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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

In the national immunization program, all Finnish children are vaccinated against 9 infectious diseases: diphtheria, tetanus, pertussis, polio, severe infections due to Haemophilus influenzae type b, measles, mumps, rubella and influenza. In addition, vaccination against tuberculosis, hepatitis A- and B-, influenza or tick-borne encephalitis are given to those at risk of contracting the diseases. More than 95% of children are vaccinated according the optimal schedule. Vaccine preventable diseases are rare in Finland. In Finland, all vaccines are imported. The decisions regarding the vaccination program are made by the Ministry of Social Affairs and Health. The National Public Health Institute is responsible for the control of the communicable diseases and the implementation of the vaccination program in practice. Evaluation of the implementation of new vaccines in the vaccination program is ongoing.
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PMID:National immunization program in Finland. 1827 4

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

This, the second report on vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, brings together the relevant sources of routinely collected data on vaccine preventable diseases--notifications, hospitalisations, deaths, and childhood and adult vaccination coverage. As a result of continued improvements in the collection of data on Indigenous status, this second report is considerably more comprehensive, with data available from more jurisdictions, and more detailed presentation, including time trends and vaccination coverage by jurisdiction. Vaccination coverage data provide evidence of successful program delivery and highlight some areas for improvement. For universally funded vaccines in children, coverage is similar in Indigenous and non-Indigenous children by 24 months of age. However, delayed vaccination is more common in Indigenous children, with 6%-8% fewer children fully vaccinated at 12 months of age. More timely vaccination, particularly within the first six months of life, is particularly important in reducing the disproportionate burdens of disease due to pertussis and Haemophilus influenzae type b (Hib). For vaccination programs targeted specifically at Aboriginal and Torres Strait Islander children and adults, coverage is substantially lower than for those programs targeted at all Australians. This is true for hepatitis A and polysaccharide pneumococcal vaccine for children, and influenza and polysaccharide pneumococcal vaccine for adults. Targeted vaccination programs present a particular challenge for health services in urban areas. Nevertheless, the impact of vaccination programs in preventing disease and reducing the disparity of disease burden between Aboriginal and Torres Strait Islander and non-Indigenous people has been substantial. This is evident in data on notifications, hospitalisations and deaths. Diseases which, in the past, have had devastating and often disproportionately high impact on Indigenous people, such as diphtheria, measles, poliomyelitis, smallpox and tetanus, are now completely or almost completely absent from Australia. Hepatitis B infection, another disease responsible for high levels of infection and substantial serious illness and death in the pre-vaccine era, is also now well controlled in age groups eligible for vaccination. Although invasive Hib disease is now rare in Australia since the introduction of vaccination in 1993, higher rates of disease persist in Aboriginal and Torres Strait Islander children. More research is needed into the contribution of environmental factors, delayed vaccination and vaccine failure to this continued disparity. Hepatitis A has disproportionately affected Aboriginal and Torres Strait Islander children in the past. Vaccination programs in north Queensland and in various other countries have been very successful in reducing the burden of hepatitis A. It is too early to assess the impact of the vaccination program for Aboriginal and Torres Strait Islander children that commenced in regions outside north Queensland in November 2005. For some other diseases the situation is more complicated. The substantial impact of the national meningococcal C vaccination program since 2003 is evident in this report, although the higher proportion of non-vaccine preventable serotype B disease in Aboriginal and Torres Strait Islander people underlines the need for a new vaccine to cover this serotype. Pneumonia remains the most important communicable disease contributor to premature mortality in Aboriginal and Torres Strait Islander people of all ages. In young Indigenous adults, the eightfold higher rate of hospitalisation compared with their non-Indigenous peers, and the 11-fold higher rate of invasive pneumococcal disease, suggest the need for more widespread use of influenza and pneumococcal vaccines in this age group. Current coverage for Indigenous 15-49 year olds, where influenza and pneumococcal vaccines are funded only for those with risk factors, is low even though some 70% of this age group have one or more risk factors. Overall, the data presented in this report provide powerful evidence for the impact of vaccines in reducing disease in Aboriginal and Torres Strait Islander people, and also point to areas for further improvement. Immunisation programs are an example of how preventive health programs in general can be enhanced to close the gap in morbidity and mortality between Indigenous and non-Indigenous Australians.
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PMID:Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2003 to 2006. 1871 98

Immunogenicity and reactogenicity of DTPa and reduced antigen dTpa booster vaccines were compared to a hepatitis A control vaccine in DTPa-primed toddlers aged 18 - 20 months. Post-booster, all DTPa and dTpa recipients were seroprotected against diphtheria and tetanus, and > or = 93.3% had a booster response to pertussis. There were similar reactogenicity rates in the DTPa and dTpa vaccine recipients. Few Grade 3 symptoms were reported. Just over one in four children in the control group had diphtheria antibody at or potentially below the correlate of protection benchmark (0.016IU/ml). Larger studies should evaluate potential benefits of reduced antigen vaccines and seroprotection in children who do not receive a booster dose of DTPa at this age, including protection against diphtheria until subsequent booster doses are given.
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PMID:Booster vaccination of toddlers with reduced antigen content diphtheria -- tetanus -- acellular pertussis vaccine. 1936 81

Adverse events following immunization (AEFI) are not uncommon, with injection site reactions (ISRs) being the most common. Predictors of injection site reactions are vaccine factors (antigen characteristics, antigen dose, dose number of antigen, antigen adjuvanting and type of diluent), vaccine administration factors (site and route of administration) and vaccinee factors (age and sex, the latter the subject of this review). 1,074 studies which reported ISRs were retrieved by searching of on line journals and databases. Analysis of these data for sex-difference was only reported in 57 studies, with 54 of these studies reporting a sex-difference (42 in subjects >17 years and 12 in subjects <17 years). In accord with the well documented greater pain sensitivity in females compared with males, in all studies with vaccines which reported pain during and post vaccination [hepatitis A, B, diphtheria/tetanus toxoid, diphtheria/tetanus/pertussis(DTaP and Tdap), anthrax and inactivated influenza], females reported a greater rate of pain than males. The pathophysiology of the sex-difference in local reactions (induration, tenderness, erythema, pruritus) following vaccination is clearly multifactorial with hypersensitivity reaction (type III, Arthus reaction-antigen/antibody immune complex formation), route of administration and hormonal factors being suggested. The data presented in this review demonstrate that studies of AEFI should recruit similar numbers of females and males and that these data should be analyzed for sex-difference. Additionally, unlike as at present, reporting of analysis of AEFI data by sex should become standard practice.
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PMID:Sex differences in injection site reactions with human vaccines. 1937 79

American Indian and Alaska Native (AI/AN) people have suffered disproportionately from infectious diseases compared with the general US population. As recently as 25 years ago, rates of hepatitis A and B virus, Haemophilus influenzae type b, and Streptococcus pneumoniae infections were as much as 10 times higher among AI/AN children compared with the general US child population. In the past quarter century, routine use of childhood immunizations for hepatitis A and B viruses has eliminated disease disparities for these pathogens in AI/AN children, and significant decreases have been demonstrated for H influenzae type b, S pneumoniae, and pertussis. Nevertheless, certain infectious diseases continue to occur at higher rates in AI/AN children. The reason for continued disparities is most likely related to adverse living conditions such as household crowding, lack of indoor plumbing, poverty, and poor indoor air quality. Although tremendous strides have been made in eliminating disparities in infectious disease among AI/AN children, further gains will require addressing disparities in adverse living conditions.
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PMID:Impact of immunizations on the disease burden of American Indian and Alaska native children. 1941 99

This study identified the type and number of doses of vaccine purchased, distributed, and administered in community pharmacies. Telephone interviews were conducted with 1704 community pharmacies in 17 states (response rate=69.1%). The 17-state population-level projections reveal that about 10% of hepatitis A, hepatitis B, meningococcal, MMR, and tetanus-containing vaccines for adults were administered in pharmacies and 90% were distributed to other sources for administration during July 2004-June 2005. Further, 24.1% of diphtheria-tetanus-pertussis for children (DTaP), 30.4% of influenza, 36.2% of pneumococcal polysaccharide, and 68.1% of travel vaccines in pharmacy inventory were administered in pharmacies, while the rest of vaccine doses were distributed to other immunizers.
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PMID:Community pharmacy involvement in vaccine distribution and administration. 1942 95

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

The National Immunization Survey (NIS) estimates vaccination coverage among children aged 19-35 months for 50 states and selected local areas. Healthy People 2010 established vaccination coverage targets of 90% for individual vaccines in the 4:3:1:3:3:1 vaccine series and 80% for the series. This report describes the 2008 NIS coverage estimates for this series and individual vaccines, 7-valent pneumococcal conjugate vaccine (PCV7), >or=2 doses of hepatitis A vaccine (HepA), and hepatitis B vaccination received in the first 3 days of life (HepB birth dose) among children born during January 2005-June 2007. In 2008, 4:3:1:3:3:1 series coverage was 76.1%, compared with 77.4% in 2007; >or=90% coverage was maintained for all recommended series vaccines, except >or=4 doses of diphtheria, tetanus, and acellular pertussis (DTaP) vaccine. Coverage with >or=3 doses of Haemophilus influenzae type b vaccine (Hib) decreased from 2007, likely because of the shortage of Hib vaccine and the recommendation to defer the routine Hib vaccine booster dose administered at age 12-15 months. Substantial variability was observed in individual and series vaccination coverage among states/local areas. Among racial/ethnic groups, coverage varied little and, after adjusting for poverty, coverage estimates were not significantly lower for any groups compared with whites. However, children living below poverty had lower coverage than children living at or above poverty for most vaccines. Sustaining high coverage levels and using effective methods of reducing disparities across states/local areas and income groups remains a priority to fully protect children and limit the incidence of vaccine-preventable diseases.
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PMID:National, state, and local area vaccination coverage among children aged 19-35 months - United States, 2008. 1971 81


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