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We have previously developed an innovative vaccine based on the genetic mutability and diversity of variable HIV-1 epitopes. This polyvalent peptide vaccine has been shown to induce a broadly reactive peripheral immune response in mice and macaques, however, the level of mucosal immune responses were not sub-optimal. In this study, we take advantage of this distinctive polyvalent immunogen cocktail paired with a well studied lipid-bile salt vesicles, to develop a novel orally-administered vaccine system which enhances both peripheral and mucosal immune responses.
METHODS: Retention and stability of Variosite formulations within the lipid vesicles were determined using quantitative and qualitative biochemical assays. The breadth of cross-subtype humoral and cellular immunity was determined in mucosal and peripheral sites.
The developed formulations also elicited a broadly reactive cellular response against a panel of HIV-1 subtypes after the last boost, suggesting that the vaccine was capable of eliciting both humoral and cell-mediated immune responses. Our findings suggest that induction of mucosal and peripheral immune responses at different sites can be controlled by choosing appropriate vaccination routes.
It is the first demonstration that influenza virus-like particles VLPs structures can form in plants and from the sole expression of the hemagglutinin antigens. The transient technology could deliver vaccines in about a month after the identification and reception of genetic sequences from the pandemic strain. Cross-reactivity was demonstrated against three of the deadliest strains of H5N1: the Turkey strain clade 2.
However, laboratory diagnostic methods are subject to classification error of varying degrees depending on the diagnostic method used. Classification error occurs when inherent limitations sensitivity, specificity of a diagnostic method result in a proportion of samples being incorrectly classified i. Failing to account for classification error may result in inaccurate and poorly comparable surveillance data as well as misinform public health interventions. PURPOSE: This study was undertaken to demonstrate the impact of classification error on influenza surveillance data and influenza epidemiology.
Known sensitivities and specificities of four influenza diagnostic methods — viral culture, direct fluorescent-antibody assay, rapid antigen tests, and reverse transcription-polymerase chain reaction — were used to adjust the reported number of positive influenza tests. An epidemic curve of a typical influenza season was plotted using the same method in order to describe the impact of diagnostic method on the epidemiologic description of the season.
After adjusting for known diagnostic method sensitivities and specificities, observed values indicated over-estimation of influenza detections in both years. However, the magnitude and direction of misclassification varied by province of testing: from a The description of a typical influenza season revealed that severity and length of the season is dependent on diagnostic method used. This information should be used by epidemiologists in order to better interpret surveillance data between provinces and over time.
Coverage rates for Ontario children have never been assessed. PURPOSE: To estimate influenza immunization coverage rates in Ontario children aged 12 years or younger for the —07 influenza season and to compare Ontario rates with those in other provinces that have targeted programs. Survey estimates for children aged 6 to 23 months were compared with vaccination rates derived from physician billing claims from health administrative data and also with vaccination rates achieved in other provinces.
The coverage rate complete and partial combined was highest in children aged 2 to 11 years with chronic conditions at The coverage rate in healthy children aged 2 to 11 years was Children aged 6 to 23 months had the lowest coverage rate at The rate of vaccination for children aged 6 to 23 months based on physician billing claims was The Ontario estimate for children aged 6 to 23 months was lower than those obtained in other provinces.
Parent-reported coverage rates for children aged 6 to 23 months are higher than those from administrative data. We estimate vaccine effectiveness VE against influenza hospitalization in this age group among during three winters. Cases were hospitalized for laboratory-confirmed influenza.
Controls were hospitalized for acute respiratory illness and test-negative for influenza. Seasonal influenza activity was characterized based on national laboratory surveillance. More than two-thirds of participants were previously healthy and less than one-third were vaccinated.
During each season, the H1N1 vaccine component was considered well-matched to circulating H1N1 virus whereas the H3N2 component was relatively strain-level mismatched and the B component was significantly lineage-level mismatched. Low numbers of participants each season and wide confidence intervals preclude definitive conclusions based on this study. Further evaluation, including antigenic strain characterization is needed.
There is a paucity of literature examining the susceptibility of new immigrants to vaccine preventable diseases. Socio-demographic and seroprevalence data were extracted and analysed. When these data are combined, Immigration status, age and birth region were associated with susceptibility. Measles susceptibility declined with age and no patients over 40y.
Mumps susceptibility also was found to decline with age. Additionally, birth region was a predictor of immunity to measles and mumps, but not rubella. Greater susceptibility to mumps was observed among patients born in Central America and the Caribbean Gender was not related to immunity.
Immunization programs in Canada should carefully consider these variations in susceptibility to infectious diseases among newcomers. As developing countries become more advanced, PICU care comes into reach. The age range was 2 mo to 14yr; mean 35mo. Mortality rose with increasing number of organs involved. Primary infection was major cause of MODS in China and in other developing countries but not in industrialized countries.
Between September 1 and November 30, , cases occurred. The increase was initially observed in post-secondary students within the 17 to 26 year age group. By November, regions implemented an enhanced mumps immunization program for students and staff in postsecondary institutions across Alberta. Within two weeks of program implementation, several suspected anaphylaxis were reported. Over the next couple of weeks three additional reports were reported.
Detailed case histories were gathered for all cases including past immunization and allergy history; all were seen by an allergist. Case histories revealed that most had at least one previous measles containing immunization as well as various allergies. It was hypothesized that the young adult population receiving the vaccine may have been more sensitive to the components than what has been seen in children.
AHW defined protocols and developed an enhanced reporting form currently in use for any severe reaction to an MMR immunization to provide further data to these investigations. PHAC is in the process of developing standard operating procedures for anaphylaxis as a result of the Alberta experience, to be used nationwide. Cell-mediated immunity CMI also develops following infant DTaP vaccinations but only limited data exist regarding its persistence prior to the pre-school booster and possible effects on booster responses.
Peripheral blood mononuclear cells PBMC were separated and tested for proliferative responses to purified vaccine antigens after 6 days of incubation, assessed by incorporation of tritiated thymidine. Proliferative responses were examined in relationship to the presence and amounts of serum antibodies in the pre-booster sample.
Only 4 subjects 2. Subjects with cellular responses had higher corresponding antibody concentrations before boosting than did proliferation-negative subjects. Subjects with CMI were more likely to retain measurable antibody, supporting a memory function.
This discrepancy between cellular and humoral immunity may explain the high rate of injection site reactions seen with pre-school boosters, which have characteristics of delayed hypersensitivity reactions. PURPOSE: To foster collaborations between researchers and educators from the differing fields of cervical cancer screening, vaccines and public health.
Thirty Canadian experts were invited to participate in each session which began with an inventory of relevant research already being done. Experts included researchers, clinicians and decision-makers providing broad representation of the various disciplines.
Each Masters Class had international experts providing the most current knowledge to the participants. This was followed by opportunities in breakout sessions to identify and discuss research project designs. Each Master Class discussed the infrastructure needed to realize the projects, existing opportunities and the steps that would be required to implement and conduct the research. Each of the research questions were discussed and project design was identified.
Decision-makers readily participated by providing insight into information required to make programmatic decisions. Identifying mechanisms to fund these projects was an immediate priority as traditional sources of research funding rarely recognize the need to support evaluation of publicly funded vaccine programs.
Although an infection prevention strategy immunization, antibiotic prophylaxis, early care for febrile illness is considered standard of care for these patients, implementation is likely not optimal. Patients pts were selected based on diagnosis dx codes for hematologic and other conditions HC for which S might be considered.
Each person was followed from the date of first dx until December 31, or death or relocation out-of province. In addition, an extraction was completed for pt files with S but without a HC, and for the 6 months post-S. S was identified in subjects without a HC dx A; 21 C. Infectious illness visits were higher in pts with S v.
Results from Cox proportional hazards regression models and modelling S as a time-dependent covariate, indicated that pts with S were are significantly higher risk of death compared to pts without S in all HCs except HS. Delivery of pneumococcal immunization to these high-risk pts appears to be very low. Immunization is associated with decreased risk of death. Improved delivery of infection prevention programs to this population is warranted. Canada was among the first countries to use Meningococcal C conjugate vaccines MenC routinely.
MenC vaccine failure was defined as serogroup C disease in a completely immunized healthy child. Among the five, one case appears to be a MenC conjugate failure, while three were incompletely immunized. The one apparent vaccine failure occurred in a healthy 2 year old who had received one dose of MenC at 12 months of age. For one case the vaccination date information is insufficient.
PURPOSE: We developed an economic model to estimate net cost, cost-effectiveness and budget impact of implementing a publicly-funded universal influenza immunization program for PW in NS and explored cost implications of different vaccine delivery strategies. Event probabilities and quality-of-life weights were derived from the literature and event costs from administrative databases. Vaccine acquisition and administration costs were provided by NS Department of Health.
Programs utilizing PHN vaccination could be extremely cost-effective, bordering on cost-saving. Targeting only PW with COM is cost-saving but risks reducing coverage rates and overall health benefit of the immunization program. In Canada, nurses play a key role in vaccination. PURPOSE: 1 to assess the knowledge, attitudes and beliefs of Quebec nurses about new vaccines; 2 to estimate the Basic Priority Rating BPR of the implementation of new immunization programs with seven candidate vaccines by using nurses responses to five statements regarding vaccine usefulness, effectiveness, safety and acceptability by the public and by the vaccinators.
The survey followed the general recommendations by Dillman Mean scores for the statements about the usefulness, safety, effectiveness and acceptability of seven new vaccines varied from 6. The highest BPR scores were observed for Twinrix 5. This heterogeneity is indicative of the complexity of issues related to potential new immunization programs implementation and the need of targeted educational efforts before implementing such programs.
METHODS: The study population includes individuals targeted in the mass immunization campaign: residents in the province of Quebec born between July 17, , and November 30, Statistics provided by vaccinators and individual data from the Meningococcal Vaccination Registry were used to estimate age-specific vaccination rates. An estimated 1,, persons received at least one dose of C-MCV and , persons were not vaccinated.
Cases of serogroup C meningococcal disease C-MD confirmed by culture or by PCR and notified to public health authorities from January 1, to December 31, were obtained. This list was complemented with information provided by the Provincial Reference Laboratory. Information on immunization status came from two independent interviews.
There was a tendency for increased protection according to the age at vaccination: 3 C-MD cases among 56, individuals vaccinated before one year of age one to 3 doses and no case among 3, non-vaccinated individuals in the same age-group; This vaccine, as its valent parent, has the potential to prevent AOM caused by Streptococcus pneumoniae and by non-typeable H.
AOM is a major cause of morbidity in young children and of health services use, including antibiotic prescriptions. In Canada, nurses are playing an increasingly important role in the promotion and administration of vaccines and there is little information on their knowledge, attitudes and beliefs KAB regarding AOM prevention.
METHODS: nurses practicing across the province of Quebec were randomly selected to participate in this anonymous, mail-based survey. Most nurses would support an eventual publicly funded immunization program with a pneumococcal vaccine with a larger spectrum of protection against AOM.
Additional information about AOM burden, vaccine safety and effectiveness should be delivered before implementing a new pneumococcal vaccine. Educational methods using accepted immunization competencies may support the development of practitioners who will champion immunization and will use both peer and patient interactions as an opportunity to modify misconceptions and reaffirm the value of immunization. PURPOSE: To identify whether the use of problem-based learning, using an immunization competency-based framework, can create an environment for transformative learning to achieve sustainable positive attitudes and behaviours.
This method allowed for the opportunity to use the Kirkpatrick framework levels 1—3 , to evaluate whether transformative learning occurred to achieve sustained positive attitudes and behaviours towards immunization. RESULTS: Preliminary results indicate that course satisfaction results were high amongst participants Kirkpatrick, —Level 1—satisfaction and that short term successes were achieved when comparing the pre course knowledge attitudes and behaviours with the post intervention results Kirkpatrick, —Level 2—Learning.
The results for the longer term achieve sustained positive attitudes and behaviours towards immunization are pending and will be available by August Influenza is reported from pediatric and adult labs in Halifax; parainfluenza and adenovirus are reported only from the former lab. Data include number of specimens tested and number of positives.
Data are compared to inf-like illness ILI diagnosed by sentinel physicians participating in FluWatch. The peak periods were from April 8 to May 5 during — season, January 14 to February 10 in —, and March 30 to April 5 in — Most RSV cases were among children under 5 years of age.
The average incidence of RSV was The incidence per specific age groups ranged from 0. The highest rate was among infant age group of 0—5 months and the lowest rate was among age group of 16—65 years of age. Delivery of the provincial passive immunization program in a weekly clinic each December was sufficiently in advance of the season to theoretically provide protection for almost all high-risk infants.
The time of onset and severity of the RSV season varied and was consistently late in the winter. This data can be used to plan palivizumab prophylaxis, and when fully developed could assist in distinguish respiratory outbreaks from other viruses in the community and acute care and long term care settings. However, these reagents may not be readily available during an influenza pandemic. As part of the Canadian Influenza Pandemic Preparedness Plan, alternate methods for determining the potency of influenza vaccines are required.
The utility of the SE-HPLC method, which is highly reproducible and independent of specific reagents, was investigated for assessing HA content as a measure of quality control of influenza vaccines. This novel approach should be advantageous in that it can be rapidly performed and does not rely on reagents. Several untreated monovalent bulks of influenza vaccines, including those for potential pandemic influenza strains, were injected into the column system.
Optimal conditions for separating the proteins were determined using different mobile phases, pH of mobile phases, and column temperatures. The HPLC profiles of those vaccines were analysed for retention time, peak area and peak height. The HA profiles for different monovalent influenza strain vaccines, including the proposed pandemic H5N1 strains, were similar.
Linearity was achieved upon varying sample concentration. Further method development will facilitate the identification of compositions of the HA peak area and standardization of this method. This assessment includes independent laboratory testing. Inactivated Poliomyelitis Vaccine IPV and acellular pertussis aP vaccine are two components included in many combination vaccines administered to healthy infants and children.
Both vaccines are manufactured using an inactivation process, and the conformations of these antigens have not been fully elucidated. This poses additional challenges for the potency testing of these two vaccines. However, there is no internationally accepted method for assessing the potency of aP vaccine. To evaluate the potency of the aP vaccine, an in vivo immunogenicity test in animals is used in our laboratory to assess the vaccine-induced total antibodies, by ELISA, and functional antibodies, using a cell-based assay.
However, the rat potency test might be more sensitive in detecting changes of IPV antigens occurred after long term storage. This observation is consistent with published data showing that the rat potency test provides the most relevant information concerning the clinical performance of the IPV vaccine. Prevention of neonatal mortality is hampered by a lack of safe and effective vaccines.
METHODS: We vaccinated newborn mice with Listeria monocytogenes Lm expressing the model vaccine ovalbumin Lm-Ova and assessed the primary and secondary responses, immune memory development and protection from lethal challenge. Cellular phenotype and effector responses were measured using multi-parameter flow cytometry, serum was assayed using multiplex bead array, and organ-specific protection was determined.
Both primary and secondary immune responses are stronger in neonates, who exhibit superior protection from vaccination with up to fold lower vaccine dose. Interestingly, effector memory T cells Tem have been demonstrated to be the protective cell type for anti-listerial immunity, and our neonatal memory T cell responses were more dominantly skewed to the Tem phenotype than adults were. Furthermore, the newborn immune response to wider arrays of vaccine epitopes introduces exciting possibilities for the use of neonatal vaccination to better protect from escape mutants in pathogens such as influenza and HIV, which are prone to antigenic shift.
These data support our notion that the neonatal immune system provides a unique and at times potentially superior immunological milieu for induction of protective immune responses by vaccination. Mean age of the children was 3 years. Parental willingness was also associated with the perceived value of action, self-efficacy, and perceived susceptibility of the child to AOM.
This can only be an effective infection control strategy if workers actually accept the vaccine. Very little is known about how health care workers will respond during a flu pandemic. Uptake of seasonal flu vaccine among health care workers is drastically below targets, despite considerable evidence of efficacy, and organizational and legal pressure to adhere to this recommendation. Some plans are explicit in their assumptions that more health care workers will accept the vaccine in a pandemic situation than in outbreaks of seasonal flu.
Evidence for this assumption is lacking. Community based data is scarce in Pakistan regarding the actual vaccination coverage of hepatitis B. METHODS: This community based health survey was conducted on 28th March in Bhitayabad one of the biggest squatter settlement in Karachi, Pakistan consisted of four villages with a total population of around , Data was collected using structured questionnaire based interview, conducted by the 25 data collectors, trained by the investigators.
Four teams of data collectors were made for all four villages and a sample of 55 houses only one participant enrolled from each house were enrolled from each village through systematic sampling every fourth house was selected. Information was collected about the demographics and vaccination doses of hepatitis received by the participants confirmed by vaccination card where available. Data was presented in mean with standard deviation SD for continuous and in percentages for categorical variables.
Hepatitis B vaccination coverage though increasing in younger population yet there is a need for massive provision of such vaccines for the whole population to reduce the spread and mortality as a result of Hepatitis B infections. The aim is to improve the efficiency and effectiveness of immunization delivery and the safe use of vaccines through the use of automated identification technology on vaccine products and to incorporate this technology into electronic immunization registries.
The mandate is to provide leadership, overall guidance and advice for the development and implementation of vaccine bar codes in Canada and to contribute to the development of global standards. This year a cost benefit analysis will be completed and a comprehensive assessment of the state of readiness of all stakeholders will be implemented. The Task Group has proposed a staged-in implementation strategy.
Results from the cost benefit analysis and assessment will be instrumental in refining this proposal for review by the Canadian Immunization Committee in October and presentation at the Conference. PURPOSE: Each staff member on the roster had differing areas of expertise but had to be prepared to offer advice on a variety of topics.
It was decided to develop a resource manual for the use of staff on call. The development of materials for the manual has had unexpected and positive ramifications for the delivery of certain aspects of an immunization program. METHODS: Each department identified the topics from their area of expertise that might generate the need for immediate action outside of regular office hours.
A manual was developed that included algorithms and tables, for example, that allowed staff to provide advice outside their normal work content. The On call team meet quarterly to review issues and share information and determine learning needs.
A powerpoint presentation was developed around wound management for PHOC staff but has been used in a variety of ways for staff education. The collection of On Call stats reflects the most common reasons for calls and has lead to the ongoing identification of learning needs and evolution of the manual content. Learning needs of on call staff has resulted in the development of presentation materials that have been used not only by on call staff but in a variety of ways with other stakeholders.
The input from on call members has led to an improved product the manual and improved teaching resources and risk management practices. Peace Country Health PCH , a northern region with traditionally poor coverage rates has developed a number of initiatives to accomplish the task. Baseline data for infant and preschool coverage rates were collected as well as a measurement of clinic capacity in appointment hours and clinic wait times.
A number of new strategies were suggested. Some were aimed at 18 month old children, the age at which coverage rates traditionally drop. Others were more population focussed, to raise the profile for immunization services in general. The latter included a marketing strategy to encourage parents to take advantage of the pain reduction possibilities for the first 3 clinic appointments and thus have their infants immunized on time. The van component has yet to be initiated.
We spent a long time deciding what to purchase and wanted to retain remaining funds until that major expenditure was realized. Clinic wait times are being monitored and show improvement. Clinic capacity has increased. Evaluation is ongoing. Not only do they administer the vaccines but they are the interface with the public.
Randomly selected nurses completed a self-administered, mail-based, anonymous questionnaire. No important differences between responses of nurses who administer vaccines and those who do not were observed. To ensure optimal immunization coverage, additional educational efforts should be made. The high cost of the vaccine makes this impractical to implement. The ID route is as immunogenic, but technically more difficult, thus a serology is recommended after vaccination.
We aim to study its feasibility and immunogenicity. Participants received 3 doses of 0. Two serologies were performed almost 1 year after vaccination, with titers below 0. This less costly alternative can increase access to pre-exposure vaccination, especially during vaccine shortages. Titers seem higher if done between 2 to 6 weeks after vaccination.
Antibody persistance will be examined in a follow up study. Excessive administration of vaccines and immunoglobulin generates useless side effects and is very expensive. Only 25 patients had a valid vaccination card; TQS were realized. Whenever TQS was positive the patient consequently received no tetanus prevention. We then compared the cost of tetanus prevention employing TQS against the cost of prevention using classical prevention.
The prevention of the non immunized patients needed boosters and TIG. Using TQS, tetanus prevention have cost Using the classical method the cost to prevent tetanus would have been The test could systematically be included in the tetanus prevention algorithm. To implement successful HPV vaccination programs, it is important to understand the psychosocial factors affecting HPV vaccine acceptability among health care professionals HCPs , parents, and young adults.
Thirty-two studies were reviewed from the existing literature. Parents and young adults were more accepting of the HPV vaccine if: they believed that vaccines were beneficial; others would recommend the vaccine; they were susceptible to HPV; and they had previous experience with a sexually transmitted infection STI.
Parents were less accepting of the HPV vaccine if they were older, had higher levels of education, believed that the vaccine was not safe, and believed that the vaccine would encourage promiscuity. HCPs were more accepting of the HPV vaccine if they believed that the vaccine was effective and relevant professional organizations would recommend the vaccine.
Greater effort should be made to tailor educational interventions especially to fit the specific needs of HCPs. PURPOSE: To describe the school-based HPV vaccination program for grade 8 females in Toronto, its effectiveness in achieving the targeted coverage rate, the opportunities and challenges associated with implementation and future program modifications. Focus groups were conducted of Toronto Public Health Vaccine Preventable Disease staff in January to ascertain the opportunities and challenges to program delivery.
A retrospective analysis of media coverage in Toronto was also performed. Challenges of this program were the short time-line to convey information to parents, limited communication resources and negative media stories. To increase coverage rates further catch-up clinics were extended into the summer, posters and post-cards were disseminated in June and a survey of parents of grade 8 females is being developed.
Lessons learned from Toronto Public Health, a large urban health unit, can provide advice and consideration for others planning similar programs. In the multivariable model, immunization was more likely in children with asthma OR 1.
The association of immunization with low IA was stronger in those without compared to those with asthma OR 1. Consistent with the literature, higher immunization rates were found in immigrant children. Contrary to expectations higher rates are also seen in children from lower IA homes. These standards include monitoring and reporting of immunization rates on a regular basis.
PURPOSE: To develop an immunization surveillance system which enables Capital Health to monitor immunization rates, report on the reasons children are delayed and identify geographic areas within the region where rates are below recommended target levels. Information collected includes patient demographics, vaccine information as well as date and location where the vaccine was administered.
Immunization rates are calculated and reported for the 4, 15 and month birth cohorts monthly, quarterly and annually. For those children who are delayed, additional follow-up will identify reasons for such, recorded as either refused, lost to follow up or other. In there were slight and unexpected declines in the immunization rate at 4, 15 and 24 months.
In specific geographic areas experiencing the largest declines, accompanying reasons for delayed were analyzed further. Early identification of such trends is essential, and was made possible by the availability of comprehensive, electronically accessible immunization information. As a result, an expanded version of the delayed immunization monitoring system is currently in development to look at more specific user-defined geographic areas, time frames and reason variables.
Analysis of this data revealed that certain populations have immunization rates below Capital Health targets. METHODS: Four general strategies were initiated: 1 enhanced community outreach, 2 facilitation of attendance at immunization clinics, 3 identification and immunization of under-immunized grade nine students in high risk schools and 4 increasing access to research based information to address immunization myths and anti-immunization information.
Education of daycare providers at onsite clinics and the development of information sheets discussing controversial immunization issues for use by community health nurses and the public to increase the level of education in the community. And finally, school based immunization programs were generally well accepted and facilitated a relationship between health providers, schools and parents. However certain challenges remain. Language barriers exist among many in the under-immunized population.
Accessing accurate and up to date immunization records for new or mobile Albertans is difficult. While distributing accurate immunization information to physicians is an excellent way to enhance public education, additional stakeholders must be identified within the community. And finally, staffing levels may not actually permit many of these programs to be maintained.
Parents of students without evidence of proper vaccination are sent up to three notices requesting information before a child is suspended from school. The goal is to ensure an adequately immunized student population, while avoiding the need to suspend students. Student demographics, overdue vaccine antigens, dates of vaccinations, and notice mail dates were used to assess vaccine status. Descriptive summaries and bivariate statistical tests were conducted with SAS.
The majority Notices either stimulated vaccination among unvaccinated students or prompted parents to provide documentation that students had been previously vaccinated. Further study is needed to determine why timely vaccination information is not being provided to TPH. A comprehensive immunization registry that collects vaccination information at the point of service could be a useful tool for keeping student vaccination records current.
Medical Officers of Health can suspend children from school if their immunizations are not up-to-date. Currently, the majority of Ontario children receive their immunizations from their physicians. Without a standard means for physicians to share vaccination information, health units must rely on parents to provide these vaccination records directly. The ultimate goal was to decrease the number of school suspensions for incomplete immunization. Gerri appears on all program resources and promotional materials, including correspondence with parents, physicians, and schools.
OPH has been approached by several provincial and national jurisdictions regarding this unique approach. One health unit has adopted Gerri as their ambassador. School suspensions will decrease in our community when parents have their children immunized routinely and know how to report this information promptly to public health. Simultaneous injection method has been reported to be a preferred vaccine administration method for multiple immunizations by vaccine providers.
PURPOSE: The study compared the differences in infant immunization distress and pain between the control sequential and experimental simultaneous groups of infants receiving multiple injections at the 4-month routine immunizations. The salivary cortisol levels and the Neonatal Pain Scale NIPS scores were the primary and secondary outcome measures of distress and pain to compare the differences between the two groups.
A significant percentage of children presenting for immunization are highly anxious and resistant to needle procedures. Immunization of children with needle fear often presents ethical, emotional and physical challenges to immunizers. Existing immunization policies focus on physiologic and mechanical elements but are silent on managing resistant behaviours associated with needle fear.
Nurse distress is not well recognized and nurses want support and resources to improve outcomes when immunizing children who fear needles. Immunizer training and involvement in developing and testing interventions with children and their caregivers during immunization procedures is needed. Although there have been economic studies of pneumococcal vaccine in Canada, all have been based on experimental study results, and none on actual experience.
All children were followed between the time of discharge from hospital at birth, to their second birthday. We linked immunization records post-cohort with provincial utilization records for physician services, out-patient services, and inpatient services. Utilization was divided into two groups — cases identified by strep pneumococcal, and cases possibly linked by not diagnosed as such e.
We tracked utilization for each child for two years, and attached costs to each service. We estimated the costs per child between the cohorts. Utilization of hospital, physician billings and outpatient emergency room services were significantly less in the pre-cohort. The implied cost-effectiveness ratio is favorable, compared with usual standards. PURPOSE: This experimental research was designed to provide evidence for the continued use of air-sensing thermometers or for their replacement with liquid-sensing thermometers in vaccine refrigerators.
In each office a data logger and a new liquid-sensing thermometer were installed into the vaccine refrigerator along with the existing old air-sensing thermometer. Refrigerator temperatures were recorded twice daily for a period of 7-days. The data loggers automatically recorded the actual refrigerator temperature during the study. Least squares linear regression was used to determine the relationships that existed between the old and new thermometers and the data loggers.
RESULTS: The results of the regression analyses suggest that there was only a modest relationship for the refrigerator temperature recording between the old air-sensing thermometers and the data loggers. A strong relationship existed between the new liquid-sensing thermometers and the data loggers. As well, the new thermometers recorded a higher frequency of vaccine refrigerator temperature fluctuations considered to be detrimental to vaccines.
The study process also sensitized vaccine refrigerator office staff to the negative effects of temperature fluctuation on vaccine integrity. Data for children immunized for hepatitis B vaccine is not available. METHODS: A cross sectional observational survey was conducted from December to September , Khyber teaching hospital was assigned as urban setup where only respondents belonging to the city area were selected and interviewed. Women from Palusi village rural area were included as rural sampling in present study.
Of total sampling Of urban sampling Mother education level in urban and rural areas varies significantly that has its impact on the EPI services, maternal education levels were: illiterate urban Father education was: illiterate urban Maternal occupation also influence the EPI program in both set up, maternal profession recorded was: house wife urban Maternal education and occupation are main factors that strongly affect the immunization on children and EPI program goals. In order to prevent the spread of HPV which is the principal cause of cervical cancer , widespread uptake of the vaccine is essential.
Therefore, it is critical to understand factors related to intentions to receive the HPV vaccine. Fifty university students aged 18—26 completed a computer task assessing implicit HPV vaccine attitudes and a questionnaire assessing demographic characteristics, sexual health and history, HPV and HPV vaccine knowledge, explicit HPV vaccine attitudes, HPV vaccine related beliefs subjective norms, perceived behavioral control, perceived susceptibility, perceived severity, benefits and barriers and intentions to receive the HPV vaccine.
Factors related to intentions included: explicit HPV vaccine attitudes, family recommendation, and the beliefs that the HPV vaccine will prevent HPV and cervical cancer, promote comfort in sexual situations, reduce anxiety about HPV and not lead to negative health consequences. Educational programs for young adults and their families regarding the health benefits of the vaccine may be beneficial in promoting acceptance of this vaccine.
Clinical expertise in administration is limited. This observation led to an evaluation of a topical anaesthetic to determine if the use of EMLA might reduce the perception of pain thereby resulting in higher subject retention and immunization acceptance. A baseline assessment of pain was performed subjective and objective at the time of dose 2. The same pain assessments were performed at the time of dose 3 administration after application or non-application of EMLA.
The use of a topical anaesthetic to reduce pain when giving HPV vaccine is neither economically nor logistically feasible, given the lack of pain reduction in adolescent girls when HPV vaccine is administered. Historically, coverage rates have been measured on a yearly basis, often months or years following year end.
This delay in reporting means little can be done to improve the situation if rates drop in the short term. The value of using automated algorithms, historically used in syndromic surveillance systems, may be a solution to this problem. We used the negative, one-sided CUSUM and three-month moving average procedures to determine if the counts for MMR and Pentacel delivery had dropped below a defined minimum acceptable level.
The counts for Pentacel, however, did show a significant and sustained drop beginning in December of Later investigation showed this was due to a vaccine shortage during this time period. The objectives of the evaluation were to:.
Inform future decisions regarding immunization program planning, design and implementation;. The design and implementation of the strategy was found to be effective, particularly in the area of increased partnerships and collaboration, improved access to programs, and enhanced affordability and security of vaccine supply.
Documents reviewed revealed that from to , twice as many children had access to the four new vaccines, and there was a significant increase in coverage for three of the four. The incidence rates in invasive pneumococcal disease and pertussis decreased, and vaccine supply became more secure with more provinces and territories participated in the bulk purchase program. While vaccination for pneumococcal, meningococcal and varicella is also recommended, it is not enforced by suspension.
PURPOSE: To understand the reasons why day care children have an incomplete recorded immunization status and to examine if the reasons differ for vaccines that are enforced versus not enforced by suspension.
Children were categorized for each vaccine and descriptive statistics were computed. Comparisons were made between those who were missing the vaccines s relative to those who had not reported their immunization information to the health unit. Follow-up calls to parents occurred to obtain records for the non-enforced vaccines, as parents were not legally required to report such information.
Coverage of the enforced vaccines is higher than public health records had indicated; however coverage of the non-enforced vaccines is unclear as a fairly large proportion of children did not submit records to the health unit. Future efforts should focus on improving vaccine record collection, particularly for vaccines not enforced by suspension.
This could benefit especially to elderly who have a weakened immune response to current influenza vaccines and are at increased risk for complications or death associated with influenza. Input data were obtained primarily from the published literature. The incremental effectiveness of intradermal vaccination was derived from the increased immune response measured in a randomised clinical trial. The primary outcome was quality-adjusted life-years QALY , accounting for lost quality of life during influenza episodes and complications, and the reduction in life expectancy.
RESULTS: The average incidence of influenza cases, influenza-associated hospitalisations and deaths were , and 68 per , persons per season among those vaccinated via intradermal route, vs. The corresponding number of QALYs gained with the intradermal vaccine was The variables with greatest influence on QALY gains were influenza-associated mortality rates and vaccine effectiveness against deaths.
The introduction of the intradermal vaccine was projected to prevent ; influenza cases, ; hospitalisations and ; deaths over 5 years in Ontario. This model provides a framework for future cost-effectiveness analyses of the new intradermal vaccine compared to current vaccination policies.
Understanding the utilization and the satisfaction with these services is important for decision makers. PURPOSE: 1 To identify factors associated with the utilization of pediatric preventive health services provided in primary health care centers and; 2 to determine the level of satisfaction among parents about the immunization services provided in primary health care centers. Five hundred parents were selected randomly during their attendance at five primary health care centers in Riyadh City, of which The data were collected on a set of independent variables including predisposing, enabling and need variables which were thought influence the utilization of preventive health services.
Bivariate and multivariate analyses were employed to determine which factors best explain the utilization of preventive health services. Enabling and need variables seemed to be the principal factors influencing the utilization of immunization services. Among the predisposing variables, distance from home to the primary health care center was the only significant variable influencing the utilization of immunization services. The study found that parents were knowledgeable about the importance of immunization services, but unaware of other preventive services provided in these centers such as sanitation and environmental services.
Incident is particularly higher in public hospitals and there is occupational injury reporting system in these hospitals. PURPOSE: This study was conducted to determine the frequency of needle stick injuries in one month period among health care workers in three public tertiary care hospitals. Data was collected by structured interview based questionnaires in Urdu and English language.
Questionnaire was designed to obtain information regarding demography, work experience, working hours, working environment, hepatitis vaccination status, and occurrence of needle stick injuries with associated factors. Needle stick injury occurred in the preceding one month period was the defined outcome. Most of the participants had morning duties in the previous one month. None of them seek medical care or reported their injury to emergency department. There is an immediate need for the refresher and training programs at regular intervals for hospital staff regarding the knowledge of the consequences of needle stick injuries and the methods of prevention.
Fixed costs and savings from prevented infections were not included. Up to 2. Although not within the usual cost-utility range of many healthcare interventions, this is comparable to other safety measures implemented by many blood suppliers over the past decade, such as donor nucleic acid testing for HIV and hepatitis C virus. Conceptually, this program could expand the current means of enhancing blood safety, which focus on donor risk behavior screening and testing, to include primary donor prevention, that further integrates blood safety into a comprehensive public health disease-prevention strategy.
With emerging evidence that a three-dose schedule of pneumococcal vaccine is as effective as four doses, the National Advisory Committee on Immunization released a recommendation supporting a three-dose conjugate vaccination program. A literature review was conducted and expert opinion sought. First Nations children under two carried a disproportionate burden of illness in both the pre-and post vaccine PCV7 era.
With the recent increase in serotype 5 and outbreaks in high risk populations, an additional dose of PPV23 at the age of two years may provide expanded serotype protection. Children living in the three northern health regions, and some First Nations communities where there is high household density would benefit from a fourth dose of PPV However, universal immunoprophylaxis in this group is impractical due to size of the cohort and the cost of treatment. Infants were divided into 2 eligibility groups.
Infants whose parents reside above 50 degree North latitude were considered remote residents and automatically eligible for immunoprophylaxis with palivizumab if born before or during the RSV season November — February. Infants not residing in remote portion of Manitoba were eligible if they were born during the RSV season and scored within the high-risk category for RSV related hospitalization using a previously developed Risk-Scoring Tool.
Hospitalization for RSV related illness was recorded. RESULTS: infants born at 33—35 wks GA were identified: infants were born during the RSV season; infants were born before the season were not eligible as residing in non-remote Manitoba ; 48 infants were born after the season ended none eligible.
A total of 39 infants from remote northern communities were identified and were enrolled. Of the non-remote infants born during the season with complete referral submitted, 10 were from Ontario and were not eligible. Of the 92 non-northern Manitoba patients, 56 scored in low risk category, 24 in moderate risk, and 12 in high risk. Only infants at high risk for RSV hospitalization were eligible and enrolled.
However, 2 moderate infants were included as they were siblings of those scored as high risk. A total of 14 infants were enrolled based on Risk Score. Of the 53 infants born at 33—35 wks GA enrolled, only 2 required hospitalization for RSV disease: one before receiving immunoprophylaxis, one after receiving only a single dose.
Eligibility criteria based on location of residence remote northern , and high risk for hospitalization Risk Score can be used to identify target groups within this cohort. However, more eligibility criteria have been added. Since its inception, the MB-RSVIP has used an active notification process: it is notified of all infants meeting standard eligibility criteria of prematurity, bronchopul-monary dysplasia BPD and hemodynamically significant congenital heart disease CHD.
Program data from to was reviewed. Additional eligibility criteria have been included: CHD since , 33—35 weeks gestation residing in remote Northern communities or at high risk of RSV related hospitalization since Overall enrolment into the MB-RSVIP has increased from initial infants in the — season, to peak of infants in —07 or 0.
As expected, inclusion of each additional eligibility criteria has increased enrolment. Inclusion of infants with CHD increased enrolment by average of 32 infants each year. The addition of the 33—35 weeks gestation criteria has resulted in an average increase of 57 infants per year.
Many cases occurred in persons born after but out of high school before the school-based second dose MMR campaign of i. Susceptibility to measles varied by birth cohort. Of those born before it was highest in those born —95 at Amongst older birth cohorts susceptibility was similar for cohorts born —79 and —89 at 8. For those born before , susceptibility was 3. Susceptibility may be underestimated if those tested for immunity are students applying to medical or nursing schools and healthcare workers starting in new posts, who may be more likely to be immune than the general population.
In contrast, patients, especially children, may have been tested because they were suspected to be non-immune which would over-estimate susceptibility. Surveillance of immunity in Ontario using representative samples should be a priority to improve policy and decision-making and ensure better measles control in future. Antigen-specific completion rates for children 2 years of age were determined by Regina city neighbourhood and rural communities.
The immunization coverage rates differ considerably by city neighbourhoods, as well as within rural communities. The assessment of the cohort of children born in also showed that Knight News Challenge: Libraries is now closed. Thanks to everyone who entered. We invite everyone to join us in looking through the ideas, asking questions and giving feedback. You can identify them on the newschallenge.
Libraries occupy a special place in our society. As the approval ratings for nearly all public institutions continue to plunge in the United States, libraries are treasured by a remarkable 90 percent, and they are used at all stages of life, from ages 3 to People visit libraries for lifelong learning and entertainment, for Internet access and digital resources, for job searches and local meetings, and to research and contribute to the history of their communities.
In many places in America and even more so around the world, libraries are the only available point of access to critical knowledge. But as central as libraries are in our communities—in the U. Over the last decade so many of us have started reading on devices for which the convenience is great, but the lock-in, with specific software and digital rights management, is even greater. Libraries have found e-books hard to purchase, and although publishers have become more open to licensing e-books to public libraries in the past few years, they treat those e-books like physical books—restricting borrowing to one user at a time—and have engaged in pricing for libraries in ways that many have seen as unfair.
The Web, not the library, has become the starting point for most research. Leetaru, a data scientist and the Yahoo Fellow at Georgetown University, writes about libraries as centers of information innovation. Imagine a world in which libraries and archives had never existed. No institutions had ever systematically collected or preserved our cultural past: Every book, letter and document was created, read and immediately thrown away.
Alternatively, what if everything had been kept and the Library of Alexandria had survived to present day, archiving all societal knowledge through the millennia? How would life be different in these two worlds, one of no history and one of all our history, and what can this suggest to us of the future role of libraries in society?
Today both of these worlds have become reality: Libraries ship the physical book world of our history off to storage, eliminating the serendipitous discovery of browsing, while the Web simultaneously creates a virtual Library of Alexandria that unifies societal knowledge. Have libraries truly been rendered obsolete in the digital world? Most evenings I ride my bike home from work past the public library here in Cambridge, Mass.
Often I see parents with their children, enjoying themselves on the playground in front of the library. I also see people quietly reading inside the building, as the evening lights around them turn on. In the same way that playgrounds are public spaces for play, I think of libraries as public spaces for learning. I have been interested in another type of public space, the concept of a digital commons, for a long time.
And today I am fascinated by the connection between these public spheres, between the physical space of the library, and the digital virtual space of information and communication. Leveraging their strengths, and tinkering with ways that they can complement each other, is one way to reimagine what the library of the future could look like.
In the past, when access to information and experts was scarce and books were unaffordable, libraries acted as archives of shared human knowledge. Today content knowledge is accessible easily via the Internet. But content knowledge is only a small part of learning. We learn best when we work on projects that ignite our passion, in collaboration with peers, and in a playful environment that encourages risk taking.
Journalism is a valuable method of inquiry. As a public service for the dissemination and analysis of information, it fulfills a crucial role in our society. The news media is the chief purveyor of information and opinion about public affairs. Access to free information plays a central role in creating a system of checks and balances in distributing power equally among governments, businesses, individuals and other social entities.
Access to verifiable information gathered by independent media sources is a service to ordinary citizens, empowering them with the tools they need to participate fully in their political, economic and cultural communities. Photo: Students learn circuitry basics. People have access to so much interesting information every second of every day that neither journalism or the entertainment industry, for that matter has the market on interesting cornered anymore.
And attention is a scarce resource. All photos by Emi Kolawole. Catching an innovator in the middle of their process can be like catching a flame with your bare hands. Innovators burn through experiments quickly in the quest to learn about the people for whom they design. Unfortunately, that heat can also make it difficult to share what they learned along the way. Why stop to tell the story when you need all the time and energy you can muster to reach the solution?
These real-world stories of innovation in process can make for effective teaching tools. When Founding Dean Stephen B. In an industry where unpaid internships are all too common, he wanted there to be a level playing field for our economically diverse student body.
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