Comparative analysis of immunization effects before and after polio vaccine immunization schedule conversion / 中华微生物学和免疫学杂志

Objective:To compare the polio antibody level of healthy children in Jiangsu Province before and after the conversion of (inactivated poliovirus vaccine, IPV) immunization program.Methods:200 serum samples of healthy children under 5 years old in Jiangsu Province were collected before and after the vaccine conversion, and the neutralizing antibody against poliomyelitis was measured using the micro cell neutralization test. We compared the differences in the positive rate and geometric mean titer (GMT) of polio antibody before and after vaccine conversion.Results:Before vaccine conversion, positive rates of antibody against poliovirus type Ⅰ and Ⅲ were 98.50% and 92.00%, with GMTs of 1∶100.43 and 1∶23.34, respectively. After the conversion, positive rates of polio antibody type I and Ⅲ were 99.00% and 96.00%, GMT were 1∶213.04 and 1∶121.10.Conclusions:There is a difference in immunization effect before and after the polio vaccine conversion, and the antibody level of the population after vaccine conversion is higher than that before vaccine conversion. It is recommended to gradually increase the IPV dose in order to finally achieve the whole course of IPV inoculation.

Relato de um caso de reação à vacina oral contra a poliomielite tratado com homeopatia / Report of a case of reaction to oral polio vaccine treated with homeopathy

Este estudo relata um caso de paresia flácida assimétrica após administração da vacina oral contra poliomielite, com acometimento do membro inferior esquerdo. A primeira dose de medicamento homeopático foi prescrita no 20º dia após o início dos sintomas. Evoluiu com desaparecimento da paresia e normalização do padrão de marcha nos 40 dias subsequentes. Pode-se considerar a homeopatia como escolha terapêutica em casos de paresias agudas. (AU)

We report a case of asymmetric flaccid paresis which developed following intake of oral polio vaccine affecting the left lower limb. Homeopathic treatment was started 20 days after the onset of symptoms. Paresis disappeared and the gait pattern became normal along the following 40 days. Homeopathy might be considered for treatment of acute paresis. (AU)

Double Whammy the Great Switch and a Complex Endgame

In 1988 the world health assembly resolved to eradicate poliomyelitis.The Live attenuated oral polio vaccine was the captain against the fight to eradicate poliomyelitis.It had indeed many advantages in the fight to eradicate polio.But despite its many advantages it has a risk for occurrence of rare cases of paralytic poliomyelitis among immunologically normal OPV recipients and additional risk of emergence of Vaccine derived polio virus(VDPVs).Poliovirus being an RNA virus are notorious for mutation.India is a polio free country since 2011 however endemicity of its neighbours are a detterent against dropping guard.This article reviews the introduction of Bivalent oral polio vaccine instead of trivalent oral polio vaccine and rationale of addition of Inactivated Polio vaccine on the road to the—Endgame Strategy

India’s Last Battle in the War Against Polio.

Type 2 vaccine virus is the predominant cause of Vaccine-derived poliovirus and Vaccine-associated paralytic poliomyelitis. Therefore, World Health Organization recommends global synchronized switching from trivalent to bivalent Oral polio vaccine. To prevent the risk of type 2 poliovirus re-emergence, atleast one dose of Inactivated polio vaccine is recommended at 14 weeks of age in routine immunization, before the switch. To protect immunocompromised children and those under 14 weeks of age, an additional dose must be given at 6 weeks of age. Mass campaigns of Injectable polio vaccine in states with poor Routine immunization coverage, before the trivalent to bivalent Oral polio vaccine switch, will reduce risk of Vaccine-derived poliovirus by covering all under-immunized pockets. The additional costs are justified as it is our ethical obligation to eliminate any iatrogenic risk.

Assessment of cold-chain maintenance in vaccine carriers during Pulse Polio National Immunization Day in a rural block of India.

India was certified polio free on 27 March 2014. Supplementary immunization activities, in the form of national immunization days, is one of the core strategies for eradication, where oral polio vaccine is administered to children aged under 5 years throughout the country. Oral polio vaccine is heat sensitive and requires maintenance of a stringent cold chain. Therefore, vaccine carriers with ice packs are used in the Pulse Polio Immunization (PPI) programme. This study assessed whether the cold chain is maintained during National Immunization Day in Beed district. A cross-sectional study was conducted at six randomly selected booths, one each from six primary health centres in Georai block of Beed district in Maharashtra. Electronic data loggers, configured to measure half-hourly temperatures, were kept in vaccine carriers throughout the day of PPI. The vaccine carrier temperature was below 8 °C at all six booths; minimum temperature recorded was –9.5 °C, while the maximum was 4.5 °C. The vaccine vial monitor did not reach discard point in any booth. A vaccine carrier with four ice packs very effectively maintains the cold chain required for oral polio vaccine.

Factors Influencing Childhood Immunization in Uganda.

This paper investigates the factors associated with childhood immunization in Uganda. We used nationallyrepresentative data from Uganda Demographic and Health Survey (UDHS) of 2006. Both bivariate and multivariate approaches were employed in the analysis. The bivariate approach involved generating average percentages of children who were immunized, with analysis of pertinent background characteristics. The multivariate approach involved employing maximum likelihood probit technique and generating marginal effects to ascertain the probability of being immunized, given the same background characteristics. It revealed that slightly over 50% of children in Uganda were fully immunized. Additionally, 89%, 24%, 52%, and 64% received BCG, DPT, polio and measles vaccines respectively. Factors which have a significant association with childhood immunization are: maternal education (especially at post-secondary level), exposure to media, maternal healthcare utilization, maternal age, occupation type, immunization plan, and regional and local peculiarities. Children whose mothers had post-secondary education were twice as likely to be fully immunized compared to their counterparts whose mothers had only primary education (p<0.01). Thus, gender parity in education enhancement efforts is crucial. There is also a need to increase media penetration, maternal healthcare utilization, and to ensure parity across localities and regions.

Safety and Reactogenicity of the Inactivated Poliomyelitis Vaccine (Poliorix(TM)) in Korea (2006-2012) / 소아감염

OBJECTIVE: As per the requirement of Korean Food and Drug Administration, this post-marketing surveillance was conducted in Korea to evaluate the safety and reactogenicity of Poliorix(TM) following its introduction in 2006. METHODS: In this open, multicenter study, the vaccine was administered as per the current practice of Korean doctors and in reference to the guidebook by the Korean Pediatric Society and as indicated in the Korean label which was as follows - for primary vaccination three doses were given to infants at ages 2, 4 and 6 months whereas, for the booster dose a single dose was given to children aged 4-6 years. Safety data during this six year surveillance was collected using diary cards which were distributed to the parents to record adverse events. RESULTS: A total of 639 subjects were enrolled into the study. Of these, 617 subjects and 22 subjects received the vaccine as a primary and booster dose, respectively. At least one unsolicited symptom was reported in 11.4% (73/639) of the subjects during the 7-day follow-up period; upper respiratory tract infection (2.5%;16/639) was the most frequently reported unsolicited symptom. One subject reported at least one unsolicited symptom (gastroenteritis) of grade 3 intensity within the 31-day post-vaccination period. Approximately 1.7% (11/639) of subjects reported 13 serious adverse events (SAEs). All SAEs were resolved by the end of the study. CONCLUSION: In Korea, primary and booster vaccination with Poliorix(TM) was well-tolerated in healthy subjects when administered according to the prescribing information as part of routine clinical practice.

Caution needed in using oral polio vaccine beyond the cold chain: Vaccine vial monitors may be unreliable at high temperatures.

Background & objectives: Stabilized live attenuated oral polio vaccine (OPV) is used to immunize children up to the age of five years to prevent poliomyelitis. It is strongly advised that the cold-chain should be maintained until the vaccine is administered. It is assumed, that vaccine vial monitors (VVMs) are reliable at all temperatures. VVMs are tested at 37°C and it is assumed that the labels reach discard point before vaccine potency drops to >0.6 log10. This study was undertaken to see if VVMs were reliable when exposed to high temperatures as can occur in field conditions in India. Methods: Vaccine vials with VVMs were incubated (10 vials for each temperature) in an incubator at different temperatures at 37, 41, 45 and 49.5°C. Time-lapse photographs of the VVMs on vials were taken hourly to look for their discard-point. Results: At 37 and 41°C the VVMs worked well. At 45°C, vaccine potency is known to drop to the discard level within 14 h whereas the VVM discard point was reached at 16 h. At 49.5°C the VVMs reached discard point at 9 h when these should have reached it at 3 h. Conclusion: Absolute reliance cannot be placed on VVM in situation where environmental temperatures are high. Caution is needed when using ‘outside the cold chain’ (OCC) protocols.

Polio / Polio

Polio continúa endémica en: Nigeria, Afganistán Pakistán e India. La iniciativa global de erradicación de polio de la OMS estableció que para 2013 no debe haber ningún niño paralítico en el mundo por el virus salvaje o por el virus derivado de la vacuna. En esta revisión se describen ambas vacunas contra el polio, la oral y la inactivada, su inmunogenicidad, seguridad y las condiciones a cumplir por un paíspara que cambie su esquema de vacunación de polio oral a inactivada. La vacuna polio oral ha permitido la erradicación de la enfermedaden varios continentes incluyendo América; sin embargo conlleva riesgos, tales como polio paralítica asociada a vacuna (VAP-siglas en inglés-) y parálisis producida por polio virus derivado de la vacuna (VDP-siglas en inglés-). La Vacuna Polio Inactivada (VPI) es segura e inmunogénica, puede ser administrada en combinaciones vacunales. Para que un país cambie a VPI debe tener cobertura y esquemaóptimo de esta vacuna, 90% de, cobertura de DTP3, vigilancia adecuada de parálisis flácida, no estar próximo en la actualidad o recientemente a un país con polio endémico. Altas coberturas vacunales son esenciales par asegurar una inmunidad adecuada de lapoblación

Polio remains endemic in Nigeria, Afghanistan, Pakistan, India. Strategic plan of Global Poliomyelitis Eradication Initiative (GPEI) of the WHO is that by 2013 no child will be paralyzed by a wild or vaccine derived poliovirus. This paper describes both oral and inactivated vaccine, safety concerns with the use of OPV, immunogenicity of IPV and the conditions to be full filled in order for a country to deliverIPV as a regular vaccine schedule. Oral polio vaccine has successfully contributed to global polio eradication in several continents including America. However, it carries risks, such as Vaccine Derived Poliovirus (VDP) and Vaccine Associated Paralytic Polio (VAPP). Inactivated Poliovirus Vaccine (IPV) is safe and immunogenic; it may be administered as monovalent or in a combined shot. Countries opting to switch from OPV to IPV should have: optimal IPV coverage and schedule, 90% of DTP 3 coverage, good surveillance of flaccid paralysis cases, and should not be near a country with endemic polio recently or at the present time. Are neither currently or were notrecently polio endemic nor has close contacts with such areas. High immunization coverage is essential to ensure adequate populationimmunity

Reactogenicidad asociada a la administración intradérmica de la vacuna de polio inactivada con un inyector sin aguja / Reactogenicity associated to the intradermally administered inactivated poliovirus vaccine with a needle-free injector

INTRODUCCIÓN: en la medida en que la meta de la erradicación de la poliomielitis llega a su concreción, la necesidad de contar con una vacuna de polio inactivada asequible y apropiada para el uso en países en vías de desarrollo se ha convertido en una meta para la Organización Mundial de la Salud. OBJETIVO: la evaluación de la reactogenicidad de la vacuna de polio inactivada. MÉTODOS: se realizó un estudio multicéntrico con diseño experimental, correspondiente a Fase I-II de un ensayo clínico controlado, aleatorio y a simple ciegas, en 471 lactantes sanos de ambos sexos nacidos entre los meses de julio y agosto de 2006 en Camagüey, cuyos padres brindaron su consentimiento por escrito y que cumplieron con los criterios de inclusión establecidos. Los niños recibieron a las 6, 10 y 14 semanas del nacimiento, tres dosis de vacuna de polio inactivada del Instituto de Sueros de Dinamarca, autorizada para su uso en esta investigación por las autoridades regulatorias nacionales. Al grupo de estudio A, se le administró por la vía intradérmica la dosis reducida de 0,1 mL de vacuna de polio inactivada en la cara anterolateral del muslo izquierdo utilizando el inyector sin aguja Biojector® 2000. El grupo control B recibió la dosis usual de 0,5 mL por la vía intramuscular profunda, administrada en el mismo sitio descrito antes con una jeringuilla prellenada. Se observaron los eventos adversos durante la primera hora, 24, 48, y 72 h subsiguientes, así como a los 7 y 30 d de administrada la vacuna. La reactogenicidad se evaluó inicialmente por el pediatra del área y luego por el médico de familia mediante la observación de los eventos adversos. RESULTADOS: 79,6 por ciento del total de niños asignados al grupo A y 75 por ciento del grupo B finalizaron el protocolo de investigación. No se detectaron eventos adversos moderados o serios. Predominaron las reacciones adversas locales menores, sobre todo induración, dolor y enrojecimiento en el sitio de la inyección. CONCLUSIÓN: el ensayo demostró la seguridad de la vacuna de polio inactivada para su uso por vía intramuscular y reconoció la seguridad del uso de la vía intradérmica y del inyector sin agujas.

INTRODUCTION: as the goal of poliomyelitis eradication is about to be accomplished, the need for an affordable and appropriate inactivated poliovirus vaccine (IPV) for use in developing countries has become a target for WHO. OBJECTIVE: to evaluate the reactogenicity of the inactivated poliovirus vaccine. METHOD: an experimental-type multicenter study was conducted, as part of a Phase I-II controlled clinical randomized and blinded assay, in 471 healthy infants of both sexes born in July and August 2006 in Camagüey province. The parents of the children who met the inclusion criteria gave their consent in writing. The children received three doses of the inactivated poliovirus vaccine at 6, 10 and 14 weeks after birth. This vaccine came form the Institute of Sera in Denmark and had been approved for use in this assay by the Cuban regularoty authorities, Low 0.1 ml inactivated poliovirus vaccine dose was intradermally administered to the study group A in the anterolateral side of the left thigh using the needle-free injector called Biojector ® 2000. The usual 0.5 mL dose was intramuscularly administered on the same site using a pre-filled syringe. The adverse events were observed during the first hour, 24, 48, and 72 hours after the immunization, as well as 7 and 30 days afterwards. The pediatrician in charge of the health area evaluated the reactogenicity at first and then the family physician was in charge of observing the adverse events in the remaining period. RESULTS: the 79.6 percent of children in group A and 75 percent in group B completed the research protocol. Mild local adverse reactions prevailed, mainly induration, pain and redness at the injection site. CONCLUSION: the clinical trial proved the safety of the inactivated poliovirus vaccine for intramuscular administration, and also showed the safety of the intradermal route of administration and of the needle-free injector.

Factors Associated with Missed Vaccination during Mass Immunization Campaigns.

Achieving a high percentage of vaccination coverage with polio vaccine, while necessary, is not sufficient to eliminate or eradicate polio. The existence of pockets of under-vaccinated children has allowed outbreaks of polio in countries that have achieved high levels of vaccination coverage and in countries with no cases for many years. In a literature review, 35 articles were identified that described factors associated with missed vaccination in mass immunization campaigns. An annotated bibliography was developed for each article; these were then coded using the AnSWR program, and codes were organized into three larger thematic categories. These thematic areas were: (a) organization and implementation of mass campaigns; (b) population characteristics; and (c) knowledge and practices of caretakers. If these factors were geographically clustered, it was suspected that these clusters might have higher likelihood of becoming pockets of unvaccinated children. Immunization programme managers can target resources to identify if such clusters exist. If so, they can then ensure supervision of vaccination efforts in those sites and take further action, if indicated, to prevent or mitigate pockets of unvaccinated children.

Eradicating Polio: It's Feasibility in Near Future.

Continuous wild poliovirus transmission despite 12 years of intensive surveillance has raised serious questions about the feasibility of polio eradication programme with current strategy in near future. At present most of the cases are confined to four endemic countries, which are causing sporadic outbreaks in non-endemic areas. India has experienced a significant increase in number of cases reported in 2006 compared to previous year. Outbreaks originated in western UP which was due to the accumulation of susceptibles between the last outbreak in 2002 and early 2006. Substantial improvement has been observed in strategies of polio eradication but still there are gaps in the programme implementation which needs immediate attention so that goal of polio eradication can be achieved at the earliest opportunity. Even though there are many issues but there are also many factors, which favour polio eradication. These factors include new tool in form of m OPV, natural immunity due to recent outbreak, limiting international spread of polio, new researches to guide programme in right direction, political commitments from endemic countries, etc. 2008 presents the best opportunity ever to interrupt wild polio virus transmission which will lead to global eradication of Polio. Since global eradication is within sight, it is scientifically possible to eradicate the disease in near future.

Assessment on Quality of single polio vaccine type 1 produced on primary monkey cells

Background: \r\n', u'October 2000, Vietnam was acknowledged as the country to successfully eradicate the polio by WHO.This success was partly due to the oral polio vaccine (OPV) produced on the primary money cells by the Centre of Research, Production of vaccines and biologicals, Ha Noi. In 2006, the Centre developed the single polio vaccine type 1 from primary monkey cells.\r\n', u'Objectives: \r\n', u'To evaluate the safety and antibody titre .\r\n', u'Subjects and method: \r\n', u'6 lots of single polio vaccine type 1 (ISO- 90, Antibodies of Polio type 1,2,3; the standard sample F113 from Japanese research on Polio Institute\ufffd?\r\n', u'Using the tests (T- maker, D maker, PFU, CCID50) to check the safety of single polio vaccine type 1. \r\n', u'Results:\r\n', u'After 14 days, 6/6 lots of viruses were observed via the microscope that they stayed in well developed, and of no serious adverse affects.There was no appearance of degenerated cells. \r\n', u'Conclusion:\r\n', u'6/6 lots of single polio vaccine type 1 produced on Macca mulltta monkey kidney cells with the first time passage at POLYVAC in 2006 are safe and high antibody titre.\r\n', u'