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A local general practice was contracted to provide the school-based immunisation program over two years in Mount Isa, Queensland. The schedule was for female Year 10, 11 and 12 students to receive three doses of human papilloma virus (HPV) vaccination (Gardasil). This was provided as part of the broader immunisation program that involved providing Year 8 students with two doses of hepatitis B vaccination and one dose of varicella-zoster, and Year 10 students with one dose of diphtheria-tetanus-pertussis (DTPa). Data were collected on the number of consent forms returned and how many declined vaccination, how many students were vaccinated and those requiring catch-up vaccinations, as well as the total number completing the full course of immunisations. Adverse events were also recorded. The total cohort of girls eligible for HPV vaccination was 304 (consented to vaccination--275 (90%), declined vaccination--13 (4%), coverage for first HPV dose--89%, coverage for second HPV dose--88%, coverage for third HPV dose--79%). When compared with other adolescent vaccinations given concurrently as part of the broader vaccination program, HPV coverage was higher. There were only three significant adverse events. Three girls fainted at the time of immunisation but recovered immediately. The HPV immunisation had a good uptake and was well tolerated. Integrating school immunisation provision with general practice provides continuity with preschool immunisations and provides a convenient location for parents to bring children who have missed out on immunisations or would like to discuss the immunisation program
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PMID:School-based vaccinations delivered by general practice in rural north Queensland: an evaluation of a new human papilloma virus vaccination program. 1852 12

Over the past few years, there have been many changes to the recommendations for children and adolescents by the Advisory Committee on Immunization Practices. These include dividing the immunization schedule into two parts (i.e., ages birth to six years and seven to 18 years, with catch-up schedules for each group); expanding the recommendations for influenza vaccine to children ages six months to 18 years without risk factors; expanding coverage for hepatitis A vaccine to include all children at one year of age; initiating routine immunization with oral rotavirus vaccine given at ages two, four, and six months; and adding a booster dose of varicella vaccine at four to six years of age. The tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap), quadrivalent meningococcal conjugate vaccine (MCV4), and quadrivalent human papillomavirus (HPV) vaccine are routinely recommended for adolescents 11 to 12 years of age. Tdap provides pertussis immunity in addition to the tetanus and diphtheria immunity provided by the tetanus and diphtheria toxoids vaccine (Td). MCV4 has improved immunogenicity compared with the older meningococcal vaccine. HPV vaccine protects against serotypes 6, 11, 16, and 18, and is given in three doses, ideally at 11 to 12 years of age; the effectiveness increases when the vaccine is given before the onset of sexual activity. Family physicians play an integral role in implementing new immunization recommendations and properly educating patients and families in the increasingly complex armamentarium of prevention.
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PMID:Update on immunizations in children and adolescents. 1858 37

Respiratory tract infections are a major reason of antibiotic prescription. Some of these infections can be prevented by vaccination. In France, the main new data concerns the following vaccines: Haemophilus influenzae: besides the vaccine effectiveness H. influenzae b, that is a virulent capsulated strain, a polyvalent vaccine effective against non-capsulated strains, responsible for otitis media, is under development. Pneumococci: the conjugated heptavalent vaccine recommended for all infants in the USA since the year 2000 allowed a dramatic drop in the incidence of invasive infections and of otitis media due to pneumococci, with an indirect impact reducing the frequency of pneumonia in adults. Influenza: the vaccinal coverage remains insufficient in people targeted by recommendations, particularly in health care workers. New recommendations concern some travel agents, people living in close contact with infants at risk and women immediately after delivery of a newborn at risk. Pertussis: the vaccinal coverage of preadolescents is insufficient. Vaccination of adults is mainly recommended for people who are expected to be in close contact with newborns (health care workers, parents). Tuberculosis: BCG vaccination is no longer mandatory, but is now strongly recommended for all infants in the greater Paris area, French Guyana, and for all infants at risk, especially immigrants depending on their native country. Varicella: universal vaccination is not recommended. To prevent respiratory complications in adults, the vaccine is now recommended for all varicella naive teenagers.
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PMID:[Current data on vaccines for respiratory diseases]. 1872 26

The live attenuated tetravalent vaccine against measles, mumps, rubella, and varicella zoster viruses (MMRV) is a combination of the measles, mumps, and rubella (MMR) vaccine and the varicella zoster virus vaccine. The immunogenicity after each dose of a two-dose vaccination course of MMRV vaccine was generally similar to that of two doses of separately administered MMR plus varicella zoster vaccines, or a single dose of separately administered MMR plus varicella zoster vaccines followed by a dose of MMR vaccine, in infants aged 9-24 months. In infants aged 9-24 months administered a two-dose course of MMRV vaccine, geometric mean titers for antibodies against all vaccine antigens increased after the second dose relative to the first dose, with the increase being most pronounced for varicella zoster virus antibodies (10- to 21-fold). MMRV as the second vaccination was immunogenic in children aged 5-6 years who had previously received either MMRV or MMR as the first vaccination at 12-24 months of age. The immunogenicity for measles, mumps, rubella, and varicella zoster viruses, in terms of seropositivity and antibody titers, was not altered when MMRV was coadministered with a booster dose of diphtheria, tetanus, acellular pertussis, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b conjugate vaccine in infants aged 12-23 months. Nor was the immunogenicity of the latter vaccine altered by coadministration. The tolerability profile of MMRV vaccine was comparable to that of separately administered MMR plus varicella zoster vaccines or of MMR vaccine alone. Injection-site redness and fever (rectal temperature > or =38degreesC or axillary temperature > or =37.5degreesC) were the most frequent adverse events in both groups.
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PMID:Live attenuated measles, mumps, rubella, and varicella zoster virus vaccine (Priorix-Tetra). 1875

Three new vaccines have been recommended for adolescents by the Advisory Committee for Immunization Practices (ACIP) since 2005: meningococcal conjugate vaccine (MCV4; 1 dose), tetanus, diphtheria, acellular pertussis vaccine (Tdap; 1 dose), and quadrivalent human papillomavirus vaccine (HPV4; 3 doses). ACIP also recommends that adolescents should receive recommended vaccinations that were missed during childhood. Since 2006, CDC has conducted the National Immunization Survey-Teen (NIS-Teen) to estimate vaccination coverage from a national sample of adolescents aged 13-17 years. This report describes the findings from NIS-Teen 2007, which indicated substantial increases in receipt of new adolescent vaccinations compared with 2006, including Tdap (from 10.8% to 30.4%) and MCV4 (from 11.7% to 32.4%), and increases in coverage with childhood vaccinations, including measles, mumps, and rubella (MMR), hepatitis B (HepB), and varicella (VAR) (among those without disease history). An assessment of HPV4 coverage, which is reported for the first time, showed that 25.1% of adolescent females initiated the vaccine series (>/=1 dose) in 2007. To improve vaccination coverage among adolescents, health-care providers should take advantage of every health-care visit as an opportunity to evaluate vaccination status and administer vaccines when needed.
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PMID:Vaccination coverage among adolescents aged 13-17 years - United States, 2007. 1884 32

Varicella is a highly infectious disease caused by the varicella-zoster virus (VZV). Usually chickenpox is a self-limiting and relatively mild disease of childhood, although it is frequently more severe with significant complications, and less often, is responsible for case fatalities. Varicella disease is more severe and its complications are more frequent and severe amongst high risk groups (neonates, pregnant women and immunocompromised patients). After the initial infection, the VZV remains dormant in dorsal root ganglia and may reactivate with declining cellular immunity to cause herpes zoster, particularly in the elderly and immunocompromised. Varicella vaccine is an effective preventive tool for decreasing the burden attributable to the disease and its complications. The incorporation of VZV vaccination in childhood immunization schedules was restricted until recently. Nowadays, many countries implement it. A few years ago, the Israeli Ministry of Health recommended adding the vaccine to the childhood immunization schedule. This was not enacted because of budgetary constraints. This is due in September this year, together with an additional dose of pertussis vaccine for pupils in 8th grade. During the next few years there are plans for other new vaccines, that are being incorporated in the routine vaccination programs in developed countries, also to be added to the Israeli childhood immunization schedule: the conjugated pneumococcal vaccine, the vaccine against the rotavirus and the HPV vaccine.
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PMID:[Incorporation of varicella-zoster virus vaccination in childhood immunization schedules]. 1893 57

The combination vaccine diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus and Haemophilus b conjugate (tetanus toxoid conjugate) vaccine (DTaP-IPV/Hib), which has been exclusively used in Canada for more than 10 years, is the first DTaP-based vaccine approved in the US that includes both poliovirus and Haemophilus influenzae type b (Hib) antigens. In clinical trials, the combined DTaP-IPV/Hib vaccine induced high immunogenecity against all of the vaccine antigens, including Hib. Administration of the DTaP-IPV/Hib vaccine as a four-dose series in infants provided high levels of seroprotection against diphtheria and tetanus toxoids, poliovirus types 1, 2, and 3, and Hib polyribosyl-ribitol-phosphate capsular polysaccharide conjugated to tetanus toxoid (PRP-T). Immune responses produced after doses 3 and 4 of DTaP-IPV/Hib vaccine were noninferior to those seen with separately administered DTaP, inactivated poliovirus, and Hib vaccines, apart from those against PRP-T in one study. Seroconversion rates for the five pertussis components in DTaP-IPV/Hib vaccine were noninferior to those seen in infants receiving the separately administered vaccines. A serology bridging study showed the noninferiority of four doses of DTaP-IPV/Hib vaccine to three doses of a DTaP vaccine in terms of seroconversion rates for filamentous hemagglutinin and fimbriae 2 and 3, but not pertactin. There were no clinically relevant changes in the immunogenicity of DTaP-IPV/Hib when coadministered with pneumococcal-7-valent-CRM197 vaccine or measles, mumps, and rubella vaccine and varicella zoster vaccine at 15 months. The tolerability profile of DTaP-IPV/Hib vaccine was generally similar to that of separately administered DTaP, IPV, and Hib vaccines.
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PMID:DTaP-IPV/Hib vaccine (Pentacel). 1899 51

Many vaccine-preventable diseases have serious consequences for the pregnant mother, the fetus, and the neonate. This article reviews the rationale and impact of including vaccinations as part of preconception care and provides recommendations for clinical care. Vaccinations that are recommended highly in preconception care include the hepatitis B and the measles, mumps, and rubella vaccines. The role of human papillomavirus, varicella, diphtheria, tetanus, and pertussis vaccinations as part of preconception care is also discussed.
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PMID:The clinical content of preconception care: immunizations as part of preconception care. 1908 23

Evidence-based guidelines for immunization of infants, children, adolescents, and adults have been prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). These updated guidelines replace the previous immunization guidelines published in 2002. These guidelines are prepared for health care professionals who care for either immunocompetent or immunocompromised people of all ages. Since 2002, the capacity to prevent more infectious diseases has increased markedly for several reasons: new vaccines have been licensed (human papillomavirus vaccine; live, attenuated influenza vaccine; meningococcal conjugate vaccine; rotavirus vaccine; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap] vaccine; and zoster vaccine), new combination vaccines have become available (measles, mumps, rubella and varicella vaccine; tetanus, diphtheria, and pertussis and inactivated polio vaccine; and tetanus, diphtheria, and pertussis and inactivated polio/Haemophilus influenzae type b vaccine), hepatitis A vaccines are now recommended universally for young children, influenza vaccines are recommended annually for all children aged 6 months through 18 years and for adults aged > or = 50 years, and a second dose of varicella vaccine has been added to the routine childhood and adolescent immunization schedule. Many of these changes have resulted in expansion of the adolescent and adult immunization schedules. In addition, increased emphasis has been placed on removing barriers to immunization, eliminating racial/ethnic disparities, addressing vaccine safety issues, financing recommended vaccines, and immunizing specific groups, including health care providers, immunocompromised people, pregnant women, international travelers, and internationally adopted children. This document includes 46 standards that, if followed, should lead to optimal disease prevention through vaccination in multiple population groups while maintaining high levels of safety.
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PMID:Immunization programs for infants, children, adolescents, and adults: clinical practice guidelines by the Infectious Diseases Society of America. 1965 33

Measuring progress toward national immunization objectives at the local level, although difficult, is becoming more feasible owing to statewide immunization information systems. This article describes how a state immunization program expanded the scope of immunization service contracts with local health departments (LHDs) to address the immunization rates among children living within their jurisdictions using the Wisconsin Immunization Registry (WIR) to measure achievement of population-based objectives. By contract year (CY) 2008, 99 percent of Wisconsin LHDs selected population-based contract objectives. In late 2008, the Wisconsin Immunization Program assessed all children at 24 months of age for completeness of the 4:3:1:3:3:1 (diphtheria, tetanus, pertussis/poliovirus/measles-containing vaccine/Haemophilus influenzae type b/hepatitis B/varicella) series by county for each of four CYs, using the WIR. From CY 2005 to CY 2008, LHDs in 61 (86%) of the 71 counties demonstrated increased series completeness rates for the series, and the overall statewide series completeness increased from 58 percent to 64 percent. However, the increases we observed cannot be attributed solely to LHDs' acceptance of population-based objectives because controlling for other factors known to influence immunization coverage levels was outside the scope of this case study. We found the WIR to be a powerful tool that can measure immunization coverage among local populations independent of the immunization provider, assess improvement toward contract objectives, and target resources toward pockets of need.
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PMID:The use of an immunization information system to establish baseline childhood immunization rates and measure contract objectives. 1970 3


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