Changes in Expanded Program for Immunization coverage for mother and child in Krakor, Cambodia 1996--1998

We evaluated a training intervention aimed at enhancing the roles of health centre staff, Village Health Volunteers (VHVs) and Traditional Birth Attendants (TBAs) within the Expanded Program for Immunization (EPI) in the district of Krakor, Cambodia. We conducted population-based surveys to determine the coverage of the EPI at baseline (1996) and after the intervention (1998), using data from health cards for mothers and their children and history data. Statistically significant changes over the 2-year period were apparent for tetanus, BCG, polio and DTP, supporting the positive impact the training intervention had on immunization coverage in the district.     

Prevalence of National Responsiveness to HBV Vaccine After 22 Years of Iranian Expanded Program on Immunization (EPI): A Systematic Review and Meta-Analysis Study

Context:

Hepatitis B Virus expanded program on immunization (EPI) started on 1993 in Iran. Most surveys have assessed the level of response to vaccine by measuring the titers of anti-HBs. This meta- analysis aimed to summarize the Iranian published data on the rate of vaccine-responders versus non-responders. Moreover, the impact of variables such as age, gender, type of vaccine, etc. on the levels of responsiveness was evaluated.

Evidence Acquisition:

All published papers on this topic in Iranian and international journals with affiliation of “Iran” were reviewed using standard keywords up to 2014. We included our study to healthy participants with no previous HBV infection and who had already received a complete course of HB vaccine. The estimated prevalence and 95% confidence intervals in 28 eligible articles for HBV vaccine responders (anti-HBs > 10 IU/mL) and non-responders (10 <) were analyzed by random effect method due to between-study heterogeneity.

Results:

The age of subjects was between 6 months and 15 years old. Overall, 5991 (51.5%) were male and 4571 (48.5%) females. Overall, 80% were responders to vaccine versus 20% nonresponders. With increase in age, the number of responders to vaccine decreased significantly (P = 0.001). There was no strong difference between responders versus nonresponders to vaccine for gender, types of vaccine, ethnicity and living area.

Conclusions:

The results arose from this meta-analysis highlighted the safety of vaccine and its effectiveness in stimulating immune response of vaccines, despite being different in generation, manufacturers and types. Moreover, there was no substantial difference between Iranian and other international investigations in the rate of nonresponsiveness to HBV vaccine.     

Immunization against diseases caused by Theileria parva: a review

Theileria parva is the causative agent of three epidemiologically different diseases, East Coast fever (ECF), Corridor disease and January disease, caused by 3 types of T. parva, T. p. parva, T. p. lawrencei and T. p. bovis, respectively. The history of immunization against these diseases has been marked by salient discoveries such as the immune status in recovered animals, the activity of tetracyclines during the incubation period, the possibility for cryopreserving supernatant of prefed ticks and the development of useful serological tests. The possibility of simultaneous administration of stabilate and long-acting tetracycline have greatly contributed to making the infection and treatment method operational. The importance of antigenic diversity in T. parva has been reflected in the difficulties related to the selection of the immunizing stock or combinations of stocks: a 'cocktail' of East African isolates may give broad protection against field challenge by ECF (T. parva parva), but Corridor disease is more problematic. On the other hand, certain single isolates may give equally good protection against ECF field challenge. Studies on the immunology of T. parva infection and the application of molecular tools have led to the discovery that sera of recovered animals neutralize sporozoites of various isolates, and to the p67 molecular vaccine; yet so far the only available method of immunizing against T. parva infections is the infection and treatment method or, in the case of T. parva bovis, the use of sublethal stabilate doses. Infection and treatment is applied on a fairly large scale in Zambia, and on a more limited scale in a few other countries. Immunity by this rather crude method is long-lasting and solid, but cross-immunity problems against some field strains remain. Furthermore, as immunized animals remain carriers, immunization may contribute to attaining and improving endemic stability in endemic areas in indigenous breeds with an adequate level of genetic tolerance to ECF. On the other hand, carrier animals may constitute a risk for spreading the disease into ECF-free areas where the vector is present. Other disadvantages of the method are that immunization of cattle during the incubation of naturally contracted East Coast fever will not prevent the disease and jeopardize its reputation. Furthermore, stabilates have to be cryopreserved, often a technical drawback, and contamination with undesirable pathogens may occur in tick-derived material. Therefore the need remains for the development of effective molecular vaccines and it must be remembered that immunization must be cost-effective and sustainable and it is only one aspect of integrated control of theileriosis and other tick-borne diseases. There is no universally valid strategy. Several factors have to be considered: value and susceptibility of cattle to theileriosis and to other tick-borne and tick-associated diseases, infestation by various ticks present in the area, the type of theileriosis (ECF, Corridor disease or January disease) and the epidemiological situation where immunization is taking place. The optimal age for immunization of the calves in endemic areas needs to be determined: when calf mortality by naturally occurring theileriosis is a problem, the sooner calves are immunized the better, but a proportion will have contracted natural infection before they can be reached, and immunization of very young calves might not be fully effective.     

Persistence of antibodies to the surface antigen of the hepatitis B virus (anti-HBs) in children subjected to the Expanded Programme on Immunization (EPI), including hepatitis-B vaccine, in Thailand

Will hepatitis-B vaccine administered at birth, and at 2 and 6 months of age, as an integral part of Thailand's Expanded Programme on Immunization, provide long-term protection? In an attempt to answer this question, residents of five provinces (representing five distinct geographical areas of Thailand) who were aged 1-10 years and had received this course of vaccination were enrolled on a serological study. Each was tested, with ELISA, for the surface antigen of hepatitis B (HBsAg) and for antibodies against this antigen (anti-HBs) or against the core antigen (anti-HBc). Over all age-groups, the prevalences of HBsAg, anti-HBs and anti-HBc were 0.67%, 71.4% and 5.5%, respectively. Although the prevalence of anti-HBs decreased with age, it remained at 56%-65% among those aged 6-10 years. Between 2% and 17% of the subjects aged 1-9 years had high titres of anti-HBs. Based on these results, an additional booster, still a controversial issue, does not appear to be required in order to prevent infection with hepatitis B virus and thus permit the eventual eradication of chronic carriage and its fatal sequelae in Thailand.     

The burden of cirrhosis and impact of universal coverage public health care system in Thailand: Nationwide study

Background and rationale. Cirrhosis is responsible for significant health-care costs and morbidity. This study aims to evaluate the burden of illness associated with cirrhosis, its impact on the universal coverage public health care system in Thailand.Material and methods. We used data from the 2010 Nationwide Hospital Admission Data, the National Health Security Office (NHSO), Thailand. Their baseline characteristics, hospital costs, and outcomes were analyzed according to national health insurance categories including medical welfare scheme (MWFS), social security scheme (SSS) and civil servant medical benefit scheme (CSMBS).Results. 92,301 admissions were eligible for analysis. The mean age was 55 ± 12.8 years, and 63.3% of patients were above 50 years old. The majority of patients (79%) belonged to the MWFS group. The MWFS group incurred the lowest medical expense and had the shortest hospital stay compared to the SSS and CSMBS groups. Overall in-hospital mortality was 10.7%. Cirrhosis complications include bleeding esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, and hepatocellular carcinoma. These complications significantly increased mortality rates compared to patients without complications (26 vs. 8.9%, p < 0.001). In-hospital mortality of patients with cirrhosis complications did not differ among the three national health insurance groups. Respiratory failure and septicemia were associated with the highest risk of death (HR 5.4; 95% CI: 4.8-5.9 and HR 5.2; 95% CI: 4.9-5.6 respectively; P < 0.001).Conclusions. Illness associated with cirrhosis is a significant public health problem in Thailand. Outcomes of cirrhosis complications did not differ between universal public health care coverage systems in Thailand.     

2005-2018年通江县扩大国家免疫规划实施前后风疹流行特征

目的了解通江县含风疹成分疫苗纳入扩大国家免疫规划实施前后风疹疫情变化情况及流行特征。方法通过《传染病报告信息管理系统》导出2005-2018年通江县风疹疫情资料,使用Excel 2016软件按扩大国家免疫规划实施前(2005-2008年)和实施后(2009-2018年)进行数据统计,采用描述流行病学分析疫情资料。率的比较使用SPSS 23.0软件进行χ2检验,检验水准α=0.05。结果2005-2018年通江县风疹年均发病率为3.43/10万。扩大国家免疫规划实施后年均发病率从实施前的10.87/10万降至0.54/10万;报告发病的乡镇比例从实施前的53.06%降至40.80%,病例均为散发,且实施前有病例报告的乡镇在实施后年均发病率降幅达20.96%~100.00%;男性年均发病率从实施前的12.08/10万降至0.54/10万,女性从实施前的9.61/10万降至0.53/10万。规划实施前以5~14岁儿童、学生发病为主(93.15%和91.78%),共发生5起中小学校风疹突发公共卫生事件;而实施后以0~4岁儿童、散居儿童发病为主(59.46%和48.65%)。规划实施前后均以春季和夏初发病为主(97.26%和64.86%)。结论通江县实施扩大国家免疫规划10年,风疹发病取得明显的控制效果,应进一步扎实开展扩大国家免疫规划和入托入学儿童预防接种证查验。     

Bone marrow leishmaniasis: a review of situation in Thailand

Leishmaniasis is an important tropical vector-borne disease. This infection can be seen in tropical area and it is considered to be one of the most important vector-borne infections at present. The general situation of the leishmaniasis in Thailand is hereby reviewed. Although Thailand is a tropical country, the leishmaniasis is not endemic but sporadic. The imported cases are documented in some literatures. The serious form of leishmaniasis, the visceral leishmaniasis is also detectable in Thailand. Also, the author performed an in depth literature review of the reports of bone marrow leishmaniasis, a specific kind of visceral leishmaniasis, in Thailand in order to summarize the characteristics of this infection among Thai patients. According to this review, there have been at least 5 reports in the literature of 6 cases of bone marrow leishmaniasis in the Thai population, of which no case was lethal. Concerning the clinical manifestations, all except had prolonged fever with unknown origin. From physical examination, all had hepatosplenomegaly. The striking findings were active hemophagocytosis with increased proliferation of lymphoidplasma cell line in the bone marrow and amastigotes of Leishmania donovani was demonstrated. Considering the treatment, pantavalent antimony compound was used and the excellent improvement and complete recovery. Finally, the author also discussed on the importance of leishmaniasis in Thailand relating to the present globalization and good traveling system.     

Opisthorchiasis in Thailand： Review and current status

Opisthorchiasis caused by Opisthorchis viverrini （Oviverrini） remains a major public health problem in many parts of Southeast Asia including Thailand, Lao PDR, Vietnam and Cambodia. The infection is associated with a number of hepatobUiary diseases, including cholangitis, obstructive jaundice, hepatomegaly, cholecystitis, cholelithiasis and cholangiocarcinoma. The liver fluke infection was induced by eating raw or uncooked fish products that is the tradition and popular in the northeastern and northern region, particularly in rural areas of Thailand. Health education programs to prevent and control opisthorchiasis are still required in high-risk areas.     

The EPI in Borno State, Nigeria: impact on routine disease notifications and hospital admissions.

An earlier report on the Nigerian expanded programme on immunization (EPI), covering 1974-1988, failed to demonstrate a clear-cut impact of the programme. This report attempts to determine the effectiveness of EPI in Borno State, Nigeria. We analysed trends in routine notifications for diphtheria, pertussis, tetanus, tuberculosis, measles, and pneumonia, from 1985 to 1991; data on poliomyelitis were excluded because of poor documentation, while we included data on pneumonia for comparison. We also performed a before (1983-1987) after (1988-1991) comparison in terms of the intensifications of EPI by age-specific strata amongst paediatric hospitalization for all EPI diseases at the University of Maiduguri Teaching Hospital, the sole referral hospital for childhood infectious diseases. Our results show an apparent reduction in morbidity from diphtheria, pertussis, tetanus, measles and pneumonia, and this was particularly prominent following intense vaccinations between 1988 and 1991. The reduction in these EPI diseases and pneumonia occurred despite the prevailing adverse socioeconomic conditions, and the absence of a specific control strategy for pneumonia in Nigeria. On the other hand, in spite of national BCG coverage of about 90% there has been a recent (1989-1991) increase in the registered cases of tuberculosis in infants and older children in Borno State. There is a need to intensify other intervention measures alongside EPI activities.     

Helicobacter pyloriinfection and respiratory diseases： a review

In the past few years, a variety of extradigestive disorders, including cardiovascular, skin, rheumatic and liver diseases, have been associated with Helicobacter pylori (H. pylori) infection. The activation of inflammatory mediators by H. pylori seems to be the pathogenetic mechanism underlying the observed associations. The present review summarizes the current literature, including our own studies, concerning the association between H. pylori infection and respiratory diseases. A small number of epidemiological and serologic, case-control studies suggest that H. pylori infection may be associated with the development of chronic bronchitis. A frequent coexistence of pulmonary tuberculosis and H. pylori infection has also been found. Moreover, recent studies have shown an increased H. pylori seroprevalence in patients with bronchiectasis and in those with lung cancer. On the other hand, bronchial asthma seems not to be related with H. pylori infection. All associations between H. pylori infection and respiratory diseases are primarily based on case-control studies, concerning relatively small numbers of patients. Moreover, there is a lack of studies focused on the pathogenetic link between respiratory diseases and H. pylori infection. Therefore, we believe that larger studies should be undertaken to confirm the observed results and to clarify the underlying pathogenetic mechanisms.     

Infectious and tropical diseases in Oman: a review

Oman is generally hot and dry, but the Salalah region in southern Dhofar province is relatively cool and rainy during the summer monsoon, and has a distinctive pattern of infection. Important, notifiable infections in Oman include tuberculosis, brucellosis (endemic in Dhofar), acute gastroenteritis, and viral hepatitis: 4.9% of the adults are seropositive for hepatitis B surface antigen and approximately 1.2% for hepatitis C virus. Infection with human immunodeficiency virus is uncommon, and leprosy, rabies, and Crimean-Congo hemorrhagic fever are rare. Between 1990 and 1998, the incidence of malaria, (>70% due to Plasmodium falciparum) decreased from 32,700 to 882 cases. Cutaneous and visceral leishmaniasis (caused by Leishmania tropica and L. infantum, respectively) and Bancroftian filariasis occur sporadically. Intestinal parasitism ranges from 17% to 42% in different populations. A solitary focus of schistosomiasis mansoni in Dhofar has been eradicated. There are major programs for the elimination of tuberculosis, leprosy, and malaria, and to control brucellosis, leishmaniasis, sexually transmitted diseases, trachoma, acute respiratory infection in children, and diarrheal diseases. The Expanded Program on Immunization was introduced in 1981: diphtheria, neonatal tetanus, and probably poliomyelitis have been eliminated.     

Immunization in rheumatic diseases of childhood: an audit of the clinical practice of British Paediatric Rheumatology Group members and a review of the evidence

OBJECTIVES: To establish opinion and clinical practice of senior clinicians working with children with rheumatic diseases with regard to immunization and to determine whether or not this is in accordance with current recommendations. To review published guidelines on the subject and examine the evidence base supporting them. METHODS: A questionnaire was sent to all consultant members of the British Paediatric Rheumatology Group. Information on a variety of issues relating to immunization practice in children with rheumatic diseases was collected. A review of published guidelines and the medical literature on the subject was undertaken to assess current recommendations for immunization in patients on immunosuppressive agents and the evidence supporting these. RESULTS: A number of different sources of information are being used to decide whether or not to immunize patients with rheumatic diseases. Clinical practice varies between individuals. Areas of discordance include the doses of corticosteroids and disease-modifying drugs at which significant immunosuppression is felt likely to occur, the level of immunosuppression conferred by rheumatological diseases themselves and whether or not vaccination should be deferred in the presence of active disease. There was also variation in policy with regard to immunizations not part of the routine recommended schedule. CONCLUSIONS: There is variation in both opinion and clinical practice regarding immunization in children with rheumatic diseases amongst senior clinicians working in the field of paediatric rheumatology. This reflects the lack of consistency between various sets of published guidelines and their non-specificity for rheumatic diseases and their treatment, and the lack of published evidence on the safety and efficacy of different vaccines in these situations. Further research is indicated in the hope that more specific guidelines may be developed for this not uncommonly encountered area of uncertainty.