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Efforts to provide the benefits of immunization to the world's children have reached an important crossroad. While remarkable progress has been achieved in successfully administering six important childhood vaccines (diphtheria, tetanus, polio, pertussis, measles, and tuberculosis), the benefits of new vaccines, such as hepatitis B and Haemophilus influenzae type B glycoconjugate vaccines, have not been realized except in the most developed countries. The three reasons often cited to explain this problem include poor access to immunization services, the evolution of complex primary immunization schedules, and the additional expense associated with new vaccines, potentially depleting scarce resources. The establishment of the Children's Vaccine Initiative is an organized effort to improve immunization by both technological and organizational innovation. Simplification of the vaccination process can be achieved by developing new combination vaccines or reducing the number of immunizations with vaccines that stimulate protective immune responses. Improvements in the organization of efforts to immunize children will also enhance the prospects of protecting the world's children from infectious diseases. To achieve the goals articulated in the Declaration of New York, the issues of transition from the old to the new vaccines must be addressed. Research on vaccines and technological innovation at all levels will be required to achieve these goals.
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PMID:The promise of new technologies. 815 63

The principal goal of the Childhood Immunization Initiative (CII) is to increase, by 1996, vaccination levels for 2-year-old children to at least 90% for the most critical doses in the vaccination series (i.e., one dose of measles-mumps-rubella vaccine [MMR] and at least three doses each of diphtheria and tetanus toxoids and pertussis vaccine [DTP], oral poliovirus vaccine [OPV], and Haemophilus influenzae type b vaccine [Hib]) and to at least 70% for at least three doses of hepatitis B vaccine (Hep B). Since 1991, annual national estimates of vaccination coverage levels of preschool-aged children have been available through the National Health Interview Survey (NHIS) conducted by CDC. This report presents vaccination coverage levels of children aged 19-35 months for 1992 and provisional estimates of vaccination coverage for the combined first and second quarters of 1993 (Table 1).
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PMID:Vaccination coverage of 2-year-old children--United States, 1992-1993. 816 35

Infection remains a major cause of morbidity and mortality in transplant patients. Many infections, however, can be successfully prevented by immunization. This presentation reviews the problems associated with, and the questions that arise concerning the use of routine pediatric vaccines, such as diphtheria-pertussis-tetanus (DPT) and measles-mumps-rubella (MMR). It also reviews the use of special vaccines such as hepatitis B, pneumococcal, and influenza vaccines in transplant patients. Data concerning the use of two experimental, live-attenuated virus vaccines, against cytomegalovirus (CMV) and varicella, are discussed. The live-attenuated varicella vaccine can be predicted to decrease the morbidity and mortality of varicella-zoster virus infection in transplant patients. It has already been given successfully to immunocompromised children and is highly effective in the prevention of varicella.
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PMID:Immunizations for pediatric transplant patients. 824 77

In the United States, children are routinely vaccinated against nine diseases--diphtheria, Haemophilus influenzae type b (Hib), hepatitis B, measles, mumps, pertussis, poliomyelitis (paralytic), rubella, and tetanus. Based on public health surveillance and epidemiologic assessment of most of these diseases, the impact of childhood vaccination on reported occurrence has been substantial: provisional surveillance data for 1993 indicate that for five of these diseases and for congenital rubella syndrome (CRS), the number of reported cases is at or near the lowest levels ever, suggesting near interruption of transmission of these diseases. This report presents provisional data for December 1993 for these 10 diseases, compares provisional data for 1993 with final data for 1992, and describes the Childhood Immunization Initiative (CII).
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PMID:Reported vaccine-preventable diseases--United States, 1993, and the childhood immunization initiative. 829 25

In 1992, there was a setback in measles vaccination for developing countries as high-titre vaccines were withdrawn following reports of excess mortality in vaccine recipients. The importance of continuing polio vaccination in industrialized countries was emphasized by an outbreak of paralytic polio among an unimmunized community in the Netherlands. Immunization programs are now increasingly using the Jeryl Lynn strain of mumps vaccine following reports of meningoencephalitis associated with the Urabe strain. A hepatitis A vaccine has become generally available and hepatitis B vaccine is being introduced into more childhood programs in countries where the disease is highly prevalent. Trials of group B meningococcal meningitis vaccines have yielded disappointing estimates of efficacy, particularly in younger children. Earlier reports of invasive bacterial infections after pertussis immunization have not been confirmed.
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PMID:Immunizations in children. 837 28

Universal immunization of infants is essential to the control of hepatitis B in areas of high endemicity where infection commonly occurs in infants and children. It is also an attractive strategy for ultimately reducing hepatitis-B-associated acute and chronic liver disease in areas of lower endemicity where infections occur primarily in adolescents and adults. Integration of hepatitis B vaccine with other routine paediatric immunizations, using flexible scheduling, will enhance compliance while minimizing the need for additional resources. Clinical studies demonstrate that a very high proportion of healthy infants and adults develop a protective level of antibody when given hepatitis B vaccine using a wide range of schedules. Compliance with universal vaccination of infants against hepatitis B may be enhanced by the development of new combination vaccines (e.g. diphtheria-tetanus-pertussis-Haemophilus influenzae b-hepatitis B) that allow complete immunization against several antigens with a minimal number of injections.
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PMID:Control of hepatitis B through routine immunization of infants: the need for flexible schedules and new combination vaccine formulations. 844 68

Many childhood diseases can be prevented by proper immunization. The purpose of this article is to provide information about the risks and benefits associated with vaccines used in the United States for children under one year of age. Vaccines can be made from live or killed organisms and can stimulate both local and systemic immunity. The immunization schedule recommended by the American Academy of Pediatrics is presented. Information about the use of routine vaccines, their risks and the diseases they prevent, is presented. Vaccines included are diphtheria, pertussis, tetanus, poliomyelitis, Haemophilus influenzae, influenza viruses and hepatitis B. Research is ongoing to develop new vaccines and improve those currently in use.
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PMID:Prevention of childhood diseases through vaccination. 847 10

The reactogenicity and immunogenicity of the administration of recombinant vaccine against hepatitis B simultaneously (but at separate sites) with diphtheria/tetanus/pertussis (DTP) and oral polio vaccines were examined. Six hundred and twenty-six children (group I) were given hepatitis B vaccine at 0, 2 and 6 months of age; the other vaccines were administered at 2, 4 and 6 months of age. A control group of 731 children (group II) received only DTP and oral polio vaccines. The results showed that 93% of the infants in group I had anti-HBs titres above the protective level ( > or = 10 mIU ml-1) after vaccination. There were no differences in the immune responses for DTP and polio between the two study groups. The vaccine efficacy against poliomyelitis was 96% for serotype I, 100% for serotype II and 97-98% for serotype III. Of the infants in both groups, 97% had antibodies against B. pertussis; all children were positive for tetanus and diphtheria. There were no differences in the incidences of general reactions between groups. Local swelling and redness were reported following 4.2 and 4.4%, respectively, of all injections of hepatitis B vaccine. These reactions were reported following 31 and 33%, respectively, of all doses of DTP vaccine. It can be concluded that the simultaneous administration of hepatitis B vaccine with the DTP and polio vaccines is well-tolerated; hepatitis B vaccine remained highly immunogenic and did not interfere with the immune response to the other antigens.
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PMID:Newborn universal immunisation against hepatitis B: immunogenicity and reactogenicity of simultaneous administration of diphtheria/tetanus/pertussis (DTP) and oral polio vaccines with hepatitis B vaccine at 0, 2 and 6 months of age. 852 90

By 1995, measles, mumps, and rubella were eliminated from Finland, acellular vaccines for pertussis were showing great promise, and the global eradication of poliomyelitis by the year 2000 looked possible. The meningococcus was replacing Haemophilus influenzae type b as the main cause of childhood meningitis, and 75 countries were vaccinating their children against hepatitis B. The United States recommended varicella vaccination for children, effective vaccines were available for hepatitis A, and new vaccines for rotavirus and cholera were being tested; malaria and HIV offer a continuing challenge.
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PMID:Update on immunization. 868 May 9

There are 23 countries/areas in this Region (Tables 1-3). BCG is used in all but 3 countries (Cyprus, Jordan and Lebanon). Most countries/areas give BCG vaccine at birth, 2 countries (Bahrain and Tunisia) schedule additional doses at school age and Kuwait uses 1 dose at the age of 3 1/2-4 years. Diphtheria-pertussis-tetanus (DPT) vaccine is used as a primary series of 3 doses in all countries/areas. Fifteen countries/areas use a fourth dose of DPT vaccine in the second year of age or later (Bahrain, Cyprus, Egypt, Iran [Islamic Republic of], Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Tunisia, and the United Arab Emirates, the United Nations Relief and Works Agency for Palestine Refugees in the Near East [UNRWA]). Six countries use 5 doses of DPT vaccine, the fifth dose being given at the age of 4-6 years (Bahrain, Cyprus, Iran [Islamic Republic of], Kuwait, Qatar, and Saudi Arabia). One or 2 booster doses of diphtheria-tetanus (DT) vaccine are used in 9 countries/areas from the age of 6-12 years. Td vaccine is used as a booster in Bahrain and Cyprus. Oral poliovirus vaccine (OPV) is used in a primary series of 3 doses simultaneously with DPT vaccine in all countries/areas. Ten countries/areas use an additional dose of OPV at birth (Djibouti, Iran [Islamic Republic of], Iraq, Kuwait, Libyan Arab Jamahiriya, Morocco, Oman, Pakistan, Syrian Arab Republic, and UNRWA). An additional dose of OPV in the second year of life is used in 15 countries, and additional doses of OPV are recommended in some countries. In UNRWA, the first 2 doses of OPV 2 and 3 months of age are given simultaneously with the inactivated poliovirus vaccine (IPV). Measles vaccine is given in most countries/areas at 9-12 months of age, usually in the form of monovalent measles vaccine. The 2-dose policy is implemented in 12 countries. In 8 countries, the second dose is given as measles-mumps-rubella (MMR) vaccine, and in 3 countries as monovalent measles vaccine. The age for the second dose varies. In 10 countries, it is given at 12-15 months of age, and in the Libyan Arab Jamahiriya at 18 months of age. The United Arab Emirates uses 3 doses. Rubella vaccine is scheduled for girls of 12-13 years of age in Bahrain, the United Arab Emirates and UNRWA and for boys and girls in Kuwait at 12 years of age. Hepatitis B vaccine is used in 15 countries/areas. All these countries use 3 primary doses of vaccine in infancy. The immunization time varies from birth (12 countries/areas) to 9 months of age. In Cyprus, hepatitis B vaccine is used in a 4-dose schedule, including a booster dose given to 5 to 6-year-old children. Tetanus toxoid is used for pregnant or non-pregnant women of childbearing age. It is also given to school-children in the Islamic Republic of Iran. The schedule includes 2-5 doses.
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PMID:Expanded programme on immunization (EPI). Immunization schedules in the WHO eastern Mediterranean region, 1995. 869 38


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