Vacunación en México: coberturas imprecisas y deficiencia en el seguimiento de los niños que no completan el esquema / Vaccination in Mexico: imprecise coverages and deficiency in the follow-up of children with incomplete immunization

Resumen: Objetivo: Analizar la veracidad de las cifras oficiales de acuerdo con la información disponible e identificar oportunidades de mejora. Material y métodos: Estimamos las coberturas de vacunación y tasas de deserción (para las vacunas administradas en multidosis) del esquema básico para niños menores de un año de edad, con base en la información de cubos dinámicos de la Secretaría de Salud de 2015 a 2017. Resultados: Observamos variaciones en los reportes mensuales de vacunación que indican bajas tasas de vacunación, así como índices altos de deserción al comparar primeras y terceras dosis aplicadas. La cobertura nacional de esquema completo se estimó en 48.9 por ciento. Conclusión: No se cuenta con información confiable que permita estimar las coberturas reales de vacunación. En los reportes oficiales hay una constante sobrestimación de las coberturas que ha creado a una "falsa sensación de seguridad". Esto se ha constituido en una barrera que impide el análisis crítico del Programa Universal de Vacunación.

Abstract: Objective: To analyze the validity of the official vaccination figures according to the available information and to identify opportunities for improvement. Materials and methods: We estimated vaccination coverage and dropout rates (for multi-dose vaccines) for one-year-old children, based on public information from the dynamic cubes of the Ministry of Health, for the years 2015 to 2017. Results: We observed variations in the vaccination monthly reports, which indicate low rates of vaccination, as well as high dropout rates when comparing first and third doses applied. For children 1 year of age, the national complete coverage was estimated at 48.9%. Conclusion: There is no reliable information to estimate the actual vaccination coverage. Government documents report a constant overestimation of vaccination coverage that creates a "false sense of security". This has become a barrier for the critical analysis of the Universal Vaccination Program.

Análisis de las Campañas de Vacunación Antigripal destinadas al personal de salud del HIBA: período 2016-2018 / Analysis of Influenza Vaccination Campaigns for HIBA health personnel: 2016-2018 period

Introducción: la vacunación antigripal es la forma más eficaz para prevenir la enfermedad por virus Influenza y sus complicaciones. La cobertura en los profesionales sanitarios es un indicador de calidad hospitalaria. Material y métodos: estudio descriptivo de corte transversal. A partir de registros vacunales, se calculó la cobertura para las campañas 2013 a 2018. Se compararon las coberturas por trienios. Se describieron características generales de las campañas de 2016 a 2018. Resultados: en 2016 se alcanzó la mayor tasa del período (59,79%, IC 95%:58,75-60,81); en 2017, la menor (34,46%, IC 95%:33,48-35,46). La campaña 2018 obtuvo una cobertura de 54,90% (IC 95%: 53,88-55,92) y se inició más tempranamente que otras. Al comparar las tasas trienales del período se observó una diferencia de proporción de -1,3% (IC 95%: -2.84-0.24). Durante los tres últimos años, el personal vacunado correspondió mayormente al sexo femenino, a la Sede Central y tenía relación contractual directa. Las mayores coberturas específicas correspondieron a la sede de San Justo y a los profesionales de enfermería. El puesto ambulante fue el que aplicó más vacunas. Conclusión: si bien hubo variaciones en las coberturas alcanzadas a lo largo de los años, siendo la del año 2016 la más elevada y la del año 2017 la más baja, no se observaron diferencias estadísticamente significativas en las coberturas alcanzadas al comparar trienios. Resulta necesario continuar realizando intervenciones adaptadas al contexto local que permitan alcanzar los objetivos de cobertura esperados. Discusión: se reconocieron varios obstáculos para alcanzar las coberturas esperadas. La educación al personal de salud, la evaluación sistematizada de los ESAVI (Eventos supuestamente atribuibles a vacunación e inmunización) y la descripción de los elementos que facilitaron las coberturas específicas elevadas de algunas subpoblaciones podrían contribuir para mejorar los resultados. (AU)

Introduction: influenza vaccination is the most effective way to prevent influenza virus disease and its complications. Coverage in health professionals measurement is an indicator of hospital quality. Material and methods: descriptive cross-sectional study. From vaccination records, the coverage was calculated for the 2013 to 2018 campaigns. The coverage for three years was compared. General characteristics of the campaigns from 2016 to 2018 were described. Results: in 2016, the highest was achieved during the period (59.79%, IC 95%: 58.75 -60.81). In 2017, the lowest (34.46%, IC 95%: 33.48-35,46). The 2018 campaign achieved a coverage of 54.90% (IC 95%: 53.88-55.92) and started earlier than others. When comparing the triennial rates of the period, a difference of proportion of -1.3% was observed (IC 95%: -2.84-0.24). During the last three years, the vaccinated staff corresponded mostly to the female sex, to the headquarters and had a direct contractual relationship. The largest specific coverage corresponded to the San Justo headquarters and to nursing professionals. The ambulatory position was the post that applied the most vaccines. Conclusion: although there were variations in the coverage achieved over the years, with 2016 being the highest and 2017 being the lowest, there were no statistically significant differences in the coverage achieved when comparing trienniums. It is necessary to continue carrying out interventions adapted to the local context to achieve the expected coverage objectives. Discussion: several obstacles were recognized to reach the expected coverage. The education of health personnel, the systematic evaluation of the ESAVIs and the description of the elements that facilitated the high specific coverage of some subpopulations could contribute to improve the results. (AU)

Auto-suficiência e inovação na produção de vacinas e saúde pública / Self-sufficiency and innovation in the production of vaccines and in public health

O Butantan desenvolve novas tecnologias e processos industriais para a produção de imunobiológicos, tendo como prioridade a saúde pública. Produz 150 milhões de doses de antígenos vacinais por ano, 82 por cento da produção nacional e 65 por cento dos soros, fornecidos a preços acessíveis ao Ministério da Saúde para distribuição universal a crianças e idosos. Novos desenvolvimentos incluem a nova vacina contra coqueluche, por um processo que permite simultaneamente produzir um adjuvante que permitirá reduzir a um quarto a dose da vacina sazonal e pandêmica da influenza, aumentando a produção e reduzindo custos; a vacina de raiva humana com o maior rendimento descrito e a vacina combinada BCG-hepatite B-pertussis da maternidade. Em colaboração comNIH, Path e PDVI, o Butantan está iniciando a produção e o ensaio das vacinas para rotavírus e dengue. O surfactante deve reduzir a mortalidade neonatal que as vacinasnão protegem.

Preventing avian influenza in humans: the role of simple public health interventions.

An influenza pandemic due to influenza virus A H5N1 subtype is considered highly likely. Strategies for prevention and control of a pandemic include actions that need to be taken by the national authorities and communities. The availability of a vaccine and antiviral drugs in sufficient quantities for billions of people in the developing world is doubtful. Simple cost effective public health interventions can significantly reduce the risk of contracting infection. These interventions include precautions that will prevent people from contracting infection from sick or dying poultry and their products, human cases and a contaminated environment. Specific measures are based on principles of cutting short the transmission of infection in humans and inactivating the virus at its source. The paper describes context specific actions that can be implemented in both rural and urban settings by the communities themselves.

Políticas de control de la influenza en Chile / Policies for influenza control in Chile

El control de la influenza se logra sobre la base de dos componentes principales: la vigilancia epidemiológica y la vacunación. En ambos aspectos, Chile tiene un alto posicionamiento en el mundo y exhibe las mejores cifras de la región, logrando una reducción de la mortalidad por influenza y neumonía en la medida del aumento en la cobertura de vacunación, la que en la actualidad alcanza a 11 por ciento de la población. La amenaza de una pandemia es permanente y obliga a los países a tener preparadas sus estrategias especiales de enfrentamiento.

Vacuna anti-influenza en niños: estado del arte / Flu vaccine in children: state of the art

La influenza es una enfermedad respiratoria aguda con elevada tasa de morbilidad y mortalidad anual. Todos los niños, tanto sanos como aquellos de alto riesgo son susceptibles a la infección. La vacuna anti-influenza es eficaz en prevenir síntomas asociados a influenza, infección demostrada por laboratorio, hospitalizaciones y muertes y ha demostrado ser una medida costo-efectiva. No se han observado claras diferencias entre las vacunas inactivadas y las nuevas vacunas elaboradas con virus vivo atenuado. Por la elevada tasa de hospitalización que los afecta, algunos países han resuelto recomendar la vacunación universal de los lactantes sanos entre 6 y 24 meses de edad. Considerando que esta medida de salud pública también ha sido incorporada en Chile, serían necesarios estudios locales que evalúen su real impacto en nuestro medio.

La prevención de la influenza: recomendaciones para la temporada de 2005-2006 / Preventing influenza: recommendations for the 2005-2006 season

Influenza is a serious health problem worldwide due to the epidemics and pandemics that it periodically causes. The Advisory Committee on Immunization Practices (ACIP) of the United States of America recently published updated recommendations for influenza prevention and control for the 2005-2006 season. Many of these guidelines are of interest to the countries of the Region of the Americas, particularly those related to vaccination, which is the mainstay for preventing and controlling this disease. Various changes have been made in the recommendations that were published in 2004. First, the ACIP recommends vaccination against influenza for persons with any condition (e.g., cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function or make eliminating respiratory secretions difficult or that can increase the risk for aspiration. Second, the ACIP strongly recommends that all health care workers be vaccinated against influenza annually and encourages facilities that employ health care workers to vaccinate them by using approaches that maximize immunization rates. Third, the ACIP encourages the use of both available vaccines (inactivated and live, attenuated influenza vaccine (LAIV)) for eligible persons every influenza season, especially persons in recommended target groups. When inactivated virus vaccine is in short supply, the use of LAIV is especially encouraged, if feasible, for eligible persons (including health care workers) because such use might considerably increase the availability of inactivated virus vaccine for persons in high-risk groups. Fourth, the 2005-06 trivalent vaccine virus strains are A/California/7/2004 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Shanghai/361/2002-like antigens. For the A/California/7/2004 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/ New York/55/2004 virus, and for the B/Shanghai/361/2002-like antigen, manufacturers may use the antigenically equivalent B/Jilin/20/2003 virus or B/Jiangsu/10/2003 virus.