A Review of Traditional Vaccine-Preventable Diseases and the Potential Impact on the Otolaryngologist

Abstract Introduction A majority of otolaryngologists have not had direct experience with many vaccine-preventable diseases since the creation of national vaccination programs. Despite the elimination of endemic transmission of some of these diseases in the United States, outbreaks can occur anywhere and still pose a threat to public health around the world. Recent outbreaks and changing trends in exemption rates indicate that it is important for physicians to maintain a working knowledge of how these diseases present and of the recommended treatment guidelines. Objectives This review will evaluate the current state of vaccination rates, vaccine exemption rates and disease incidence in the United States and in the world. It will also examine the clinical presentation and treatment recommendations of these diseases. Data Synthesis United States estimated vaccination rates, vaccine exemption rates and vaccine-preventable disease incidences were obtained from data compiled by the Centers for Disease Control and Prevention. World vaccination rates and disease incidences were obtained from the World Health Organization databases, which compile official figures reported by member states. A PubMed literature review provided information on the current state of vaccination exemptions and outbreaks in the United States. Conclusion Vaccination and vaccine exemption rates continue to put the United States and many areas of the world at risk for outbreaks of vaccine-preventable diseases. Clinical guidelines should be reviewed in the event of a local outbreak.

Proportion of fever attributable to malaria in Colombia: potential indicators for monitoring progress towards malaria elimination / Proporción de fiebre atribuible a malaria en Colombia: indicadores potenciales para el seguimiento hacia la eliminación

ABSTRACT Objective Identify and characterize indicators to assess progress in terms of control and monitoring of malaria in endemic areas of Colombia and compare malaria elimination findings with those of countries in the same region. Methods Cross-sectional surveys were carried out in 2011 and 2014 in malaria endemic areas in Colombia, Pacific and Caribbean regions. A socio-demographic and a clinical questionnaire were applied to each participant; likewise, written and informed consents were obtained. Capillary blood samples were taken and examined through microscopic tests and rapid diagnostic test. A narrative systematic review was conducted to correlate malaria elimination in Colombia and in countries of the Amazon Region. Results The sample consisted of 548 participants from the departments of Córdoba and Nariño, Colombia. The proportion of positive malaria cases was 3 % (17/548), in which the prevalence of malaria mixed infections was 47 % (8/17). Regarding fever, temperature over 38.0o C, its prevalence was 2.7 % (15/548). Only two febrile patients tested positive for the disease. Prevalence of asymptomatic malaria cases among all positive cases was 88 %. Conclusion Asymptomatic malaria cases, mixed infections and self-medication are the challenges that malaria control and elimination programs face. It is important to note that studies on subclinical malaria in the region are scarce. Endemic areas with dense populations and experiencing an increase in immigration levels are more vulnerable to malaria reemergence. Imported malaria cases impact the basic reproduction rate (Ro). Funding resources availability has impact on the sustainability of public health actions and the elimination of malaria in South America.(AU)

RESUMEN Objetivo Identificar y caracterizar indicadores de evaluación del progreso en el control de la malaria en regiones endémicas de Colombia y contrastar los hallazgos de eliminación con países de la misma región. Métodos Se realizaron cortes transversal en 2011 y 2014, en regiones endémicas para malaria de la Costa Pacífica y del Caribe de Colombia. Se obtuvo consentimiento informado y se aplicó una encuesta socio-demográfica y clínica a cada voluntario. La punción capilar se utilizó para examen microscópico y pruebas de diagnóstico rápido. La revisión narrativa y sistemática permitió comparar el estado de eliminación de malaria en Colombia y los países de la Amazonía. Resultados Un total de 548 voluntarios fueron estudiados en Córdoba y Nariño. La proporción de casos positivos de malaria fue 3 % (17/548). Las infecciones mixtas de malaria se presentaron en un 47 % (8/17). La prevalencia de fiebre, temperatura mayor o igual a 38oC, fue 2.7 % (15/548). Dos pacientes febriles fueron positivos para malaria. La prevalencia de casos asintomáticos se presentó en 88 %. Conclusión Los casos de malaria asintomática, infecciones mixtas y la automedicación constituyen un reto para los programas de control y eliminación. Estudios sobre malaria subclínica y eliminación son limitados en la región. Regiones endémicas con alta densidad poblacional y aumento en los niveles de migración incrementan la vulnerabilidad. Los casos importados afectan la reducción de la tasa reproductiva básica (Ro) por debajo de 1. El recurso financiero insuficiente afecta la sostenibilidad de las acciones de salud pública y la eliminación de malaria en las Américas.(AU)

The Expanded Program on Immunization in the English- and Dutch-speaking Caribbean (1977-2016): reasons for its success / Programa Ampliado de Inmunización en el Caribe de habla inglesa y holandesa (1977-2016): las razones de su éxito / Programa Ampliado de Imunização nos países do Caribe de língua inglesa e holandesa (1977-2016): motivos para um programa bem-sucedido

ABSTRACT The year 2017 marks the 40th year of the establishment of the Expanded Program on Immunization (EPI) by the Pan American Health Organization (PAHO), the regional office of the World Health Organization (WHO) in the Americas, the first WHO region certified as eliminating poliomyelitis (1994), measles (2016), and rubella and congenital rubella syndrome (CRS) (2015). The English- and Dutch-speaking Caribbean subregion of the Americas paved the way in eliminating these diseases. This report highlights the innovative strategies used in this subregion that helped make the EPI a success. A review of published/unpublished reports and written and oral accounts of the experiences of Immunization Advisors and national EPI managers was conducted to identify the strategies used to strengthen the Immunization program in the subregion since its implementation by countries in 1977. The results show that these include strong collective political commitment, country-specific immunization legislation, joint use of a standard coverage monitoring chart, annual meetings of national EPI managers, collaborative development of annual national Plans of Action for Immunization, coordinated implementation of vaccination campaigns, subregional oversight of surveillance and laboratory support, a performance award system for countries, and subregional standardized templates for immunization manuals and procedural guidelines. Political will and support for immunization has been particularly strong in this subregion, where 99% of EPI costs are borne by governments. Dedicated health staff and multi-country agreement and application of strategies have led to high sustained coverage and good-quality surveillance, resulting in the absence of wild polio for 34 years, measles for 25 years, CRS for 17 years, and rubella for 15 years.

RESUMEN En el 2017 se celebra el cuadragésimo año de la instauración del Programa Ampliado de Inmunización (PAI) por la Organización Panamericana de la Salud (OPS), la Oficina Regional de la Organización Mundial de la Salud (OMS) para las Américas. Esta fue la primera región de la OMS que obtuvo la certificación de la eliminación de la poliomielitis (1994), el sarampión (2016) y la rubéola y el síndrome de rubéola congénita (2015). La subregión de habla inglesa y holandesa del Caribe en las Américas abrió el camino a la eliminación de estas enfermedades. En el presente artículo se destacan las estrategias innovadoras utilizadas en esta subregión que contribuyeron al éxito del PAI. Se llevó a cabo una revisión de los informes publicados e inéditos y de los relatos escritos y orales de las experiencias de los Expertos en Inmunización y los gerentes nacionales del PAI con el objeto de determinar las estrategias utilizadas con miras a fortalecer el programa de vacunación en la subregión, desde su introducción en los países en 1977. Los resultados ponen de manifiesto que los programas comportaban un fuerte compromiso político colectivo, legislaciones en materia de inmunización propias de cada país, la utilización común de un registro gráfico normalizado de monitoreo de coberturas de vacunación, reuniones anuales de los gerentes nacionales del PAI, la elaboración conjunta de planes de acción anuales nacionales sobre vacunas, la ejecución coordinada de campañas de vacunación, la supervisión de la vigilancia y el apoyo a los laboratorios a escala subregional, un sistema de reconocimiento al desempeño de los países y plantillas subregionales normalizadas de los manuales de vacunación y los procedimientos recomendados. La voluntad política y el apoyo a la vacunación han sido muy sólidos en esta subregión, donde los gobiernos sufragan 99% de los costos del PAI. La existencia de personal sanitario dedicado y los acuerdos multinacionales y la aplicación de las estrategias permitieron alcanzar una alta cobertura de manera sostenida y una vigilancia de buena calidad, cuyo resultado fue la ausencia de poliomielitis salvaje durante 34 años, de sarampión durante 25 años, del síndrome de la rubéola congénita durante 17 años y de la rubéola durante 15 años.

RESUMO O ano de 2017 marca o 40° aniversário da criação do Programa Ampliado de Imunização (PAI) pela Organização Pan-Americana da Saúde (OPAS), Escritório Regional da Organização Mundial da Saúde (OMS) nas Américas, primeira Região da OMS certificada como tendo eliminado a poliomielite (1994), o sarampo (2016) e a rubéola e síndrome da rubéola congênita (2015). A sub-região das Américas constituída pelos países do Caribe de língua inglesa e holandesa abriu caminho ao eliminar essas doenças. Este relato destaca as estratégias inovadoras usadas nesta sub-região que contribuíram para tornar o PAI um programa bem-sucedido. Foi realizada uma análise de informes publicados/inéditos e relatos orais e escritos da experiência dos assessores para assuntos de imunização e coordenadores nacionais do PAI visando identificar as estratégias aplicadas para consolidar o programa nos países da sub-região desde a sua implementação em 1977. Os resultados demonstram firme compromisso político coletivo, legislação de vacinação própria em cada país, uso conjunto de uma lista padrão para o monitoramento da cobertura, reuniões anuais dos coordenadores nacionais do PAI, desenvolvimento colaborativo de planos de ação nacionais anuais para vacinação, campanhas coordenadas de vacinação, supervisão sub-regional da vigilância e infraestrutura laboratorial, sistema de premiação dos países por bom desempenho, modelos padronizados para os manuais de vacinação e protocolos de procedimentos. A sub-região se caracteriza sobretudo pela vontade e apoio políticos para vacinação, sendo 99% do custo do PAI financiados pelos governos. Equipes de saúde diligentes, acordos entre vários países e emprego de estratégias são fatores que contribuem para elevada cobertura sustentada e vigilância de boa qualidade com a consequente não ocorrência de casos de poliomielite por vírus selvagem por 34 anos, de casos de sarampo por 25 anos, de casos de síndrome da rubéola congênita por 17 anos e de casos de rubéola por 15 anos.

How do health care providers deal with kala-azar in the Indian subcontinent.

Background & objectives: Three countries, Bangladesh, India and Nepal, set out to eliminate kala-azar by 2015. This study was aimed to document the knowledge and practices in kala-azar case management of public and private health providers in these three countries. Methods: A health care provider survey was conducted in 2007 at 4 study sites, viz., Muzaffarpur and Vaishali districts in India, Mahottari district in Nepal, and Rajshahi district in Bangladesh. Interviews were conducted with formal and informal health care providers at their home or practice. Results: About half of the providers in India and Nepal knew the rapid diagnostic test rK39 recommended by the elimination initiative, but this was not in Bangladesh. Knowledge of the recommended first-line drug, miltefosine, was good in India and Nepal but less so in Bangladesh. Interpretation & conclusions: Innovative tools for VL care have not yet been fully taken up by private for profit care providers in the three countries that launched a VL elimination initiative. The elimination initiative needs to address these gaps in private providers’ knowledge, given their substantial share in the care of VL patients.