Should outbreak response immunization be recommended for measles outbreaks in middle- and low-income countries? An update.

Measles caused mortality in >164,000 children in 2008, with most deaths occurring during outbreaks. Nonetheless, the impact and desirability of conducting measles outbreak response immunization (ORI) in middle- and low-income countries has been controversial. World Health Organization guidelines published in 1999 recommended against ORI in such settings, although recently these guidelines have been reversed for countries with measles mortality reduction goals

Too little but not too late: Results of a literature review to improve routine immunization programs in developing countries

<p>Abstract</p> <p>Background</p> <p>Globally, immunization services have been the center of renewed interest with increased funding to improve services, acceleration of the introduction of new vaccines, and the development of a health systems approach to improve vaccine delivery. Much of the credit for the increased attention is due to the work of the GAVI Alliance and to new funding streams. If routine immunization programs are to take full advantage of the newly available resources, managers need to understand the range of proven strategies and approaches to deliver vaccines to reduce the incidence of diseases. In this paper, we present strategies that may be used at the sub-national level to improve routine immunization programs.</p> <p>Methods</p> <p>We conducted a systematic review of studies and projects reported in the published and gray literature. Each paper that met our inclusion criteria was rated based on methodological rigor and data were systematically abstracted. Routine-immunization – specific papers with a methodological rigor rating of greater than 60% and with conclusive results were reported.</p> <p>Results</p> <p>Greater than 11,000 papers were identified, of which 60 met our inclusion criteria and 25 papers were reported. Papers were grouped into four strategy approaches: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccination (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7).</p> <p>Conclusion</p> <p>Immunization programs are at a historical crossroads in terms of developing new funding streams, introducing new vaccines, and responding to the global interest in the health systems approach to improving immunization delivery. However, to complement this, actual service delivery needs to be strengthened and program managers must be aware of proven strategies. Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level. However it was startling to see how few papers were identified and in particular how few were of strong scientific quality. Further well-designed and well-conducted scientific research is warranted. Proposed areas of additional research include integration of additional services with immunization delivery, collaboration of immunization programs with new partners, best approaches to new vaccine introduction, and how to improve service delivery.</p

Timing of hepatitis B vaccination and impact of non-simultaneous vaccination with DTP vaccine following introduction of a hepatitis B birth dose in the Philippines

Timely administration of hepatitis B vaccine beginning at birth prevents up to 95 per cent of perinatally acquired hepatitis B virus infections in infants of infected mothers. The Philippines changed its national HepB schedule in 2007 to include a dose at birth. We evaluated vaccination schedule change by reviewing infant records at selected health facilities to measure completeness and timeliness of HepB administration and frequency of recommended, simultaneous vaccination with diphtheria-tetanus-pertussis (DTP) vaccine. Of 1431 sampled infants, 1106 (77 per cent) completed the HepB series and 10 per cent followed the national schedule. The proportion with timely vaccination declined with successive doses: HepB1 (71 per cent), HepB2 (47 per cent), and HepB3 (26 per cent). Twenty-six per cent received HepB2 simultaneously with DTP1 and 34 per cent received HepB3 simultaneously with DTP3. If HepB and DTP vaccination were given simultaneously, 10 per cent more infants could have received all HepB doses. Program implementers should monitor vaccination timeliness and increase simultaneous administration to improve vaccination coverage and decrease disease incidence

Bi-cultural dynamics for risk and protective factors for cardiometabolic health in an Alaska Native (Yup’ik) population

<div><p>Alaska Native people experience disparities in mortality from heart disease and stroke. This work attempts to better understand the relationships between socioeconomic, behavioral, and cardiometabolic risk factors among Yup’ik people of southwestern Alaska, with a focus on the role of the socioeconomic, and cultural components. Using a cross-sectional sample of 486 Yup’ik adults, we fitted a Partial Least Squares Path Model (PLS-PM) to assess the associations between components, including demographic factors [age and gender], socioeconomic factors [education, economic status, Yup’ik culture, and Western culture], behavioral factors [diet, cigarette smoking and smokeless tobacco use, and physical activity], and cardiometabolic risk factors [adiposity, triglyceride-HDL and LDL lipids, glycemia, and blood pressure]. We found relatively mild associations of education and economic status with cardiometabolic risk factors, in contrast with studies in other populations. The socioeconomic factor and participation in Yup’ik culture had potentially protective associations with adiposity, triglyceride-HDL lipids, and blood pressure, whereas participation in Western culture had a protective association with blood pressure. We also found a moderating effect of participation in Western culture on the relationships between Yup’ik culture participation and both blood pressure and LDL lipids, indicating a potentially beneficial additional effect of bi-culturalism. Our results suggest that reinforcing protective effects of both Yup’ik and Western cultures could be useful for interventions aimed at reducing cardiometabolic health disparities.</p></div

Direct paths and total effects coefficients of interaction between Western and Yup’ik culture, for inner Partial Least Squares Path Model, with Bootstrap Standard Error and 95% confidence intervals (n = 486).

<p>Direct paths and total effects coefficients of interaction between Western and Yup’ik culture, for inner Partial Least Squares Path Model, with Bootstrap Standard Error and 95% confidence intervals (n = 486).</p

Model predictions of LDL and blood pressure for Western and Yup’ik cultures interaction by level of Yup’ik culture.

<p>Black full line represents the effect of Yup’ik culture for the lowest level of Western culture; purple dashed line represents the effect of Yup’ik culture for the highest level of Western culture; Red dotted line represents the main effect.</p

PLS-PM relationships with total effect coefficients between all latent variables other than gender and age.

<p>Significant effects only (α = 0.05). Ellipses are latent variables; rectangles are measured variables composing each latent variable. Plain black lines and red dotted lines represent positive and negative associations respectively.</p