Prevalence of neutralizing antibodies against poliovirus 1, 2, and 3 in healthcare professionals aged 20-50 years / Prevalência de anticorpos neutralizantes contra poliovírus 1, 2 e 3 em profissionais de saúde de 20 a 50 anos de idade

ABSTRACT Objective: To describe the prevalence of neutralizing antibodies against poliovirus (PV1, PV2, and PV3) in blood samples of healthcare professionals aged 20 to 50 years. Methods: Health professionals who serve children at Darcy Vargas Children's Hospital and the Department of Pediatrics of Irmandade da Santa Casa de São Paulo. The sample size was calculated at 323 participants. The Mantel-Haenszel chi-square was used to verify differences between groups. The neutralization reaction detected human poliovirus antibodies. For susceptible individuals, vaccination with the inactivated+triple acellular polio vaccine was performed, and neutralizing antibodies were re-dosed after one week. Results: 333 professionals were studied - 92.8% were immune to poliovirus 1, 86.5% to poliovirus 2, and 63.3% to poliovirus 3; 37% had titers less than 1:8 for any serotype, 5;1% had titers below 1:8 for all three. Vaccination with inactivated polio vaccine was performed for susceptible participants, and neutralizing antibodies were dosed after one week, showing increased titers for all polioviruses. Conclusions: Despite the detection of a significant percentage of individuals with low poliovirus antibody titer, the challenge with vaccination demonstrated immune response compatible with poliovirus immunity.

RESUMO Objetivo: Descrever a prevalência de anticorpos neutralizantes contra poliovírus (tipos 1, 2 e 3) em amostra de sangue de profissionais de saúde com idade de 20 a 50 anos. Métodos: Profissionais de saúde que atendem crianças do Hospital Infantil Darcy Vargas e do Departamento de Pediatria da Irmandade da Santa Casa de São Paulo. O tamanho da amostra foi de 323 participantes. Os anticorpos contra poliovírus humanos foram detectados pela reação de neutralização. Para os indivíduos suscetíveis, foram administradas vacina para poliomielite inativada+tríplice e nova dosagem de anticorpos neutralizantes após uma semana. Utilizou-se o teste do qui-quadrado de Mantel-Haenszel para verificar as diferenças entre os grupos. Resultados: Foram estudados 333 profissionais - 92,8% eram imunes ao poliovírus 1; 86,5%, ao poliovírus 2; 63,57%, ao poliovírus 3; 37% apresentaram títulos inferiores a 1:8 para qualquer sorotipo; 5,1% tinham títulos abaixo de 1:8 para os três. Após a vacinação dos suscetíveis, houve elevação dos títulos para todos os poliovírus. Conclusões: Apesar da detecção de percentual significativo de indivíduos com baixo título de anticorpos para poliovírus, o desafio da vacinação demonstrou resposta imune robusta compatível.

Vacunas e inmunizaciones en recién nacidos y recién nacidos prematuros / Vaccines in newborn and preterm infants

El recién nacido de pretérmino (RNPT), especialmente el menor de 32 semanas de edad gestacional, presenta un mayor riesgo de adquirir infecciones y que estas sean de curso más grave respecto a los recién nacidos de término (RNT), debido, entre otros factores a una inmadurez de varios componentes del sistema inmune. Muchas de estas infecciones son inmunoprevenibles por vacunas disponibles en nuestro medio y la recomendación actual es vacunar a los lactantes nacidos de pretérmino o bajo peso, salvo pocas excepciones, con todas las vacunas rutinariamente recomendadas según su edad cronológica al igual que un RNT. Sin embrago, en muchas oportunidades se observa un retraso en los calendarios de inmunización de estos lactantes principalmente por las aprehensiones respecto a la inmunogenicidad y seguridad de las vacunas en esta población. El objetivo de este artículo es revisar la evidencia disponible respecto a la eficacia y seguridad de las vacunas habitualmente utilizadas en lactantes, enfocados en los RNPT.

Preterm infants, especially those born with less than 32 weeks of gestational age, have a higher risk of acquiring serious infections compared to term infants due among other factors, to a decrease in several components of the immune system. Many of these infections are immunopreventable by vaccines available in our country. The current recommendation is to vaccinate all preterm or low weight born infants with few exceptions, using vaccines routinely recommended according to their chronological age just as term infants. However, on many occasions there is a delay in the immunization schedules of these infants mainly due to the apprehensions regarding the immunogenicity and safety of vaccines in this population. The aim of this article is to review the available evidence regarding the efficacy and safety of vaccines commonly used in preterm infants.

Vacunación de la embarazada / Maternal immunization

Las vacunas han sido una de las herramientas más útiles para lograr disminuir la mortalidad infantil. Sin embargo, los beneficios de las vacunas para menores de un año son dispares, debido a que son muy pequeños para ser vacunados. Otro grupo vulnerable son las embarazadas, quienes presentan mayor morbimortalidad por enfermedades como la influenza. La inmunización materna puede proteger a la madre contra las infecciones prevenibles por vacuna y al recién nacido mediante el traspaso de anticuerpos específicos al feto. No hay evidencia de resultados adversos en el embarazo o el feto/recién nacido por la vacunación de mujeres gestantes con vacuna inactivada contra virus, bacterias o toxoides. Por lo tanto, el embarazo no debe impedir que las mujeres reciban las vacunas que están médicamente indicadas. En Chile, se recomienda la vacunación de las mujeres gestantes, antes o durante la temporada de influenza. A fines de 2017 se implementó la vacunación con dTpa de las embarazadas con más de 28 semanas de gestación, con el objetivo de proteger al recién nacido contra el coqueluche y sus complicaciones. En el presente artículo, se hace una revisión de la literatura disponible sobre la vacunación de las embarazadas, principalmente enfocado en inmunización contra la influenza, el coqueluche y los beneficios en sus hijos.

Vaccines have been one of the most useful tools to reduce infant mortality. However, the benefits of vaccines for children under one year are disparate, because they are too small to be vaccinated. Another vulnerable group are pregnant women, who have a higher morbidity and mortality due to diseases such as influenza. Maternal immunization can protect the mother against vaccine-preventable infections and the newborn by transferring specific antibodies to the fetus. There is no evidence of adverse outcomes in pregnancy or the fetus / newborn by vaccination of pregnant women with inactivated vaccine against viruses, bacteria or toxoids. Therefore, pregnancy should not prevent women from receiving vaccines that are medically indicated. In Chile, vaccination is recommended for pregnant women, before or during the influenza season. In addition to the end of 2017, vaccination with Tdap of pregnant women with more than 28 weeks of gestation was implemented, with the aim of protecting the newly born against pertussis and its complications. In this article, we review the available literature on the vaccination of pregnant women, mainly focused on immunization against influenza, pertussis and benefits in their children.

Vacunas en salud laboral: una oportunidad para prevenir e invertir en salud / Vaccines in occupational medicine: an opportunity to prevent and invest in health

La vacunación es la medida preventiva más costo-efectiva para evitar las enfermedades infecciosas inmunoprevenibles, a nivel individual y comunitario. Los riesgos biológicos laborales, deben ser manejados en un sistema de gestión del riesgo, donde la vacuna es el elemento clave de protección personal (EPP) específico cuya provisión y uso obligatorio tiene normas legislativas referidas a la entrega por el empleador, la capacitación en la prevención y el uso por el trabajador. En Chile, hay 8.364.282 trabajadores según datos de Superintendencia de Seguridad Social (SUSESO). La Ley 16.744 y sus Decretos Supremos (DS) indican las condiciones que se deben mantener en los lugares de trabajo y el derecho a saber por parte del trabajador; también existen circulares del Ministerio de Salud que incluyen situaciones y grupos especiales laborales a vacunar, pero es necesaria una normativa que oriente a trabajadores dependientes e independientes y a empleadores sobre qué vacunas colocar, en qué situaciones y a quiénes dependiendo de la actividad laboral. En este artículo, hacemos una reseña de la situación legal, de recomendaciones en otros países y enumeramos algunas vacunas que podrían implementarse en la población expuesta a riesgo.

Vaccination is the most cost-effective measure for immune-preventable infectious diseases, at individual and community level. Biological occupational hazards must be faced in a risk management system, where the vaccine is a specific key as an element of personal protection, whose provision and obligatory use has legislative norms related to the delivery by the employer, the training in the prevention and the use by the worker. Several countries count with technical guides for vaccination in the working population. In Chile in 2018, there were 8.364.282 workers according with Superintendence of Social Security. Law 16.744 and Supreme Decrees indicate the environmental conditions for workers and the right to know the risks; also, Ministry of Health has issued circulars where some working conditions need specific vaccination. Is for that reason that is necessary a regulation that guides dependent and independent workers and employers on when and which vaccines must be used depending on the labor activity. In this article, we review the legal situation, other guides in different countries and list some vaccines that could be implemented in the population at specifical risks.

Influenza A (H1N1): outbreak management in a dialysis unit and clinical outcomes of infection in chronic hemodialysis patients / Influenza A (H1N1): controle de surto em unidade de diálise e desfechos clínicos da infecção em pacientes em hemodiálise crônica

ABSTRACT Introduction: Chronic hemodialysis (HD) patients are considered to be at high risk for infection. Here, we describe the clinical outcomes of chronic HD patients with influenza A (H1N1) infection and the strategies adopted to control an outbreak of influenza A in a dialysis unit. Methods: Among a total of 62 chronic HD patients, H1N1 infection was identified in 12 (19.4%). Of the 32 staff members, four (12.5%) were found to be infected with the H1N1 virus. Outcomes included symptoms at presentation, comorbidities, occurrence of hypoxemia, hospital admission, and clinical evaluation. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction. Results: The 12 patients who had H1N1 infection did not differ significantly from the other 50 non-infected patients with respect to age, sex, dialysis vintage, dialysis modality, or proportion of comorbidities. Obesity was higher in the H1N1-infected group (41.5 vs. 4%, p<0.002). The most common symptoms were fever (92%), cough (92%), and rhinorrhea (83%). Early empirical antiviral treatment with oseltamivir was started in symptomatic patients and infection control measures, including the intensification of contact-reduction measures by the staff members, antiviral chemoprophylaxis to asymptomatic patients undergoing HD in the same shift of infected patients, and dismiss of staff members suspected of being infected, were implemented to control the spread of infection in the dialysis unit. Conclusion: The clinical course of infection with H1N1 in our patients was favorable. None of the patients developed severe disease and the strategies adopted to control the outbreak were successful.

RESUMO Introdução: Pacientes em hemodiálise (HD) crônica apresentam risco elevado para infecções. O presente estudo descreve os desfechos clínicos de pacientes em HD crônica com infecção pelo vírus influenza A (H1N1) e as estratégias adotadas para controlar um surto de influenza A numa unidade de diálise. Métodos: Doze (19,4%) de 62 pacientes em HD crônica e quatro (12,5%) de 32 funcionários desta unidade de diálise apresentaram infecção pelo vírus H1N1. Os desfechos incluíram sintomas à apresentação, comorbidades, ocorrência de hipoxemia, internação hospitalar e avaliação clínica. A presença de infecção foi confirmada por reação em cadeia da polimerase via transcriptase reversa (RT-PCR) em tempo real. Resultados: Os 12 pacientes com infecção por H1N1 não diferiram significativamente dos 50 pacientes sem infecção no tocante a idade, sexo, tempo em diálise, modalidade de diálise e percentual de comorbidades. O percentual de obesidade foi mais elevado no grupo com infecção por H1N1 (41,5% vs. 4%, p<0,002). Os sintomas mais comuns foram febre (92%), tosse (92%) e rinorreia (83%). Os pacientes foram submetidos a tratamento antiviral com oseltamivir e medidas de controle (intensificação das medidas de redução de contato pelos funcionários da clínica, quimioprofilaxia com antiviral para pacientes assintomáticos em HD na mesma sala dos pacientes com infecção e afastamento de funcionários da clínica com suspeita de infecção) para controlar a disseminação da infecção pela unidade de diálise. Conclusão: O curso clínico da infecção por H1N1 em nossos pacientes foi favorável. Nenhum evoluiu para doença grave e as estratégias adotadas foram efetivas no controle do surto.

Usando a imunologia de sistemas para entender os mecanismos moleculares de doenças e vacinas / Using systems immunology to understand the molecular mechanisms of diseases and vaccines

Nas últimas décadas, dados relacionados com a saúde humana, desde informações clínicas e epidemiológicas até imagens médicas e experimentos ômicos, foram gerados e acumulados em uma quantidade sem precedentes na história. Um campo novo de pesquisa chamado "Imunologia de Sistemas" emergiu para tentar integrar, analisar, interpretar e predizer os mecanismos moleculares de doenças e vacinas. Esta tese mostra diversas aplicações da Imunologia de Sistemas no estudo de arboviroses, vacina da gripe, câncer, tuberculose, pneumonia, artrite, dentre outros. Também mostra o desenvolvimento de ferramentas computacionais amigáveis que permitem com que qualquer cientista, sem conhecimento prévio de bioinformática, possa realizar análises de Imunologia de Sistemas. Os achados das análises forneceram novas hipóteses e insights que, ao serem testados e validados experimentalmente, melhoram nosso entendimento sobre os processos imunológicos por trás da vacinação e de doenças humanas

Conocimiento vaccinal en madres con hijos menores de 5 años / Vaccinal knowledge, in mothers with children under 5 years old

La inmunización, es un mecanismo de defensa que asegura la inmunidad humoral para prevenir enfermedades infantiles graves, y es responsabilidad de los padres. Objetivo: Se plantea indagar el conocimiento vaccinal, en madres con hijos menores de 5 años. Métodos: el estudio se orienta bajo el paradigma cualitativo, enfoque fenomenológico; Los participantes del estudio fueron madres que vacunaron a sus hijos en el centro de salud 20 de febrero, distrito 12D03 Quevedo-Mocache, Ecuador. Para el análisis de los datos se utilizó el soware Atlas ti, vinculando 18 preguntas de reflexión. Resultados: Las categorías emergentes fueron: 1) Las vacunas son muy importantes y necesarias. 2. Vacunaron porque sus hijos crecen sanos y fuertes. 3. para algunas el vacunatorio es agradable y para otras no. 4. Algunas reciben buen trato y atención, otras no. 5. Es insuficiente la información sobre las vacunas. 6. Piden cambios de enfermeras y horarios. Conclusión: el conocimiento vaccinal de las madres, esdeterminante para la protección y la no propagación de enfermedades en sus hijos(AU)

Immunization is a defense mechanism that ensures humoral immunity to prevent serious childhood diseases, and is the responsibility of the parents. Objective: to investigate the vaccine knowledge in mothers with children under 5 years. Methods: the study is oriented under the qualitative paradigm, hermeneutic approach; e study participants were mothers who vaccinated their children in the health center February 20, district 12D03 Quevedo-Mocache, Ecuador. The Atlas ti soware was used to analyze the data, linking 18 reflection questions. Results: The emerging categories were: 1) Vaccines are very important and necessary. 2. They vaccinated because their children grow up healthy and strong. 3. For some the vaccine is nice and for others it is not. 4. Some receive good treatment and attention, others do not. 5. Insufficient information about vaccines. 6. Ask for changes of nurses and schedules. Conclusion: the vaccinal knowledge of the mothers, is decisive for the protection and non-propagation of diseases in their children(AU)

Cribado de virus de hepatitis B en mujeres embarazadas: inmigrantes, y chilenas con conductas de riesgo. Manejo del binomio madre-hijo: Plan piloto / Screening of hepatitis B in high risk Chilean and immigrant pregnant women: management of mother to child transmission

Resumen Introducción: Chile es un país de baja endemia de virus de hepatitis B (VHB), pero los países de mayor flujo migratorio hacia Chile tienen una endemia intermediaalta. La inmunoprofilaxis (IP) en el recién nacido (RN) es fundamental para evitar la transmisión vertical de VHB. Objetivos: Determinar la prevalencia de HBsAg en mujeres embarazadas: inmigrantes, y chilenas con conductas de riesgo (CR), y evaluar el cumplimiento de la indicación de IP a los RN de madre con HBsAg reactivo. Material y Métodos: Cohorte prospectiva de cribado de HBsAg a mujeres embarazadas inmigrantes, y chilenas con CR, entre julio 2017 y junio 2018 en CABL. Los RN de madre con HBsAg reactivo se les administró IP adecuada (antes de 12 h de vida). Resultados: Se realizó un total de 1.415 HBsAg: 1.265 a inmigrantes y 150 a chilenas con CR. Se obtuvieron 37 pacientes con HBsAg reactivos. Dos falsos positivos. La prevalencia HBsAg en inmigrantes fue 2,7% y 0,66% en chilenas con CR (p < 0,05). El 91,1% provenía de Haití, con una prevalencia de 3,5% en nuestra área. Todos los RN (36) recibieron IP. La mediana de administración de IP fue 3:02 h. Conclusiones: La prevalencia de VHB en mujeres gestantes inmigrantes fue superior a lo reportado en la población general y en mujeres chilenas con CR. Planteamos la necesidad de implementar el cribado universal en el embarazo, y en especial, en mujeres embarazadas provenientes de países con endemia intermedia-alta.

Background: Chile is a low-endemic HBV country, but countries with the highest migratory flow to Chile have an intermediate-high endemicity. In order to avoid vertical transmission of HBV, immunoprophylaxis (IP) in the newborn (NB) is a key factor. Aim: To identify HBsAg prevalence in pregnant immigrants and Chilean pregnant women with risk behaviors (RB) and to asses IP use in the NB. Material and Methods: Prospective HBsAg screening cohort of immigrant and Chilean pregnant women with RB, between July 1, 2017 and June 30, 2018 in CABL. IP of all NB of reactive HBsAg mothers was assessed. Results: 1,415 HBsAg samples, 1,265 immigrants and 150 Chileans with RB. 37 reactive HBsAg. Two false positive. HBsAg prevalence in immigrant pregnant women was 2.7% and 0.66% in Chileans with RB (p < 0.05). 91.1% came from Haiti, with a prevalence of 3.5% in our region. All NB (36) received IP with a median of administration of 3:02 h. Conclusions: The prevalence in immigrant pregnant women was higher than that reported in the general population and in Chilean women with RB. We proposed the need for universal screening in pregnancy, especially in pregnant women from countries with intermediate-high endemicity.

Programas de vacunación infantil en América Latina, 2000-2015 / Children vaccination programs in Latin America, 2000-2015

Introducción: La cobertura de los programas de vacunación infantil está asociada con la probabilidad de supervivencia de los infantes y es una medida de desempeño de los sistemas nacionales de inmunización. Objetivo: Caracterizar los programas de vacunación infantil en países latinoamericanos a partir de la supervivencia de infantes durante el periodo 2000-2015. Método: Se realizó un estudio descriptivo retrospectivo del programa de inmunización de 21 países de América Latina soportado en la metodología del análisis envolvente de datos con ventanas de tiempo. Las variables asociadas son: vacunas (Bacillus calmette-Guérin, difteria, Bordetella pertussis y el tétanos, sarampión, polio) y tasa de supervivencia (menores de 1 año, menores de 5 años). Resultado: Durante el periodo de estudio, 2000-2015, la eficiencia de los programas de vacunación varió entre el 77 por ciento y el 99 por ciento y la ineficiencia se comportó entre el rango de valores del 1 por ciento al 23 por ciento. Se pudieron identificar cuatro grupos de países con una clasificación correcta del 95,2 por ciento. Conclusiones: En América Latina los programas de vacunación infantil tienen comportamientos diferentes en cada país. El conjunto formado por Argentina, Brasil, Cuba, México y Uruguay son referentes en este tipo de programa, debido a la tasa de cobertura de vacunación y tasa de supervivencia de niños menores a cinco años de edad, de acuerdo a los resultados de eficiencia, este grupo podría obtener iguales tasas de supervivencia con menor tasa de cobertura(AU)

Introduction: Coverage of children vaccination programs is associated with the survival probability of infants and it is a measure of the performance of national immunization systems. Objective: To characterize children vaccination programs in Latin American countries from infants survival during 2000-2015. Methods: A retrospective descriptive study of the immunization program in 21 Latin American countries was carried out based in the methodology of the data envelopment analysis with time windows. The associated variables were: vaccines (Bacillus Calmette-Guérin, diphtheria, Bordetella pertussis and tetanus, measles, polio) and survival rate (under 1 year, under 5 years). The information was taken from the reports of the World Health Organization. Results: During the studied period (2000-2015), the efficiency of vaccination programs varied between 77 percent and 99 percent, and the inefficiency was in the range from 1 percent to 23 percent. The result showed the identification of four groups of countries with a correct classification of 95,2 percent. Conclusions: In Latin America, children's vaccination programs present different behaviors in each country. The group formed by Argentina, Brazil, Cuba, Mexico and Uruguay are the reference in children vaccination programs, due to the rate of vaccination coverage and the survival rates in children under 5 years. In accordance to the efficiency results, this group would have equal survival rates with less rate of coverage(AU)

Sarampión: antecedentes históricos y situación actual / Measles: historical background and current situation

Resumen: El sarampión sigue siendo una causa importante de morbilidad y mortalidad en el niño. Durante estos últimos años, se ha convertido en un problema de salud pública mundial, que se atribuye a bajas coberturas de vacunación observadas en diferentes países. Para su control se dispone de una vacuna a virus vivo, altamente eficaz, que fue empleada por primera vez en Chile en 1964, logrando cobertura en prácticamente todo el país en un breve plazo. Esta fue la primera experiencia mundial, imitada lue go por otros países que resulto en una importante caída de las tasas de morbilidad y de mortalidad. Su eficacia ha sido ampliamente demostrada, pero requiere de la mantención de coberturas superiores a 95%. En Chile persistió una situación de endemia de menor magnitud hasta el año 1993. En años recientes, ha habido algunos brotes reducidos y casos esporádicos vinculados a contactos con casos importados, sin embargo, según datos recientes, el sarampión está circulando ahora en más de 160 países en un nivel de propagación sin precedentes, siendo los viajeros infectados el principal vehículo de transmisión. En Chile, el Ministerio de Salud ha decidido reforzar y poner al día la vacunación de grupos susceptibles, en especial viajeros. En esta actualización se revisan aspectos históricos y la información actual de esta enfermedad que ha resurgido mostrando su alto impacto epidemiológico en la población pediátrica y adulta a nivel global.

Abstract: Measles is still a major cause of child morbidity and mortality. In recent years, it has become a global public health problem, attributed to low vaccination coverage observed in different countries. In order to control it, a highly effective live virus vaccine is available, which was used for the first time in Chile in 1964, covering practically the whole country in a short period of time. This was the first world experience, which was later imitated by other countries leading to a significant drop in mor bidity and mortality rates. Its effectiveness has been amply demonstrated, but it requires coverage maintenance higher than 95%. In Chile, minor endemic situation persisted until 1993. In recent years, there have been some reduced outbreaks and sporadic cases linked to contacts with imported cases, however, according to recent data, measles is now circulating in more than 160 countries at an unprecedented spread level, where infected travelers are the main vehicle of transmission. In Chile, the Ministry of Health has decided to strengthen and update the vaccination of susceptible groups, especially travelers. This update reviews historical aspects and current information on this re-emer ging disease, showing its high epidemiological impact on the pediatric and adult population globally.

Remarks on the possibility of introducing the fractionated dose of the inactivated poliomyelitis vaccine in the Latin American Child Immunization Schedule

Abstract Given that the last notified case of poliomyelitis due to wild poliovirus type 2 was in 1999, in 2012, the Strategic Advisory Group of Experts on Immunization (SAGE) of the World Health Organization (WHO) recommended the withdrawal of the type 2 component of oral polio vaccine (OPV) and the introduction of a bivalent OPV (bOPV) in all countries by 2016. WHO recommended also that the withdrawal should be preceded by the introduction of at least one dose of inactivated poliovirus vaccine (IPV) in routine immunization schedules. The introduction of IPV prior to the change of the bOPV in 2016 to trivalent OPV (tOPV) was based on the concept of ensuring that a substantial proportion of the population would be protected against type 2 polio after the removal of the type 2 OPV. However, the world's two producers of IPV (Bilthoven Biologicals and Sanofi) have faced problems in the production of this vaccine and therefore reported a reduction of the global supply of IPV. In response to the potential shortage of IPV, at a meeting held on March 10 2017, the SAGE and Technical Advisory Group (TAG) of the Pan American Health Organization (PAHO) urged the countries in the Latin American region to replace the routine administration of the full doses of inactivated polio vaccine (IPV-C) in the immunization schedule (administered by intramuscular route), administering a fraction of the full dose in two intradermal shots (IPV-f). The possibility of this strategy was analyzed by opinion leaders convened by the Paraguayan Society of Pediatrics with the support of the Latin American Society of Pediatric Infectious Diseases (SLIPE) and Latin American Association of Pediatrics (ALAPE). This document presents the results of the discussion.

Percepções acerca da importância das vacinas e da recusa vacinal numa escola de medicina / Perceptions on the importance of vaccination and vaccine refusal in a medical school

RESUMO Objetivo: Identificar a percepção da importância das vacinas e os riscos da recusa vacinal entre alunos de Medicina e médicos. Métodos: Estudo transversal realizado por meio da aplicação de questionários sobre vacinas, recusa vacinal e suas repercussões acerca da saúde pública e individual. A amostra, de 92 sujeitos, foi selecionada numa escola privada de Medicina: grupo 1 (53 estudantes do primeiro ao quarto ano) e grupo 2 (39 médicos). Os dados colhidos foram tabulados no programa Microsoft Excel e analisados estatisticamente com o teste exato de Fisher. Resultados: Os dois grupos consideram o Programa Nacional de Imunizações confiável e reconhecem a importância das vacinas, mas 64,2% dos estudantes e 38,5% dos médicos desconhecem o número de doenças infecciosas evitáveis pelas vacinas no calendário básico. A maioria dos entrevistados possuía carteira de vacinas, mas nem todos receberam vacina influenza 2015. Conheciam pessoas que recusavam vacinas e/ou recusavam vacinar seus filhos (respectivamente, 54,7 e 43,3% dos estudantes e 59,0 e 41,0% dos médicos). Dos médicos, 48,7% já atenderam pacientes que se recusaram a receber vacinas. Consideram causas de recusa vacinal: medo de eventos adversos, razões filosóficas, religiosas e desconhecimento sobre gravidade e frequência das doenças. Aspectos éticos da recusa vacinal e possibilidades legais de exigir vacinas para crianças não são consenso. Conclusões: Alunos de Medicina e médicos não se vacinam adequadamente, apresentam dúvidas sobre calendário vacinal, segurança das vacinas e recusa vacinal. Melhorar sua capacitação é importante estratégia para manter as coberturas vacinais e abordar a recusa vacinal de forma ética.

ABSTRACT Objective: To identify the perception of medical students and physicians on the importance of vaccination and the risks of vaccine refusal. Methods: Cross-sectional study with application of questionnaires about vaccines, vaccine refusal and its repercussions on public and individual health. A sample of 92 subjects was selected from a private medical school: group 1 (53 students from first to fourth grades) and group 2 (39 physicians). Data collected were tabulated in the Microsoft Excel Program and analyzed by Fisher's exact test. Results: Both groups considered the National Immunization Program reliable and recognized the importance of vaccines, but 64.2% of students and 38.5% of physicians are unaware of the vaccine-preventable infectious diseases in the basic immunization schedule. Most of the interviewees had a personal vaccine registry, but not all had received the 2015 influenza vaccine. Both groups had known people who refused vaccines for themselves or for their children (respectively, 54.7 and 43.3% of students and 59.0 and 41.0% of physicians). The total of 48.7% of physicians had already assisted vaccine refusers. Appointed causes of vaccine refusal were: fear of adverse events, philosophical and religious reasons and lack of knowledge about severity and frequency of diseases. Ethical aspects of vaccine refusal and legal possibilities of vaccine requirements for children are not consensus. Conclusions: Medical students and doctors are not adequately vaccinated and have queries about the vaccination schedule, vaccine safety and vaccine refusal. Improving these professionals' knowledge is an important strategy to maintain vaccine coverage and address vaccine refusal ethically.

Consideraciones referente a la posibilidad de introducir la dosis fraccionada de la vacuna antipoliomielitis inactivada en el calendario de Inmunizaciones del Niño Latinoamericano / Remarks on the possibility of the introduction of fractionated dose of the inactivated poliomyelitis vaccine in the Latin American Child Immunization Schedule

As last notified case of poliomyelitis due to wild poliovirus type 2 was 1999, in 2012, the Strategic Advisory Group of Experts on Immunization (SAGE) of the World Health Organization (WHO) recommended the withdrawal of the type 2 component of oral polio vaccine (OPV) and the introduction of bivalent OPV (bOPV) in all countries by 2016. WHO recommended also that the withdrawal should be preceded by the introduction of at least one dose of inactivated poliovirus vaccine (IPV) in routine immunization schedules. The introduction of IPV prior to the change of the bOPV in 2016 to trivalent OPV (tOPV) was based on the concept of ensuring that a substantial proportion of the population would be protected against type 2 polio after the removal of the type 2 OPV. However, the world's two producers of IPV (Bilthoven Biologicals and Sanofi) have faced problems in the production of this vaccine and therefore reported reduction in IPV global supply. In response to the possible shortage of IPV, the SAGE and Technical Adviser Group (TAG) of the Pan American Health Organization (PAHO), in the meeting of March 10, 2017, has urged that countries in the Latinamerican region should replace the routine administration of the full doses of polio inactivated vaccine (IPV-C) in the immunization schedule (administered by intramuscular route) by the administration of a fraction of the full dose in two shots by intradermal route (IPV-f). The possibility of this strategy was analyzed by leaders of opinions gathered by the call of the Paraguayan Pediatric Society with the support of the Latin American Society of Pediatric Infectious Diseases (SLIPE) and Latin American Association of Pediatrics (ALAPE). The results of the discussion are presented in this document.

Infecciones del tracto urinario, inmunidad y vacunación / Urinary tract infections, immunity, and vaccination

Resumen Las infecciones del tracto urinario (ITU) se consideran como una de las principales causas de morbilidad en el mundo, y Escherichia coli uropatogénica (UPEC, por sus siglas en inglés) es el agente causal asociado a estas infecciones. La alta morbilidad generada por las ITU y la limitación de tratamientos debido al aumento de la resistencia bacteriana a los diversos antibióticos inducen la búsqueda de nuevas alternativas contra estas infecciones. El conocimiento que se ha generado acerca de la respuesta inmunitaria en el tracto urinario (TU) es importante para el desarrollo de estrategias efectivas en la prevención, el tratamiento y el control de las ITU. Los avances en las herramientas de biología molecular y bioinformática han permitido generar proteínas de fusión consideradas como biomoléculas potenciales para el desarrollo de una vacuna viable contra las ITU. Las adhesinas fimbriales (FimH, CsgA y PapG) de UPEC son factores de virulencia que contribuyen a la adherencia, la invasión y la formación de comunidades bacterianas intracelulares. Pocos estudios in vivo e in vitro han mostrado que las proteínas de fusión promueven una respuesta inmunitaria eficiente y de protección contra las ITU causadas por UPEC. Adicionalmente, la vía de inmunización intranasal con moléculas inmunogénicas ha generado una respuesta en la mucosa del TU en comparación contra otras vías de inmunización. El objetivo de esta revisión fue proponer un diseño de vacuna contra las ITU causadas por UPEC, describiendo el panorama general de la infección, el mecanismo de patogenicidad de la bacteria y la respuesta inmunitaria del huésped.

Abstract Urinary tract infections (UTI) are considered one of the main causes of morbidity worldwide, and uropathogenic Escherichia coli (UPEC) is the etiological agent associated with these infections. The high morbidity produced by the UTI and the limitation of antibiotic treatments promotes the search for new alternatives against these infections. The knowledge that has been generated regarding the immune response in the urinary tract is important for the development of effective strategies in the UTI prevention, treatment, and control. Molecular biology and bioinformatic tools have allowed the construction of fusion proteins as biomolecules for the development of a viable vaccine against UTI. The fimbrial adhesins (FimH, CsgA, and PapG) of UPEC are virulence factors that contribute to the adhesion, invasion, and formation of intracellular bacterial communities. The generation of recombinant proteins from fimbrial adhesins as a single molecule is obtained by fusion technology. A few in vivo and in vitro studies have shown that fusion proteins provide an efficient immune response and protection against UTI produced by UPEC. Intranasal immunization of immunogenic molecules has generated a response in the urinary tract mucosa compared with other routes of immunization. The objective of this review was to propose a vaccine designed against UTI caused by UPEC, describing the general scenario of the infection, the mechanism of pathogenicity of bacteria, and the immune response of the host.