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Factors to be considered in designing immunization programs in developing countries are summarized. The limiting factors will usually be costs of vaccines, administration equipment and supplies, transport and maintenance of the cold chain. Choices have to be made about the sources of vaccines, whether produced locally or imported, size of vaccine lots and type of package, and quality control of vaccines. Selection of vaccines is treated in a separate appendix, but generally 3 groups are recognized: 1) recommended for general use: smallpox, diphtheria, tetanus, pertussis, BCG, typhoid and measles; 2) recommended for special cases: polio and yellow fever; 3) not recommended for developing countries: rubella, mumps, influenza, cholera; and 4) vaccines in development stage only: arbovirus, rickettsia, trachoma, meningococci, plague and shigella. Schedules for vaccine administration are suggested, such as plans for vaccination every 2 years, plans for 4 courses of vaccinations including 1 at school entry, and special programs such as smallpox campaigns and immunization of adolescent girls and fertile women with tetanus. Finally the importance of recording of vaccinees and assessment of programs is discussed.
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PMID:Design of immunization programmes for developing countries. 467 78

A cross-sectional study on vaccine coverage and vaccine effectiveness was carried out on a randomized sample of the cohort of schoolchildren born in 1983 attending school in Andorra, prior to the introduction of a Systematic Immunisation Plan that included centralised import and delivery of vaccines to vaccinating clinics, surveillance of the cold-chain during vaccine delivery, and a clearly-defined immunization schedule against diphtheria, tetanus, -pertussis, polio, mumps, rubella and measles. Vaccine coverage was estimated from vaccination card records; history of disease and sociodemographic variables were obtained through a questionnaire to the children's parents and vaccine effectiveness was estimated through serum antibody testing. Vaccine coverage levels for DTP and OPV were 97.8% for both. Protective serum antibody prevalence was correspondingly high except for the polio viruses. The authors suggest that decreased vaccine effectiveness, probably due to poor preservation of the cold chain, might be the cause of this finding. In countries or regions with an otherwise developed organisation of health services, an important issue like this can still be overlooked.
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PMID:A cross-sectional study on vaccine coverage and seroprevalence in schoolchildren in Andorra. 821 15

In postinfection cold agglutination, certain cold agglutinin (CA) specificities are associated with distinct infectious agents. The combined occurrence of anti-I and anti-Sia-b1 CAs following Mycoplasma pneumoniae infection has been reported recently. After renal transplantation and hyperacute graft rejection, transiently occurring CAs were observed in an 18-year-old boy. The CAs were characterized by serum cold absorption with sialidase-treated red cells and warm elution from the cells. An anti-Sia-b1 CA could be differentiated from an accompanying low-liter anti-I. Fresh infections with Mycoplasma pneumoniae, Epstein-Barr virus, rubella, and varicella viruses were excluded, but CMV infection was demonstrated. This is the first case of a postinfection anti-Sia-b1 CA associated with CMV infection.
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PMID:CMV-induced anti-Sia-b1 cold agglutinin in an immunocompromised patient. 935 71

Cold agglutinins (CA) are observed during acute infections as transiently occurring postinfection autoantibodies directed against erythrocyte antigens. Distinct infectious agents induce CA of distinct specificity. A common association is the infection with Mycoplasma pneumoniae and the production of CA with anti-I specificity. In infections with varicella-zoster virus (VZV) and rubella virus (RV) a few cases of CA appearance are reported, all of them showing specificity for the Pr antigens. We examined the frequency of CA with the anti-Pr specificity in patients suffering from acute infections with VZV and RV (table 1). The known association of anti-I in about 70% of the cases with acute Mycoplasma pneumoniae infection is confirmed by our results. The occurrence of CA in infections with VZV and RV is a rare event. Based on published data, the specificity of these CA apparently is anti-Pr. Three of 5 anti-Pr examples were found in newborns with rubella embryopathy. Possibly, anti-Pr can be observed more frequently in these patients compared to adults.
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PMID:[Increase of post-infection cold agglutinins after infection with Mycoplasma pneumoniae, varicella-zoster and rubella virus]. 948 85

Cuba is about to implement a new plan of action aimed at correcting weaknesses in its immunization program. Components of this plan include: 1) coordination of activities with community organizations to achieve the elimination of measles by 1984; 2) identification of funding sources for the purchase of cold boxes and thermoses to handle vaccines at the local level; 3) coordination with the Ministry of Education to require presentation of a vaccination certificate for entrance into the school system; 4) introduction of rubella and mumps vaccine in the national vaccination schedule; 5) establishment of quarterly program evaluations at the central level to be carried out by the Division of Epidemiology, as well as immunization evaluation at the provincial level as part of the overall effort to decrease infant mortality; and 6) creation of a national multidisciplinary commission to analyze all aspects of the national immunization schedule, including statistical data, control methods, and general program norms. An evaluation of Cuban immunization activities conducted in 1981 concluded that Cuba has made impressive progress in the control of most vaccine-preventable diseases. Factors judged to have contributed to this success include the presence of a single unified health system, active involvement of community organizations, well-staffed statistical services, the high priority accorded immunization activities, a practical system for local health planning, and a system of supervision and evaluation. Most immunizations in Cuba are delivered by local polyclinics, hospitals, or rural health posts. Cuba's epidemiologic surveillance system is among the most reliable in Latin America, and every health care institution telephones reports in daily to the municipality. Only 2 cases of polio have been reported since 1970, and there have been no cases of diphtheria or neonatal tetanus in the last 10 years. Although there has been a marked decrease in measles mortality since immunization began in 1974, morbidity from this disease remains relatively high.
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PMID:EPI in Cuba: immunization gets top priority. 1231 89

An improved method for the isolation of rubella virus-like particles (RVLP) from cell culture supernatant of transfected Chinese hamster ovary (CHO24S) cells is described. It employs a combination of membrane filtration with sucrose gradient ultracentrifugation. It was found that staining the RVLP band with Coomassie brilliant blue G (CBB) resulted in the CBB crystals adsorbing RVLP. After ultracentrifugation (25,000 rpm, 3h, 4 degrees C) a sharp blue band with crystals (diameter 30-40 microm) was observed (at a density of 1.250 g/ml at 25 degrees C) in a 30-60% sucrose gradient. Using a combination of SDS-PAGE and Western blotting techniques, E1 rubella virus structural protein was detected only in the solutions derived from the sharp blue band. A decrease in crystal concentration a few millimeters above or below the main band was associated with a decrease in protein concentration. By dilution with a saturated ice-cold 30% sucrose solution it was possible to pellet the crystals by centrifugation (15,000 rpm, 10 min). SDS-PAGE showed a much higher concentration of RVLP structural protein in the pellet than in the supernatant. This RVLP-containing material is especially suitable for the preparation of rubella virus immunoblot stripes.
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PMID:A technique for isolation of rubella virus-like particles by sucrose gradient ultracentrifugation using Coomassie brilliant blue G crystals. 1241 34

In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from 2003 to 2006, data on acute/infectious and chronic diseases were collected from a population-based sample of 17,641 subjects aged 0 to 17 years. The annual prevalence rates among acute diseases vary widely. Children and adolescents are most frequently affected by acute (infectious) respiratory conditions. 88.5 % of the surveyed children and adolescents experienced at least one episode of common cold within the last 12 months. Among the other acute respiratory infections, bronchitis and tonsillitis were the most frequently encountered conditions with 19.9 % and 18.5 %, respectively. The 12-month prevalence of otitis media and pseudocroup was 11 % and 6.6 %, respectively. 1.5 % of the children and adolescents experienced an episode of pneumonia. Apart from respiratory infections, gastrointestinal infections were very frequently stated as reasons for acute illness. Furthermore, 12.8 % of the children and adolescents experienced a herpetic infection, 7.8 % a conjunctivitis and 4.8 % a urinary tract infection. Lifetime prevalence rates of infectious diseases were as follows: pertussis 8.7 %, measles 7.4 %, mumps 4.0 %, rubella 8.5 %, varicella 70.6 %, scarlet fever 23.5 %. The various chronic somatic diseases in children and adolescents had different lifetime prevalence rates. Most frequently, children and adolescents were affected by obstructive bronchitis (13.3 %), neurodermatitis/atopic eczema (13.2 %) and hay fever (10.7 %). Scoliosis and asthma had been diagnosed by a doctor in 5.2 % and 4.7 % of subjects aged 0-17 years, respectively. The lifetime prevalence rates of the remaining diseases varied between 0.14 % for diabetes mellitus and 3.6 % for convulsions/epileptic fits. For the first time ever, these survey results provide nationwide representative information on the prevalence rates of acute/infectious and chronic diseases in children and adolescents which is based on a population-representative sample.
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PMID:[Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. 1751 53

A 58-year-old man was admitted to our hospital with fever, vomiting and disturbance of consciousness after common cold-like symptoms for 2 days. Physical examination showed high fever, moderate hypertension and tachycardia. There were no superficial lymph nodes swelling nor skin rashes. Cerebrospinal fluid (CSF) examination revealed increased protein level (467 mg/dl) and pleocytosis (508 cells/mm3), but no glucose was detected. CSF smear test detected the pneumococcus. Intravenous cefotaxime was administered along with intravenous immunoglobulins and steroid pulse therapy. However, DIC developed, so FOY therapy was started. With these treatments, level of consciousness gradually improved and he became able to eat. At 11th days after the onset, the patient suddenly developed left facial palsy and paresis of the left arm. Head T2-weighted magnetic resonance imaging demonstrated tumor-like hyperintensity signal lesions (28 x 16.6 mm) with ring enhancements in the right frontal lobe. Acute disseminated encephalomyelitis (ADEM) was diagnosed based on MRI and CSF findings, and then additional corticosteroid pulse therapy was administered twice. Herpes simplex virus and herpes zoster virus DNA in the CSF were undetectable by PCR. After 6 days of treatment with corticosteroid pulse therapy, left facial palsy and paresis of the left arm gradually improved and MRI showed the disappearance of tumor-like hyperintense signals. Although ADEM usually develops as a complication after viral infection such as measles, rubella, mumps and herpes zoster, this case suggests that ADEM complication should be considered even after pneumococcal meningoencephalitis.
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PMID:[A case of acute disseminated encephalomyelitis (ADEM) following treatment for pneumococcal meningoencephalitis]. 1934 73

Primary vaccine failures can occur after high immunization coverage has been achieved. Healthcare workers' knowledge and practices are influential factors in preventing vaccine failures. Adequate knowledge and practices in the cold chain system are important to keep potency of vaccines and effectiveness of immunization. This cross-sectional study was performed to assess healthcare workers' knowledge and practices regarding an expanded program on immunization and the cold chain system in Kalasin, Thailand. Data collection methods included interviews, observations and document audit. Ninety primary care units and 117 respondents were selected. Only 55.6% of respondents provided correct answers for questions regarding the immunization schedule of school children and 59.0% of respondents answered correctly for questions about Measles-Mumps-Rubella Vaccine. Healthcare workers in hospitals had better knowledge than healthcare workers in health centers (P < 0.001). Healthcare workers who had sufficient training had better knowledge than healthcare workers who had no training (P < 0.001). Only 61.1% of primary care units recorded the temperature in the vaccine refrigerator twice a day and 63.3% of primary care units had a flowchart regarding what to do when there is an electric power failure. About 13% of vaccine refrigerators had temperatures outside the recommended range of 2 to 8 degrees C. Practices in hospitals were also better than those in health centers (P = 0.001). Knowledge and practices were significantly different between healthcare workers in hospitals and in health centers. Coverage training and regular supervision on vaccine handling and the cold chain system are recommended, especially for health centers in remote areas.
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PMID:Healthcare workers' knowledge and practices regarding expanded program on immunization in Kalasin, Thailand. 2192 99

Live attenuated rubella vaccine is used for vaccination. Temperature-sensitive (ts) phenotype was proved for almost all rubella vaccine strains, and the acquisition of the ts phenotype during cold adaptation was strongly correlated with the attenuation of the wild-type viruses. Nevertheless, the molecular mechanisms of the attenuation have been insufficiently understood for rubella virus. Study ofthese mechanisms, identifying genotypic markers of attenuation, which together with the sequence analyses could be used for genetic stability control of vaccine strains, is still of current interest. In this work, we determined nearly complete genome sequences of attenuated (ca) and the wildtype progenitor (wt) of the rubella virus strain C-77 isolated in Russia. Possible genetic determinants of attenuation were detected. Thus, 13 nucleotide differences leading to 6 amino acid substitutions were found. Four amino acid substitutions were found to be almost unique. Special consideration should be given to Tyr1042Cys substitution in the protease domain of C-77 strain, because it most probably plays the crucial role in acquisition of ts-phenotype.
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PMID:[Studying of molecular mechanisms of rubella virus attenuation evidence from Russian strain C-77]. 2298 71


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