1.2;23.8).CONCLUSIONSThe seroprevalence profile changed with the mass immunization plan, with higher titers of IgG antibodies in those born before the start of the immunization. It is recommended that the level of long-term protection be monitored and concerted action taken to improve potentially associated socioeconomic conditions.

Vaccination généralisée contre l'hépatite B en Suisse: Qu'en pensent les médecins vaccinateurs?

Enquete par questionnaire: Les medecins vaccinateurs indiquent que Les medecins exercant la medecine scolaire jugent que la vaccination, en milieu scolaire, des adolescents serait faisable mais soul⪻verait des problemes logistiques.

Introduction of general hepatitis B vaccination in Switzerland

The Swiss Federal Office of Public Health and the Advisory Board on Immunisation recommended that all adolescents aged 11 to 15 should be vaccinated against hepatitis B in December 1997. The introduction of universal immunisation is justified for epidemiological and economical reasons. Universal immunisation in no way excludes the immunisation of all persons exposed to a specific risk and the prenatal screening and immunisation of exposed newborns. Hepatitis B vaccines are safe and highly effective. The main reasons for this recommendation are summarised in the article.

General hepatitis B vaccination in Switzerland: what is the attitude of vaccinating physicians?

The purpose of this study is to assess Swiss physicians' knowledge on hepatitis B, their perception of parental information concerning this infection, their attitude towards planned universal vaccination, and their agreement with different universal immunisation scenarios. Vaccination scenarios were assessed in the following groups: infants, children at school entry, children aged 11 to 13, and children aged 14 to 16. Furthermore, scenarios involving the immunisation of school-aged children included the administration of the vaccine doses by the child's private physician or by the school health officer. Questionnaires were mailed to members of the Swiss Society of Pediatrics (n = 994), to a random sample of family physicians (n = 1000), to internists practicing general medicine (n = 500), and to chief medical officers of school health services in nine major Swiss cities. Physicians reported that they were sufficiently well informed on the serious potential sequelae of hepatitis B and the efficacy of vaccine prevention, but insufficiently informed on its epidemiology. They do not fundamentally disagree with the introduction of universal immunisation and think that parents are not aware of the potential long term dangers associated with this infection. Pediatricians and general practitioners believe that vaccinating infants at the cost of three extra injections would not be accepted by their peers and parents, and that immunising older children in their office would be feasible though difficult. School health officers believe that the immunisation of children aged 14 to 16 within the school health setting would be feasible. Universal vaccination of older children and adolescents is the scenario that best fits Switzerland's needs, perceptions and present circumstances.

Introduction en Suisse de la vaccination généralisée contre l'hépatite B

• Il est recommande de vacciner tous les adolescents âges de 11 a 15 ans. • L'introduction en Suisse de la vaccination generalisee contre l'hepatite B est justifiee par des arguments epidemiologiques et economiques. • Le vaccin contre l'hepatite B a deja fait la preuve de son efficacite et de sa securite. • La recommandation de la vaccination generalisee ne supprime en aucun cas la necessite de poursuivre le depistage prenatal et la vaccination selective des sujets a risque eleve d'exposition.