Public Vaccination Programs Research Articles

Applied Anthropology, Vaccine Trials and Feasibility Studies: Intersections of Local Knowledge, Biomedicine, and Policy

While a significant number of studies have been undertaken to increase knowledge regarding social, cultural, and economic factors associated with utilization of vaccines, fewer studies have examined participation in vaccine trials and feasibility studies. The experimental nature of trials adds a layer to the already complex contexts of public health vaccination programs. For over ten years, we have been involved in the development and implementation of socio-cultural research in Asia and Africa utilizing a range of qualitative and quantitative methods toward assessment of community, scientific, and policy perceptions and knowledge in relation to vaccine trials and feasibility studies. In this paper, we present a framework for assessing the multiple perspectives of local, national, and international stakeholders and anthropology's contribution to research for the development of communication campaigns and social mobilization before, during, and after trials and feasibility studies.

Optimizing Canadian Public Immunization Programs: A Prescription for Action

Recent expansion of public vaccination programs for children and youth offers new health benefits but at substantially increased cost. As with other large public investments, immunization programs ought to be systematically evaluated for safety, effectiveness and economic value. At present, program evaluations are suboptimal in most provinces and territories. Experts in public health and vaccinology who attended a workshop in 2009 reviewed the shortcomings and produced prescriptions for action to improve matters. Six key recommendations were made: 1) a formal requirement should exist to evaluate all public vaccination programs appropriately; 2) greater voluntary harmonization of programs will facilitate evaluations; 3) a mechanism is needed to prioritize and coordinate program-specific evaluations; 4) new funding mechanisms are needed for basic jurisdictional studies and joint studies of broad relevance; 5) strong emphasis is needed on capacity development and training; and 6) administrative barriers to accessing health information systems and publishing evaluation studies need to be overcome. The expert group considered the need to improve program evaluations as urgent and compelling, with success achievable with dedicated funding and effective leadership. Demonstrating that Canadian immunization programs are among the world's best and safest is a sound strategy for maintaining public participation in those programs.

Optimizing Canadian public immunization programs: a prescription for action.

Recent expansion of public vaccination programs for children and youth offers new health benefits but at substantially increased cost. As with other large public investments, immunization programs ought to be systematically evaluated for safety, effectiveness and economic value. At present, program evaluations are suboptimal in most provinces and territories. Experts in public health and vaccinology who attended a workshop in 2009 reviewed the shortcomings and produced "prescriptions for action" to improve matters. Six key recommendations were made: 1) a formal requirement should exist to evaluate all public vaccination programs appropriately; 2) greater voluntary harmonization of programs will facilitate evaluations; 3) a mechanism is needed to prioritize and coordinate program-specific evaluations; 4) new funding mechanisms are needed for basic jurisdictional studies and joint studies of broad relevance; 5) strong emphasis is needed on capacity development and training; and 6) administrative barriers to accessing health information systems and publishing evaluation studies need to be overcome. The expert group considered the need to improve program evaluations as urgent and compelling, with success achievable with dedicated funding and effective leadership. Demonstrating that Canadian immunization programs are among the world's best and safest is a sound strategy for maintaining public participation in those programs.

An Outbreak of Varicella among Schoolchildren in Taipei

BackgroundThe reported cases with varicella have not decreased and outbreaks of varicella among vaccinated children continue to be reported 9 years after the public vaccination program in Taipei. We investigated an outbreak to determine varicella vaccine coverage and effectiveness.MethodsAn outbreak occurred in an elementary school which located in southern Taipei from April 2007 through May 2007. A retrospect cohort study was performed by using a self-administered questionnaire for parents.ResultsTen out of sixteen varicella cases were vaccinated. Overall vaccine coverage was 71.2%. The common reasons for not receiving varicella vaccine were that varicella vaccine was unavailable because the student didn't live in Taipei (29.4%) or the children could not be vaccinated due to certain illnesses (23.5%). The sensitivity and specificity of self-reported vaccination status was 0.900 (95% CI: 0.864, 0.935) and 0.611 (95% CI: 0.514, 0.701).The vaccine effectiveness was 69.3%-100.0% against any disease severity of varicella. Overall vaccine effectiveness against moderate or severe varicella was 85.5%. Attending cram school was associated with the risk of developing the varicella illness (RR: 13.39; 95% CI: 5.38, 33.31). Unvaccinated students tended to show moderate to severe (>50 lesions) afflictions of the disease (RR: 4.17; 95% CI: 1.15, 15.14).ConclusionsBecause of the low vaccination coverage, varicella outbreaks continue to be reported in Taipei. Increasing vaccine coverage and second dose vaccination for increasing vaccine effectiveness may be considered.

Health Belief Model: Evaluating Marketing Promotion in a Public Vaccination Program

National health objectives are driven to increase participation rates. Individual health decisions are determined by attitudes, behavior, lifestyles, and government policies. This research, therefore, examined not just the development and delivery of a message targeting individual voluntary behavior change, but the intention of changes in social structures that will facilitate individuals reaching their potential; thus the purpose of this article is to shed light on the uptake of the human papillomavirus (HPV) immunization using the health belief model (HBM). Research was conducted with the use of focus groups by drawing on the framework of the HBM. This research approach is conceptual by nature, based on the virtue of marketing promotion and on HBM literature. Though offering the vaccine free to the general public provides additional evidence to certain groups on the intention to act or uptake of the vaccine, awareness levels were found to be poor despite increased efforts by the government trying to promote this vaccine. There was evidence that social capital and trust can produce effective communication message strategies that reinforce social bonds. This article provides an interesting basis for further investigation; however, as implausible as it seems the article also contributes to the concept of perceived benefits and of self-efficacy.

Seroprevalence of human papillomavirus 6, 11, 16, and 18 in young primiparous women in Sao Paulo, Brazil.

Data on epidemiology of HPV infection are needed for the development of human papillomavirus (HPV) vaccine recommendations, especially in countries where HPV vaccination is not yet included in public vaccination programs. The aim of this study was to determine the prevalence of serum antibodies to HPV types 6, 11, 16, and 18 and associated factors among young women after birth of the first child. This cross-sectional study was carried out in a large public maternity hospital in Sao Paulo, Brazil. Three hundred one women aged 15 to 24 years who gave birth to their first child were recruited between 43 and 60 days after delivery. Seroprevalence was performed using a type-specific enzyme-linked immunosorbent assay based on HPV Late protein 1 viruslike particles. The association of seroreactivity with these 4 HPV types with selected demographic and behavioral factors was assessed by Generalized Linear Model analysis. Fifty-eight (19.3%) women (95% confidence interval, 15.0%-24.2%) had antibodies to any of the 4 viruslike particles tested. The overall seroprevalence rates of the HPV types were: HPV16, 9.0%; HPV18, 7.0%; and HPV 6+11, 7.7%, which are targeted by the HPV prophylactic vaccines. In the multivariate analysis, only age (inversely, P = 0.044 for trend) and previous sexually transmitted disease (P = 0.008) were 2 factors independently associated with HPV seropositivity. These data offer additional information on the epidemiology of HPV in a group of young Brazilian women after first delivery and contribute to establish a baseline of HPV seroprevalence against which post-HPV vaccine era seroprevalence can be compared.

Epidemiology of Human Papillomavirus Infection and Cervical Cancer and Future Perspectives in Hong Kong, Singapore and Taiwan

Hong Kong, Singapore and Taiwan are three island states that are newly emerged affluent economic areas in Asia. The majority of the populations are ethnically Chinese with a total population of 6.98, 4.5 and 23 million, respectively. Cervical cancer has been declining over the last thirty years in all three states and is largely attributable to widespread opportunistic cervical cancer screening. The age-standardized incidence rates of cervical cancer are 9.6 per 100,000 women in Hong Kong in 2004, 10.6 per 100,000 women in Singapore in 2002 and 18.6 per 100,000 women in Taiwan in 2003. High prevalence of human papillomavirus (HPV) was observed in all three states. In cervical cancer, HPV 16 and 18 are the two most prevalent HPV types, but HPV 58 and 52 are also highly prevalent in these three states. Important epidemiological risk factors for invasive cervical cancer include smoking and age at sexual debut for women, although this is changing towards an earlier age. Of the three states, Taiwan was the first to have a comprehensive national screening programme in 1995 followed by Hong Kong in 2002 and Singapore in 2004. Women in these three states are well aware of cervical cancer and the preventative means by Pap smear screening, although their awareness and understanding of the role of HPV in cervical carcinogenesis is low. Prophylactic HPV vaccines have been licensed in the three states. Routine comprehensive public vaccination programme for adolescent girls has yet to be adopted by the governmental agency, despite an affirmative recommendation by medical professional bodies.

Impact of public vaccination programs on adult vaccination rates: Two examples from Ontario, Canada

This study examined adult vaccination rates in Metropolitan Toronto/Peel Region following the implementation of publicly funded adult pneumococcal and universal influenza vaccination programs in Ontario. Community-living adults eligible for pneumococcal vaccines were surveyed regarding vaccination rates, and factors potentially associated with vaccination. Influenza vaccine rates increased over time, but only respondents 65 years of age and older met Canadian targets. Pneumococcal vaccine rates were below target for all respondents. More than 90% of unvaccinated respondents had seen a physician within the past year, and most vaccinations occurred in a physician's office, suggesting a role for physician advocacy to improve immunization rates. Adult vaccination programs may be less successful than pediatric programs in achieving vaccine uptake, and require on-going assessment and promotion.

Epidemiology of hepatitis B virus infection among young adults in Taiwan, China after public vaccination program

The public vaccination program of hepatitis B virus (HBV) was launched during 1984 in Taiwan, China. However, the long-lasting protective efficacy of HBV vaccination among adolescents older than 15 years of age was seldom recorded. A seroepidemiological survey was conducted among 4575 first-year university students in Taiwan, China during 2000 to 2003, including the serological data of HBV by testing HBV surface antigen (HBsAg), surface antibody (anti-HBs), HBV core antibody (anti-HBc) and demographic information. HBsAg carrier rate among male university students born before the initiation of the HBV vaccination program decreased from 12.8% to 4.8% among those born after the vaccination program (P < 0.001, chi(2) test for linear trend). Similarly, HBsAg carrier rate among female university students born before the initiation of the HBV vaccination program decreased from 8.1% to 2.7% among those born after the vaccination program (P < 0.001, chi(2) test for linear trend). Both male and female students in eastern Taiwan had the highest HBsAg carrier rate compared with the other places. Using multiple logistic regression analysis, compared with students born after July 1984, the adjusted OR of HBsAg carrier rate decreased from 3.10 for students born before June 1981 to 1.56 for students born from July 1983 to June 1984 (95% CI 1.96 - 4.91, P < 0.001; 95% CI 1.06 - 2.28, P = 0.024; respectively). Public vaccination provides long-lasting protection again HBV infection among the university students in Taiwan, China older than 18 years of age. There is a geographic variation of HBV infection among young adults in Taiwan, China.

Human papilloma virus (HPV) prophylactic vaccination: Challenges for public health and implications for screening

Prophylactic vaccination against high risk human papilloma virus (HPV) 16 and 18 represents an exciting means of protection against HPV related malignancy. However, this strategy alone, even if there is a level of cross protection against other oncogenic viruses, cannot completely prevent cervical cancer. In some developed countries cervical screening programmes have reduced the incidence of invasive cervical cancer by up to 80% although this decline has now reached a plateau with current cancers occurring in patients who have failed to attend for screening or where the sensitivity of the tests have proved inadequate. Cervical screening is inevitably associated with significant anxiety for the many women who require investigation and treatment following abnormal cervical cytology. However, it is vitally important to stress the need for continued cervical screening to complement vaccination in order to optimise prevention in vaccinees and prevent cervical cancer in older women where the value of vaccination is currently unclear. It is likely that vaccination will ultimately change the natural history of HPV disease by reducing the influence of the highly oncogenic types HPV 16 and 18. In the long term this is likely to lead to an increase in recommended screening intervals. HPV vaccination may also reduce the positive predictive value of cervical cytology by reducing the number of truly positive abnormal smears. Careful consideration is required to ensure vaccination occurs at an age when the vaccine is most effective immunologically and when uptake is likely to be high. Antibody titres following vaccination in girls 12–16 years have been shown to be significantly higher than in older women, favouring vaccination in early adolescence prior contact with the virus. Highest prevalence rates for HPV infection are seen following the onset of sexual activity and therefore vaccination would need to be given prior to sexual debut. Since 20% of adolescents are sexually active at the age of 14 years, vaccination has been suggested at 10–12 years. However, parental concerns over the sexual implications of HPV vaccination may reduce uptake of vaccination thereby reducing the efficacy of an HPV vaccination programme. Concerns have already been raised over the acceptability of a vaccine preventing a sexually transmitted infection in young adolescents, particularly amongst parents or communities who consider their children to be at low risk of infection. This may be a particularly sensitive issue for ethnic minority groups. This paper considers the factors which will influence the efficacy of a public HPV vaccination programme and its impact on cervical screening.

Use of National Health Insurance database to evaluate the impact of public varicella vaccination program on burden of varicella in Taiwan

The aims of this study were to investigate the epidemiology of varicella and evaluate the effect of varicella vaccination on the burden of varicella in Taiwan. The outpatient and hospitalization claims made to the National Health Insurance (NHI) in public and private vaccination areas were compared during 2000–2002. In 2002, the outpatient visit rates for 1- to 5-year-old children in public vaccination areas were 66–78% lower than their counterparts in private vaccination areas. The reduction in outpatient visit rate was the greatest among preschool children. The reductions also occurred in every age group including infants and adults. This study showed significant evidence of vaccine impact with a marked decline in clinical cases in the short term.

Smallpox, vaccination and adverse reactions to smallpox vaccine.

Public fear of the reintroduction of smallpox as a biological weapon or agent of bioterrorism has led to a renaissance of interest in smallpox, and a military and public health vaccination programme in the USA. Clinical experience from the last century together with novel immunobiological findings is the basis for current knowledge on smallpox as a disease. Pre-existing knowledge on smallpox vaccination, plus recent vaccination campaign-derived data, is the basis of current risk-benefit assessments. This article summarizes, from a dermatologist's point of view, current aspects of smallpox, smallpox vaccination and adverse reactions to vaccinia, the live virus smallpox vaccine. The smallpox vaccination campaign in the USA has involved over 600,000 vaccinees, and has largely confirmed incidence data on complications. An increased rate of myopericarditis is the new finding in the current vaccination campaign. Immunodeficiencies, manifest atopic dermatitis lesions and a history of atopic dermatitis remain contraindications to vaccination. Plasmacytoid dendritic cells are a key regulator of the human antiviral immune response and are recruited to inflamed skin in many skin diseases, but are depleted in atopic dermatitis lesions. The lack of plasmacytoid dendritic cell recruitment, together with the missing upregulation of antiviral peptides such as cathelicidin LL37 in atopic dermatitis lesions, is considered relevant for an atopic dermatitis patient's susceptibility to eczema vaccinatum. Recent experience from the US smallpox vaccination campaign has largely confirmed what was known in the 1960s. Current immunobiological research will enhance our understanding of the interaction between poxviruses and the skin's immune system.

A Vaccination Model for Transmission Dynamics of Influenza

Despite the availability of preventive vaccines and public health vaccination programs, influenza inflicts substantial morbidity, mortality, and socio-economic costs and remains a major public heal...

Moving from recommendation to implementation and audit: Part 2. Review of interventions and audit

There are multiple interventions available that may help to control the development and spread of resistance to antimicrobial agents in bacteria implicated in community-acquired respiratory tract infections. Unfortunately, very few studies have assessed the effectiveness of these interventions using objective end-points, such as reduction in resistance rates and improvement in clinical outcomes. Most interventions are centered on reducing inappropriate or unnecessary use of antibiotics; others focus on reducing disease burden and bacterial colonization. With regard to antibiotic use, efforts should be concentrated at both the prescriber and consumer levels. Interventions that target prescribers include: provision of educational materials; strategies and tools to improve diagnosis; implementation of practice guidelines; personalized interactive sessions with feedback on the practice profile; and use of delayed prescription and alternative prescribing strategies. Optimal results are usually obtained when these interventions are combined with consumer education. Regulatory interventions (e.g. licensing regulations and controlled access to drugs), restrictions in the use of agents for growth promotion in animals, and use of nonantimicrobial therapies (e.g. probiotics) may help further to reduce inappropriate antibiotic use and thereby decrease the selective pressure for development of resistance. Infection-control strategies, public health measures, vaccination programs, and new antibiotics all have a role in minimizing the spread of resistant organisms. Ideally, resistance-control programs should include predefined criteria for success and integral audit processes based on objective end-points (antibiotic use, resistance trends, and health outcomes). Standardization of data collection is imperative so that the relative merits of various interventions can be compared. Effective implementation and audit of interventions is often difficult in developing countries owing to poor health-care infrastructures, lack of resources, poor education/training, and minimal regulatory controls on the supply and quality of antimicrobials. Substantial support from governments and health-care organizations across the globe is required to initiate and sustain effective intervention programs to control antimicrobial resistance.

Academy adds voice to vaccine safety debate

As the issue of vaccine safety continues to heat up, a committee in the U.S. Congress held a second oversight hearing to investigate the current vaccine program. On Aug. 3, the House Committee on Government Reform, chaired by Rep. Dan Burton (R-Ind.), convened to examine whether the risks outweigh the benefits of public vaccination programs and to discuss finding a balance between public health and individual choice. Parents, medical experts and U.S. Surgeon General David Satcher, M.D., testified before the committee to offer scientific expertise and personal experiences. The Academy was represented by Samuel Katz, M.D., FAAP, a member of the Infectious Diseases Society of America. Immunization is the single intervention that has most dramatically reduced childhood morbidity and mortality, said Dr. Katz in his testimony. In our lifetime, it has led to longer, healthier and happier lives.

Public knowledge about hepatitis B-related issues in Korea.

Hepatitis B infection is endemic in many parts of the world, including Korea. Basic knowledge of the hepatitis B virus by the public is a prerequisite for the development of a successful vaccination program. A survey was conducted in rural Korea to examine public knowledge of hepatitis B etiology, symptoms, transmission, risk factors and prevention. It was found that knowledge independently correlated with education and female sex, but that overall knowledge of hepatitis B was poor. The preferred information sources in order of preference were physicians, television and public health nurses. This information may be useful in designing public health education and vaccination programs in developing populations.

Critical issues surrounding hepatitis B vaccination for adolescents: A roundtable

Hepatitis B virus infection the only sexually transmitted disease that currently can be prevented by immunization poses a significant health risk to adolescents. Past recommendations for adolescents involved identifying and vaccinating only those deemed at high risk. This approach has not proved effective. Fewer than 1% of the 18 million adolescents in the United States have been vaccinated against this disease. Hepatitis B infections in teenagers have increased by 27% over the past decade. Ninety percent of all cases reported to the Centers for Disease Control and Prevention occur in teens and young adults. Hepatitis B remains the only vaccine-preventable disease in which transmission rates have not dropped after introduction of a vaccine. The panel recommended universal vaccination of all adolescents through private and public health vaccination programs with a target on young adolescents in the middle school setting. An edited version of the panel presentations and discussions provides the background for this recommendation. (excerpt)

Canine distemper virus-specific antibodies in multiple sclerosis.

Current postulates support the idea that MS is triggered by an infectious agent or agents through an autoimmune reaction directed against brain antigens in genetically susceptible individuals. Evidence for an infectious etiology of MS is indirect. We have proposed that MS may, in some instances, be due to a zoonotic infection and that canine distemper virus, a measles-like virus in dogs, is a likely candidate in the causation of this disorder. The high homology between canine distemper and measles virus proteins has made it extremely difficult to distinguish distemper from measles antibodies serologically. We now provide evidence that humans can be infected with this neurotropic dog virus. Furthermore, a high titer of canine distemper virus antibodies is significantly associated with MS. Identification of the etiologic agent in MS may lead to the elucidation of disease pathogenesis and to disease prevention through appropriate public health and vaccination programs.

Effect of outer membrane vesicle vaccine against group B meningococcal disease in Norway

For more than 15 years, Norway has had the highest incidence of meningococcal disease in northern Europe, with 80% of cases being due to serogroup B meningococci. The case-fatality has remained high, at about 10%. In this study, an outer membrane vaccine, which had previously been shown to induce an increase in bactericidal antibodies to the parent strain, was assessed in a large-scale, randomised, double-blind trial. From October, 1988, 171 800 students in secondary schools volunteered to take part in a double-blind, placebo-controlled, efficacy trial with school as the randomisation unit. Hospitals and clinics that routinely receive patients with infectious disease were asked to report urgently all cases of suspected meningitis and/or septicaemia in 13-21-year-old students in Norway. These cases were registered and further investigated according to a detailed protocol. 89 out of the 221 cases investigated by June 3, 1991, were shown to be severe systemic disease due to group B meningococci. 36 cases in 35 schools took part in the trial (11 schools with vaccinated students and 24 with students given placebo). The calculated rate of protection was thus 57·2% (p=0·012, one-sided test). The findings suggest that, although the vaccine conferred protection against group B meningococcal disease, the effect was insufficient to justify a public vaccination programme.