Intensification of measles vaccination coverage

Better coverage of susceptibles with measles vaccine has clear demonstratable impact on disease incidence. Education and strong motivation of implementors and community at large and improvement in other managerial and administrative support actions for the programme are considered essential to boost up measles immunisation coverage. It is therefore, expected that with well planned and sustained implementation of country wide campaign of measles immunisation, the disease can be brought under control. This needs strong will, determination and urgency for well planned and sustained actions if we have to achieve desired goal--"IMMUNISATION FOR ALL BY 1990". The efforts required for achieving the targets are discussed in this paper.     

Economic burden of varicella in Singapore--a cost benefit estimate of implementation of a routine varicella vaccination

Varicella is a common childhood illness that can result in significant morbidity and mortality. As early as 1995, recommendations for routine varicella vaccination have been published, but have not been universally implemented, with cost of vaccination as a major reason. Though available from 1996, the vaccine has yet to be routinely implemented in Singapore. We set out to assess the economic burden of varicella and the cost-benefit of adding a varicella vaccine to the existing immunization schedule in Singapore. In this study, using data from 1994--1995 the direct cost estimates were based on all levels of medical care; inpatient care, emergency room visits, primary health care and medication. Indirect costs were estimated from the cost of time lost by patients and their families attending to medical needs, as well as loss of productivity due to absenteeism. The cost of a vaccination program targeted at 15-month old infants receiving concomitant measles-mumps-rubella immunization was also assessed. The cost-benefit ratio was then estimated. The total cost of varicella in Singapore was estimated to be US$11.8 million per annum. The loss of productivity accounted for a large proportion of the total cost as a lot of parents took leave when their children were ill. The estimates of total cost represent approximately US$188 per varicella case per year. In comparison, the cost of a vaccination program was found to be US$3.3 million per annum. The cost per case averted was US$104. From a societal point of view, for every dollar invested in a vaccination program, we would save about US$2 dollars.     

Optimal age for vaccination against measles

A review of the general aspects of the transmission dynamics of measles is presented. Similarities and differences in the patterns of transmission of measles in developed and developing countries are pointed out. Epidemiological, demographic and nutritional variables relevant to the design of an immunization program are briefly discussed. Since there is no cohort in developing countries in which most individuals are susceptible, it is concluded that there is no single optimum age at which to vaccinate against measles. Finally, a simple method based upon case notification records, for calculating the force and average age of infection as well as the optimum age for vaccination against measles is illustrated.     

Individualizing the risk/benefit ratio of NSAIDs in older patients.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have provided safe, effective relief of pain and inflammation in millions of elderly patients. Their role in the therapy of rheumatic disease, particularly in helping patients to maintain an independent lifestyle, is indisputable. Despite this success, recent epidemiologic studies have confirmed an increased relative risk for a wide variety of significant toxicities. Advanced age has emerged as one of the most striking risk factors for all of the commonly associated side effects. However, considering the large proportion of the population using these drugs, the absolute risk is remarkably low. Recognizing those elderly individuals most likely to benefit and least likely to suffer from NSAID use is the key to their appropriate use.     

Evolution of the measles vaccination program in Costa Rica

The vaccination program instituted in Costa Rica in 1967 has had a great impact on measles. Since 1973 the downturn in its incidence and in mortality due to the disease are due solely to the continued vaccination of susceptible children throughout the country. An epidemic outbreak occurred in 1977. Since the vaccine was given primarily to children of school age, this outbreak probably was the result of an accumulation of susceptible subjects. There was little change in the mortality rates. Programs resulting in a coverage of 70% attempted to prevent a new outbreak in 1979, but failed. Because the vaccine was routinely administered to children one year of age and older, most of the cases were in the group younger than that age. At present, the incidence of measles is minimal, and no fatalities occurred in 1981. Vaccination coverage for children two years of age exceeds 90%, and Costa Rica's goal is the complete eradication of the disease.     

Pulse mass measles vaccination across age cohorts.

Although vaccines against measles have been routinely applied over a quarter of a century, measles is still persistent in Israel, with major epidemics roughly every 5 years. Recent serological analyses have shown that only 85% of Israelis aged 18 years have anti-measles IgG antibodies. Considering the high transmissibility of the virus and the high level of herd immunity required for disease eradication, the Israeli vaccination policy against measles is now being reevaluated. Motivated by theoretical studies of populations in perturbed environments, we examined the possibility of replacing the conventional cohort vaccination strategy by a pulse strategy--i.e., periodic vaccination of several age cohorts at the same time. Numerical studies of a deterministic age-structured model suggest that vaccination, which renders immunity to no more than 85% of the susceptible children aged 1-7 years, once every 5 years will suffice to prevent epidemics in Israel, where infection rate is highest amongst schoolchildren. The model suggests that by using such a strategy the density of susceptible individuals is always kept below the threshold above which recurrent epidemics will be maintained. Analysis of simpler, non-age-structured, models serves to clarify the basic properties of the proposed strategy. Our theoretical results indicate that the advantages and disadvantages of a pulse strategy should be seriously examined in Israel and in countries with similar patterns of measles virus transmission.     

Risk/benefit ratio of long-term treatment withβ 2-adrenoceptor agonists

Optimal control of chronic obstructive airway disorders is usually achieved with therapy based onβ ₂-adrenoceptor agonist administration. Aerosols are highly effective, have few side effects, allow for fine adjustment of dosage to titrate symptoms, and result in reduction in hyperreactivity. Equivalent bronchodilating doses of oral agents cause side effects that limit acceptability. With oral agents, cardiohemodynamic disturbances are usually minor, while tremor and restlessness diminish with continued drug use. In chronic regimens, an aerosolβ ₂-adrenergic agent should be chosen whose overall incidence of side effects is less than 5%, and an oral agent that produces no more than a 10% incidence of tremor. Suboptimal oral dosages in combination with maximal dosages ofβ ₂-agonist aerosol, with or without other bronchodilator drugs, are advisable for chronic therapy. An optimal risk/benefit ratio with broxaterol therapy will probably be achieved by using an aerosol-oral combination. Thus, broxaterol, a newβ ₂-agent, should be studied further to determine its value in chronic bronchospastic disorders.     

Early measles vaccination in bone marrow transplant recipients

Measles vaccination has been recommended after the second year following bone marrow transplant (BMT) in patients not receiving immunosuppressive drugs. During a measles outbreak, we vaccinated all patients after the first year of transplant, and conducted a prospective trial to evaluate safety, effectiveness and sustained immunity after early vaccination. Patients received attenuated virus vaccine between 9 and 18 months after BMT. A total of 51 patients were evaluated and 27 of them (52.9%) were receiving immunosuppressive drugs. Only mild adverse reactions were noted. Nine patients (17.6%) were susceptible (IgG< or =100 mIU/ml) at vaccination, and all seroconverted. In those immune at vaccination, a four-fold increase in measles IgG titers was found in one of 34 patients (2.9%) with specific IgG> or =200 mIU/ml compared to 14 of 17 (82.3%) with IgG<200 mIU/ml (P< 0.0001). Sustained immunity after 24 months was more likely to occur in patients with specific IgG levels< or =200 or > or =500 mIU/mL (83.4 and 100%, respectively) in comparison to patients with 200相似文献   

Antibody response to measles vaccination in Turkish children

Summary In recent years, there has been a remarkable increase in measles cases among preschool and secondary school children in Turkey, as in many other countries. The seroconversion and coverage rates of measles vaccine should therefore be evaluated in order to obtain data that could be used to determine the vaccination policy for Turkey. Measles immunity status was studied by an enzyme-linked immunosorbent (ELISA) test determining the anti-measles IgG antibody levels. Measles specific IgG antibodies were found to be positive in 77.88% of the entire study group of 800 children aged 11 months to 12 years, while 21.25% had negative sera. Seven (0.87%) subjects had borderline results. The results of this study indicate the need to administer a second dose of measles vaccine, preferably at 18 months of age concomitant with other vaccines. This vaccination policy, together with an increase in the extent of immunization coverage, may help to achieve the World Health Organization's (WHO) target of the complete eradication of measles.

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Antikörperantwort auf Masernimpfung bei türkischen Kindern

Zusammenfassung Masernfälle haben in den letzten Jahren bei Vorschul- und Schulkindern in der Türkei erheblich zugenommen. Diese Beobachtung wurde auch in anderen Ländern gemacht. Es ist daher nötig, Untersuchungen zur Serokonversion und Durchimpfung mit Masernimpfstoff durchzuführen, um Daten zu haben, die als Grundlage für die Impfstrategien in der Türkei verwendet werden können. Der Masern-Immunstatus wurde mittels enzymgebundenem Immunsorbent-Assay (ELISA) bestimmt. Die Messung der anti-Masern IgG-Antikörperspiegel ergab einen positiven Befund bei 77,88% der gesamten Gruppe von 800 Kindern im Alter von 11 Monaten bis 12 Jahren. 21,25% der Seren wurden als negativ beurteilt. Sieben Kinder (0,87%) hatten grenzwertige Ergebnisse. Die Daten der Studie sprechen dafür, vorzugsweise im Alter von 18 Monaten eine zweite Dosis Masernimpfstoff zu applizieren, wenn auch andere Impfungen erfolgen. Mit dieser Impfstrategie und einer besseren Durchimpfung könnte das Ziel der Weltgesundheitsorganisation (WHO), Masern völlig auszurotten, leichter erreicht werden.

     

Severity of measles among patients with incidental postexposure vaccination

It has not been well elucidated whether patients with measles who have undergone postexposure prophylaxis (PEP) exhibit milder clinical symptoms than would be expected in the absence of PEP. In the present study, we compared the severity of measles of patients who had undergone incidental PEP to those of patients who had not received such prophylaxis. An outbreak of measles occurred among the personnel of the Japan Self-Defense Forces (SDF) between 7 May and 14 June 2007 at 3 camps in or near Sendai City. All patients were admitted to SDF Sendai Hospital for isolation and care. Measles was confirmed in 21 patients (age: 21.9 +/- 5.9 years). Of the 15 ill recruits (persons who had just joined SDF), 8 underwent incidental PEP on 10 May, 3 days after the onset of the prodromal symptoms in the first patient. The vaccination was not originally intended as PEP and was administered within the framework of a routine vaccination program. Compared to recruits without PEP (n = 7), the admission period was 5.6 days shorter, the period with high fever (39C or more) was 2.7 days shorter, and the maximum body temperature was 1.1C lower in the recruits with PEP (n = 8). These results suggest that PEP ameliorates the clinical symptoms of measles.