VoICE : Search Immunization Evidence

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The VoICE tool is a compendium of the many direct and downstream impacts of vaccine-preventable disease and immunization. The database contains summary explanations of the link between immunization and each impact, as well as sources of evidence for each link. You can browse the VoICE tool by topic, or use the filters to find results based on topic, disease or vaccine, location and published year.

23 Key Ideas, 16 Sources
Key Idea

Malnutrition is a leading contributor to morbidity and mortality during humanitarian emergencies and a cyclical relationship exists between malnutrition and infectious diseases. Universal immunization programs have been shown to improve the height and weight measurement markers associated with malnutrition.

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Key Idea

The detection of H1N1 influenza virus in Mexico in 2009, and subsequently throughout other countries in the Americas, benefited from the laboratory experience with measles and rubella in the region…. [leading to] the rapid detection of and response to what eventually became a novel pandemic virus.

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Key Idea

During the conflict in Yemen, efforts spearheaded by WHO, with coordination among partners and effective use of resources, especially GAVI, resulted in continued high pentavalent vaccine coverage decreasing only 3% from 2010 to 2015. Yemen also remained polio-free through 2015 and smoothly introduced two new vaccines (MR and IPV).

During the humanitarian crisis in the Syrian Arab Republic, the constant support from WHO, UNICEF and local NGOs resulted in immunizations against VPDs reaching over 90% of children.

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Key Idea

In urban residents in the Democratic Republic of Congo, chronically malnourished children were less likely to have received two doses of measles-containing vaccine, compared to healthy children (OR=0.4).

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Key Idea

Children living in the Yida refugee camp in South Sudan in 2013 were found to have an elevated rate of pneumonia infections likely due to malnutrition, overcrowding, and inadequate shelter. Using these data, the CDC estimated that the use of Hib and pneumococcal vaccines in children under 2 years of age in the camp would be cost-effective under all dosing scenarios evaluated. Medecines Sans Frontiers (MSF) provided medical services to this refugee camp and found delivery of these vaccines to be feasible and effective in this setting.

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Key Idea

In a study of nearly 40,000 recipients of PCV7 and control subjects in northern California, there was a 5.4% reduction in the number of antibiotic prescriptions and a 12.6% reduction in the use of “second-line antibiotics” among children who received the pneumococcal conjugate vaccine. Between the time the first dose was administered and the age of 3.5 years, use of the vaccine prevented 35 antibiotic prescriptions per 100 fully vaccinated children.

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Key Idea

Kenyan parents who were HIV positive were 16% more likely to be carriers of pneumococcal bacteria than HIV negative parents living in the same compounds. HIV positive parents in poorer health (those with a CD4 count below 250) were at a significantly greater risk of being pneumococcal carriers.

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Key Idea

This study from South Africa demonstrates significant declines in invasive pneumococcal disease cases caused by bacteria that are resistant to one or more antibiotics. In fact, the rate of infections resistant to two different antibiotics declined nearly twice as much as infections that could be treated with antibiotics.

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Key Idea

2 of the 18 drug-resistant threats to US health security identified in a 2013 CDC report are potentially vaccine-preventable.

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Key Idea

Among all parents (HIV positive and negative) in this study in Kenya, 99% of pneumococcal strains found and tested were resistant to one or more antibiotics.16% more strains carried by HIV positive parents were resistant to penicillin than those carried by HIV negative parents.

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Key Idea

Reductions in the number of days that patients received antibiotic therapy have been documented among day-care attendees in Israel who received the 9-valent conjugate vaccine. Children who received vaccine had 10% fewer days of antibiotic usage for upper respiratory tract infections, 47% fewer days of antibiotic usage for lower respiratory tract infections and 20% fewer days of antibiotic usage for otitis media (ear infections) as compared to children who did not receive PCV.

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In a study of nearly 40,000 recipients of PCV7 and control subjects in northern California, there was a 5.4% reduction in the number of antibiotic prescriptions and a 12.6% reduction in the use of “second-line antibiotics” among children who received the pneumococcal conjugate vaccine. Between the time the first dose was administered and the age of 3.5 years, use of the vaccine prevented 35 antibiotic prescriptions per 100 fully vaccinated children.

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Key Idea

The US CDC identifies the use of vaccines as one of the 4 critical steps for controlling the spread of antibiotic resistance.

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A systematic review of studies from India found that prior to widespread use of the pneumococcal conjugate vaccine, antibiotic resistance in serious pneumoccocal infections among Indian children has been common. Penicillin resistance was found in 10% of invasive pneumococcal disease (IPD) cases, while trimethoprim/sulfamethoxazole resistance was found in more than 80% of these cases.

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Key Idea

The ongoing conflict in Syria has caused the breakdown of immunization services, leading to outbreaks of vaccine preventable diseases in the region, and to the re-emergence of polio in Syria for the first time in 15 years. The potential for polio to re-emerge in neighboring areas with low coverage of inactivated polio vaccine (IPV) threatens the success of global efforts to eradicate polio.

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Key Idea

In a study modeling the cost-effectiveness of vaccination campaigns in Somalia – the country with the second largest number of refugees in 2012 – the use of Hib vaccine, PCV10, or both Hib and PCV10 were all found to be cost effective means to prevent excess morbidity and mortality from pneumonia in young Somali children. Such a vaccination campaign could conservatively reduce pneumonia cases and deaths by nearly 20%.

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Children living in the Yida refugee camp in South Sudan in 2013 were found to have an elevated rate of pneumonia infections likely due to malnutrition, overcrowding, and inadequate shelter. Using these data, the CDC estimated that the use of Hib and pneumococcal vaccines in children under 2 years of age in the camp would be cost-effective under all dosing scenarios evaluated. Medecines Sans Frontiers (MSF) provided medical services to this refugee camp and found delivery of these vaccines to be feasible and effective in this setting.

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Key Idea

Researchers investigating the causes of a measles outbreak in Burkina Faso that occurred despite a recent mass vaccination campaign, found that migration to and from Cote d’Ivoire was a major risk factor for children. Unvaccinated children who developed measles were 8.5x more likely to have recently traveled to Cote d’Ivoire than unvaccinated children who had not traveled across the border. Children returning to Burkina Faso after a period of time in Cote d’Ivoire were less likely to have been vaccinated due to low routine coverage of measles vaccines in Cote d’Ivoire. Conversely, unvaccinated children from Burkina Faso who traveled to Cote d’Ivoire and returned were more likely to be exposed to measles and thus had a higher rate of disease than children who never visited Cote d’Ivoire.

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Large measles outbreaks occurred in Lebanon and Jordan, following an influx of Syrian refuges migrating to escape conflict. In Lebanon, the measles incidence increased 200-fold in one year following high migration. There were 2.1 measles cases per million population in Lebanon in 2012; this increased to 411 cases in 2013.

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Key Idea

Vaccines against yellow fever and cholera continue to be critical to managing outbreaks of disease and protecting national and international health security.

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Key Idea

In 2013 nearly all of the 175 cases of measles in the US could be traced back to international importations.

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Key Idea

TB and pneumococcal infections are two of 18 drug-resistant threats to US health security identified by the CDC in 2013 and are potentially vaccine-preventable. Most antibiotic resistant TB infections in the US occur in people born outside the US.

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Key Idea

Mothers infected with rubella virus during the first trimester of pregnancy can give birth to children with permanent disabilities such as intellectual impairment, autism, blindness, deafness and cardiac defects. The infection is completely preventable if mothers are vaccinated before pregnancy.

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Key Idea

In the Americas, a platform built to secure polio eradication has been expanded to help track, control, prevent and monitor immunization impact for measles and rubella. In India, highly trained polio health workers have become the basis for a trained workforce working towards the elimination of measles and rubella and helping ensure India’s certification by WHO for having eliminated maternal and neonatal tetanus.

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Key Idea

The American Academy of Pediatrics and the International Pediatric Association were included as partners in the measles and rubella elimination initiative, allowing for more direct collaboration around the interactions of primary health and immunization services and concerns.

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Key Idea

The detection of H1N1 influenza virus in Mexico in 2009, and subsequently throughout other countries in the Americas, benefited from the laboratory experience with measles and rubella in the region…. [leading to] the rapid detection of and response to what eventually became a novel pandemic virus.

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Key Idea

The US CDC estimates that antibiotic resistant pneumococcal infections in the US add $96 million to the costs of treatment each year.

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