Vaccine
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Measles-mumps-rubella-varicella (MMRV) vaccine is associated with increased febrile seizure risk compared with measles-mumps-rubella and varicella vaccine given separately (MMR+V) in children 12-15-month old. We assessed knowledge regarding MMRV and febrile seizures, intended practices, and factors influencing the decision to recommend MMRV. ⋯ After receiving data regarding febrile seizure risk after MMRV, few physicians report they would recommend MMRV to a healthy 12-15-month-old child.
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Comparative Study
Revaccination with Fendrix® or HBVaxPro® results in better response rates than does revaccination with three doses of Engerix-B® in previous non-responders.
Because non-response (<10 IU/l anti-HBs) after revaccination for hepatitis B occurs frequently (50%), this study aimed to provide evidence for a more effective revaccination regimen by comparing four different revaccinations: (1) three revaccinations with Engerix-B(®) (n=201); (2) one revaccination with Engerix-B(®) (n=37); (3) one revaccination with HBVaxPro-40(®) (n=108); (4) one revaccination with Fendrix(®) (n=39). The level of anti-HBs antibodies was determined with the AXSYM-MEIA system (Abbott, Chicago, USA). Using linear and logistic regression, the efficacy (antibody response) after the four revaccinations was compared. ⋯ The height of the primary titre independently predicted antibody response. Compared to the revaccination scheme using three Engerix-B(®) doses, revaccination with a single dose of HBVaxPro-40(®) or Fendrix(®) performed significantly better. The use of these highly potent vaccines should be considered when revaccinating hepatitis B vaccine non-responders.
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Rotavirus vaccines have shown great potential for reducing the disease burden of the major cause of severe childhood gastroenteritis. The decision regarding whether rotavirus vaccination will be introduced into the national immunization program is currently being reviewed. The conclusions of previous evaluations of rotavirus vaccination cost-effectiveness contradict each other. ⋯ Our budget impact analysis demonstrates that for the realistic base case scenarios, 58-96% of the cost outlay for vaccination will be recouped within the first four years of a program. Our results indicate that rotavirus vaccination would be beneficial to public health and could be economically sound. Since rotavirus vaccination is not presently on the immunization schedule for England and Wales but is currently under review, this study can inform policymakers of the cost-effectiveness and budget impact of implementing a mass rotavirus vaccine strategy.
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In 2003 the existing 23-valent pneumococcal vaccine (PPV23) programme for high risk groups was extended to include all ≥ 65 year olds in England and Wales, starting with ≥ 80 year olds and moving to 75-79 and 65-74 year olds by 2005. We conducted an ecological study to assess the impact of the extended PPV23 programme on serotype-specific incidence of invasive pneumococcal disease (IPD) and a case-control study to assess vaccine effectiveness (VE) using the national IPD surveillance dataset. Between 1998 and 2006 IPD incidence caused by PPV23 serotypes in the targeted age-groups was unchanged. ⋯ In conclusion PPV23 was effective, particularly in healthy under 75 year olds, but protection waned after 5 years. There was no discernible impact of PPV23 on IPD incidence or PCV7-induced serotype replacement, consistent with the modest overall effectiveness, the 45% increased coverage over the former risk-based programme and lack of herd immunity from the PPV23 programme. Based on the VE estimates PPV23 was still considered a cost-effective intervention for the low risk elderly.
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Two rotavirus vaccines have been licensed globally since 2006. In China, only a lamb rotavirus vaccine is licensed and several new rotavirus vaccines are in development. Data regarding the projected health impact and cost-effectiveness of vaccination of children in China against rotavirus will assist policy makers in developing recommendations for vaccination. ⋯ A national rotavirus vaccination program could be a cost-effective measure to effectively reduce deaths, hospitalizations, and outpatient visits due to rotavirus disease in China.