This document describes an evaluation of acute (meningitis)-encephalitis syndrome (AES/AMES) surveillance established in India, Bangladesh and China. The key objectives of the project included 1) building on existing networks for syndromic surveillance and laboratory confirmation, 2) establishing laboratory-based surveillance for vaccine-preventable causes of encephalitis and meningitis, 3) enhancing capacity to use data to guide disease control and prevention programs, and 4) improving capacity to recognize new or emerging diseases. The syndromes encompass several diseases, including Japanese encephalitis (JE), pneumococcal meningitis, Haemophilus influenzae type b (Hib), and meningococcal meningitis. The purpose of the evaluation is to assess the extent to which the key objectives were met in the three project countries, compare and contrast the experiences among the countries, document the strengths and weaknesses, and make recommendations. The indicators used in the evaluation include feasibility of integration, availability of country protocols, appropriate training, data quality, sensitivity, specificity, positive predictive value, negative predictive value, representativeness, timeliness, integration with AFP surveillance, simplicity and efficiency, acceptability, usefulness, flexibility, stability, and sustainability. The criteria and standards are based on WHO recommendations. Data sources include AES/AMES epidemiologic and laboratory data sets, trip reports, country reports, field observations, and published bulletins. All countries made substantial progress in a relatively short period of time using the infrastructure and technical tools of existing surveillance and laboratory networks for acute flaccid paralysis. After one year, India and Bangladesh collects and maintains high quality epidemiologic data, exceeds targets for timeliness of reporting, and has quality-assured capacity for laboratory confirmation of Japanese encephalitis (JE) virus infection. India now has regional laboratory capacity for reference testing on virology and bacteriology. After two years of operations, China has population-based surveillance data for JE that meets targets for timeliness. Several levels have well-established capacity for laboratory confirmation of JE virus infection. The national level has the technical ability to provide proficiency testing for virology and to provide reference testing for bacteriology. In all countries, challenges in building capacity for basic bacteriology, quality control and quality assurance for all laboratory testing, and management of laboratory data.

BACKGROUND: The under-5 mortality rate in Ethiopia is 118/1000. A child in Ethiopia is 30 times more likely to die before age 5 than a child in Western Europe. Children are the most vulnerable segment of the population, but many of the ailments that cause death in this population can be avoided by completion of routine childhood vaccination. METHODS: Data regarding child health from the Demographic and Health Survey (DHS), a periodic cross-sectional survey administered at the household level was utilized in this study. Data from 8,905 mothers of living children between 0-5 years of age was included in the study. Univariate and multivariate analyses of selected socio-demographic variables were conducted to examine association with vaccination status. RESULTS: Risk factors for vaccination defaulting were identified. Logistic modeling with the selected factors was conducted with vaccination status and the demographic characteristics of families as independent factors. Type of Residence, Region and Wealth Index were the only significant characteristic in predicting the likelihood of a child being vaccinated when controlled for other factors. CONCLUSION: The results of this study illustrate that geographic disparities result in lower vaccination completion for lower income families from rural settings than other groups. Families’ behavior around child vaccination is a microcosm of various social determinants affecting their decision-making. Resources further removed from health such as better roads and education can improve vaccination uptake.

HPV vaccine school entry mandates and vaccine funding by state was examined using the Diffusion of Innovations (DOI) theory. The DOI was applied to HPV immunization policy to evaluate the rate of vaccine adoption and to determine whether associations existed between an empirical need for vaccine adoption and action by the states. State-level data on political characteristics, health and policy were collected from several secondary sources. Data analyses were performed utilizing SPSS logistic regression models. Odds rations were used to evaluate the associations between the independent and dependent variables to determine whether there was a statistical significance level of .05. Cervical Cancer incidence in a state was significantly associated with HPV school entry mandates (proposed or enacted), but it did not show a significant association with HPV vaccine funding. Diffusion of vaccine innovation is slow, which may offer additional opportunities to evaluate effective policy strategies for coverage and use of the HPV vaccine.

Economic barriers remain an obstacle to ensuring that children in the United States are protected against vaccine-preventable diseases. Disparities persist despite programs in place to alleviate them, such as the Vaccines for Children program, which provides free vaccines for eligible children. Using data from the 2010 National Immunization Survey, this study addresses whether insurance status has an impact on immunization uptake by investigating associations between vaccine receipt and insurance type, VFC eligibility, and insurance continuity. Logistic regression was performed using possible important factors suggested in the literature. Among children in the national sample, results showed strong associations between up-to-date immunization status and insurance type, VFC eligibility, and insurance continuity, suggesting that additional steps must be taken to alleviate disparities in vaccine receipt. Regression analysis showed child’s age group, insurance continuity, and number of vaccine providers to be the strongest predictors of up-to-date status among children in the national sample.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2007. / Härtill 4 uppsatser.

Thesis (M.Sc. (Pathobiology))--Mahidol University, 1983.

Thesis (M.Sc. (Public Health))--Mahidol University, 1982.

Thesis (Ph.D. (Microbiology))--Mahidol University, 1979.

Thesis (M.Sc. in Microbiology) -- Mahidol University, 1976.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2007. / LICL has E-Thesis 0023 ; please contact computer services.