The epidemiology of invasive pneumococcal disease in the Canadian North from 1999 to 2010

Introduction . The International Circumpolar Surveillance network is a population-based surveillance system that collects data on invasive pneumococcal disease (IPD) in Northern Canada. A 7-valent pneumococcal conjugate vaccine was first introduced in some regions of Northern Canada in 2002, followed by 10-valent (2009) and 13-valent (PCV-13) vaccines (2010). A 23-valent polysaccharide (PPV-23) vaccine was first introduced in 1988 for special populations and adults aged 65 years and older. To describe the epidemiology in the context of pneumococcal vaccination programs, we analysed surveillance data from Northern Canada from 1999 to 2010. Methods . A standardized case report form capturing demographic and clinical information was completed for all IPD cases in Northern Canada meeting the national case definition. Isolates were sent to a reference laboratory for confirmation, serotyping and antimicrobial resistance testing. Both laboratory and epidemiological data were sent to the Public Health Agency of Canada for analysis. Population denominators were obtained from Statistics Canada. Results . From 1999 to 2010, 433 IPD cases were reported (average 36 cases per year). Incidence was greatest among infants aged <2 years and among those aged 65 years and older, with an average annual incidence of 133 and 67 cases per 100,000 population, respectively. After a peak in incidence in 2008, rates among infants have declined. Incidence rates varied from 2 to 16 times greater, depending on the year, among Aboriginals compared to non-Aboriginals. Hospitalization was reported in 89% of all cases and the case fatality ratio was 6.0%. Clinical manifestations varied, with some patients reporting >1 manifestation. Pneumonia was the most common (70%), followed by bacteremia/septicaemia (30%) and meningitis (8%). Approximately, 42% of cases aged <2 years in 2009 and 2010 had serotypes covered by the PCV-13. In addition, the majority (89%) of serotypes isolated in cases aged 65 years and older were included in the PPV-23 vaccine. Conclusion . IPD continues to be a major cause of disease in Northern Canadian populations, with particularly high rates among infants and Aboriginals. Continued surveillance is needed to determine the impact of conjugate pneumococcal vaccine programs. Additional studies investigating factors that predispose infants and Aboriginal peoples would also be beneficial

Ascertainment of childhood vaccination histories in northern Malawi

OBJECTIVE: To assess factors related to recorded vaccine uptake, which may confound the evaluation of vaccine impact.METHODS: Analysis of documented vaccination histories of children under 5 years and demographic and socio-economic characteristics collected by a demographic surveillance system in Karonga District, Malawi. Associations between deviations from the standard vaccination schedule and characteristics that are likely to be associated with increased mortality were determined by multivariate logistic regression.RESULTS: Approximately 78% of children aged 6-23 months had a vaccination document, declining to <50% by 5 years of age. Living closer to an under-5 clinic, having a better educated father, and both parents being alive were associated with having a vaccination document. For a small percentage of children, vaccination records were incomplete and/or faulty. Vaccination uptake was high overall, but delayed among children living further from the nearest under-5 clinic or from poorer socio-economic backgrounds. Approximately 9% of children had received their last dose of DPT with or after measles vaccine. These children were from relatively less educated parents, and were more likely to have been born outside the health services.CONCLUSIONS: Though overall coverage in this community was high and variation in coverage according to child or parental characteristics small, there was strong evidence of more timely coverage among children from better socio-economic conditions and among those who lived closer to health facilities. These factors are likely to be strong confounders in the association of vaccinations with mortality, and may offer an alternative explanation for the non-specific mortality impact of vaccines described by other studies

Evaluation and use of surveillance system data toward the identification of high-risk areas for potential cholera vaccination: a case study from Niger.

In 2008, Africa accounted for 94% of the cholera cases reported worldwide. Although the World Health Organization currently recommends the oral cholera vaccine in endemic areas for high-risk populations, its use in Sub-Saharan Africa has been limited. Here, we provide the principal results of an evaluation of the cholera surveillance system in the region of Maradi in Niger and an analysis of its data towards identifying high-risk areas for cholera

Guidelines for vaccinating pregnant women: abstracted from recommendations of the Advisory Committee on Immunization Practices (ACIP)

The table on the following page may be used to find the general rule for vaccinating a pregnant woman with a particular vaccine. The third column of the table refers the reader to the page in this document where more specific information from the appropriate ACIP recommendations will be found. Each quotation from an ACIP recommendation in turn references the entire document, where the quotation(s) may be found in context.March 2013.Available via the World Wide Web as an Acrobat .pdf file (141.93 KB, 13 p.).Includes bibliographical references (p. 9-10)

Immunization of health-care personnel : recommendations of the Advisory Committee on Immunization Practices (ACIP)

"This report updates the previously published summary of recommendations for vaccinating health-care personnel (HCP) in the United States (CDC. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices [ACIP] and the Hospital Infection Control Practices Advisory Committee [HICPAC]. MMWR 1997;46[No. RR-18]). This report was reviewed by and includes input from the Healthcare (formerly Hospital) Infection Control Practices Advisory Committee. These updated recommendations can assist hospital administrators, infection-control practitioners, employee health clinicians, and HCP in optimizing infection prevention and control programs. The recommendations for vaccinating HCP are presented by disease in two categories: 1) those diseases for which vaccination or documentation of immunity is recommended because of risks to HCP in their work settings for acquiring disease or transmitting to patients and 2) those for which vaccination might be indicated in certain circumstances. Background information for each vaccine-preventable disease and specific recommendations for use of each vaccine are presented. Certain infection-control measures that relate to vaccination also are included in this report. In addition, ACIP recommendations for the remaining vaccines that are recommended for certain or all adults are summarized, as are considerations for catch-up and travel vaccinations and for work restrictions. This report summarizes all current ACIP recommendations for vaccination of HCP and does not contain any new recommendations or policies. The recommendations provided in this report apply, but are not limited, to HCP in acute-care hospitals; long-term--care facilities (e.g., nursing homes and skilled nursing facilities); physician's offices; rehabilitation centers; urgent care centers, and outpatient clinics as well as to persons who provide home health care and emergency medical services." - p.1Introduction -- Methods -- Diseases for which vaccination is recommended -- Diseases for which vaccination might be indicated in certain circumstances -- Other vaccines recommended for adults -- Acknowledgments -- Referencesprepared by Abigail Shefer, William Atkinson, Carole Friedman, David T. Kuhar, Gina Mootrey, Stephanie R. Bialek, Amanda Cohn, Anthony Fiore, Lisa Grohskopf, Jennifer L. Liang, Suchita A. Lorick, Mona Marin, Eric Mintz, Trudy V. Murphy, Anna Newton, Amy Parker Fiebelkorn, Jane Seward, Gregory Wallace."The material in this report originated in the National Center for Immunization and Respiratory Diseases, Anne Schuchat, MD, Director." - p. 1Includes bibliographical references (p. 29-37).Infectious DiseaseOccupational HealthPrevention and ControlCurrentACIP2210858

Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP)

"In June 2005 and June 2006, ACIP adopted new recommendations regarding the use of live, attenuated varicella vaccines for prevention of varicella. This report revises, updates, and replaces the 1996 and 1999 ACIP statements for prevention of varicella. The new recommendations include 1) implementation of a routine 2-dose varicella vaccination program for children, with the first dose administered at age 12-15 months and the second dose at age 4-6 years; 2) a second dose catch-up varicella vaccination for children, adolescents, and adults who previously had received 1 dose; 3) routine vaccination of all healthy persons aged >13 years without evidence of immunity; 4) prenatal assessment and postpartum vaccination; 5) expanding the use of the varicella vaccine for HIV-infected children with age-specific CD4+T lymphocyte percentages of 15%-24% and adolescents and adults with CD4+T lymphocyte counts >200 cells/\u3bcL; and 6) establishing middle school, high school, and college entry vaccination requirements. ACIP also approved criteria for evidence of immunity to varicella." - p. 1prepared by Mona Marin, Dalya Gu\u308ris, Sandra S. Chaves, Scott Schmid, Jane F. Seward, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDCIncludes bibliographical references (p. 32-37).Infectious DiseasePrevention and ControlCurrentACI

Measles, mumps, and rubella: vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps : recommendations of the Advisory Committee on Immunization Practices (ACIP)

These revised recommendations of the Advisory Committee on Immunization Practices (ACIP) on measles, mumps, and rubella prevention supersede recommendations published in 1989 and 1990. This statement summarizes the goals and current strategies for measles, rubella, and congenital rubella syndrome (CRS) elimination and for mumps reduction in the United States. Changes from previous recommendations include: Emphasis on the use of combined MMR vaccine for most indications; A change in the recommended age for routine vaccination to 12-15 months for the first dose of MMR, and to 4-6 years for the second dose of MMR; A recommendation that all states take immediate steps to implement a two dose MMR requirement for school entry and any additional measures needed to ensure that all school-aged children are vaccinated with two doses of MMR by 2001; A clarification of the role of serologic screening to determine immunity; A change in the criteria for determining acceptable evidence of rubella immunity; A recommendation that all persons who work in health-care facilities have acceptable evidence of measles and rubella immunity; Changes in the recommended interval between administration of immune globulin and measles vaccination; and Updated information on adverse events and contraindications, particularly for persons with severe HIV infection, persons with a history of egg allergy or gelatin allergy, persons with a history of thrombocytopenia, and persons receiving steroid therapy.May 22, 1998.The following CDC staff members prepared this report: John C. Watson, Stephen C. Hadler, Clare A. Dykewicz, Susan Reef, Lynelle Phillips, Epidemiology and Surveillance Division, National Immunization Program.Includes bibliographical references (p. 48-58)

Recommended immunization schedules for persons aged 0 through 18 years and adults aged 19 years and older -- United States, 2013

Each year, recommendations for routine use of vaccines in children, adolescents, and adults in the United States are developed by the Advisory Committee on Immunization Practices (ACIP). This year, for the first time, recommended immunization schedules for persons aged 0 through 18 years and adults aged 19 years and older are being published togetherIntroduction -- Placing these schedules on your website -- Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for persons aged 0 through 18 years - United States, 2013 / ACIP Childhood/Adolescent Immunization Work Group: Iyabode Akinsanya-Beysolow, Ren\ue9e Jenkins, H. Cody Meissner -- Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for adults aged 19 years and older --United States, 2013 / ACIP Adult Immunization Work Group: Carolyn B. Bridges, LaDora Woods, Tamera Coyne-BeasleyFebruary 1, 2013.Available via the World Wide Web as an Acrobat .pdf file (1 MB, 21 p.).Includes bibliographical references.Infectious DiseasePrevention and ControlCurrentACIP2336430

A Comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). Part II. Immunization of adults

Hepatitis B vaccination is the most effective measure to prevent hepatitis B virus (HBV) infection and its consequences, including cirrhosis of the liver, liver cancer, liver failure, and death. In adults, ongoing HBV transmission occurs primarily among unvaccinated persons with behavioral risks for HBV transmission (e.g., heterosexuals with multiple sex partners, injection-drug users [IDUs], and men who have sex with men [MSM]) and among household contacts and sex partners of persons with chronic HBV infection. This report, the second of a two-part statement from the Advisory Committee on Immunization Practices (ACIP), provides updated recommendations to increase hepatitis B vaccination of adults at risk for HBV infection. The first part of the ACIP statement, which provided recommendations for immunization of infants, children, and adolescents, was published previously (CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices [ACIP]. Part 1: immunization of infants, children, and adolescents. MMWR 2005;54[No. RR-16]:1--33). In settings in which a high proportion of adults have risks for HBV infection (e.g., sexually transmitted disease/human immunodeficiency virus testing and treatment facilities, drug-abuse treatment and prevention settings, health-care settings targeting services to IDUs, health-care settings targeting services to MSM, and correctional facilities), ACIP recommends universal hepatitis B vaccination for all unvaccinated adults. In other primary care and specialty medical settings in which adults at risk for HBV infection receive care, health-care providers should inform all patients about the health benefits of vaccination, including risks for HBV infection and persons for whom vaccination is recommended, and vaccinate adults who report risks for HBV infection and any adults requesting protection from HBV infection. To promote vaccination in all settings, health-care providers should implement standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine clinical services, not require acknowledgment of an HBV infection risk factor for adults to receive vaccine, and use available reimbursement mechanisms to remove financial barriers to hepatitis B vaccination.prepared by Eric E. Mast, Cindy M. Weinbaum, Anthony E. Fiore, Miriam J. Alter, Beth P. Bell, Lyn Finelli, Lance E. Rodewald, John M. Douglas, Robert S. Janssen, John W. WardThe material in this report originated in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed), Kevin A. Fenton, MD, PhD, Director; the Division of Viral Hepatitis, John W. Ward, MD, Director; the Division of STD Prevention, John M. Douglas, Jr., MD, Director; and the Division of HIV/AIDS Prevention, Robert S. Janssen, MD, Director; the National Center for Immunization and Respiratory Diseases, Anne Schuchat, MD, Director; and the Immunization Services Division, Lance E. Rodewald, MD, Director.Includes bibliographical references (p. 18-25).17159833Infectious DiseasePrevention and ControlCurrentACI

Yellow fever vaccine : recommendations of the Advisory Committee on Immunization Practices (ACIP), 2002

This report updates CDC's recommendations for using yellow fever vaccine (CDC. Yellow Fever Vaccine: Recommendations of the Advisory Committee on Immunizations Practices: MMWR 1990;39[No. RR-6]1-6). The 2002 recommendations include new or updated information regarding 1) reports of yellow fever vaccine-associated viscerotropic disease (previously reported as febrile multiple organ system failure); 2) use of yellow fever vaccine for pregnant women and persons infected with human immunodeficiency virus (HIV); and 3) concurrent use of yellow fever vaccine with other vaccines. A link to this report and other information related to yellow fever can be accessed at the website for Travelers' Health, Division of Global Migration and Quarantine, National Center for Infectious Diseases, CDC, at http://www.cdc.gov/travel/index.htm, and through the website for the Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, CDC, at http://www.cdc.gov/ncidod/ dvbid/yellowfever/index.htm.Introduction -- Yellow fever vaccine -- Precautions and contraindications -- Surveillance and research priorities -- References -- Appendix: Waiver letters from physiciansprepared by Martin S. Cetron, Anthony A. Marfin, Kathleen G. Julian, Duane J. Gubler, Donald J. Sharp, Rachel S. Barwick. Leisa H. Weld, Robert Chen, Richard D. Clover, Jaime Deseda-Tous, Victor Marchessault, Paul A. Offit, and Thomas P. Monath."November 8, 2002."The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, M.D., Director, and the Division of Global Migration and Quarantine, Tony D. Perez, Director.Includes bibliographical references (p. 9-10).Infectious DiseasePrevention and ControlSupersededACIPEMBeltrami9/02/20151243719