In 1994, countries of the Region of the Americas set a goal of interrupting indigenous measles transmission, and the regional plan of action for achieving this goal was begun in 1996. As of March 16, 2003, the Region of the Americas has been free for 17 weeks from known circulation of the d9 measles virus, the strain responsible for the only large outbreak of measles in the region during 2002 (Figure).
OBJECTIVE: Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the United States and greater mortality among American Indian/Alaska Natives. Vaccination reduces S. pneumoniae illness. We describe the methods used to achieve the Healthy People 2010 coverage rate goals for adult pneumococcal vaccine among those at high risk for severe disease in this population. METHODS: We implemented a pneumococcal vaccination project to bolster coverage followed by an ongoing multidisciplinary program. We used community, home, inpatient, and outpatient vaccinations without financial barriers together with data improvement, staff and patient education, standing orders, and electronic and printed vaccination reminders. We reviewed local and national coverage rates and queried our electronic database to determine coverage rates. RESULTS: In 2007, pneumococcal vaccination coverage rates among people > or = 65 years of age and among high-risk people aged 18-64 years were 96.0% and 61.2%, respectively, exceeding Healthy People 2010 goals. Government Performance and Results Act analyses reports revealed a 2.7-fold increase (36.0% to 98.0%) of coverage from 2000 to 2007 among people > or = 65 years of age at Whiteriver Service Unit in Whiteriver, Arizona. CONCLUSIONS: We achieved pneumococcal vaccination rates in targeted groups of an American Indian population that reached Healthy People 2010 goals and were higher than rates in other U.S. populations. Our program may be a useful model for other communities attempting to meet Healthy People 2010 goals.
We studied the incidence and bacterial epidemiology of acute epiglottitis presenting in the first 16 years following the introduction of general childhood vaccination against Haemophilus influenzae type b. Our main objectives were to analyse (1) the incidence of Streptococcus pneumoniae epiglottitis in adults and (2) the distribution of pneumococcal serotypes involved.
The medical records of patients with acute epiglottitis (International Classification of Disease code J05.1) were investigated. Streptococcus pneumoniae serotyping was performed using gel precipitation.
The overall incidence of acute epiglottitis was 0.98 cases/100,000/year, compared with 4.5 cases/100,000/year before the vaccination programme. The incidence was reduced both in children and adults, compared with pre-vaccination values. However, the incidence of Streptococcus pneumoniae epiglottitis in adults increased from 0.1 to 0.28 cases/100,000/year over the same time period. The causative agent was Streptococcus pneumoniae in 10 adults. Nine of 10 pneumococcal strains could be serotyped. All but one serotype is represented in the 23-valent pneumococcal polysaccharide vaccine (PPV23) used in adults.
In acute epiglottitis, now a disease of adults, the most important bacterial aetiology is Streptococcus pneumoniae. The serotype distribution found in this study indicates that the infection is preventable by PPV-23 vaccination with the 23-valent polysaccharide vaccine.
The incidence of acute epiglottitis in children is declining in the province of Quebec, Canada. In 1988, a PRP-D anti-Haemophilus type B vaccine was introduced into the routine vaccination schedule of 18-month-old children. A substantial reduction in the occurrence of acute epiglottitis was perceived by clinicians. Since 1992, improved new vaccines (PRP-T, HbOC, PRP-OMPC), given to 2-month-old infants, have been expected to increase the efficacy of the immunization program. The impact of the immunization program on preventing acute epiglottitis was verified using a provincial database system called Med-Echo. In the presumably vaccinated target population (0 to 6 years old), 15 children suffered acute epiglottitis in 1993, whereas 97 cases were reported on the average for each yearly period from 1984 to 1987, just before the program's inception. Thus, the incidence of acute epiglottitis in preschoolers was reduced to 15.4% of its former level. The overall efficacy of the immunization program in preventing acute epiglottitis, therefore, is estimated to be 84.6%.
Ever since the advent of pediatric vaccination, individuals have expressed concerns about both its risks and benefits. These concerns have once again resurfaced among some segments of the population and could potentially undermine national vaccination programs. The views of the public, however, must be considered and respected in the formulation of vaccination policy. We have conducted an analysis of the pediatric vaccination "debate" in the Canadian context. We believe that there is common ground between those who support pediatric vaccination and those who are concerned about these programs. Based on our findings, we believe that the goal of public health authorities should be to maintain trust in vaccines by continuing to meet certain reciprocal responsibilities. To do so, we recommend the following: 1) increased investment in adverse event reporting systems; 2) request for proposals for consideration of a no-fault compensation program; 3) developing pre-emptive strategies to deal with potential vaccine risks; 4) further examination of mechanisms to improve communication between physicians and parents concerned about vaccination. All of these approaches would require additional investment in pediatric vaccination. However, such an investment is easy to justify given the benefits offered by pediatric vaccination and the ramifications of failing to maintain confidence in vaccination programs or missing a vaccine-related adverse event.
Comment In: Can J Public Health. 2006 Mar-Apr;97(2):86-916619991
The objective of this study was to describe the offer and accessibility of vaccination services for adolescents and adults so they can be adapted to needs in the future.
A descriptive cross-sectional study was carried out among the 81 medical clinics that offer vaccination services in a region of Québec.
The response was 70% (57/81). Over 90% of clinics planned to maintain or increase their offer of vaccination services over the next 5 years. One quarter of clinics did not have the facilities to optimize the cold chain respect. The principal barriers were the cost of purchasing vaccines and the low level of remuneration for vaccination.
This study provided better knowledge of the actual and future offer and accessibility of vaccination for adolescents and adults in Québec. It was shown that evidence-based interventions known to improve vaccine storage and accessibility were absent in many medical clinics.
A significant progress in the management of controllable infections achieved by the early XXI century made it possible eliminate poliomyelitis across the nation, and practically eliminate measeles by vaccinating 96-99% of the children without raising the complication rate. The list of counterindications was shortened significantly, the Calendar of immunoprophylaxis was supplemented by inoculations against hepatitis B, rubella, flu, and type b Haemophilis influenzae infections. Morbidity of controllable infections in Russia decreased substantially compared with that in the 1990s. Nevertheless, the public health services are faced with the necessity of speedy application of new vaccines (including combined ones) allowing the inoculation impact on the child to be reduced. A rationale for the use of vaccines against pneumococcal and meningococcal infections, hepatitis A, varicella and for scaling up anti-pertussis vaccination coverage is proposed. Equally important is more extensive vaccination against papillomavirus infection as a means of cervical cancer prevention and introduction of the rotavirus vaccine to control most viral diarrheas.
When the diseases we try to prevent through vaccination are rare, we tend to focus more on the associated risks. Vaccination has led to unfortunate consequences, mainly due to production failure and inadequate control in earlier years. The requirements for vaccine control are now so rigorous that the risk for such occurrences is close to zero. Local and mild systemic reactions to vaccines are rather common, and are usually well known and described in detail when a vaccine is licensed. Some vaccine reactions are however so rare that they only will be discovered through surveillance after the vaccine has become available for routine use. Suspicion of adverse events will now normally arise through the official notification systems for adverse events. Large epidemiological studies are often necessary to decide whether there is a causal relationship or only a coincidence. Recording of adverse events following vaccination and transparency about their existence, are important issues in the work to maintain the credibility of vaccines.
In September 2007, a school-based human papillomavirus (HPV) vaccination program targeting grade 8 girls (approximately 13 years old) and delivered by public health was implemented in Ontario, Canada. We assessed reports of adverse events following immunization (AEFI) from the school-based program as part of quadrivalent HPV (HPV4) vaccine safety surveillance and to contribute to a comprehensive HPV vaccine program evaluation.
AEFIs following HPV4 vaccine (Gardasil(®)) administered between September 1, 2007 and December 31, 2011 were extracted from the province's reportable disease system. Confirmed AEFI reports among females 12-15 years old (i.e. assumed to have received vaccine through the program) were included. Events were grouped according to provincial AEFI case definitions. Rates were calculated using doses distributed as the denominator.
Between 2007 and 2011, 133 confirmed AEFIs were reported while 691,994 HPV4 vaccine doses were distributed in the school-based program. The overall reporting rate was 19.2 HPV4 AEFI per 100,000 doses distributed. Annual reporting rates decreased from 30.0 to 18.3 per 100,000 doses distributed. Frequently reported events included 'allergic reaction-dermatologic/mucosa' (25%), 'rash' (22%), and 'local/injection site reaction' (20%); 26% of reports had a non-specific event of 'other severe/unusual events' selected. Ten serious AEFIs were reported (7.5% of reports) including 2 anaphylaxis, 2 seizures, 1 thrombocytopenia and 1 death. Further review found that the reports of anaphylaxis did not meet the Brighton anaphylaxis definition and the death was attributed to a preexisting cardiac condition.
Overall these findings are consistent with the safety profile of HPV4 vaccine from pre-licensure clinical trials and post-marketing surveillance reports and importantly, no new safety signals were identified, especially no reports of VTE in this younger female population. Continued assessment of HPV4 AEFI surveillance data may be important to detect and investigate safety signals.
To determine the incidence of severe adverse events temporally associated with meningococcal vaccines administered as part of a mass vaccination program.
Retrospective descriptive study of events reported to a passive provincial surveillance system.
The province of Quebec.
The 1,198,751 individuals aged 6 months to 20 years who were vaccinated against meningococcal disease between Dec. 27, 1992, and Mar. 31, 1993.
Total numbers and rates of severe adverse events, including allergic reactions, anaphylactic reactions, neurological events (other than abnormal crying and screaming) and other serious or unusual events.
A total of 118 reports of severe adverse events were selected from the surveillance system. The most frequent were allergic reactions (9.2 per 100,000 doses). Few anaphylactic or neurologic reactions were reported (0.1 and 0.5 per 100,000 doses respectively). There were no reports of sequelae or of encephalopathy, meningitis or encephalitis.
Meningococcal vaccines seem to be associated with fewer adverse events than have previously been reported. Existing surveillance programs are useful for determining the incidence of adverse events temporally associated with vaccines.