Hello, sageworksinc-ga!
I have included the history of vaccinations and recent vaccine
information for Mumps, Polio myelitis, Cholera, Measles, Chicken Pox,
Yellow Fever and Whooping Cough (Pertussis) as you requested. Since
the Chicken Pox vaccine is so new, I am not sure if you actually meant
Smallpox instead. Therefore, I have included Smallpox references just
in case. I have also included references for Rubella since it is used
in conjunction with the MMR vaccine.
Since you are in such a rush for this information, I have provided
the most comprehensive references so that you can extract the
pertinent information that you need. All of the information I have
provided has been excerpted from websites "as is." Therefore, you can
rewrite the necessary information in your own words if it is needed
for a paper.
If I have left out any specific information that is urgently needed,
please leave a clarification so I can get back to you late this
evening.
===============
VACCINE HISTORY
===============
"The history of Vaccination." World Health Organization
http://www.who.int/vaccines-diseases/history/history.shtml
The closing years of the 19th century and the early years of the 20th
century were marked by the achievements of great vaccine scientists
such as Pasteur. Since the introduction of vaccinia by Jenner 200
years ago ("vaccination" in its true sense), nine major diseases of
man have been controlled to a greater or lesser extent through the use
of vaccines (Table 1.). Several other vaccines have been used in
individuals at risk from disease of such as rabies and plague, but
have not been systematically applied on a global scale. While BCG has
been widely administered to newborns, thus successfully preventing
complications such as meningitis and miliary tuberculosis,
administration of the vaccine has not resulted in control of the
disease.
Table 1. The date of introduction of first generation of vaccines for
use in humans*
1798 Smallpox
1885 Rabies
1897 Plague
1923 Diphtheria
1926 Pertussis
1927 Tuberculosis (BCG)
1927 Tetanus
1935 Yellow Fever
After World War II
1955 Injectable Polio Vaccine (IPV)
1962 Oral Polio Vaccine (OPV)
1964 Measles
1967 Mumps
1970 Rubella
1981 Hepatitis B
*This list is not exhaustive. After Plotkin SA and Mortimer EA , 1994 (ref 1)
"Although the first vaccines were, in some respects, crude, they have
proved to be robust and efficient, and continue to be the workhorses
of global immunization programmes. They have dramatically reduced the
burden of death and disease from these nine infections, and have given
credibility to the entire preventive health movement. During the
1920s, diphtheria and tetanus toxoids, whole cell pertussis vaccine
and BCG were introduced. Thanks to the development of the
chorioallantoic membrane for culturing viruses, a yellow fever vaccine
was available by 1935. After the Second World War, there followed an
explosion of technology, resulting in the emergence of other vaccines
still in use today. These included the killed and oral polio vaccines,
and the measles, mumps and rubella vaccines."
Early national immunization programmes 1900-1973
------------------------------------------------
"During this period, the use of available vaccines was largely
confined to industrialized countries. For instance, smallpox vaccine
was offered to all age groups, but only those at risk - health care
workers and travellers - were specially targeted. As a result,
coverage was patchy and outbreaks continued to occur throughout the
world. When this happened, massive vaccination efforts were mounted by
health authorities, often very successfully, to contain the infection
through vaccination and isolation or quarantine of infected
individuals or suspected cases."
"Other vaccines such as BCG were gradually introduced in the West,
(Table 2) as they became available. Better-off families who could
afford vaccination benefited most - the poor benefited the least.
Because of low, irregular coverage, communities continued to be
devastated intermittently by outbreaks of these vaccine-preventable
diseases throughout the 1930s and 1940s."
"An injectable form of killed polio vaccine (IPV) became available in
1955, resulting in widespread administration in schools and clinics in
industrialized countries across a broad age range resulting in a
marked drop in cases in these countries. In 1962, the oral polio
vaccine (OPV) replaced IPV and continues to be the vaccine of choice
for eradication of the virus. Despite initial low coverage, the
vaccine showed itself capable of dramatically reducing the number of
polio cases when administered to a wide age range over a short period
of time."
Table 2. Vaccines used in national immunization programmes up to 1974
Smallpox
BCG
Diphtheria toxoid
Tetanus toxoid
Pertussis
IPV then OPV
Measles
"In terms of strategy, the early programmes offered routine
immunization through regular maternal and child health services. While
efforts were made to encourage acceptance, no major effort was made to
achieve total coverage. The implied target was to raise coverage, but
there was no disease reduction target specified."
The eradication era
--------------------
"The early years of the 19th century saw widespread but haphazard use
of Jenner's vaccine. However, application of smallpox vaccine was
systematic in Mexico and Guatemala around 1805 (ref 2). The first
attempt to use it on a global scale began in 1956 when the World
Health Organization and others selected smallpox for eradication from
the globe."
"It was not the first time disease eradication had been mooted.
Already the scientific community had considered the possibility of
eradicating bovine contagious pleuropneumonia (a highly fatal
disease of cattle), hookworm, yellow fever, malaria and yaws. Now with
a clear strategy and a highly effective, affordable vaccine, it was
possible to unite all countries in a mighty effort to rid themselves
of this disease and the tremendous annual cost it incurred. To meet
this special circumstance, very high population coverage with the
smallpox vaccine was used. Finally in the late 1960s, an additional
strategy was developed whereby cases were identified through intensive
surveillance and confined ("containment"), and possible contacts
within a given radius were vaccinated. Details of this effort are
chronicled elsewhere (ref 3)."
"The next notable attempt at large-scale control was undertaken in
Gambia in 1967-1970 when Foege and his team administered measles
vaccine in a mass country-wide campaign. As a result, indigenous
measles was entirely absent from the Gambia until 1972. However, due
to the inability to sustain immunization coverage, the situation soon
reverted to pre-campaign levels."
"Following the impressive success of the smallpox eradication
programme, the World Health Organization looked for other activities
that could build on what had already been achieved. In 1974 the
Expanded Programme on Immunization was created. "Expanded" because
most programmes until then had only used smallpox, BCG and diphtheria,
tetanus and pertussis (DTP) vaccines. EPI would include two new
diseases. The six diseases chosen were tuberculosis, diphtheria,
neonatal tetanus, whooping cough, poliomyelitis and measles. Selection
was made on the basis of a high burden of disease and the availability
of a well-tried vaccines at an affordable price. "Expanded" also meant
increased coverage - incredibly, less than 5% of children in
developing countries were being reached at that time by immunization
services."
"Gradually, global coverage for the six vaccines rose (Fig.1),
although success was not uniform. Regions and countries with the
greatest resources, infrastructure and political will were able to
raise coverage faster and higher (Fig. 2). Many organizations such as
UNICEF and Rotary International became partners in the programme.
Between 1974 and 1980, the programme developed training materials and
disseminated them widely. In those busy years, almost every country in
the world adopted the principle of a national immunization programme.
(Many used and continue to use the name "EPI" which has become a trade
mark). Hundreds of training courses in dozens of languages were
conducted resulting in a huge mobilizations of human resources.
Personnel were trained in the management of the programme so that
every community was reached (at least in theory) by some form of
immunization service. The number of doses administered and the number
of target diseases occurring were recorded and reported."
Table 3. Vaccines used by the Expanded Programme on Immunization from 1974 onwards
BCG
Polio
DTP
Measles*
Added later
Yellow Fever (in endemic countries)
Hepatitis B
Many industrialized countries now use measles, mumps and rubella
combined vaccine (MMR)
"Although coverage for all EPI target diseases climbined steadily in
all regions throughout the 1980s disease incidence was not always
proportionate decreasing. It became clear that pockets of low coverage
in most if not all countries could perpetuate disease transmission. In
the mid-1980s, more effort was placed on developing surveillance
systems. As the programme moved into the 1990s with a mandate for
eradication of polio, it became imperative that all countries should
be able to mount effective surveillance of all target diseases. Now
countries were able to focus attention on areas of low coverage and
high disease incidence. Special strategies such as house-to-house
visits were developed in the Americas and elsewhere, enabling pockets
of low coverage and high disease incidence to be reached."
Polio eradication by the year 2000:
------------------------------------
"In 1988, the World Health Assembly responded to the remarkable
successes of the Americas in controlling poliomyelitis by selecting
this disease as the next disease to be targeted for global
eradication. Strong commitment at global, regional and national levels
has led to wide implementation of WHO's recommended strategies with
consequent reduction in virus transmission. Globally, as of September
1995, 78% of children had received at least three doses of polio
vaccine by 12 months of age by routine immunization, and supplementary
immunization has now been conducted as national or sub-national
immunization days in 63 countries."
"The key to polio eradication lies in effective surveillance for all
cases of acute flaccid paralysis in children. One hundred and seven
countries are now conducting surveillance specifically for cases of
acute flaccid paralysis. Six specialized reference laboratories, 16
regional and 60 national laboratories are now providing virological
confirmation of diagnosis in suspected cases. In addition, they are
able to identify the source of the virus by molecular studies."
"All countries embarking on polio eradication have undertaken mass
campaigns using OPV, followed by "mopping-up" (house-to-house visits)
in locations where cases persist. The incidence of polio has continued
downward and, more importantly, increasing areas of the world are
becoming free of the disease. In 1994, the Americas were declared
polio-free. Polio-free zones also exist in Western Europe and in the
Pacific basin, with emerging low incidence zones in the countries of
the Mahgreb Union, the Gulf countries and in Southern Africa. Dramatic
reductions in incidence have been recorded in countries such as China
and Egypt. As of September 1995, 146 countries reported zero polio
cases. While success is in sight, zones and countries where there is
currently armed conflict remain difficult locations in which to
implement effective and comprehensive immunization programmes. Here
the problems have been partly overcome by "Days of tranquillity" when
conflicts cease and immunization of women and children is carried
out."
Measles Control:
---------------
"In 1990, the World Health Assembly set another global goal, this time
for a "Reduction by 95% in measles deaths and reduction by 90 per cent
of measles cases compared to pre-immunization levels by 1995, as a
major step towards the global eradication of measles in the longer
run". As of September 1995, estimated global coverage for measles
vaccine had reached 78%, and is expected to rise still further. Many
countries, especially those mounting mass campaigns, have already
achieved the reduction goals."
"For many countries, however, the disease reduction goal will be hard
to reach. Many of them did not introduce the use of measles vaccine
until 1985, thirty years it had became available. Since then however
the global number of reported cases of measles has fallen, but
thousands of measles cases continue to occur every year in many of the
larger developing countries, especially in Africa. High transmission
rates for measles virus in densely populated areas means that very
high, uniform measles vaccine coverage is needed to control the
disease in this environment if a one-dose schedule is followed."
"Mass campaigns in the Americas have resulted in the virtual
disappearance of measles from that hemisphere. One after another,
countries have undertaken mass campaigns targeting 9 months to 14 year
olds, regardless of previous immunization history. There is clearly a
role for this strategy to be expanded to other areas of the globe."
Yellow fever:
--------------
"Although a vaccine has been available since 1935, this diseases has
not yet been adequately controlled . While the global burden of
disease is not as high as some other vaccine-preventable diseases,
outbreaks still occur in endemic countries with great loss of life.
Indeed, statistics indicate the disease is currently on the upswing."
====================================
CURRENT VACCINE USE AROUND THE WORLD
====================================
YELLOW FEVER VACCINE
====================
From World Health Organization
http://www.who.int/vaccines/en/yellowfever.shtml
"Yellow fever is endemic in 33 countries in Africa and 11 countries in
South America. There are two modes of transmission of the yellow fever
virus, the sylvatic or forest cycle and the urban cycle. Transmission
begins when vector mosquitos (Aedes africanus in Africa, and several
species of the genus Haemagogus in South America) feed on non-human
primates infected with the virus. The infected mosquitos then feed on
humans travelling through the forest. The greatest risk of an epidemic
occurs when viraemic humans return to urban areas and are fed on by
the domestic vector mosquito Aedes aegypti, which then transmits the
virus to other humans."
"A severe epidemic is most likely to occur if conditions allow the
density of vector populations to increase substantially, as can happen
in a rainy season. Good epidemiological surveillance can be critical
in preventing an epidemic."
"Yellow fever continues to be a public health concern in many
countries of Africa and the Americas. It is estimated that 200 000
cases and 30 000 deaths are attributable to yellow fever annually,
most of them occurring in sub-Saharan Africa, although far fewer cases
than this are reported."
WHO perspective
"For the 33 countries of equatorial Africa where yellow fever is
endemic, which have a combined population of 508 million, the vaccine
should be routinely administered at the same time as measles vaccine,
i.e. around nine months of age. Immunization services and
disease-reporting systems are well established in these countries, all
of which are committed to the goals of measles reduction and polio
eradication. Improvement in disease surveillance is expected to follow
and to be sustainable. Linking yellow fever to planned polio and
measles immunization activities could save thousands of lives each
year."
"The incorporation of yellow fever vaccine into the routine infant and
child immunization schedules was recommended in 1988 by a joint
WHO/UNICEF Technical Group on Immunization in Africa. It was suggested
that this be done at the time of the visit for measles vaccine (at 9
to 12 months of age), thus avoiding the need for an additional visit.
As at the end of 2001, 15 of the 33 at-risk countries had implemented
the recommendation. At the end of 2000, 10 countries in Africa
reported coverage by the age of 12 months, the estimated average being
42%. In the at-risk countries of the Americas, 204 cases and 97 deaths
were reported in 1999. After this, a more aggressive implementation
contributed to a significant reduction in the number of cases from the
Americas (102 cases and 51 deaths in 2000, and 80 cases and 46 deaths
in 2001)."
Read more.....
"Yellow Fever - Disease and Vaccine." Center for Disease Control
http://www.cdc.gov/ncidod/dvbid/yellowfever/index.htm
WHO Fact Sheet on Yellow Fever (Dec. 2001)
http://www.who.int/inf-fs/en/fact100.html
"Countries at risk for yellow fever & having reported at least 1
outbreak." World Health Organization
http://www.who.int/vaccines-surveillance/graphics/htmls/YF.htm
PERTUSSIS VACCINE (Whooping Cough)
==================================
From World Health Organization
http://www.who.int/vaccines/en/pertussis.shtml
Summary and conclusions:
"Pertussis (whooping cough) is a highly contagious disease caused by
Bordetella pertussis. Worldwide, this bacterial agent causes some
20-40 million cases of pertussis and an estimated 200,000-400,000
fatalities each year. Although pertussis may occur at any age, most
cases of serious disease and the majority of fatalities are observed
in early infancy. Vaccines are the most rational approach to pertussis
control. For several decades inactivated whole cell vaccines (wP) have
been part of national childhood vaccination programmes, dramatically
reducing the considerable public health impact of pertussis. These
vaccines are currently being produced in over 40 countries, including
many developing countries. Currently, worldwide pertussis vaccination
coverage is about 80%. Frequent (but usually mild) adverse reactions
and a fear of rare but serious acute or chronic neurological events
associated with wP vaccination have prompted the development of a new
generation of pertussis vaccines, the acellular (aP) vaccines.
However, despite thorough investigations, the link suspected between
wP vaccines and rare cases of permanent neurological damage has not
been confirmed. The aP vaccines, which contain one to five different
components of B. pertussis, have proved to be efficacious, although
more expensive, and to compare favourably with wP vaccines in terms of
common adverse effects. They are now licensed in several countries. At
their most effective, aP and wP vaccines share similar efficacies.
Both wP and aP are usually administered in combination with diphtheria
and tetanus toxoids (DTwP or DTaP)."
"For more than four decades, use of wP of documented quality in infant
immunization programmes has been highly effective in preventing
pertussis all over the world.
* wP vaccines are considerably less costly than the aP vaccines.
Therefore, in most countries, wP vaccines remain the appropriate
choice for public health immunization programmes.
* While in terms of severe adverse effects aP and wP vaccines appear
to have the same high level of safety, mild to moderate adverse
reactions are less commonly associated with the aP vaccines.
* Similar high efficacy levels are obtained with the best aP and wP
vaccines, but the level of efficacy may vary considerably between the
vaccines within these two groups. Reliable comparisons of different aP
and wP vaccines or between aP and wP vaccines, are possible only in
studies that are carefully designed for that purpose. So far, no trial
has had the optimal design to adequately compare different candidate
antigens and the choice and number of antigen components of the ideal
aP vaccine is still debated.
* WHO endorses the use of aP vaccines of documented quality in
countries where pertussis vaccination is not widely accepted because
of the reactogenicity of wP.
* The main impediments to wider use of the aP vaccines are their high
price and concern about their duration of protection. If these issues
can be satisfactorily resolved, widespread use of this product will be
encouraged in the long term.
* Areas in need of further research include the duration of protection
following primary immunization with wP or aP vaccines, interference
between aP and other vaccines when used in combination, ability of aP
to induce a herd effect, and the epidemiology of pertussis in the
adult population."
Read more............
MEASLES
========
From "Measles." World Health Organization
------------------------------------------
http://www.who.int/vaccine_research/documents/new_vaccines/en/index9.html
"Measles, in spite of available vaccination, remains a heavy public
health burden worldwide especially in developing countries with 30-40
million cases, 26 million DALYs (WHO, 2002 ) and 745 000 deaths (WHO,
2002 ) for the year 2001. This represents 50-60% of the estimated
million deaths attributable to vaccine-preventable diseases of
childhood. Measles may be ultimately responsible for more child deaths
than any other single agent because of complications from pneumonia,
diarrhoea and malnutrition. Measles is also the major cause of
preventable blindness in the world, affecting the same disadvantaged
populations."
"Of the deaths attributable to measles, 98% occur in developing
countries, where vitamin A deficiency is common. Case-fatality rates
in these countries are usually estimated to be in the range 1-5% but
may reach 10-30% in some situations. Specific goals for reduction in
measles mortality and morbidity were set by the World Heath Assembly
in 1989 and the Word Summit for Children in 1990, as major steps
towards the eventual eradication of the disease. Subsequently, target
dates of 2000, 2007 and 2010 for its elimination were established for
the Region of the Americas, the European Region and the Eastern
Mediterranean Region respectively. The aim in the African Region, the
South-East Asia Region and Western Pacific Region is to reduce measles
mortality."
"Several strategies are now developed to increase coverage of
immunization including a two-dose schedule, mopping up strategies,
supplementary immunization strategies such vitamin A supplementation,
one-round national and regional mass immunizations, and development of
high-quality case-based measles surveillance supported by regional
measles laboratory."
"Measles vaccination is one of the most cost effective health
interventions available and one of the most powerful tools for
providing health equity to poor children. It is cost-effective to
improve routine measles vaccination, as preliminary estimates suggest
that the cost per life-year gained for expanding measles coverage from
50% to 80% is US$ 2.53 in areas with high disease incidence and high
measles case-fatality ratios. Measles vaccine is highly effective,
safe and inexpensive. With US$ 0.15 for one measles vaccine dose,
children in developing countries can survive exposure to measles
without sequelae. However, coverage with measles vaccine is low in
many countries due to limited resources. Coverage could be greatly
enhanced if the method of administration could be simplified. Current
measles vaccination requires injection with a needle and syringe. The
drawbacks of the needle and syringe technology are as follows: 1) it
requires highly skilled personnel to administer the vaccine; 2) it is
associated with a risk of transmitting blood-borne diseases such as
hepatitis and HIV if syringes and needles are re-used. This risk can
be minimized if auto-disable syringes are used and 3) injection may be
painful and present a risk of infection if a proper technique is not
used."
"As the natural route of infection for measles virus is the
respiratory tract, administration of live attenuated measles vaccine
through the respiratory tract has been investigated as an alternative
to injection. Early studies have shown fewer acute adverse events
following aerosol vaccination, as compared to conventional parenteral
vaccine. Aerosolized vaccine is immunogenic and affective in
seronegative and seropositive children. More than 4 million children
were vaccinated with aerosolized measles vaccine in mass immunization
campaigns in Mexico with good public acceptance. Aerosol vaccination
can be performed by non-medical staff with some training. As aerosol
vaccination uses the same vaccine formulation as parenteral
vaccination, most cold chain procedures are identical. Now that the
development of a respiratory route of administration is so promising
for measles vaccine, WHO has convened a Product Development Group
(PDG) to identify critical licensure steps, define clinical trials
strategies and assist in protocol design, identify sites for clinical
trials and ensure adequate implementation, monitoring and
documentation of good practice. Following the current work plan
aerosolized measles vaccine could be licensed in 2007 and introduced
in practical use in 2009. This project is managed as a partnership
between WHO, CDC and the American Red Cross, with funding from the
Bill & Melinda Gates Foundation."
"In addition, studies are in progress to develop new measles vaccine
effective for immunization of infants before 6-months of age. Indeed,
infants are refractory to conventional measles vaccines in the
presence of maternal anti-measles antibodies. To reach this objective
several technologies are currently being tested including DNA
vaccines, bacterial vectors, viral vectors (e.g. adenoviruses,
poxviruses, alpha viruses) or ISCOMS."
"Measles incidence rate per country (map)." WHO
http://www.who.int/vaccines-surveillance/graphics/htmls/meainc.htm
"Coverage rate with measles vaccine in infants by country (map)" WHO
http://www.who.int/vaccines-surveillance/graphics/htmls/meacovmap.htm
"Global measles vaccine coverage rate and measles cases." WHO
http://www.who.int/vaccines-surveillance/graphics/htmls/measlescascov.htm
MUMPS Vaccine
==============
From World Health Organization.
http://www.who.int/vaccines/en/mumps.shtml
Summary and conclusions:
"Mumps, or parotis epidemica is a viral infection primarily affecting
the salivary glands. Although mostly a mild childhood disease, mumps
virus may also affect adults, among whom complications such as
meningitis and orchitis are relatively common. Encephalitis and
permanent neurological sequelae are rare complications of mumps. In
most parts of the world the annual incidence of mumps is in the range
of 100 - 1000 per 100,000 population, with epidemic peaks every two to
five years. Peak incidence is found among children five to nine years
of age. Natural infection with mumps virus is likely to confer
lifelong protection."
"All commercially available mumps vaccines are based on live,
attenuated strains of the virus. Extensive use of these vaccines in
industrialized countries has proved them to be safe and efficacious;
so far about 500 million doses have been administered. Approximately
120 countries are using mumps vaccine in their national immunization
programmes. Where sustained vaccination has been achieved the
incidence of mumps has been significantly reduced. In general, adverse
reactions to mumps vaccination are rare and mild."
"Large-scale mumps vaccination is recommended in countries with an
efficient childhood vaccination programme and sufficient resources to
maintain high-level vaccination coverage. In such countries the
combination of mumps vaccine with measles, or preferably, measles and
rubella vaccines is recommended."
"National decisions to implement large-scale mumps vaccination should
be based on careful cost-benefit analyses. As insufficient childhood
vaccination coverage may result in an unfortunate epidemiological
shift in the incidence of mumps to older age groups, childhood mumps
vaccination should aim at a 80% coverage rate, or higher. In countries
with lower childhood coverage rates, mumps vaccination may also be
offered to assumed non-immune children 9-12 years of age."
"WHO recommends making mumps a notifiable disease. If a large
proportion of the population remains seronegative for mumps, care
should be taken to vaccinate adults considered to be at special risk.
Regular serosurveillance will provide information on the
susceptibility for mumps in various age groups."
Read entire article..........
CHOLERA VACCINE
================
The cholera vaccine is still in a stage of development. Read the following article:
"Cholera." World Health Organization
http://www.who.int/vaccine_research/documents/new_vaccines/en/index1.html
"During 2001, 58 countries officially notified WHO of a total of 184
311 cases (one third more than in 2000) and 2 728 deaths. The reported
overall case-fatality rate (CFR) has dropped to 1.48% with regards to
the 3.6% reported in 2000. This absolute decline in CFR reflects
contrasting realities, as CFR for South Africa is very low (0.22%)
whereas rates of up to 30% have been observed in other parts of
Africa. With a total of 173 359 cases, Africa accounted for 94% of the
global total. Asia reported a total of 10 340 cases, which represents
a small decrease compared to 2000. However, globally, the actual
figures are likely to be higher, owing to the under-reporting and
other limitations of surveillance systems. The year 2001 was marked by
major outbreaks of cholera in several African subregions."
"Vibrio cholerae is the infectious agent responsible for cholera. Only
Vibrio cholerae serogroup O1 and serogroup O139 are known to cause
epidemics of cholera. Isolates of Vibrio cholerae serogroup O1 are
classified into two biotypes, El Tor and classical, on the basis of
several phenotypic characteristics. Currently, the El Tor biotype is
responsible for virtually all of the cholera cases throughout the
world, and classical isolates are not encountered outside of
Bangladesh. In addition, V. cholerae O1 is classified into two
serotypes, Inaba and Ogawa, based on agglutination in antiserum. A
possible third serotype, Hikojima, has been described, but it is very
rare. Immunity due to previous Vibrio cholerae infection is serogroup
specific. There are other serogroups of Vibrio cholerae , which can
cause isolated cases of watery diarrhoea, but they do not cause
epidemics (O5, O37). The current seventh pandemic of cholera is due to
Vibrio cholerae O1 that has been reported form all regions of the
world."
Vaccines:
"The old killed injectable whole-cell vaccine was efficient in 50% of
the cases and for no longer than 6 months. To date, 3 oral cholera
vaccines are available, which have been shown to be safe, immunogenic
and effective. These vaccines have been licensed in some countries and
are mainly used by travellers. Oral cholera vaccines are now under
consideration for use in public health. As mentioned above, several
countries have already vaccinated populations considered to be at high
risk from a cholera outbreak (including Mayotte Island and Micronesia
Island)."
"One vaccine consists of heat- or formalin-killed whole-cell V.
cholerae O1, Inaba and Ogawa serotypes, classical and El Tor biotypes
with purified recombinant B-subunit of cholera toxoid (WC/rBS), (SBL
Sweden, now PowderJect). Field trials in Bangladesh, and Peru have
shown that this vaccine is safe and confers 85-90% protection during 6
months in all age groups after administration of 2 doses, one or two
weeks apart. In Bangladesh, protection declined rapidly after 6 months
in young children, but was still about 60% in older children and
adults after 2 years. The vaccine was also used successfully for mass
vaccination in a refugee camp in Uganda. Since protection is achieved
one week after the second dose, the study showed that a minimum of 4-5
weeks was needed to achieve protection of a refugee camp . As a result
of technology transfer, a variant of the WC/rB vaccine containing no
recombinant B-subunit has been produced and tested in Viet Nam. It is
administered in 2 doses, 1 week apart. A field trial conducted in
1992-1993 in Viet Nam (Nha-Trang) showed an efficacy of 66% against El
Tor at 8 months in all age groups. The vaccine is licensed only in
Viet Nam and is currently also being produced in Indonesia. A
whole-cell bivalent O1 and O139 oral vaccine without CTB developed in
Viet Nam was shown to be safe and very immunogenic in both adults and
children . This bivalent vaccine is actually the only existing vaccine
against O139 serogroup infection. Other oral live attenuated O139
cholera vaccines are currently under development."
"Another oral vaccine consists of a live attenuated genetically
modified V. cholerae O1 strain (CVD 103-HgR), developed by Berna
Biotech (Switzerland). Placebo-controlled trials in a number of
countries in South America and Asia have shown the safety and
immunogenicity of a single dose of CVD 103-HgR. The vaccine is
currently licensed in some industrialized countries. The efficacy of
this vaccine has been investigated in adult volunteers in the United
States, where it has been found that a single dose of this oral
vaccine confers high protection (up to 90%) against moderate and
severe cholera following a challenge with V. cholerae O1 of either El
Tor or classical biotype given 3 months after administration. The
overall protective efficacy against El Tor cholera of any severity
(i.e. including mild cases) was 80%. A large field trial performed in
Indonesia has not shown convincing protection in a population exposed
to cholera a long time after vaccination."
"Another live attenuated vaccine developed in Cuba (one oral dose) has
been tested in Phase I. A parenteral O-antigen-conjugated vaccine
(Pasteur Institute Paris , NIH ) was tested in Phase I in the US and
is still in preclinical development at the Institut Pasteur. The
University Putra Malaysia and the Malaysia National Biotechnology
Directorate are developing a naked DNA cholera vaccine derived from a
local isolate, to be administered by intramuscular injection. The work
is still at a pre-clinical stage. In addition, Avant
Immunotherapeutics (USA) and BioSidus S.A. (Argentinia) are currently
testing in Phase II trials a live oral recombinant vaccine strain (see
announcement)."
"WHO is currently investigating the use of oral cholera vaccines as an
additional tool to traditional control measures. Conventional
recommendations focusing upon basic sanitary and hygiene measures are
efficient when properly applied, but it is also recognized that they
are often difficult to implement fully. In May 1999 WHO convened a
meeting of experts which, in light of the progress made in development
and evaluation of oral cholera vaccines since 1995 and new data
available on feasibility and accountability relating to these
vaccines, recommended considering the use of the oral WC/rB cholera
vaccine among the tools to prevent cholera in populations believed to
be at risk of a cholera epidemic within 6 months, and not experiencing
a current epidemic. Such high-risk populations may include, but are
not limited to, refugees and urban slum residents. Currently WHO is
investigation the role of mass vaccination as a public health strategy
for populations at high risk in order to contains as well as prevent
outbreaks. Issues being addressed include logisitics, costs,
financing, vaccine production capacities and other criteria.
Consultation is expected to establish guidelines for the use of oral
cholera vaccination in cholera control activities."
"In December 2002, WHO convened a panel of experts to discuss the
potential use of cholera vaccines in public health."
POLIOMYELITIS
==============
From "Poliomyelitis Vaccine". World Health Organization.
http://www.who.int/vaccines/en/polio.shtml
"In 1988 the World Health Assembly set the goal of worldwide polio
eradication. Subsequently, the end of 2005 was made the target date
for global certification of the eradication of the disease. Since
1988, WHO has been working with national governments, UNICEF, Rotary
International, the Centers for Disease Control and Prevention, and a
broad array of public and private partners in order to support the
work of eradicating polio from the countries where the disease has
been endemic. The four principal strategies of polio eradication are:
routine immunization of infants, supplementary immunization through
national immunization days (NIDs), surveillance for acute flaccid
paralysis (AFP) and mop-up immunization campaigns.
Routine immunization of infants:
---------------------------------
"All infants should receive a minimum of four doses of oral polio
vaccine (OPV) during their first year of life. Routine immunization
provides a basic level of immunity against polio. High routine
immunization coverage also reduces the amount of circulating wild
poliovirus, thus facilitating eradication."
Supplementary immunization
--------------------------
"A national immunization day is a mass campaign that aims to deliver
two doses of OPV to all children aged less than five years in an
entire country. In a subnational immunization day (SNID) the same
approach is used in a large area of a country. All children are
immunized regardless of their prior immunization status. The two
rounds are approximately a month apart and are normally conducted
during the cool dry season in order to facilitate the logistics and
improve the immune response to vaccination. NIDs rapidly increase
population immunity, particularly intestinal secretory IgA, to high
levels that interrupt the circulation of wild polioviruses."
Mop-up immunization
--------------------
"Mop-up immunization is conducted when poliovirus transmission becomes
focal. Surveillance data are used to identify the final reservoirs of
transmission in a country. In order to increase coverage to the
highest possible level, mop-up activities involve a strategy of
house-to-house vaccine delivery. All children aged under five years
are immunized with two doses of OPV, regardless of their prior
immunization status. This strategy is also employed in the event of an
importation or an outbreak."
WHO recommendations for routine immunization
--------------------------------------------
"The immunization schedule recommended by WHO calls for the four doses
of OPV to be given at birth and at 6, 10 and 14 weeks of age in
polio-endemic countries. In countries where the disease is not endemic
the birth dose may be omitted, with the fourth dose given at the time
the child is brought for vaccination against measles, or at any other
contact with the health system in the first year of life. There should
be an interval of at least four weeks between doses. OPV is composed
of three types of attenuated poliovirus (Sabin strains). The purpose
of recommending several doses is to assure seroconversion against all
types of poliovirus."
"Inactivated polio vaccine (IPV) is not recommended for routine
immunization in developing countries because of its high cost,
uncertain efficacy if given at 6, 10 and 14 weeks, and the added
logistical considerations such as the need for syringes and needles.
The Global Technical Consultative Group is evaluating the potential
for using IPV in developing countries in the post-certification era.
Because of the time needed to complete these deliberations and
research, countries should plan to continue using OPV for the
foreseeable future."
Also read "Polio News." Global Polio Eradication (October 2003)
http://www.who.int/vaccines-polio/all/news/files/pdf/PolioNews20.pdf
Please read "The Global Polio Eradication Initiative Strategic Plan
2004-2008." (Draft)
http://www.who.int/vaccines-polio/all/news/files/pdf/DRAFTpoliostratplan2004.pdf
CHICKEN POX VACCINE
====================
The vaccine for Chicken Pox is relatively new! It has only been
available in the US since 1995.
From "Chicken Pox Vaccine."
http://medic.med.uth.tmc.edu/ptnt/00001180.htm
"The varicella zoster virus, better known as chicken pox, causes an
itchy blister like skin rash that covers the face, scalp, and trunk.
It is accompanied by fever, headache, malaise, and loss of appetite.
In most children the disease is an annoyance, but in children who
already have a suppressed immune system serious complications can
accompany the infection. Approximately 9,000 individuals are
hospitalized each year from chicken pox infections, 80 percent of
which are children. Around 50 children each year die from
complications of the disease."
"A vaccine for chickenpox is now available for immunization which is
70 to 90 percent effective in preventing people from getting the
disease. Those individuals who do develop the disease after
immunization will have a milder case than non-immunized individuals.
The vaccine will be integrated into immunization schedules for
children. The vaccine is being recomended as a single shot for
children ages 12 months to 12 years who have not had the disease. Ages
13 to adult who have not had chicken pox should receive two doses four
to eight weeks apart. Infants under the age of one cannot receive the
vaccine, but their exposure to the disease should be minimized as
older children are vaccinated. Your physician may perform a laboratory
test to detect whether you have been exposed to the virus prior to
giving the vaccine. Some individuals are infected with the virus and
create antibodies against it, but never have a rash that is recognized
as chicken pox. These individuals would not benefit from being
vaccinated."
"The vaccine was more than a decade in development by Merck and the
company has spent two years to prove to the FDA that the vaccine was
safe and the effect was durable. The vaccine was tested on 9,545
healthy children and 1, 648 teenagers and adults. There are several
unanswered questions about the vaccine, including:
* How long it protects against chicken pox and whether booster shots
will be required to keep immunity.
*If the vaccine will have any beneficial effect for older adults in
the prevention of shingles. Shingles results when an adult loses their
immunity to the varicella zoster virus. It appears as a rash with
painful blister like qualities generally in one area of the body.
==
"Varicella Vaccine." Questions and Answers. Center for Disease Control
http://www.cdc.gov/nip/vaccine/varicella/faqs-gen-vaccine.htm
"Chicken Pox. It's More Serious Than You Know." National Immunization Program
http://www.cdc.gov/nip/events/niiw/pastPDF/SampleOpEdChickenpox.pdf
"Higher Chicken Pox Vaccination Rates Decrease Disease Even in the
Unvaccinated." DukeMed.
(4/30/2001) http://dukemednews.duke.edu/news/article.php?id=2093
"Chicken Pox Vaccine." Family Doctor Org.
http://familydoctor.org/193.xml
=====
Just in case you need the following:
SMALLPOX VACCINE
================
From "Smallpox Vacine." World Health Organization
http://www.who.int/vaccines/en/smallpox.shtml
"On 8 May 1980, during the Thirty-Third World Health Assembly,
smallpox was declared to have been eradicated. Small stocks of the
virus remained in secure laboratories and some other laboratories were
allowed to maintain stocks of up to 20% of the genome sequence for the
purpose of international research. An emergency stock of smallpox
vaccine (vaccinia) was kept in deep freeze in certain locations. No
vaccination of populations has been carried out since eradication was
declared. However, vaccination has continued for at-risk laboratory
workers and other persons working with vaccinia virus that is not
highly attenuated, recombinant vaccinia viruses derived from vaccinia
strains that are not highly attenuated, or other non-variola
orthopoxviruses (e.g. monkeypox), as well as for certain military
personnel."
Special issues:
"Bioterrorism Intermittent discussions have continued since the 1980s
about the potential threat of the use of smallpox as a terrorist
weapon. Governments have recently begun to seriously consider whether
the vaccine should be available for widespread use. New smallpox
vaccines are being developed as a contingency for the protection of
civilian and military personnel against the deliberate dissemination
of the smallpox virus by terrorists. WHO has not made any
recommendation about the use of the vaccine in this new environment,
but it remains for each country to conduct a risk assessment vis-à-vis
its own population. At present the risk of smallpox virus being used
for terrorist purposes appears to be extremely low in most countries."
"During the smallpox eradication programme, targeted vaccination of
close contacts played the most important role in preventing the spread
of the disease and assured the administration of vaccine to those at
greatest risk. This was sometimes supplemented with broader
vaccination campaigns if there were large numbers of cases in a
community. If contacts are vaccinated within four days of exposure
they may be protected or at least develop less severe disease than
would otherwise be the case."
*** WHO perspective
"No vaccine is currently available for widespread use. WHO maintains a
web site with latest information."
Read the "WHO Fact Sheet on Smallpox."
http://www.who.int/mediacentre/factsheets/smallpox/en/
Read "STATEMENT TO THE PRESS BY THE DIRECTOR-GENERAL OF THE WORLD
HEALTH ORGANIZATION, DR GRO HARLEM BRUNDTLAND: WORLD HEALTH
ORGANIZATION ANNOUNCES UPDATED GUIDANCE ON SMALLPOX VACCINATION."
(October 2001)
http://www.who.int/inf-pr-2001/en/state2001-16.html
"In summary, the guidance is that vaccination of entire populations is
not recommended. The reason for not recommending such mass vaccination
is that there is a risk of severe reactions to the vaccine, including
death, and the fact that vaccination can prevent smallpox even after
exposure to the virus."
Read "Smallpox: The beginning of vaccines, the end of a disease."
http://www.health.state.nd.us/disease/bioterrorism/public/virual/Vaccinations1.htm
RUBELLA VACCINE
================
"Rubella vaccine." World Health Organization
http://www.who.int/vaccines/en/rubella.shtml
Summary and conclusions:
"Rubella occurs worldwide and is normally a mild childhood disease.
However, infection during early pregnancy may cause fetal death or
congenital rubella syndrome (CRS); the latter characterized by
multiple defects, particularly to the brain, heart, eyes and ears. CRS
is an important cause of hearing and visual impairment and mental
retardation in countries where acquired rubella infection has not been
controlled or eliminated."
"Although the burden of CRS is not well characterized in all
countries, it is estimated that more than 100 000 cases occur each
year in developing countries alone. Caring for CRS cases is costly
because of the permanent disabilities caused by this condition.
Cost-benefit studies in developed as well as developing countries have
demonstrated that, when combined with measles vaccine in countries
with coverage of over 80%, the benefits of rubella vaccination
outweigh the costs."
"The primary purpose of rubella vaccination is to prevent the
occurrence of congenital rubella infection including CRS. Two
approaches are recommended: (a) prevention of CRS only, through
immunization of adolescent girls and/or women of childbearing age; or
(b) elimination of rubella as well as CRS through universal
vaccination of infants and young children (with/without mass
campaigns), surveillance, and assuring immunity in women of
childbearing age."
"The currently licensed rubella vaccines in wide international use are
based on the live attenuated RA 27/3 strain of the virus. Other
attenuated vaccine strains are available in China and Japan. The 27/3
vaccines are propagated in human diploid cells and have proven to be
safe and efficacious. Rubella vaccines are commercially available in a
monovalent form, a bivalent combination with measles vaccine or mumps
vaccine, or as trivalent measles-mumps-rubella vaccine (MMR).
Following well-designed and implemented programmes, rubella and CRS
have almost disappeared from many countries."
Read more.......
==============
I hope I have covered all the bases for you!
Sincerely,
umiat
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