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1.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32029684

RESUMO

BACKGROUND: Administering inactivated influenza vaccine (IIV), 13-valent pneumococcal conjugate vaccine (PCV13), and diphtheria-tetanus-acellular pertussis (DTaP) vaccine together has been associated with increased risk for febrile seizure after vaccination. We assessed the effect of administering IIV at a separate visit from PCV13 and DTaP on postvaccination fever. METHODS: In 2017-2018, children aged 12 to 16 months were randomly assigned to receive study vaccines simultaneously or sequentially. They had 2 study visits 2 weeks apart; nonstudy vaccines were permitted at visit 1. The simultaneous group received PCV13, DTaP, and quadrivalent IIV (IIV4) at visit 1 and no vaccines at visit 2. The sequential group received PCV13 and DTaP at visit 1 and IIV4 at visit 2. Participants were monitored for fever (≥38°C) and antipyretic use during the 8 days after visits. RESULTS: There were 110 children randomly assigned to the simultaneous group and 111 children to the sequential group; 90% received ≥1 nonstudy vaccine at visit 1. Similar proportions of children experienced fever on days 1 to 2 after visits 1 and 2 combined (simultaneous [8.1%] versus sequential [9.3%]; adjusted relative risk = 0.87 [95% confidence interval 0.36-2.10]). During days 1 to 2 after visit 1, more children in the simultaneous group received antipyretics (37.4% vs 22.4%; P = .020). CONCLUSIONS: In our study, delaying IIV4 administration by 2 weeks in children receiving DTaP and PCV13 did not reduce fever occurrence after vaccination. Reevaluating this strategy to prevent fever using an IIV4 with a different composition in a future influenza season may be considered.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Febre/etiologia , Vacinas contra Influenza/efeitos adversos , Vacinas Pneumocócicas/efeitos adversos , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Humanos , Lactente , Vacinas contra Influenza/administração & dosagem , Masculino , Vacinas Pneumocócicas/administração & dosagem
2.
MMWR Morb Mortal Wkly Rep ; 69(5): 136-139, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32027629

RESUMO

On December 21, 2018 the Food and Drug Administration (FDA) licensed a hexavalent combined diphtheria and tetanus toxoids and acellular pertussis (DTaP) adsorbed, inactivated poliovirus (IPV), Haemophilus influenzae type b (Hib) conjugate (meningococcal protein conjugate) and hepatitis B (HepB) (recombinant) vaccine, DTaP-IPV-Hib-HepB (Vaxelis; MCM Vaccine Company),* for use as a 3-dose series in infants at ages 2, 4, and 6 months (1). On June 26, 2019, after reviewing data on safety and immunogenicity, the Advisory Committee on Immunization Practices (ACIP)† voted to include DTaP-IPV-Hib-HepB in the federal Vaccines for Children (VFC) program.§ This report summarizes the indications for DTaP-IPV-Hib-HepB and provides guidance for its use.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Vacinas Anti-Haemophilus/administração & dosagem , Vacinas contra Hepatite B/administração & dosagem , Vacina Antipólio de Vírus Inativado/administração & dosagem , Pré-Escolar , Humanos , Esquemas de Imunização , Lactente , Licenciamento , Estados Unidos , Vacinas Combinadas/administração & dosagem , Vacinas Conjugadas/administração & dosagem
3.
MMWR Morb Mortal Wkly Rep ; 69(3): 77-83, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31971933

RESUMO

Since 2005, a single dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine has been recommended by the Advisory Committee on Immunization Practices (ACIP) for adolescents and adults (1,2). After receipt of Tdap, booster doses of tetanus and diphtheria toxoids (Td) vaccine are recommended every 10 years or when indicated for wound management. During the October 2019 meeting of ACIP, the organization updated its recommendations to allow use of either Td or Tdap where previously only Td was recommended. These situations include decennial Td booster doses, tetanus prophylaxis when indicated for wound management in persons who had previously received Tdap, and for multiple doses in the catch-up immunization schedule for persons aged ≥7 years with incomplete or unknown vaccination history. Allowing either Tdap or Td to be used in situations where Td only was previously recommended increases provider point-of-care flexibility. This report updates ACIP recommendations and guidance regarding the use of Tdap vaccines (3).


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Adolescente , Adulto , Comitês Consultivos , Idoso , Centers for Disease Control and Prevention, U.S. , Criança , Feminino , Humanos , Esquemas de Imunização , Imunização Secundária , Masculino , Pessoa de Meia-Idade , Gravidez , Estados Unidos , Adulto Jovem
4.
MMWR Morb Mortal Wkly Rep ; 69(3): 72-76, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31971934

RESUMO

Infants are at increased risk for pertussis-associated morbidity and mortality, and pregnant women and their infants are more likely than other patient populations to experience severe influenza-related illness (1,2). The Advisory Committee on Immunization Practices (ACIP) recommends that all women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, preferably during the early part of gestational weeks 27-36 (3). ACIP also recommends that women who are or might be pregnant during the influenza season receive the inactivated influenza vaccine at any time during pregnancy (4). Despite these recommendations, coverage with Tdap and influenza vaccines during pregnancy has been low, with approximately one half of women receiving each vaccine and only one third receiving both, based on a survey during March-April 2019 (5). Data obtained through a retrospective chart review of randomly selected pregnant women who delivered at the University of Florida Health Shands Hospital in Gainesville, Florida, from January 1, 2016, to December 31, 2018, were analyzed to assess vaccination coverage by insurance type. Because the Florida Medicaid policy at that time did not cover these vaccines during pregnancy, the hospital system offered Tdap and influenza vaccines at no additional cost to mothers during the immediate postpartum hospital stay. Among 341 women, 68.6% of privately insured and 13.4% with Medicaid received Tdap during pregnancy, and among 316 women, 70.4% of privately insured and 35.6% with Medicaid received influenza vaccine during pregnancy. Many women, especially those with Medicaid, were vaccinated in the immediate postpartum period, when vaccination was available at no cost, increasing Tdap vaccination rates to 79.3% for privately insured and 51.7% for women with Medicaid; influenza vaccination rates rose to 72.0% for privately insured and 43.5% for women with Medicaid. These data suggest that the state Medicaid policy to not cover these vaccines during pregnancy might have significantly reduced coverage among its enrollees.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Vacinas contra Influenza/administração & dosagem , Seguro Saúde/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Feminino , Florida , Humanos , Medicaid/estatística & dados numéricos , Gravidez , Setor Privado/estatística & dados numéricos , Estados Unidos , Adulto Jovem
5.
Ig Sanita Pubbl ; 75(4): 317-325, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31887737

RESUMO

The possible risk of hyperimmunization after tetanus vaccination is currently discussed after the National Vaccine Prevention Plan 2017-2019 confirmed the recommendation of a booster dose every ten years. Due to the ubiquitous nature of tetanus spores and the inability to obtain herd-immunity through vaccination, efforts to reduce the incidence of tetanus aim at eliminating the disease. The only way to prevent infection is vaccination followed by recommended periodic booster doses. Between 2012 and 2016, Italy notified 45% (252/564) of all cases reported by the 26 EU Member States, most of them in the over 65 age group, generally women in the rural areas. The recommendation of the antipertussis vaccine, combined with anti-tetanus, in pregnancy and the indications for antitetanic prophylaxis by vaccination or specific immunoglobulins in emergency setting, gives rise to doubts about the risk of hyperimmunization. Studies generally agree on the safety of diphtheria-tetanus-pertussis combined vaccines during the third trimester of pregnancy, and the time elapsed since the previous tetanus vaccination seems not to be related to significant differences in the incidence of adverse events or obstetrical complications. In the emergency wards, given the relatively high incidence of tetanus in Italy, the risk/benefit ratio often leads to prefer vaccination to no-intervention. The administration of tetanus immunoglobulins in subjects not vaccinated in the last 10 years seems justified by the epidemiology of tetanus in Italy.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Vacinas contra Difteria, Tétano e Coqueluche Acelular/imunologia , Difteria/prevenção & controle , Imunização Secundária/efeitos adversos , Tétano/prevenção & controle , Coqueluche/prevenção & controle , Anticorpos Antibacterianos/imunologia , Difteria/imunologia , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Humanos , Itália , Tétano/imunologia , Coqueluche/imunologia
6.
MMWR Morb Mortal Wkly Rep ; 68(40): 885-892, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31600186

RESUMO

INTRODUCTION: Vaccinating pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can reduce influenza and pertussis risk for themselves and their infants. METHODS: Surveillance data were analyzed to ascertain influenza-associated hospitalization among pregnant women and infant hospitalization and death associated with influenza and pertussis. An Internet panel survey was conducted during March 27-April 8, 2019, among women aged 18-49 years who reported being pregnant any time since August 1, 2018. Influenza vaccination before or during pregnancy was assessed among respondents with known influenza vaccination status who were pregnant any time during October 2018-January 2019 (2,097). Tdap receipt during pregnancy was assessed among respondents with known Tdap status who reported a live birth by their survey date (817). RESULTS: From 2010-11 to 2017-18, pregnant women accounted for 24%-34% of influenza-associated hospitalizations per season among females aged 15-44 years. From 2010 to 2017, a total of 3,928 pertussis-related hospitalizations were reported among infants aged <2 months (annual range = 262-743). Maternal influenza and Tdap vaccination coverage rates reported as of April 2019 were 53.7% and 54.9%, respectively. Among women whose health care providers offered vaccination or provided referrals, 65.7% received influenza vaccine and 70.5% received Tdap. The most commonly reported reasons for nonvaccination were believing the vaccine is not effective (influenza; 17.6%) and not knowing that vaccination is needed during each pregnancy (Tdap; 37.9%), followed by safety concerns for the infant (influenza =15.9%; Tdap = 17.1%). CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Many pregnant women do not receive the vaccines recommended to protect themselves and their infants, even when vaccination is offered. CDC and provider organizations' resources are available to help providers convey strong, specific recommendations for influenza and Tdap vaccination that are responsive to pregnant women's concerns.


Assuntos
Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Adolescente , Adulto , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Humanos , Lactente , Recém-Nascido , Vacinas contra Influenza/administração & dosagem , Pessoa de Meia-Idade , Gravidez , Estados Unidos/epidemiologia , Vacinação/estatística & dados numéricos , Adulto Jovem
7.
Public Health Rep ; 134(6): 587-591, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31568732

RESUMO

Oregon continues to face epidemics of pertussis, and infants younger than 2 months of age have the highest incidence and rates of hospitalization and complications. We describe the medical course and sequelae of an infant's severe pertussis illness through age 5½ years. The child has failed to meet developmental milestones, requires substantial medical care, and bears the burdens of chronic lung disease, stroke, epilepsy, impaired neurodevelopment, and problems with vision. The medical and social burden of pertussis among infants too young to be vaccinated underscores the importance of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination during pregnancy.


Assuntos
Epidemias , Vacinação , Coqueluche/complicações , Coqueluche/epidemiologia , Coqueluche/terapia , Pré-Escolar , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Seguimentos , Hospitalização , Humanos , Incidência , Lactente , Recém-Nascido , Mães , Transtornos do Neurodesenvolvimento , Oregon , Gravidez
8.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31182549

RESUMO

OBJECTIVES: To determine pertussis risk by diphtheria-tetanus-acellular pertussis (DTaP) vaccination status and time since last DTaP dose. METHODS: Children born at Kaiser Permanente Northern California between 1999 and 2016 were followed from 3 months of age until they tested positive for pertussis; disenrolled from Kaiser Permanente Northern California; received the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed vaccine; turned 11 years of age, or the end of the study period. DTaP vaccination status was categorized on the basis of the number of doses received in relation to the number of doses expected according to the Advisory Committee on Immunization Practice-recommended ages. RESULTS: Among 469 982 children ages 3 months to 11 years, we identified 738 pertussis cases. A total of 99 cases were unvaccinated, 36 were undervaccinated, 515 were fully vaccinated, and 88 were fully vaccinated plus 1 dose. Pertussis risk was 13 times higher among unvaccinated (adjusted hazard ratio [aHR] = 13.53; 95% confidence interval [CI] 10.64-17.21) compared with fully vaccinated children and 1.9 times higher (aHR = 1.86; 95% CI 1.32-2.63) among undervaccinated children. Among vaccinated children ages 19 to <84 months, pertussis risk was 5 times higher (aHR = 5.04; 95% CI 1.84-13.80) ≥3 years vs <1 year after vaccination. Among children ages 84 to 132 months, risk was 2 times higher (aHR = 2.32; 95% CI 0.97-5.59) ≥6 years vs <3 years after vaccination. CONCLUSIONS: Undervaccinated and especially unvaccinated children were at greater risk of pertussis. However, most pertussis cases occurred among children age-appropriately vaccinated who were further away from their last DTaP dose, suggesting that suboptimal vaccine effectiveness played a major role in recent pertussis epidemics.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Coqueluche/prevenção & controle , California/epidemiologia , Criança , Pré-Escolar , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Seguimentos , Humanos , Esquemas de Imunização , Lactente , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Tempo , Cobertura Vacinal , Coqueluche/epidemiologia
9.
WMJ ; 118(1): 42-43, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31083834

RESUMO

BACKGROUND: Human papillomavirus (HPV) is the most commonly sexually transmitted pathogen and has been implicated in several types of cancers, yet immunization rates have remained low. METHODS: Wisconsin pediatricians participated in a 3-month health care collaborative from April through June 2016. RESULTS: HPV vaccination initiation increased overall among all participating practices from 56.4% at baseline to 71.2% after the 3-month time period. In addition, Tdap and meningococcal vaccine rates increased in these practices as well. DISCUSSION/CONCLUSIONS: A statewide pediatric health care collaborative can make significant improvements in HPV vaccination rates in a relatively short period of time and also can directly improve rates of other adolescent vaccines.


Assuntos
Vacinas contra Papillomavirus/administração & dosagem , Melhoria de Qualidade , Criança , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Humanos , Masculino , Vacinas Meningocócicas/administração & dosagem , Wisconsin
10.
Minerva Ginecol ; 71(4): 288-297, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30938116

RESUMO

BACKGROUND: Italian National Immunization Plan (NIP) 2017-2019 has introduced new recommendations regarding immunization practices during pregnancy. In this cross-sectional study, we documented specific knowledge, attitudes, and practices (KAP) in a sample of obstetrician-gynecologists (OBGYN). METHODS: A total of 68 OBGYN (39.7% of males, mean age of 47.7±9.3 years old) compiled a structured online questionnaire. Participants were asked about: knowledge of vaccine issues (both in general and regarding NIP recommendations for pregnant women); actual performance/recommendation of seasonal influenza (SID) and tetanus-diphtheria-acellular pertussis vaccinations (Tdap); risk perception about SID and pertussis. Eventually, a regression analysis was performed in order to identify predictive factors for vaccine propensity. RESULTS: Although most OBGYN were aware of official recommendations, only 57.4% and 55.9% correctly recalled the appropriate timing for vaccinations shots for SID and Tdap. Overall, 79.4% and 67.6% of participants usually delivered or recommended SID and Tdap to pregnant women, respectively. Main perceived barriers were identified by OBGYN in patients' fear of side effects (89.7%), their low risk perception (82.3%), insufficient awareness of official recommendations among pregnant women (75.0%). Significant predictors of Tdap practice were identified in higher risk perception (OR 6.466, 95% CI: 1.077; 38.803) and better knowledge of official recommendations (OR 7.310, 95% CI: 1.195; 44.704), whereas SID was apparently unrelated with individual characteristics of participants. CONCLUSIONS: Sampled OBGYN were largely favorable towards vaccination of pregnant women. As knowledge of official recommendations was identified as a main predictor of appropriate behavior at least for Tdap practice, future educational interventions could eventually improve immunization rates.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Coqueluche/prevenção & controle , Adulto , Estudos Transversais , Feminino , Ginecologia/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Obstetrícia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Estações do Ano , Vacinação/estatística & dados numéricos
11.
Tex Med ; 115(4): 47, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30995333

RESUMO

Almost all U.S. tetanus cases occur among people who are unvaccinated or did not receive a booster shot, according to the U.S. Centers for Disease Control and Prevention.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Tétano/prevenção & controle , Tétano/terapia , Criança , Pré-Escolar , Humanos , Esquemas de Imunização , Lactente , Estados Unidos
13.
Expert Rev Vaccines ; 18(3): 205-208, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30736722

RESUMO

INTRODUCTION: Today, in the developed world, virtually all deaths due to Bordetella pertussis illnesses occur in young infants. Areas Covered: Pertussis in young infants is characterized by an afebrile cough illness with coryza, apnea, seizures, cyanosis, and emesis. Severe illness is associated with high leukocyte and lymphocyte counts, rapid respiratory and cardiac rates and pneumonia. Many routine intensive care treatment procedures are detrimental: these include steroids and nitric oxide. Preventative measures include: quarantine, prophylactic antimicrobial agents and immunizations of the mother to be with Tdap between 27 and 36 weeks gestation. Expert Opinion: Infants deaths are due to the irreversible pulmonary hypertension which is caused by aggregates of leukocytes in the small vessels in the lung. The leukocytosis with lymphocytosis is due to pertussis toxin. It can be treated by exchange blood transfusions. However for this to be successful it needs to be started before shock or organ failure has occurred. To prevent pertussis in young infants, attention needs to be directed to the diagnosis and treatment of pertussis in adolescents and adults. Also important are antimicrobial prophylaxis in the infant and the immunization of mothers to be with Tdap vaccine during all pregnancies.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Vacinação/métodos , Coqueluche/prevenção & controle , Adolescente , Adulto , Bordetella pertussis/isolamento & purificação , Feminino , Humanos , Lactente , Gravidez , Coqueluche/mortalidade , Coqueluche/fisiopatologia
14.
Hum Vaccin Immunother ; 15(5): 1080-1091, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735474

RESUMO

Pertussis vaccination of parents and household contacts ('cocooning') to protect newborn infants is an established strategy in many countries, although uptake may be low. Many aspects may influence such decision-making. We conducted a cross-sectional survey (NCT01890447) of households and other close contacts of newborns aged ≤6 months (or of expectant mothers in their last trimester) in Spain and Italy, using an adaptive discrete-choice experiment questionnaire. Aims were to assess the relative importance of attributes influencing vaccine adoption, and to estimate variation in vaccine adoption rates and the impact of cost on vaccination rates. Six hundred and fifteen participants (Spain, n = 313; Italy, n = 302) completed the survey. Of 144 available questionnaire scenarios, the most frequently selected (14% of respondents in both countries) were infant protection by household vaccination at vaccination center, recommendation by family physician and health authorities, with information available on leaflets and websites. The attribute with highest median relative importance was 'reduction in source of infection' in Spain (23.1%) and 'vaccination location' in Italy (18.8%). Differences between other attributes were low in both countries, with media attributes showing low importance. Over 80% of respondents indicated a definite or probable response to vaccine adoption (at no-cost) with estimated probability of adoption of 89-98%; applying vaccine costs (25€ per person) would reduce the probability of uptake by 7-20% in definite/probable respondents. Awareness of these determinants is helpful in informing Health Authorities and healthcare practitioners implementing a cocooning strategy for those populations where maternal immunization is not a preferred option.


Assuntos
Tomada de Decisões , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Pais/psicologia , Vacinação/psicologia , Coqueluche/prevenção & controle , Adulto , Idoso , Estudos Transversais , Vacinas contra Difteria, Tétano e Coqueluche Acelular/economia , Feminino , Humanos , Recém-Nascido , Itália , Masculino , Pessoa de Meia-Idade , Espanha , Coqueluche/transmissão , Adulto Jovem
15.
Hum Vaccin Immunother ; 15(4): 786-799, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785357

RESUMO

In many countries, a second dose of a combined measles, mumps, and rubella (MMR) vaccine is recommended at 4-6 years of age - similarly to the booster of diphtheria, tetanus, acellular pertussis, and inactivated polio vaccine (DTaP-IPV) and the second dose of varicella vaccine (VV). Vaccine co-administration is generally encouraged if no interferences exist among the vaccines. This phase IIIa, randomized, controlled trial (NCT01621802) evaluated the immunogenicity and safety of MMR-RIT (Priorix, GSK) when given as a second dose with or without co-administration of DTaP-IPV and VV, using MMR II (M-M-R II, Merck & Co Inc.) as comparator. Antibody geometric mean concentrations or titers (GMCs/GMTs) and response rates to the components of all the administered vaccines were assessed. Solicited, unsolicited, and serious adverse events were recorded. Four thousand eleven children aged 4-6 years were enrolled. MMR-RIT elicited immune responses that were not inferior to those of MMR II in terms of GMCs and seroresponse rates when administered alone or when co-administered with DTaP-IPV and VV. The immune responses to the co-administered vaccines in MMR-RIT recipients were non-inferior to those in MMR II recipients. MMR-RIT and MMR II demonstrated similar reactogenicity profiles; the most frequent solicited adverse events across vaccine groups and sub-cohorts were local pain and fever. In conclusion, the immunogenicity and safety profiles of MMR-RIT administered with or without DTaP-IPV and VV were similar to those of MMR II.


Assuntos
Vacina contra Varicela/administração & dosagem , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Imunização Secundária , Imunogenicidade da Vacina , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Vacina Antipólio de Vírus Inativado/administração & dosagem , Anticorpos Antibacterianos/sangue , Anticorpos Antivirais/imunologia , Vacina contra Varicela/imunologia , Criança , Pré-Escolar , Vacinas contra Difteria, Tétano e Coqueluche Acelular/imunologia , Esquema de Medicação , Feminino , Humanos , Masculino , Vacina contra Sarampo-Caxumba-Rubéola/imunologia , Vacina Antipólio de Vírus Inativado/imunologia , Vacinas Combinadas/administração & dosagem
16.
BMJ Open ; 9(1): e025113, 2019 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-30700487

RESUMO

INTRODUCTION: Childhood vaccination programmes have been established in all Organisation for Economic Co-operation and Development (OECD) countries; however, measles, mumps and rubella (MMR) as well as diphtheria, tetanus, pertussis and polio (Tdap-IPV) vaccination rates are not optimal in adolescents. Education in combination with easy access vaccination may be a promising approach to improve vaccination rates. We aim at improving MMR and Tdap-IPV rates in a school setting in the context of a planned cluster randomised controlled trial (cRCT), the present paper describes the detailed protocol of this trial. METHODS AND ANALYSIS: We will conduct a school-based cRCT, where schools will be randomised to either an educational condition addressing knowledge, risk communication and enhancing self-efficacy regarding vaccination or a low-intensity information condition. In both conditions, a bus equipped with medical staff and materials, will be delivering MMR and Tdap-IPV vaccine directly after the intervention. Schools in the city centre of Berlin, Germany, will be stratified by percentage of migration and type of school. Primary outcome is the number of students who receive vaccination in the bus. Secondary outcomes are knowledge and self-efficacy. An estimated sample size of 355 school classes with approximately 25 students per class is required. The planned analyses will take the nested structure of students, classes and schools into account. ETHICS AND DISSEMINATION: The study will be performed according to the principles of Good Clinical Practice and the Declaration of Helsinki. Approval was obtained by the local ethics committee. Parents of all students will be informed in advance. Their written consent will be obtained, in case students are underage. For dissemination, we will engage with governmental organisations to create potential of our educational unit to be included in future public health prevention schemes. TRIAL REGISTRATION NUMBER: ISRCTN18026662;Pre-results.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Educação em Saúde/métodos , Instituições Acadêmicas , Vacinação/estatística & dados numéricos , Adolescente , Berlim , Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Pais/psicologia , Vacina Antipólio de Vírus Inativado/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoeficácia , Estudantes/psicologia
18.
Hum Vaccin Immunother ; 15(5): 1145-1153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30668217

RESUMO

Infanrix-IPV (GSK, Belgium) is a diphtheria, tetanus, acellular pertussis, and inactivated poliovirus combination vaccine (DTaP-IPV) licensed in many countries including Korea. In accordance with Korean regulations, we conducted a post-marketing surveillance (PMS) to evaluate the safety of DTaP-IPV administered to Korean children in routine immunization schedules. Children aged <7 years receiving at least one dose of DTaP-IPV either as part of a primary (3-dose) vaccination series or as a subsequent booster were enrolled. Adverse events (AEs), adverse drug reactions (ADRs) and serious AEs (SAEs) were recorded after each dose during the 30-day post-vaccination follow-up period. Among a total of 639 children, 289 subjects (45.2%) experienced AEs, mostly (79.2%) assessed as being unlikely to be related to the vaccination. ADRs were reported in 13.0% of subjects. Fever was the most commonly reported expected AE (11.9% of subjects) and also the most commonly reported expected ADR (8.5% of subjects). No obvious association between AE incidence and vaccine dose sequence was apparent. An unexpected AE was seen in 32.9% of children, and unexpected ADRs were far less common (1.9%). Thirty-four SAEs were recorded in 26 subjects (4.1%), in two of whom a causal association with the vaccine could not be excluded, although both resolved quickly. Data from this PMS indicate that DTaP-IPV has an acceptable safety profile when given to Korean children in accordance with local prescribing recommendations in routine childhood immunization. ClinicalTrials.gov identifier: NCT01568060.


Assuntos
Anticorpos Antibacterianos/sangue , Anticorpos Antivirais/sangue , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Vacina Antipólio de Vírus Inativado/administração & dosagem , Vigilância de Produtos Comercializados , Criança , Pré-Escolar , Difteria/prevenção & controle , Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Feminino , Humanos , Imunização Secundária , Lactente , Masculino , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado/efeitos adversos , Estudos Prospectivos , República da Coreia , Tétano/prevenção & controle , Vacinas Combinadas/administração & dosagem , Vacinas Combinadas/efeitos adversos , Coqueluche/prevenção & controle
19.
Public Health ; 167: 41-49, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30639802

RESUMO

OBJECTIVES: Using 542,159 vaccination records from children born between April 1, 2007, and March 31, 2012, in the Michigan Care Improvement Registry and data from the American Community Survey, we determine if neighbourhood-level characteristics at the Census tract level and block level are associated with low uptake of the fourth dose of diphtheria-tetanus-acellular pertussis vaccine (DTaP4). STUDY DESIGN: This study was a cross-sectional study. METHODS: We used exploratory factor analysis to determine important socio-economic factors at the Census block level and tract level. We then used generalised estimating equations to test the relationship between block- and tract-level socio-economic factors and DTaP4 uptake. RESULTS: DTaP4 coverage was 88.6% (95% confidence interval [CI]: 88.4%-88.7%) in Michigan. At the Census tract level, two factors surfaced as important for DTaP4 vaccination: 'affluence' (Cronbach's alpha = 0.88) and 'socio-economic disadvantage' (Cronbach's alpha = 0.89). At the Census block level, one factor was important: 'affluence' (Cronbach's alpha = 0.90). Affluence may relate to knowledge about medical exemptions and antivaccination sentiment, while socio-economic disadvantage may indicate limited access to healthcare resources. Children in high-affluence tracts had 1.08% lower vaccination coverage (95% CI: -1.62% to -0.55%) than children in low affluence tracts. Children in low socio-economic disadvantage tracts had 2.92% higher coverage than children in high socio-economic disadvantage tracts (95% CI: 2.58%-3.26%). CONCLUSIONS: This study articulates the need to further understand the contribution of neighbourhood-level characteristics, from both affluent and socioeconomically disadvantaged areas to low vaccination rates. Developing a better understanding of these social environmental factors will help determine useful community-level interventions to improve vaccination rates and reduce disease burden.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Características de Residência/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Humanos , Michigan , Fatores Socioeconômicos
20.
Matern Child Health J ; 23(2): 201-211, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30288661

RESUMO

Objectives The Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that pregnant women receive the Tdap vaccine during every pregnancy. The objectives of this paper are to evaluate disparities in Tdap vaccination among pregnant women in the U.S., and to assess whether race/ethnicity and other characteristics are associated with factors that inform pregnant women's decisions about Tdap vaccination. Methods We conducted a nationwide cross-sectional web-based survey of pregnant women in the U.S. during June-July 2014. The primary outcome was self-reported vaccination status with Tdap during pregnancy, categorized as vaccinated, unvaccinated with intent to be vaccinated during the current pregnancy, and unvaccinated with no intent to be vaccinated during the current pregnancy. Secondary outcomes included factors that influenced women's decisions about vaccination and information needs. We used multivariable logistic regression models to estimate odds ratios for associations between race/ethnicity and the outcomes. Results Among pregnant women who completed the survey, 41% (95% CI 36-45%) reported that they had received Tdap during the current pregnancy. Among those women in the third trimester at the time of survey, 52% (95% CI 43-60%) had received Tdap during the current pregnancy. Hispanic women had higher Tdap vaccination than white women and black women (53%, p < 0.05, compared with 38 and 36%, respectively). In logistic regression models adjusting for maternal age, geographic region, education, and income, Hispanic women were more likely to have been vaccinated with Tdap compared with white women (aOR 2.29, 95% CI 1.20-4.37). Higher income and residing in the western U.S. were also independently associated with Tdap vaccination during pregnancy. Twenty-six percent of surveyed women had not been vaccinated with Tdap yet but intended to receive the vaccine during the current pregnancy; this proportion did not differ significantly by race/ethnicity. The most common factor that influenced women to get vaccinated was a health care provider (HCP) recommendation. The most common reason for not getting vaccinated was a concern about safety of the vaccine. Conclusions This study found that some disparities exist in Tdap vaccination among pregnant women in the U.S., and HCPs have an important role in providing information and recommendations about the maternal Tdap recommendation to pregnant women so they can make informed vaccination decisions.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/uso terapêutico , Disparidades em Assistência à Saúde/estatística & dados numéricos , Comportamento de Busca de Informação , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Gestantes , Vacinação/métodos , Adolescente , Adulto , Grupos de Populações Continentais/estatística & dados numéricos , Estudos Transversais , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Inquéritos e Questionários , Coqueluche/prevenção & controle
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