Boosting COVID-19 vaccine inoculation and booster shots: a systematic review and meta-analysis of factors that influence coronavirus vaccine uptake in practice

Introduction: Vaccines alone do not control pandemics, but vaccinations. The hope of COVID-19 pandemic control is hinged on vaccinations and other public health measures. This systematic review/meta-analysis (SR/MA) investigated the factors that inform coronavirus vaccine uptake globally in an attempt to improve COVID-19 immunization. Method: The PRISMA 2020 methodology was used for this review. A total of 2902 articles were identified from electronic databases and other sources. After screening, 33 articles were included in the review and quantitative meta-analysis. Comprehensive meta-analysis software version 3 was used for the meta-analysis. Results: We observed that vaccine effectiveness, side effects and the proportion of acquaintances vaccinated significantly influenced respondents' COVID-19 immunization decision. Also, associations of vaccine effectiveness, smaller risks to serious side effects, free and voluntary vaccinations and fewer vaccine doses, and longer duration to wanning were observed. We also observed variations in vaccine hesitancy trends in studies carried out in Asia, Europe, America, and Africa. Conclusion: Wanning and acquaintance's vaccination status as factors to vaccination are insights the present paper is bringing to the limelight. Health promotion and COVID-19 vaccination planning are crucial for enhancing vaccine uptake

Deaths, infections, and herd immunity in the COVID-19 pandemic: A comparative study of the strategies for disease containment implemented in Peru and the United Kingdom / Muertes, infecciones e inmunidad de rebaño en la pandemia por COVID-19: un estudio comparativo de las estrategias de control de la pandemia implementadas en Perú y Reino Unido

Abstract Introduction: In light of the threat posed by the COVID-19 pandemic, most countries have implemented several containment and prevention measures to slow down the rapid spread of the disease. Objectives: To compare the COVID-19 pandemic containment strategies implemented in Peru [World Health Organization (WHO) - confinement and social distancing] and the United Kingdom [herd immunity (HI)] in terms of morbidity and mortality, and to simulate the implementation of HI in Peru during the initial stage of the pandemic. Materials and methods: Exploratory study with a simulation model based on official data obtained from both countries at the beginning of the pandemic. Mortality, case fatality, and infection rates documented within the first 55 days after the first COVID-19 case report in the United Kingdom and the start of the WHO-recommended containment and prevention strategy implementation in Peru were evaluated. Additionally, the impact of applying HI, according to WHO guidelines, as the initial strategy in Peru was simulated. The Paired-samples t-test was used to determine the differences between the two strategies at both stages of the study. Results: During the follow-up period, 15 034 and 33 931 COVID-19 cases were reported in the United Kingdom and Peru, respectively. The case fatality rate was higher in the United Kingdom (7.82% vs. 2.74%), while the cumulative mortality rate was higher in Peru (2.89 vs. 1.74x100 000 inhabitants p= 0.0001). Regarding the simulation, a minimum critical population of 60% (>19 million positive cases) was established for Peru to achieve HI, with 1 223 473.1 deaths and a hospitalization rate of 44 770x100 000 patients. Conclusions: During the follow-up period (55 days), the United Kingdom's strategy resulted in a higher case fatality rate, while the Peruvian strategy in over twice as many COVID-19 cases. The HI simulation strategy in Peru showed a sharp increase in all unfavorable indicators of the pandemic.

Resumen Introducción. Ante la amenaza de la pandemia por COVID-19, la mayoría de los países han establecido diversas medidas de control y prevención para disminuir la rápida propagación de esta enfermedad. Objetivos. Comparar las estrategias de control de la pandemia por COVID-19 implementadas en Perú (de confinamiento y distanciamiento social de la Organización Mundial de la Salud (OMS)) y Reino Unido (de inmunidad de rebaño (IR)) en términos de morbimortalidad, y simular la implementación de la IR en Perú durante la etapa inicial de la pandemia. Materiales y métodos. Estudio exploratorio con un modelo de simulación basado en datos oficiales de ambos países registrados al inicio de la pandemia. Se evaluaron las tasas de mortalidad, letalidad e infección en Reino Unido (IR) y Perú (confinamiento y distanciamiento social) dentro de los 55 días posteriores al reporte del primer caso de COVID-19 en Reino Unido y al inicio de la implementación de la estrategia de control y prevención recomendada por la OMS en Perú. Además, se simuló el impacto de haber aplicado la IR, según pautas de la OMS, como estrategia inicial en Perú. Se utilizó la prueba t-Student para muestras relacionadas para determinar las diferencias entre ambas estrategias en las dos etapas del estudio. Resultados. En el periodo de seguimiento se registraron 15 034 y 33 931 casos de COVID-19 en Reino Unido y Perú, respectivamente. La tasa de letalidad fue mayor para Reino Unido (7.82% vs. 2.74%), y la tasa de mortalidad acumulada fue mayor en Perú (2.89 vs. 1.74x100 000 habitantes; p=0.0001). Respecto a la simulación, se estableció una población crítica mínima de 60% (>19 millones de casos positivos) para que Perú logre la IR, con 1 223 473.1 muertes y una tasa de hospitalización de 44 770x100 000 pacientes. Conclusiones. Durante el periodo de seguimiento (55 días), la estrategia de Reino Unido resultó en una mayor letalidad y la peruana, en más del doble de casos de COVID-19. La simulación de la IR en Perú mostró un dramático incremento de todos los indicadores desfavorables de la pandemia.

Cultura de rebaño e inmunidad de rebaño / Herd culture and herd immunity

Resumen Aunque las enfermedades transmisibles afectan nuestros cuerpos, ocurren en una sociedad que las interpreta y dota de significado, y cuyos individuos causan o evitan. La inmunidad de rebaño permite lograr una protección del cuerpo, sin embargo, para su sustentabilidad, se requiere de cambios en la manera cómo las personas interpretan y responden a la enfermedad, de transformaciones culturales que permitan desarrollar conocimientos, hábitos y destrezas que hagan factible y sostenible la inmunidad de rebaño. La cultura de rebaño permite a los individuos protegerse y restringir su libertad para proteger a los demás, es una forma de ejercicio de la libertad positiva y el complemento necesario de la inmunidad del rebaño en la sociedad democrática.

Abstract Although communicable diseases affect our bodies, they occur in a society that interprets and gives them meaning. Herd immunity provides the body protection; however, long-term protection requires shifts in the way people interpret and respond to disease, cultural transformation that enables the development of the knowledge, habits and skills that make herd immunity feasible and sustainable. Herd culture allows individuals to protect themselves and restrict their liberty in order to protect others; it is a form of exercising positive liberty and a necessary complement to herd immunity in a democratic society.

Covid-19 Morbidity amongst Covishield Vaccinated Vs Non-Vaccinated: A Comparative Study

Introduction: Covid-19 pandemic is further spreading its leg in India. Indigenous Covishield vaccination drive was started to protect people from the disease. Objective: This observational cross sectional study was conducted to assess the morbidity and mortality pattern amongst Covishield vaccinated people Vs non-vaccinated patients of covid19. Methodology: This observation study was conducted in a dedicated covid-19 hospital. All RTPCR covid-19 patients were included. The data on vaccination against covid-19 amongst the patients was obtained, and analysed using statistical software. Results: The study population comprised of 155 cases of confirmed covid-19 patients of which 24 (15.48%) were fully vaccinated, however 41 (26.45%) and 90 (58.06%) were partially and non-vaccinated respectively. Fully vaccinated people were protected from development of severe form of disease (X2=9.57, d.f=2, p=0.0083). Mortality was significantly less amongst vaccinated group (X2=4.83, d.f=1, p= 0.028). Conclusion: Patients who are completely vaccinated with Covishield vaccine are protected from development of severe form of diseases and deaths and hence mass vaccination of Indian population to overcome the pandemic is required at the earliest.

Evaluation of the direct and indirect impact on pneumonia hospitalization after almost a decade of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine in Brazil

Introduction: Pneumococcal pneumonia is a leading cause of severe disease, leading to approximately 2.2 million hospital admissions in 2019 in Brazil. Since 2010, the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine was introduced in Brazil, as part of the National Immunization Program (NIP) with universal access, approximated coverage of 91.4% in 2019. Although studies from many countries are available, there is still a need to understand the effect of the vaccine introduction on the incidence of pneumonia hospitalizations in Brazil.Methods: Data on hospitalization associated with the diagnosis of pneumonia in the population assisted by the Brazilian Public Health System were accessed to fit a time series analysis, which tested the main hypothesis of the influence of vaccination on the trends for the incidence of pneumonia hospitalizations.Results: The post-vaccination period showed a negative trend, reducing 1.75, 0.16, and 0.11 cases per 100,000 inhabitants per month for the groups < 1, 1­4, and 5­9 years old, respectively. In individuals older than 20 years, the post-vaccination period has a positive trend, but not as great as compared trends before the vaccination period. These results indicate a protective herd effect in the older population, nine years after introducing the pneumococcal vaccine in the NIP.Conclusion: Vaccination with pneumococcal conjugated vaccine reduces hospitalizations associated with pneumonia diagnosis in vaccinated and non-vaccinated populations in a sustained and progressive manner.

Revisión del concepto de inmunidad poblacional, a propósito de la epidemia COVID-19 y del desarrollo de vacunas / Review of the concept of herd immunity, in the context of COVID-19 epidemic and the development of vaccines

Resumen Se revisa brevemente el concepto de inmunidad de grupo, poblacional o efecto "rebaño", mostrando que algunas ideas popularizadas no corresponden al concepto original. Se establece la relación con los números reproductivo básico y efectivo, enfatizándose que el umbral para el efecto rebaño no indica el número de individuos que se contagiarán en una epidemia. Se establece la relación con el umbral de vacunación efectiva y su relación con la efectividad de la vacuna. Se analiza el efecto reductor del umbral de inmunidad de rebaño producido por la heterogeneidad de transmisión y mezcla en la población y la existencia de subpoblaciones aisladas lo que podría llegar a ser importante y que podría explicar los bajos niveles de seroprevalencia post-epidemia de algunos lugares, ayudando a mitigar nuevos brotes.

Abstract The concept of herd immunity is briefly reviewed, showing that some popularized ideas do not correspond to the original concept. The relationship with the basic and effective reproductive numbers is established. It is pointed out that the threshold for the herd effect does not indicate the number of individuals that will be infected in an epidemic. The relationship with the effective vaccination threshold and its relationship with the effectiveness of the vaccine are established. The reducing effect of the herd immunity threshold produced by the heterogeneity of transmission and mixing in the population and the existence of isolated subpopulations are analyzed, which could be important and could explain the low levels of post-epidemic seroprevalence in some places helping to mitigate new outbreaks.

The ecology of herd immunity

The COVID-19 pandemic that began in early 2020 is currently the subject of thousands of articles on the various aspects of its epidemiology. One recurrent theme is the phenomenon of herd immunity or herd effect. In this article, I present a short history of the concept, the arguments around its nomenclature, and the ecologist's view of the herd effect, using the case history of the sleeping sickness control in Africa.

COVID-19 rhapsody:Rage towards advanced diagnostics and therapeutic strategy / 药物分析学报

The deadly global outbreak of coronavirus disease-2019(COVID-19)has forged an unrivaled threat to human civilization.Contemplating its profuse impact,initial risk management and therapies are needed,as well as rapid detection strategies alongside treatments with existing drugs or traditional treatments to provide better clinical support for critical patients.Conventional detection techniques have been considered but do not sufficiently meet the current challenges of effective COVID-19 diagnosis.Therefore,several modern techniques including point-of-care diagnosis with a biosensor,clustered regularly interspaced short palindromic repeats(CRISPR)-associated proteins that function as nuclease(Cas)technology,next-generation sequencing,serological,digital,and imaging approaches have delivered improved and noteworthy success compared to that using traditional strategies.Conventional drug treatment,plasma therapy,and vaccine development are also ongoing.However,alternative medicines including Ayurveda,herbal drugs,homeopathy,and Unani have also been enlisted as prominent treat-ment strategies for developing herd immunity and physical defenses against COVID-19.All considered,this review can help develop rapid and simplified diagnostic strategies,as well as advanced evidence-based modern therapeutic approaches that will aid in combating the global pandemic.

Estimated prevalence of COVID-19 in Brazil with probabilistic bias correction / Prevalência estimada de COVID-19 no Brasil com correção probabilística de vieses / Prevalencia estimada de COVID-19 en Brasil con corrección probabilística de sesgo

Abstract: Using data collected by the Brazilian National Household Sample Survey - COVID-19 (PNAD-COVID19) and semi-Bayesian modelling developed by Wu et al., we have estimated the effect of underreporting of COVID-19 cases in Brazil as of December 2020. The total number of infected individuals is about 3 to 8 times the number of cases reported, depending on the state. Confirmed cases are at 3.1% of the total population and our estimate of total cases is at almost 15% of the approximately 212 million Brazilians as of 2020. The method we adopted from Wu et al., with slight modifications in prior specifications, applies bias corrections to account for incomplete testing and imperfect test accuracy. Our estimates, which are comparable to results obtained by Wu et al. for the United States, indicate that projections from compartmental models (such as SEIR models) tend to overestimate the number of infections and that there is considerable regional heterogeneity (results are presented by state).

Resumo: Estimamos o efeito da subnotificação de casos de COVID-19 no Brasil até dezembro de 2020, com base nos dados coletados pela Pesquisa Nacional de Amostra de Domicílios sobre COVID-19 (PNAD-COVID19) e a modelagem semi-bayesiana desenvolvida por Wu et al. O número total de indivíduos infectados é cerca de 3 a 8 vezes o número de casos notificados, a depender do estado do país. No final de 2020, os casos confirmados representavam 3,1% da população total, enquanto nossa estimativa aponta para quase 15% dos cerca de 212 milhões de brasileiros no mesmo período. O método de Wu et al., que adotamos com pequenas modificações nas especificações, aplica correções de vieses para compensar pela testagem incompleta e pela acurácia imperfeita dos testes. Nossas estimativas, que são comparáveis aos resultados obtidos por Wu et al. para os Estados Unidos, indicam que projeções a partir de modelos compartimentais (tais como modelos SEIR) tendem a superestimar o número de infecções, e que há uma heterogeneidade regional considerável (resultados apresentados por estado).

Resumen: Usando los datos recogidos por la Encuesta Nacional por Muestra de Domicilios - COVID-19 (PNAD-COVID19) y un modelado semibayesiano desarrollado por Wu et al., hemos estimado el efecto del subregistro de casos de COVID-19 en Brasil en diciembre de 2020. El número total de individuos infectados es de entre 3 a 8 veces más el número de casos informados, dependiendo del estado. Los casos confirmados son un 3,1% del total de población y nuestra estimación del total de casos es al menos un 15% de aproximadamente 212 millones de brasileños en 2020. El método que se tomó fue el de Wu et al., con leves modificaciones en las especificaciones previas, es aplicable a las correcciones de sesgo para tener en cuenta los test incompletos y la imprecisión de los tests. Nuestras estimaciones, que son comparables a los resultados obtenidos por Wu et al. para los Estados Unidos, indican las proyecciones de los modelos compartimentales (tales como los modelos SEIR), que tienden a sobreestimar el número de infecciones, así como la considerable heterogeneidad regional (los resultados se presentan por estado).

Covid-19: a catástrofe latino-americana, entre a caça e a imaginação / Covid-19: the Latin American catastrophe between the hunting and the imagination / Covid-19: la catástrofe latinoamericana, entre la caza y la imaginación

Esta nota expõe um breve balanço da história da pandemia de Covid após sete meses de crise. Com esse objetivo, apreendemos três grandes tendências: o impacto letal do negacionismo em países como os Estados Unidos e o Brasil; a chegada da segunda onda na Europa e, enfim, a catástrofe nos países latinoamericanos onde os indicadores pioram em todos eles independentemente das políticas de contenção que foram implementadas desde o mês de março de 2020. Para a discussão dessas três tendências, elaboramos três momentos de reflexão de maior fôlego: a clivagem que separa os modelos de gestão da pandemia na Ásia no Ocidente; a necessidade de uma política social (como o auxílio emergencial) para tornar viáveis as políticas sanitárias na América Latina; e, enfim, uma reflexão mais geral sobre a relação entre as catástrofes e a imaginação.

This paper presents a brief analysis of the history concerning Covid pandemic after its beginning seven months ago. In pursuing this purpose we realised three major trends: the lethal impact of denialism in countries such as United States and Brazil; the arrival of the second wave of coronavirus in Europe; and finally, the Latin American catastrophe where the indicators of people affected by disease worsen in all their countries regardless of the policies to restrain it implemented since March 2020. To discuss these three trends, we have deepened three reflections: the cleavage between the management model of the pandemic in Asia and the Western management model; the need for a social policy (such as an emergency financial aid) to make health policies viable in Latin America; and at last a general reflection on the relationship between the catastrophes and the imagination.

Esta nota expone un breve análisis de la historia de la pandemia de Covid después de siete meses de crisis. Intentando alcanzar este propósito, hemos distinguido tres grandes tendencias: el impacto letal del negacionismo en países como Estados Unidos y Brasil; la llegada de la segunda ola a Europa; y finalmente la catástrofe latinoamericana donde los indicadores del contagio empeoraron en todos los países independiente de las políticas de contención implementadas desde marzo de 2020. Para discutir estas tres tendencias, hemos profundizado tres reflexiones: la diferencia entre el modelo de gestión de la pandemia en Asia y el modelo implementado en Occidente; la necesidad de una política social (como lo auxilio financiero de emergencia) para hacer viables las políticas de salud en Latinoamérica; y por último una reflexión de forma más general sobre la relación entre las catástrofes y la imaginación.

Estimación del número reproductivo efectivo del brote de sarampión 2018-2019 en Chile / Estimation of the effective reproduction number of measles 2018-2019 in Chile

Resumen Introducción: Los casos de sarampión están resurgiendo en muchos países del mundo. Hubo un brote de sarampión importado entre noviembre de 2018 y febrero de 2019 en Chile, lo que generó preocupación entre el público y las autoridades sanitarias. Muchos se preocuparon por la tasa de inmunización contra el sarampión de la población, un factor que se relaciona con la capacidad reproductiva del virus (medida de transmisibilidad de un patógeno). Objetivo: Aquí estimamos el número reproductivo efectivo (Re) de este brote de sarampión. Resultados: Aunque la estimación tiene mucha incertidumbre por el bajo número de casos y la ausencia de mezcla homogénea de la población, encontramos que Re fue aproximadamente 1,5. Discusión y Conclusiones: En consecuencia estimamos que aproximadamente 90,3% de la población tiene inmunidad al sarampión, lo que coincide con las estimaciones del Ministerio de Salud. Estos resultados sugieren que la población chilena ha establecido la inmunidad colectiva contra la introducción de casos importados de sarampión, lo que refleja un manejo preventivo adecuado de esta enfermedad.

Abstract Background: Measles cases are reemerging in many countries across the globe. There was an outbreak of imported measles between November 2018 and February 2019 in Chile, raising concern among the public and health authorities. Many were worried about the Chilean measles herd immunity, a factor that relates to the reproductive capacity of the virus (measure of transmissibility of a pathogen). Aim: Here we estimate the effective reproductive number (Re) of this measles outbreak. Results: Although the estimate is highly uncertain due to the low number of cases and the absence of homogeneous mixing of the population, we found Re was approximately 1.5. Discussion and Conclusions: Consequently we estimated about 90,3 % had measles immunity, consistent with administrative estimates from the Ministry of Health. These results suggest the Chilean population has established herd immunity against the introduction of imported measles cases, reflecting adequate preventive management of this disease.

Understanding the COVID-19 prevention and control strategies and their appropriate applicability through the basics of epidemiology

The current article is about the background knowledge of corona, various epidemiological definitions and different strategies adopted to prevent and control corona infection. How the preventive measures are applied and what is epidemiological basis behind these measures is the core of the article. The article also mentioned the variations in mortality pattern and goes on defining important indicators as case-fatality ratio, deaths/1 lakh population and the relevance of both in the current situation of corona infection. In the article, important terms such as different types of cases in corona infection, basic reproduction number, effective reproduction number, and their epidemiological significance in corona infection, herd immunity, and herd immunity threshold are discussed. The importance of lockdown as a preventive measure, enforcement of epidemic disease act 1897 and its amendment, disaster management act 2005, social distancing, cough etiquette, and others are highlighted.

Posición del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología en relación a los cuestionamientos de las vacunas y su obligatoriedad / Statement from the Immunization Committee of the Chilean Infectious Diseases Society in reference to vaccine refusal and mandatory policy on vaccination

Resumen: A pesar del enorme impacto de las vacunas en la salud de la población, estas han sido y son objeto de cuestionamientos por grupos que las consideran innecesarias o inseguras y argumentan que las personas tienen el derecho a decidir sobre si estas deben ser administradas o no. Sin embargo el uso de vacunas tiene connotaciones distintas a otras decisiones en salud, ya que no vacunar impacta no solo al individuo, sino también a la comunidad que lo rodea. El inmunizar a un alto porcentaje de la población permite limitar la circulación de los agentes infecciosos, logrando la llamada inmunidad comunitaria que protege a los no vacunados por razones médicas o porque son muy pequeños. Por esta razón muchos países han definido las vacunas como obligatorias. Como Comité Consultivo de Inmunizaciones nos parece que esta estrategia es correcta sin embargo debe ser acompañada por una política de educación de la población y personal de salud sobre los beneficios y riesgos reales de las va cunas. Así mismo es necesario introducir mejoras en el sistema de notificación de reacciones adversas a vacunas haciéndolo más accesible. Adicionalmente se debe dar respuesta oportuna a los afectados por supuestas o reales reacciones a vacunas y en los casos de eventos adversos graves efectivamente asociados a vacunas. Entregar cobertura económica y acompañamiento. Finalmente es esencial la coordinación entre los diferentes actores y comunicadores para transmitir mensajes que generen confianza y respondan a las inquietudes de la población de hoy en día.

Abstract: Although vaccines have had a tremendous impact in public health they are questioned by certain groups that consider them unnecessary or unsafe and argue in favor of the right to decide to be vacci nated or not. However vaccines must have special considerations because unlike other medical deci sions, not vaccinating has consequences not only for the individual but also for other members of the community. Immunizing a high proportion of the population limits the circulation of an infectious agent attaining what is called community or herd immunity that protects the susceptible members of the group. For this reason many countries consider vaccination mandatory as a responsibility of every citizen. This committee agrees with this view but thinks other strategies should be implemented as well, such as special educational efforts for the public and parents addressing benefits and real risks of vaccinating. Also health care professionals should be trained in vaccines. The notification system for adverse events currently available should be improved and be more accessible. Persons truly affected by adverse events due to vaccination should receive on time responses and be offered psychological and financial support. Finally all stakeholders should make coordinated efforts to work together to deliver messages that answer concerns on vaccines and bring confidence back to the public.

Colonización nasofaríngea por serotipos de Streptococcus pneumoniae en niños uruguayos antes y después de la introducción de las vacunas antineumocóccicas conjugadas / Nasopharyngeal colonization from Streptococcus pneumoniae serotypes in Uruguayan children before and after pneumococcal conjugate vaccines / Colonização nasofaríngea por sorotipos de Streptococcus pneumoniae em crianças uruguaias antes e após da introdução de vacinas pneumocócicas conjugadas

Resumen: Las vacunas conjugadas neumocóccicas (VCN) son efectivas para el control de las infecciones severas en niños y también limitan la colonización nasofaríngea por los serotipos que integran sus fórmulas. En Uruguay, no se dispone de publicaciones recientes sobre los serotipos albergados en el reservorio nasofaríngeo de los niños, ni antes ni luego de la introducción de las VCN. Con el objetivo de caracterizar la colonización nasofaríngea de niños menores de 2 años y describir los serotipos de S. pneumoniae identificados antes y después de la introducción de las vacunas conjugadas antineumocóccicas en el certificado esquema de vacunación (CEV) de Uruguay, se llevó a cabo un estudio descriptivo, retrospectivo, incluyendo tres períodos de tiempo: años 2002- 2003 y 2014-2015 en Paysandú, y 2012-2013 en Montevideo. Los aislamientos de S. pneumoniae se realizaron en laboratorios locales y la serotipificación por "quellung" se efectuó en el Departamento de Laboratorios de Salud Pública. Se procesaron 831 muestras, con 54,8% de recuperación de neumococos (n=456), de los cuales 223 fueron tipificados. El estudio previo a la vacunación mostró portación de serotipos invasores, con predominio de los serotipos 6A, 6B, 14 y 19F, todos incluidos en la vacuna 13-valente. En los niños de la policlínica de HIV, la colonización por neumococos invasores fue mucho menor, y el otro estudio, también posvacunación, evidenció la casi desaparición de cepas invasoras (6/93), con predominio de serotipos poco habituales, lo que constituyó un llamado de atención para instrumentar una vigilancia que monitorice la dinámica de la colonización infantil.

Summary: Pneumococcal conjugate vaccines (PCV) are effective against children's severe infections and they also constrain nasopharyngeal colonization due to the serotypes in their formulas. There are no recent publications in Uruguay regarding serotypes hosted in the children's nasopharyngeal reservoir, either from before or after the introduction of the PCV. With the purpose of characterizing nasopharyngeal colonization of children under 2 years of age and describing the S. pneumoniae serotypes before and after the pneumococcal conjugate vaccines in the Uruguayan National Vaccination Report, we carried out a descriptive retrospective study including three periods: 2002- 2003 and 2014-2015 in Paysandú, and 2012-2013 in Montevideo. S. pneumoniae was isolated in local laboratories and the "quellung" serotypification was carried out in the Laboratories of the Public Health Department. We processed 831 samples and recovered 54.8% pneumococci (n=456), of which 223 were typified. Prior to the vaccination, the study showed invasive serotype carriage, mainly of the 6A, 6B, 14 and 19F serotypes, all included in the 13-valent vaccine. At the HIV clinic, colonization from invasive pneumococci was much lower and the post vaccination study showed the almost complete disappearance of the invasive strains (6/93), mainly of the less common serotypes, which called the attention towards the increase of vigilance towards the monitoring of children colonization dynamics.

Resumo: As Vacinas Pneumocócicas Conjugadas (VPC) são eficazes contra infecções graves em crianças e também restringem a colonização nasofaríngea, devido aos sorotipos utilizados em suas fórmulas. Não há publicações recentes no Uruguai relativas aos sorotipos que incluem reservatório nasofaringeos nas crianças, nem de antes ou depois das vacinas VPN. Com o objetivo de caracterizar a colonização nasofaríngea de crianças menores de 2 anos de idade e descrevendo os sorotipos S. pneumoniae antes e depois das vacinas antipneumocócicas conjugadas no Relatório Nacional de Vacinação do Uruguai, realizou-se um estudo retrospectivo descritivo, incluindo três períodos: 2002- 2003 e 2014-2015 em Paysandú e 2012-2013 em Montevideo. S. pneumoniae foi isolada em laboratórios locais e a soro tipificação "quellung" foi realizada nos Laboratórios do Departamento de Saúde Pública. Foram processadas 831 amostras e recuperado 54,8% de pneumococo (n = 456), dos quais 223 foram tipificados. Antes da vacinação, o estudo mostrou transporte de sorotipos invasores, principalmente dos sorotipos 6A, 6B, 14, 19F, todos incluídos na vacina 13-valente. Na clínica de HIV, a colonização invasiva de pneumococos foi muito menor, e o estudo pós-vacinação mostrou o desaparecimento quase total das cepas invasivas (6/93), principalmente dos sorotipos menos comuns, o que sugere a necessidade de aumentar a vigilância no monitoramento da dinâmica de colonização de crianças.

Progress in assessment of vaccine on herd protection / 中华流行病学杂志

The importance of vaccine on public health is related to the herd protection related to the levels of vaccine coverage,which directly influences the vaccinated individuals as well as the unvaccinated community.Reaching the level of herd protection by increasing vaccine coverage is the basic strategy to eradicate related infectious diseases.Again,herd protection has played an important role in public health practices.With the increasing interests in estimating the vaccine herd protection,we however,have seen only few relevant papers including observational population-based and cluster-randomized clinical trials reported in China.We hope to discuss the study designs for evaluating the vaccine herd protection in order to generate evidence-based related research in this field.

Progress in assessment of vaccine on herd protection / 中华流行病学杂志

The importance of vaccine on public health is related to the herd protection related to the levels of vaccine coverage,which directly influences the vaccinated individuals as well as the unvaccinated community.Reaching the level of herd protection by increasing vaccine coverage is the basic strategy to eradicate related infectious diseases.Again,herd protection has played an important role in public health practices.With the increasing interests in estimating the vaccine herd protection,we however,have seen only few relevant papers including observational population-based and cluster-randomized clinical trials reported in China.We hope to discuss the study designs for evaluating the vaccine herd protection in order to generate evidence-based related research in this field.

Acute porcine reproductive and respiratory syndrome outbreaksin immunized sow herds: from occurrence to stabilization under whole herd vaccination strategy / 대한수의학회지

Outbreaks of porcine reproductive and respiratory syndrome virus (PRRSV) in vaccinated sow herds from occurrence to stabilization were monitored and analyzed in terms of serology and reproductive performance. Three different conventional pig farms experienced severe reproductive failures with the introduction of a type 1 PRRSV. These farms had adopted mass vaccination of sows using a type 2 PRRSV modified live vaccine (MLV). Therefore, to control the type 1 PRRSV, an alternative vaccination program utilizing both type 1 and type 2 MLV was undertaken. Following whole herd vaccinations with both types of MLV, successful stabilization of PRRS outbreaks was identified based on serological data (no viremia and downward trends in ELISA antibody titers in both sows and suckling piglets) and recovery of reproductive performance. Additionally, through comparison of the reproductive parameters between outbreak and non-outbreak periods, it was identified that PRRSV significantly affected the farrowing rate and the number of suckling piglets per litter at all three pig farms. Comparison of reproductive parameters between periods when the different vaccination strategies were applied revealed that the number of piglets born in total and born dead per litter were significantly increased after the introduction of the type 1 PRRS MLV.

Declaración del Comité Consultivo de Inmunizaciones de Sociedad Chilena de Infectología en relación a los cuestionamientos de las vacunas y su obligatoriedad / Statement from the Immunization Committee of the Chilean Infectious Diseases Society in reference to vaccine refusal and mandatory policy on vaccination

Resumen A pesar del enorme impacto de las vacunas en la salud de la población, éstas han sido y son objeto de cuestionamientos por grupos que las consideran innecesarias o inseguras y argumentan que las personas tienen el derecho a decidir sobre si éstas deben ser administradas o no. Sin embargo, el uso de vacunas tiene connotaciones distintas a otras decisiones en salud, ya que no vacunar impacta no sólo al individuo, sino también a la comunidad que lo rodea. El inmunizar a un alto porcentaje de la población permite limitar la circulación de los agentes infecciosos, logrando la llamada inmunidad comunitaria que protege a los no vacunados por razones médicas o porque son muy pequeños. Por esta razón muchos países han definido las vacunas como obligatorias. Como Comité Consultivo de Inmunizaciones nos parece que esta estrategia es correcta; sin embargo, debe ser acompañada por una política de educación de la población y personal de salud sobre los beneficios y riesgos reales de las vacunas. Así mismo es necesario introducir mejoras en el sistema de notificación de reacciones adversas a vacunas haciéndolo más accesible. Adicionalmente, se debe dar respuesta oportuna a los afectados por supuestas o reales reacciones a vacunas, y en los casos de eventos adversos graves efectivamente asociados a vacunas. entregar cobertura económica y acompañamiento. Finalmente, es esencial la coordinación entre los diferentes actores y comunicadores para transmitir mensajes que generen confianza y respondan a las inquietudes de la población de hoy en día.

Although vaccines have had a tremendous impact in public health they are questioned by certain groups that consider them unnecessary or unsafe and argue in favor of the right to decide to be vaccinated or not. However vaccines must have special considerations because unlike other medical decisions, not vaccinating has consequences not only for the individual but also for other members of the community. Immunizing a high proportion of the population limits the circulation of an infectious agent attaining what is called herd immunity that protects the susceptible members of the group. For this reason many countries consider vaccination mandatory as a responsibility of every citizen. This committee agrees with this view but thinks other strategies should be implemented as well, such as special educational efforts for the public and parents addressing benefits and real risks of vaccinating. Also health care professionals should be trained in vaccines. The notification system for adverse events currently available should be improved and be more accessible. Persons truly affected by adverse events due to vaccination should receive on time responses and be offered psychological and financial support. Finally all stakeholders should make coordinated efforts to work together to deliver messages that answer concerns on vaccines and bring confidence back to the public.

Enfermedad neumoccócica invasora en recién nacidos, antes y después de la vacunación universal con vacuna conjugada 7 y 13 valente en Uruguay / Pneumococcal invasive disease in newborns before and after 7-valent and 13-valent universal pneumococcal vaccination in Uruguay

Introduction: Streptococcus pneumoniae infections are not frequent in neonates, but presents high morbidity and mortality. In 2008, the 7-valent pneumococcal conjugate vaccine (PCV) was introduced in the childhood vaccination schedule and then replaced by 13-valent PCV in 2010. First dose is given at 2 months of age. Protection of neonates is expected with universal vaccination. Objective: To describe the clinical presentation, microbiology and outcome of neonates with pneumococcal invasive infections (PII) detected in two hospitals in Uruguay in 2001-2007 (pre-vaccination), 2008 (intervention) and 2009-2013 (post-vaccination). Methods: A descriptive, retrospective study was done at Pereira Rossell Hospital and Paysandú Hospital. All isolates of S. pneumoniae obtained from normally sterile fluids were included. Data were obtained from the clinical records and the microbiology laboratory. A statistical analysis with absolute frequencies, relative, rates and relative risk was performed. Results: 25 neonates were enrolled with diagnosis of: sepsis (n = 13), meningitis (n = 9), bacteremia (n = 1), pneumonia with empyema (n = 1) and pneumonia (n = 1). The incidence of PII in the prevaccination period was 19/25, with a rate of 0.30/1,000 births, compared to post-vaccination rate of 0.04/1,000. The relative risk was 5.9. 6/20 (30%) cases of death were reported (meningitis n = 3; sepsis n = 2; empyema n = 1). Most common serotypes were 5 and 1 (14/25) and 24/25 strains were susceptible to penicillin. Discussion: The symptoms were indistinguishable to infections caused by other pathogens. PII cases decreased and no deaths occurred in the post-vaccination period. No increase in non-vaccine serotypes was observed.

Introducción: Streptococcus pneumoniae infrecuentemente produce infecciones en recién nacidos (RN), presentando elevada morbi-mortalidad. En Uruguay, en 2008 se incorporó al calendario de inmunizaciones infantil la vacuna conjugada neumocóccica (VCN) 7 valente, (sustituída por VCN13 en 2010). La vacunación comienza a los dos meses de vida. Se espera que la vacunación universal tenga impacto en la protección de RN. Objetivo: Describir la presentación clínica, microbiología y evolución de RN con enfermedad neumocóccica invasora (ENI), identificados en dos hospitales de Uruguay, años 2001-2007 (pre-vacunación), 2008 (intervención) y 2009-2013 (post-vacunación). Material y Métodos: Estudio descriptivo, retrospectivo. Lugar: Hospital Pereira Rossell y Hospital Paysandú. Se incluyeron todos los aislados de S. pneumoniae a partir de líquidos normalmente estériles. Fuente de datos: laboratorios de bacteriología e historias clínicas. Análisis estadístico: frecuencias absolutas, relativas, tasas y riesgo relativo. Resultados: RN con ENI: 25, sepsis (n: 13), meningitis (n: 9), bacteriemia (n: 1), neumonía con empiema (n: 1), neumonía (n: 1). Incidencia de ENI en el período pre-vacunación 19/25, tasa 0,30/1.000 nacimientos; tasa post-vacunación: 0,04/1.000. Riesgo relativo 5,9. Fallecimientos: 6/20 (30%): meningitis (n: 3), sepsis (n: 2), empiema (n: 1). Los serotipos más frecuentes fueron: 5 y 1 (14/25). Susceptibles a penicilina: 24/25. Discusión: Los síntomas fueron indistinguibles de infecciones causadas por otros patógenos. Disminuyeron los casos de ENI y no ocurrieron fallecimientos en el período post-vacunación. No aumentaron los serotipos no vacunales.

Seasonal influenza and vaccine herd effect

The seasonal influenza vaccine programs in many regions aimed to protect most vulnerable population, but current trivalent influenza vaccine does not provide sufficient effectiveness among people under high risk for severe outcome of the influenza. The vaccine herd effect (VHE) is the extra protection of non-immune high risk persons, with increase of immunity among vaccinated healthier persons which prevents circulation of influenza in the community. Accumulating evidences are supporting the immunization of extended population with regard to the VHE.