Ranking de los programas de vacunación en América Latina, 2020 / Ranking of immunization programs in Latin America, 2020 / Ranking dos programas de vacinação na América Latina, 2020

RESUMEN Objetivo. Construir y comparar el ranking de los programas nacionales de inmunizaciones (PNI) de América Latina del año 2020 con el año anterior. Métodos. Se evaluaron 18 PNI con base en la información pública obtenida de sitios oficiales de los ministerios de salud de los países, la Organización Mundial de la Salud, la Organización Panamericana de la Salud, el Fondo de las Naciones Unidas para la Infancia y referentes locales. El ranking se elaboró con base en el calendario de vacunación del año 2020 en distintas etapas de la vida, situaciones especiales, vacunación antigripal, coberturas vacunales (CV) del 2019 y aspectos programáticos. Resultados. Las CV disminuyeron en la mayoría de los países. El puntaje promedio regional y de la mayoría de los países también bajó en el 2020 excepto en Chile y Colombia. Chile lidera el ranking, seguido por Uruguay, Panamá y Costa Rica, y se destaca por su calendario completo, mayores CV y logros programáticos. Conclusiones. El menor puntaje global del 2020 resalta que es necesario recuperar la CV en la Región. Este análisis busca motivar a los países a abordar los desafíos pendientes.

ABSTRACT Objective. Construct a ranking of national immunization programs in Latin America in 2020 and compare it with the previous year. Methods. Eighteen national immunization programs were evaluated on the basis of public information obtained from official sites of the countries' ministries of health, the World Health Organization, the Pan American Health Organization, the United Nations Children's Fund, and local sources. The ranking was based on the 2020 vaccination schedule for different life stages, special situations, vaccination against influenza, 2019 vaccination coverage, and programmatic aspects. Results. Vaccination coverage decreased in most countries. The average regional declined in 2020, as did the scores for most countries, except Chile and Colombia. Chile leads the ranking, followed by Uruguay, Panama, and Costa Rica. Chile stands out for its full calendar, higher vaccination coverage rates, and programmatic achievements. Conclusions. The lower overall score in 2020 highlights the need to recover the Region's vaccination coverage rates. This analysis seeks to motivate countries to address pending challenges.

RESUMO Objetivo. Construir e comparar o ranking dos programas nacionais de imunização (PNIs) na América Latina em 2020 com o ano anterior. Métodos. Foram avaliados 18 PNIs com base em informações públicas obtidas de sites oficiais dos ministérios da Saúde dos países, da Organização Mundial da Saúde, da Organização Pan-Americana da Saúde, do Fundo das Nações Unidas para a Infância e de fontes locais. O ranking foi compilado com base no calendário de vacinação de 2020 para diferentes fases da vida, situações especiais, vacinação contra a gripe, cobertura vacinal (CV) de 2019 e aspectos programáticos. Resultados. As CVs diminuíram na maioria dos países. A pontuação média regional e a pontuação da maioria dos países também caíram em 2020, exceto no Chile e na Colômbia. O Chile lidera o ranking, seguido do Uruguai, do Panamá e da Costa Rica, e se destaca por ter um calendário completo, maiores CVs e êxitos programáticos. Conclusões. A pontuação global mais baixa em 2020 destaca a necessidade de recuperar a CV da região. Esta análise busca motivar os países a enfrentar os desafios pendentes.

Comparación de protocolos de vacunación contra el virus del papiloma humano en Ecuador y América Latina / Comparation of vaccination protocols against the human papillomavirus in Ecuador and Latin America

INTRODUCCIÓN: El virus del papiloma humano (VPH), con más de 100 tipos, es de transmisión sexual. Varios países de América Latina han introducido las vacunas contra el VPH. Aunque América Latina es la región que más rápido avanzó en la vacunación contra el VPH, sus sistemas de seguimiento y vigilancia son aún deficientes. OBJETIVO: Comparar las diferentes estrategias de vacunación contra el VPH en Ecuador y América Latina. MÉTODO: Revisión bibliográfica, en la que se obtuvo información de documentos gubernamentales y artículos indexados en los últimos 5 años sobre las estrategias de vacunación contra el VPH en Ecuador y América Latina. RESULTADOS: La mayoría de los países de América Latina han logrado introducir la vacuna contra el VPH, excepto Venezuela, Martinica, Haití, Nicaragua y Cuba. CONCLUSIONES: Los protocolos de vacunación de Ecuador y América Latina necesitan mejorar sus sistemas de seguimiento y aumentar la expansión de datos de cobertura disponibles de manera consistente. Actualmente siguen existiendo desafíos para introducir las vacunas, lograr una alta cobertura y fortalecer el seguimiento, la evaluación y la notificación.

INTRODUCTION: The human papilloma virus (HPV), with more than 100 types, is a sexual transmission infection. Many Latin American countries have introduced the vaccines against the HPV. Although Latin América is the region which advanced faster against the HPV, its surveillance and follow-up systems are yet deficient. OBJECTIVE: To compare the different strategies to assume the vaccination against the HPV in Ecuador and Latin America. METHOD: Bibliographic review, in which information was obtained from government documents and articles indexed in the last five years on vaccination strategies against HPV in Ecuador and Latin America. RESULTS: Most Latin American countries have managed to introduce the vaccine against the HPV, except Venezuela, Martinica, Haiti, Nicaragua and Cuba. CONCLUSIONS: The vaccination protocols of Ecuador and Latin América need to improve their systems of follow-up and monitoring, and increase the expansion of available data in a consistent manner. Now, there are still existing challenges to introduce the vaccines, manage a high reach and fortify the follow-up, the evaluation, and the notification.

Recommendations for modernizing infant vaccination schedules with combination vaccines in Colombia and Peru / Recomendaciones para modernizar los calendarios de vacunación infantil con vacunas combinadas en Colombia y Perú / Recomendações para modernizar os esquemas de vacinação infantil com vacinas combinadas na Colômbia e no Peru

ABSTRACT The objective of this article was to consider the vaccination challenges in Colombia and Peru and the role of pediatric combination vaccines in overcoming these challenges. Barriers to including new vaccines with more antigens remain apparent in parts of these countries, where vaccine-preventable diseases in infants continue to be a major problem. The challenges include the heterogeneity of vaccine coverage within each country and in neighboring countries, which can contribute to poor rates of vaccination coverage; the adverse impact of the inward migration of unvaccinated individuals, which has favored the re-emergence of vaccine-preventable diseases; vaccine shortages; and the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the associated shifts in health care resources. To improve the coverage of pediatric vaccines in Colombia and Peru, it will be necessary to ensure the widespread integration into vaccine schedules of combination vaccines containing diphtheria, tetanus, acellular pertussis, inactivated poliovirus, Haemophilus influenzae type b and hepatitis B antigens with a three-dose primary series delivered at 2, 4 and 6 months of age followed by a booster at 18 months of age. Such vaccines play important roles in preventing diphtheria, tetanus and pertussis; eradicating polio; and providing boosting against H. influenzae type b.

RESUMEN El objetivo de este artículo es considerar los desafíos que se enfrentan en Colombia y Perú con respecto a la vacunación y el papel de las vacunas combinadas pediátricas para superar estos desafíos. Los obstáculos para incluir vacunas nuevas con más antígenos siguen siendo evidentes en algunos lugares de estos países, donde las enfermedades prevenibles por vacunación en menores de 1 año continúan siendo un grave problema. Entre los desafíos se incluye la heterogeneidad de la cobertura de vacunación en cada país y en los países vecinos, lo que puede contribuir con que se registren tasas bajas de cobertura de vacunación; el impacto adverso de la migración interna de personas no vacunadas, lo que ha favorecido la reaparición de enfermedades prevenibles por vacunación; la escasez de vacunas, y el impacto de la pandemia del coronavirus de tipo 2 causante del síndrome respiratorio agudo grave (SARS-CoV-2) y los consiguientes cambios en los recursos de atención médica. Para mejorar la cobertura de las vacunas pediátricas en Colombia y Perú será necesario integrar de manera generalizada en los calendarios de vacunación vacunas combinadas con antígenos de difteria, tétanos, tos ferina acelular, poliovirus inactivados, Haemophilus influenzae tipo b y hepatitis B con una serie primaria de tres dosis administradas a los 2, 4 y 6 meses de edad, seguida de un refuerzo a los 18 meses de edad. Esas vacunas desempeñan un papel esencial en la prevención de la difteria, el tétanos y la tos ferina; la erradicación de la polio; y el refuerzo contra H. influenzae tipo b.

RESUMO O objetivo deste artigo foi avaliar os desafios da vacinação na Colômbia e no Peru e o papel das vacinas pediátricas combinadas na superação de tais desafios. Os obstáculos para incluir novas vacinas com mais antígenos permanecem visíveis em partes desses países, onde doenças imunopreveníveis em lactentes continuam a ser um grande problema. Os desafios incluem a heterogeneidade da cobertura vacinal dentro de cada país e nos países vizinhos, o que pode contribuir para baixas taxas de cobertura vacinal; o impacto adverso da migração interna de pessoas não vacinadas, o que favoreceu o ressurgimento de doenças imunopreveníveis; a escassez de vacinas; e o impacto da pandemia de síndrome respiratória aguda grave do coronavírus 2 (SARS-CoV-2) e mudanças relacionadas nos recursos de atenção à saúde. Para melhorar a cobertura das vacinas pediátricas na Colômbia e no Peru, será necessário assegurar sua integração generalizada em esquemas de vacinas combinadas contendo antígenos de difteria, tétano, pertussis acelular, poliovírus inativado, Haemophilus influenzae tipo B e hepatite B, com uma série primária de três doses aplicadas aos 2, 4 e 6 meses de idade seguidas de um reforço aos 18 meses de idade. Tais vacinas desempenham papéis importantes na prevenção da difteria, tétano e coqueluche; na erradicação da poliomielite; e no reforço contra H. influenzae tipo b.

Temporal trend of the dropout rate and vaccination coverage of the triple viral vaccine in Brazil, 2014-2021 / Tendencia temporal de tasa de abandono y cobertura de vacunación de la vacuna triple viral en Brasil, 2014-2021 / Tendência temporal da taxa de abandono e da cobertura da vacina tríplice viral no Brasil, 2014-2021

Abstract Objective: to analyze the temporal trend of coverage and dropout rate for triple viral vaccine in Brazil, according to the country's Federative Units and Macro-Regions, between 2014 and 2021. Methods: this was an ecological time series study, using data from the National Immunization Program Information System and the Live Birth Information System; joinpoint regression models were used. Results: in Brazil as a whole annual vaccination coverage was below 95% and ranged from 92.3% (2015) to 54.4% (2021); the second dose of the vaccine showed a decreasing temporal trend in the period (average change over the period = -5.8; 95%CI -10.5;-0.8); the temporal trends were stationary and decreasing in the country's Federative Units; the dropout rate ranged from 22.2% (2014) to 37.4% (2021). Conclusion: there was a downward trend in vaccination coverage and an increase in the dropout rate in Brazil as a whole and in the country's Federative Units.

Resumen Objetivo: analizar la tendencia temporal de cobertura y tasa deserción de la vacuna triple viral en Brasil, y según Unidades de la Federación y Regiones, entre 2014 y 2021. Métodos: estudio de serie temporal ecológica, sobre datos de los sistemas del Inmunizaciones y Nacido Vivo; se utilizaron modelos de regresión de punto de inflexión. Resultados: la cobertura anual de vacunación estuvo por debajo del 95% y osciló entre 92,3% (2015) y 54,4% (2021), en Brasil; la segunda dosis mostró una tendencia temporal decreciente en el período (variación promedia en el periodo = -5,8; IC95% -10,5;-0,8); las tendencias temporales fueron estacionarias y decrecientes en las Unidades de la Federación; la tasa deserción de varió del 22,2% (2014) al 37,4% (2021). Conclusión: hubo una tendencia a la baja en las coberturas de vacunación y un aumento en la tasa de deserción en Brasil y en las Unidades de la Federación.

Resumo Objetivo: analisar a tendência temporal da cobertura e da taxa de abandono da vacina tríplice viral no Brasil, nas Unidades da Federação (UFs) e grandes regiões nacionais, entre 2014 e 2021. Métodos: estudo ecológico de série temporal, sobre dados do Sistema de Informações do Programa Nacional de Imunizações e do Sistema de Informações sobre Nascidos Vivos; foram utilizados modelos de regressão por pontos de inflexão. Resultados: as coberturas vacinais anuais, no Brasil como um todo, estiveram abaixo de 95%, variando de 92,3% (2015) a 54,4% (2021); a segunda dose da vacina apresentou tendência temporal decrescente no período (variação média no período = -5,8; IC95% -10,5;-0,8); as tendências temporais foram estacionárias e decrescentes nas UFs; a taxa de abandono variou de 22,2% (2014) a 37,4% (2021). Conclusão: houve tendência de queda da cobertura vacinal e aumento da taxa de abandono, no Brasil como um todo e nas UFs.

Hepatitis B: Anticuerpos contra antígeno de superficie en residentes de pediatría, Hospital Central de Maracay

Introducción: Los profesionales del área de la salud tienen un riesgo incrementado de contraer la infección por el virus de hepatitis B (VHB). Objetivo: Evaluar anticuerpos contra el antígeno de superficie de la hepatitis B, en los residentes de pediatría del Hospital Central de Maracay en el período junio-agosto de 2021. Materiales y métodos: Estudio clínico epidemiológico, no experimental y de corte transversal, en el que se tomó muestra sanguínea a 54 médicos residentes para la determinación de anticuerpos contra el antígeno de superficie del VHB (Anti-HBs). Resultados: El promedio de edad fue 27,48 años con una desviación estándar de 1,6. El 83,33 % pertenecían al sexo femenino, 51,85.% cursaban el 1er año del posgrado, 33,33 % con esquema de vacunación documentado, de estos, 66,67.% completaron el esquema y 77,78 % cumplidos en la adultez. Con respecto al tiempo de la última dosis, el 66,67 % hasta 10 años. Se detectaron niveles de Anti-HBs mayores de 10 mUl/mL en el 94,44 %, con mayor prevalencia de niveles protectores a favor del sexo femenino. Se evidenció una correlación lineal positiva entre los niveles de Anti-HBs y el tiempo desde la última dosis de la vacuna contra la hepatitis B. Conclusiones: Aunque existe una debilidad en los médicos residentes en cuanto a la tenencia y cumplimiento del esquema de inmunización, la mayoría de ellos mostraron niveles protectores de anti-HBs. A mayor tiempo transcurrido desde la última dosis de la vacuna hay un descenso en los niveles de anti-HBs lo que justifica dosis de refuerzo a los 10 años.

Introduction: Health professionals have an increased risk of contracting hepatitis B virus infection (HBV). Objective: To evaluate antibodies against hepatitis B surface antigen in residents of pediatrics of the Central Hospital of Maracay in the period June-August. 2021. Materials and methods: Clinical epidemiological, nonexperimental and cross-sectional study, in which blood samples were taken from fifty-four medical residents for the determination of antibodies against the HBV surface antigen. Results: The average age was 27.48 years with a standard deviation of 1.6. 83.33 % were female, 51.85 % were in the first year of postgraduate studies, 33.33 % had a documented vaccination schedule, of these, 66.67 % completed the schedule and 77.78 % completed it in adulthood. Regarding the time of the last dose, for 66.67 % of the study population, it was up to 10 years ago. Anti-HBs levels greater than 10mUl/ml were detected in 94.44 %, with a higher prevalence of protective levels in favor of the female sex. A positive linear correlation between the levels of Anti-HBs and the time since the last dose of the hepatitis B vaccine was evidenced. Conclusions: Although there is a weakness in the resident doctors in terms of possession and compliance with the immunization schedule, the most of them showed protective levels of anti-HBs. The longer the time elapsed since the last dose of the vaccine, there is a decrease in anti-HBs levels, which justifies a booster dose at 10 years.

Incidência de coqueluche em crianças menores de 1 ano e relação com a vacinação materna no Brasil, 2008 a 2018 / Incidencia de tos ferina en niños menores de 1 año y relación con la vacunación materna en Brasil, 2008 a 2018 / Pertussis incidence in children under 1 year old and relation with maternal vaccination in Brazil, 2008-2018

Objetivo: Analisar o impacto da vacina adsorvida difteria, tétano e coqueluche (pertússis acelular), tipo adulto (dTpa), materna, na incidência de coqueluche em crianças menores de 1 ano no Brasil, de 2008 a 2018. Métodos: Estudo de tipo ecológico, descritivo de tendência temporal, utilizando-se de dados dos sistemas de vigilância do Departamento de Informática do Sistema Único de Saúde (Datasus). Foram calculadas taxas de incidência e razão das taxas de incidência (IRR), com respectivos intervalos de confiança de 95% (IC95%). Resultados: O número de casos de coqueluche foi de 20.650. Houve redução na incidência de coqueluche no período pós-vacinal, de 26,6% (IRR = 0,73; IC95% 0,66;0,82) nas crianças de 3 meses a 1 ano incompleto, e de 63,6% (IRR = 0,36; IC95% 0,15;0,58) nas crianças de zero a 2 meses. Conclusão: O aumento da cobertura da vacinação com dTpa materna correspondeu à redução na incidência de coqueluche, principalmente na faixa etária de zero a 2 meses.

Objetivo: Analizar la incidencia de tos ferina en menores de 1 año y su relación con la cobertura de vacunación materna por la vacuna adsorbida contra la difteria, el tétanos y la tos ferina (tos ferina acelular) tipo adulto (dTpa), de 2008 a 2018, en Brasil. Métodos: Estudio ecológico descriptivo de tendencia temporal utilizando datos de los sistemas de vigilancia del Departamento de Informática do Sistema Único de Saúde (Datasus). Se calcularon los tasas de incidencia y las razones de tasas de incidencia (RTI) con los respectivos intervalos de confianza del 95% (IC95%). Resultados: El número de casos de tos ferina en el período de estudio fue de 20,650. Hubo una reducción en la incidencia de tos ferina en el período post-vacunación. En los niños de 3 meses a 1 año incompleto, la reducción fue del 26,6% (RTI = 0,73; IC95% 0,66;0,82), mientras que en el otro grupo la diferencia relativa fue del 63,6% (RTI = 0,36; IC95% 0,15;0,58)]. Conclusión: La vacunación materna con dTpa coincide con una reducción en la incidencia de tos ferina, especialmente en el grupo de edad de cero a 2 meses.

Objetive: To analyze the impact of maternal vaccination coverage with diphtheria-tetanus-acellular pertussis (Tdap) adsorbed vaccine for adults on pertussis incidence in children under 1 year old in Brazil from 2008 to 2018. Methods: This was a descriptive ecological temporal trend study using data from surveillance systems managed by the Brazilian National Health System Information Technology Department (DATASUS). Incidence rates and incidence rate ratios (IRR) were calculated with respective 95% confidence intervals (95%CI). Results: There were 20,650 pertussis cases in the study period. In the post-vaccination period there was a 26.6% reduction (IRR = 0.73; 95%CI 0.66;0.82) in pertussis incidence among children aged from 3 months up to but not including 1 year old, and a 63.6% reduction (IRR = 0.36; 95%CI 0.15;0.58) among children from birth to 2 months old. Conclusion: The increase in maternal Tdap vaccination coverage coincided with a reduction in pertussis incidence, especially in the birth to two-month-old age group.

Adesão à vacina contra hepatite B entre pessoas que vivem em situação de rua / Hepatitis B vaccine adherence among homeless people

RESUMO Objetivo estimar a adesão à vacina contra a hepatite B em pessoas que vivem em situação de rua. Métodos estudo transversal com 90 pessoas que vivem em situação de rua com a coleta de 5ml de sangue para a detecção do anticorpo contra o antígeno de superfície do vírus da hepatite B. Resultados do total, 89 (98,9%) foram vacinados com a primeira dose; desses, 45 (50,7%) apresentaram anticorpo contra o antígeno de superfície do vírus da hepatite B inferior a 10 UI/mL; 25 (53,3%) receberam a segunda dose da vacina contra a hepatite B e nove (45,8%) participantes receberam a terceira dose de vacina. Indivíduos que mantinham relação com ambos os gêneros tiveram maior chance de aderir ao esquema completo da vacina contra a hepatite B. Conclusão evidenciaram-se a baixa adesão à vacina contra a hepatite B e o número reduzido de participantes com anticorpos que conferem imunidade contra essa infecção.

ABSTRACT Objective to estimate the adherence to hepatitis B vaccine in homeless people. Methods a cross-sectional study with 90 homeless people, with the collection of 5 ml of blood for the detection of antibody against the surface antigen of the hepatitis B virus. Results of the total, 89 (98.9%) were vaccinated with the first dose; of these, 45 (50.7%) had antibodies against hepatitis B virus surface antigen lower than 10 IU/L; 25 (53.3%) received the second dose of hepatitis B vaccine, and nine (45.8%) participants received the third dose of vaccine. Individuals who were related to both genders were more likely to adhere to the full hepatitis B vaccine schedule. Conclusion the low adherence to hepatitis B vaccination and the small number of participants with antibodies that confer immunity against this infection were evidenced.

Progress in optimizing the immunization schedule of recombinant human papillomavirus vaccines / 中华微生物学和免疫学杂志

Human papillomavirus (HPV) is closely associated with cervical cancer and other anogenital cancers or diseases, and HPV vaccination is an important measure of primary prevention. Currently, there are four licensed HPV vaccines. Clinical trials and real-world studies have confirmed the efficacy and effectiveness of the routine three-dose immunization schedule. Expanding HPV vaccination coverage can accelerate the process of cervical cancer elimination, so optimizing the immunization schedule, including extending dosing intervals and decreasing vaccination doses, is one of the key considerations for future application of HPV vaccines. This review summarized the progress related to the immunogenicity and efficacy of HPV vaccination with fewer doses and non-standard three-dose schedule.

Comparative analysis of immunization effects before and after polio vaccine immunization schedule conversion / 中华微生物学和免疫学杂志

Objective:To compare the polio antibody level of healthy children in Jiangsu Province before and after the conversion of (inactivated poliovirus vaccine, IPV) immunization program.Methods:200 serum samples of healthy children under 5 years old in Jiangsu Province were collected before and after the vaccine conversion, and the neutralizing antibody against poliomyelitis was measured using the micro cell neutralization test. We compared the differences in the positive rate and geometric mean titer (GMT) of polio antibody before and after vaccine conversion.Results:Before vaccine conversion, positive rates of antibody against poliovirus type Ⅰ and Ⅲ were 98.50% and 92.00%, with GMTs of 1∶100.43 and 1∶23.34, respectively. After the conversion, positive rates of polio antibody type I and Ⅲ were 99.00% and 96.00%, GMT were 1∶213.04 and 1∶121.10.Conclusions:There is a difference in immunization effect before and after the polio vaccine conversion, and the antibody level of the population after vaccine conversion is higher than that before vaccine conversion. It is recommended to gradually increase the IPV dose in order to finally achieve the whole course of IPV inoculation.

Consideration of clinical trial design for human rabies vaccines with different immunization schedules / 中华微生物学和免疫学杂志

This article referred to the relevant guidelines for vaccine clinical trials and the accumulated experience in the development and review of human rabies vaccines, as well as combined the technical recommendations for human rabies vaccines from major health facilities such as WHO, to discuss the key considerations in the design of clinical trials for human rabies vaccines, including control vaccines, evaluation of efficacy endpoints, clinical subjects, the sample size, immunity persistence, re-exposure immunization schedule and post-marketing study. This article aimed to provide reference for the design of human rabies vaccine clinical trials.

Factores que afectan al proceso de inmunización en la comunidad étnica Chachis, Ecuador 2018 / Factors that affect the immunization process in the ethnic community of Chachis, Ecuador 2018

RESUMEN Fundamento: la inmunización es un componente esencial del derecho a la salud a través de las vacunas, la Estrategia Nacional de Inmunizaciones tiene como objetivo contribuir a reducir la morbilidad y mortalidad infantil de las enfermedades prevenibles por vacunación, por lo cual, se considera una intervención sanitaria eficaz y de bajo costo que salva la vida de millones de niños. Sin embargo, los niños de madres indígenas presentan mayor vulnerabilidad de contraer enfermedades inmunoprevenibles al no recibir las vacunas; en el grupo étnico se identificaron diversos factores que afectan al proceso de inmunización, ya sea por desconocimientos, actitudes y prácticas propias de la etnia. Objetivo: identificar los factores que afectan al proceso de inmunización en la comunidad étnica Chachis. Métodos: se realizó un estudio con enfoque cuantitativo de carácter descriptivo y de corte transversal, dirigida a las familias con niño/as de hasta cinco años de edad en la comunidad étnica Chachis, Santo Domingo de los Tsáchilas-Ecuador del 15 abril al 10 agosto del año 2018. El universo de estudio estuvo conformado por 170 nativos de la comunidad Chachis, a los que se les aplicó criterios de inclusión y exclusión donde quedó como muestra representativa 30 miembros de la comunidad. Resultados: el proceso de inmunización se ve afectado por factores como el nivel instrucción académica, seguida por la realización de prácticas propias de su cultura y por no recibir un trato cordial por el personal de salud hacia los Chachis. Conclusiones: existe un inadecuado proceso de inmunización en la comuna indígena Chachis motivado por factores socioculturales, lo que trae consigo que dicha población no se encuentra apta para enfrentar enfermedades infecciosas prevenibles.

ABSTRACT Background: the immunization is an important component of the right to health. The National Strategy of Immunization has the objective of contributing to the reduction of infant morbidity and infant mortality due to preventable diseases through immunization. Vaccination is considered to be an effective and low-cost procedure that saves lives of millions of children. However, the children of indigenous communities are vulnerable to preventable diseases by vaccination due to being non-recipient of immunization. Factors that affect the immunization process are: lack of knowledge, attitude, and ethnic practices. Objective: to identify the factors that affect the immunization process in ethnic community of Chachis. Methods: a quantitative, descriptive, cross-sectional study was used for families with children up to 5 years old in the ethnic community of Chachis, Santo Domingo de los Tsáchilas, Ecuador from April 15th to August 10th, 2018. The population was composed of 170 natives of Chachis community while the sample was 30 members of the community to whom the criteria of inclusion and exclusion were applied. Results: the immunization process was affected by factors such as: educational level, cultural practices and hostile treatment of health personnel towards the Chachis. Conclusions: there is an inadequate immunization process in the indigenous community of Chachis due to socio-cultural factors. Due to this, the mentioned community is not prepared to face preventable infectious diseases.

Vaccination coverage and its determinants in rural areas of district Doda of Jammu and Kashmir, India

Background: India accounts for the highest number of under-five deaths in the world. Estimates claim that 89 lakh children in India receive fewer vaccines or no vaccine at all. One out of every three children in India does not receive all vaccines under the universal immunization programme. 5% children in urban and 8% children in rural areas remain unimmunized. According to NFHS-4 data complete vaccination coverage in India stands at 62%. The objectives of this study were to evaluate complete vaccination coverage, dropout rate and identify factors for failure of vaccination coverage in Doda district of Jammu and Kashmir, state of India.Methods: A cross-sectional quantitative study was conducted to evaluate the complete vaccination coverage by using an interview schedule devised as per WHO-UNICEF coverage cluster survey reference manual and National Immunization Schedule. A pre-determined sample size according to the WHO-UNICEF coverage cluster survey reference manual was adopted for the purpose of the study.Results: Of the total 207 children included in the study 66.2% (n=137) were fully immunized. 19.8% of the children had dropped out and did not receive the recommended dose of pentavalent vaccine. Among the reasons for low complete vaccination coverage, lack of awareness, mother too busy and vaccinator being absent were identified as the major reasons.Conclusions: Complete vaccination coverage has shown an increase with an increase in the coverage of the individual vaccines. But the coverage is still low and more efforts are needed to further improve the vaccination coverage.

Eficácia de um novo esquema vacinal contra hepatite B em pacientes submetidos a transplante de fígado / New immunization schedule effectiveness against hepatitis b in liver transplantation patients

ABSTRACT BACKGROUND: Although liver transplantation is considered to be a high-risk procedure, it is well-established as a treatment option for the cure and quality of life enhancement for individuals who suffer from diseases. Preventing an infection by hepatitis B virus through immunization schedules has been the most effective way to reduce complications, since it decreases the number of people who suffer from chronic hepatitis caused by the hepatitis B virus and eradicates its transmission. OBJECTIVE: 1. Analyzing evidence in the literature on various schedules employed for immunization against hepatitis B in patients who have received a liver transplantation. 2. Suggesting potential immunization schedules against hepatitis B in patients who suffer from liver cirrhosis, without previous verifying documentation, using the Child-Turcotte Pugh score, according to evidences found in the literature. METHODS: Systematic review of the literature, conducted on the data bases MedLine, PubMed, and Lilacs, between September, 2017 and January, 2018, by using the following keywords: "Liver Transplantation, "Immunization Schedule", "Hepatitis B Vaccines". In order to analyze the articles, a summary figure was especially designed and both the results and discussion were presented in a descriptive way. RESULTS: We included 24 studies; among them, eight had accelerated immunization schedules, 13 followed the conventional schedules, and three had super accelerated schedules. Regarding immunization, 21 studies were conducted with patients in the pre-transplant period, one with a transplanted patient, one with a pre-transplant group, and one with a post-transplant group. Found articles suggest that, disregarding the chosen immunization schedule, seroconversion rates tended to be lower as the liver disease advanced, compared to the healthy population. CONCLUSION: The studies did not find seroconversion superiority between the different immunization schedules (conventional and unconventional). However, since candidates to liver transplantation are usually very vulnerable, results show that super accelerated immunization schedules are possibly recommended for such group of patients; serologic test results will be higher when the immunization schedule is completed in the pre-transplant period.

RESUMO CONTEXTO: O transplante de fígado, apesar de ser um procedimento de elevado risco, está consolidado como recurso terapêutico para cura e melhoria da qualidade de vida de indivíduos acometidos por doenças. A prevenção da infecção pelo vírus da hepatite B através da vacinação tem sido a medida mais efetiva para reduzir complicações, diminuindo o número de pessoas com hepatite crônica pelo vírus da hepatite B e eliminando a transmissão. OBJETIVO: 1. Analisar as evidências na literatura sobre os diferentes esquemas utilizados para a vacina contra a hepatite B em pacientes submetidos a transplante de fígado. 2. Sugerir possíveis esquemas de vacinação contra hepatite B para pacientes com cirrose hepática, sem documentação comprovatória anterior, em relação à classificação de Child-Turcotte Pugh, segundo evidências encontradas na literatura. MÉTODOS: Revisão sistemática da literatura, realizada nas bases de dados MedLine, PubMed e Lilacs, no período de setembro/2017 a janeiro/2018, com as seguintes palavras chaves: "Liver Transplantation, "Immunization Schedule", "Hepatitis B Vaccines". Para análise dos artigos foi utilizado um quadro sinóptico especialmente construído para esse fim e a apresentação dos resultados e discussão foi feita de forma descritiva. RESULTADOS: Foram incluídos 24 estudos, sendo oito com esquemas vacinais acelerados, 13 com esquemas convencionais e três com esquemas super acelerado. Quanto ao período da vacinação, 21 estudos foram realizados com pacientes no período pré-transplante, um em pacientes transplantados e um com um grupo pré e um grupo pós transplante. Os artigos encontrados sugerem que independente do esquema vacinal escolhido, as taxas de soroconversão tendem a ser menores conforme o avançar da doença hepática, em relação à população saudável. CONCLUSÃO: Os estudos não encontraram superioridade de soroconversão entre os diferentes esquemas de vacinação (convencional e não convencional). Entretanto, sabendo da vulnerabilidade que os candidatos a transplante de fígado estão expostos, os resultados demonstram que o esquema de vacinação superacelerado pode ser indicado para este grupo de pacientes, e que os resultados sorológicos são mais elevados quando o esquema de vacinação é completado no período pré-transplante.

Assessment of immunization status among under five children in rural Mangaluru: a cross sectional study

Background: Immunization is the process whereby a person is made immune resistant to an infectious disease, typically by the administration of vaccine. If exposure to a disease occurs in a community there is a little to no risk of an epidemic if people have been immunized. This study was to assess the immunization status among children up to 5 years in rural Mangaluru.Methods: A community based cross sectional study was conducted among children of 0-5 years of age group (n=93) in rural Mangaluru using convenient sampling technique. After obtaining oral consent from parents, immunization status of children was assessed using validated questionnaire and details of child found to be partially immunized or not at all, reasons for not giving the vaccine were also collected.Results: 52.7% of the study population was partially immunized and 46.2% were fully immunized; only 83.9% possessed an immunization card. Majority of them have not taken measles/MR (55.9%) and also IPV 1 (46.2%) and Vitamin A2 (61.3%) because of unaware need for further immunization (58%).Conclusions: According to the survey, conducted in rural fields, we found that half of the population was partially immunized. Reasons being lack of awareness, negligence of parents, unaware of 2nd and 3rd dose of vaccines.

Matriz de recomendações estratégicas para a vacinação dos trabalhadores de saúde / Matrix of strategic recommendations for immunization of health workers

Introdução: Os trabalhadores de saúde estão sob risco de exposição a doenças contagiosas, muitas delas imunopreveníveis. A imunoprevenção ocorre por meio da vacinação, sendo um direito dos trabalhadores e um dever das instituições empregadoras, conforme legislação trabalhista brasileira. Objetivo: O objetivo deste estudo foi construir uma matriz de recomendações estratégicas diante da situação vacinal de trabalhadores de saúde, dados os riscos a que tais profissionais estão expostos. Método: Trata-se de pesquisa qualitativa, realizada em uma Unidade Básica de Saúde (UBS), entre novembro e dezembro de 2016. Foram realizadas três oficinas, com participação média de 22 trabalhadores por oficina. Utilizou-se a Metodologia da Problematização com aplicação das etapas do Arco de Maguerez. As oficinas foram registradas em um diário de campo. Resultados: Essa metodologia possibilitou a compreensão dos participantes sobre o processo de adoecer e o cuidado com a saúde. As oficinas subsidiaram a construção da Matriz de Recomendações, que apresenta estratégias para orientar e monitorar a vacinação dos trabalhadores de saúde, como: informações sobre as vacinas indicadas aos trabalhadores de saúde; atualização do esquema vacinal; e a vigilância da saúde do trabalhador. Conclusão: Considera-se que esta pesquisa subsidia o cuidado em saúde do trabalhador diante da situação vacinal dos participantes e de outros trabalhadores de saúde. Tais recomendações estratégicas visam à melhoria da cobertura vacinal dos trabalhadores de saúde, contribuindo para minimizar o risco de adoecimento por doenças imunopreveníveis, que podem causar absenteísmo para o tratamento, ou até mesmo o afastamento do trabalho por tempo indeterminado.

Background: Health workers are at high risk of exposure to contagious diseases, many of which might be prevented through vaccination. According to the Brazilian labor legislation, vaccination is a right of workers and an obligation for employers. Objective: To develop a matrix of strategic recommendations relative to the vaccination status of health workers as a function of the risks to which this occupational group is exposed. Methods: Qualitative study performed at a Health Basic Unit in November and December 2016. We held three workshops with an average of 22 participants and following a problematization method based on the Maguerez arc approach. The data collected in the workshops were recorded on a field notebook. Results: The selected method helped the participants gain insights the process of illness and healthcare. The workshops resulted in a matrix of recommendations of strategies to orient and monitor immunizations for health workers, including: information on vaccinations recommended for health workers, vaccination status updates and occupational health surveillance. Conclusion: The present study provides grounds for occupational healthcare as concerns the vaccination status of the participants and other health workers. The resulting strategic recommendations aim at improving the vaccination status of health workers and thus reduce the risk of diseases preventable through immunizations, which might be a reason for sickness absenteeism, and even of indefinite sick leave.

A retrospective study on timeliness of vaccination among children aged 0 to 23 months in a rural area of Pondicherry

Background: Immunization is the cost-effective public health intervention that prevents and protects against vaccine preventable diseases. The objective was to estimate the timeliness in receiving age appropriate vaccines and to study selected factors influencing the timeliness of age appropriate vaccines as per national immunization schedule among children aged 0 to 23 months in a rural area of Pondicherry. Methods: A retrospective study was done at a Community Health Centre, Karikalampakkam, Pondicherry using data from immunization registers of children aged 0 to 23 months, who were born between July 01, 2013 to July 31, 2015. If the child was vaccinated within 7 days of the scheduled time, it was considered as timely vaccination. Results: Out of 679 children, 52% were males and 48% were females. The median days of delay in vaccination were ranged from 1-171 days. The proportion and the median days of delay were increased progressively as the age of the child increased. The place of delivery was significantly associated with birth doses of OPV, Hepatitis B and BCG vaccination. There was a significant difference in timeliness of vaccination across the birth order of the children for the first, second and third doses of OPV and Pentavalent vaccines (p=0.02). Birth weight of the children was not statistically associated with vaccination delay. Conclusions: Delay in vaccination in varying frequency was observed for the vaccines administered under the national immunisation schedule. Hence, the age-appropriate vaccinations should be given up-to-date as well as on time.

Human rabies post-exposure prophylaxis relative to the disease epidemiological status / Tratamento antirrábico humano pós-exposição em relação à situação epidemiológica da doença

Abstract This study evaluated the prophylactic measures adopted after attacks by dogs and cats in the main city of Northwester São Paulo State, based on the technical manual for post-exposure treatment, considering the not controlled (1990-1996) and controlled (1997-2010) rabies status. A retrospective analysis was done using the data from the SINAN records (W64-CID10) between 1990 and 2010. In most cases, the accidents were mild (76.9%), and biting animals were healthy (75.4%); therefore, no treatment was needed in 53.3% of the cases. In 64.6% of cases, the prescribed PEP treatment was inappropriate. The most indicated PEP treatments consisted of vaccine and RIG (43.4%), and either three doses of mouse brain vaccine or two doses of cell culture vaccine (76.5%), during the not controlled and controlled rabies periods, respectively. The treatment was more appropriate and followed the technical recommendations during controlled rabies periods compared to not controlled (p < 0.0001) periods. However, excessive application of RIG and rabies vaccine was observed in both periods.

Resumo O objetivo da presente pesquisa foi avaliar a conduta profilática adotada após agressões por cães e gatos no município de Araçatuba, SP, com base no Manual Técnico de Tratamento Antirrábico Humano e considerando-se as situações de raiva não controlada (1990-1996) e controlada (1997-2010). Foi realizada uma análise retrospectiva dos dados das fichas do SINAN (W64-CID10) preenchidas pelo serviço de atendimento antirrábico no período de 1990 a 2010. Na maioria dos casos os acidentes foram leves (76,9%) e os animais agressores estavam sadios (75,4%), resultando em 53,3% de dispensa do tratamento. Em 64,6% dos casos em que houve indicação de tratamento esta foi considerada inadequada. No período de raiva não controlada houve maior indicação do tratamento com vacina e soro (43,4%) e no de raiva controlada o tratamento com três doses de vacina Fuenzalida e Palácios ou duas doses de vacina de cultivo celular (76,5%). No período de raiva controlada as condutas foram mais adequadas, segundo as recomendações técnicas, do que no período de raiva não controlada (p < 0,0001), embora, em ambos os períodos, tenha se observado uma aplicação excessiva de soro e vacina.

Recommended immunization schedule for children and adolescents: Committee on Infectious Diseases of the Korean Pediatric Society, 2018 / 소아과

The Committee on Infectious Diseases of the Korean Pediatric Society recommended immunization schedule for children and adolescents aged 18 years or younger in the 9th (2018) edition of Immunization guideline. This report provides the revised recommendations made by the committee and summarizes several changes from the 2015 guideline. National immunization program (NIP) launched a human papillomavirus (HPV) immunization for girls aged 12 years in 2016. NIP has also expanded age indication for inactivated influenza vaccine (IIV) to 12 years of age in the 2018-2019 season. Quadrivalent IIVs with a full dose (0.5 mL) are approved for all children of 6 months or older. Recommendations of live attenuated influenza vaccine were removed. For inactivated Japanese encephalitis vaccine, first 2 doses are considered as the primary series. Recommendations for use of newly introduced vaccines (diphtheria-tetanus-acellular pertussis/inactivated poliovirus/Haemophilus influenzae type b, 9-valent HPV, new varicella vaccine, new quadrivalent IIV, and attenuated oral typhoid vaccine) were added. Lastly, monitoring system for adverse events following immunization was updated. Other changes can be found in the 9th edition of Immunization guideline in detail.

Incidence of varicella in children in Jeju-do, Korea, 2005–2016: age-period-cohort analysis / 한국역학회지

OBJECTIVES: Although the nationwide inoculation rate of varicella vaccine was approximately 95% in Korean children recently, the number of notified varicella cases is unexpectedly continuously increasing till now. To suggest some hypotheses regarding this discrepancy, an age-period-cohort (APC) analysis as a descriptive epidemiology study was conducted for children residing in Jeju-do, Korea. METHODS: The raw data were obtained from the nationwide database for insurance claim of healthcare fee provided by the National Health Insurance Service, Korea. The selection criteria were children aged 2–13 years who visited any healthcare center due to varicella from 2005 to 2016 while residing in Jeju-do. After calculating the birth cohort-specific crude incidence rates by age and year, the intrinsic estimator method was used to perform the APC analysis. RESULTS: As the annual crude incidence rates decreased with increasing age between 2005 and 2016, the age and period effects also decreased. The intrinsic estimator coefficients suggesting the cohort effect shifted from positive to negative in 2011, the starting year of free varicella vaccine program in Jeju-do. CONCLUSIONS: The results suggested that inoculated varicella vaccines have preventive effects. However, further studies to evaluate waning immunity would be needed.

Incidence of varicella in children in Jeju-do, Korea, 2005–2016: age-period-cohort analysis / 한국역학회지

OBJECTIVES: Although the nationwide inoculation rate of varicella vaccine was approximately 95% in Korean children recently, the number of notified varicella cases is unexpectedly continuously increasing till now. To suggest some hypotheses regarding this discrepancy, an age-period-cohort (APC) analysis as a descriptive epidemiology study was conducted for children residing in Jeju-do, Korea.METHODS: The raw data were obtained from the nationwide database for insurance claim of healthcare fee provided by the National Health Insurance Service, Korea. The selection criteria were children aged 2–13 years who visited any healthcare center due to varicella from 2005 to 2016 while residing in Jeju-do. After calculating the birth cohort-specific crude incidence rates by age and year, the intrinsic estimator method was used to perform the APC analysis.RESULTS: As the annual crude incidence rates decreased with increasing age between 2005 and 2016, the age and period effects also decreased. The intrinsic estimator coefficients suggesting the cohort effect shifted from positive to negative in 2011, the starting year of free varicella vaccine program in Jeju-do.CONCLUSIONS: The results suggested that inoculated varicella vaccines have preventive effects. However, further studies to evaluate waning immunity would be needed.