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Vaccine Administration (vaccine + administration)
Selected AbstractsHepatitis A and B immunization for individuals with inherited bleeding disordersHAEMOPHILIA, Issue 2 2009M. STEELE Summary., Hepatitis A and B vaccines are highly effective tools that can greatly reduce infection risk in the bleeding disorder population. Although hepatitis A and B immunization for individuals with bleeding disorders is universally recommended, various advisory bodies often differ with respect to many practical aspects of vaccination. To review the published literature and guidelines and form a practical, comprehensive and consistent approach to hepatitis A and B immunization for individuals with bleeding disorders. We reviewed published immunization guidelines from North American immunization advisory bodies and published statements from North American and international haemophilia advisory bodies. A search of the MEDLINE database was performed to find original published literature pertaining to hepatitis A or B immunization of patients with haemophilia or bleeding disorder patients that provided supporting or refuting evidence for advisory body guidelines. Various advisory bodies' immunization guidelines regarding individuals with bleeding disorders have contradictory statements and often did not clarify issues (e.g. post vaccination surveillance). Published literature addressing immunization in bleeding disorder patients is sparse and mostly examines route of vaccine administration, complications and corresponding antibody response. Although the risk of hepatitis A and B infection is low, the use of simple measures such as vaccination is reasonable and advocated by haemophilia advisory bodies. Following our review of the available literature and North American guidelines, we have developed comprehensive and practical recommendations addressing hepatitis A and B immunization for the bleeding disorder population that may be applicable in Bleeding Disorder clinics. [source] Response to hepatitis A vaccine in HIV-positive patients,JOURNAL OF VIRAL HEPATITIS, Issue 2 2006S. Weissman Summary., The USPHS/IDSA guidelines for Prevention of Opportunistic Infections in Persons with human immunodeficiency virus (HIV) recommends that all susceptible HIV+ patients at increased risk for hepatitis A virus (HAV) or with chronic liver disease, be vaccinated against HAV. Immune response to HAV vaccine has not been well studied in HIV+ patients. In particular, there is little information in the literature regarding the effect and relationship of the CD4 count and the immune response in HIV patients. A retrospective analysis of HIV+ patients who received HAV vaccine was performed, and the antibody response to HAV (anti-HAV) measured. Univariate and multivariate analyses were performed to determine predictors of response to vaccine administration. Of the 503 patients evaluated, 138 patients completed their HAV vaccination series and 48% of them had postvaccine anti-HAV positive results (responders). There was no difference in age, race, antiretroviral therapy use, or hepatitis C virus exposure between responders and nonresponders. In univariate analysis, responders were more likely to be female (40.3%vs 21.1%, P = 0.01), have a higher CD4 count at vaccine (508.6 cells/mm3vs 344.3 cells/mm3, P = 0.001) and marginally lower viral load at vaccine (2.65 log copies vs 2.94 log copies, P = 0.07). Multivariate analysis showed that female gender and higher CD4 count at vaccine were independent predictors of response to vaccine. Forty-eight per cent of our HIV+ patients responded to HAV vaccine administration. This is much lower than reported rates of 100% in HIV-negative patients. Female gender and CD4 count at vaccine, but not CD4 nadir, predicted response to vaccine. [source] Helicobacter pylori vaccines,the current statusALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2000Sutton In this review, we take a look at the current status in the development of a vaccine against the human pathogenic bacterium, Helicobacter pylori, a major aetiological factor in peptic ulcer disease and gastric adenocarcinoma. Various animal models are now in use from mice infected with H. pylori, through gnotobiotic pigs and primates to ferrets naturally infected with their own Helicobacter, H. mustelae. A significant problem remains the requirement for a suitable mucosal adjuvant. Detoxification or the use of low doses of adjuvants already available may provide a solution and new immune stimulating compounds have been tested with some success. New approaches include the delivery of Helicobacter antigens by DNA immunization, microparticles or live vectors such as attenuated salmonella and the examination of alternative routes of vaccine administration. The phenomenon of post-immunization gastritis and improvements in vaccine efficacy are also discussed. A major area of interest is the mechanism by which immunization actually influences Helicobacter colonization. This remains a mystery: antibodies appear to be unimportant whereas CD4+ T-cells essential. Finally, a viewpoint is given on whom should be immunized when a final vaccine becomes available. [source] Comparing data mining methods on the VAERS database,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 9 2005David Banks PhD Abstract Purpose Data mining may enhance traditional surveillance of vaccine adverse events by identifying events that are reported more commonly after administering one vaccine than other vaccines. Data mining methods find signals as the proportion of times a condition or group of conditions is reported soon after the administration of a vaccine; thus it is a relative proportion compared across vaccines, and not an absolute rate for the condition. The Vaccine Adverse Event Reporting System (VAERS) contains approximately 150,000 reports of adverse events that are possibly associated with vaccine administration. Methods We studied four data mining techniques: empirical Bayes geometric mean (EBGM), lower-bound of the EBGM's 90% confidence interval (EB05), proportional reporting ratio (PRR), and screened PRR (SPRR). We applied these to the VAERS database and compared the agreement among methods and other performance properties, particularly focusing on the vaccine,event combinations with the highest numerical scores in the various methods. Results The vaccine,event combinations with the highest numerical scores varied substantially among the methods. Not all combinations representing known associations appeared in the top 100 vaccine,event pairs for all methods. Conclusions The four methods differ in their ranking of vaccine,COSTART pairs. A given method may be superior in certain situations but inferior in others. This paper examines the statistical relationships among the four estimators. Determining which method is best for public health will require additional analysis that focuses on the true alarm and false alarm rates using known vaccine,event associations. Evaluating the properties of these data mining methods will help determine the value of such methods in vaccine safety surveillance. Copyright © 2005 John Wiley & Sons, Ltd. [source] Brief Report: Quality Improvement in Critical Access Hospitals: Addressing Immunizations Prior to DischargeTHE JOURNAL OF RURAL HEALTH, Issue 4 2003Edward F. Ellerbeck MD These hospitalizations may represent a missed opportunity to address immunizations. Addressing these missed immunizations could provide an opportunity for CAHs to gain practical experience in data-driven quality improvement. Purpose: To improve documentation and delivery of influenza and pneumococcal immunizations prior to hospital discharge and provide CAHs with quality improvement experience. Methods: We recruited 17 CAHs in Kansas to participate in a rapidcycle quality improvement project to address inpatient immunizations. Each hospital identified patient discharges on a monthly basis and abstracted medical records to see if the patient's immunization status had been assessed and if patients had been vaccinated prior to discharge. Findings: Documentation of influenza immunization status improved from 17% of admissions at baseline to 62% at follow-up (P<0.001). Documentation of pneumococcal immunization status increased from 36% at baseline to 51% at follow-up (P<0.001). Documentation of immunizations was significantly higher among the 8 hospitals that developed standard charting forms for recording immunization status (P<0.01). Despite improved documentation of immunization status, at remeasurement only 3.4% received an influenza vaccination and 1.3% received a pneumococcal vaccination prior to discharge. Conclusions: Critical access hospitals can effectively participate in quality improvement activities, but increased involvement of medical staff or standing immunization orders may be needed to improve actual vaccine administration prior to discharge. [source] Immunization responses in rheumatoid arthritis patients treated with rituximab: Results from a controlled clinical trial,ARTHRITIS & RHEUMATISM, Issue 1 2010Clifton O. Bingham III Objective To examine immunization responses in patients with rheumatoid arthritis (RA) treated with rituximab and to investigate the effects of rituximab-induced CD20+ B cell depletion on immune responses to tetanus toxoid (T cell,dependent antigen), pneumococcal polysaccharide (T cell,independent antigen), and keyhole limpet hemocyanin (KLH) (neoantigen) and on delayed-type hypersensitivity (DTH). Methods In a controlled trial, we enrolled 103 patients with active RA receiving a stable dose of methotrexate (MTX). Tetanus toxoid, pneumococcal polysaccharide, and KLH vaccines as well as a Candida albicans skin test were administered to 1 group of patients receiving rituximab plus MTX (called rituximab-treated patients) for 36 weeks and to 1 group of patients receiving MTX alone for 12 weeks. The primary end point was the proportion of patients with a ,4-fold rise in antitetanus IgG levels. Antitetanus, antipneumococcal, and anti-KLH serum IgG levels were measured prior to and 4 weeks following vaccine administration. The DTH response to C albicans was measured 2,3 days following placement. Results Responses to tetanus toxoid vaccine (,4-fold rise) were similar in both groups (39.1% of rituximab-treated patients and 42.3% of patients treated with MTX alone). The ability to maintain a positive DTH response to the C albicans skin test was comparable in both groups (77.4% of rituximab-treated patients and 70% of patients treated with MTX alone), showing no effect of rituximab treatment. Rituximab-treated patients had decreased responses to pneumococcal polysaccharide vaccine (57% of patients had a 2-fold rise in titer in response to ,1 serotype, compared with 82% of patients treated with MTX alone) and to KLH vaccine (47% of patients had detectable anti-KLH IgG, compared with 93% of patients treated with MTX alone). Conclusion Recall responses to the T cell,dependent protein antigen tetanus toxoid as well as DTH responses were preserved in rituximab-treated RA patients 24 weeks after treatment. Responses to neoantigen (KLH) and T cell,independent responses to pneumococcal vaccine were decreased, but many patients were able to mount responses. These data suggest that polysaccharide and primary immunizations should be administered prior to rituximab infusions to maximize responses. [source] Vaccination rate and age of premature infants weighing <1500 g: a pilot study in north-western SwitzerlandACTA PAEDIATRICA, Issue 12 2001BU Tillmann In Switzerland, there are no special vaccination recommendations for premature and low-birthweight infants with respect to a particular target vaccination age. Incomplete and delayed vaccination bears the inherent risk of preventable infections. Therefore, the vaccination rate and age of 60 premature infants in north-western Switzerland born in 1994/95 were investigated in a retrospective case-control study. For this group of patients these are the first data ever available for this region. At the age of 4,5 y, the vaccination rates for polio and diphtheria, tetanus, pertussis (DTP acellular) as well as Haemophilus influenzae b (Hib) were similar in both preterm and full-term infants. In both groups, the fourth dose of vaccine against DTP, Hib and polio was far less frequently administered than the first three. The vaccination age in preterm infants for most vaccinations was significantly higher than in age-matched full-term controls. This was particularly obvious for the first dose of vaccine against polio and DTP. In preterm infants, the median age (5th; 95th percentile) at the date of the first polio vaccination was 131 (89; 270) d and 82 (60; 182) in full-term controls (p < 0.00001). The age difference was even larger for the first DTP vaccination (62 d, p < 0.00001). The main reasons for delayed vaccination may include insufficient information given to parents as well as prolonged hospitalization. Conclusion: Vaccination of preterm infants should be discussed in every discharge communication, with emphasis on vaccine administration at the appropriate chronological age. [source] | ||||||||||