National Immunization Policy Research Articles

Improving the monitoring of immunization services in Kyrgyzstan

Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish both goals, the MOH updated the national immunization policies and established a more effective structure for managing immunization services. To support the MOH, the US Agency for International Development (USAID) Resources for Child Health (REACH) and Basic Support for Institutionalizing Child Survival (BASICS) projects provided technical assistance through a resident coordinator and consultants, and by organizing an international seminar. The improvements extended beyond systems and forms, but, instead, emphasized monitoring by the frontline health worker and supervising the quality of health information. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. This group, representing both national and local levels, was composed of MOH epidemiologists, paediatricians and a management information specialist. To reduce the burden of excessive record-keeping and reporting requirements, the Working Group identified four key indicators for the service delivery level: (1) DPT3 immunization coverage rates for children less than 1 year of age; (2) contraindication rates for DPT; (3) usage of DPT vaccine; and (4) daily refrigerator temperatures. Additional indicators were included at district and provincial levels. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system improve, but the new approach provided visible evidence, from facility to national levels, that the MOH was approaching their objective of reducing contraindication rates for DPT immunizations to 5% or less, and that vaccine wastage could be substantially reduced. The project demonstrated that giving health workers the basic epidemiologic skills to monitor their own work measurably improved the quality of the data, and by acquiring the new skills, the workers developed a sense of pride in their work.

Use of antivirals in influenza in the elderly: prophylaxis and therapy.

Amantadine and rimantadine inhibit H1N1, H2N2, and H3N2 strains of influenza A, but not influenza B. Rimantadine exerts somewhat greater antiviral activity than amantadine, and there are several potentially important differences between the pharmacokinetic profiles and elimination pathways of the two drugs in favour of rimantadine. Adverse effects are more prominent in the elderly but can be minimized by dosage reductions. Both drugs are effective prophylactically and therapeutically and can be used for 'seasonal' prophylaxis, postexposure prophylaxis, outbreak control in residential care, and treatment during community outbreaks of influenza A. Drug-resistant strains of influenza have been recovered in up to half the subjects undergoing treatment, and prophylaxis may fail in homes where drug is given for both prophylaxis and therapy. Elderly residential patients and others identified by national immunization policies may benefit most from prophylactic administration of drug when influenza is first identified locally and for the duration of the outbreak.

The susceptibility of young adult Americans to vaccine-preventable infections. A national serosurvey of US Army recruits

Due to recent resurgences of measles, mumps, and rubella among young US adults, we sought to generate antibody prevalence data for national and military immunization policy evaluations.We used a questionnaire and serological survey of Army recruits to assess antibody status to measles, mumps, rubella, and varicella by enzyme-linked immunosorbent assay and to poliovirus types 1, 2, and 3 by microneutralization assay.Basic training reception centers at Fort Benning, Ga., and Fort Jackson, SC.The study included 1547 US Army recruits who were inducted during September and October 1989.Seronegativity by various demographic factors.Seronegativity rates, directly adjusted to the 15- to 24-year-old US population in 1980, were 20.7% for measles, 15.6% for mumps, 17.5% for rubella, and 6.9% for varicella. For measles, mumps, and rubella, susceptibility was less in females, blacks, and college-educated recruits, and varicella susceptibility was greater in females and blacks. Recruitment who were born after 1969 lacked measles, mumps, and rubella antibodies more often than older recruits. The adjusted seronegativity rates for poliovirus types 1, 2, and 3 were 2.3%, 0.6%, and 14.6%, respectively; trends by age, sex, and race-ethnicity were generally unremarkable.Among young adult Americans, susceptibility to measles, mumps, and rubella is unevenly distributed and may be substantial. Our findings support national objectives to further improve immunization coverage in school-age and adult populations and provide further impetus for legislation requiring college entrants to present evidence of having received at least two doses of measles vaccine, with one on or after entry into elementary school.

The Susceptibility of Young Adult Americans to Vaccine-Preventable Infections

Due to recent resurgences of measles, mumps, and rubella among young US adults, we sought to generate antibody prevalence data for national and military immunization policy evaluations. We used a questionnaire and serological survey of Army recruits to assess antibody status to measles, mumps, rubella, and varicella by enzyme-linked immunosorbent assay and to poliovirus types 1, 2, and 3 by microneutralization assay. Basic training reception centers at Fort Benning, Ga., and Fort Jackson, SC. The study included 1547 US Army recruits who were inducted during September and October 1989. Seronegativity by various demographic factors. Seronegativity rates, directly adjusted to the 15- to 24-year-old US population in 1980, were 20.7% for measles, 15.6% for mumps, 17.5% for rubella, and 6.9% for varicella. For measles, mumps, and rubella, susceptibility was less in females, blacks, and college-educated recruits, and varicella susceptibility was greater in females and blacks. Recruitment who were born after 1969 lacked measles, mumps, and rubella antibodies more often than older recruits. The adjusted seronegativity rates for poliovirus types 1, 2, and 3 were 2.3%, 0.6%, and 14.6%, respectively; trends by age, sex, and race-ethnicity were generally unremarkable. Among young adult Americans, susceptibility to measles, mumps, and rubella is unevenly distributed and may be substantial. Our findings support national objectives to further improve immunization coverage in school-age and adult populations and provide further impetus for legislation requiring college entrants to present evidence of having received at least two doses of measles vaccine, with one on or after entry into elementary school.

Measles, mumps, and rubella: the need for a change in immunisation policy.

There is growing evidence that the present policy of childhood immunisation in the United Kingdom is inadequate. It is unlikely ever to achieve complete eradication of the congenital rubella syndrome and measles, and the problem of mumps has not even begun to be addressed. After a coordinated campaign to increase uptake of immunisation in Fife the uptake of rubella immunisation in teenage girls increased from 75% in 1981 to 94% in 1985 and the uptake of measles vaccination in preschool children from 55% in 1981 to 81% in 1985. There are a few girls each year who do not accept rubella immunisation, whose immune state is unknown, and who are consequently at risk of rubella during future pregnancies. Despite the increased uptake of measles vaccine over the past four years there is currently an epidemic of measles in Fife, with 544 notified cases in the first quarter of 1986. In 1984, 19 Fife residents were admitted to hospital because of complications of mumps. The time is ripe for a complete reassessment of the national immunisation policy.