The Leogane, Haiti demonstration project: decreased microfilaremia and program costs after three years of mass drug administration.
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To support the global program to eliminate lymphatic filariasis (LF), well-monitored demonstration projects are important for defining the relationship between coverage and reductions in microfilaremia. We are using mass treatment with diethylcarbamazine (DEC) and albendazole in an effort to eliminate LF from Leogane, Haiti. Wuchereria bancrofti microfilaremia prevalence at baseline ranged from 0.8% to 15.9% in four sentinel sites. After three rounds of DEC-albendazole mass drug administration (MDA), both microfilaremia prevalence and intensity decreased dramatically. Mild and moderate adverse reactions after treatment were common, especially after the first MDA, but decreased after subsequent MDAs. Drug coverage for the first year was estimated to be 72%, but concerns about adverse reactions appeared to decrease drug coverage in the second MDA. As a result of community education efforts that focused on providing a greater understanding of adverse reactions, coverage increased dramatically for the third round. Program efficiency increased substantially; the costs per person treated for three rounds of MDA were 2.23 US dollars, 1.96 US dollars, and 1.30 US dollars per person, respectively. The Leogane experience highlights the importance of adapting community education and mobilization campaigns to achieve and maintain good coverage. (+info)
Socio-economic inequity in demand for insecticide-treated nets, in-door residual house spraying, larviciding and fogging in Sudan.
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BACKGROUND: In order to optimally prioritize and use public and private budgets for equitable malaria vector control, there is a need to determine the level and determinants of consumer demand for different vector control tools. OBJECTIVES: To determine the demand from people of different socio-economic groups for indoor residual house-spraying (IRHS), insecticide-treated nets (ITNs), larviciding with chemicals (LWC), and space spraying/fogging (SS) and the disease control implications of the result. METHODS: Ratings and levels of willingness-to-pay (WTP) for the vector control tools were determined using a random cross-sectional sample of 720 householdes drawn from two states. WTP was elicited using the bidding game. An asset-based socio-economic status (SES) index was used to explore whether WTP was related to SES of the respondents. RESULTS: IRHS received the highest proportion of highest preferred rating (41.0%) followed by ITNs (23.1%). However, ITNs had the highest mean WTP followed by IRHS, while LWC had the least. The regression analysis showed that SES was positively and statistically significantly related to WTP across the four vector control tools and that the respondents' rating of IRHS and ITNs significantly explained their levels of WTP for the two tools. CONCLUSION: People were willing to pay for all the vector-control tools, but the demand for the vector control tools was related to the SES of the respondents. Hence, it is vital that there are public policies and financing mechanisms to ensure equitable provision and utilisation of vector control tools, as well as protecting the poor from cost-sharing arrangements. (+info)
Establishing government-operated vaccine programs: an industry perspective.
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During 2000-2002, shortages of numerous routinely administered pediatric vaccines occurred. The reasons for these shortages were varied, but they included policy, manufacturing, and regulatory issues. The use of government manufacturing programs has been proposed as a way to stabilize the fragile vaccine supply and to prevent periodic shortages. Although such programs might be useful for defense needs, it is likely that such an approach would have limited value for routinely administered vaccines. Each of the vaccine components would require a dedicated manufacturing facility, and many components are administered in combination vaccines. Timing is also an important consideration. The restarting of an idled manufacturing facility would take many months; in addition, it often takes nearly 12 months to produce and release a single lot of vaccine. Finally, government-owned programs would face the same issues of regulatory changes, technological advancements, and facility updates as non-government-owned programs do--all of which would require sustained operation and investment. A secure and stable vaccine supply is best built by establishing the importance and value of our vaccine programs, which would, in turn, provide incentives to manufacturers to build capacity and inventories. (+info)
Strengthening the supply of routinely recommended vaccines in the United States: a perspective from the American Medical Association.
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Influenza virus vaccine shortages and delays in distribution require continued collaborative efforts by all stakeholders to ensure that Healthy People 2010 goals are met. Problems with supplies of other vaccines jeopardize at-risk populations. The American Medical Association recommends that the US Department of Health and Human Services establish a task force to explore the causes of vaccine shortages and maldistribution. The task force should commission an appropriate body of experts to identify solutions for breakdowns in vaccine manufacturing and distribution systems. Potential areas for improvement include earlier notification of shortages to the US Food and Drug Administration, improved communication to physicians, financial incentives to market medically necessary but unprofitable products, and a national stockpile of certain vaccines. The American Medical Association believes that the strategies proposed by the National Vaccine Program Office (i.e., increasing financial incentives, streamlining the regulatory process, establishing government-directed programs, creating and maintaining vaccine stockpiles, and increasing liability protection) could improve vaccine availability; however, increasing vaccine stockpiles is the most promising strategy. (+info)
The United States pediatric vaccine stockpile program.
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The initial goal of the national vaccine stockpile program was to establish a 6-month supply of all recommended childhood vaccines, to meet national demands if a manufacturing process was interrupted. When the first vaccine stockpiles were created in 1983, the childhood immunization schedule was much less complicated than it is today, and the first stockpiles included only measles-mumps-rubella, poliovirus, and pertussis vaccines, as well as diphtheria and tetanus toxoids. However, today's vaccine needs are much greater, and current stockpiles do not include all recommended childhood vaccines, partially because inclusion of vaccines that are universally recommended, fully implemented, and produced by a single manufacturer has been made a priority. Future planning must also consider substantially higher vaccine costs, the development of new combination vaccines, a wide range of production times, and changes in immunization recommendations. Expansion and strengthening of the national vaccine stockpile program are critical to protect against future disruptions in vaccine supply. (+info)
Diet, activity, and overweight among preschool-age children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
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INTRODUCTION: Overweight is affecting children at younger ages and in increasing numbers, putting them at risk for a lifetime of chronic disease. Consumption of unhealthy foods and time spent watching television have increased concurrently. METHODS: Parents of 526 children aged 2 to 4 years old enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) answered questions about their children's food and beverage consumption, television-viewing and computer time, and physical activity. The children's height and weight measurements were collected from administrative records. Crude and adjusted odds ratios were calculated to test for associations between demographic, consumption, and activity variables and overweight or at risk of overweight (body mass index > or =85th percentile for age and sex). RESULTS: Of the participants, 38% of the children were overweight or at risk of overweight. Hispanic and white children were twice as likely as black children to be overweight or at risk of overweight. Fifty-eight percent of the children drank more than one and 30% drank more than two 8-oz servings of fruit juice per day. The children who drank more than one serving of nonjuice fruit drink per day (30%) had increased odds of being overweight or at risk of overweight. On average, the children spent more than twice as much time watching television and using computers as they did engaging in physical activity. In multivariate analyses, race and ethnicity as well as physical activity were associated with being overweight or at risk of overweight. CONCLUSION: Efforts to improve nutrition and prevent overweight in children should focus on the parents of infants and toddlers and provide them with anticipatory guidance on physical activity for young children and nutrition and food transitions. (+info)
Adherence to the screening program for HBV infection in pregnant women delivering in Greece.
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BACKGROUND: Hepatitis B infection (HBV) is a major Public Health Problem. Perinatal transmission can be prevented with the identification of HBsAg(+) women and administration of immunoprophylaxis to their newborns. A national prevention programme for HBV with universal screening of pregnant women and vaccination of infants is in effect since 1998 in Greece. METHODS: To evaluate adherence to the national guidelines, all women delivering in Greece between 17-30/03/03 were included in the study. Trained health professionals completed a questionnaire on demographic data, prenatal or perinatal screening for HBsAg and the implementation of appropriate immunoprophylaxis. RESULTS: During the study period 3,760 women delivered. Prenatal screening for HBsAg was documented in 91.3%. Greek women were more likely to have had prenatal testing. HBsAg prevalence was 2.89% (95%CI 2.3-3.4%). Higher prevalence of HBV-infection was noted in immigrant women, especially those born in Albania (9.8%). Other risk factors associated with maternal HBsAg (+) included young maternal age and absence of prenatal testing. No prenatal or perinatal HBsAg testing was performed in 3.2% women. Delivering in public hospital and illiteracy were identifiable risk factors for never being tested. All newborns of identified HBsAg (+) mothers received appropriate immunoprophylaxis. CONCLUSION: The prevalence of HBsAg in Greek pregnant women is low and comparable to other European countries. However, immigrant women composing almost 20% of our childbearing population, have significant higher prevalence rates. There are still women who never get tested. Universal vaccination against HBV at birth and reinforcement of perinatal testing of all women not prenatally tested should be discussed with Public Health Authorities. (+info)
Smallpox vaccine injury compensation program: Smallpox (Vaccinia) Vaccine Injury Table. Adoption of interim final rule as final rule with an amendment.
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This document adopts the Smallpox (Vaccinia) Vaccine Injury Table (the Table) Interim Final Rule as the Final Rule with an amendment, as follows: the Final Rule clarifies that, in order for the presumption of causation to apply, the time intervals listed on the Table refer specifically to the period in which the first symptom or manifestation of onset of injury must appear following administration of the smallpox vaccine or exposure to vaccinia, and that the time intervals listed have no relevance to time of diagnosis of the injury. (+info)