A mass vaccination campaign targeting adults and children to prevent typhoid fever in Hechi; expanding the use of Vi polysaccharide vaccine in southeast China: a cluster-randomized trial

Jin Yang, Camilo J Acosta, Guo-ai Si, Jun Zeng, Cui-yun Li, Da-bin Liang, R Leon Ochiai, Anne-Laure Page, M Carolina Danovaro-Holliday, Jie Zhang, Bao-de Zhou, He-zhuang Liao, Ming-liu Wang, Dong-mei Tan, Zhen-zhu Tang, Jian Gong, Jin-kyung Park, Mohammad Ali, Bernard Ivanoff, Gui-chen Liang, Hong-hui Yang, Tikki Pang, Zhi-yi Xu, Allan Donner, Claudia M Galindo, Bai-qing Dong, John D Clemens, Jin Yang, Camilo J Acosta, Guo-ai Si, Jun Zeng, Cui-yun Li, Da-bin Liang, R Leon Ochiai, Anne-Laure Page, M Carolina Danovaro-Holliday, Jie Zhang, Bao-de Zhou, He-zhuang Liao, Ming-liu Wang, Dong-mei Tan, Zhen-zhu Tang, Jian Gong, Jin-kyung Park, Mohammad Ali, Bernard Ivanoff, Gui-chen Liang, Hong-hui Yang, Tikki Pang, Zhi-yi Xu, Allan Donner, Claudia M Galindo, Bai-qing Dong, John D Clemens

Abstract

Background: One of the goals of this study was to learn the coverage, safety and logistics of a mass vaccination campaign against typhoid fever in children and adults using locally produced typhoid Vi polysaccharide (PS) and group A meningococcal PS vaccines in southern China.

Methods: The vaccination campaign targeted 118,588 persons in Hechi, Guangxi Province, aged between 5 to 60 years, in 2003. The study area was divided into 107 geographic clusters, which were randomly allocated to receive one of the single-dose parenteral vaccines. All aspects regarding vaccination logistics, feasibility and safety were documented and systematically recorded. Results of the logistics, feasibility and safety are reported.

Results: The campaign lasted 5 weeks and the overall vaccination coverage was 78%. On average, the 30 vaccine teams gave immunizations on 23 days. Vaccine rates were higher in those aged < or = 15 years (90%) than in adolescents and young adults (70%). Planned mop-up activities increased the coverage by 17%. The overall vaccine wastage was 11%. The cold chain was maintained and documented. 66 individuals reported of adverse events out of all vaccinees, where fever (21%), malaise (19%) and local redness (19%) were the major symptoms; no life-threatening event occurred. Three needle-sharp events were reported.

Conclusion: The mass immunization proved feasible and safe, and vaccine coverage was high. Emphasis should be placed on: injection safety measures, community involvement and incorporation of mop-up strategies into any vaccination campaign. School-based and all-age Vi mass immunizations programs are potentially important public health strategies for prevention of typhoid fever in high-risk populations in southern China.

Figures

Figure 1
Figure 1
Hechi in Guangxi Province, PR China. shows the location of Hechi and Guangxi in China.
Figure 2
Figure 2
Vaccine coverage in Hechi. shows the vaccine coverage by cluster and household locations in Hechi. Darker the color, higher the coverage is. Boundary of the city is also shown.
Figure 3
Figure 3
Vaccine coverage by age group. shows the coverage of each vaccine by age group.
Figure 4
Figure 4
Cluster vaccine coverage by campaign stages. shows the cluster vaccine coverage by campaign stages.

References

    1. Acharya IL, Lowe CU, Thapa R, Gurubacharya VL, Shrestha MB, Bryla DA, Cramton T, Trollfors B, Cadoz M, Schulz D, Armand J, Schneerson R, Robbins JB. Prevention of typhoid fever in Nepal with the Vi capsular polysaccharide of Salmonella typhi: A preliminary report one year after immunization. N Engl J Med. 1987;317:1101–1104.
    1. Klugman KP, Gilbertson IT, Koornhof HJ, Robbins JB, Schneerson R, Schulz D, Cadoz M, Armand J, Vaccine Advisory Committee Protective activity of Vi capsular polysaccharide vaccine against typhoid fever. Lancet. 1987;2:1165–1169. doi: 10.1016/S0140-6736(87)91316-X.
    1. Robbins JD, Robbins JB. Reexamination of the protective role of the capsular polysaccharide (Vi antigen) of Salmonella typhi. J Infect Dis. 1984;150:436–449.
    1. World Health Organization Annex 1: Requirements for Vi polysaccharide typhoid vaccine (Requirements for Biological Substances No 48) WHO Technical Report Series No 840. 1994. pp. 15–29.
    1. Wang ZG, Zhou WZ, Shi J. [Efficacy and side effects following immunization with Salmonella typhi Vi capsular polysaccharide vaccine] (in Chinese) Zhonghua Liu Xing Bing Xue Za Zhi. 1997;18:26–29.
    1. Yang HH, Wu CG, Xie GZ, Gu QW, Wang BR, Wang LY, Wang HF, Ding ZS, Yang Y, Tan WS, Wang WY, Wang XC, Qin M, Wang JH, Tang HA, Jiang XM, Li YH, Wang ML, Zhang SL, Li GL. Efficacy trial of Vi polysaccharide vaccine against typhoid fever in south-western China. Bull World Health Organ. 2001;79:625–631.
    1. Yang HH, Kilgore PE, Yang LH, Park JK, Pan YF, Kim Y, Lee YJ, Xu ZY, Clemens JD. An outbreak of typhoid fever, Xing-An County, People's Republic of China, 1999: estimation of the field effectiveness of Vi polysaccharide typhoid vaccine. J Infect Dis. 2001;183:1775–1780. doi: 10.1086/320729.
    1. DeRoeck D, Clemens JD, Nyamete A, Mahoney RT. Policymakers' views regarding the introduction of new-generation vaccines against typhoid fever, shigellosis and cholera in Asia. Vaccine. 2005;23:2762–2774. doi: 10.1016/j.vaccine.2004.11.044. 2005 Apr 15.
    1. Guangxi CDC. Health statistical records Guangxi. 1999.
    1. Acosta CJ, Galindo CM, Ochiai RL, Danovaro-Holliday MC, Page AL, Thiem VD, Park JK, Koo HW, Park E, Wang XY, Abu-Elyazeed R, Ali M, Ivanoff B, Pang T, Xu ZY, Clemens JD. The role of epidemiology in the introduction of typhoid fever Vi polysaccharide vaccines in Asia. J Health Popul Nutr. 2004;22:240–245.
    1. Acosta CJ, Galindo CM, Ali M, Abu-Elyazeed R, Ochiai RL, Danovaro-Holliday MC, Page AL, Vu DT, Yang J, Park JK, Lee H, Puri MK, Ivanoff B, Agtini MD, Soeharno R, Simanjuntak CH, Punjabi N, Canh DG, Sur D, Nizami Q, Manna B, Dong B, Dang DA, Yang H, Bhattacharya SK, Bhutta ZA, Trach DD, Xu ZY, Pang T, Donner A, Clemens JD. A Multi-Country Cluster Randomized Controlled Effectiveness Evaluation to Accelerate the Introduction of Vi Polysaccharide Typhoid Vaccine in Developing Countries in Asia: Rationale and Design. J Trop Med Int Health.
    1. Tozzi AE. Field evaluation of vaccine safety. Vaccine. 2004;22:2091–2095. doi: 10.1016/j.vaccine.2004.01.013.
    1. Vu DT, Hossain MM, Nguyen DS, Nguyen TH, Rao MR, Do GC, Naficy A, Nguyen TK, Acosta CJ, Deen JL, Clemens JD, Dang DT. Coverage and costs of mass immunization of an oral cholera vaccine in Vietnam. J Health Popul Nutr. 2003;21:304–308.
    1. World Health Organization Background document: The diagnosis, treatment and prevention of typhoid fever. 2003. WHO/V&B/03.07.
    1. Lin F-YC, Ho VA, Khiem HB, Trach DD, Bay PV, Thanh TC, Kossaczka Z, Bryla DA, Shiloach J, Robbins JB, Schneerson R, Szu SC. The efficacy of a Salmonella typhi Vi conjugate vaccine in two-to-five-year-old children. N Engl J Med. 2001;344:1263–1269. doi: 10.1056/NEJM200104263441701.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel