Vaccination In England Research Articles

The epidemiology of herpes zoster and potential cost-effectiveness of vaccination in England and Wales

The epidemiology of herpes zoster and post-herpetic neuralgia (PHN) was quantified from a variety of data sources and the potential cost-effectiveness of vaccination assessed. The annual incidence and severity of zoster increases sharply with age, as measured by physician consultation and hospitalisation rates, average length of stay, average proportion of cases developing PHN and the age-specific case-fatality ratio. Combining these data with information on health related quality of life results in an estimated loss of 20 000 quality adjusted life years (QALYs) annually in England and Wales from herpes zoster (17 400 due to PHN). The current cost of treating herpes zoster associated disease is estimated to be £47.6m annually. Since both the health and economic burden are high, vaccination of the elderly is expected to be cost-effective under most scenarios, the attractiveness of immunisation increasing with age due to the increased burden of disease in the very elderly.

Efficacy of meningococcal serogroup C conjugate vaccine in teenagers and toddlers in England

The UK was the first country to use meningococcal serogroup C conjugate (MCC) vaccines, which were licensed on the basis of immunogenicity and safety data but without a formal efficacy study. Increased surveillance during the first 9 months since introduction has shown that short-term efficacy of the MCC vaccine in England was 97% (95% CI 77-99) for teenagers and 92% (65-98) for toddlers. These early results confirm the superiority of MCC over plain C polysaccharide vaccines, which are ineffective in young children.

Intervention times series analysis of pertussis vaccination in England and Wales

We use the ARIMA model with intervention in order to analyse the epidemiological situation of whooping-cough in England and Wales for the period of 1940–1990. The ARIMA modelling of this illness contains intervention variables, such as the introduction of widespread vaccination in 1957 and the fall in the level of vaccination down to 30% in 1978. The results of this analysis confirm the role of the intervention variables on the evolution of the morbidity due to whooping-cough, by quantifying their impact on the level of the morbidity, as well as the delay needed before they have an influence on the increase of recorded cases of whooping-cough.

Impact of vaccination on the spatial correlation and persistence of measles dynamics.

The onset of measles vaccination in England and Wales in 1968 coincided with a marked drop in the temporal correlation of epidemic patterns between major cities. We analyze a variety of hypotheses for the mechanisms driving this change. Straightforward stochastic models suggest that the interaction between a lowered susceptible population (and hence increased demographic noise) and nonlinear dynamics is sufficient to cause the observed drop in correlation. The decorrelation of epidemics could potentially lessen the chance of global extinction and so inhibit attempts at measles eradication.

Predicting the impact of measles vaccination in England and Wales: model validation and analysis of policy options - Errata

Predicting the impact of measles vaccination in England and Wales: model validation and analysis of policy options - Errata

Predicting the impact of measles vaccination in England and Wales: model validation and analysis of policy options

Measles incidence in England and Wales has fallen to an all-time low. Attention is now focused on preventing local outbreaks, and, in the long run, on the elimination of indigenous measles. A realistic age-structured (RAS) mathematical model of measles transmission is used to reconstruct the impact of measles vaccination in England and Wales from 1968 to the present and to evaluate the merits of future policy options. In general, the predictions of the model show good agreement with long-term age stratified case reports and seroprevalence surveys. The model underestimates the proportion of cases that are notified in 0-2-year-old children. However, recent work suggests a high degree of misdiagnosis in this age group. Projections on the basis of the existing vaccination strategy in the UK suggest that the present level of measles vaccine coverage will be insufficient to eliminate small seasonal outbreaks of measles. This result is, however, sensitive to the assumed level of vaccine efficacy. Explorations of a variety of changes to current vaccination strategy favour a 2-dose schedule with the second dose administered at age 4 years irrespective of vaccination history. A vaccination campaign in school-age children, to reduce deficits in herd immunity, would accelerate progress towards measles elimination.

The implementation of compulsory health legislation: infant smallpox vaccination in England and Wales, 1840-1890

In 1853 a system of compulsory infant vaccination against smallpox was introduced in England and Wales. The policy was highly controversial, overriding an individual's right to choose for the good of the wider community in the name of public health. It was also made more unpopular by the involvement of the Poor Law authorities as the agency charged with the responsibility of administering vaccination. A great deal of research in this area has focused on the anti-vaccination movement, but the consequences of this resistance, in terms of the uptake of vaccination, have not been evaluated. This paper examines the implementation of the Vaccination Acts within England and Wales. It looks at the pattern of coverage among infants in the years immediately before and after the practice was made obligatory and also in subsequent years when successive legislative measures tightened up the compulsory provisions of the Acts. These patterns are then discussed in relation to the last major smallpox epidemic which struck England and Wales in 1871-72 and which put vaccination policy to the test, revealing both its strengths and weaknesses.

Pertussis in England and Wales: an investigation of transmission dynamics and control by mass vaccination

The epidemiology of pertussis and its prospects for control by mass vaccination in England and Wales are investigated by analyses of longitudinal records on incidence and vaccine uptake, and horizontal data on age-stratified case reports. Mathematical models of the transmission dynamics of the infection that incorporate loss of natural and vaccine-induced immunity plus variable vaccine efficacy are developed, and their predictions compared with observed trends. Analyses of case reports reveal that the individual force of infection is age dependent, with peak transmission in the 5- to 10-year-old age class. A model incorporating this age dependency, along with partial vaccine efficacy and loss of vaccine-induced immunity, generates predicted patterns that best mirror observed trends since mass vaccination was inaugurated in 1957 in England and Wales. Model projections accurately mirror the failure of mass vaccination to increase the inter-epidemic period of the infection (three years) over that pertaining before control. The analysis suggests that this is due to the impact of partial vaccine efficacy. Projected trends do not accurately reflect the low levels of pertussis incidence reported between epidemics in the periods of high vaccine uptake. This is thought to arise from a combination of factors, including loss of natural and vaccine induced immunity, biases in case reporting (where reporting efficiency is positively associated with the incidence of pertussis), and seasonal variations in transmission. Model predictions suggest that the vaccination of 88% of each birth cohort before the age of 1 year will eliminate bacterial transmission, provided the vaccine confers lifelong protection against infection. If vaccine-induced immunity is significantly less than lifelong (or if vaccination fails to protect all its recipients) repeated cohort immunization is predicted to be necessary to eliminate transmission. Future research needs are discussed, and emphasis is placed on the need for more refined data on vaccine efficacy, the duration of natural and vaccine-induced immunity and the incidence of clinical pertussis and subclinical infections (perhaps by the development of reliable serological tests). Future mathematical models will need especially to incorporate seasonality in transmission.

Effectiveness of BCG vaccination in england and wales in 1983

The effectiveness of BCG vaccination, at about age 13 years, in the prevention of tuberculosis at ages 15–24 years in England and Wales in 1983, has been determined by the same method as in two previous surveys in 1973 and 1978. In 1983, the tuberculosis notification rate among those vaccinated in the schools' scheme was 3.30 per 100 000, compared with an estimated rate of 13.20 per 100 000 among those who were tuberculin negative and not vaccinated in the scheme. The protective effectiveness of BCG vaccination at ages 15–24 years in England and Wales in 1983 is thus estimated as 75 %; the estimated efficacy in the white ethnic group is closely similar, namely 76 %. The estimated efficacy of BCG at ages 15–19 and 20–24 years in the three surveys, both in the white ethnic group and in the entire cohort, has been compared with that found in the Medical Research Council's controlled trial of tuberculosis vaccines which began in 1950. There is no evidence of any decrease in the protective efficacy of BCG vaccination between the four cohorts of young adults, which span a total period of 29 years. However, there were steep decreases between the cohorts in the annual notification rates for the white ethnic group; these decreases occurred in the BCG vaccinated and in the tuberculin negative unvaccinated groups, as well as among those found tuberculin positive (and not vaccinated) in the schools' scheme. It is concluded that the level of protective efficacy of BCG vaccination at ages 15–24 years is high, and has remained unchanged since the start of the BCG in schools' scheme. However, as the tuberculosis notification rate in young adults has decreased steeply throughout this period, and is continuing to decrease, the benefits to be expected from the BCG in schools' scheme will decrease equally rapidly.

The epidemiology of pertussis and pertussis immunization in the United Kingdom and the United State: A Comparative study

Pertussis is a common serious illness of childhood that can be controlled by immunization. It is a unique disease in that it is clinically manifested more often in females than in males. In the 20th century the mortality from pertussis has decreased steadily in both the United Kingdom and the United States. This decline in death rate was well underway prior to the introduction of pertussis vaccine but was accelerated after vaccine use became widespread. In recent years the case fatality rate in the United States has been considerably greater than that in the United Kingdom. One obvious reason for this difference is the difference in age-specific attack rates in the two nations. Available data also suggest that recent pertussis deaths in infants in England and Wales may frequently be reported as due to respiratory diseases other than pertussis. Although it is frequently suggested by some observers, there is no evidence that the incidence of pertussis was declining prior to the widespread use of vaccine. All available evidence indicates that pertussis vaccine use in both the United Kingdom and the United States was responsible for a drastic reduction in the magnitude of both endemic and epidemic pertussis. Decreased utilization of pertussis vaccine in England and Wales beginning in 1975 resulted in two major epidemics of pertussis in 1977-1979 and 1982-1983. Moderate local and systemic reactions commonly occur following pertussis immunization. These reactions appear to be less common and less severe in the United Kingdom than in the United States, but in contrast to recent studies in the United States, there are no recent quantitative studies in the United Kingdom. There are virtually no data available in the United States on the incidence of serious neurologic disease resulting from pertussis immunization. In contrast, the recently published findings of the NCES, a case-control study of national scope, have allowed attributable risk estimates of serious neurologic disease to be made. Although the NCES was a carefully controlled study, its findings in regard to attributable risk were surprisingly similar to those of several other studies in which no allowance was made for background encephalopathy due to other causes.(ABSTRACT TRUNCATED AT 400 WORDS)

Efficacy of pertussis vaccination in England. Report from the PHLS Epidemiological Research Laboratory and 21 area health authorities.

A national assessment of the efficacy of pertussis vaccination was made in 21 area health authorities in England. Notification rates for children given either three doses of diphtheria/tetanus/pertussis vaccine or diphtheria/tetanus vaccine were studied during the two and a half-year period January 1978-June 1980. A survey of home circumstances showed that the two vaccine groups could be validly compared. Home visits were made to assess the severity of the illness, the attack rates in home contacts, and to take pernasal swabs. Pertussis vaccination was found to be of outstanding value in preventing serious disease. Nevertheless, its effect in controlling whooping cough is limited by the fact that protection for home contacts is less satisfactory, and by the occurrence of mild cases in vaccinated children which may contribute to the spread of the disease.

Present effectiveness of BCG vaccination in England and Wales A report from the Research Committee of the British Thoracic and Tuberculosis Association

From a survey of notifications of tuberculosis in England and Wales it is estimated that each 100,000 BCG vaccinations of school-children in 1966–1971 prevented 15 notifications of persons aged 15–19 years in 1973. Making allowance for the declining infection risk, it is probable that each 100,000 vaccinations in 1966–1971 will eventually prevent about 133 notifications in the 15 years following vaccination. It is estimated that one notification of tuberculosis will be prevented by 750 vaccinations given in 1968, by l,500 vaccinations in 1973, by 3,000 vaccinations in 1978, and by 5,00010,000 vaccinations in the 1980's.

G. B. Shaw and Doctors

<h3>To the Editor:—</h3> Dr. Sigmund L. Wilens' "Mr. Shaw on Doctors" reminded me of the correspondence which Shaw carried on with my father, Jay F. Schamberg, MD, on the topic of vaccination. I have in my possession a letter signed by G. Bernard Shaw, addressed to my father, which might be of interest to readers ofThe Journal. 22nd November 1928 Dear Sir, I think I can beat your 25 years study. I have read up the subject for 45 years; and I began by reading Jenner, whose works are evidently unknown to you at first hand. Being a vaccinated person I suffered from smallpox in one of the two appalling epidemics which followed the ruthless enforcement of compulsory vaccination in England. Later on, I was a member of a Public Health Committee during the last epidemic which caused any alarm in London, and was an unwilling party to the

SURVEILLANCE OF THE SAFETY OF ORAL POLIOMYELITIS VACCINE IN ENGLAND AND WALES 1962-4.

When, in 1956, inactivated poliomyelitis (Salk) vaccine became available for routine immunization in England and Wales the Ministry of Health set up a scheme of poliomyelitis surveillance. The objects were to provide a means of rapid detection pf pos sible outbreaks of vaccine-induced poliomyelitis, such as occurred in the United States owing to the presence of incompletely inactivated virus in a batch of vaccine (Nathanson and Langmuir, 1963), and to observe the efficacy of the vaccine. The results were reported by Geffen and Spicer (1960), Geffen (1960), and Roden (1964), and though a number of vaccine associated cases occurred they concluded that the vaccine was both safe and effective.

RESPONSE OF CHILDREN TO MEASLES VACCINE IN ENGLAND.

RESPONSE OF CHILDREN TO MEASLES VACCINE IN ENGLAND.

Development of Smallpox Vaccine in England in the Eighteenth and Nineteenth Centuries

Development of Smallpox Vaccine in England in the Eighteenth and Nineteenth Centuries

The optimum age for mass B.C.G. vaccination in England and Wales.

Three years have passed since B.C.G. vaccination of 13-year-old schoolchildren was first authorized in England and Wales, and, although this is not a long period in the epidemiology of tuberculosis, further information now available about vaccination, as well as the probable reduction in the risk of tuberculous infec tion since 1953, makes it of interest to inquire whether 13 years is the most suitable age at which to give the first, and in most cases the only, anti-tuberculosis vaccination under present conditions. To make an assessment of this kind, the current proportion of children infected with tubercle bacilli by the age of 13, the results of tuberculous infection acquired before that age, the risks of infection at puberty and adolescence, the duration of protection conferred by vaccination, and some other factors all need to be considered.

B.C.G. vaccination in England and Wales

B.C.G. vaccination in England and Wales

Vaccination in England

Vaccination in England

Smallpox and Vaccination in Japan

To the Editor:— The opponents of vaccination in England and in the United States are circulating the statistics of smallpox in Japan in recent years with a view to discrediting the prophylactic effect of vaccination in that country. They point out that Japan, which is supposed to be a thoroughly vaccinated country, has had, in the twenty years from 1889 to 1908, 171,500 cases of smallpox, and that in 1908 there were 18,139 cases. If the inhabitants of Japan were all thoroughly well vaccinated, these figures would seriously challenge the effectiveness of vaccination as a preventive measure against smallpox. There is, however, information at hand to show that a very large number of Japanese subjects have not been successfully vaccinated, and this information comes to us from an unimpeachable and authentic source. Dr. T. Amako, director of the Municipal Hospital for Infectious Diseases in Kobe, Japan, has recently published an