Routine Childhood Vaccines Given From 1 through 18 Years of Age.

In addition to the vaccines due in the first year of life, the US Advisory Committee on Immunization Practices recommends that children continue to receive vaccines regularly against a variety of infectious diseases. Starting at 12 to 15 months of life, these include the two-dose measles-mumps-rubella vaccine series and the two-dose varicella vaccine series. Also in the second year of life, infants should begin the two-dose hepatitis A vaccine series and complete the Haemophilus influenzae type B vaccine series as well as the pneumococcal conjugate vaccine series. Before 19 months of life, infants should receive the third dose of the poliovirus vaccine and the fourth dose of diphtheria-tetanus-acellular pertussis (DTaP) vaccine. The final doses of poliovirus and tetanus-diphtheria-acellular pertussis vaccines are both due at 4 to 6 years of life. Before each influenza season, every child should receive the influenza vaccine. Those less than 9 years of age who previously received less than two doses need two doses a month apart. At 11 to 12 years of life, all should get two doses of the human papillomavirus vaccine, the adolescent/adult version of the tetanus-diphtheria-acellular pertussis vaccine, and begin a two-dose series of meningococcal ACWY vaccine. Each of these vaccines is due when the vaccine works to protect against both an immediate risk as well as to provide long-term protection. Each vaccine-preventable disease varies in terms of the nature of exposure, the form of the morbidity, the risk of mortality, and potential to prevent or ameliorate its harm.

Standardization of rubella immunoassays.

Currently, rubella and congenital rubella has been eliminated or is becoming a rare disease in many countries that have implemented effective vaccination programs. In most of these countries, it is recommended and of major importance to screen childbearing age women in order to identify susceptible women and offer them vaccination before pregnancy or after delivery. Immunity to rubella virus (RV) is commonly determined by measuring rubella-specific IgG (RV-IgG). However, looking at literature, it is obvious that standardization of RV-IgG assays is not effective, with different levels of International Units per milliliter (IU/mL) reported for a same sample, and consequently different interpretations of the result. This situation leads to misinterpretation of results, sometimes causing adverse clinical outcomes. This article aimed to review several factors, such as the introduction of large-scale vaccination programs and changes in epidemiology of RV infection, along with the development of new technologies that have complicated appreciation of the immune status of patients. However, there is currently no evidence that these factors may be of any influence on rubella resurgence.

Development of a high-throughput rubella virus infectivity assay based on viral activation of caspases.

Rubella virus (RV, German measles) is a teratogenic agent that can lead to serious congenital defects after maternal infection during early pregnancy. Currently, the disease can be prevented effectively by available live attenuated vaccines. An important requisite for the manufacture and release of a safe and potent live virus vaccine is the measurement of the vaccine titer (potency), to ensure the correct dose and efficacy of the vaccine. One historical method for measuring potency is the endpoint dilution TCID(50) assay. Traditionally, RV TCID(50) titers are calculated after visual inspection of cells for presence of cytopathic effect (CPE). Such visual scoring is tedious and labor intensive. The development of a new TCID(50) readout method, based on a fluorescent molecular marker of RV-induced apoptosis, is described in this report. Further, in order to calculate TCID(50) potency a novel mathematical model was established to convert the numerical fluorescence measurements into categorical data. Finally, the assay parameters such as signal-to-noise ratio, robustness, variability and bias were optimized. This new readout method demonstrated strong concordance with the standard manual scoring of CPE, and therefore can provide a practical, objective and higher-throughput alternative to the traditional TCID(50) readout used for calculating titers of rubella virus.

Immunogenicity of measles and rubella vaccines in Oman: a prospective clinical trial.

A prospective immunogenicity trial of measles and rubella vaccines was conducted in Oman. Children received measles vaccine at age 9 months and measles-rubella vaccine at age 15 months. Serum specimens were tested for measles-specific IgG and rubella-specific IgG. Of 1025 eligible infants, 881 (86.0%) returned for all five visits and had adequate serum samples for testing. Seroconversion to measles after vaccination at 9 months was 98.1%. At 15 months, 47 (5.3%) of the 881 children were seronegative for measles; of these, 44 (93.6%) seroconverted. At 16 months, 99% of the children seronegative at age 9 months seroconverted after receiving two doses of measles vaccine. At age 15 months, 684 (77.6%) children were seronegative for rubella. Of these, 676 (98.8%) seroconverted by age 16 months. One dose of measles vaccine at age 9 months was highly immunogenic. One dose of measles-rubella vaccine at age 15 months closed the remaining measles immunogenicity gap and resulted in a high rate of rubella seroconversion.

Tipos de vacunas pediátricas / Types of pediatric vaccines

La autora describe las vacunas pediátricas de uso obligatorio en nuestro país en la actualidad. Se menciona su acción, vía de administración, efectos adversos y contraindicaciones (AU)

Tipos de vacunas pediátricas / Types of pediatric vaccines

La autora describe las vacunas pediátricas de uso obligatorio en nuestro país en la actualidad. Se menciona su acción, vía de administración, efectos adversos y contraindicaciones

Clinical safety issues of measles, mumps and rubella vaccines.

The clinical safety of measles and measles-mumps-rubella vaccines has been questioned in recent reports that propose a possible link between measles virus or measles vaccines and the occurrence of juvenile Crohn disease and autism. This article reviews the outcomes of several laboratory investigations which were carried out independently to identify the presence or absence of measles virus in the intestinal tissues derived from cases of inflammatory bowel disease. One research group reported the presence of measles virus particles and genomic RNA in inflammatory bowel disease tissues, but this could not be confirmed by other groups, despite use of techniques that are highly specific and sensitive for the detection of measles virus nucleic acid in clinical specimens down to the molecular level. Based on the published data reviewed here, it can be concluded that there is no direct association between measles virus or measles vaccines and the development of Crohn disease, a conclusion which is supported by most epidemiological findings.

A simple vaccination model with multiple endemic states.

A simple two-dimensional SIS model with vaccination exhibits a backward bifurcation for some parameter values. A two-population version of the model leads to the consideration of vaccination policies in paired border towns. The results of our mathematical analysis indicate that a vaccination campaign φ meant to reduce a disease's reproduction number R(φ) below one may fail to control the disease. If the aim is to prevent an epidemic outbreak, a large initial number of infective persons can cause a high endemicity level to arise rather suddenly even if the vaccine-reduced reproduction number is below threshold. If the aim is to eradicate an already established disease, bringing the vaccine-reduced reproduction number below one may not be sufficient to do so. The complete bifurcation analysis of the model in terms of the vaccine-reduced reproduction number is given, and some extensions are considered.

Making vaccination policy: the experience with rubella.

The massive rubella epidemic of 1962-1965 stimulated the development of rubella vaccine. Once vaccines were developed, the U.S. vaccination program, initially focused on infants and children, reduced both rubella and congenital rubella. However, later extension of vaccination to certain older age groups achieved significantly better control. While rubella clearly is not the perfect model for pertussis, a review of its history is illuminating. Current rubella vaccination policies resulted from an evolution in scientific understanding. Controversies, including those related to communicability, reactivity, and teratogenicity of the rubella vaccine virus, duration of immunity following vaccination, and protection following reinfection, led countries to use different approaches for national immunization programs. These differences were eventually resolved by clinical and epidemiological research coupled with rigorous scientific debate. Increased scientific understanding of pertussis, its epidemiology, and the effects of the new pertussis vaccines will similarly enable informed decision making on whether to extend pertussis immunization to adolescents and adults.

Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP).

These revised recommendations of the Advisory Committee on Immunization Practices (ACIP) on measles, mumps, and rubella prevention supersede recommendations published in 1989 and 1990. This statement summarizes the goals and current strategies for measles, rubella, and congenital rubella syndrome (CRS) elimination and for mumps reduction in the United States. Changes from previous recommendations include: Emphasis on the use of combined MMR vaccine for most indications; A change in the recommended age for routine vaccination to 12-15 months for the first dose of MMR, and to 4-6 years for the second dose of MMR; A recommendation that all states take immediate steps to implement a two dose MMR requirement for school entry and any additional measures needed to ensure that all school-aged children are vaccinated with two doses of MMR by 2001; A clarification of the role of serologic screening to determine immunity; A change in the criteria for determining acceptable evidence of rubella immunity; A recommendation that all persons who work in health-care facilities have acceptable evidence of measles and rubella immunity; Changes in the recommended interval between administration of immune globulin and measles vaccination; and Updated information on adverse events and contraindications, particularly for persons with severe HIV infection, persons with a history of egg allergy or gelatin allergy, persons with a history of thrombocytopenia, and persons receiving steroid therapy.

Application of PCR for detection of mycoplasma DNA and pestivirus RNA in human live viral vaccines.

PCR techniques were applied for the detection of mycoplasma DNA and pestivirus RNA to 43 lots of live viral vaccines (measles, mumps, rubella, and oral poliomyelitis) produced by six manufacturers in Japan. Although mycoplasma DNA was not detected in any of the vaccines tested, pestivirus RNA was detected in 12 lots (28%). The incidence of contamination among the four viral vaccines was in the range of 20 to 37%, and the incidence among the six manufacturers varied from 0 to 56%.

WHO activities towards the three Rs in the development and control of biological products.

WHO supports the concept of replacement, reduction and refinement of the use of in vivo methods for biologicals production and control, and regularly conducts reviews of its recommended procedures to allow reduction in the use of animals. The coordination of collaborative studies, publication of standardized methods, and holding of workshops on the use of these methods contributes to their use. The neurovirulence test for oral poliovaccine is probably the single most visible animal test for which alternative methods are sought. Collaborative studies on alternative methods for screening products are currently being sponsored by WHO. The use of Vero cells rather than primary monkey kidney cells for poliovaccine production can avoid the use of many monkeys. Cell banks of Vero and HEp-2 cells have been developed by WHO, tested for virus sensitivity and freedom from adventitious agents, and are available for vaccine production and control, replacing primary animal cells. For the future, final product testing will increasingly be directed towards establishment of consistency of production rather than potency. By supporting the validation and use of this approach, WHO can effectively influence more rational animal use in biological production and control.

[Comparison of the efficacy of various strains of mumps vaccine: a school survey]. / Comparaison de l'efficacité de différentes souches de vaccin ourlien: une enquête en milieu scolaire.

BACKGROUND: Since the beginning of the program of immunization of children against measles, mumps and rubella (MMR) in 1987, various outbreaks of mumps have occurred in Switzerland, with a significant proportion of cases in immunized children. Previous studies have suggested a possible lack of efficacy of the Rubini vaccine strain, which has been much used in this country. METHODS: Incidence study of secondary cases of mumps in the schools of Geneva, between March 18th and June 30th 1994. STUDY POPULATION: During the study period, mumps outbreaks have been observed in 10 school classes. After exclusion of the 10 primary cases, the study population comprised 195 children aged 4 to 12 years. RESULTS: Raw estimation of vaccine efficacy against mumps was 72.5%. Whereas both the Urabe and Jeryl-Lynn strains showed a significant efficacy, the Rubini strain didn't show any significant protective effect. After adjustment by Poisson regressions for the confounding effect of age, efficacy rates and 95% confidence limits were 75.8% (35.6%, 90.9%) for Urabe; 64.7% (10.6%, 86.0%) for Jeryl-Lynn; and 12.4% (-102%, 62.1%) für Rubini. CONCLUSION: This study didn't show any protective effect of the Rubini vaccine strain. Furthermore, it demonstrated a statistically significant protective effect of the Urabe and Jeryl-Lynn strains, compared to the Rubini strains. In this conditions the use of the Rubini strain should be restricted to situations of confirmed contra-indications to the other vaccinal strains, as long as its protective efficacy is not clearly demonstrated.

[Mumps epidemiology in Switzerland: results from the Sentinella surveillance system 1986-1993. Sentinella Work Group]. / Mumps-Epidemiologie in der Schweiz: Ergebnisse der Sentinella-Uberwachung 1986-1993. Sentinella-Arbeitsgemeinschaft.

UNLABELLED: Since 1990, there have been reports of an increasing number of mumps cases in Switzerland, in particular among vaccinated children, and of local outbreaks of mumps. Using data from the Sentinella reporting system, a network of voluntary participating doctors (general practitioners, internists and paediatricians, yearly average: n = 141), trends and factors influencing mumps incidence in the general population were assessed during the last seven years. Following an initial decline in mumps reports, since 1990, there has been a continuous and marked increase in reports from a minimum of 0.7 cases per physician and year in 1989/90 to a near five-fold increase of 3.3 cases in the last reporting period from June-December 1993 (calculated for one year). Half of this increase, which is reflected in a doubling of the number of cases reported in 1986/87, is explained by an increase in cases among vaccinated children. The trend in mumps cases contrasts with that of measles and rubella, where there has been a clear decline in these reports since 1986 (approximately 70-80%). Complications were reported in 75 (4.0%) of the total number of mumps patients (n = 1894); in 2/5 of the cases this was a meningitis, in 1/3 an orchitis. Based on available data on vaccination coverage, the estimated efficacy of the mumps vaccines against parotitis is between 47-77%; this is clearly lower than the corresponding figure for measles (91-97%) and rubella (89-97%) vaccines. The relatively low efficacy against parotitis is mainly due to a protective level of 13-73% of the vaccines containing the Rubini strain. The estimated efficacy of the Rubini vaccines against complications is 50-81%; it is nearly 60-90% if a possible reporting bias is taken into consideration. CONCLUSIONS: 1. The Rubini strain vaccines, which are the most commonly used in Switzerland, seem to have played an important role in the clear increase in mumps cases since 1990. 2. The situation seems more favourable concerning the efficacy against complications of the vaccines used. 3. Our data support the high efficacy of all measles and rubella vaccines. 4. The surveillance of MMR by the Sentinella reporting system provides a useful and effective manner to evaluate the MMR vaccination programme.

Evidence of pestivirus RNA in human virus vaccines.

We examined live virus vaccines against measles, mumps, and rubella for the presence of pestivirus RNA or of pestiviruses by reverse transcription PCR. Pestivirus RNA was detected in two measles-mumps-rubella combined vaccines and in two monovalent vaccines against mumps and rubella. Nucleotide sequence analysis of the PCR products indicated that a modified live vaccine strain used for immunization of cattle against bovine viral diarrhea is not responsible for the contamination of the vaccines.

A European collaborative study to assess the proficiency of laboratory estimates of potency of live measles, mumps and rubella tri-valent vaccines.

A collaborative study involving 10 European laboratories was undertaken to assess the variability of estimates of the potency of measles, mumps and rubella tri-valent vaccines. The precision of assays as demonstrated by tests on duplicate samples was good; differences averaged around 0.2 log10 steps. Similarly, assay to assay variation within laboratories was small with most achieving consistency around 5% over three assays. In contrast, overall median variations in potency between laboratories were around 1.0 log10 for measles, 3.0 log10 for mumps and 2.0 log10 for rubella. Unexpectedly, the variations in estimates for measles and rubella were not improved when potencies were expressed relative to reference preparations. However, for mumps variability was reduced by using a reference but only for the vaccines of the same strain as the reference. For these Urabe mumps vaccines the variation in relative potency was around 1.5 log10.

A new combined trivalent live measles (AIK-C strain), mumps (Hoshino strain), and rubella (Takahashi strain) vaccine. Findings in clinical and laboratory studies.

Trivalent virus vaccine, containing measles AIK-C strain, mumps Hoshino strain, and rubella Takahashi strain, was administered to a total of 1369 healthy children, 8 months to 18 years of age. For comparative study, monovalent vaccines of AIK-C strain and Hoshino strain were administered to 147 and 122 initially seronegative children, respectively. The clinical and serological responses following vaccination were analyzed. Among the recipients of the trivalent vaccine, 893 were initially seronegative to all three viruses. Inoculation induced sufficient serological responses: 99.7% for measles and rubella viruses and 96.3% for mumps virus. The incidence of febrile reaction (greater than or equal to 37.5 degrees C axillary temperature) was low, 15.9%, and a temperature of 39.0 degrees C or higher occurred in only 1.3% of the subjects. The seroconversion rate, magnitude of antibody titers, and incidence of clinical reactions following the trivalent vaccination were similar to those occurring after the monovalent measles vaccination.

Improvement in potency assay of measles-mumps-rubella trivalent vaccine: interference between components and measures for its elimination.

In the potency assay of trivalent measles-mumps-rubella (MMR) vaccine by the immunocytochemical focus assay reported previously (Fukuda et al., 1987), development of rubella foci in RK13 cells was inhibited in the presence of a large excess of mumps component, resulting in an underestimation of the titre of the rubella component. When RK13 cells are infected with the mixture of mumps and rubella viruses, mumps virus interfered with the growth of rubella virus. Interference was mediated most likely by interferon induced by mumps virus. The interference was eliminated by a partial neutralization of mumps component by the addition of anti-mumps serum to the inoculum to RK13 cells. Improved method of potency assay of MMR vaccine incorporating the above measures and other modifications are described.