Correspondencia vacunación-inmunización como necesidad social y reto para la ciencia y la educación médica / Vaccination-immunization correspondence as a social need and challenge for science and medical education

Introducción: La vacunación constituye el arma preventiva más efectiva para las enfermedades trasmisibles que conoce la humanidad. Hacer que las vacunas aplicadas sean realmente inmunizantes resulta la responsabilidad de los profesionales de la atención primaria. Del mismo modo, es importante que se acepte, sin recelo, la vacunación, sobre todo en la situación epidemiológica actual. Objetivo: Describir las implicaciones sociales, económicas y éticas relacionadas con la existencia de vacunas teóricamente no inmunizantes. Métodos: Se emplearon los resultados de un programa de intervención educativa en edades pediátricas en el Policlínico 13 de marzo. Se utilizó la prueba de rangos con signo de Wilcoxon, con índice de confianza del 95 por ciento. Resultados: Inicialmente, predominó el nivel inadecuado de conocimiento, que luego mejoró significativamente. Se recuperaron 48 niños no vacunados y 29 vacunaciones no inmunizados. Conclusiones: No existe correspondencia entre las coberturas vacunales y la inmunización. Están instauradas, como correctas, falsas contraindicaciones para la vacunación. La intervención educativa fue efectiva, y se hizo patente la pertinencia de programas de pregrado y posgrado que perfeccionen la formación de los profesionales y la calidad en el desempeño profesional(AU)

Introduction: Vaccination is the most effective preventive weapon for communicable diseases known to humanity. It is the responsibility of primary health care professionals to ensure that the administered vaccines are truly immunizing. Likewise, it is important that vaccination be accepted without hesitations, especially in the current epidemiological situation. Objective: To describe the social, economic and ethical implications related to the existence of theoretically nonimmunizing vaccines. Methods: The results of an educational intervention program in pediatric ages at 13 de Marzo Policlinic were used. The Wilcoxon signed-rank test was used, with a confidence index of 95 percent. Results: Initially, an inadequate level of knowledge predominated, which later improved significantly. Forty-eight unvaccinated children and 29 unimmunized children recovered. Conclusions: There is no correspondence between vaccination coverage and immunization. False contraindications for vaccination are established as correct. The educational intervention was effective, while the relevance became evident for undergraduate and postgraduate programs to improve the training of professionals and the quality of professional performance(AU)

Inmunización para influenza y neumococo en prevención cardiovascular / [Influenza and pneumococcal immunization in cardiovascular prevention]

A group of interdisciplinary experts (cardiologists, clinicians, infectologists met with the purpose of analyzing the evidence revealed by the relationship between respiratory diseases caused by influenza, pneumococcal diseases and cardiovascular events, and the role played by immunization strategies applied in cardiovascular prevention. The present statement summarizes the conclusions reached by the expertise of the aforementioned professionals. Systematic revisions imply consistent evidence that influenza and pneumococcal infection lead to acute myocardial infarction and cardiovascular death. Studies published during the last 15 years suggest that vaccination against influenza and S. pneumoniae reduce the risk of acute coronary syndromes. With the current evidence, and considering cost-effectiveness, reducing operating expenses and safety profile of the vaccines, scientific societies, national and international government health agencies strongly recommend incorporating immunization programs in those patients with chronic cardiovascular disease.

Cost-Benefit Analysis of Haemophilus Influenzae Type B Immunization in Korea

An economic evaluation of Haemophilus influenzae type b (Hib) immunization was conducted to examine whether Hib immunization should be included in the Korea's national immunization program. The costs and benefits included direct and indirect values and an estimation of the economic efficiency. We determined that a universal Hib immunization program in Korea would prevent 17 deaths and 280 invasive Hib cases. When we assumed the one Hib immunization cost as 26,000 won, the national Hib immunization would cost 34.6 billion won. Costs for various Hib diseases were estimated at 26.8 billion won (11.8 billion won from direct costs and 14.9 billion won from indirect costs). A benefit-cost ratio of 0.77 showed that the economic efficiency of the integration of Hib immunization in Korea is low because of the low incidence rate of Hib disease and high price of vaccine. However, if the Hib immunization cost decrease to less than 20,000 won, a benefit-cost ratio increase to 1.0 and above, integrating Hib immunization into the national immunization program with economic efficiency can be considered.

Private sector contribution to childhood immunization: Sri Lankan experience.

BACKGROUND: The main service provider for childhood immunization in Sri Lanka is the government sector. However, utilization of private sector for childhood immunization is increasing rapidly. Existing national immunization data does not routinely include statistics on private sector immunization delivery adequately. OBJECTIVE: To estimate the proportion of children immunized in the private sector; describe socio-demographic characteristics of private sector users and compare these with government sector users. MATERIALS AND METHODS: A community-based crosssectional descriptive study was conducted using a pre-tested interviewer-administered structured questionnaire. This was done in the Colombo municipal council area using the WHO 30 cluster methodology. The total number of households in the sample was 553. RESULTS: Out of the 5,028 total immunizations reported in the present study, around one-third (2,544) was obtained through the private sector. Nineteen percent (104) of children were exclusively immunized from the private sector. The distribution of usual immunization provider was - government sector 72.3% (400) and private sector 27.7% (153). Significant differences were observed (P < 0.001) between private and government sector users with regard to family income, social class, ethnicity, religion and educational level of the mother. The age-appropriate immunization among the 12- to 23-month age group was 92.3% (144) in the government sector, whereas it was 95% (38) in the private sector. Among the 24- to 35-month age group, it was 91.7% (121) and 92.7% (76) respectively. The age-adjusted immunization coverage rates were almost same among the government and private sector users except for the measles vaccine, where the private sector users had significantly (P = 0.016) higher coverage. CONCLUSIONS: Utilization of private sector immunization services is high in the Colombo municipal council area.

[Costs of basic health services in a health district in Tunisia]

Information on the cost of health services is essential for good planning and management and the efficient use of resources. We calculated the total costs incurred in running primary health services for one year [1995] in the health district of Enfidha [Tunisia]. The yearly operating expenditure for the health district was 1 219 099 Tunisian dinars and the cost per inhabitant was 17.494 dinars [US dollar 1 = Tunisian dinar 0.950 in 1995]; 65.37% of total costs went on staff and 17.03% on drugs. Looked at another way, 84,96% went on curative services and 14.04% on preventive services.The cost of a consultation for curative care was 6.847dinars, for perinatal care was 2.764 dinars, for immunization was 3.680 and for school visit was 6.680 dinars. The study helps to identify ways in which cost analysis can be used to explore efficiency and resource adequacy in the district

Una aproximación al estudio de costos de servicios de salud en México / An approach to the study of helth services costs in Mexico

Objetivo. Abordar el análisis de costos de servicios de salud en eventos trazadores para instituciones de los sectores público y privado en México. Material y métodos. A partir de las funciones de producción y los insumos requeridos para el manejo de casos estándar de cada enfermedad o evento, se procedió a hacer el ajuste en el manejo de los trazadores para cada institución, mediante la técnica de consenso y con la participación de expertos por institución. Identificados los insumos y cantidades para la producción de servicios especificos de salud, se determinaron los costos de manejo de caso. Como trazadores se seleccionaron: hipertensión, diabetes, diarreas, neumonías, apendicectomía, atención del parto, consulta típica y vacunas. Se incluyeron tres instituciones del sector público y cinco del sector privado. Resultados. Los resultados indican que al determinar y comparar el costo de manejo de caso para cada trazador existen diferencias significativas para fines de producción de servicios médicos entre ambos sectores y al interior de cada uno. Conclusiones. El análisis comparativo en el costo de manejo de caso para cada trazador, presenta diferencias que se explican por procesos cualitativos y cuantitativos que caracterizan a cada institución en la combinación de insumos para producir servicios y por los distintos costos de insumos para cada uno de los sectores analizados, resultando los costos más bajos en instituciones del sector público, particularmente en la Secretaría de Salud, y los costos más altos en el sector privado, particularmente en seguros médicos privados

Objective. To approach the cost analysis of the health services for eight tracer conditions, in three institutions of the public sector and in five of the private sector. Material and Methods. First, production functions and inputs required for standard case-management of each tracer condition were identified. Subsequently, tracer case-management was adjusted for each institution through expert consensus techniques. Once the type and amount of inputs necessary to produce tracer-specific health care services were identified, case-management costs were estimated. Tracer conditions were: hypertension, diabetes, diarrheas, pneumonia, appendicectomy, labor and delivery care, routine ambulatory medical care and vaccines. Results. Results indicate significant differences with regards to the production of medical services between both sectors and within each one. Conclusions. The comparative analysis in the cost per case-management for each tracer presents differences that could be explained due to the quantitative and qualitative processes that characterized each institution in the combination of inputs to produce services and for the different costs of the inputs for each of the sectors analyzed, resulting in lower costs in the public sector and higher costs in the private sector, particularly for private health insurance.

Prevention of hepatitis B infection: the appropriate strategy for India.

Hepatitis B infection is a major global health problem with a high morbidity and mortality. With safe and effective vaccines available, it is now possible to prevent it. Many countries have started national hepatitis B control programmes but no attempt has been made to do this in our country. An analysis of the available data on the epidemiology of hepatitis B infection in India reveals that perinatal maternofoetal transmission accounts for only a minority of hepatitis B virus carriers in India. Therefore, a policy of screening pregnant mothers for the presence of hepatitis B surface antigen and selective immunization of babies born to those who are surface antigen positive will have very little effect on the hepatitis B carrier rate in our population. Universal immunization of all newborns will have a much greater impact, it will be logistically simpler and more cost-effective--the cost of preventing one hepatitis B carrier being nearly one-fourth of that with selective immunization. We recommend that hepatitis B vaccine should be included in our country's expanded programme of immunization.

Análisis de las coberturas de inmunizaciones en menores de un año en jurisdicciones Amazónicas del Perú para 1989 / Analysis of the immunization coverings in one year old children in Amazonic jurisdictions in Peru to 1989

Se revisaron las coberturas de inmunizaciones en menores de 1 año para el año 1989, notificadas por el Programa Ampliado de Inmunizaciones (PAI) del Ministerio de Salud y correspondientes a jurisdicciones amazónicas del Perú, comparándoseles con las coberturas de jurisdicciones no amazónicas. Seguidamente, se analizó la asociación de los valores hallados en ambos grupos a factores demográficos, administrativos y logisticos. Encontramos que las coberturas globales para la región amazónica fueron: antipolio 47.2 por ciento, DPT 46.7 por ciento antisarampionosa 43.3 por ciento y BCG 52.8 por ciento, siendo menores que las cifras para el resto del país. Sobre la base de la vacuna antipolio, de 34 provincias amazónicas estudiadas, 20 tuvieron coberturas menores a 50 por ciento, 11 entre 50 y 79 por ciento y sólo 3 alcanzaron 80 por ciento o más. Hallamos que la variable "porcentaje de población rural" guarda una relación inversa con las coberturas de inmunizaciones, explicándose asi los bajos niveles presentados por las provincias amazónicas, predominantes rurales. Por el contrario, la asociación entre las variables "densidad poblacional" y "tasa de servicios periféricos de salud por mil menores de un año" establece una relación directa con las coberturas de inmunizaciones. Se indicia que la optimización de los factores administrativos y logísticos de la oferta del PAI contribuye a mejorar las coberturas de inmunizaciones en las juridicciones amazónicas