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This article reviews the 2007 recommended childhood and adolescent immunization schedules; the catch-up immunization schedules for children and adolescents; the 2006-2007 recommended adult immunization schedule; recommended and minimum ages and intervals between vaccine doses; contraindications for immunization; and general guidelines on immunization procedures. With the exception of some formulations of influenza vaccines, all recommended childhood vaccines are thimerosal-free. Since 2005, changes in vaccine schedules affect the following vaccinations: hepatitis A, rotavirus, human papillomavirus, varicella, meningococcal, adult tetanus and diphtheria toxoids and acellular pertussis, and influenza. Minimal intervals between vaccines and vaccine precautions, contraindications, administration, and storage are reviewed. Sources of up-to-date vaccine information are presented.
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PMID:Vaccine schedules and procedures, 2007. 1727 Jan 10

Seasonality is a driving force that has a major effect on the spatio-temporal dynamics of natural systems and their populations. This is especially true for the transmission of common infectious diseases (such as influenza, measles, chickenpox and pertussis), and is of great relevance for host-parasite relationships in general. Here we gain further insights into the nonlinear dynamics of recurrent diseases through the analysis of the classical seasonally forced SIR (susceptible, infectious or recovered) epidemic model. Our analysis differs from other modelling studies in that the focus is more on post-epidemic dynamics than the outbreak itself. Despite the mathematical intractability of the forced SIR model, we identify a new threshold effect and give clear analytical conditions for predicting the occurrence of either a future epidemic outbreak, or a 'skip'-a year in which an epidemic fails to initiate. The threshold is determined by the population's susceptibility measured after the last outbreak and the rate at which new susceptible individuals are recruited into the population. Moreover, the time of occurrence (that is, the phase) of an outbreak proves to be a useful parameter that carries important epidemiological information. In forced systems, seasonal changes can prevent late-peaking diseases (that is, those having high phase) from spreading widely, thereby increasing population susceptibility, and controlling the triggering and intensity of future epidemics. These principles yield forecasting tools that should have relevance for the study of newly emerging and re-emerging diseases controlled by seasonal vectors.
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PMID:Seasonal dynamics of recurrent epidemics. 1739 85

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

This study was undertaken to assess the co-administration of an experimental measles-mumps-rubella-varicella vaccine (MMRV, GlaxoSmithKline Biologicals) with a combined diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b conjugate (DTPa-HBV-IPV/Hib) vaccine in healthy children. Healthy children aged 12-23 months (N = 451) were randomised to one of three parallel groups to receive one dose of MMRV vaccine co-administered with a booster dose of DTPa-HBV-IPV/Hib vaccine (co-administration group), or one dose of MMRV vaccine alone (MMRV group), or a booster dose of DTPa-HBV-IPV/Hib vaccine alone (DTPa-HBV-IPV/Hib group). No differences in seroconversion rates for measles (>95%), mumps (>80%), rubella (>99%) and varicella (>98%) were seen between the co-administration group and the MMRV group. No differences in geometric mean titres (GMTs) were observed between the two groups with the exception of anti-measles titres, which were observed to be higher in the MMRV group than in the co-administration group (4,419.2 vs. 3,441.8 mIU/ml respectively). Immune response to the booster dose of DTPa-HBV-IPV/Hib vaccine was observed to be similar in the co-administration group and the DTPa-HBV-IPV/Hib group. Co-administration of the MMRV vaccine with a booster dose of DTPa-HBV-IPV/Hib vaccine was well-tolerated and did not exacerbate the reactogenicity profile of either vaccine. In summary, GlaxoSmithKline Biologicals' experimental MMRV vaccine was immunogenic and well-tolerated when administered with a booster dose of DTPa-HBV-IPV/Hib vaccine during the second year of life. The ability to co-administer the MMRV vaccine at the same time as other routine childhood immunisation vaccines could increase compliance with varicella vaccination in countries where this vaccine is already recommended and may facilitate implementation of varicella vaccination elsewhere.
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PMID:Immunogenicity and safety of a tetravalent measles-mumps-rubella-varicella vaccine co-administered with a booster dose of a combined diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine in healthy children aged 12-23 months. 1754 39

Healthy People 2010 objectives include increasing vaccination coverage among children in kindergarten and first grade (objective 14-23). For these children, the target is >/=95% vaccination coverage for the following: hepatitis B vaccine; diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and tetanus toxoids and acellular pertussis vaccine, or diphtheria and tetanus toxoids vaccine (DTP/DTaP/DT); poliovirus vaccine; measles, mumps, and rubella (MMR) vaccine; and varicella vaccine. To assess progress toward national goals and determine vaccination coverage among children in kindergarten, data were analyzed from reports submitted to CDC by 49 states and the District of Columbia (DC) for the 2006-07 school year. This report summarizes findings from that analysis, which indicated that approximately 75% of states have reached the 2010 objective of at least 95% coverage for all of the vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) for children in kindergarten. These results underscore the effectiveness of school-entry requirements in increasing vaccination coverage but highlight a need for more standardized vaccination reporting among states.
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PMID:Vaccination coverage among children in kindergarten--United States, 2006-07 school year. 1770 72

The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19-35 months for each of the 50 states and selected urban and county areas. This report describes the findings of the 2006 NIS, which indicated increases in national coverage with pneumococcal conjugate vaccine (PCV) and varicella vaccine (VAR) and a stable coverage level for the 4:3:1:3:3:1 vaccine series (i.e., > or =4 doses of diphtheria, tetanus toxoid, and any acellular pertussis vaccine [DTaP]; > or =3 doses of poliovirus vaccine; > or =1 dose of measles, mumps, and rubella vaccine [MMR]; > or =3 doses of Haemophilus influenzae type b [Hib] vaccine; > or =3 doses of hepatitis B vaccine [HepB]; and > or =1 dose of VAR). However, national coverage estimates remained below the Healthy People 2010 target of 90% coverage for PCV, DTaP, and VAR and below the 80% target for the 4:3:1:3:3:1 vaccine series. No significant racial/ethnic disparities in 4:3:1:3:3:1 series coverage were observed after controlling for family income. State and local immunization programs should continue to identify and target children who are not fully vaccinated, especially because of low socioeconomic status and other barriers.
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PMID:National, state, and local area vaccination coverage among children aged 19-35 months--United States, 2006. 1772 93

In the last 25 years, the number of diseases prevented by vaccination in childhood has more than doubled, challenging practitioners to become familiar with a host of new vaccine recommendations. Incorporating new vaccines into practice is facilitated by an understanding of the processes that affect their use. Factors that influence the successful incorporation of a vaccine into routine practice include licensing, development of recommendations, identification of funding sources, liability coverage in the event of adverse outcomes, the development of mandates for use, and consideration of parental knowledge and attitudes. New vaccine recommendations offer increased protection against rotavirus, hepatitis A, varicella, pertussis, meningococcus, and human papillomavirus. With increasing complexity and changing recommendations, practitioners should refer to reliable resources for accessing up-to-date information.
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PMID:What is going on with vaccines: keeping up with the childhood immunization schedule. 1798 6

Vaccine-preventable diseases remain a major source of morbidity and mortality in transplant recipients. Since the publication of the American Society of Transplantation's guidelines for vaccination of solid organ transplant recipients in 2004 (1), several new vaccines have been licensed. Transplant clinicians have been inundated by questions from patients and colleagues regarding the utility and safety of these vaccines in transplant candidates and recipients. In addition, new data has appeared regarding utility of some established vaccines, lack of rejection after vaccination and newer adjuvant strategies. Literature published between 2004 and 2007 was reviewed in a Medline search. Guidelines from the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices are reviewed and summarized, with particular attention to vaccines for human papillomavirus, varicella and varicella-zoster, tetanus-reduced diphtheria-acellular pertussis (Tdap) and hepatitis B, as well as conjugated meningococcal and conjugated pneumococcal vaccines. Although randomized controlled trials in transplant recipients have not been performed for most new licensed vaccines, preliminary recommendations can be formulated based on current data and guidelines. Further studies will be important to determine the indications and optimal timing of newer immunizations and immunization strategies.
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PMID:Update on immunizations in solid organ transplant recipients: what clinicians need to know. 1809 71

Infection control has a particularly important role in paediatric hospitals and must take into account the specificity of the needs and environment of the paediatric patient. Children are susceptible to infections that are prevented in older patients by vaccination or previous natural exposure. Consequently, the nosocomial pathogens and most common health-care-associated infection sites in children differ from those observed among adults. The immunological naivety of young children, especially neonates, translates into an enhanced susceptibility to many infections with important health consequences as well as higher rates and longer duration of microorganism shedding. In particular, respiratory virus infections, rotavirus, varicella zoster virus, and pertussis represent persistent challenges in children's hospitals. Specific factors such as the use of breastmilk, toys, or therapy animals are associated with an increased risk for health-care-associated infections. We review the emergence of antimicrobial-resistant organisms and strategies to prevent health-care-associated infections in the paediatric setting.
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PMID:Infection control in paediatrics. 1815 87

Adolescents in the United States now have the opportunity to receive new vaccines that prevent invasive meningococcal infections, pertussis (whooping cough), and cervical cancer. Except for their potential to cause serious illness, these infections could not be more different. Their incidence ranges from extremely low to quite high. Early clinical manifestations of infection range from none to life-threatening illness. Two of the vaccines are similar to those already in use, whereas 1 is completely new. In conjunction with the 4 vaccines previously recommended for adolescents (the tetanus and diphtheria booster, hepatitis B, measles-mumps-rubella, and varicella), the 3 new vaccines (meningococcal, human papillomavirus, and the tetanus-diphtheria-pertussis booster [which replaced the tetanus-diphtheria booster]) bring the number recommended for adolescents to 6. In this article, we describe key characteristics of the 3 new vaccines and infections they were designed to prevent. We also briefly discuss other vaccines recommended for all adolescents who have not already received them and new vaccines that are still under development.
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PMID:New, and some not-so-new, vaccines for adolescents and diseases they prevent. 1817 21


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