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Under the National Childhood Vaccine Injury Act (42 U.S.C. section 300aa-26), CDC must develop vaccine information materials that health care providers are required to give to patients/parents prior to administration of specific vaccines. CDC seeks written comment on proposed new vaccine information materials for hepatitis B, Haemophilus influenzae type b, and Varicella vaccines, and revised vaccine information materials for measles, mumps, rubella (MMR) vaccines.
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PMID:Proposed vaccine information materials for hepatitis B, Haemophilus influenzae type b (Hib), Varicella (chickenpox), and measles, mumps, rubella (MMR) vaccines--CDC. Notice with comment period. 1018 7

In contrast to the 1980s, immunization rates increased dramatically in the United States in the mid-1990s. Three-quarters of all 2-year-olds had received all recommended immunizations in 1997 as compared to just over one-half in 1992. Immunization rates for individual vaccines have reached 90 percent for three of the vaccines--measles, mumps, rubella; pollo; and Haemophilus influenzae type b (Hib). The vaccine for diphtheria, tetanus and pertussis, however, and the newer vaccine for hepatitis B have not yet reached 90 percent of 2-year-olds. The rising immunization levels in young children have resulted in declining incidence of almost all of the vaccine-preventable illnesses. Cases of measles and Hib have declined 95 percent and the incidence of rubella and congenital rubella, hepatitis B and mumps has also declined. Pertussis (whooping cough), however, continued its pattern of periodic increases and decreases. This lack of improvement is probably due to a combination of lower immunization levels for pertussis and waning immunity in previously immunized adolescents and young adults. Federal efforts such as the President's Childhood Immunization Initiative along with its Vaccines for Children program have been credited for a great deal of this improvement. These programs increased public awareness of the need for and access to immunizations, better tracking of immunizations and vaccine-preventable illnesses and have also removed cost barriers to receipt of such protection. At the same time, new vaccines (against chickenpox and rotavirus) and safer versions of older vaccines (pertussis) have been brought into widespread use. Children can now be vaccinated against increasing varieties of childhood diseases. While progress in immunization has been good, areas in need of improvement remain. Pertussis continues to be a problem both in terms of incidence and immunization levels. Also, immunization levels differ significantly by poverty level and race and ethnicity. Black, Hisparic, American Indian and Asian children are less likely to be fully immunized than non-Hispanic white children and poor children are less likely to be fully immunized than nonpoor children.
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PMID:Immunization and vaccine-preventable illness, United States, 1992 to 1997. 1032 22

Eradication is the permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed. To date, the only infectious disease that has been eradicated is smallpox. Poliomyelitis is targeted for eradication by the year 2000, and the eradication initiative is well under way, with the Western Hemisphere certified as being polio-free and more than one year having passed since polio cases occurred in the Western Pacific Region of the World Health Organization. A review of the technical feasibility of eradicating other diseases preventable by vaccines currently licensed for civilian use in the United States indicates that measles, hepatitis B, mumps, rubella, and possibly disease caused by Haemophilus influenzae type b are potential candidates. From a practical point of view, measles seems most likely to be the next target. Global capacity to undertake eradication is limited, and care must be taken to ensure that a potential measles eradication effort does not impede achievement of polio eradication. Even in the absence of eradication, major improvements in control are both feasible and necessary with existing vaccines. New and improved vaccines may give further possibilities of eradication in the future. Eradication represents the ultimate in sustainability and social justice.
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PMID:Eradication of vaccine-preventable diseases. 1035 57

Taking into account the global status of polio, it seems evident that the continuing use of oral poliovaccine in all countries is the most obvious and prudent public health policy for the foreseeable future. Possible exceptions might include those countries which are not troubled by the added cost of the inactivated vaccine; whose health services are able to guarantee high levels of vaccine coverage; and which can expect to experience comparatively few importations of wild poliovirus. An important question is whether it is warranted at this time to recommend a combined schedule of inactivated vaccine followed by live vaccine. This implies the addition of at least two inoculations of inactivated vaccine to an already complex vaccination schedule. In most countries, this now includes the administration of three inoculations each of DTP and Haemophilus influenzae as well as one of measles-mumps-rubella vaccine by approximately 12 months of age. Some countries also routinely vaccinate young children against hepatitis B (three additional inoculations). Because most physicians and clinics, as a policy, do not give more than two inoculations at one visit, it implies the need for scheduling additional well-child visits. In the United States, this is a principal factor in the greatly increased estimated costs of such a programme. Experience also shows that as the number of routine visits which are required for vaccination increases, overall vaccination coverage diminishes. The schedule recommended in the United States possesses yet a further problem. Children there would not receive the second dose of oral vaccine until five years of age, thus permitting the accumulation of a large number of preschool children with limited intestinal immunity-a potentially explosive problem were wild virus to be introduced. The inactivated polio vaccine is useful and certainly indicated for the small numbers of persons for whom the live, oral vaccine is contraindicated. However, to use it routinely implies accepting the potential of substantial penalties while reducing but not eliminating, an already extremely small risk of vaccine-associated paralytic illness. From the public health perspective, I therefore argue against the proposition. Copyright 1997 John Wiley & Sons, Ltd.
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PMID:Developed countries should not use inactivated polio vaccine for the prevention of poliomyelitis. 1039 73

Previous studies have suggested that infant vaccinations may reduce the risk of subsequent childhood leukaemia. Vaccination histories were compared in 439 children (ages 0-14) diagnosed with acute lymphoblastic leukaemia (ALL) in nine Midwestern and Mid-Atlantic states (USA) between 1 January 1989 and 30 June 1993 and 439 controls selected by random-digit dialing and individually matched to cases on age, race and telephone exchange. Among matched pairs, similar proportions of cases and controls had received at least one dose of oral poliovirus (98%), diphtheria-tetanus-pertussis (97%), and measles-mumps-rubella (90%) vaccines. Only 47% of cases and 53% of controls had received any Haemophilus influenzae type b (Hib) vaccine (relative risk (RR) = 0.73; 95% confidence interval (CI) 0.50-1.06). Although similar proportions of cases (12%) and controls (11%) received the polysaccharide Hib vaccine (RR = 1.13; 95% CI 0.64-1.98), more controls (41%) than cases (35%) received the conjugate Hib vaccine (RR = 0.57; 95% CI 0.36-0.89). Although we found no relationship between most infant vaccinations and subsequent risk of childhood ALL, our findings suggest that infants receiving the conjugate Hib vaccine may be at reduced risk of subsequent childhood acute lymphoblastic leukemia. Further studies are needed to confirm this association and, if confirmed, to elucidate the underlying mechanism.
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PMID:Infant vaccinations and risk of childhood acute lymphoblastic leukaemia in the USA. 1048 30

Under the National Childhood Vaccine Injury Act (42 U.S.C. 300aa-26), the CDC must develop vaccine information materials that all health care providers, whether public or private, are required to distribute to patients/parents prior to administration of each dose of specific vaccines. On September 3, 1998, CDC published a notice in the Federal Register (63 FR 47026) seeking public comment on proposed vaccine information materials for the newly covered vaccines hepatitis B, Haemophilus influenzae type b, and varicella vaccines, and also seeking comment on proposed revised vaccine information materials for measles, mumps, rubella (MMR) vaccines. The 60 day comment period ended on November 2, 1998. Following review of the comments submitted and consultation as required under the law, CDC has finalized these vaccine information materials. The final materials are contained in this notice.
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PMID:New vaccine information materials for hepatitis B, Haemophilus influenzae type b (Hib), and varicella (chickenpox) vaccines, and revised vaccine information materials for measles, mumps, rubella (MMR) vaccines. Centers for Disease Control and Prevention (CDC), Department of Health and Human Services. Notice. 1055 92

Poland has a long history of prophylactic vaccination against infectious diseases. Hepatitis B vaccination was introduced in Poland between 1989 and 1996 as part of the Expanded Programme on Immunization (EPI). All newborns and those at high risk of hepatitis B virus (HBV) infection currently receive hepatitis B vaccine free of charge. For many years Poland has reached or exceeded the indicators required by the World Health Organization for vaccination programmes, and about 10% of the population has now been vaccinated against hepatitis B. The incidence of hepatitis B has decreased from about 40 per 100,000 in the early 1990s to 12.7 per 100,000 in 1997. It is hoped to modify the EPI in the future to improve vaccination against mumps, rubella and poliomyelitis. The possible benefit of vaccination against Haemophilus influenzae type b is currently being evaluated. Financial constraints, however, mean that not all of the approved vaccinations can be implemented. The EPI is supported by recommended vaccinations in certain groups, who pay for the vaccines. For hepatitis B, these include children, teenagers, those between 20 and 40 years of age, and those at high risk because of lifestyle or occupation.
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PMID:The expanded programme on immunization calendar in Poland. 1068 44

Vast changes are taking place in vaccinology consequent to the introduction of new technologies. Amongst the vaccines included in the Expanded Programme of Immunization (EPI), the pertussis vaccine has been replaced by acellular purified fractions devoid of side-effects. Non-pathogenic but immunogenic mutants of tetanus and diptheria toxins are likely to replace the toxoids. An effective vaccine against hepatitis B prepared by recombinant technology is in large-scale use. Conjugated vaccines against Haemophilus influenzae b, S. pneumococcus and meningococcus are now available, as also vaccines against mumps, rubella and measles. Combination vaccines have been devised to limit the number of injections. Vaccine delivery systems have been developed to deliver multiple doses of the vaccine at a single contact point. A genetically-engineered oral vaccine for typhoid imparts better and longer duration of immunity. Oral vaccines for cholera and other enteric infections are under clinical trials. The nose as a route for immunization is showing promise for mucosal immunity and for anti-inflammatory experimental vaccines against multiple sclerosis and insulin-dependent diabetes mellitus. The range of vaccines has expanded to include pathogens resident in the body such as Helicobacter pylori (duodenal ulcer), S. mutans (dental caries), and human papilloma virus (carcinoma of the cervix). An important progress is the recognition that DNA alone can constitute the vaccines, inducing both humoral and cell-mediated immune responses. A large number of DNA vaccines have been made and shown interesting results in experimental animals. Live recombinant vaccines against rabies and rinderpest have proven to be highly effective for controlling these infections in the field, and those for AIDS are under clinical trial. Potent adjuvants have added to the efficacy of the vaccines. New technologies have emerged to 'humanize' mouse monoclonals by genetic engineering and express these efficiently in plants. These recombinant antibodies are opening out an era of highly specific and safe therapeutic interventions. Human recombinant antibodies would be invaluable for treating patients with terminal tetanus and rabies. Antibodies are already in use for treatment of cancer, rheumatoid arthritis and allergies. An advantage of preformed antibodies directed at a defined target and given in adequate amounts is the certainty of efficacy in every recipient, in contrast to vaccines, where the quality and quantum of immune response varies from individual to individual.
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PMID:The impact of new technologies on vaccines. 1073 30

Based on analysis of eleven-year intense epidemiological intervention against smallpox, a number of findings and demands ensued which should be met by an infectious disease to be included into the programme of eradication or elimination. The author mentions several episodes from the programme of smallpox eradication in which he participated as a member of a WHO team. Part of the paper is a detailed explanation of the terms eradication and elimination. The main part of the article is a characteristic of infections where the global programme of eradication or elimination is underway. At present the eradication of poliomyelitis and dracunculiasis is completed and elimination of tetanus of neonates as well as leprosy, all by the year 2000. By 2010 measles, possibly German measles and mumps should be eradicated and possibly leprosy and Chagas' disease and onchocerciasis should be eliminated. Also for other infections such as lymphatic filariasis, trachoma and non-veneric treponematoses more remote terms are given or are not yet given. Depending on the decision of WHO on the programme of global eradication, under precisely defined conditions seven other infections may be included: cysticercosis (Taenia solium), diseases caused by Haemophilus influenzae b, viral hepatitis A, rotavirus enteritis, diphtheria, whooping cough and tuberculosis. In the case of viral hepatitis B only elimination is foreseen.
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PMID:[Eradication of contagious diseases]. 1103 69

Through careful follow-up of a cohort, born March to August 1994, we have recorded the highest ever primary immunisation uptake figures for the Dublin area, with completed uptake for Diphtheria, Tetanus and Oral Polio of 92.1%, Haemophilus influenzae type b of 88.7%, Pertussis of 85.7% and Measles/Mumps/Rubella of 78.1%. Eastern Health Board uptake estimates for the same period are 8.1-21.4% lower. We believe the rigour of our data gathering explains this discrepancy. Evidence is reviewed in support of the hypothesis that Eastern Health Board databases underestimate true immunisation uptake.
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PMID:Apparent low immunisation uptake in Dublin: under-performance or under-recording? 1113 57


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