Optic neuritis after influenza vaccination

PURPOSE: To present evidence for a causal relation between optic neuritis and influenza vaccination. METHODS: Case report. In a 59-year-old woman with bilateral optic neuritis, neuro-ophthalmologic examination, magnetic resonance imaging, fluorescent treponemal antibody absorption test, antinuclear antibodies, and complete blood cell count and chemistry were performed. RESULTS: Our patient developed bilateral optic neuritis on two occasions, 1 year apart. No evidence of neuroretinitis, syphilis, or systemic lupus erythematosus was identified. Influenza vaccination was given 2 weeks before the onset of each episode. CONCLUSION: This case provides compelling clinical evidence that implicates influenza vaccination as a cause of optic neuritis.     

Clinical effectiveness of influenza vaccination in Manitoba

OBJECTIVE: To assess the clinical effectiveness of influenza vaccination in preventing influenza-associated hospitalization and death. DESIGN: Case-control study. SETTING AND PATIENTS: Noninstitutionalized persons aged 45 years or older living in Manitoba, on December 1, 1982, and December 1, 1985. METHODS: Linked records of the Manitoba population registry, hospital-discharge abstracts, physician claims for ambulatory-patient visits and influenza vaccination, and vital statistics were used. A matched-set analysis estimated the clinical effectiveness of influenza vaccination in preventing hospital admissions and deaths from influenza-associated conditions during influenza A (H3N2) outbreak periods in 1982 to 1983 (12 weeks) and 1985 to 1986 (10 weeks). The analysis adjusted for hospital discharge and ambulatory care for high-risk conditions within the previous 15 months and 3 months, respectively. RESULTS: Influenza vaccination prevented 32% to 39% of hospital admissions with pneumonia and influenza and 15% to 34% of admissions with all respiratory conditions. Vaccination was 43% to 65% effective in preventing hospital deaths with these conditions (all listed diagnoses) and 27% to 30% effective in preventing deaths from all causes. CONCLUSION: Influenza vaccination has substantial clinical effectiveness in preventing hospital admission and death from influenza-associated conditions in noninstitutionalized individuals.     

Implementation of a community pharmacy-based influenza vaccination program

OBJECTIVE: To increase accessibility of influenza vaccine in a rural community by establishing a community pharmacy-based influenza vaccination program. SETTING: An independent pharmacy in a rural eastern Iowa community of 5,000 people. PRACTICE DESCRIPTION: Protocols for identification and screening of patients, administration of vaccine, and treatment of emergencies were developed by the pharmacist and approved by the county health department medical director. Administration of vaccine began October 15, 1996, and was completed on December 6, 1996. PRACTICE INNOVATION: Patients were prospectively and retrospectively identified to receive the vaccination. Informed consent was obtained. Vaccine was administered by the pharmacist after screening for contraindications and counseling the patient. Weekly vaccination records were forwarded to the collaborating physician to update patient charts. MAIN OUTCOME MEASUREMENTS: To determine whether accessibility of influenza vaccine in the community was increased through pharmacist administration, the proportion of patients immunized in the pharmacy who were not vaccinated the previous year was determined. RESULTS: The pharmacist administered 343 doses of vaccine. Two-thirds of the immunized patients (67.9%) reported also being immunized the previous year. These patients were generally older (65 years of age +/- 13) than the previously nonimmunized patients (54 years of age +/- 16). However, 60.8% of the patients not immunized the previous year reported either they would not have gone elsewhere for the immunization (45.3%), or were unsure (25.5%). CONCLUSION: The data collected suggest that pharmacist administration of influenza vaccination in a rural community pharmacy increases access and, possibly, immunization rates. This may be especially true among high-risk younger adults who are often overlooked and would not normally have received the immunization.     

Qualitative interview study on acceptance of influenza vaccination among the elderly

Nine elderly men and women were interviewed in order to discover factors of importance in accepting influenza vaccinations. The study demonstrated that the fee to be paid by the patients was a considerable barrier to an improvement of the vaccination rate. The elderly informants were all aware that influenza vaccine is available. Some informants expressed uncertainty whether they themselves belonged to the risk groups who should be vaccinated. Sources of information were the general practitioner (GP), relatives, and the mass media. More personal information from the GP to persons at risk was wanted. Influenza vaccination behaviour was found to be consistent with the Health Belief Model. The present organization of influenza vaccinations does not promote a sufficient immunization rate. The threshold for accepting influenza vaccinations appears to be too high for the elderly population.     

Evaluation of the DTP vaccination technique in infants

OBJECTIVE: To evaluate the techniques of DPT vaccination in the nursing child. DESIGN: An observation study of a crossover type. Evaluation by means of an anonymous survey of those responsible for administering the vaccinations. Statistical analysis using the precise Fisher test. PARTICIPANTS: The thirteen official vaccination centres in Health Areas 11 and 12 in the Community of Valencia. MEASUREMENTS AND MAIN RESULTS: 12 centres (91%) answered the questionnaire. Four of them (41%) used different needles to aspirate the contents of the vial and give the injection to the nursing child. The DPT was always administered in the gluteal region. 33% used needles which were 16 mm long. Prophylactic paracetamol was used in two of the Centres as a matter of course. The Centre's size or length of time in use did not affect the techniques used. CONCLUSIONS: There is no uniformity in the technique of administering the DPT vaccine to the nursing child in the different Vaccination Centres of Areas 11 and 12 in the Community of Valencia. The techniques used for vaccinations often differ from those recommended by groups of experts.     

Effectiveness of influenza vaccination in patients undergoing regular dialysis treatments

From October 1994 to March 1996 158 inguinal or femoral hernias were repaired in 124 patients through a total extraperitoneal approach. The repairs were done with polypropylene mesh. The patients were seen 6 to 8 weeks postop; until today 57 patients were seen 12 months postop. This method favours an early return to work. Patients with unilateral hernias returned to work after an average of 14 days, patients with bilateral hernias after an average of 19 days. Complications were rare and mostly minor. So far we have seen no recurrences and no mesh related complications. We consider the laparoscopic extraperitoneal mesh repair a safe procedure for inguinal and femoral hernias.     

Risk perceptions: Assessment and relationship to influenza vaccination.

Objective: Accurate measurement of beliefs about risk probability is essential to determine what role these beliefs have in health behavior. This study investigated the ability of several types of risk perception measures and of other constructs from health behavior theories to predict influenza vaccination. Design: Prospective study in which students, faculty, and staff at 3 universities (N = 428) were interviewed in the fall, before influenza vaccine was available, and again early in the next calendar year. Main Outcome Measure: Self-reported influenza vaccination. Results: Two interview questions that asked about feeling at risk and feeling vulnerable predicted subsequent behavior better (r = .44, p = .001) than 2 questions that asked for agreement or disagreement with statements about risk probability (r = .25, p = .001) or 4 questions that asked respondents to estimate the magnitude of the risk probability (r = .30, p = .001). Of the 4 perceived risk magnitude scales, a 7-point verbal scale was the best predictor of behavior. Anticipated regret was the strongest predictor of vaccination (r = .45, p = .001) of all constructs studied, including risk perceptions, worry, and perceived vaccine effectiveness. Conclusion: Risk perceptions predicted subsequent vaccination. However, perceived risk phrased in terms of feelings rather than as a purely cognitive probability judgment predicted better. Because neither feeling at risk nor anticipated regret is represented in the most commonly used theories of health behavior, the data suggest that these theories are missing important constructs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving neglected influenza vaccination among healthcare workers in long-term care

OBJECTIVE: To increase utilization of influenza vaccination among long-term-care health workers. DESIGN: Before-after intervention study. SETTING: A 300-bed life-care community served by 195 staff employees. INTERVENTION: An educational intervention followed by a Vaccination Fair. MEASUREMENTS: Percent receiving vaccination. A post-intervention survey was used to define staff attitudes towards vaccination. RESULTS: Use of influenza vaccination among staff increased from 8% the previous year to 46% during a Vaccination Fair and to 54% during a similar Fair the next year. CONCLUSIONS: Organized institutional efforts to promote immunization among health-care workers, such as a Vaccination Fair, improves compliance among health-care workers.     

International trends in influenza control: preparing for the next pandemic and vaccination

The prevention of influenza continues to be a major public health concern, and a program of vaccination has been promoted, especially to high-risk individuals such as the elderly. In addition, concerted efforts are being expended in many developed countries in order to better cope with the next influenza pandemic. These efforts include enhancing influenza virus surveillance, improving vaccine production and its delivery systems, centralizing vaccine distribution and establishing priorities, etc. In Japan, on the other hand, influenza is only considered a minor illness, and thus little attention has been give to measures against influenza. To disseminate information on recent international trends in influenza control to Japanese public health specialists, I herein outline the recommendations made at two recent international meetings: "Pandemic Influenza: Confronting a Reemergent Threat" held in the u.s., at Bethesda, Maryland, in December 1995; and "The 7th European Meeting of Influenza and Its Prevention" held in Berlin. Germany, in September 1993. Since a routine system capable of responding adequately to annual epidemics is considered to be the best defense against a pandemic, I also describe the present state of influenza control in other countries to contrast it with that in Japan: the target groups for special vaccination programs recommended by the U.S. Advisory Committee on Immunization Practices; the recommendations for influenza vaccination and reimbursement for the vaccination of recommended groups in developed countries: and influenza vaccine distribution in Japan and the U.S., 1980-1994. At present in Japan, the efficacy of the currently used inactivated vaccine is regarded as either very low or none at all. There is also no official national recommendations as to what groups should be targeted for active immunization, nor any system for vaccination reimbursement. Public health specialists in Japan, therefore need to fully understand Japan's peculiar situation and, as a result, better recognize the importance of influenza and its prevention.     

The choice of the optimal schedules in the vaccination procedure against influenza in elderly subjects

The paper describes a clinical case of the cerebral hyperperfusion syndrome, a rare complication of carotid endarterectomy. The syndrome appeared as the generalized convulsive syndrome in the patient in the early postoperative period. In the context of clinical observation, the results of analysis of the literature are presented and the pathogenesis, diagnosis, therapy, and prevention of the cerebral hyperperfusion syndrome considered.     

Effect of an influenza vaccination campaign in the municipality of Copenhagen during the 1996-1997 season

In Denmark influenza vaccinations are usually paid for by the patients. In the autumn of 1996 Copenhagen City Council offered free influenza vaccinations to all residents aged 70 years or older. The impact of the campaign was evaluated in a questionnaire study of a random sample of the Danish population aged 70 years or older. In Copenhagen 81% (95% Confidence interval: 67-95%) of the elderly at risk were vaccinated compared to 51% (45-56%) outside Copenhagen. Offering free influenza vaccinations in a mass campaign is an effective way of improving coverage rate. However, no substantial difference was found in cost between the mass campaign and a targeted campaign with free vaccination in general practice.     

Effects of influenza vaccination in HIV-infected adults: a double-blind, placebo-controlled trial

Annual influenza vaccine is recommended for persons with HIV infection. Recent reports indicate that immunizations may increase HIV replication in infected individuals. Forty-seven HIV-infected patients were randomized to influenza vaccine or saline placebo using a double blind study design. One month after vaccination, plasma HIV-1 RNA increased in the vaccinated but not placebo group (p = 0.029). At 3 months, CD4% dropped an average of 1.6 points in the vaccinated group compared to an increase of 0.1 points in the placebo group (p = 0.039). Patients on stable antiretroviral regimens had CD4% drop an average of 2.3 points in the vaccinated group at 3 months versus 0.1 points in the placebo group (p = 0.015). It is concluded that HIV-infected patients are at risk for increased HIV replication and decreases in CD4% following influenza vaccination. Since influenza has not been associated with significant morbidity in this population, further study of routine influenza vaccination for HIV-infected patients is warranted.     

The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community

BACKGROUND: Despite recommendations for annual vaccination against influenza, more than half of elderly Americans do not receive this vaccine. In a serial cohort study, we assessed the efficacy and cost effectiveness of influenza vaccine administered to older persons living in the community. METHODS: Using administrative data bases, we studied men and women over 64 years of age who were enrolled in a large health maintenance organization in the Minneapolis-St. Paul area. We examined the rate of vaccination and the occurrence of influenza and its complications in each of three seasons: 1990-1991, 1991-1992, and 1992-1993. Outcomes were adjusted for age, sex, diagnoses indicating a high risk, use of medications, and previous use of health care services. RESULTS: Each cohort included more than 25,000 persons 65 years of age or older. Immunization rates ranged from 45 percent to 58 percent. Although the vaccine recipients had more coexisting illnesses at base line than those who did not receive the vaccine, during each influenza season vaccination was associated with a reduction in the rate of hospitalization for pneumonia and influenza (by 48 to 57 percent, P < or = 0.002) and for all acute and chronic respiratory conditions (by 27 to 39 percent, P < or = 0.01). Vaccination was also associated with a 37 percent reduction (P = 0.04) in the rate of hospitalization for congestive heart failure during the 1991-1992 season, when influenza A was epidemic. The costs of hospitalization for all types of illness studied were lower in the vaccinated group during 1991-1992 (range of reduction, 47 to 66 percent; P < 0.005) and for acute and chronic respiratory conditions and congestive heart failure in 1990-1991 (reductions of 37 percent and 43 percent, respectively; P < or = 0.05). Direct savings per year averaged $117 per person vaccinated (range, $21 to $235), with cumulative savings of nearly $5 million. Vaccination was also associated with reductions of 39 to 54 percent in mortality from all causes during the three influenza seasons (P < 0.001). CONCLUSIONS: For elderly citizens living in the community, vaccination against influenza is associated with reductions in the rate of hospitalization and in deaths from influenza and its complications, as compared with the rates in unvaccinated elderly persons, and vaccination produces direct dollar savings.     

An early humoral immune response in peripheral blood following parenteral inactivated influenza vaccination

The enzyme-linked immunospot assay was used to examine the humoral immune response in 15 healthy volunteers immunized with either split or subunit inactivated trivalent influenza vaccine containing A/Beijing/353/89 (H3N2), A/Taiwan/1/86 (H1N1) and B/Yamagata/16/88. The rapidity of the individual B-cell and serum antibody response was examined in lymphocyte and serum samples collected at various time intervals after vaccination. A rapid serological response was detected with increases in antibody titre detected in the majority of volunteers by 7-8 days postvaccination. Influenza-specific plasma cells were detected as early as 4 days postvaccination, higher numbers of IgA and IgG antibody-secreting cells (ASC) were observed which peaked at 7-8 days postvaccination. The number of ASCs then declined, with low numbers of cells detected at 11 days postvaccination. Influenza-specific IgA ASCs were predominantly of the IgA1 subclass. This rapid immune response may have a bearing on future vaccination policies of unimmunized 'at risk groups' in times of high influenza activity.     

Emotions and preventive health behavior: Worry, regret, and influenza vaccination.

The role of worry, regret, and perceived risk in preventive health decisions was explored in a longitudinal questionnaire study on influenza vaccination among 428 university employees. The study yielded 3 main findings. First, ratings of anticipated worry and regret were stronger predictors of vaccination than perceived risk and mediated the effect of risk on vaccination. Second, the anticipated level of emotions differed systematically from experienced emotions, such that vaccinated individuals anticipated more regret and less worry than they actually experienced. Third, anticipated and experienced emotions had implications for subsequent vaccination decisions. Those who did not vaccinate in the 1st year but had high levels of worry and regret were likely to be vaccinated the following year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)