Universal Childhood Vaccination Research Articles

Impact of universal childhood vaccination against hepatitis B in Ghana: A pilot study.

Hepatitis B virus (HBV) infection is of public health importance worldwide. Vaccination against the infection, especially in early childhood has significantly reduced the public health impact. This pilot study was undertaken in Cape Coast Metropolitan area to assess the impact of the introduction of HBV vaccination in children. A cross-sectional multi-stage cluster sampling of 501 pupils from 30 public and private primary and junior high schools within the Cape Coast metropolis. A questionnaire covering basic demographic details and immunisation history were administered to the participants after consent and assent had been sought. Hepatitis B serological test for HBsAg, HBcAb, HBsAb, HBeAg and HbeAb was undertaken using Hepatitis B test kit and capillary blood from the participants. The general prevalence of HBcAb, HBsAg and HBsAb was found to be 3.6, 2.6 and 19.8% respectively. The prevalence of HBcAb was 2.6 and 6.1% among pupils delivered after and before the vaccine programme introduction respectively. Introduction of the vaccination programme in Ghana has had a positive impact on the HBV infection in Ghana

Measles: a disease often forgotten but not gone.

Measles (rubeola) is a highly contagious vaccine-preventable disease caused by the measles virus-a virus of the Paramyxoviridae family. The illness typically begins with fever, runny nose, cough, and pathognomonic enanthem (Koplik spots) followed by a characteristic erythematous, maculopapular rash. The rash classically begins on the face and becomes more confluent as it spreads cephalocaudally. Laboratory confirmation of measles virus infection can be based on a positive serological test for measles-specific immunoglobulin M antibody, a four-fold or greater increase in measles-specific immunoglobulin G between acute and convalescent sera, isolation of measles virus in culture, or detection of measles virus ribonucleic acid by reverse transcriptase-polymerase chain reaction. Complications occur in 10% to 40% of patients, and treatment is mainly symptomatic. Bacterial superinfections, if present, should be properly treated with antibiotics. To eradicate measles, universal childhood immunisation and vaccination of all susceptible individuals with measles vaccine would be ideal. In developed countries, routine immunisation with measles-containing vaccine is recommended, with the first and second doses at ages 12 to 15 months and 4 to 6 years, respectively. The World Health Organization recommends that the first and second doses of measles-containing vaccine be given at ages 9 months and 15 to 18 months, respectively, in countries with high rates of measles transmission.

Impact of the introduction of a universal childhood influenza vaccination programme on influenza-related admissions to paediatric intensive care units in England

IntroductionA universal childhood influenza vaccination programme was introduced in the UK in September 2013. We examine the impact of the gradual introduction of this programme on influenza-related paediatric intensive care...

EVALUATION OF THE IMMUNE RESPONSE TO POLIO VACCINE IN MALNOURISHED CHILDREN IN SANA'A CITY

Objective: This study was made to evaluate the immune response to polio virus vaccine among PEM children by measuring the level of circulating Immunoglobulin G (IgG) antibodies against polio virus (IgG-PV) after immunization with the primary series of POV, and determining the coverage rate of universal childhood vaccine for polio virus. A cross-sectional laboratory study was conducted in Department of Medical Microbiology and Clinical Immunology, Faculty of Medicine and Health Sciences, and Al-Sabeen University Hospital, Sana’a University. Methods: A total of 279 PEM children were selected and investigated for universal childhood vaccination coverage rate for polio vaccine. Blood samples were collected from all, then tested for levels of IgG-PV by ELISA method. For assessment IgG-PV levels more than 10 units/ml were considered protected against polio virus infection. Results: The coverage rate of polio virus vaccine for first year vaccine was 96.8%; and 91.1% of vaccinated PEM children responded to the vaccine with mean level of 46.2 U/ml. A statistically significant difference was observed with respect to sero-protective IgG-PV between males and females (85.7% and 94.1% respectively, p=0.002); and older children (>37 months) (97.7%). Conclusion: We conclude that a small proportion of malnourished vaccinated children with a normal immune status were not serologically immune to polio virus infection, and remain to be reconsidered for either revaccination or booster doses due to lack of or inadequate response. PEM group gave slightly reduced response to OPV hence there is need to give this group IPV (injectable polio vaccine) along with OPV and different micro-nutrition deficiencies like Zinc and iron. Peer Review History: Received 29 March 2018; Revised 20 April; Accepted 7 May, Available online 15 May 2018 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 4.5/10 Average Peer review marks at publication stage: 8.0/10 Reviewer(s) detail: Dr. O.J Owolabi, University of Benin, Nigeria, owolabi@uniben.edu Dr. Sameh Abdelmoneem Mohammed Ali, Faculty of Pharmacy, Beni-Suef University, Egypt, same7_pharma18@yahoo.com Similar Articles: COCCIDIAN INTESTINAL PARASITES AMONG CHILDREN IN AL-TORBAH CITY IN YEMEN: IN COUNTRY WITH HIGH INCIDENCE OF MALNUTRITION PREVALENCE AND POTENTIAL RISK FACTORS OF HEPATITIS B VIRUS IN A SAMPLE OF CHILDREN IN TWO SELECTED AREAS IN YEMEN

PSS10 - The Benefits and Costs Of Different Scenarios for Varicella Vaccination in Chile

Universal childhood vaccination (UVV) against varicella has not been implemented in Chile. The benefits and costs of introducing UVV under various possible vaccination scenarios were explored through modelling. A dynamic transmission model of varicella infection, with proportionate mixing in a static population, and with time, age, and vaccination-status varying force of infection, was calibrated based on the Chilean population and Argentinean seroprevalence data. Rates of healthcare utilization and costs were from a recent observational study. Five vaccination strategies based on the current vaccination visits in the pediatric vaccination programme were considered, with first dose given at either 12 months (90% coverage) or 18 months (85% coverage), and a second dose either not administered, or given at 18 months (85% coverage)or 6 years (85% coverage). Three different types of varicella vaccines (highly-, moderately-, and weakly-effective) were hypothesized. The resulting 15 vaccination scenarios were compared to a no-vaccination scenario. Benefits and costs were calculated from the payer and societal perspectives over a 25-year time horizon, and discounted at 3% annually. The model estimated over 200,000 varicella cases annually in Chile in the absence of varicella vaccination. All vaccination scenarios reduced the number of cases by 86.0-99.7% and all were cost-saving. One-dose strategies with a highly- or moderately-effective vaccine were the most cost-saving scenarios, saving $239M-$252M over 25 years. Cost-benefit ratios were 2.63-3.53 for one-dose and 1.92-2.52 for two-dose scenarios. The optimum vaccination scenario from a cost perspective was one dose at 12 months with 90% coverage; two doses given at 12 and 18 months reduced morbidity and mortality the most. Both one- and two-dose UVV programs are predicted to be cost-saving in Chile. The optimum strategy based on cost-benefit ratios from a societal perspective is vaccination with a single dose of a highly- or moderately-effective varicella vaccine at 12 months.

Hepatitis A vaccine immune response 22 years after vaccination.

In the United States, the incidence of hepatitis A virus (HAV) infection has been reduced through universal childhood vaccination. However, the duration of immunogenicity for the hepatitis A vaccine is not known. We report on the 22 year follow-up time point of a cohort of Alaska children who were randomized to three different vaccine schedules: A) 0, 1, and 2 months; B) 0, 1, and 6 months; and C) 0, 1, and 12 months. Among 46 participant available for follow-up, 40 (87%) maintained protective levels of anti-hepatitis A antibody. These results indicate that a supplemental booster dose is not yet necessary at or before the 22-year time point.

Immunization against Hepatitis A.

Worldwide, there are multiple formaldehyde-inactivated and at least two live attenuated hepatitis A vaccines now in clinical use. The impressive immunogenicity of inactivated vaccines is reflected in rapid seroconversion rates, enabling both preexposure and postexposure prophylaxis. Universal childhood vaccination programs targeting young children have led to significant drops in the incidence of hepatitis A both in toddlers and in susceptible nonimmune adults in regions with intermediate endemicity for hepatitis A. Although the safety of inactivated vaccines is well established, further studies are needed concerning the implications of fecal virus shedding by recipients of attenuated vaccines, as well as the long-term persistence of immune memory in children receiving novel immunization schedules consisting of single doses of inactivated vaccines.

Near universal childhood vaccination rates in Rwanda: how was this achieved and can it be duplicated?

Abstract Background According to data from the WHO Vaccine-Preventable Disease Monitoring System, Rwanda has achieved near universal childhood vaccination rates, with an overall national coverage rate for childhood immunisation of 98% in 2015. These rates are striking given the country's status as a post-conflict, post-genocide, and low-income country. In this study, we aimed to determine factors that contributed to the success of Rwanda's childhood immunisation programme. Methods We used primary and secondary sources to identify such factors. Primary research was conducted in August, 2017, in Eastern Province, Northern Province, and the city of Kigali, Rwanda. We used snow-ball sampling to recruit interviewees. Semi-structured interviews were conducted with government, multilateral organisations, and non-governmental staff members involved in the planning and delivery of Rwanda's immunisation programme. Secondary sources included review of primary databases, grey literature, and peer-reviewed literature that was identified through searches in Google Scholar and PubMed for articles written in English and published since Jan 1, 2000, using combinations of the search terms “Rwanda”, “vaccination”, “immunisation”, and “programme”. Findings 24 interviews were conducted and secondary data were analysed. Several factors have contributed to Rwanda's vaccination success. First, at the local level, an engaged cadre of community health workers sensitises communities on the importance of vaccinations and performs health surveillance duties. Second, an integrated health management information system guides vaccination procurement and distribution to support vaccine delivery at the local level. Third, at the governmental level, the vaccination programme is driven by strong political will to prioritise health. Fourth, implementation is sufficiently decentralised to the district and village level to tailor appropriate approaches for the local population. Fifth, the uniquely Rwandan practice of imihigo, which involves leaders at all levels of government (centrally and locally) signing performance contracts to achieve certain targets, enhances accountability and ownership. Finally, the Rwandan health system benefits from strong relationships with development partners and cross-over effects from global health initiatives, particularly in developing capacity for supply chain and cold chain management. Interpretation Although cultural factors such as imihigo differentiate Rwanda from demographically comparable countries, the success of the Rwandan vaccine programme is multifactorial. These factors include strong, high-level political will, multilevel accountability, effective use of funding, partnership with development partners, integrated health information, and community-level data collection. Countries aiming to improve coverage may wish to study and emulate these factors. Funding Mastercard Center for Inclusive Growth.

Factors associated with parental acceptance of seasonal influenza vaccination for their children – A telephone survey in the adult population in Germany

IntroductionInfluenza vaccination of children with underlying chronic diseases is currently recommended in Germany, but targeting all children constitutes an alternative approach to control seasonal influenza. To inform the modelling of vaccination impact and possible communication activities, we aimed to assess among parents the acceptance of universal childhood vaccination against seasonal influenza and possible modifiers. MethodsWe conducted a telephone survey in households in Germany using random digit dialing. We interviewed parents with children aged <18 years by constructing three hypothetical scenarios in subsequent order: (1) hearing about the influenza vaccination recommendation through the media, (2) the vaccine being recommended by a physician, and (3) being informed about the availability of the vaccine as a nasal spray. We calculated the proportion of parents who would immunize their child and used univariable and multivariable logistic regression to identify factors associated with influenza vaccination intention. ResultsResponse was between 22 and 46%. Of 518 participants, 74% were female, mean age was 41.3 years. Participants had on average 1.6 children with a mean age of 8.9 years. In scenario 1, 52% of parents would immunize their child, compared to 64% in scenario 2 (p<0.01) and to 45% in scenario 3 (p=0.20). Factors independently associated with vaccination acceptance in scenario 1 were previous influenza vaccination of the child or parent (adjusted odds ratio [aOR] 4.5 and 8.6, respectively), perceived severity of influenza (aOR=5.1) and living in eastern Germany (aOR=2.4). ConclusionIf seasonal influenza vaccination was recommended for all children, more than half of the parents would potentially agree to immunize their child. Involving physicians in future information campaigns is essential to achieve high uptake. As intranasal vaccine administration is non-invasive and easily done, it remains unclear why scenario 3 was associated with low acceptance among parents, and the underlying reasons should be further explored.

Systematic review and meta-analysis of indirect protection afforded by vaccinating children against seasonal influenza: implications for policy

Universal childhood vaccination is a potential solution to reduce seasonal influenza burden. We reviewed systematically the literature on "herd"/indirect protection from vaccinating children aged 6 months to 17 years against influenza. Of 30 studies included, 14 (including 1 cluster randomized controlled trial [cRCT]) used live attenuated influenza vaccine, 11 (7 cRCTs) used inactivated influenza vaccine, and 5 (1 cRCT) compared both vaccine types. Twenty of 30 studies reported statistically significant indirect protection effectiveness (IPE) with point estimates ranging from 4% to 66%. Meta-regression suggests that studies with high quality and/or sufficiently large sample size are more likely to report significant IPE. In meta-analyses of 6 cRCTs with full randomization (rated as moderate quality overall), significant IPE was found in 1 cRCT in closely connected communities where school-aged children were vaccinated: 60% (95% confidence interval [CI], 41%-72%; I2 = 0%; N = 2326) against laboratory-confirmed influenza, and 3 household cRCTs in which preschool-aged children were vaccinated: 22% (95% CI, 1%-38%; I2 = 0%; N = 1903) against acute respiratory infections or influenza-like illness. Significant IPE was also reported in a large-scale cRCT (N = 8510) that was not fully randomized, and 3 ecological studies (N > 10000) of moderate quality including 36% reduction in influenza-related mortality among the elderly in a Japanese school-based program. Data on IPE in other settings are heterogeneous and lacked power to draw a firm conclusion. The available evidence suggests that influenza vaccination of children confers indirect protection in some but not all settings. Robust, large-scaled studies are required to better quantify the indirect protection from vaccinating children for different settings/endpoints.

The economic impact of prenatal varicella immunity among pregnant women in Alberta

In light of the changing epidemiology of varicella, we sought to examine varicella antibody levels in the prenatal population in the Canadian province of Alberta. All prenatal varicella screening tests performed between August 1, 2002 and February 2, 2014 (454,592) were included in this study. Test results, demographics and vaccination status were examined to identify varicella seroprevalence and correlates for being seronegative. An overall seroprevalence for varicella of 95.8% was found across all pregnancy screenings. Significant independent correlates of seronegativity included younger age (AOR: 4.72 (95% CI: 3.87–5.77) for <20years of age vs. >40years of age) and having immigrated to Alberta from Africa or Asia (AOR: 4.55 (95% CI: 4.10–5.05) and AOR: 5.83 (95%CI; 5.48–6.19), respectively). Women who were initially seronegative for varicella antibodies and who received both postnatal vaccination and post-vaccination prenatal screening (2566) were examined to assess seroconversion. 66.3% of women who were tested up to six months post-vaccination were seropositive, however only 36.9% of women tested after 36months were seropositive. Finally, 40.9% of all prenatal varicella specimens tested were deemed redundant, i.e. women had either a history of (1) ⩾2 doses of varicella vaccine, (2) varicella infection, or (3) a previous positive varicella serology. Eliminating this redundant screening could provide an estimated $96,000 in savings annually in laboratory and Public Health follow-up costs alone. As the number of women with vaccine-derived immunity through universal childhood vaccination increase in the prenatal population, screening methods may need to adapt to ensure varicella immunity is accurately conducted and assessed.

Hepatitis A seroprevalence in public school children in Campos dos Goytacazes, Rio de Janeiro State, Brazil, prior to the introduction of the hepatitis A universal childhood vaccination.

This cross-sectional study was carried out between August 2011 and July 2012 in the city of Campos dos Goytacazes in Rio de Janeiro State, Brazil. Dried blood spot samples were collected on filter paper from 919 individuals between the ages of 1 and 19 and were tested for antibodies against the hepatitis A virus (anti-HAV). The total prevalence was 20.7%, while 94.7% of children under the age of 5 were found to be susceptible to HAV infection. The prevalence of anti-HAV increased with age, reaching 33.3% among individuals aged between 15 and 19, thereby indicating that this municipality has a low level of endemicity for hepatitis A. Age, non-white skin color, accustomed to swimming in the river and more than five people living at home were the factors that were associated with an increase in the chance of a positive anti-HAV result. Mother's education level (secondary or tertiary) was considered a protective factor for HAV infection. The data obtained showed that a large proportion of the children from Campos dos Goytacazes were at risk of HAV infection, which should be minimized with the introduction of the vaccination program against hepatitis A that was launched in the municipality in 2011.

Uptake of childhood influenza vaccine from 2012–2013 to 2014–2015 in the UK and the implications for high-risk children: a retrospective observational cohort study

ObjectivesTo evaluate changes in influenza vaccination rates in healthy and at-risk children following the implementation of the UK's childhood influenza immunisation programme.DesignObservational cohort study before and after initiation of the...

Nasopharyngeal pneumococcal carriage rates among HIV-infected adults following widespread pediatric use of conjugate pneumococcal vaccine-13

ABSTRACTBackground: Nasopharyngeal pneumococcal carriage rates among HIV-infected adults has not been described since conjugate pneumococcal vaccine-13 (PCV13) was added to the universal infant and childhood vaccination schedule in 2010. Methods: HIV-infected adults presenting for routine health care visits to the Designated AIDS Center in Syracuse, NY between December 2013 and June 2015 were eligible for enrollment. Demographic, medical, and social history were recorded after obtaining informed consent. Nasopharyngeal samples were collected and cultured for the presence of Streptococcus pneumoniae using standard microbiologic techniques. Antibiotic susceptibility testing was performed using E-test→. Results: 707 nasopharyngeal samples were collected from 414 HIV-infected adults. 18 samples were culture positive for S. pneumoniae; 1 (6%) isolate was of vaccine-type, 9 (50%) were non-vaccine types, and 8 (44%) were non-typeable. The 18 isolates were recovered from 15 different patients (4% of those enrolled). Three patients were culture positive for pneumococcus isolated from 2 consecutive samples, with non-typeable pneumococci identified consecutively from 2 patients and serotype 35B identified consecutively from 1 patient. The most commonly identified non-vaccine serotypes were 35B and 15B/C. Identified pneumococci were penicillin and cefotaxime susceptible. Conclusion: Four percent of HIV-infected adults in our study population were colonized with S. pneumoniae. The non-vaccine serotypes 35B and 15B/C predominated.

Epidemiological impact and cost-effectiveness of universal vaccination with Bexsero® to reduce meningococcal group B disease in Germany

Bexsero, a new vaccine against serogroup B meningococcal disease (MenB), was licensed in Europe in January 2013. In Germany, Bexsero is recommended for persons at increased risk of invasive meningococcal disease, but not for universal childhood vaccination. To support decision making we adapted the independently developed model for England to the German setting to predict the potential health impact and cost-effectiveness of universal vaccination with Bexsero® against MenB disease. We used both cohort and transmission dynamic mathematical models, the latter allowing for herd effects, to consider the impact of vaccination on individuals aged 0–99 years. Vaccination strategies included infant and adolescent vaccination, alone or in combination, and with one-off catch-up programmes. German specific data were used where possible from routine surveillance data and the literature. We assessed the impact of vaccination through cases averted and quality adjusted life years (QALY) gained and calculated costs per QALY gained. Assuming 65% vaccine uptake and 82% strain coverage, infant vaccination was estimated to prevent 15% (34) of MenB cases over the lifetime of one birth cohort. Including herd effects from vaccination increased the cases averted by infant vaccination to 22%, with an estimated 8461 infants requiring vaccination to prevent one case. In the short term the greatest health benefit is achieved through routine infant vaccination with large-scale catch-up, which could reduce cases by 24.9% after 5 years and 27.9% after 10 years. In the long term (20+ years) policies including routine adolescent vaccination are most favourable if herd effects are assumed. Under base case assumptions with a vaccine list price of €96.96 the incremental cost-effectiveness ratio (ICER) was >€500,000 per QALY for all considered strategies. Given the current very low incidence of MenB disease in Germany, universal vaccination with Bexsero® would prevent only a small absolute number of cases, at a high overall cost.

Hepatitis A Infections Among Food Handlers in the United States, 1993-2011.

We reviewed news reports of hepatitis A virus (HAV)-infected food handlers in the United States from 1993 to 2011 using the LexisNexis® search engine. Using U.S. news reports, we identified 192 HAV-infected food handlers who worked while infectious; of these HAV-infected individuals, 34 (18%) transmitted HAV to restaurant patrons. News reports of HAV-infected food handlers declined from 1993 to 2011. This analysis suggests that universal childhood vaccination contributed to the decrease in reports of HAV-infected food handlers, but mandatory vaccination of this group is unlikely to be cost-effective.

Hepatitis A virus epidemiology in Turkey as universal childhood vaccination begins: seroprevalence and endemicity by region.

This paper presents the results of a comprehensive examination of current distribution of Hepatitis A virus (HAV) seroprevalence and endemicity in Turkey and the possible links between HAV endemicity and socioeconomic development. We performed a systematic search in online resources published between January 2000 and August 2015. The 22 provinces were able to be assigned a hepatitis A endemicity level based on this systematic review. The incidence rates for symptomatic hepatitis A infection are higher in the eastern part of Turkey than in the western and central region. These differences in socioeconomic indicators by region suggest the likelihood of lower seroprevalence rates in the western parts of the country and higher rates in the eastern region. Turkey's current policy of recommending hepatitis A immunization for all children without contraindications is an appropriate one and is likely to remain the best option for at least the next decade or two.

Influenza: the rational use of oseltamivir

Influenza viruses cause a substantial burden of disease every year. 1 Goldstein E Viboud C Charu V Lipsitch M Improving the estimation of influenza-related mortality over a seasonal baseline. Epidemiology. 2012; 23: 829-838 Crossref PubMed Scopus (107) Google Scholar Vaccination is the main preventive measure, and is widely recommended. The UK is rolling out a universal childhood vaccination programme 2 Pebody RG Green HK Andrews N et al. Uptake and impact of a new live attenuated influenza vaccine programme in England: early results of a pilot in primary school-age children, 2013/14 influenza season. Eurosurveillance. 2014; 19: 20823 Crossref Scopus (71) Google Scholar that is predicted to have a substantial effect on influenza morbidity and mortality. 3 Baguelin M Flasche S Camacho A Demiris N Miller E Edmunds WJ Assessing optimal target populations for influenza vaccination programmes: an evidence synthesis and modelling study. PLoS Med. 2013; 10: e1001527 Crossref PubMed Scopus (185) Google Scholar Antiviral drugs are available for the treatment of infections, and the most commonly used is oseltamivir (Tamiflu). The effectiveness of oseltamivir has been the subject of much debate. 4 Jefferson T Doshi P Multisystem failure: the story of anti-influenza drugs. BMJ. 2014; 348: g2263 Crossref PubMed Scopus (48) Google Scholar Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trialsOur findings show that oseltamivir in adults with influenza accelerates time to clinical symptom alleviation, reduces risk of lower respiratory tract complications, and admittance to hospital, but increases the occurrence of nausea and vomiting. Full-Text PDF

Early impact of PCV7/PCV13 sequential introduction to the national pediatric immunization plan, on adult invasive pneumococcal disease: A nationwide surveillance study

BackgroundPCV7 was introduced as a universal childhood vaccination in Israel on July 2009 and was gradually replaced by PCV13 from November 2010. We report data on adult invasive pneumococcal disease (IPD), two years post PCV13 implementation. MethodsAn ongoing nationwide active surveillance (all 27 laboratories performing blood/CSF cultures nationwide), initiated in 2009, providing all blood/CSF Streptococcus pneumoniae isolated from persons ≥18 years. Capture-recapture method assured reporting of >95% cases. All isolates were serotyped in one central laboratory. Medical history and outcomes were recorded in ∼90%. ResultsOf 1809 IPD episodes, S. pneumoniae was isolated from the blood in 95% and most cases had pneumonia. Predisposing comorbidities were present in >70%. During the four study years, overall IPD incidence decreased from 9.2 to 7.2/100,000, incidence of pneumonia and particularly severe pneumonia cases decreased significantly from 6.6 to 4.7/100,000, (p=0.029). Vaccine type (VT7/VT13) serotypes decreased by 70%/57% within 4 years. This was accompanied by a 52% increase in non-VT13 strains. These changes were most apparent in winter. PCV impact was most pronounced in younger adults (39% decrease in overall IPD with only a non-significant increase in non-VT13 cases) while in those >65 years a non-significant decrease in overall IPD was observed with a 64% increase in non-VT13 cases. Non-VT13 serotypes that increased significantly were 12F, 15A 10A and 6C. A continuous reduction in isolates with penicillin MIC>0.06μg/ml was observed (26% to 11%, p<0.001). ConclusionsFour years after PCV7 and 2.5 years after PCV13 universal implementation in children, incidence of adult IPD caused by VT7 and VT13 decreased in all ages, mainly in younger adults. Despite increase in non-VT13 IPD, overall IPD decreased. Additional follow-up is needed to determine the long-term impact of PCV13.

Estado inmunitario de la población española frente a las enfermedades inmunoprevenibles mediante vacunaciones sistemáticas

In this review we analyze the seroepidemiology of diseases preventable by routine vaccination schedules included in official vaccinations in Spain.The sources of data have been mainly the Ministry of Health and some autonomous communities.Universal vaccination of children with the vaccines included in the schedules of universal vaccination has had an extraordinary impact on the epidemiology of the diseases prevented by vaccination. Some of them have been eliminated (smallpox, diphtheria, polio) or may be medium term (measles, rubella). The other (tetanus, whooping cough) have very significant declines and are now controlled.In view of these results, we can say that the official policy of universal vaccination of children's population with vaccines in the immunization schedules have been one of the most important successes of public health in our country and one of the health interventions more effective.