Vaccination competence.

OBJECTIVE: Vaccinating is one of the most significant methods of health promotion in the world. The purpose of this study was to describe vaccination competence from the perspective of professionals, clients, and students. DESIGN: A cross-sectional interview study. SAMPLE: Participants (n=40) were public health nurses, physicians, nursing teachers and graduating public health nursing students, and vaccinated clients of various ages or vaccinated children's parents in Finland. MEASUREMENTS: Interview data were collected using semistructured interviews in focus groups and individual interviews, and were analyzed by content analysis. RESULTS: The participants pointed out that the competent vaccinator (CV) displays distinctive personal qualities, possesses the necessary attributes required in the vaccinator-client relationship, and is authorized to administer vaccinations. The competent vaccinator is a health care professional who is committed to vaccinating and who fosters social awareness of vaccinations. The competent implementation of the vaccination procedure consists of the vaccinator's actions before, during, and after the vaccination. The outcomes of a competent implementation are divided into immediate and long-term outcomes. CONCLUSIONS: Vaccination competence is a broad entity. These results may be utilized for improving the practical implementation of vaccinations, administration, education, and research of vaccination procedures.

National immunization program in Finland.

In the national immunization program, all Finnish children are vaccinated against 9 infectious diseases: diphtheria, tetanus, pertussis, polio, severe infections due to Haemophilus influenzae type b, measles, mumps, rubella and influenza. In addition, vaccination against tuberculosis, hepatitis A- and B-, influenza or tick-borne encephalitis are given to those at risk of contracting the diseases. More than 95% of children are vaccinated according the optimal schedule. Vaccine preventable diseases are rare in Finland. In Finland, all vaccines are imported. The decisions regarding the vaccination program are made by the Ministry of Social Affairs and Health. The National Public Health Institute is responsible for the control of the communicable diseases and the implementation of the vaccination program in practice. Evaluation of the implementation of new vaccines in the vaccination program is ongoing.

Development of antibodies against pneumococcal proteins alpha-enolase, immunoglobulin A1 protease, streptococcal lipoprotein rotamase A, and putative proteinase maturation protein A in relation to pneumococcal carriage and Otitis Media.

Surface associated pneumococcal proteins alpha-enolase (Eno), immunoglobulin A1 protease (Iga), streptococcal lipoprotein rotamase A (SlrA), and putative proteinase maturation protein A (PpmA) have potential as candidates for future protein-based anti-pneumococcal vaccines. The immunogenicity of these proteins were studied in a cohort of 329 children during their first two years of life. During the first recorded episode of otitis media, acute and convalescent phase sera were available from 151 children. Concentrations of antibodies against Eno, Iga, SlrA and PpmA were measured by EIA and detected in 99% (300/302), 95% (288/302), 95% (288/302), and 83% (251/302) of the sera, respectively. There were no statistically significant differences between the groups of children with and without a history of pneumococcal contact or with respect to the type of pneumococcal contact. Despite a mean overall decrease in the antibody titers in the convalescent sera following AOM, several children were able to respond with a more than twofold increase in antibody titer in response to AOM. The majority of the children with increased antibody concentrations appeared in the groups, which were colonized with pneumococci at the time of serum collection, but were recorded as having no prior contact with pneumococci. In conclusion, SlrA, PpmA, Eno and Iga are immunogenic proteins that elicit antibody responses early in life. No significant correlation between antibody titers to these proteins and pneumococcal carriage or infection was found. Presumably, this results from the presence of cross-reactive epitopes on commensal bacteria.

Anti-PsaA and the risk of pneumococcal AOM and carriage.

Pneumococcal surface adhesin A (PsaA) is one of the common protein antigens of Streptococcus pneumoniae investigated as a possible vaccine candidate on the basis of studies in experimental animal models. The relation between the serum anti-PsaA concentration collected at 6, 12 and 18 months of age and the risk of pneumococcal carriage and acute otitis media (AOM) in the following 6 months was evaluated in 329 children of the Finnish Otitis Media (FinOM) Cohort Study. A higher anti-PsaA concentration at all three time points studied was found to predict a higher risk of pneumococcal carriage 6 months later. A higher anti-PsaA concentration at 6 months also predicted a higher risk of pneumococcal AOM during the following 6 months (RR 1.51, 95% CI 1.24-1.83), whereas a higher anti-PsaA concentration at 12 or 18 months seemed to decrease the risk of pneumococcal AOM (RR 0.94 [95% CI 0.80-1.09] and RR 0.88 [95% CI 0.73-1.07], respectively). These relations remained the same when concomitant risk factors for pneumococcal AOM were included in the models. Previous pneumococcal AOM was the most important risk factor for a subsequent pneumococcal AOM (RR 5.93 [95% CI 2.87-12.3], RR 2.2 [95% CI 1.21-4.00], and RR 3.3 [95% CI 1.72-6.32] during the three periods).