Appropriate strategy for immunisation of children in India 3. Community-based annual pulse (cluster) immunisation

A strategy of annual pulse vaccination is proposed as the most appropriate technique for achieving high immunisation rates in our country. Because vaccine is taken to children in their communities on announced dates, acceptance will be much higher than with conventional clinic vaccination. A simplified immunisation schedule and a family-retained record are used to reduce complexity. Vaccines and other materials are managed at a district level; the local arrangements for vaccination are made by the PHC staff and village level workers. The advantages of this technique include higher coverage, shortened and strengthened cold chain, reduced red tape for recipients of vaccine, the involvement of private health institutions in a national campaign, and a strengthening of the PHC system

Maine’s Food System: An Overview and Assessment

From an agrarian and seafaring past, Maine’s food system has seen profound changes over the past two centuries. Grain, milk, livestock, fish, potatoes, vegetables and fruits used to come from small, family farms. Today, most people in Maine don’t know where their food comes from. Many are dependent on federal, state and local “emergency food systems” such as food stamps, food pantries, and childhood nutrition programs. Food-processing facilities, distribution systems, and value-added products are in short supply. Nevertheless, Maine has a diversity and abundance of food prod­ucts. In this article, the authors provide a historical overview and current analysis of Maine’s food system, highlighting encouraging trends and opportunities for the state

Vaccine-preventable haemophilus influenza type B disease burden and cost-effectiveness of infant vaccination in Indonesia.

BACKGROUND: Most of Asia, including Indonesia, does not use Haemophilus influenzae type b (Hib) conjugate vaccines. We estimated total vaccine-preventable disease burden and the cost-effectiveness of Hib conjugate vaccine in Indonesia. METHODS: Hib pneumonia and meningitis incidences for children with access to health care were derived from a randomized vaccine probe study on Lombok Island, Indonesia during 1998-2002. Incidences were adjusted for limited access to care. Health system and patient out-of-pocket treatment cost data were collected concurrent with the probe study. For Hib vaccine in monovalent and combined (with DTP-HepB) presentations, we used 2007 UNICEF vaccine prices of US$3.30 and$3.75 per dose. RESULTS: For the 2007 Indonesian birth cohort, Hib vaccine would prevent meningitis in 1 of every 179 children, pneumonia in 1 of every 18 children, and 4.9% of mortality among those younger than 5 years. The total incremental societal costs of introducing Hib vaccine in monovalent and pentavalent presentations were, respectively, US$11.74 and$8.93 per child vaccinated. Annual discounted treatment costs averted amounted to 20% of pentavalent vaccine costs. For the pentavalent vaccine, the incremental costs per discounted death and disability adjusted life-year averted amounted to US$3102 and$74, respectively, versus $4438 and$102 for monovalent vaccine. CONCLUSIONS: Routine infant Hib vaccination would prevent a large burden of pediatric illness and death in Indonesia. Even without external funding support, Hib vaccine will be a highly cost-effective intervention in either a monovalent or pentavalent presentation based on commonly used benchmarks

Comparison of different culture media and storage temperatures for the long-term preservation of Streptococcus pneumoniae in the tropics

Objective: The preservation of Streptococcus pneumoniae by standard freezing methods for subsequent tests- such as serotyping and antibiotic susceptibility-is not possible or is difficult in many developing countries because of the high cost of equipment, inadequate equipment maintenance, and irregular power supply. We evaluated alternative low-cost methods, by comparing different culture media and storage temperatures. Methods: Clinical isolates of five capsular types (1, 5, 7, 19, and 23) of S. pneumoniae were preserved in rabbit blood, sheep blood, skimmed milk, or glycerol-chocolate broth, and stored at -20 °C or -70 °C. The cultures were also preserved by lyophilization or sand desiccation, followed by storage at room temperature and 4 °C. The viability of the preserved cultures was determined by making serial colony counts on day 0 and after 1 week, 4 weeks, 4 months and 16 months. The viability of cultures preserved by sand desiccation and storage at 4 °C was also determined every 6 months for up to 68 months. Findings: Irrespective of the media used, cultures maintained at -20 °C became nonviable by the fourth month, while those maintained at -70 °C were still viable at 16 months. Cultures preserved by lyophilization or sand desiccation lost their viability by the fourth month when maintained at local room temperature (30-42 °C), but remained viable when stored at 4 °C for up to 68 months. Conclusions: Our results confirm that freezing at -70 °C, or lyophilization and storage at 4 °C are the ideal methods for the preservation of S. pneumoniae. In laboratories where lyophilization is not feasible, sand desiccation and storage at 4 °C offers an alternative low-cost method for the long-term preservation of S. pneumoniae

Maternal Influenza Immunization and Reduced Likelihood of Prematurity and Small for Gestational Age Births: A Retrospective Cohort Study

In an analysis of surveillance data from the state of Georgia (US), Saad Omer and colleagues show an association between receipt of influenza vaccination among pregnant women and reduced risk of premature births

Designs of two randomized, community-based trials to assess the impact of influenza immunization during pregnancy on respiratory illness among pregnant women and their infants and reproductive outcomes in rural Nepal

Background: Among the most important causes of illness and death in both pregnant women and their newborn infants are respiratory infections including influenza. Pregnant women in North America have a 4 to 5 fold excess rate of hospitalization compared to non-pregnant women. Rates of infant hospitalization associated with influenza are much higher than in their mothers. Fully half of children hospitalized for influenza in the US are in the age group 0–5 months, a group where no vaccine is licensed. Data on influenza are much fewer in low income countries where the risks of serious morbidity and mortality are much higher. A recent trial in Bangladesh suggested that influenza immunization in pregnant women could have important protective effects against influenza in both mothers and their infants. These trials were designed to provide additional evidence about the effect of influenza vaccination in pregnancy in settings where influenza may circulate for up to ten months/year. Methods/Design: We conducted a consecutive pair of community-based, placebo-controlled, randomized trials of influenza vaccination of pregnant women in a rural district in southern Nepal. Two trials were conducted to insure, as much as possible, the match of circulating strains with those included in the vaccine. Eligible women included all who were or became pregnant over a one year period. Each trial included a one year cohort of pregnant women who were individually randomized to the influenza vaccine available at the time of their enrollment or placebo. Exclusions included a history of allergy to vaccine components, prior influenza vaccine receipt, and for the second trial, participation in the first trial. Morbidity was assessed on a weekly basis for women throughout pregnancy and through 180 days post-partum. Infants were followed weekly through 180 days. Primary outcomes included: 1) incidence of influenza like illness in women, 2) incidence of laboratory confirmed influenza illness in infants, and 3) birthweight among newborn infants. Discussion: We have presented the design and methods of two randomized trials of influenza immunization of pregnant women

Infant vaccination timing: Beyond traditional coverage metrics for maximizing impact of vaccine programs, an example from southern Nepal.

Background Immunization programs currently measure coverage by assessing the proportion of children 12–24 months who have been immunized but this does not address the important question of when the scheduled vaccines were administered. Data capturing the timing of vaccination in first 6 months, when severe disease is most likely to occur, are limited. Objective To estimate the time to Bacillus Calmette–Guérin (BCG) (recommended at birth), diphtheria-tetanus-pertussis-H, influenza b-hepatitis B (DTP-Hib-HepB), and oral polio vaccine (OPV) (recommended at 6, 10, and 14 weeks) vaccinations and risk factors for vaccination delay in infants \u3c6 months of age in a district in southern Nepal where traditional coverage metrics are high. Design/methods Infants enrolled in a randomized controlled trial of maternal influenza vaccination were visited weekly at home from birth through age 6 months to ascertain if any vaccinations had been given in the prior week. Infant, maternal, and household characteristics were recorded. BCG, DTP-Hib-HepB, and OPV vaccination coverage at 4 and 6 months was estimated. Time to vaccination was estimated through Kaplan–Meier curves; Cox-proportional hazards models were used to examine risk factors for delay for the first vaccine. Results The median age of BCG, first OPV and DTP-Hib-HepB receipt was 22, 21, and 18 weeks, respectively. Almost half of infants received no BCG by age 6 months. Only 8% and 7% of infants had received three doses of OPV and DTP-Hib-HepB, respectively, by age 6 months. Conclusion A significant delay in receipt of infant vaccines was found in a prospective, population-based, cohort in southern Nepal despite traditional coverage metrics being high. Immunization programs should consider measuring time to receipt relative to the official schedule in order to maximize benefits for disease control and child health

Supporting Global Health at the Pediatric Department Level: Why and How

Over the past 20 years, involvement in pediatric global health (GH), the study and practice of improving the health of children worldwide, has evolved from an extracurricular activity to a robust academic pursuit that enhances the clinical, educational, and research missions of academic health centers (Fig 1). As evidenced by the paradigm shift laid out in the United Nations Sustainable Development Goals, which focus on the health of all people worldwide, GH is no longer a field constrained by arbitrary borders.1 Likewise, pediatric departments seeking to expand knowledge, train pediatricians, or improve care for children through research and innovation must be concerned with the health of all children and addressing health equity, which by definition, implies GH work.2 This article aims to provide pediatric department leadership with the background and action steps necessary to respond to the call that support for GH should not be a luxury limited to a few elite institutions but a core part of pediatric education and research across the country.