Efectividad y seguridad de la vacuna Sarampión-Paperas-Rubéola (SPR) en mayores de cinco años / Effectiveness and safety of the Measles-Mumps-Rubella vaccine (SPR) in over five years

ANTECEDENTES: La inmunización es una de las intervenciones en salud pública más costo efectivas y rentables. Sarampión, parotiditis y rubeola (SPR) son enfermedades virales, que pueden causar complicaciones y consecuencias graves, especialmente en niños desnutridos e inmunodeprimidos; siendo importante destacar, que estas enfermedades son prevenibles mediante la vacunación. El resurgimiento de las infecciones por el virus de las paperas entre personas previamente vacunados con dos dosis, ha planteado preocupaciones en el mundo, sobre la ausencia de inmunidad a largo plazo después de la vacunación contra esta enfermedad y ha aperturado discusiones sobre nuevas estrategias para mitigar el riesgo de brotes futuros, incluyendo la posibilidad de implementar una tercera dosis de la vacuna SPR como respuesta a un brote epidémico, frente al cual, además surge la necesidad de estudios adicionales que evalúen la protección a largo plazo proporcionada por tres dosis de las vacunas SPR, así como la rentabilidad de la implementación de ésta intervención. OBJETIVO: El objetivo de la presente revisión sistemática es sintetizar evidencias científicas sobre la seguridad y efectividad frente a parotiditis de la vacuna Sarampión, Rubéola, Paperas (SPR) en personas mayores de 5 años. METODOLOGÍA: La búsqueda sistemática se realizó en la base de datos de Medline (PubMed), Lilacs y Cochrane Library fueron formuladas una estrategia de búsqueda para la pregunta PICO de la revisión, no se aplicaron filtros de fecha ni idiomas, la búsqueda abordó la evidencia publicada hasta 12 de marzo del 2020. La selección de título y resumen y extracción de datos fue realizada por un solo revisor. RESULTADOS: La búsqueda identificó 9 estudios: 1 revisión sistemática, 1 ensayo clínico y 7 estudios observacionales. La revisión incluyó tres estudios en niños y adolescentes. El ensayo clínico se realizó en adultos y los estudios observacionales fueron en adultos y en niños. CONCLUSIONES: No se observan diferencias estadísticamente significativas entre los niños que reciben una tercera dosis con los que reciben dos dosis. La vacuna SPR en niños mayores de 5 años presenta pocos y leves reacciones adversas. En adultos sanos, la tercera dosis de SPR no presenta reacciones adversas graves o largo plazo. En población militar, la aplicación de vacuna SPR no se asocia con aparición de diabetes mellitus tipo 1. (AU)

Measles, rubella, mumps and Toxoplasma gondii antibodies in saliva of vaccinated students of schools and universities in São Paulo City, Brazil

ABSTRACT Introduction: Vaccines are well-established public health interventions with major impacton the prevalence of infectious diseases, but outbreaks are occurring frequently due to pri-mary and secondary failures, despite high coverage. Surveillance of efficacy and duration ofinduced immunity is a difficult task as it requires invasive blood sampling in children andteenagers. Saliva can be an acceptable alternative source of IgG to assess vaccine efficacyand toxoplasmosis incidence. We investigated IgG response for measles, mumps, rubella,and T. gondii in saliva samples of vaccinated young people. Methods: Saliva was collected from 249 public schools students from São Paulo, Brazil, aged7 to 13 years old, during an interactive exhibition on hygiene. We used S. aureus proteinA solid phase capture assay for IgG reactive to biotinylated purified proteins. Paired salivaand serum (47) were tested from young adults with serum evidence of T. gondii infectionand from negative children less than 12 month old for standardization. Reproducibility wasgreater than 98% and sensitivity and specificity of the saliva assays were greater than 95%,as well as the concordance of paired saliva and serum samples. Results: Saliva from high school students showed a prevalence of 8.5% (95% CI: 5.0-11.9%)for anti T. gondii IgG; 96.8% (94.6-99%) of anti-measles IgG; 59.1% (53-65%) of anti-rubella IgG,and 57.5% (51.3-63.6%) of anti-mumps IgG. Discussion: The prevalence of antibodies against mumps and rubella after 6-8 years of vaccination was lower than against measles among students. The findings of this study demonstrate the feasibility of saliva sampling for follow-up of vaccine immune status in teenagers. This useful approach allows for IgG detection for vaccine control or epidemio- logical studies.

Falhas vacinais: avaliando vacinas febre amarela, sarampo, varicela e caxumba / Fallos en vacunas: evaluando vacunas de fiebre amarilla, sarampión, varicela y parotiditis / Vaccine failures: assessing yellow fever, measles, varicella, and mumps vaccines

Resumo: A vacinação é uma das maiores intervenções em saúde pública pela segurança e efetividade, porém nem sempre vacinar significa imunizar. Inúmeros aspectos relacionados tanto ao indivíduo que recebe a vacina, quanto à especificidade de cada imunobiológico administrado compõem o processo para a obtenção de uma adequada imunização, sendo essencial que sejam observados para não culminar em falhas vacinais. A análise dos estudos de imunogenicidade e efetividade para as vacinas sarampo, varicela e caxumba apontam para a necessidade da incorporação de duas doses aos calendários básicos de vacinação para o controle das referidas doenças. Estudos epidemiológicos que analisaram surtos dessas doenças identificaram casos em indivíduos que receberam duas doses da vacina, o que pode apontar provável falha secundária. Para a vacina febre amarela, a discussão atual reside no número de doses ideal para a proteção individual. A Organização Mundial da Saúde recomenda dose única para toda a vida. Apesar dos poucos relatos em literatura a respeito das falhas vacinais, os estudos de imunogenicidade demonstram perda de proteção ao longo dos anos, principalmente na faixa etária pediátrica. Num cenário atual de eliminação e controle de doenças, associado à diminuição da circulação de vírus selvagens, o papel da vigilância epidemiológica é fundamental para aprofundar o conhecimento a respeito dos múltiplos fatores envolvidos, que culminam com falhas vacinais e surgimento de surtos. A ocorrência de surtos de doenças imunopreveníveis impacta negativamente a credibilidade dos programas de imunização, acarretando baixas coberturas vacinais e interferindo no êxito da vacinação.

Resumen: La vacunación es una de las mayores intervenciones en salud pública, por su seguridad y efectividad, sin embargo, no siempre vacunar significa inmunizar. Innumerables aspectos relacionados tanto con el individuo que recibe la vacuna, como con la especificidad de cada inmunobiológico administrado, componen el proceso para conseguir una adecuada inmunización, siendo esencial que sean observados para no acabar con fallos en las vacunas. El análisis de los estudios de inmunogenicidad y efectividad para las vacunas sarampión, varicela y parotiditis, apuntan hacia la necesidad de la incorporación de dos dosis a los calendarios básicos de vacunación para el control de las mencionadas enfermedades. Estudios epidemiológicos que analizaron brotes de esas enfermedades identificaron casos en individuos que recibieron dos dosis de la vacuna, lo que puede apuntar un probable fallo secundario. Para la vacuna de fiebre amarilla la discusión actual reside en el número de dosis ideal para protección individual. La Organización Mundial de la Salud recomienda una dosis única para toda la vida. A pesar de los pocos relatos en la literatura, respecto a los fallos en las vacunas, los estudios de inmunogenicidad demuestran una pérdida de protección a lo largo de los años, principalmente en la franja de etaria pediátrica. En un escenario actual de eliminación y control de enfermedades, asociado a la disminución de la circulación de virus salvajes, el papel de la vigilancia epidemiológica es fundamental para profundizar el conocimiento respecto a los múltiples factores implicados, que culminan con fallos en las vacunas y surgimiento de brotes. La ocurrencia de brotes de enfermedades inmunoprevenibles impacta negativamente en la credibilidad de los programas de inmunización, acarreando bajas coberturas de vacunación e interfiriendo en el éxito de la vacunación.

Abstract: Vaccination is one of the greatest public health interventions, based on its safety and effectiveness, but vaccination does not always mean immunization. Numerous aspects related both to the individual that receives the vaccine and the specificity of each vaccine administered are part of the process of obtaining adequate immunization, and it is essential to observe the aspects in order to avoid vaccine failures. The analysis of immunogenicity and effectiveness studies for the measles, varicella, and mumps vaccines point to the need to incorporate two doses into the basic vaccination calendars in order to control these diseases. Epidemiological studies that analyzed outbreaks of these diseases identified cases in individuals that received two doses of the vaccine, which may indicate likely secondary failure. For the yellow fever vaccine, the current discussion lies in the ideal number of doses for individual protection. The World Health Organization recommends a single dose for life. Despite the few reports in the literature concerning vaccine failures, immunogenicity studies demonstrate waning protection over the years, mainly in the pediatric age bracket. In the current scenario of elimination and control of diseases, associated with the decrease in the circulation of the wild-type viruses, the role of epidemiological surveillance is crucial for expanding knowledge on the multiple factors involved, culminating in vaccine failures and the emergence of outbreaks. Outbreaks of vaccine-preventable diseases negatively impact the credibility of immunization programs, leading to low vaccination coverage rates and interfering in vaccination's success.

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.

Anafilaxia relacionada à vacina sarampo, caxumba e rubéola, Santa Catarina, Brasil, 2014 e 2015 / Anaphylaxis related to measles, mumps, and rubella vaccine in Santa Catarina State, Brazil, 2014 and 2015 / Anafilaxia relacionada a la vacuna sarampión, paperas y rubeola, Santa Catarina, Brasil, 2014 y 2015

Resumo: Os objetivos consistiram em descrever os casos e verificar a frequência de anafilaxia relacionada à vacina sarampo, caxumba e rubéola (SCR) do produtor A, bem como avaliar os possíveis fatores de risco associados. Estudo de caso-controle (1:4), em Santa Catarina, Brasil, de 14 de julho de 2014 a 12 de janeiro de 2015, em crianças de um a menores de cinco anos, vacinadas com SCR e notificadas com anafilaxia, sendo os controles sem anafilaxia. Utilizou-se, como medida de associação, odds ratio (OR) com intervalo de 95% de confiança (IC95%) e os testes qui-quadrado e exato de Fisher. Calcularam-se taxas de anafilaxia por doses distribuídas/aplicadas. Entrevistaram-se 15 casos e 60 controles, em 12 municípios. As taxas de anafilaxia foram 2,46 e 5,05 por doses distribuídas e aplicadas, respectivamente. Dentre os casos de anafilaxia, oito (53,4%) eram do sexo masculino, e dentre os controles, 36 (60%), com p = 0,64. Na análise bivariada referente à anafilaxia e alergia à proteína do leite de vaca (APLV), verificou-se OR = 51,62, com p = 0,00002 e IC95%: 5,59-476,11. As variáveis alergia alimentar familiar, aleitamento materno, evento adverso pós-vacinação (EAPV) anterior e vacinação simultânea não foram estatisticamente significativas (p = 0,48; p = 1,00; p = 0,49; p = 0,61). Taxas de anafilaxia por doses distribuídas/aplicadas ficaram acima de 1/100 mil doses aplicadas (taxa esperada). Anafilaxia e APLV apresentaram associação estatisticamente significativa. Não foram encontradas associações estatísticas referentes à vacinação simultânea, aleitamento materno, alergia alimentar familiar e EAPV anterior. Recomendou-se ao produtor informar na bula todos os componentes do produto e que crianças com história pregressa de APLV não sejam vacinadas com essa vacina.

Abstract: The study aimed to describe cases and verify the frequency of anaphylaxis related to measles, mumps, and rubella (MMR) vaccine produced by manufacturer A and to assess associated risk factors. This was a case-control study (1:4) in Santa Catarina State, Brazil, from July 14, 2014, to January 12, 2015, in children from one year to less than five years of age, vaccinated with MMR and reported with anaphylaxis, while the controls were without anaphylaxis. The measure of association was odds ratio (OR) with 95% confidence interval (95%CI), using the chi-square and Fisher's exact tests. Anaphylaxis rates were calculated per doses distributed/administered. Fifteen cases and 60 controls were interviewed in 12 municipalities (counties). Anaphylaxis rates were 2.46 and 5.05 cases per 100,000 doses distributed and administered, respectively. Among the cases of anaphylaxis, eight (53.4%) were males, and among the controls, 36 (60%), with p = 0.64. The bivariate analysis of anaphylaxis and cow's milk protein allergy (CMPA) showed OR = 51.62, with p = 0.00002 and 95%CI: 5.59-476.11. The variables family food allergy, breastfeeding, previous post-vaccine adverse event (PVAE), and simultaneous vaccination were not statistically significant (p = 0.48; p = 1.00; p = 0.49; p = 0.61). Anaphylaxis rates per doses distributed/administered exceeded 1/100,000 doses administered (expected rate). Anaphylaxis and CMPA showed a statistically significant association. No statistically significant associations were found with simultaneous vaccination, breastfeeding, family food allergy, or history of PVAE. Recommendations: the manufacturer should specify the product's components in the package insert, and children with a history of CMPA should not be vaccinated with this vaccine.

Resumen: Los objetivos consistieron en describir los casos y verificar la frecuencia de anafilaxia, relacionada con la vacuna del sarampión, paperas y rubeola (SCR) del productor A, así como evaluar los posibles factores de riesgo asociados. Estudio de caso-control (1:4), en Santa Catarina, Brasil, de 14 de julio de 2014 a 12 de enero de 2015, en niños de uno a menores de cinco años, vacunadas con SCR y notificadas con anafilaxia, siendo los controles sin anafilaxia. Se utilizó, como medida de asociación, odds ratio (OR) con un intervalo de 95% de confianza (IC95%) y los testes chi-cuadrado y exacto de Fisher. Se calcularon las tasas de anafilaxia por dosis distribuidas/aplicadas. Se entrevistaron 15 casos y 60 controles, en 12 municipios. Las tasas de anafilaxia fueron 2,46 y 5,05 por dosis distribuidas y aplicadas, respectivamente. Entre los casos de anafilaxia, ocho (53,4%) eran del sexo masculino, y entre los controles, 36 (60%), con p = 0,64. En el análisis bivariado referente a la anafilaxia y alergia a la proteína de leche de vaca (APLV), se verificó OR = 51,62, con p = 0,00002 e IC95%: 5,59-476,11. Las variables alergia alimentaria familiar, lactancia materna , evento adverso pos-vacunación (EAPV) anterior y vacunación simultánea no fueron estadísticamente significativas (p = 0,48; p = 1,00; p = 0,49; p = 0,61). Tasas de anafilaxia por dosis distribuidas/aplicadas se situaron encima de 1/100.000 dosis aplicadas (tasa esperada). Anafilaxia y APLV presentaron una asociación estadísticamente significativa. No fueron encontradas asociaciones estadísticas referentes a la vacunación simultánea, lactancia materna, alergia alimentaria familiar y EAPV anterior. Se recomendó al productor informar en el prospecto sobre todos los componentes del producto, y que los niños con historial anterior de APLV no sean vacunados con esa vacuna.

Reemergence of mumps in São Paulo, Brazil - the urgent need for booster shot campaign to prevent a serious infectious disease

Abstract INTRODUCTION: Neglected infectious diseases like mumps may be opportunistic in controlled areas with low vaccine coverage, particularly in developed and emerging countries. METHODS: A retrospective analysis of mumps-related data from 2001 to 2016 for São Paulo State, Brazil was conducted. RESULTS: From 2014 to 2015, there was an increase of 82% in reported mumps cases in São Paulo, with prevalence of n=49 and 297, respectively in young adults aged 15-29 years. CONCLUSIONS: A booster-shot campaign on MMR vaccination is recommended to prevent the spread of mumps in unvaccinated children and recipients of only the first dose.

Immune response to the mumps component of the MMR vaccine in the routine of immunisation services in the Brazilian National Immunisation Program

A non-controlled longitudinal study was conducted to evaluate the combined vaccine against measles, mumps and rubella (MMR) immunogenicity in 150 children vaccinated in the routine of three health units in the city of Rio de Janeiro, Brazil, 2008-2009, without other vaccines administered during the period from 30 days before to 30 days after vaccination. A previous study conducted in Brazil in 2007, in 1,769 children ranging from 12-15 months of age vaccinated against yellow fever and MMR simultaneously or at intervals of 30 days or more between doses, had shown low seroconversion for mumps regardless of the interval between administration of the two vaccines. The current study showed 89.5% (95% confidence interval: 83.3; 94.0) seroconversion rate for mumps. All children seroconverted for measles and rubella. After revaccination, high antibody titres and seroconversion rates were achieved against mumps. The results of this study and others suggest that two MMR doses confer optimal immunoresponses for all three antigens and the possible need for additional doses should be studied taking into account not only serological, but also epidemiological data, as there is no serological correlate of protection for mumps.

Detection of serum antibodies against measles, mumps and rubella after primary measles, mumps and rubella [MMR] vaccination in children

In Iran, the measles, mumps and rubella vaccine [MMR] is administered in a two-dose protocol where the first dose is scheduled at 12 months of age. This study aims to determine the efficacy of the MMR vaccine by testing IgM and IgG antibody levels 4 - 7 weeks after primary vaccination. A single group cohort study was performed on healthy children, 12 - 15 months of age, who were vaccinated at health centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran, from January to April 2009. Children with negative vaccination and/or clinical history for measles, mumps or rubella were administered the first dose of the MMR live attenuated vaccine. IgG and IgM antibodies were checked by enzyme linked immunoassay [ELISA] in serum samples 4 - 7 weeks after vaccination. A child was considered seropositive if antibody levels were higher than the assay cut-off level set by the ELISA kit. Samples from 240 children were checked for antibodies against measles and rubella. Measles serum IgM level was positive in 71.7% of samples and IgG in 75.8%. The rubella serum IgM level was positive in 71.7% of children and IgG in 73.8%. From 190 blood samples that were checked for mumps antibodies, serum IgM was positive in 68.9% and IgG in 95.3%. No significant relationship was found between seropositivity and age or gender. IgG and IgM antibody levels were below the assay cut-off levels against measles and rubella in approximately one-fourth of the children following primary MMR vaccination. A second dose was necessary to raise the level of protection against measles and rubella

Factors Associated with Vaccination among Inflammatory Bowel Disease Patients in Korea / 대한소화기학회지

BACKGROUND/AIMS: Vaccinations are generally recommended in patients with inflammatory bowel disease (IBD). However, several studies showed low rates of vaccinations in IBD patients. Furthermore, vaccination rate among IBD patients in Korea has never been investigated. We investigated the vaccination rate among IBD patients in Korea and evaluated some factors that might affect the vaccination rate. METHODS: From November 2011 to February 2012, a total of 192 patients with IBD who visited Samsung Medical Center (Seoul, Korea) answered the IRB-approved questionnaire. The questionnaire included their sex, age, residence, past medical history, type of IBD, duration of illness, medications, history of vaccination about measles-mumps-rubella (MMR), varicella, tetanus-diphtheria (Td), influenza, hepatitis A and B, pneumococcus and human papilloma virus (HPV). RESULTS: One hundred twenty one (63.0%) male and 71 (37.0%) female answered the questionnaire. The mean age of the enrolled patients was 39.7 (18-76) years. Eighty four patients (43.8%) had ulcerative colitis and 108 patients (56.3%) had Crohn's disease (CD). The percentage of the patients who had got vaccination was 42.2% for MMR, 34.9% for varicella, 15.6% for Td, 37.5% for influenza, 15.6% for hepatitis A, 52.6% for hepatitis B, 6.3% for pneumococcus and 11.3% for HPV respectively. Not knowing the necessity or the existence were the common reasons for non-vaccination. Age less than 40 years, CD patients and duration of illness less than 10 years were associated with a higher vaccination rate (p=0.002, 0.015 and 0.020, respectively). CONCLUSIONS: Immunization rates for recommended vaccinations were very low in patients with IBD. Efforts to improve vaccination rate are needed.

Rapid response to a case of mumps: implications for preventing transmission at a medical research facility / Respuesta rápida a un caso de paperas: implicaciones para la prevención del contagio en una instalación de investigación biomédica

OBJECTIVE: To prevent transmission among the staff and potentially among the non-human primate (NHP) colony at the U.S. Naval Medical Research Center Detachment in Peru, where an active case of mumps was discovered in a senior laboratory technician in Sep 03, 2007. MATERIAL AND METHODS: Subjects at the research facility were interviewed and potentially susceptible contacts were tested for mumps IgG. RESULTS: In total, 81 out of 106 staff members (76 percent) had close contact with the case. Only 6/81 (7 percent) had MMR, 33 (41 percent) reported having had mumps, and 8 of 45 (18 percent) of the potentially susceptible individuals did not have immunity (IgG > 20.0). All the susceptible, exposed individuals received MMR vaccine. There were no secondary cases and access to the NHP colony was restricted. DISCUSSION: Immediate and thorough investigation and occupational health response were imperative in preventing secondary cases of mumps among humans and NHP.

OBJETIVO: Prevenir el contagio de parotiditis al personal y potencialmente a la colonia de primates no humanos (PNH), tras detectarse un caso en el personal técnico de laboratorio en el Centro de Investigación de Enfermedades de la Marina de los EUA (NMRCD). MATERIAL Y MÉTODOS: El personal fue entrevistado y se hizo una prueba de IgG para parotiditis a los contactos potencialmente susceptibles. RESULTADOS: En total, 81 de 106 miembros del personal tuvo contacto cercano con el caso. Sólo 6/81 (7 por ciento) tenían vacuna y 33 (41 por ciento) reportaron haber tenido parotiditis, y 8 de 45 (18 por ciento) de los susceptibles potenciales no tenían inmunidad (IgG > 20.0). Todos los susceptibles expuestos fueron vacunados y no hubo casos secundarios. Se restringió el acceso a la colonia de PNH. CONCLUSIÓN: La investigación inmediata y la respuesta de salud ocupacional fue imperativa para prevenir casos secundarios de parotiditis en el personal y los NHP.

Prevalence of antibodies against measles, mumps, and rubella before and after vaccination of school-age children with three different triple combined viral vaccines, Rio Grande do Sul, Brazil, 1996

OBJECTIVE: We evaluated the seroprevalence for measles, mumps, and rubella in school-age children (6-12 years old) before and after the administration of three triple combined viral vaccines. METHODS: In two municipal schools of Rio Grande do Sul, Brazil, 692 blood samples were collected before vaccination and 636 samples 21 to 30 days after vaccination during 1996. IgG antibody seropositivity was investigated by enzyme-linked immunosorbent assay (measles and mumps with Enzygnost [Behring, Marburg, Germany]; rubella with Rubenostika [Organon Teknica, Boxtel, the Netherlands]). The vaccines compared were: A: E-Zagreb, L-Zagreb, and Wistar RA 27/3 (Tresivac); B: Moraten, J-Lynn, and Wistar RA 27/3 (M-M-R II); and C: Schwarz, Urabe AM-9, and Wistar RA 27/3 (Trimovax). RESULTS: Before vaccination, 79.2 percent [95 percent confidence interval (CI) = 76.0 percent-82.2 percent] of the samples were positive for measles, 69.4 percent (95 percent CI = 65.8 percent-72.8 percent) for mumps, and 55.4 percent (95 percent CI = 51.6 percent-59.2 percent) for rubella. After vaccination with the A, B, and C vaccines, seropositivity was 100.0 percent, 99.5 percent, and 100.0 percent, respectively for measles; 99.5 percent, 94.5 percent, and 92.0 percent for mumps; and 92.6 percent, 91.3 percent, and 88.6 percent for rubella. CONCLUSIONS: About one-fifth (20.8 percent) of the schoolchildren who could have been vaccinated against measles at age 9 months had levels of antibodies insufficient for protection. In the sample of schoolchildren without previous vaccination against mumps and rubella, high proportions of susceptible levels were found. All vaccines were immunogenic, but vaccine A yielded a seroconversion rate of 99.5 percent for the mumps component, which was significantly higher than the other two vaccines (P < 0.01).

OBJETIVO: Se evaluó la seroprevalencia para sarampión, paperas y rubéola en niños en edad escolar (6-12 años) antes y después de la administración de tres vacunas triples antivirales combinadas. MÉTODOS: Se colectaron 692 muestras de sangre antes de la vacunación y 636 muestras entre 21 y 30 días después de la vacunación a niños de dos escuelas municipales de Rio Grande do Sul, Brasil, durante 1996. Se investigó la seropositividad de anticuerpos de la clase IgG mediante un ensayo de inmunoadsorción enzimática tipo ELISA (sarampión y paperas con Enzygnost [Behring, Marburgo, Alemania] y rubéola con Rubenostika [Organon Teknica, Boxtel, Países Bajos]). Las vacunas comparadas fueron: a) E-Zagreb, L-Zagreb y Wistar RA 27/3 (Tresivac); b) Moraten, J-Lynn y Wistar RA 27/3 (M-M-R II); y c) Schwarz, Urabe AM-9 y Wistar RA 27/3 (Trimovax). RESULTADOS: Antes de la vacunación, 79,2 por ciento (intervalo de confianza [IC] 95 por ciento: 76,0 a 82,2) de las muestras fueron positivas para sarampión, 69,4 por ciento (IC 95 por ciento: 65,8 a 72,8) para paperas y 55,4 por ciento (IC 95 por ciento: 51,6 a 59,2) para rubéola. Después de la vacunación con las vacunas A, B y C, la seropositividad fue de 100 por ciento, 99,5 por ciento y 100 por ciento, respectivamente para sarampión; de 99,5 por ciento, 94,5 por ciento y 92,0 por ciento para paperas; y de 92,6 por ciento, 92,3 por ciento y 88,6 por ciento para rubéola. CONCLUSIONES: Alrededor de un quinto (20,8 por ciento) de los escolares que pudieron haber sido vacunados contra el sarampión a los 9 meses de edad tenían niveles de anticuerpos insuficientes para protegerlos. En la muestra de escolares sin vacunación previa contra paperas y rubéola se encontró una alta proporción de niños susceptibles. Todas las vacunas fueron inmunogénicas, pero la vacuna A produjo una tasa de seroconversión de 99,5 por ciento para el componente de paperas, significativamente mayor que la de las otras dos vacunas (P < 0,01).

Vacinas contra varicela e vacina quádrupla viral / Varicella vaccines and measles, mumps, rubella, and varicella vaccine

OBJETIVOS: Apresentar uma revisão atualizada sobre os estudos de eficácia, eventos adversos e esquema vacinal da vacina contra varicela e a nova apresentação combinada com a vacina contra sarampo, caxumba e rubéola. FONTES DOS DADOS: Revisão bibliográfica utilizando a base de dados MEDLINE e LILACS no período de 1999 a 2006. SíNTESE DOS DADOS: A vacina contra varicela tem uma eficácia entre 70 a 90 por cento contra a infecção e 95 a 98 por cento de proteção contra as formas graves. É uma vacina bem tolerada e pouco reatogênica. Após o seu licenciamento, foram comprovados apenas três casos de transmissão do vírus vacinal de pessoas previamente saudáveis para contatos domiciliares, que desenvolveram doença leve. Apesar das evidências de que a proteção conferida pela vacina pode diminuir com o passar dos anos, ainda não é possível afirmar que seja necessário, no momento, a aplicação de uma segunda dose, tendo em vista a exposição ao vírus selvagem. Após a vacinação universal, as chances de estímulo natural deverão diminuir, e muito provavelmente será necessário a aplicação de doses de reforço. Recentemente foi licenciada a vacina quádrupla viral, um produto combinado com a vacina contra sarampo, caxumba, rubéola e varicela com elevadas taxas de soroconversão. CONCLUSÃO:A vacina contra varicela é recomendada pela Sociedade Brasileira de Pediatria (SBP) para as crianças a partir de 1 ano de idade. Esperamos que, em breve, a vacina quádrupla viral esteja disponível no Brasil, pois o uso de vacinas combinadas possibilita uma maior cobertura vacinal.

Atualização do Programa Estadual de Imunização - 1999 / São Paulo State Program of Immunization - 1999

A Secretaria de Saúde do Estado de Säo Paulo, através de seus diversos órgäos de assessoria, estabelece novas normas de vacinaçäo que os autores atualizam, salientando-se a implantaçäo da vacinaçäo contra a hepatite B dos menores de um ano. Neste artigo de revisäo säo apresentadas as normas atualizadas, incluindo agentes imunizantes, pessoas a serem imunizadas, associaçäo de vacinas, situaçöes especiais, eventos adversos pós-imunizaçäo, bem como o Calendário de Vacinaçäo até os seis anos e acima dessa idade. Os detalhes de vacinaçäo para tuberculose, hepatite B, difteria, coqueluche e tétano, poliomielite, sarampo, caxumba e rubeóla, além de febre amarela e raiva, säo também apresentados detalhadamente