Immunization issues for the 21st century

Nutritional and immunization status of under-five children of India and Bangladesh

BACKGROUND

The nutritional and immunization status of children can play an important role in determining their future health status of a particular country. The aim of the present study is to investigate the nutritional and immunization status of under-five children in India and Bangladesh, and to find the difference in the status between these two countries.

METHODS

We have used the National Family Health Survey data, 2015-2016 of India and Bangladesh Demographic Health Survey, 2017-2018 datasets. The sample sizes are 222,418, among them 8759 and 8759 children for India and Bangladesh respectively. The nutritional status of under-five children is measured by standard anthropometric indicators of height-for-age (HAZ) and weight-for-age (WAZ). Regarding child immunization status, only BCG, DPT, polio and measles vaccinations are considered for the present study. Multiple binary logistic model has been used for analysing the data.

RESULTS

This study reveals that the prevalence of stunting and underweight of under-five children in India are higher than Bangladeshi children. Secondary and higher educated mothers are more likely of having normal HAZ and WAZ children than up to primary educated mothers for both countries. Chances of having normal HAZ and WAZ are higher among non-poor category for both countries. The present study also shows that immunization status of Bangladeshi children is better than Indian children except measles. Religion of mother also shows influence on immunization status of children in India whereas Bangladesh shows no significant results regarding religion. Mother's educational attainment and wealth index show influence on immunization status among children for both countries.

CONCLUSIONS

The study concludes that a remarkable number of under-five children are suffering from under nutrition for both countries, however Bangladeshi children have better nutritional and immunization status compared to Indian children. Higher wealth index, better educational attainment and lower unemployment of Bangladeshi mothers may be the causes for better nutritional and immunization status of children. Mother's socio-economic factors have significant impact on determining the child's health status. Our findings can help to government of Indian and Bangladesh for taking health policy to improve under-five children nutritional and immunization status.

How often do children receive their vaccinations late, and why?

OBJECTIVES

To assess vaccination timeliness, risk factors associated with delays and the reasons for delayed vaccinations among children below the age of 3 years in Jeddah, Kingdom of Saudi Arabia.

METHODS

This is a cross-sectional study conducted in Jeddah, Saudi Arabia during the period of May 2016 to August 2017. Data were obtained from parents of children under the age of 3 years using a structured questionnaire comprised of questions about sociodemographics, physical well-being of the child and the reasons that are used to justify delayed vaccinations. Vaccinations were considered delayed if they occurred more than 30 days after the time designated on the primary vaccination schedule. Logistic regression was used to assess the risk factors for vaccination delays.

RESULTS

The study included 351 children. Delayed vaccinations were observed in 85/351 (24.2%) of the sample. Delays were noted to occur most frequently for Measles, Mumps, Rubella vaccine (MMR), seconddose of meningococcal conjugate quadrivalent vaccine (MCV4), second  dose of oral polio vaccine (OPV) and fourth  dose of pneumococcal conjugate vaccine (PCV) in 19/125 (15.2%) of the sample. Traveling at the time of vaccination was the most common delay reason and was reported in 31/142 (21.3%) of the sample.

CONCLUSION

Adherence to vaccination is fairly common in this part of the country. However, vaccination delays are still present and should be addressed to improve health care.

A combined diphtheria, tetanus, five-component acellular pertussis, poliovirus andHaemophilus influenzaetype b vaccine

Ideally, combination vaccines should not only be safe and effective, but also integrate smoothly into the vaccination schedule and provide advantages over the use of separately administered vaccines. Pentaceltrade mark (Sanofi Pasteur Ltd., Toronto, Canada), a combination vaccine first licensed in Canada and subsequently in other countries, is immunogenic against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b when administered at 2, 4, 6 and 15-18 months of age. In published studies, the safety, immunogenicity and effectiveness of this combination vaccine were comparable with those of separately administered vaccines, with the advantage of a simplified dosing schedule.

Organizações Não Governamentais na área da Saúde da Criança - revisão da literatura

A segunda metade do século vinte assistiu ao crescimento de entidades que refletiam a mobilização da sociedade civil para uma participação mais efetiva nas questões de interesse público e de cunho social. Desta forma surgiram as organizações não governamentais (ONG) que ganharam espaço como parceiros dos setores públicos e privados para a atuação em diferentes áreas, entre elas a saúde. Baseado em uma revisão da literatura, este trabalho teve como objetivo conhecer o status do conhecimento científico sobre a participação das ONG na saúde da criança e a partir da identificação e classificação de suas atividades, observar se esta atuação tem se compatibilizado com a agenda desse campo. A análise das publicações considerou a procedência dos autores, o periódico, os objetivos, a origem e o local de atuação das ONG e a procedência dos recursos aplicados nos projetos desenvolvidos. A natureza das atividades variou de acordo com o grau de desenvolvimento da região onde as ONG atuavam e os temas, parceria entre órgãos de governo e terceiro setor, sustentabilidade e impacto das ações nas comunidades beneficiárias foram os principais tópicos destacados pelos autores. Concluiu-se que as questões estão apenas se esboçando e que o impacto das intervenções das ONG na área da saúde da criança é um campo de conhecimento a ser explorado.

Robust γδ+ T cell expansion in infants immunized at birth with BCG vaccine

Cell-mediated immune responses to BCG vaccine were evaluated in 7-month-old infants vaccinated with intradermal combined BCG and Hepatitis B or intradermal BCG and intramuscular Hepatitis B at birth. Peripheral blood mononuclear cell cultures from both groups showed CD4(+), CD8(+) and remarkable gammadelta(+) T cell BCG-specific proliferation, without significant differences. Also, IL-10, IL-12, IFN-gamma and TNF-alpha concentrations in culture supernatants, measured by ELISA, were similar. The results suggested that the combined BCG and Hepatitis B vaccine was as immunogenic as BCG separated from Hepatitis B vaccine.

Immunogenicity and reactogenicity of four doses of diphtheria-tetanus-three-component acellular pertussis-hepatitis B-inactivated polio virus-Haemophilus influenzae type b vaccine coadministered with 7-valent pneumococcal conjugate Vaccine

BACKGROUND

The 7-valent pneumococcal (7vPn) conjugate vaccine is licensed for primary and booster vaccination according to the same immunization schedules as routinely recommended diphtheria-tetanus-pertussis-based childhood vaccines and can be coadministered during the same vaccination visit.

METHODS

An open, randomized study evaluated the immunogenicity and safety of a hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated polio virus-Haemophilus influenzae type b (DTPa-HBV-IPV/Hib) vaccine and a 7vPn conjugate vaccine when coadministered at 2, 3 and 4 months and 12-23 months of age, compared with the administration of the hexavalent DTPa-HBV-IPV/Hib vaccine given alone. Serum antibody titers were measured before and 1 month after the primary course and before and 1 month after the booster dose. Solicited local and general adverse events were recorded for 4 days and unsolicited adverse events were recorded for 30 days after each vaccine dose.

RESULTS

A total of 345 subjects were enrolled for primary vaccination with the hexavalent vaccine (170 without and 175 with the 7vPn vaccine coadministered) and 266 returned for booster vaccination (122 without and 144 with coadministration of the 7vPn vaccine). After primary vaccination, antibody responses against the common antigens were similar in both groups, with seroprotection rates of 93.6-100% and with similar antibody decay before booster vaccination. The fourth dose induced a vigorous booster response, with seroprotection/vaccine response rates of 96.8-100%. Response to the 7vPn primary and booster vaccination was within previously reported ranges. Differences in reactogenicity resulted from higher incidences of symptoms after concomitant vaccination. Rectal temperature >39.5 degrees C was observed after 1.2% of the coadministered vaccine doses during primary vaccination and after 2.8% of the booster vaccine doses.

CONCLUSION

Coadministration of the DTPa-HBV-IPV/Hib and 7vPn vaccines at separate injection sites during the same vaccination visit was effective and safe.

Major factors affecting the emergence and re-emergence of infectious diseases

The diversity of infectious disease threats currently facing humanity is unprecedented because of the remarkable emergence and reemergence of pathogens worldwide. Because of population mobility, globalization of commerce and the food supply, and the effects of the HIV/AIDS pandemic, infections in the developing world must be addressed to prevent infections in industrialized countries. Because pathogens do not recognize national boundaries, the rapidity with which individuals can circumnavigate the globe incubating infections makes the control of communicable diseases an enormous challenge for governments as well as for the public and primary health care systems. A global strategy for dealing with infectious disease threats must be developed and implemented as soon as possible.

Pertussis vaccination and the risk of respiratory syncytial virus-associated hospitalization

BACKGROUND

Animal data suggest an association between recent vaccination with a pertussis-containing vaccine and increased severity of respiratory syncytial virus (RSV) infection. We sought to determine whether such an association exists in humans by studying a population-based cohort of young children.

PATIENTS AND METHODS

We performed a nested case-control study of 280 children younger than 24 months of age hospitalized with RSV infection in Olmsted County, MN from January 1990 to December 1999. Controls (2 per case) consisted of nonhospitalized residents of Olmsted County matched to cases by date of birth and sex. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for the odds of hospitalization for RSV infection among subjects with a recent pertussis-containing vaccination in proximity to the cases' date of hospitalization relative to the odds among subjects with no vaccination.

RESULTS

The OR for receipt of a pertussis-containing vaccine within 0 to 6 days of a case's hospitalization for RSV disease was 0.8 (95% CI 0.4-1.8). For the time intervals 7-13, 14-20 and > or =21 days, the OR were 1.3 (95% CI 0.5-3.0), 1.3 (95% CI 0.5-3.2) and 0.7 (95% CI 0.3-1.5), respectively. Adjusting for vaccine delay and for risk status did not alter the findings. The median interval between the most recent pertussis-containing vaccine and the case's date of hospitalization was 40 days for cases and 42.5 days for controls (P = 0.69). Among the RSV cases, pertussis vaccination in the month preceding hospitalization was not a risk factor for oxygen requirement (P = 0.82), intensive care unit admission (P = 0.46) or need for mechanical ventilation (P = 0.28).

CONCLUSION

In our study, recent immunization with a pertussis-containing vaccine was not a risk factor for hospitalization for RSV infection. In addition, among children hospitalized with RSV infection, recent pertussis immunization was not associated with a more severe clinical course.

The use of vaccines in pregnancy

Adult immunization rates in the United States lag behind pediatric immunization rates. Healthcare providers in all settings should discuss immunization with their patients. There are concerns regarding the use of vaccine in women who are pregnant or breastfeeding. This article reviews selected vaccines and the use of vaccines in women who are pregnant or breastfeeding. Basic principles of vaccine administration are discussed as well as standards for immunization practice. Concerns regarding vaccine safety in any population are reviewed.

Diffusion of innovations: a world tour

This contribution to the 40th Anniversary celebration of the Diffusion of Innovations Theory discusses three health communication projects which applied the tenets of Diffusion of Innovation Theory with differing results: Using voodoo practitioners to pave the way for HIV/AIDS education in Haiti. A food-based approach to improving Vitamin A nutrition in Nepal. Diffusion at the horizon of life: The difficulties of communicating reproductive health to youth in Mali. The article illustrates a spectrum of circumstances in which diffusion theory has been applied, in order to show the application of the theory with different populations or target groups, in different sectors, and in different regions of the world.