To assess a hepatitis B vaccination program offered to all grade 6 students in British Columbia in 1992.
British Columbia, Canada.
All grade 6 students were offered vaccine. Subsets of 454 and 259 students participated in studies of minor adverse events and seroresponse, respectively.
The vaccine used was Engerix-B, 20 micrograms, given at intervals of 0, 1, and 6 months.
Province-wide acceptance and series completion rates and reports of severe adverse events. Minor adverse events and immunogenicity in subsamples.
A total of 127,922 vaccine doses were administered. Initial enrollment totaled 43,358 students or 95.4% of those eligible. The series was completed by 41,594 students (95.6%). Minor adverse events were infrequent in the cohort assessed: no absenteeism or physician visits resulted from vaccination. Sixty-nine reported severe adverse events met surveillance definitions, the major categories being injection site reactions (23% of reports), fainting (20%), and rashes (17%). There was one instance of anaphylaxis. Only 13 of these events resulted in recommendations to discontinue the series. Of students tested following the series, 98% had levels of antibody to hepatitis B surface antigen considered to be protective (> or = 10 IU/L), the geometric mean titer being 690 IU/L (95% confidence interval, 498 to 957 IU/L).
Our experience indicates that school-based programs for universal vaccination of preadolescents can be highly acceptable and efficient.
Comment In: JAMA. 1995 Oct 18;274(15):1242-37563516
Over the last decade, in response to the heightened awareness of HBV and HIV infections, world health authorities have produced specific infection control recommendations for dental practices. Surveys have been done in various countries to investigate the level of compliance to these recommendations. This paper reports on the changes in compliance over a six year period among British Columbia dentists, as indicated from four volunteer surveys conducted between 1987 and 1993. During that period, the percentage of dentists who reported taking a medical history for each new patient increased from 70 per cent to 99 per cent. The routine use of gloves increased from 61 per cent to 95 per cent, and of face masks from 49 per cent to 83 per cent. In 1993, most dentists (91 per cent) used a new pair of gloves with each patient, up from 62 per cent three years earlier. Dentists also reported on their sterilization and hygiene methods. Autoclavable handpieces were used by 66 per cent of respondents in 1990, and by 74 per cent in 1993. High-speed autoclavable handpieces were used by 83 per cent of dentists in 1993, but only 62 per cent sterilized these handpieces. Similarly, 65 per cent reported using low-speed autoclavable handpieces, but only 47 per cent sterilized them. It is apparent that disinfection of handpieces and intraoral instruments is still an important part of regular operatory hygiene. Biologic monitors were used by 61.6 per cent of respondents to test the efficiency of their office sterilizer in 1993.(ABSTRACT TRUNCATED AT 250 WORDS)
The Downtown Eastside (DTES) of Vancouver is an inner-city neighbourhood of 10 square blocks where poverty, crowded housing, homelessness, poor nutrition and hygiene, chronic illness, and substance abuse put residents at risk for communicable diseases. The objective of the program was to minimize the burden of illness from vaccine-preventable diseases in this vulnerable population. This article describes the process and lessons learned to enable others to implement similar programs.
Influenza and pneumococcal vaccinations were offered in community settings to all persons living in, working in, or visiting the DTES by teams of public health nurses and volunteers in the fall of 1999. Hepatitis A and B vaccinations were offered in January/February 2000. All 4 vaccines were offered in Fall 2000, influenza vaccine alone was offered in Fall 2001 and 2002; and pneumococcal, hepatitis A and B vaccines were offered in June 2002.
During the initial 5-week influenza/pneumococcal immunization blitz, 8,723 persons were immunized; 79% received both vaccines. There was a reduction in visits for pneumonia to local emergency departments in the 3 months following this blitz. During the 5-week 2000 hepatitis A and B vaccination blitz, 3,542 persons were immunized; 58% received both vaccines. A reduction in reported cases of hepatitis A followed. Uptake of influenza vaccine was considerably reduced when offered in combination with 3 other vaccines. To maximize uptake, influenza vaccine was offered alone in subsequent years.
Immunizations can be successfully delivered to high-risk inner-city populations in non-traditional settings, using public health nursing outreach in a blitz format.
Between 1980 and 1992 there was a 70-fold increase in reported hepatitis B cases in British Columbia (BC), to a rate of 32 per 100,000 population, more than three times the national average of 10 per 100,000. In BC, this disease is one of young adults--less than 5% of reported cases occur under the age of 15 years. While Canada remains an area of low endemicity where transmission is mostly sexual or as a result of lifestyle choices, programmes of targeted immunization of certain high-risk groups (neonates of infected mothers, household and sexual contacts of acute cases and selected healthcare workers) begun in the mid-1980s have failed to reduce the increasing rate of reported infection. In September 1992, an expanded programme of hepatitis B immunization was implemented in BC. The programme has two main components: universal immunization of a cohort of pre-adolescent children in schools and broadened targeted immunization of groups at known elevated risk for transmission. The school-based programme involves provision of a three-dose series by public health nurses to all children in grade 6 (age 11 years) for whom parental consent is given. During the 1992-1993 school year, more than 42,000 grade 6 students were eligible for hepatitis B vaccine and the three-dose series was completed by 91% of students throughout the province.(ABSTRACT TRUNCATED AT 250 WORDS)
British Columbia (BC) implemented a universal infant hepatitis B (HB) immunization program in 2001. The study objective was to evaluate HB immunization coverage among the first six-month cohort of eligible infants in the province outside of the Vancouver-Richmond health region and to assess parent/guardian behavioural and attitudinal determinants of HB immunization.
A cross-sectional survey of HB immunization was conducted using a random sample of eligible infants born between 1 January-30 June 2001. HB immunization coverage data were obtained from the provincial Public Health Information System, and through a telephone survey of 487 of eligible infants' parents/guardians that was conducted between October 2002-January 2003. At this time, parents/guardians were also asked about behaviours and attitudes towards immunization, based on the Immunization Health Belief Model Scale.
HB immunization coverage with at least one dose of HB vaccine was 89% and uptake of 3 doses of HB vaccine was 78%. HB immunization was significantly associated (p