Vacunas antineumocócicas conjugadas: una revisión de las consideraciones éticas e impacto socio-económico / Pneumococcal conjugate vaccines: a review of ethical considerations and socio-economic impact

Introducción: Desde hace más de 15 años, las vacunas antineumocócicas conjugadas (PCVs) están disponibles en muchas partes del mundo, y son efectivas en la prevención de las enfermedades neumocócicas en niños. La OMS recomienda la inclusión de las PCVs en los programas de inmunización infantil en todo el mundo. Objetivo: Valorar el abordaje ético y el impacto socioeconómico de las vacunas antineumocócicas conjugadas para la decisión de uso en diferentes contextos. Material y Métodos: Se realizó una búsqueda bibliográfica en las bases de datos PubMed y SciELO, considerando informes de la web de la OMS. Desarrollo: Está globalmente considerado que para la reglamentación, el desarrollo y el uso de las PCVs，se deben tener en cuenta aspectos regulatorios, resultados de investigaciones y el consentimiento informado (CI) de los sujetos. En el contexto de países como China，la PCV13 de la empresa Pfizer es de la Clase II debido a su alto precio de importación, en otros contextos como Cuba no se ha introducido la vacunación contra neumococo por limitaciones financieras. Los equipos de investigación trabajan en el desarrollo de las PCVs para reducir el coste de la importación de estas vacunas, haciendo realidad la inclusión de las PCVs en el programa nacional de inmunización. A pesar de complejidad cada vez mayor de la investigación vacunológica, los investigadores seguirán obligados a adherirse a los principios éticos. Conclusiones: Es necesario una vacuna antineumocócica conjugada más económica para tener un impacto socio-económico más alto. Los profesionales sanitarios tienen la obligación de ser éticos y rigurosos en las investigaciones vacunológicas. Además, estas investigaciones requieren de la revisión por parte de un consejo de revisión ética a escala nacional y su seguimiento debe ser sistemático. Cabe señalar que los estudios en población infantil deben ser fuertemente regulados y controlados(AU)

Introduction: Pneumococcal conjugate vaccines (PCVs) have been available in many parts of the world for more than 15 years and are effective in preventing pneumococcal diseases in children. The WHO recommends the inclusion of PCVs in childhood immunization programmes worldwide. Objective: To value the approach to ethics and the socioeconomic impact of the conjugate pneumococcal vaccines. Material and Methods: A bibliographic review was carried out in databases such as PubMed and SciELO, considering reports from the WHO website. Development: It is globally considered that regulatory aspects, research results and informed consent (IC) of the subjects should be taken into account for the regulation, development and use of PCVs. In the context of countries such as China，the PCV13 of the Pfizer company is Class II due to its high import price. In other contexts, such as Cuba, pneumococcal vaccination has not been introduced due to financial limitations. Research teams are working on the development of PCVs to reduce the cost of importing these vaccines, making the inclusion of PCVs in the national immunization program a reality. Despite the increasing complexity of vaccinology research, researchers will continue to be obliged to adhere to ethical principles. Conclusions: A cheaper pneumococcal conjugate vaccine would be needed to have a higher socioeconomic impact. Healthcare professionals have the obligation to be ethical and rigorous in vaccinology research. In addition, such research requires review by a national ethical review board and should be systematically monitored. It should be noted that studies in the pediatric population should be strongly regulated and controlled(AU)

Implantes cocleares: aspectos tecnológicos e papel socioeconômico / Cochlear implants: technological aspects and socioeconomic role

INTRODUÇÃO: O grande número de deficientes auditivos faz da perda auditiva um sério problema social, econômico e de saúde pública. Próteses auditivas e implantes cocleares representam os principais dispositivos utilizados como paliativos por pessoas com deficiência auditiva, sendo que os implantes cocleares são muitas vezes a única opção nos casos de deficiência auditiva severa e profunda. Nesse artigo discute-se de maneira geral os diferentes aspectos envolvendo implantes cocleares, tanto de âmbito tecnológico como seu papel socioeconômico. MÉTODOS: Baseado em dados do SUS, IBGE e outras fontes, um levantamento qualitativo e quantitativo é feito pela primeira vez especificamente para a população brasileira. O artigo discute ainda o estado da arte das tecnologias envolvidas no implante coclear, com base em literatura científica e informações de fabricantes, bem como as perspectivas para as próximas gerações de implantes cocleares. CONCLUSÃO: Há potencial e demanda para evoluções nos implantes atuais. A implantação precoce é benéfica para pacientes e sociedade, compensando os custos econômica e socialmente. No entanto, as políticas públicas de reabilitação necessitam se adequar para atender com eficácia à crescente população afetada pela deficiência auditiva.

INTRODUCTION: Due to the great number of affected people, hearing loss is considered a serious social, economic and public health problem. Hearing aids and cochlear implants are the primary devices used as palliatives for people with hearing loss, and cochlear implants are often the only option in cases of severe to profound hearing impairment. This paper covers both technological and socio-economic aspects of cochlear implant, which is considered as one of most recommended treatments to alleviate severe to profound hearing loss. METHODS: Brazilian unified health system data is used to display qualitative and quantitative analysis impact on Brazilian population and government. A state-of-art review based on scientific literature and manufacturer data is provided, as well as perspectives for the next cochlear implant generation. CONCLUSION: There is potential and demand for evolutions in current implants. Early implantation is beneficial for patients and society, compensating the costs economic and socially. However, public programs need to adapt in order to efficiently attend the increasing affected population.