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Query: UMLS:C0043167 (pertussis)
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The economic analysis reported below, based on hypothetical estimates of the programme impact, indicates that an expanded programme of immunization for diphtheria, pertussis, tetanus, and tuberculosis can be expected to be highly cost-effective in comparison with treatment. Sensitivity tests illustrate that this conclusion remains valid even when costs are increased by 20% and benefits reduced by 50%. A separate analysis was made of the DPT-tetanus toxoid and BCG components of the programme. The analysis revealed that although the BCG programme may not be justifiable when operated independently, its inclusion in a joint immunization programme is strongly justifiable on economic grounds (assuming a vaccine efficacy of 0.5). This result confirms one of the basic arguments advanced for the WHO programmes of expanded immunization and illustrates that other immunizations, such as for poliomyelitis and measles, which may not be cost-efficient by themselves may be economically justifiable when included as part of a larger immunization programme.
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PMID:Cost-effectiveness of an immunization programme in Indonisia. 677 26

This review discusses the indications for the routine immunizations covered by the Swiss "Immunization Schedule 1981" (diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, BCG), as well as the indications for special immunizations (hepatitis B, influenza, pneumococci, rabies, tickencephalitis) and for the immunisations for travellers (cholera, yellow fever, meningococci, typhoid fever). Vaccination against measles, mumps and rubella should be given to girls and boys at the age of 18 (to 24) months as a combined injection. In view of the low prevalence of tuberculosis BCG vaccination is justifiable only at school leaving age, if at all. The indications for influenza and pneumococcal vaccines are still limited, the value of a general vaccination of all over 65 year old individuals is not proven for either vaccine. A nationwide vaccination campaign against hepatitis B was started early this year with a newly licensed vaccine for all population groups at risk. Only HDC-vaccines should be used for immunisation against rabies. The newly licensed, highly protective oral attenuated live typhoid vaccine will probably replace the parenteral typhoid vaccine.
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PMID:[Vaccination: 1982 status]. 713 94

Adverse Events Following Immunization (AEFI) are disadvantageous side effects of preventive vaccination. In 1993 we found 17 cases of AEFI out of 1440 children between 0 and 2 years of age who had received BCG, diphtheria-tetanus-pertussis, measles or poliomyelitis vaccine. They were classified as reactions in 14 children (0.9%) or complications in 3 children (0.2%). Twelve adverse reactions followed DTP vaccination (0.8%), two followed BCG vaccination (0.14%), another two measles vaccination (0.14%) and one followed poliomyelitis vaccination (0.07%). Both generalized and local symptoms were present and they regressed with no further complications. Two children who had received BCG were noted to have a deeply placed abscess at the injection site remaining scar as well as axillary, submandibular and cervical lymph nodes enlargement within 6 months. In a 3 months old child, after the first injection of DTP vaccine, convulsions and consciousness disorder occurred. Transfontanel ultrasonography revealed intraventricular haemorrhage. After one year of intensive neurological care child's health state was improved. In spite of using still more and more safe vaccines none of them is the ideal one--the one with no adverse events following vaccination. Vaccination technics, distribution and storage of vaccines are to be improved which may result in decrease number of AEFI.
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PMID:[Adverse events following immunization: AEFI in 17 children between 0 and 2 years of age]. 759 91

During mid-1988 in Zambia, a baseline survey of 388 households in Choma District in the Southern Province was conducted to collect data on immunization coverage among children 12-23 years old, diarrhea morbidity among children younger than 5, use of oral rehydration among these children, and nutritional status among children 24-59 months old. 75% of children were completely immunized against BCG, polio, diphtheria-pertussis-tetanus, and measles and had an immunization card compared to 36% for rural Zambia in 1986. Immunization coverage ranged from 79% for measles to 95% for BCG. The rural health centers (RHCs) reported 38 patients with measles, suggesting either that some children did not fully benefit from the immunization program or problems existed with the cold chain. Fluctuation in the DPT and polio vaccine supply resulted in a dropout rate of 12% between 1st and 3rd dose and 9% between 1st and 2nd dose, respectively, compared to 38% and 31%, respectively, for rural Zambia (1986). 22% of children had had a recent episode of diarrhea. The 2-week diarrhea incidence rate was 0.16 (assuming the diarrhea episode lasted 6 days). The annual diarrhea incidence rate stood at 4.8 episodes/child. 52% of children who had had a diarrheal episode used oral rehydration solution obtained from an RHC or a community health worker. 15% ingested home-made sugar/salt solution. 81% of mothers would first take their child with diarrhea to an RHC. Only 10% of households had access to potable water from a borehole. Leading water sources were shallow water holes (32%), dug wells (25%), and rivers (16%). The water supply evaporated during the dry season for 50% of households. Dumping feces in the bush (67%) and use of a pit latrine (30%) were the main methods of feces disposal. After the harvest, 38% of children 12-23 months old and 74% of those 24-59 months old were well-nourished. A health education program on safe water supplies and better sanitation and an intersectoral agriculture and health program are needed to control diarrhea and to fight malnutrition, respectively.
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PMID:A primary health care baseline survey in a rural district in Zambia. 762 3

During 1987-1988 and 1990-1992, the Center for International Health Information investigated all available data on infant mortality, vaccination coverage, and oral rehydration solution (ORS) use in Guatemala from various sources. It found 16 different sources for infant mortality; 13 sources for BCG vaccination, 14 sources for DPT (diphtheria, pertussis, tetanus), polio, and measles coverage; eight sources for tetanus toxoid coverage; and eight sources for ORS use. Infant mortality tended to decrease steadily during the 1980s. All vaccination coverages and ORS use stayed rather low (no greater than 50%) during the 1980s. DPT 3, polio 3, and measles coverages were more or less the same during the first half of the 1980s and then fluctuated during the last half of the decade. They were all higher at the end of the decade than at the beginning, but BCG coverage in 1989 was higher according to WHO but lower according to USAID. All sources showed steady rising trends for tetanus toxoid coverage and ORS use. 1985 data generated 10 different infant mortality estimates with the difference between the highest and lowest estimates being 23.8 deaths (56-79.8/1000 live births). BCG coverage ranged from 30% to 60.5%. DPT 3 coverage ranged from 3.5% to 34.2%. Polio 3 coverage ranged from 3.5% to 33.5%. Measles vaccine coverage ranged from 11% to 58.2%. Tetanus toxoid coverage ranged from 1% to 8.2%. ORS use ranged from 3.5% to 7.2% in 1985, from 8.7% to 17% in 1987, and 38.3% to 69.5% in 1989. Guatemalan Ministry of Health estimates for 1984 infant mortality varied from 52.4 to 79.9. UNICEF estimates for 1985 infant mortality ranged from 65 to 79.8. USAID 1987 infant mortality estimates ranged from 59 to 72. Different definitions, data sources, estimation methods, and reporting methods contributed to the differences in estimates. These problems influenced the reliability of current data. Policy makers need to consider these problems when making decisions based on one or a few estimates of child survival indicators.
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PMID:Variations in estimates of Guatemalan infant mortality, vaccination coverage, and ORS use reported by different sources. 775 21

In Bangladesh an evaluation of the Expanded Programme on Immunization (EPI) was conducted in February 1993. Data, including immunization coverage based on random surveys, were collected from all 4 divisions, 8 rural districts, 25 sub-districts (thanas) and from the cities of Dhaka and Chittagong. The Review Team assessed and made several recommendations concerning immunization coverage, surveillance for the EPI target diseases, immunization in urban areas, the cold chain and logistics, training, communication and social mobilization, other primary health care (PHC) interventions, vaccine supply, and the sustainability of EPI achievements. The population of Bangladesh is 110 million, with an estimated 3.6 million newborns during 1993. More than 90% of the 108,000 routine monthly immunization services are being conducted as scheduled. Nationally, among children 0-11 months of age, BCG coverage is 89%, as measured by evaluation surveys, coverage with 3 doses of diphtheria/pertussis/tetanus (DPT3) and oral polio vaccine (OPV3) is 63%, and measles coverage is 59%. Coverage with a second dose of tetanus toxoid (TT2) for pregnant women is 80%. In urban areas, BCG coverage for infants is 92%, DPT3/OPV3 76%, measles 68%, and TT2 for pregnant women 82%. In 2/3 of the sites visited, immunization was combined with vitamin A supplementation, oral rehydration treatment, or family planning. The coverage for both BCG and DPT3/OPV3 increased from only 2% in 1985 to almost 90% of infants having BCG immunization services in 1992. Yet only 50% of children are reached before their first birthday, and at least 20% of newborns are not protected against neonatal tetanus at birth. DPT1 and DPT3 drop-out is 29% nationally and 17% in urban areas. In 1992, an estimated 117,000 cases of neonatal tetanus and 6700 cases of poliomyelitis were prevented by immunization. Surveys of neonatal tetanus in selected districts have confirmed a reduction in incidence from 40/1000 live births in 1986 to 10/1000 in 1991.
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PMID:Expanded programme on immunization. Programme review. 800 3

The potency tests for bacterial vaccines are quite diverse. For some products (pertussis, cholera, anthrax, typhoid and BCG vaccines) these are specified as Additional Standards in the Code of Federal Regulations. For other products (tetanus and diphtheria toxoids, plague vaccine) the testing is done according to so-called Minimum Requirements, which have less regulatory authority than Additional Standards. Still other products (e.g., polysaccharide conjugate vaccines, acellular pertussis vaccine, live oral typhoid) are tested according to individualized criteria that are contained in their specific Product License Applications. For some products there is inadequate knowledge of the pathogenic mechanisms and/or protective factors to design valid in vitro potency tests. In these cases, animal testing with subsequent serologic evaluation or challenge testing is often necessary. Examples would include vaccines such as cholera and plague vaccines. The FDA supports the elimination of animal testing when suitable alternatives are available. Thus, many of the potency tests, especially for newer products, rely on in vitro characterization. For example, the immunogenicity of conventional polysaccharide vaccines is largely proportional to their molecular weight. Potency testing therefore relies heavily on physical characterization in terms of composition, molecular weight, and quantity.
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PMID:Potency testing of bacterial vaccines for human use. 811 90

UNICEF decided to achieve the 1977 World Health Organization objective Health For All By The Year 2000 through primary health care, utilizing growth monitoring, oral rehydration therapy, breast-feeding, immunization, family planning, and education of women. Since the 1960s BCG (bacillus Calmette-Guerin) vaccination, DPT (diphtheria, pertussis, tetanus) and OPV (oral polio vaccine) have been available in Sri Lanka. The expanded program of immunization has almost eliminated diphtheria, pertussis, neonatal tetanus, and poliomyelitis. Tuberculous meningitis, bone and joint tuberculosis, measles, and miliary tuberculosis have become very rare. Among other vaccine-preventable diseases, mumps is the commonest cause of aseptic meningitis and viral encephalitis in children. Maternal rubella in the first trimester causes abortion or gross teratogenic effects including congenital heart disease. Safe vaccines may be used to prevent mumps and rubella. In recent years there has been a resurgence of measles in North America among school children, and presently a 2nd dose of vaccine is recommended for children. Japanese B encephalitis has a mortality rate of over 30% and half the survivors have residual brain damage. The Ministry of Health has immunized susceptible children in some of the prevalent areas. This vaccine also gives partial protection against dengue hemorrhagic fever. In Hong Kong, Singapore, and Taiwan hepatitis B vaccine is part of the national immunization schedule because of the common occurrence of primary hepatoma of the liver. At present this vaccine is recommended for health workers in Sri Lanka. Meningococcal meningitis occurs in some Middle East countries such as Saudi Arabia, thus Haj pilgrims are advised to be vaccinated against it before the pilgrimage. In Sri Lanka beta-thalassemia major is prevalent, and as most of these patients are subjected to splenectomy, pneumococcal vaccine should be given to them. Currently research work is being carried out for development of vaccines against rotavirus, streptococcal, and hepatitis A infection.
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PMID:Improving child survival through immunisation. 814 30

A nationwide survey was carried-out aiming at determination of immunization coverage level against the six killer diseases of childhood (tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, and measles). Variations between geographical zones, urban-rural settings, age, education and mother's employment, father's education, and child's birth order were studied. The standard WHO cluster technique was used. The sample (1102 children) was restricted to Saudi children 1-2 years old. Interviewers were exposed to training and methods of calibration, and involved in a pilot survey. Nationally, the survey showed very high coverage levels, BCG was the highest (99 per cent), measles was the lowest (90 per cent), whereas the three doses of DPT (diphtheria, pertussis and tetanus) and TOPV (trivalent oral polio vaccine) were in between (98, 96 and 94 per cent, respectively). There was no marked differences between urban-rural settings. The western zone showed the lowest coverage by all vaccines. The national coverage by the six vaccines reached 86 per cent correctly immunized (according to WHO standards), 14 per cent partially immunized and 1 per cent non-immunized. Immunization coverage was higher for children to younger mothers. The non-immunized group belonged exclusively to illiterate mothers (1 per cent). Children to mothers with basic education showed the highest coverage (88 per cent). Birth order had negative effect on coverage. Nationally, 88 per cent of children had immunization certificate while 12 per cent had not. The eastern and central zones had the highest percentages of children with certificates (92 and 91 per cent, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:National Immunization Coverage Survey Saudi Arabia, 1991. 856 52

During March-April 1993, in Madhya Pradesh, India, a team of trained medical staff conducted a door-to-door survey in five villages in the rural block of Sanwer near Indore, where Integrated Child Development Services (ICDS) provide nutrition and immunization services to children aged 1-6 (709 children) and five other villages in which ICDS does not operate (500 children). The survey was conducted to evaluate whether or not the community adequately used the nutrition and immunization services. Children in the ICDS group were just as likely to be malnourished as those in the control group (grade I, 74.3% vs. 72.4%; grade II, 18.1% vs. 20.8%; grade III, 7.05% vs. 6.8%). For children aged 1-2, BCG vaccination status was 80.2% for the ICDS group and 88.8% for the control group. The control group was significantly more likely than the ICDS group to have received three doses of the diphtheria-pertussis-tetanus vaccine, three doses of the oral polio vaccine, and the measles vaccines (94.4% vs. 79.5%, p .005; 95.4% vs. 88%, p = .05; and 62% vs. 45.8%, p .005, respectively). These findings indicate that, three years after implementation of ICDS in Sanwer block, nutritional and immunization status has not improved. Possible reasons include insufficient knowledge, lack of aptitude, and limited devotion of health and ICDS workers.
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PMID:Utilization of ICDS scheme in children one to six years of age in a rural block of central India. 861 34


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