Universal Childhood Immunization Research Articles

The Contribution of Immunization to Economic Development

Immunization received intensive support during the 1980s in light of its demonstrable value, relatively low cost, and established infrastructure. The goal of universal childhood immunization was achieved in 1990 on the basis of a strategy of expanding coverage, technological improvements, and social mobilization. Although its impact is difficult to quantify precisely, the Expanded Programme on Immunization (EPI) has had significant positive effects on national and household economies as a result of the reduction of morbidity and mortality. It also has contributed to the development of the managerial and operational capacity of health systems and to the generation of widespread social and political support for health actions through a variety of different mechanisms. Priorities for the next decade include attention to policies to ensure the maintenance of high levels of coverage, continued technical development, and further strengthening of EPI planning and management.

Acellular pertussis vaccines--a solution to the pertussis problem.

Available data relating to pertussis and pertussis immunization are frequently overlooked or misinterpreted. Mortality due to pertussis is underreported. Most whole cell pertussis vaccines are effective; there is no evidence that pertussis vaccines cause brain damage. Moreover, acellular pertussis vaccines have been used successfully in Japan since 1981. Third-generation, genetically derived acellular pertussis vaccines have been developed, but knowledge of antigens and concentrations required has not kept pace with vaccine technology. There is substantial evidence that pertussis is not a single lymphocytosis-promoting factor (LPF) toxin disease. Pertussis vaccine efficacy studies suggest that monocomponent LPF toxoid or biocomponent LPF toxoid/filamentous hemagglutinin (FHA) vaccines are not as effective as vaccines that contain pertactin and fimbrial antigens as well as LPF toxoid and FHA. Future programs with multicomponent acellular vaccines and universal childhood immunization followed by booster doses in adults will effectively curtail disease incidence and the circulation of Bordetella pertussis.

Vaccine Program Advisory Committee Sticks Secretary Lee With Plan to Fix Vaccination System

A LONG-AWAITED plan for more effective use of vaccines is in the hands of the assistant secretary for health, Philip Lee, MD. By unanimous vote, an advisory committee to the National Vaccine Program Office approved the plan and recommended that the program office's director, Kenneth J. Bart, MD, send it to Lee. If it is put into effect, the plan's drafters believe that some 25 major human diseases caused by viruses or bacteria can be eliminated or at least controlled by vaccines. Given the Clinton administration's much-publicized Comprehensive Childhood Vaccination Initiative, which calls for universal immunization of all eligible children, the plan amounts to a blueprint for almost certain action. Although the emphasis is on fully immunizing children by the age of 2 years, the plan also deals with the need to immunize adults. (The most recent "Standards for Pediatric Immunization Practices," recommended by the National Vaccine Advisory Committee and

The Children's Vaccine Initiative

In November 1991, the United Nations declared and celebrated the success of its universal childhood immunization campaign. Seventeen years after the Expanded Program on Immunization began by capitalizing on investments in the global smallpox eradication campaign, the United Nations Children's Fund (UNICEF) and World Health Organization (WHO) achieved their goal. Over 80% of children born in the world in 1990 received the six standard vaccines (against tuberculosis, diphtheria, pertussis, tetanus, polio, and measles). The United Nations Children's Fund estimates that over 3.2 million children's lives are saved annually.1Yet infectious diseases continue to kill children in developing countries. We are not getting the full benefits of the six Expanded Program on Immunization vaccines. Measles account for the death of almost 1 million children each year. There are 500 000 neonatal deaths related to tetanus each year and 400 000 to pertussis according to UNICEF. In Africa, Latin America, and

Prospects for Control of Hepatitis B Virus Infection: Implications of Childhood Vaccination and Long-term Protection

Hepatitis B vaccine has been recommended for high-risk individuals in the United States for more than a decade. This targeted strategy, however, has failed to control hepatitis B virus (HBV) infection. Universal immunization is being considered as an alternative approach, in particular the inclusion of hepatitis B vaccine with routine childhood vaccinations. Data presented herein demonstrate a high degree of efficacy for hepatitis vaccine with hepatitis B immune globulin in preventing perinatal HBV infection in newborns. Immune response to vaccine was dependent in part on the dose administered, with some enhancement of response if the infant was older at the time of initial injection or if the booster dose was given later. Long-term follow-up showed persistence of vaccine-induced antibody for 5 to 10 years in 90% of immunized infants and adults. Only 3% to 5% of these high-risk individuals had serologic evidence of an HBV infection. None of the infections had been symptomatic and none resulted in a chronic HBV carrier state. Thus, immune responses and efficacy of hepatitis B vaccine in infants were excellent, and immunity and protection against clinically significant HBV infection persisted for at least 5 to 10 years, features essential to success of a program of universal childhood immunization against HBV.

Mortality of American Indian and Alaska native infants.

Accurate determination of infant mortality rates among Indians in seriously hampered by variations in the identification of Indian persons and use of different subsets of the Indian population for various purposes. Lack of consistency in the reporting of racial origin on birth and death records is a source of substantial error. Because of these factors, more than the usual care must attend comparisons and inferences drawn from data in which these differences are present. At present, it would seem prudent to regard all data about American Indians as provisional. Even though Indian infant mortality remains higher than that for US all races, regardless of techniques used for estimates, the decline of Indian infant mortality by more than 80% since the establishment of the IHS is a truly remarkable achievement. This success has been ascribed to a combination of activities, including the provision of safe drinking water, especially as an integral part of the IHS program; the nearly universal immunization of Indian children; and emphasis upon comprehensive, community-oriented programs focused on maternal and child care. These successes have contributed to changes in the distribution of the leading causes of Indian infant mortality, so that the most prominent causes now are SIDS, congenital anomalies, injuries, and various infections. Because of these changes and advances in knowledge, the IHS has recently revised its five-year plan for dealing with infant mortality to provide greater attention to injuries and infections and has embarked upon a series of discussions with the American Academy of Pediatrics to address postneonatal deaths and the difficult problem of SIDS. Low socioeconomic conditions, so important in influencing mortality rates (7, 14, 29), have thus far proved to be intractable. In the meantime, success will depend upon ensuring optimal prenatal care, reducing those risk factors amenable to correction, and solving the problem of SIDS.

Pertussis: the trials and tribulations of old and new pertussis vaccines

The mortality from pertussis in unvaccinated infants is significantly greater than that reported. Most present day whole-cell pertussis vaccines are efficacious. Although they cause frequent reactions, studies during the last 15 years reveal no evidence that they cause brain damage. Acellular pertussis vaccines have been used successfully in Japan since 1981. In spite of this, five vaccine efficacy trials in three countries are presently in progress. Of the six vaccines being studied, three seem to be less than optimal choices for study because they are similar to the two vaccines evaluated in the original Swedish efficacy trial which had disappointing efficacy. The lessened reactions associated with acellular pertussis vaccines make routine adult booster immunization possible. A future immunization programme with vaccines that elicit antibodies which completely block bacterial attachment to ciliary epithelial cells, and which includes universal childhood immunization and adult booster doses can be expected to have a dramatic effect upon disease incidence and the circulation of Bordetella pertussis in the community.

Universal childhood immunization.

Universal childhood immunization.

Universal childhood immunization

Universal childhood immunization

PROTECTING THE WORLD'S CHILDREN An Agenda for the 1990s

The 3rd Bellagio conference was held on March 10-12 1988 at Talloires France. It was convened to ensure continued commitment to the goal of universal childhood immunization by 1990 and the provision of the necessary support to that end. The principal foci of the meeting were sustainability of immunization the addition of new and better vaccines and the introduction of other major cost-effective health initiatives. When the Expanded Program on Immunization (EPI) started work in 1974 only 5% of the children of the developing world were immunized. It is now expected that in 1990 the long-term EPI goal of 80% of the worlds children immunized will be achieved. Many new more powerful and more specific vaccines are expected to be available by the end of the century. At the conference detailed discussions of the control of diarrheal diseases and of fertility took place. I was clear at the meeting that the Child Survival and Development Revolution has generated massive political commitment to child health throughout the developing world.

Diphtheria Immunity Status in Montgomery County School Seniors and Adults

IPPHTHERIA, onice primarily a disease of infants and young children, has been increasing among adults and teen-aged children over the past 20 years (1-4). The shift in age-specific morbidity rates can be traced to markedly decreasing exposures to virulent Corynebacterium. diphtheriae. The almost universal artificial immunization of infants and children has resulted in less frequent natural immunity among adults. Somewhere between the adult and the child, lhowever, lies a zone where the protection of unreinforced early immunization begins to wear off. Outbreaks of diphtheria in Detroit, Mich., Albuquerque, N. Mex., and South Carolina in the fall of 1956, while this study was still in the planning stages, pointed up the importance of continued awareness of the disease as a public health problein (5, 6). It also reemphasized the value of current data on the relative immunity of various population segments in anticipating and preventing outbreaks. In this study we undertook specifically to determine the relative immunity to diphtheria of the young adult population in an area where only 2 cases, both in white men in their early twenties, have been reported during the preceding 2 years. The study was conducted in Montgomery County, Md., during January and February 1957. The county, principally a suburban residential center, is northwest of the District of Columbia and has an area of about 525 square miles. Its population, growing at a prodigious rate in the postwar period wvith the influx of Governament workers, is niearly 300,000. Of these, 6 percent are Negro. The county has the highest per capita income in Maryland. Information gathered at the time of preschool conferences over the past 4 years reveals that about 92.5 percent of Montgomery County children have been actively immunized against diphtheria prior to registering for school, and the remainder are almost all given prinmary immunizations at this time (7). However, because of the large population influx, the inadequacy of transferred school health records, and basic doubt as to the duration of immunization in infancy and early childhood (8), the status of children finishing high school has been heretofore unknown. With the approval of the Montgomery County Medical Society and the superintendent of schools and the aid of the Maryland State Departmenlt of Health, the Montgomery County Health Department planned to give Schick tests to all 12th grade students in the county's nine high schools.