MMR2 vaccination coverage and timeliness among children born in 2004 - 2009: a national survey in Saint Lucia, 2015 / Cobertura de vacunación y respeto de los plazos de la segunda dosis de la vacuna triple viral en los niños nacidos en el período 2004-2009: encuesta nacional realizada en Santa Lucía en el 2015 / Cobertura e momento oportuno de vacinação da segunda dose da vacina tríplice viral em crianças nascidas em 2004-2009: pesquisa nacional em Santa Lúcia, 2015

ABSTRACT Objectives To more accurately determine coverage and timeliness of the second dose of measles-mumps-rubella vaccine (MMR2), while identifying factors associated with low MMR2 vaccination uptake among children in Saint Lucia. Methods A survey was conducted in October - November 2015 targeting children born in 2004 - 2009. At 86 preschools and primary schools, two children from each grade were randomly selected, yielding an effective sample of 836 children. Health records were reviewed to assess vaccination coverage and timeliness. Parents and/or guardians and principals of all 86 schools were interviewed regarding knowledge, attitudes, and practices related to vaccination. Results Of 767 children included, 75% were vaccinated with MMR2 (n = 572); 46.7% were vaccinated in a timely manner, i.e., by 5 years of age. Cohorts born in 2004, 2005, and 2008 reported the lowest proportion. 'Mothers as caregivers' was positively associated with timely MMR2 vaccination. Although 97% of principals surveyed considered vaccination important, 48.8% were not aware of national legislation requiring complete vaccination prior to school entry. Survey results concurred with the low MMR2 administrative coverage rates reported by Saint Lucia, much lower than the recommended 95%. Conclusions Based on the results of this survey, Saint Lucia's national immunization program has lowered the age of MMR2 to 18 months in 2016, increased advocacy with schools to enforce the school-entry law, and is working to vaccinate the cohorts of children who have not received timely MMR2.

RESUMEN Objetivos Determinar con mayor precisión la cobertura y el respeto de los plazos de vacunación de la segunda dosis de la vacuna contra el sarampión, la rubéola y la parotiditis (triple viral), al tiempo que se detectan los factores asociados con la baja aceptación de esa vacuna en Santa Lucía. Métodos En octubre y noviembre del 2015 se llevó a cabo una encuesta centrada en niños nacidos entre el 2004 y el 2009. En 86 centros preescolares y primarios se seleccionó al azar a dos niños de cada grado, lo que arrojó un tamaño real de la muestra de 836 niños. Se analizaron los registros de salud para evaluar la cobertura y el respeto de los plazos de vacunación. Se entrevistó a los padres o tutores y los directores de las 86 escuelas sobre conocimientos, actitudes y prácticas en materia de vacunación. Resultados De los 767 niños incluidos, el 75% fueron vacunados con la segunda dosis de la triple viral (n = 572); el 46,7% fueron vacunados a tiempo, es decir, a los 5 años de edad. La proporción más baja se dio en las cohortes nacidas en el 2004, 2005 y 2008. Se observó que las madres cuidadoras influían positivamente en el respeto de los plazos de vacunación de la segunda dosis de la triple viral. Aunque el 97% de los directores encuestados consideraba que la vacunación era importante, el 48,8% desconocía la legislación nacional que exige la vacunación completa antes de ingresar a la escuela. Los resultados de la encuesta estaban en consonancia con las tasas bajas de cobertura administrativa de la segunda dosis de la triple viral informadas por Santa Lucía, muy por debajo del 95% recomendado. Conclusiones Según los resultados de esta encuesta, el programa nacional de vacunación de Santa Lucía redujo la edad de la segunda dosis de la triple viral a los 18 meses en el 2016, aumentó las actividades de promoción en las escuelas para fomentar el cumplimiento de la ley que obliga a recibir la vacunación antes de ingresar a la escuela y está trabajando para vacunar a las cohortes de niños que no recibieron la segunda dosis de la triple viral en su debido momento.

RESUMO Objetivos Determinar com precisão a cobertura vacinal e o momento oportuno para ministrar a segunda dose da vacina tríplice viral (sarampo, caxumba e rubéola - SCR) e identificar os fatores associados à baixa utilização da vacina em crianças. Métodos Uma pesquisa direcionada a crianças nascidas de 2004 a 2009 foi realizada em Santa Lúcia em outubro e novembro de 2015. Em 86 unidades de ensino infantil e fundamental, duas crianças de cada série foram selecionadas aleatoriamente, constituindo uma amostra efetiva de 836 crianças. Dados sobre a cobertura e o momento oportuno de vacinação foram obtidos das fichas de saúde. Foram conduzidas entrevistas com os pais e/ou responsáveis e os diretores das 86 escolas sobre conhecimento, atitudes e práticas relacionadas à vacinação. Resultados Das 767 crianças incluídas na amostra, 75% foram vacinadas com a segunda dose de SCR (n = 572) e 46,7% receberam a vacina no momento oportuno (ou seja, até os 5 anos de idade). Observou-se menor proporção de vacinados nas coortes nascidas em 2004, 2005 e 2008. "Mães como cuidadoras" teve uma associação positiva com ministrar a segunda dose de SCR no momento oportuno. Apesar de 97% dos diretores entrevistados considerarem a vacinação importante, 48,8% desconheciam a legislação nacional que exige vacinação completa para a matrícula escolar. Os resultados reforçaram a baixa cobertura vacinal da segunda dose de SCR registrada em Santa Lúcia, bem inferior ao índice recomendado de 95%. Conclusões A partir dos resultados desta pesquisa, em 2016, o programa nacional de vacinação de Santa Lúcia reduziu para 18 meses a idade de administração da segunda dose de SCR, intensificou a recomendação para que as escolas cumpram com a legislação para matrícula escolar e está empenhado em vacinar as coortes de crianças que não receberam a segunda dose de SCR no momento oportuno.

Experiencia del desarrollo de herramientas para el monitoreo de coberturas de vacunación y quimioterapia preventiva / Experience with development of tools to monitor vaccination coverage and preventive chemotherapy coverage / Experiência do desenvolvimento de ferramentas para o monitoramento da cobertura vacinal e quimioprofilaxia

RESUMEN Objetivo Describir la experiencia y las lecciones aprendidas en el desarrollo de herramientas para el monitoreo de las coberturas de vacunación y de quimioterapia preventiva en las Américas. Métodos Se compiló y revisó la documentación disponible en los programas regionales de inmunización integral de la familia y de las enfermedades infecciosas desatendidas de la Organización Panamericana de la Salud/Organización Mundial de la Salud producida durante el proceso de desarrollo de las herramientas entre 2012 y 2017 incluidos: búsqueda sistemática de literatura, reportes técnicos, informes de reuniones internas, reporte de la prueba piloto e informes y resultados de las evaluaciones de los talleres de entrenamiento en doce países de las Américas. La documentación se organizó, se extrajo la información más relevante sobre el desarrollo de las herramientas y se consensuaron las principales lecciones aprendidas en el proceso. Resultados El proceso facilitó la organización y sistematización de las herramientas aplicadas durante las últimas dos décadas en los programas de vacunación en las Américas para el análisis y monitoreo de las coberturas y su rápida adaptación para el monitoreo de las coberturas de la quimioterapia preventiva. Se integró un conjunto de herramientas cuya aplicación se define con un algoritmo de decisiones y pueden ser utilizadas por los países. Conclusiones Las lecciones aprendidas pueden aplicarse para desarrollos similares y para promover el trabajo interprogramático en salud pública. El trabajo integrado aceleró el desarrollo de herramientas útiles para los países.

ABSTRACT Objective Describe the experience and lessons learned in the development of tools to monitor vaccination coverage and preventive chemotherapy coverage in the Americas. Methods The available documentation on Pan American Health Organization/World Health Organization regional programs for comprehensive family immunization and neglected infectious diseases--produced during the process of tool development from 2012 to 2017--was compiled and reviewed, including: systematic literature search, technical reports, internal meeting reports, pilot study report, and reports and results from evaluations of training workshops in 12 countries of the Americas. The documentation was organized, gleaning the most relevant information on tool development, and consensus was reached on the principal lessons learned in the process. Results The process facilitated the organization and dissemination of tools used to analyze and monitor vaccination coverage during the last two decades in vaccination programs in the Americas, and the rapid adaptation of these tools for monitoring preventive chemotherapy coverage. A toolkit was put together, accompanied by a decision tree to aid in its application, which countries can use.

RESUMO Objetivo Descrever a experiência e as lições aprendidas no desenvolvimento de ferramentas para o monitoramento da cobertura vacinal e quimioprofilaxia nas Américas. Métodos Foi coletada e revisada a documentação disponível nos programas regionais de imunização integral da família e doenças infecciosas negligenciadas da Organização Pan-Americana da Saúde/Organização Mundial da Saúde, produzida no processo de desenvolvimento de ferramentas entre 2012 e 2017. Os arquivos englobavam resultados de busca sistemática da literatura, relatórios técnicos, atas de reuniões internas, informe de teste-piloto e relatórios e resultados das avaliações dos seminários de capacitação em 12 países das Américas. A documentação foi organizada e foram extraídos os dados mais relevantes sobre o desenvolvimento das ferramentas. As principais lições aprendidas no processo foram decididas por consenso. Resultados O processo facilitou a organização e a sistematização das ferramentas empregadas nas últimas duas décadas nos programas de vacinação nas Américas para avaliação e monitoramento da cobertura vacinal e sua rápida adaptação para o monitoramento da cobertura da quimioprofilaxia. Foi integrado um conjunto de ferramentas cuja aplicação é definida com um algoritmo de decisões e que pode ser utilizado pelos países. Conclusões As lições aprendidas podem ser aplicadas em processos semelhantes de desenvolvimento e para promover o trabalho interprogramático em saúde pública. O trabalho integrado acelerou o desenvolvimento de ferramentas úteis para os países.

Diphtheria in the Dominican Republic: reduction of cases following a large outbreak / Difteria en la República Dominicana: reducción de casos tras un extenso brote epidémico

OBJECTIVE: To describe the most recent outbreak of diphtheria in the Dominican Republic and the disease's occurrence and vaccination coverage in 2004-2013. METHODS: Clinical data of diphtheria cases that occurred in 2004 and that met the study's case definition were reviewed along with socioeconomic and epidemiological information from the cases' families. Univariate and multivariate analyses were performed to assess risk factors for fatal diphtheria. Routine surveillance and vaccination coverage data are presented. RESULTS: From January 2004-April 2005, a total of 145 diphtheria cases were reported; 80 (66%) of the 122 cases reported in 2004 met the case definition; 26 were fatal (case-fatality rate: 32.5%). Incidence was highest in the group 1-4 years of age at 5.3 per 100 000; 62.5% were male. Of the 80 cases, 61 (76%) where hospitalized in Hospital A, 17 in Hospital B, and 2 in two other hospitals. Earlier onset (first half of 2004), birth order, and tracheotomy were associated with fatal diphtheria (P < 0.05); cases in Hospital A were also more likely to be fatal (P = 0.066). The average annual diphtheria incidence was 4.91 cases/1 million people in 2000-2003, climbed to 8.8 cases per million in 2004-2005, and dropped to 0.38 in 2006-2014; no diphtheria cases have been reported since 2011. DTP3 vaccination coverage ranged from 72%-81% in 2000-2004 and from 81%-89% in 2005-2013. CONCLUSIONS: The 2004-2005 diphtheria outbreak in the Dominican Republic resulted in important and avoidable morbidity and mortality. Annual cases declined and no cases have been reported in recent years. Maintaining high vaccination coverage and diligent surveillance are crucial to preventing diphtheria outbreaks and controlling the disease.

OBJETIVO: Describir el brote epidémico más reciente de difteria en la República Dominicana, la incidencia de la enfermedad y la cobertura de la vacunación del 2004 al 2013. MÉTODOS: Se analizaron los datos clínicos de los casos de difteria acaecidos en el 2004 y que cumplieron con la definición de caso del estudio, junto con la información socioeconómica y epidemiológica de las familias en las que aparecieron los casos. Se llevaron a cabo análisis de una sola variable y de múltiples variables para evaluar los factores de riesgo de difteria mortal. Se presentan los datos de vigilancia ordinaria y cobertura vacunal. RESULTADOS: De enero del 2004 a abril del 2005, se notificaron un total de 145 casos de difteria; 80 (66%) de los 122 casos notificados en el 2004 cumplieron con la definición de caso; 26 fueron mortales (tasa de letalidad por caso: 32,5%). La incidencia más alta (5,3 por 100 000) se produjo en el grupo de 1 a 4 años de edad; 62,5% fueron varones. De los 80 casos, 61 (76%) se hospitalizaron en el Hospital A, 17 en el Hospital B, y 2 en otros dos hospitales. La aparición más temprana (primera mitad del 2004), el orden de nacimiento y la traqueotomía se asociaron con difteria mortal (P < 0 ,05); la probabilidad de evolución mortal fue mayor en los casos ingresados en el Hospital A (P = 0,066). La incidencia promedio anual de difteria fue de 4,91 casos por millón de personas del 2000 al 2003, ascendió a 8,8 casos por millón durante los años 2004 y 2005, y descendió a 0,38 del 2006 al 2014; no se han notificado casos de difteria desde el 2011. La cobertura de la vacunación con DTP3 varió de 72 a 81% del 2000 al 2004 y de 81 a 89% del 2005 al 2013. CONCLUSIONES: El brote epidémico de difteria de los años 2004 y 2005 en la República Dominicana ocasionó una importante morbimortalidad prevenible. Se produjo un descenso en la incidencia de casos y no se han notificado nuevos casos en los últimos años. El mantenimiento de una alta cobertura vacunal y de una vigilancia eficiente es crucial para la prevención de los brotes epidémicos de difteria y el control de la enfermedad.

Electronic immunization registries in Latin America: progress and lessons learned / Registros electrónicos de vacunación en América Latina: avances y enseñanzas

Most of the current vaccination coverage monitoring in Latin America relies on aggregated data. Improved monitoring has been shown to result in better coverage. Taking advantage of current information and communication technologies, the use of electronic immunization registries (EIRs) can facilitate coverage monitoring in terms of particularity (at the level of the individual), timeliness, and accuracy. Countries in Latin America are rapidly developing and implementing national EIRs to improve the monitoring of immunization coverage. These countries are using a variety of approaches toward system conception and development; integration with larger health information systems; different modalities for data collection, entry, and transmission; and other key features. Some countries are exploring linkages with mHealth (mobile health) for data collection and for automated recall/reminders. Evaluating EIRs and sharing experiences are important to streamlining and improving national EIR development, implementation, and use, and to ensuring its sustainability.

La mayor parte de la vigilancia actual de la cobertura vacunal en América Latina se basa en datos consolidados. Sin embargo, se ha demostrado que una mejor vigilancia puede llevar a una mayor cobertura. Si se aprovechan las tecnologías de la información y la comunicación que existen en la actualidad, el uso de registros electrónicos de vacunación puede facilitar la vigilancia de la cobertura en cuanto a aspectos particulares (a escala individual), pertinencia temporal y exactitud. Los países de América Latina están elaborando e implantando rápidamente este tipo de registros electrónicos a escala nacional con objeto de mejorar la vigilancia de la cobertura vacunal. Estos países están empleando diversos métodos para diseñar y crear el sistema; integrarlo con otros sistemas de información sanitaria más amplios; considerar las diferentes modalidades de recopilación, introducción y transmisión de datos, y otras características importantes. Algunos países están explorando posibles vínculos con la tecnología móvil en el ámbito de la salud (mHealth) para recopilar datos y generar recordatorios automatizados. La evaluación de los registros electrónicos de vacunación y el intercambio de experiencias son importantes para racionalizar y mejorar el desarrollo, la implantación y el empleo de estos registros a escala nacional, y garantizar su sostenibilidad.

Assessment of the quality of immunization data produced by the national individual registration system in Uruguay, 2006 / Evaluación de la calidad de los datos de vacunación generados por el sistema nacional de registro individual en Uruguay, 2006

OBJECTIVE: The nominal registration system of Uruguay's national immunization program (NIP) tracks administered vaccines on a paper form filled out after each vaccination and collated into a national database, thus allowing for individual follow-up. This study performed a comprehensive assessment of the quality of Uruguay's immunization data in November 2006 to evaluate the validity of the information and to confirm the high national immunization coverage reported by the program. METHODS: The research team analyzed the concordance of the operational-level numerators (infant immunization data from 18 public and private vaccination centers in six country departments) with department- and national-level data, and compared the national-level (NIP) infant denominators with other official sources. A standardized questionnaire was used to evaluate system performance at the operational (vaccination center), department, and national level. Rapid house-to-house monitoring was conducted to generate additional coverage estimates. RESULTS: Numerator accuracy throughout the data flow was 100 percent, and national-level denominators appeared to be exhaustive. Overall system performance was excellent (proper archiving and recording of form data, sufficient supply of forms, timely flow of information, adequate defaulter tracing practices and computer system security). The main weaknesses were the degree of data analysis and feedback to peripheral levels. House-to-house monitoring showed high overall immunization coverage (97 percent). CONCLUSION: Uruguay's NIP registration system produces remarkably reliable information, ensuring valid measurement of immunization coverage. In addition, by allowing for monitoring of each child's current vaccination status, it facilitates management of interventions designed to reduce vaccination default and thus helps achieve the country's high level of coverage.

OBJETIVOS: El sistema de registro nominal del programa nacional de vacunación (PNV) de Uruguay registra las vacunas administradas en un modelo en papel que se llena después de cada vacunación y se introduce en una base de datos nacional, lo que permite el seguimiento individual. En este estudio, realizado en noviembre de 2006, se hizo un análisis integral de la calidad de los datos de vacunación en Uruguay para evaluar la validez de la información y confirmar la alta cobertura nacional de vacunación informada por el programa. MÉTODOS: Se analizó la concordancia de los numeradores operacionales (datos de vacunación infantil de 18 centros de vacunación públicos y privados de seis departamentos del país) con los datos departamentales y nacionales, y se compararon los denominadores del PNV infantil a nivel nacional con los de otras fuentes oficiales. Se empleó un cuestionario estandarizado para evaluar el desempeño del sistema en los niveles operacional (centros de vacunación), departamental y nacional. Se realizó un monitoreo rápido de casa en casa para obtener estimados adicionales de la cobertura. RESULTADOS: La precisión de los numeradores en todo el flujo de datos fue de 100 por ciento y los denominadores a nivel nacional al parecer eran exhaustivos. El desempeño general del sistema fue excelente (archivo y registro adecuados de los datos, suministro suficiente de modelos, flujo oportuno de información, práctica adecuada de rastreo de fallas y sistema apropiado de seguridad informática). Las principales debilidades fueron el grado de análisis de los datos y la retroalimentación a las instancias periféricas. El monitoreo de casa en casa mostró una alta cobertura general de vacunación (97 por ciento). CONCLUSIONES: El sistema uruguayo de registro del PNV genera una información notablemente confiable, lo que asegura la validez de la medición de la cobertura de vacunación. Además, al permitir el monitoreo del estado de vacunación actual ...

The feasibility of a school-based VI polysaccharide vaccine mass immunization campaign in Hue City, central Vietnam: streamlining a typhoid fever preventive strategy.

We report the coverage, safety, and logistics of a school-based typhoid fever immunization campaign that took place in Hue City, central Vietnam; a typhoid fever endemic area. A cluster-randomized evaluation-blinded controlled trial was designed where 68 schools (cluster) were randomly allocated the single dose Vi polysaccharide vaccine (Typherix) or the active control hepatitis A vaccine (Havrix). A safety surveillance system was implemented. A total of 32,267 children were immunized with a coverage of 57.5%. Strong predictors for vaccination were attending primary schools, peri-urban location of the school, and low family income. Human resources were mainly schoolteachers and the campaign was completed in about 1 month. Most adverse events reported were mild. Safe injection and safe sharp-waste disposal practices were followed. A typhoid fever school-based immunization campaign was safe and logistically possible. Coverage was moderate and can be interpreted as the minimum that could have been achievable because individual written informed consent procedures were sought for the first time in Hue City and the trial nature of the campaign. The lessons learned, together with cost-effectiveness results to be obtained by the end of follow-up period, will hopefully accelerate the introduction of Vi typhoid fever vaccine in Vietnam.

The role of epidemiology in the introduction of vi polysaccharide typhoid fever vaccines in Asia.

Despite the availability of at least two licensed typhoid fever vaccines--injectable sub-unit Vi polysaccharide vaccine and live, oral Ty21a vaccine--for the last decade, these vaccines have not been widely introduced in public-health programmes in countries endemic for typhoid fever. The goal of the multidisciplinary DOMI (Diseases of the Most Impoverished) typhoid fever programme is to generate policy-relevant data to support public decision-making regarding the introduction of Vi polysaccharide typhoid fever immunization programmes in China, Viet Nam, Pakistan, India, Bangladesh, and Indonesia. Through epidemiological studies, the DOMI Programme is generating these data and is offering a model for the accelerated, rational introduction of new vaccines into health programmes in low-income countries. Practical and specific examples of the role of epidemiology are described in this paper. These examples cover: (a) selection of available typhoid fever vaccines to be introduced in the programme, (b) generation of policy-relevant data, (c) providing the 'backbone' for the implementation of other multidisciplinary projects, and (d) generation of unexpected but useful information relevant for the introduction of vaccines. Epidemiological studies contribute to all stages of development of vaccine evaluation and introduction.

Factors associated with reported diarrhoea episodes and treatment-seeking in an urban slum of Kolkata, India.

In an urban slum in eastern Kolkata, India, reported diarrhoea rates, healthcare-use patterns, and factors associated with reported diarrhoea episodes were studied as a part of a diarrhoea-surveillance project. Data were collected through a structured interview during a census and healthcare-use survey of an urban slum population in Kolkata. Several variables were analyzed, including (a) individual demographics, such as age and educational level, (b) household characteristics, such as number of household members, religious affiliation of the household head, building material, expenditure, water supply and sanitation, and (c) behaviour, such as hand-washing after defecation and healthcare use. Of 57,099 study subjects, 428 (0.7%) reported a diarrhoea episode sometime during the four weeks preceding the interview. The strongest independent factors for reporting a history of diarrhoea were having another household member with diarrhoea (adjusted odds ratio [OR]=3.8; 95% confidence interval [CI] 3.3-4.4) and age less than 60 months (adjusted OR=3.7; 95% CI 3.0-4.7). The first choice of treatment by the 428 subjects was as follows: 151 (35%) had self- or parent-treatment, 150 (35%) consulted a private allopathic practitioner, 70 (16%) went directly to a pharmacy, 29 (7%) visited a hospital, 14 (3%) a homoeopathic practitioner, 2 (0.5%) an ayurvedic practitioner, and 12 (3%) other traditional healers. The choices varied significantly with the age of patients and their religion. The findings increase the understanding of the factors and healthcare-use patterns associated with diarrhoea episodes and may assist in developing public-health messages and infrastructure in Kolkata.