Increasing hepatitis B vaccine coverage in prisons in England and Wales

The most frequently reported risk factor for hepatitis B infection in England and Wales is injecting drug use (38%). Since approximately 61% of injecting drug users (IDUs) had been imprisoned and less than 40% had received hepatitis B vaccine, a prison based hepatitis B vaccination programme was set up in 2001. At the 42 establishments participating in this study, all prisoners were offered vaccine at reception. Prisoners over 18 years were vaccinated using the 0, 7 and 21 days schedule and those under 18 years, using the 0, 1 and 2 months schedule. As far as possible a fourth dose was given to all after 12 months. In 2003, 14,163 prisoners received at least one dose of vaccine and altogether 26,265 doses were administered. A further 1111 prisoners reported they had already been vaccinated against hepatitis B. The median vaccine coverage rate was 17% (range 0-94%). Despite low coverage levels, the vaccination programme in prisons can be said to have vaccinated a sizable number of young, male prisoners, a group that have previously been shown to be at high risk of infection. The prisons which achieved vaccine coverage levels over 50% had designated nursing staff who ran the vaccination clinics.     

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.     

Vaccine coverage levels after implementation of a middle school vaccination requirement, Florida, 1997-2000

OBJECTIVE: Little information is available about the effectiveness of school entry vaccination requirements at the middle school level. This study examined coverage levels among students entering seventh grade in Florida following implementation of a school entry vaccination requirement in 1997. METHODS: The authors analyzed county-specific vaccination coverage levels (three doses of hepatitis B vaccine, a second dose of measles, mumps, and rubella [MMR] vaccine, and a booster dose of tetanus and diphtheria toxoids [Td]) among students entering public and private schools in Florida from 1997 through 2000. In 1998, a survey of all county health departments was conducted, and the resulting data were linked to county-specific vaccination rates. RESULTS: During the 1997-1998 school year, the first year the requirement went into effect, at school entry 121,219 seventh-grade students (61.8%) were fully vaccinated, 72,275 seventh grade students (36.9%) lacked one or more doses of vaccine but were considered in process, 1,817 were non-compliant (0.9%), and 763 had medical or religious exemptions (0.4%). In the 2000-2001 school year, the proportions of students reported fully vaccinated at school entry had increased to 66%. Most of this change was related to an increase in hepatitis B coverage. There was a significant inverse relationship between the proportion of students fully vaccinated and the size of the county''s seventh grade population. CONCLUSIONS: The seventh grade vaccination entry requirement was associated with sustained high levels of vaccination coverage. Passing a school entry vaccination requirement appears may be sufficient to increase coverage, but other strategies may be required to achieve full immunization of middle school students.     

Evaluation of invalid vaccine doses

BACKGROUND: The 2002 Recommended Childhood Immunization Schedule clarified the definition of an invalid dose of vaccine as any dose administered >/=5 days before the minimum age or interval had elapsed. Any invalid dose of vaccine should be repeated. OBJECTIVE: Determine the proportion of U.S. children who received an invalid dose of vaccine, evaluate the impact on vaccination coverage levels if invalid doses were not counted, and determine the vaccine purchase cost if at least one invalid dose is repeated. METHODS: Provider-reported vaccination histories of children aged 19 to 35 months sampled by the 2000 National Immunization Survey were evaluated. Analyses were performed in 2002 after the 2002 Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule was released. Any vaccine dose administered >/=5 days before the recommended minimum age or interval was classified as invalid. Change in vaccination coverage was determined by subtracting estimated valid-dose coverage (based on number of valid doses received) from the estimated up-to-date coverage (based on number of doses received regardless of age or spacing). RESULTS: Overall, 10.5% (+/-0.6%) of children had received at least one invalid dose of vaccine. Of the invalid doses, 51% were hepatitis B, 100% of which were the third dose; 19% were diphtheria-tetanus-pertussis (DTP/DTaP), 92% of which were the fourth dose; 12% were measles-containing vaccine (MCV); 15% were varicella vaccine; and 4% were polio vaccine, 96% of which were the first dose. Excluding invalid doses resulted in a small change in vaccination coverage: 2.2% for DTP/DTaP, 0.7% for polio, 6.5% for hepatitis B, 1.4% for MCV, and 1.7% for varicella. The vaccine purchase cost to repeat at least one invalid dose ranged from approximately $10 million (public-purchased) to approximately $18 million (private-purchased). CONCLUSIONS: Nationally about 595,000 of children aged 19 to 35 months, born between February 1997 and May 1999, received at least one invalid dose of vaccine. The cost of revaccinating these children is substantial and may have a negative impact on parents, physicians, and vaccine purchasers. Educating immunization providers regarding proper immunization timing should be conducted to reduce the administration of invalid doses of vaccines.     

The Impact of State Policies on Vaccine Coverage by Age 13 in an Insured Population

PurposeTo determine the impact of state policies on vaccine coverage among adolescents with managed care insurance.MethodsWe used the 2003 Health Plan Employer Data and Information Set to determine state-specific hepatitis B and varicella vaccine coverage among children with managed care insurance who turned 13 years in 2002. Our outcomes of interest were receipt of hepatitis B and varicella vaccines by age 13. Utilizing weighted least-squares methods, multiple linear regression models were developed to evaluate the relationship between hepatitis B and varicella vaccine coverage and state policies, while controlling for state sociodemographic variables.ResultsAcross 28 states, adolescent hepatitis B vaccine coverage ranged from 35.3% to 80.5% (mean = 55.3%) and varicella vaccine coverage ranged from 22.9% to 7.6% (mean = 42.3%). In separate multiple regression models, after adjusting for potentially confounding sociodemographic variables, middle school mandates were significantly associated with hepatitis B vaccine coverage (p = .002) and varicella vaccine coverage (p = .024). Other policies, including universal purchase of vaccines and availability of philosophic exemptions, were not associated with vaccine coverage in this insured population.ConclusionsIn this population of insured adolescents, middle school vaccine mandates were the only state policy associated with improved hepatitis B and varicella vaccine coverage. Mandates are an effective method for promoting adolescent immunization.     

邹城市儿童常规免疫接种情况调查

[目的]了解现阶段儿童常规免疫接种率及其影响因素,进一步推动儿童计划免疫持续、深入地发展。[方法]按容量比例概率抽样（PPS）法,调查630名2001年1月1日至2003年12月31日出生儿童的“四苗”及乙肝疫苗接种情况。[结果]“四苗”全程合格接种率为95．48％,乙肝疫苗首针及时接种率为92．06％。不合格接种原因：超期接种占54．13％。99．68％的儿童都是到预防接种门诊进行接种。[结论]邹城市计划免疫“四苗”及乙肝疫苗接种率均保持在较高水平,规范化接种门诊建设效果显著,已进入新的发展阶段。     

Hepatitis B vaccination coverage levels among healthcare workers in the United States, 2002-2003.

BACKGROUND: Hepatitis B virus (HBV) infection is a well recognized risk for healthcare workers (HCWs), and routine vaccination of HCWs has been recommended since 1982. By 1995, the level of vaccination coverage among HCWs was only 67%. OBJECTIVE: To obtain an accurate estimate of hepatitis B vaccination coverage levels among HCWs and to describe the hospital characteristics and hepatitis B vaccination policies associated with various coverage levels. DESIGN: Cross-sectional survey. METHODS: A representative sample of 425 of 6,116 American Hospital Association member hospitals was selected to participate, using probability-proportional-to-size methods during 2002-2003. The data collected included information regarding each hospital's hepatitis B vaccination policies. Vaccination coverage levels were estimated from a systematic sample of 25 HCWs from each hospital whose medical records were reviewed for demographic and vaccination data. The main outcome measure was hepatitis B vaccination coverage levels. RESULTS: Among at-risk HCWs, 75% had received 3 or more doses of the hepatitis B vaccine, corresponding to an estimated 2.5 million vaccinated hospital-based HCWs. The coverage level was 81% among staff physicians and nurses. Compared with nurses, coverage was significantly lower among phlebotomists (71.1%) and nurses' aides and/or other patient care staff (70.9%; P<.05). Hepatitis B vaccination coverage was highest among white HCWs (79.5%) and lowest among black HCWs (67.6%; P<.05). Compared with HCWs who worked in hospitals that required vaccination only of HCWs with identified risk for exposure to blood or other potentially infectious material, hepatitis B vaccination coverage was significantly lower among HCWs who worked in hospitals that required vaccination of HCWs without identified risk for exposure to blood or other potentially infectious material (76.6% vs 62.4%; P<.05). CONCLUSIONS: In the United States, an estimated 75% of HCWs have been vaccinated against hepatitis B. Important differences in coverage levels exist among various demographic groups. Hospitals need to identify methods to improve hepatitis B vaccination coverage levels and should consider developing targeted vaccination programs directed at unvaccinated, at-risk HCWs who have frequent or potential exposure to blood or other potentially infectious material.     

北京市安定镇15岁以下人群水痘疫苗接种情况

目的了解北京市安定镇15岁以下人群水痘疫苗接种情况,为提高水痘疫苗接种率和控制水痘疫情提供依据。方法对北京市安定镇全部15岁以下人群通过免疫规划信息系统和查阅应急接种表,对水痘疫苗接种史进行描述性分析。结果共调查3 461人,水痘疫苗接种率66.57%(76.62～34.39%),1～7岁组接种率维持在较高水平(71.64%～76.62%),年龄组接种率差异有统计学意义(P0.01)。该地人群与外地人群接种率分别为60.78%、67.56%,差异有统计学意义(P0.01)。进口水痘疫苗接种率随年龄下降而增加;托幼机构和小学、中学水痘疫苗接种率分别为78.72%、63.84%、41.40%,差异有统计学意义(P0.01)。应急接种占总接种数的42.52%;小、中学生应急接种分别占该年龄组接种总数的52.67%、94.76%。结论该镇要加强15岁以下人群水痘疫苗接种宣传,提高接种率,控制托幼机构和学校水痘疫情。     

2002-2004年甘肃省43县出生儿童乙肝疫苗漏种调查

目的了解甘肃省国家扶持开发工作重点县（国扶县）2002-2004年出生儿童乙肝疫苗查漏补种情况。方法 2008-10/2009-03对甘肃省43个国扶县适龄儿童开展乙肝疫苗接种情况进行调查,对漏种的儿童进行补种。结果调查352856名儿童,漏种率为18.14%,其中2002-2004年出生儿童乙肝疫苗漏种率分别为23.16%、16.23%和14.82%;漏种3剂次的儿童数占漏种儿童总数的46.53%,较漏种1剂次儿童数和漏种2剂次儿童数多;完成全程补种率为97.16%;补种剂次率为97.25%。结论甘肃省43个国扶县适龄儿童乙肝疫苗漏种率逐年下降,但部分儿童仍存在免疫空白。     

Mass measles vaccination in urban Burkina Faso, 1998

OBJECTIVE: To assess the impact of the National Immunization Days (NIDs) on measles vaccine coverage in Burkina Faso in 1998. METHODS: During the week after the campaign, in which measles vaccine was offered to children aged 9-59 months in six cities regardless of vaccination history, a cluster survey was conducted in Ouagadougou and Bobo Dioulasso, the country's two largest cities. Interviewers visited the parents of 1267 children aged up to 59 months and examined vaccination cards. We analysed the data using cluster sample methodology for the 1041 children who were aged 9-59 months. FINDINGS: A total of 604 (57%) children had received routine measles vaccination prior to the campaign, and 823 (79%) were vaccinated during the NIDs. Among those who had previously had a routine vaccination, 484 (81%) were revaccinated during the NIDs. Among those not previously vaccinated, 339 (78%) received one dose during the NIDs. After the campaign, 943 (91%) children had received at least one dose of measles vaccine. Better socioeconomic status was associated with a higher chance of having been vaccinated routinely, but it was not associated with NID coverage. CONCLUSION: The mass campaign enabled a substantial increase in measles vaccine coverage to be made because it reached a high proportion of children who were difficult to reach through routine methods.     

乙肝疫苗扩免策略实施效果评价

目的:评价乙肝疫苗扩免策略实施效果。方法:分析烟台市新生儿乙肝疫苗接种及影响因素,整群随机检测1 543名7～12月龄儿童乙肝表面抗体(Anti-HBs)水平;描述分析15岁以下儿童乙肝发病状况。结果:烟台市新生儿乙肝疫苗接种率、及时率保持在97%以上,阳性母亲的新生儿77.35%采用乙肝免疫球蛋白(HBIG)联合阻断;5μg啤酒酵母扩免乙肝疫苗具有较高的免疫原性,80.75%儿童能够产生保护性应答,接种医院级别及父母乙肝感染状况是影响免疫应答的因素;扩免策略实施后儿童乙肝发病率大幅下降,5年降低了78.99%。结论:烟台市新生儿乙肝疫苗免疫策略效果显著,强化产科培训,正确把握接种禁忌,普及孕妇HBV检测,完善低/无应答者免疫将进一步降低乙肝发病率。     

Coverage rates of influenza vaccination in France: a population-based cross-sectional analysis of seasons 2001-2002 and 2002-2003

INTRODUCTION: Influenza is a serious health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. OBJECTIVES: The authors had for aim to assess influenza vaccination coverage during two seasons in France, to understand the incentives and barriers to vaccination and to determine vaccination intentions for the following winter. METHODS: A random-sampling, mail-based household survey was made among non-institutionalised individuals aged 15 and over. The surveys for 2001-2002 and 2002-2003 used the same questionnaire and were subsequently pooled. Three target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field and (3) persons aged 65 and over or working in the medical field. RESULTS: Influenza vaccination coverage in France decreased from 23.0% in 2001-2002 to 22.4% in 2002-2003. Most frequent reasons for being vaccinated were advice from the family doctor (50.8%), influenza considered as a serious illness (45.3%) and free vaccine (44.1%). Reasons for not being vaccinated mentioned by people who had never been vaccinated were young age (27.0%), not considering vaccination (18.9%), and not expecting to catch influenza (13.9%). CONCLUSION: Vaccination coverage decreased during the 2002-2003 season in comparison to the 2001-2002 season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.     

江苏省沭阳县中小学生乙肝疫苗接种率与HBV感染率调查

目的为了解中小学生乙肝疫苗接种率及乙肝病毒（HBV）感染水平,探讨乙肝疫苗的免疫效果及持久性,为制定其他人群乙肝防制措施提供依据。方法调查分析江苏省沭阳县中小学生乙肝疫苗免疫史及检测其HBV血清标志物,并比较二者关系。结果乙肝疫苗接种率为84．79％,加强接种率为41．60％,未种率为1．66％,年龄越低接种率越高;HBSAg阳性率为2．67％,随年龄增长而增高;抗-HBs阳性率为55．66％,随年龄增长而下降;HBsAg阳性率与接种针次成反比,抗-HBs阳性率与接种针次成正比。结论接种乙肝疫苗是控制HBV感染的有效手段,在提高初免接种率的同时,应定期开展加强接种。     

Implementing a seventh grade vaccination law: school factors associated with completion of required immunizations

OBJECTIVES: We investigated school factors associated with successful implementation of a seventh grade vaccination requirement. METHODS: The proportion of students vaccinated with hepatitis B vaccine and measles containing vaccine was determined from records of schools in San Diego County, California. A school survey identified compliance strategies. Analysis identified factors associated with coverage. RESULTS: In October 1999, 67.2% of 38,875 students had received the required vaccine doses. Of 315 schools, coverage was less than 40% in 60 schools and exceeded 80% in 111 schools. Factors associated with high coverage included private schools, early and frequent notice to parents, and, for public schools, higher overall socioeconomic status of students. CONCLUSIONS: In preparation for a middle school vaccination requirement, early and frequent notification of parents improves coverage. Schools with a high percentage of low socioeconomic status students may require extra resources to support implementation.     

Cost-effectiveness of routine and campaign vaccination strategies in Ecuador

A national household coverage survey of 3697 Ecuadorean children, carried out in July 1986, provided an opportunity for a cost-effectiveness analysis of (1) routine vaccination services based in fixed facilities and (2) mass immunization campaigns. A major purpose of the campaigns was to complement the routine services and to accelerate immunization activities. Based on the coverage survey, the Program for Reduction of Maternal and Childhood Illness (PREMI) and earlier campaigns increased the proportion of children under 5 years who were fully vaccinated from 43% to 64%. In one year, the PREMI campaign was responsible for fully vaccinating 11% of children under one year, 21% of 1-2-year-old children, and 13% of all children under 5 years. The campaign also helped ensure that vaccinations were completed when children were still very young and at greatest risk. The average cost per vaccination dose (in 1985 US$ prices) was approximately $0.29 for fixed facilities and $0.83 for the PREMI campaign. Total national costs were $675,000 and $1,665,000 for routine and campaign services respectively. The cost per fully vaccinated child (FVC) was $4.39 for routine vaccination services and $8.60 for the campaign. The cost per death averted was about $1900 for routine vaccination services, $4200 for the PREMI campaign, and $3200 for the combined programme. Because of Ecuador's lower mortality rates, the costs per death averted in Ecuador from both vaccination strategies are not as low as those from studies of vaccinations in Africa. The campaigns, though less cost-effective than routine services, significantly improved the vaccination coverage of younger children who had been missed by the routine services. The costs per FVC of both the campaign and the routine services compare favourably with such programmes in other countries.     

中国不同地区产妇住院分娩率与新生儿乙型肝炎疫苗接种率分析

目的分析新生儿乙型肝炎(乙肝)疫苗(HepB)接种率与产妇住院分娩率之间的关系,指导HepB预防接种工作。方法将2003年国家卫生服务调查的产妇住院分娩数据与2005年全国常规免疫接种报告的新生儿HepB接种数据进行配比分析。结果城市产妇住院分娩率高于农村,城市新生儿HepB接种率高于农村。在农村,产妇住院分娩率越高,新生儿HepB接种率越高,新生儿HepB接种率和产妇住院分娩率关系密切。结论为了提高新生儿HepB接种率,必须大力提倡产妇住院分娩,保证在医院出生的新生儿及时接种HepB;对在家出生的新生儿应采取特殊策略,保证及时接种HepB。     

Solid organ transplantation and response to vaccination

Although early vaccination is recommended in candidates for solid organ transplantation (SOT), consensual protocols do not yet exist. We applied an SOT vaccination protocol in the Hospital Clinic of Barcelona (Spain). Serology was performed before and after vaccination and compliance with the vaccination schedule was analysed during the period 2003-2004. Two hundred and thirty seven patients (72.9% male; mean age 56.31 years, range 19-72) were included. A total of 74.5% of subjects susceptible to hepatitis B virus infection responded to hepatitis B vaccination. Most patients were protected against hepatitis A, varicella, measles, rubella and mumps. The vaccine protocol was implemented satisfactorily and the administration of two courses of hepatitis B vaccine was shown to be effective.     

National, state, and local area vaccination coverage among children aged 19-35 months--United States, 2006

The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19-35 months for each of the 50 states and selected urban and county areas. This report describes the findings of the 2006 NIS, which indicated increases in national coverage with pneumococcal conjugate vaccine (PCV) and varicella vaccine (VAR) and a stable coverage level for the 4:3:1:3:3:1 vaccine series (i.e., > or =4 doses of diphtheria, tetanus toxoid, and any acellular pertussis vaccine [DTaP]; > or =3 doses of poliovirus vaccine; > or =1 dose of measles, mumps, and rubella vaccine [MMR]; > or =3 doses of Haemophilus influenzae type b [Hib] vaccine; > or =3 doses of hepatitis B vaccine [HepB]; and > or =1 dose of VAR). However, national coverage estimates remained below the Healthy People 2010 target of 90% coverage for PCV, DTaP, and VAR and below the 80% target for the 4:3:1:3:3:1 vaccine series. No significant racial/ethnic disparities in 4:3:1:3:3:1 series coverage were observed after controlling for family income. State and local immunization programs should continue to identify and target children who are not fully vaccinated, especially because of low socioeconomic status and other barriers.     

2009～2011年潍坊市15岁以下儿童乙肝疫苗漏种补种情况调查

[目的]了解潍坊市乙肝疫苗漏种补种情况,为降低儿童乙肝病毒感染率和乙肝表面抗原携带率提供科学依据。[方法]2009～2011年,对潍坊市1994年1月1日至2001年12月31日出生的未接种或未完成乙肝疫苗全程接种儿童进行调查并实施补种乙肝疫苗。[结果]调查儿童692 661人,查出漏种乙肝疫苗儿童101 351人,漏种率为14.63%;应补种101 351针次,实补种100 963人,补种率为99.62%。其中1针次、2针次和3针次乙肝疫苗补种率分别为99.62%、99.60%、99.62%。2009～2011年补种率分别为99.82%、99.10%、99.89%。[结论]潍坊市15岁以下儿童乙肝疫苗补种率较高。     

石家庄市饮食行业从业人员乙型肝炎疫苗接种率与乙型肝炎知识知晓率的关系

目的了解石家庄市饮食行业从业人员乙型肝炎（乙肝）疫苗接种情况与乙肝知识知晓情况之间的关系。方法采用分层整群随机抽样方法,对4065名HBsAg阴性的饮食行业人员进行问卷调查,同时进行乙肝表面抗体（抗-HBs）的检测。结果乙肝相关知识平均知晓率为72.72%;其中有乙肝疫苗接种史的知晓率为73.28%,无乙肝疫苗接种史和不详的知晓率分别为69.96%和71.55。结论石家庄市饮食行业从业人员中有乙肝疫苗接种史的知晓率较高,但对某些知识点存在误区,应加强健康教育。