Monitoring vaccine safety: a critical component of every immunisation program

Postmarketing surveillance of vaccine safety requires active input from vaccine providers and health care professionals.

Evaluation of the measles-rubella mass vaccination campaign in the population covered by Tehran University of Medical Sciences

We evaluated the measles-rubella mass vaccination campaign in the Islamic Republic of Iran in December 2003. Vaccination coverage, community awareness of the campaign and the quality of vaccination services were assessed in the population covered by Tehran University of Medical Sciences. At the end of the campaign 96.4% (95% CI: 94.6%-98.2%) of the population sample (n = 390) had been vaccinated. Awareness of the campaign was 80.59% of the sample (n = 190) at the start, rising to 96.8% during and 100.0% at the end of the campaign. None of the 24 vaccination teams sampled were over the threshold for unacceptable performance. The mass media and vaccination teams demonstrated good performance and have achieved their goals.

Protecting public health and global freight transportation systems during an influenza pandemic

The H5N1 influenza threat is resulting in global preparations for the next influenza pandemic. Pandemic influenza planners are prioritizing scarce vaccine, antivirals, and public health support for different segments of society. The freight, bulk goods, and energy transportation network comprise the maritime, rail, air, and trucking industries. It relies on small numbers of specialized workers who cannot be rapidly replaced if lost due to death, illness, or voluntary absenteeism. Because transportation networks link economies, provide critical infrastructures with working material, and supply citizens with necessary commodities, disrupted transportation systems can lead to cascading failures in social and economic systems. However, some pandemic influenza plans have assigned transportation workers a low priority for public health support, vaccine, and antivirals. The science of Transportation Geography demonstrates that transportation networks and workers are concentrated at, or funnel through, a small number of chokepoints and corridors. Chokepoints should be used to rapidly and efficiently vaccinate and prophylax the transportation worker cohort and to implement transmission prevention measures and thereby protect the ability to move goods. Nations, states, the transportation industry and unions, businesses, and other stakeholders must plan, resource, and exercise, and then conduct a transportation health assurance and security campaign for an influenza pandemic.

Preparing for pandemic influenza: revisit the basics

AIMS AND OBJECTIVES

This paper attempts to address the global concern of the possible pandemic of influenza and avian influenza. In doing this, some unfounded beliefs related to influenza vaccines and antiviral treatment and prophylaxis are explored. This study also describes the essential measures for getting prepared.

BACKGROUND

Based on the current epidemiology, availability of vaccines, antiviral prophylaxis and treatment and experience from SARS outbreak, the authors suggested that basic infection control measures should be emphasized to prepare for the pandemic. These measures include personal and environmental hygiene, surveillance and infection control precautions and education.

CONCLUSION

The authors provide evidence and explanations to demystify pandemic influenza and recommend measures that help to prevent cross infection.

RELEVANCE TO CLINICAL PRACTICE

Although the preparedness is everyone's business, nurses play a crucial and indispensable role in this exercise. With prepared personnel, facilities and good infection control practices, nosocomial spread of the disease and pandemic can be prevented.

The Meningitis Vaccine Project

Epidemic meningococcal meningitis is an important public health problem in sub-Saharan Africa. Current control measures rely on reactive immunizations with polysaccharide (PS) vaccines that do not induce herd immunity and are of limited effectiveness in those under 2 years of age. Conversely, polysaccharide conjugate vaccines are effective in infants and have consistently shown an important effect on decreasing carriage, two characteristics that facilitate disease control. In 2001 the Meningitis Vaccine Project (MVP) was created as a partnership between PATH and the World Health Organization (WHO) with the goal of eliminating meningococcal epidemics in Africa through the development, licensure, introduction, and widespread use of conjugate meningococcal vaccines. Since group A Neisseria meningitidis (N. meningitidis) is the dominant pathogen causing epidemic meningitis in Africa MVP is developing an affordable (US$ 0.40 per dose) meningococcal A (Men A) conjugate vaccine through an innovative international partnership that saw transfer of a conjugation and fermentation technology to a developing country vaccine manufacturer. A Phase 1 study of the vaccine in India has shown that the product is safe and immunogenic. Phase 2 studies have begun in Africa, and a large demonstration study of the conjugate vaccine is envisioned for 2008-2009. After extensive consultations with African public health officials a vaccine introduction plan has been developed that includes introduction of the Men A conjugate vaccine into standard Expanded Programme on Immunization (EPI) schedules but also emphasizes mass vaccination of 1-29 years old to induce herd immunity, a strategy that has been shown to be highly effective when the meningococcal C (Men C) conjugate vaccine was introduced in several European countries. The MVP model is a clear example of the usefulness of a "push mechanism" to finance the development of a needed vaccine for the developing world.

Lessons learned from smallpox vaccination of U.S. Navy forces before Operation Iraqi Freedom

Our objectives were to document and to analyze the U.S. Navy's smallpox vaccination program before Operation Iraqi Freedom, discerning lessons for future mass vaccination programs. This research scrutinized the challenges inherent in vaccinating approximately 40,000 personnel at diverse locations within a few weeks. We interviewed and observed participants at multiple locations throughout the vaccination process, while also collecting documentation. Subsequently, we analyzed how the Navy addressed the challenges of mass vaccination on a compressed timeline. We found that the population was vaccinated with no significant logistical challenges, few medical complications, almost no refusals, and minimal operational impact. Our analysis led us to conclude that two primary factors contributed to the vaccination program's success; both of these can be replicated in future mass vaccination programs. The first factor was a strong educational program, which repeated consistent messages via multiple communications channels. The second factor was vocal, demonstrative, high-level support for vaccination.

The current status of HPV and rotavirus vaccines in national immunisation schedules in the EU – preliminary results of a VENICE survey

In the second half of 2006, two vaccines against rotavirus infections and one against human papillomavirus (HPV) infection were granted licensing authorisations by the European Medicines Agency (EMEA).

Pandemic vaccines: promises and pitfalls

Prototype vaccines against influenza A/H5N1 may be poorly immunogenic, and two or more doses may be required to induce levels of neutralising antibody that are deemed to be protective. The actual levels of antibody required to protect against a highly pathogenic virus that potentially can spread beyond the large airways is unknown. The global capacity for vaccine manufacture in eggs or tissue culture is considerable, but the number of doses that can theoretically be produced in a pandemic context will only be sufficient for a small fraction of the world's population, even less if a high antigen content is required. The safety of new pandemic vaccines should be addressed in an internationally coordinated way. Steps are underway through the Therapeutic Goods Administration to evaluate mock-up vaccines now, so that the time to registration of a new product can be minimised. It will be 3-6 months into the pandemic before an effective vaccine becomes available, so other control measures will be important in the early stages of a pandemic. The primary goal of a pandemic influenza vaccine must be to prevent death, and not necessarily to prevent infection.

Polio eradication in India: the way forward

Despite remarkable decline in the number of poliomyelitis cases, the dream of polio eradication in India remains elusive. This is despite considerable effort and expenditure for well over a decade. Various reasons have been cited for this and interventions implemented accordingly. None of these seem to have borne fruit. It is appropriate to have a relook at the polio eradication strategies in order to learn from past errors and determine a feasible solution to achieve the goal. This article examines important tissues that hamper the eradication effort and proposes a way forward.

Novel use of the intranet to document health care personnel participation in a mandatory influenza vaccination reporting program

BACKGROUND

The Advisory Committee on Immunization Practices and the Healthcare Infection Control Practices Advisory Committee recommend health care personnel (HCP) influenza vaccination to prevent transmission to patients. Recommendations include documenting declination and providing feedback of rates. We report the use of the intranet to achieve recommendations with mandatory participation of 20,170 HCP in an 1100-bed hospital.

METHODS

Employees were required to log onto the intranet and select "vaccine received," "contraindicated," or "declined." Declining employees automatically received a screen with education about vaccination. A Microsoft Structured Query Language database was created and linked to a Human Resource database. Administrators were provided feedback on participation rates. Employees were notified of the program via letter. Reminders were provided through managers and newsletters.

RESULTS

Eighty-nine percent (17,998/20,170) accessed the intranet. Fifty-five percent (11,068) indicated "vaccine received" versus 38% in 2004-2005 (P < .000001), 31% (6300) "declined," and 3% (630) had "contraindications." Unit rates ranged from 24% to 91%.

CONCLUSION

The intranet provides a tool for measuring and reporting participation, declination, and vaccination rates. The intranet and a mandatory participation program were associated with an increase in rates. Low rates in HCP with access to, and education about, vaccine may impact consideration of a mandatory vaccination program.

Rotavirus vaccines: considerations for successful implementation in Europe

A group of European experts in infectious diseases and vaccinology has met on several occasions to assess the rationale for universal vaccination against rotavirus infection of infants in Europe. On the basis of the available data, we concluded that vaccination was the best approach to prevent severe rotavirus gastroenteritis, and that European countries should consider implementing rotavirus vaccination in their routine immunisation programmes. The main barrier to the implementation of rotavirus vaccination in Europe is a general lack of awareness of stakeholders, policymakers, health-care professionals, and parents about rotavirus disease and the advantages of vaccination. Further studies on the cost of the disease and the benefit of vaccination, together with raising awareness are necessary steps to ensure successful implementation of rotavirus vaccination in Europe.

Universal influenza vaccination: the time to act is now

Annual influenza epidemics create a significant public health burden each year in the United States. That influenza continues to pose a public health threat despite being largely preventable through vaccination is indicative of continuing weaknesses in the U.S.'s public health system. Moreover, the burden of annual influenza epidemics and the fragility and instability of the capacity to respond to them underscore the U.S.'s ongoing vulnerability to pandemic influenza and highlights gaps in bioterrorism preparedness and response efforts. This article examines the burden of annual influenza epidemics in the U.S., efforts to combat that burden with vaccination, shortcomings of influenza vaccination efforts, and how those shortcomings exemplify weaknesses in pandemic influenza and bioterrorism preparedness efforts. We make the case for establishing an annual universal influenza vaccination program to assure access to influenza vaccination to anyone who can safely receive vaccination and desires it. Such a program could greatly reduce the annual burden of influenza while advancing and maintaining U.S. pandemic influenza and bioterrorism preparedness and response efforts.

Introducing Vi polysaccharide typhoid fever vaccine to primary school children in North Jakarta, Indonesia, via an existent school-based vaccination platform

OBJECTIVES

To report results on coverage, safety and logistics of a large-scale, school-based Vi polysaccharide immunization campaign in North Jakarta.

METHODS

Of 443 primary schools in North Jakarta, Indonesia, 18 public schools were randomly selected for this study. Exclusion criteria were fever 37.5 degrees C or higher at the time of vaccination or a known history of hypersensitivity to any vaccine. Adverse events were monitored and recorded for 1 month after immunization. Because this was a pilot programme, resource use was tracked in detail.

RESULTS

During the February 2004 vaccination campaign, 4828 students were immunized (91% of the target population); another 394 students (7%) were vaccinated during mop-up programmes. Informed consent was obtained for 98% of the target population. In all, 34 adverse events were reported, corresponding to seven events per 1000 doses injected; none was serious. The manufacturer recommended cold chain was maintained throughout the programme.

CONCLUSIONS

This demonstration project in two sub-districts of North Jakarta shows that a large-scale, school-based typhoid fever Vi polysaccharide vaccination campaign is logistically feasible, safe and minimally disruptive to regular school activities, when used in the context of an existing successful immunization platform. The project had high parental acceptance. Nonetheless, policy-relevant questions still need to be answered before implementing a widespread Vi polysaccharide vaccine programme in Indonesia.

Strategic National Stockpile Program: Implications for Military Medicine

The Strategic National Stockpile (SNS) program, managed by the Centers for Disease Control and Prevention, Department of Health and Human Services, is designed to deliver critical medical resources to the site of a national emergency. A recent interagency agreement between the Department of Defense and the Department of Health and Human Services indicates that military medical treatment facility commanders should be actively engaged in cooperative planning with local and state public health officials, so that reception, storage, distribution, and dispensing of SNS materials as a consequence of an actual event could occur without disruption or delay. This article describes the SNS program and discusses issues of relevance to medical treatment facility commanders and Department of Defense medical planners and logisticians.

Exploring the time to intervene with a reactive mass vaccination campaign in measles epidemics

The current WHO policy during measles outbreaks focuses on case management rather than reactive vaccination campaigns in urban areas of resource-poor countries having low vaccine coverage. Vaccination campaigns may be costly, or not timely enough to impact significantly on morbidity and mortality. We explored the time available for intervention during two recent epidemics. Our analysis suggests that the spread of measles in African urban settings may not be as fast as expected. Examining measles epidemic spread in Kinshasa (DRC), and Niamey (Niger) reveals a progression of smaller epidemics. Intervening with a mass campaign or in areas where cases have not yet been reported could slow the epidemic spread. The results of this preliminary analysis illustrate the importance of revisiting outbreak response plans.

Immunization to protect the US Armed Forces: heritage, current practice, and prospects

Americans serving with the US Armed Forces need protection from the dangerous infections that they can contract during training, based on occupation, during overseas deployment, or because of underlying health status. For over 230 years, the military health-care system has immunized troops to protect them personally and to help them accomplish their missions. Military researchers have invented, developed, and improved vaccines and immunization delivery methods against more than 20 diseases. This article consolidates content from several previous historical reviews, adds additional sources, and cites primary literature regarding military contributions and accomplishments. Discussion emphasizes smallpox, typhoid fever, tetanus, influenza, meningococcal disease, adenovirus, yellow fever, pneumococcal disease, and anthrax. Delivery issues include documentation, simultaneous immunization, seroscreening, safety surveillance, jet injection, and cold-chain management. Immunization policies for each major US conflict are described. Military immunization programs need to be individualized on the basis of personal contraindications and prior immunity. The proper conduct of military immunization programs respects the need for detailed education of military personnel, maximizes quality in immunization delivery, and supports quality clinical care to prevent and treat adverse events after immunization. Military immunization programs maintain the health of soldiers, marines, sailors, airmen, and coast guardsmen, the resources most critical to military success.