Vaccination principles for dogs and cats in animal shelters / Princípios da vacinação de cães e gatos em abrigos

Animal shelters are places with a high risk of exposure to infectious diseases due to the high density, population dynamics of the shelter, and the stress to which dogs and cats are subjected. The immunization process through vaccines is an essential component in the prevention and health and welfare management program for these animals. This review aims to evaluate the guidelines on vaccination of dogs and cats in shelter environments, highlighting points of comparison with the Brazilian reality.(AU)

Os abrigos de animais são locais com um alto risco de exposição às doenças infecciosas devido à alta densidade, à dinâmica populacional do abrigo e ao estresse a que os cães e gatos estão submetidos. O processo de imunização por meio das vacinas é um componente essencial no programa de prevenção e gestão de saúde e bem-estar para esses animais. Esta revisão tem como objetivo revisar as diretrizes sobre a vacinação de cães e gatos em ambientes de abrigos, ressaltando pontos de comparação com a realidade brasileira.(AU)

Incidência de erros de imunização em Minas Gerais: estudo transversal, 2015-2019 / La incidencia de los errores de inmunización en Minas Gerais, Brasil: estudio transversal, 2015-2019 / Incidence of immunization errors in the state of Minas Gerais, Brazil: a cross-sectional study, 2015-2019

Objetivo: Avaliar a incidência do erro de imunização no serviço público de saúde do estado de Minas Gerais, Brasil. Métodos: Estudo transversal, a partir dos erros notificados no Sistema de Informação do Programa Nacional de Imunização entre 2015 e 2019. Realizaram-se análise descritiva e cálculo da incidência para as macrorregiões de saúde do estado. Resultados: Foram analisadas 3.829 notificações. Crianças menores de 1 ano foram as mais acometidas (39,1%) e a via intramuscular foi responsável por 29,4% dos erros. O erro mais frequente foi a administração de vacina fora da idade recomendada (37,7%). Observou-se maior incidência de erros nas macrorregiões Vale do Aço (26,5/100 mil) e Triângulo do Norte (22,6/100 mil). Conclusão: Os erros de imunização apresentaram incidência heterogênea entre as macrorregiões de Minas Gerais, no período 2015-2019, e a administração de vacinas fora da idade recomendada foi o erro mais notificado.

Objetivo: Evaluar la incidencia de errores de inmunización en el servicio público de salud del estado de Minas Gerais, Brasil. Métodos: Estudio transversal basado en errores notificados en el Sistema de Información del Programa Nacional de Vacunación entre 2015 y 2019. Se realizó un análisis descriptivo y cálculo de la incidencia para las macrorregiones de salud del estado. Resultados: Se analizaron un total de 3.829 notificaciones. Los niños menores de 1 año fueron los más afectados (39,1%) y la vía intramuscular fue responsable del 29,4% de los errores. El error más frecuente fue la administración de la vacuna fuera de la edad recomendada (37,7%). Se observó una mayor incidencia en las macrorregiones Vale do Aço (26,5/100.000) y Triângulo do Norte (22,6/100.000). Conclusión: Los errores de inmunización mostraron una incidencia heterogénea entre las macrorregiones del estado de Minas Gerais de 2015 a 2019 y la administración de vacunas fuera de la edad recomendada fue el error más reportado.

Objective: To evaluate the incidence of immunization errors in the public health service of the state of Minas Gerais, Brazil. Methods: This was a cross-sectional study, based on errors reported on the National Immunization Program Information System between 2015 and 2019. A descriptive analysis and calculation of the incidence for the state's health macro-regions were performed. Results: A total of 3,829 notifications were analyzed. Children younger than 1 year old were the most affected (39.1%) and the intramuscular route accounted for 29.4% of the errors. The most frequently reported error was administration of vaccines outside minimum and maximum recommended ages (37.7%). There was a higher incidence of errors in Vale do Aço (26.5/100,000) and Triângulo do Norte (22.6/100,000) macro-regions. Conclusion: Immunization errors showed a heterogeneous incidence among the macro-regions of the state of Minas Gerais, between 2015-2019, and the administration of vaccines outside minimum and maximum recommended ages was the most frequently reported error.

Covid-19: imunidade natural e vacinal / Covid-19: natural immunity and vaccination

De acordo com o Centers for Disease Control and Prevention (CDC) apesar dos avanços obtidos, nos últimos meses, no desenvolvimento de imunizantes para a COVID-19, algumas perguntas continuam sem respostas, como por exemplo, por quanto tempo as vacinas são capazes de proteger a população da infecção pelo SARS-CoV-2 (CDC, 2021), imunidade híbrida e a necessidade de booster, adicionado ao protocolo inicialmente proposto. Apesar de a maioria dos estudos utilizar os níveis séricos de anticorpos neutralizantes contra o SARS-CoV-2, ainda considera-se desconhecido o nível de anticorpos neutralizantes que garante proteção contra a COVID-19 (CALLAWAY, 2021; BENOTMANE et al., 2021). Por outro lado, embora existam outros mecanismos responsáveis pela resposta imune mediada por células T e B de memória imunológica, Khoury e colaboradores (2021) consideram que a concentração dos anticorpos neutralizantes após contato com o vírus (indivíduos convalescentes soropositivos) e/ou após administração de um imunizante seja capaz de predizer a resposta imune à doença.

According to the Centers for Disease Control and Prevention (CDC), despite the advances made in recent months in the development of immunizers for COVID-19, some questions remain unanswered, such as, for example, how long are vaccines able to protect the population from SARS-CoV-2 infection (CDC, 2021), hybrid immunity and the need for a booster, added to the initially proposed protocol. Although most studies use serum levels of neutralizing antibodies against SARS-CoV-2, the level of neutralizing antibodies that guarantee protection against COVID-19 is still unknown (CALLAWAY, 2021; BENOTMANE et al., 2021 ). On the other hand, although there are other mechanisms responsible for the immune response mediated by immune memory T and B cells, Khoury et al (2021) consider that the concentration of neutralizing antibodies after contact with the virus (convalescent seropositive individuals) and/or after administration of an immunizing agent is able to predict the immune response to the disease.

Vacinas Covid-19: eficácia e segurança / Covid-19 vaccines: efficacy and safety

A síntese trata da eficácia e segurança das vacinas contra Covid-19 em desenvolvimento no mundo. Os estudos utilizados como base para o registro e liberação de vacinas para a imunização da população são divididos em três fases. Na fase I os ensaios clínicos têm como objetivo principal avaliar a segurança e a melhor forma de administração do produto testado, já na fase II os principais objetivos são avaliar qual será a melhor dose e o intervalo de tempo ideal entre as doses para garantir a eficácia da imunização, a fase III tem como objetivo avaliar se a vacina apresenta resposta imunológica protetora aos humanos que estão em contato com a doença em estudo. (INSTITUTO BUTANTAN, 2020).

The synthesis addresses the efficacy and safety of covid-19 vaccines in development worldwide. The studies used as a basis for the registration and release of vaccines for immunization of the population are divided into three phases. In phase I the clinical trials have as main objective to evaluate the safety and the best way of administration of the tested product, already in phase II the main objectives are to evaluate what will be the best dose and the ideal time interval between doses to ensure the effectiveness of immunization, phase III aims to evaluate whether the vaccine presents protective immune response to humans who are in contact with the disease under study. (BUTANTAN INSTITUTE, 2020)

Farmacovigilancia de vacunas y su aplicación en Chile / Vaccine pharmacovigilance and its application in Chile

La inmunización se encuentra entre las intervenciones en salud pública más exitosas y costo efectivas de todas las épocas, siendo su beneficio tan importante como su seguridad. Las vacunas, como cualquier otro medicamento, pueden generar eventos adversos, los que deben ser monitorizados permanentemente por sistemas de vigilancia. Esta disciplina recibe el nombre de Farmacovigilancia de Vacunas (FVV), encargada de estudiar los Eventos Supuestamente Atribuidos a la Vacunación ó Inmunización (ESAVI). El objetivo de este trabajo es revisar la evolución del sistema de farmacovigilancia de vacunas en Chile. El sistema de FVV chileno se basa en la vigilancia pasiva, y contempla la notificación obligatoria al Instituto de Salud Pública (ISP) de todos los ESAVI detectados, por parte de profesionales de la salud, directores de establecimientos y titulares de registro sanitario, priorizando las notificaciones de ESAVI serios e incluyendo la monitorización de todas las vacunas usadas en el país, tanto las que se encuentran incorporadas al Programa Nacional de Inmunización (PNI), como las que se encuentran fuera de este. El sistema de FVV chileno se caracteriza por un trabajo colaborativo permanente entre el ISP y el PNI, y parte de sus desafíos incluyen generar capacidades y alianzas estratégicas con la academia para la realización de estudios post comercialización sobre seguridad de vacunas. Finalmente, es importante destacar que tanto el marco normativo promulgado el año 2010, como la elaboración de procedimientos, el trabajo permanente con el PNI, y la conformación de un comité de expertos de ESAVI, y las diferentes estrategias de retroalimentación, son medidas implementadas que han contribuido a mejorar la tasa de reporte nacional y el análisis de los casos.

Immunization is among the most successful and cost-effective public health interventions of all times, its benefits being as important as its safety. Vaccines, like any other medicine, can generate adverse events, which must be permanently monitored by surveillance systems. Vaccine Pharmacovigilance (VPV) is the discipline responsible for studying Adverse Events Following Immunization (AEFI). The objective of this article is to review the evolution of the pharmacovigilance system of vaccines in Chile. The Chilean VPV system is based on passive surveillance, and establishes the mandatory reporting of all AEFI detected by healthcare workers, directors of healthcare facilities, and Marketing Authorization holders, to the Public Health Institute of Chile (PHI), prioritizing the reporting of serious ESAVI and including the monitoring of all vaccines used in the country, both those that are incorporated into the National Immunization Program (NIP), and those that are outside of it. The Chilean VPV system is characterized by a permanent collaborative work between the PHI and the NIP, and its challenges include generating capacities and strategic alliances with the academy to carry out post-marketing studies on vaccine safety. Finally, it's important to point out that the regulatory framework promulgated in 2010, as well as the elaboration of procedures, the permanent work with the NIP, the formation of an AEFI expert committee, and the different feedback strategies implemented, have contributed in improving case analysis and the national reporting rate.

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.

Inmunizaciones en niños, adolescentes y adultos inmunosuprimidos / Immunizations in children, adolescent and adult immunocompromised hosts

Los pacientes inmunosuprimidos presentan un riesgo mayor de infecciones, debido a sus disfunciones inmunes, producto de la actividad de su enfermedad y la terapia inmunosupresora. El uso de vacunas disminuye este riesgo, otorgando protección directa e indirecta, a través de la vacunación del paciente y sus contactos. Las vacunas inactivadas han demostrado un perfil de seguridad adecuado en estos pacientes, por lo que no están contraindicadas, aunque su respuesta inmune puede ser inadecuada. Las vacunas vivas atenuadas, formalmente contraindicadas, poseen una información creciente que permite evaluar su riesgo/beneficio de manera individual. Por este motivo es necesario procurar mantener el calendario de vacunas actualizado y complementado, evitando el retraso en esquemas de vacunación y poniéndolo al día lo antes posible, con estrategias basadas en el individuo. Para llevar a cabo esto, se debe conocer y considerar los intervalos entre las vacunas, los esquemas acelerados, la solicitud de vacunas especiales, las aprobaciones vigentes y, finalmente, sus contraindicaciones.

Immunecompromised patients are at higher risk of infections due to their immune dysfunction caused by ongoing disease processes and immunosuppressive therapy. Patient vaccination or vaccination of the people in contact with patients diminishes their risk of infection. Although the immune response of immunocompromised patients might be impaired, the use of inactivated vaccines is safe and it is not contraindicated in these patients. Formerly, live attenuated vaccines were contraindicated in immunecompromised patients, but recently more data supports their use when evaluating case by case the risks and benefits of their application. Thus, it is important to keep and up-to-date, taylor-based and enhanced vaccination schedule in these cases. For this, specialists need to be informed about the availability of regular and special vaccines, their current approvals, vaccine administration protocols under specific situations and vaccine contraindications.

Vacunas en pacientes con VIH/SIDA / Immunizations in HIV/AIDS patients

Los sujetos con infección por Virus de inmunodeficiencia humana (VIH) tienen mayor susceptibilidad de adquirir infecciones por su deterioro inmunológico. Según el deterioro inmunológico y el uso de terapia antiretroviral (TARV) en niños y adultos VIH (+), la intensidad de la respuesta inmune a las vacunas es menor que la población general. Por este motivo es preferible administrar vacunas una vez que la TARV haya permitido la inmunoreconstitución, y se recomiendan dosis de refuerzo. Por otra parte, las vacunas vivas atenuadas deben ser usadas con precaución, y están contraindicadas en inmunosupresión severa.

Patients with Human Immunodeficiency Virus (HIV) are more susceptible to acquiring infections due to their immune deterioration. The intensity of the immune response to vaccines is lower than general population, depending on immune status and the use of antiretroviral therapy (ARV). For this reason, it is preferable to administer vaccines once ART has allowed immune reconstitution, and booster doses are recommended. On the other hand, live vaccines should be used with caution, and are contraindicated in severe immunosuppression.

Priorización de nuevas vacunas e innovación al servicio de estrategias de vacunación / New vaccines prioritization and immunization-related innovation

La vacunación es el medio más efectivo para controlar la morbilidad y mortalidad relacionadas con enfermedades infecciosas. Para lograr esto, necesitamos vacunas inmunogénicas y seguras que faciliten y mejoren sus condiciones de transporte, almacenamiento y administración. Gracias a los avances en inmunología y bioinformática, es posible impulsar el descubrimiento de nuevas vacunas para enfrentar la tuberculosis, el virus respiratorio sincicial, el Streptococcus agalactiae, la enfermedad meningocócica invasora, entre otros. Así también, nuevas tecnologías, como la producción de vacunas utilizando plantas transgénicas y parches de microagujas, los cuales podrían facilitar la producción, disminuir los costos y efectos adversos. Sin embargo, no solo necesitamos las vacunas, sino que debemos conocer la epidemiología de las enfermedades prevenibles con vacuna para tomar decisiones fundadas, con el objetivo de planificar estrategias sanitarias, medir su impacto y evaluar la seguridad de su utilización, para alcanzar las metas de salud pública y la confianza de la población.

Vaccination is the most effective strategy to avoid morbidity and mortality related to infectious diseases. To achieve this, we need immunogenic and safe vaccines that facilitate and improve its transport, storage and administration conditions. Thanks to current advances in immunology and bioinformatics, it is possible to boost the discovery of new vaccines to deal with tuberculosis, the respiratory syncytial virus, Streptococcus agalactiae, meningococcal invasive disease, among others. In addition to new technologies such as the production of plant-based vaccines, and microneedles patches, which can facilitate its production, reducing costs and adverse effects. However, vaccines is not the only thing that we need, because we must know the epidemiology and burden of disease to take informed decisions to design optimal strategies, measuring their impact and assessing the safety of their use in order to achieve the goals health and population confidence.

Effect of doses and administration routes of 9R vaccine on protection of Japanese quails against experimental infection with Salmonella Gallinarum / Efeito das doses e vias de administração da vacina 9R na proteção de codornas japonesas contra infeccção experimental com Salmonella Gallinarum

Coturniculture has increased significantly in the last decades. There are several pathogens that can affect these birds. Among the diseases, fowl typhoid stands out as a disease with a potentially great impact to the poultry industry. The objective of this the study was to evaluate the effect of doses and administration routes of live 9R vaccine on protection of Japanese quails against experimental infection with Salmonella Gallinarum (SG). Two hundred and fifty birds were used, divided into five groups: G1, oral vaccination with one dose; G2, oral vaccination with 2 doses; G3, subcutaneous vaccination with one dose; G4, subcutaneous vaccination with two doses and G5 not vaccinated. All birds from all five groups were challenged with SG at an age of 45 days. SG was quantified in the periods of one, four, seven and twelve days after the challenge. The presence of clinical signs and macroscopic lesions of the disease were observed. The groups vaccinated by subcutaneous route had a higher egg production and lower mortality rate. Birds receiving a dose of the vaccine by subcutaneous route also showed lower amount of SG in the liver and spleen seven days after the challenge.(AU)

A coturnicultura tem aumentado significativamente nas últimas décadas. Existem vários patógenos que podem afetar essas aves. Entre as doenças, o tifo aviário se destaca como uma doença de grande impacto para a indústria avícola. O objetivo deste estudo foi avaliar o efeito de doses e vias de administração da vacina viva 9R na proteção de codornas japonesas contra infecção experimental por Salmonella Gallinarum (SG). Foram utilizadas duzentos e cinquenta aves, divididas em cinco grupos: G1, vacinação oral com uma dose; G2, vacinação oral com 2 doses; G3, vacinação subcutânea com uma dose; G4, vacinação subcutânea com duas doses e G5 não vacinado. Todas as aves dos cinco grupos foram desafiadas com SG aos 45 dias de idade. A SG foi quantificada nos períodos de um, quatro, sete e doze dias após o desafio. Foi observada a presença de sinais clínicos e lesões macroscópicas da doença. Os grupos vacinados por via subcutânea apresentaram maior produção de ovos e menor taxa de mortalidade. Aves recebendo uma dose da vacina por via subcutânea também apresentaram menor quantidade de SG no fígado e baço sete dias após o desafio.(AU)

Impacto de um modelo de melhoria da qualidade na redução de erro relacionado à administração de vacina em Unidade Básica de Saúde / Impact of a quality improvement model on reducing errors related to vaccine administration in a Basic Health Unit

Justificativa: em minha atuação como enfermeira de uma Unidade Básica de Saúde (UBS), me deparei, com frequência, com as dúvidas dos profissionais de enfermagem sobre o manejo seguro das vacinas, incluindo dose correta segundo faixa etária, intervalo entre doses e faixa etária alvo da vacina. Tais dúvidas tinham potencial para resultar em danos aos usuários e, por este motivo, o presente estudo foi proposto. Objetivo: Avaliar o impacto de um programa de melhoria da qualidade na redução de erro relacionado à administração de vacina. Método: estudo observacional voltado para a comparação de medidas de resultados antes (Fase I) e após (Fase II) a implementação de um programa de melhoria da qualidade, segundo o referencial teórico e metodológico do Institute for Healthcare Improvement (IHI). O estudo foi realizado em uma UBS do interior do estado de São Paulo, no período de março a setembro de 2019. O universo em estudo foi constituído por 164 doses de vacinas preparadas e administradas por 15 técnicas de enfermagem. Para a coleta de dados foi utilizado um formulário eletrônico desenvolvido na Plataforma on-line Survey Monkey®. O estudo foi realizado em duas fases: na primeira, realizou-se a observação direta e participante dos profissionais de enfermagem durante o preparo e a administração das doses (linha de base). Em seguida, os resultados foram apresentados para a equipe de enfermagem da UBS e foi estabelecida uma equipe de melhoria da qualidade. Foram utilizadas as seguintes ferramentas da qualidade: análise de causa raiz; diagrama de Ishikawa; diagrama de Pareto e ciclos PDSA (Plan-Do-Study-Act). Foi estabelecida a meta de 100% de orientações realizadas aos usuários da UBS que necessitavam de vacinas e/ou aos responsáveis, sobre potenciais reações adversas em um período de seis meses. O planejamento das ações foi realizado com o auxílio do formulário PDSA do IHI. Na Fase II, quatro ciclos PDSA foram realizados para testar as mudanças que incluíram: capacitação da equipe de enfermagem da UBS sobre os principais eventos adversos relacionados às vacinas e orientações aos familiares/responsáveis sobre o risco do uso do celular na sala de vacina. Resultados: No primeiro Ciclo PDSA, 13 (72,2%) usuários/responsáveis foram orientados sobre potenciais reações adversas relacionadas às vacinas; contudo, cinco (27,7%) usuários/responsáveis não receberam tais orientações. No segundo Ciclo PDSA, das 30 doses administradas, houve orientações sobre possíveis reações adversas para 100% dos usuários/responsáveis. No terceiro e quarto Ciclos PDSA, essa porcentagem se manteve e foi confirmada a melhoria no processo. Conclusão: Os resultados demonstram que a abordagem de melhoria da qualidade, baseada em ciclos PDSA, contribuiram com a redução de erro no processo de administração de vacinas em uma UBS, na medida que houve aumento da porcentagem de orientações realizadas aos usuários e/ou responsáveis sobre potenciais reações adversas e que a mudança foi sustentável, pois se manteve ao longo do tempo. Implicações para a prática clínica: A equipe de enfermagem se mostrou mais segura quanto à realização dos procedimentos relacionados ao preparo e à administração de vacinas após a capacitação e demonstrou maior envolvimento nos processos, a partir da definição e construção deste projeto de melhoria. Ainda que não fosse o objetivo do estudo, o método selecionado também permitiu que os profissionais de enfermagem se atentassem para outras falhas nos processos que poderiam resultar em danos ao usuário; tais como: manutenção de agulhas nos frascos-ampolas após aspiração das doses e não realização da assepsia da pele antes das injeções. Durante as etapas do estudo, esses problemas foram sanados e as mudanças se mantiveram ao longo do tempo. A metodologia de melhoria da qualidade também contribuiu para o envolvimento da equipe médica na tomada de decisão sobre as mudanças a serem testadas. Têm-se como produto técnico deste projeto de melhoria a capacitação da equipe de enfermagem sobre o tema "Reações adversas às vacinas"; capacitação da equipe de enfermagem sobre abordagem ao usuário e/ou responsável sobre as principais reações adversas relacionadas à administração de vacinas; elaboração e disponibilização, para a equipe, de folder contendo os tipos de vacina e suas reações locais e sistêmicas; elaboração e disponibilização, na sala de vacina, de folder de proibição do uso de celular pelos usuários e/ou responsáveis.

Justification: in my work as a nurse at a Basic Health Unit (UBS), I have often come across questions from nursing professionals about the safe management of vaccines, including the correct dosage according to age group, dose interval, and the target age range of the vaccine. Such doubts had the potential to result in harm to users, and for this reason, the present study was proposed. Objective: To evaluate the impact of a quality improvement program in reducing errors related to vaccine administration. Method: observational study aimed at comparing measures of results before (Phase I) and after (Phase II) the implementation of a quality improvement program, according to the theoretical and methodological framework of the Institute for Healthcare Improvement (IHI). The study was carried out at a UBS in the São Paulo's interior, from March to September 2019. The universe under study consisted of 164 doses of vaccines prepared and administered by 15 nursing techniques. An electronic form developed at online platform Survey Monkey® was used for data collection. The study was conducted in two phases: In the first, direct observation and participation of nursing professionals during preparation and doses administration was performed (baseline). The results were then presented to the UBS nursing team and a quality improvement team was established. The following quality tools were used: root cause analysis; Ishikawa diagram; Pareto diagram and rapid PDSA (Plan-Do-Study-Act) cycles. A goal of 100% guidance to UBS users who needed vaccines and/or those responsible for potential adverse reactions over a six-month period was established. The actions planning was carried out with PDSA's help form from IHI. In Phase II, four PDSA cycles were conducted to test the changes that included: training of the UBS nursing team on major vaccine related adverse events and guidance to family/guardians about the risk of using cell phones in the vaccine room. Results: In the first PDSA Cycle, 13 (72.2%) users/responsibles were advised on potential adverse reactions related to vaccines; however, five (27.7%) users/responsibles did not receive such guidance. In the second PDSA Cycle, of the 30 doses administered, there was guidance on possible adverse reactions for 100% of the users/responsibles. In the third and fourth PDSA Cycles, this percentage was maintained and improvement in the process was confirmed. Conclusion: The results shows that the quality improvement approach, based on PDSA cycles, has contributed to reducing errors in the vaccine administration process at a UBS, as there has been an increase in the percentage of guidance provided to users and/or guardians about potential adverse reactions and the change has been sustainable because it has been maintained over time. Implications for clinical practice: The nursing team proved to be safer about performing procedures related to vaccine preparation and administration after training and also showed greater involvement in the processes, from the definition and construction of this improvement project. Although it was not the objective of the study, the method selected also allowed nursing professionals to pay attention to other failures in the processes that could result in damage to the user, such as: maintenance of needles in vials after doses aspiration and not performing skin asepsis before injections. During the study's stages, these problems were remedied and the changes were maintained over time. The quality improvement methodology also contributed to the involvement of medical team making the decision about the changes that will be tested. The technical product of this improvement project is about training the nursing team on "Adverse reactions to vaccines"; approaching the nursing team on how to user and/or responsible person on the main adverse reactions related to vaccine administration; preparation and availability for the team of a folder containing the types of vaccine and their local and systemic reactions; preparation and availability folder in the vaccine room prohibiting the use of cell phones by users and/or responsible persons.

Perdas físicas de imunobiológicos no estado do Ceará, 2014-2016 / Pérdidas físicas de inmunobiológicos en el estado de Ceará, Brasil, 2014-2016 / Physical wastage of immunobiological products in the state of Ceará, Brazil, 2014-2016

Objetivo: descrever as perdas físicas, por descarte, dos imunobiológicos fornecidos pelo Programa Nacional de Imunizações (PNI) ao estado do Ceará no período 2014-2016, e os custos das doses perdidas. Métodos: estudo descritivo, com dados dos formulários de avaliação de imunobiológicos sob suspeita e dos pareceres favoráveis de descarte. Resultados: foram incluídos 317 formulários, dos quais 72,0% obtiveram parecer de descarte; foram identificadas 160.767 doses perdidas, totalizando um custo de R$ 1.834.604,75; as perdas representaram 0,45%, 0,93% e 0,53% do custo total das vacinas nos anos de 2014, 2015 e 2016, respectivamente; o principal motivo das perdas físicas identificadas foi a falta de energia elétrica (54,9%). Conclusão: identificou-se grande número de doses descartadas por perdas físicas, com elevado custo absoluto; faz-se necessário um controle mais rigoroso, pois falhas na dinâmica de conservação podem interferir na oferta dos imunobiológicos.

Objetivo: describir las pérdidas físicas por eliminación de inmunobiológicos proporcionados por el Programa Nacional de Inmunización (PNI) al estado de Ceará, en el periodo 2014-2016, y los costos de las dosis omitidas. Métodos: estudio descriptivo, con datos de formula-rios de evaluación de los inmunobiológicos sospechosos y de las opiniones favorables de descarte. Resultados: se incluyeron un total de 317 formularios, de los cuales el 72,0% obtuvo una opinión de descarte, y se identificaron 160.767 dosis omitidas, con un costo total de R$ 1.834.604,75; las pérdidas representaron el 0,45%, el 0,93% y el 0,53% del costo total de las vacunas en 2014, 2015 y 2016, respectivamente; la razón principal de las pérdidas físicas identificadas fue la falta de electricidad (54,9%). Conclusión: iden-tificamos un gran número de dosis descartadas por pérdidas físicas, con un alto costo absoluto; es necesario un control más estricto, ya que las fallas en la dinámica de conser-vación pueden interferir con el suministro de inmunobiológicos.

Objective: to describe discarded wasted immunobiological products provided by the National Im-munization Program (PNI) to the State of Ceará between 2014 and 2016, and the costs of discarded doses. Methods: this was a descriptive study using data from suspect im-munobiological product evaluation forms and data from disposal approval forms. Results: a total of 317 forms were included, 72.0% of which had a disposal approval form, and 160,767 discarded doses were identified, at a total cost of BRL 1,834,604.75; wastage accounted for 0.45%, 0.93% and 0.53% of the total cost of vaccines in 2014, 2015 and 2016, respectively; the main reason for the wastage identified was electric power shortage (54.9%). Conclusion: we identified a large number of discarded wasted doses, with high absolute cost; tighter control is necessary, as failures in conservation dynamics may interfere with the supply of immunobiologicals.

Posición del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología en relación a los cuestionamientos de las vacunas y su obligatoriedad / Statement from the Immunization Committee of the Chilean Infectious Diseases Society in reference to vaccine refusal and mandatory policy on vaccination

Resumen: A pesar del enorme impacto de las vacunas en la salud de la población, estas han sido y son objeto de cuestionamientos por grupos que las consideran innecesarias o inseguras y argumentan que las personas tienen el derecho a decidir sobre si estas deben ser administradas o no. Sin embargo el uso de vacunas tiene connotaciones distintas a otras decisiones en salud, ya que no vacunar impacta no solo al individuo, sino también a la comunidad que lo rodea. El inmunizar a un alto porcentaje de la población permite limitar la circulación de los agentes infecciosos, logrando la llamada inmunidad comunitaria que protege a los no vacunados por razones médicas o porque son muy pequeños. Por esta razón muchos países han definido las vacunas como obligatorias. Como Comité Consultivo de Inmunizaciones nos parece que esta estrategia es correcta sin embargo debe ser acompañada por una política de educación de la población y personal de salud sobre los beneficios y riesgos reales de las va cunas. Así mismo es necesario introducir mejoras en el sistema de notificación de reacciones adversas a vacunas haciéndolo más accesible. Adicionalmente se debe dar respuesta oportuna a los afectados por supuestas o reales reacciones a vacunas y en los casos de eventos adversos graves efectivamente asociados a vacunas. Entregar cobertura económica y acompañamiento. Finalmente es esencial la coordinación entre los diferentes actores y comunicadores para transmitir mensajes que generen confianza y respondan a las inquietudes de la población de hoy en día.

Abstract: Although vaccines have had a tremendous impact in public health they are questioned by certain groups that consider them unnecessary or unsafe and argue in favor of the right to decide to be vacci nated or not. However vaccines must have special considerations because unlike other medical deci sions, not vaccinating has consequences not only for the individual but also for other members of the community. Immunizing a high proportion of the population limits the circulation of an infectious agent attaining what is called community or herd immunity that protects the susceptible members of the group. For this reason many countries consider vaccination mandatory as a responsibility of every citizen. This committee agrees with this view but thinks other strategies should be implemented as well, such as special educational efforts for the public and parents addressing benefits and real risks of vaccinating. Also health care professionals should be trained in vaccines. The notification system for adverse events currently available should be improved and be more accessible. Persons truly affected by adverse events due to vaccination should receive on time responses and be offered psychological and financial support. Finally all stakeholders should make coordinated efforts to work together to deliver messages that answer concerns on vaccines and bring confidence back to the public.

Inmunización en personal de salud / Immunization in health care workers

Resumen Justificación: la inmunoprofilaxis del personal sanitario conlleva múltiples propósitos que engloban tanto la protección de los pacientes como de los funcionarios mismos, y redunda en un claro beneficio para el empleador. En particular, la protección de pacientes inmunocomprometidos y con bajo potencial de desarrollar respuestas vacunales efectivas es de suma importancia. Programas de inmunización sistemática del personal de salud pueden reducir el riesgo de enfermedad, minimizar el impacto de accidentes laborales con materiales infecciosos y mantener la fuerza de trabajo indemne en los centros médicos durante los brotes estacionales de algunas infecciones. Objetivos: concatenar los esquemas de vacunación recomendados actualmente para los funcionarios que laboran en centros de salud y ofrecer una guía adaptada a la realidad epidemiológica nacional. Métodos: se efectuó una revisión no sistemática de bibliografía médica publicada en Internet entre 1990 y 2018, concerniente a vacunación de empleados sanitarios. De igual manera, se compararon los respectivos esquemas de inmunización vigentes en América y Europa. Conclusiones: la trasmisión de enfermedades infecciosas en los centros sanitarios es un problema de salud pública frecuentemente no reconocido, pero sustancial, que pone en riesgo tanto a los usuarios como al personal de estas instituciones. La inmunización de los trabajadores sanitarios es una estrategia fundamental para prevenir y contener la diseminación de agentes infecciosos a nivel hospitalario. Esta medida puede crear "inmunidad de rebaño" para proteger a pacientes y funcionarios que no se hayan vacunado o no puedan generar inmunidad suficiente contra determinados patógenos. Además, la vacunación de los empleados de salud constituye un punto de referencia para motivar las inmunizaciones en los demás segmentos de la población.

Abstract Background: Immune prophylaxis in health care personnel induces multiple positive effects that include protection for patients, as well as for employees and results with a clear benefit for the employers. Especially in immunological compromised patient groups and individuals who present a diminished potential to develop immunity to vaccination, contagion prevention is of highest importance. Systematic immunization programs can help to lower disease risks, minimize impact of occupational accidents related to handling of contagious materials and maintain the intactness of workforce in medical centers during periods of seasonal infection outbreaks. Objectives: this article resumes the present recommended schemes for vaccination of health care personnel and concludes them in a guideline adapted to the country´s epidemiologic reality. Methods: a non-systematic revision of medical literature related to immunization of health care personnel, published online between 1990 and 2018, was realized. In the same manner, a comparison of active vaccination schemes existing in Europe and the United States of America has been executed. Conclusion: the transmission of infectious diseases in health care installations represents a frequently ignored problem which substantially elevates the infection risk of patients as well as of health care personnel. The vaccination of health care personnel represents the easiest to imply and most effective strategy to inhibit this kind of transmission of infectious diseases. As well, this measure can create a "herd immunity" protecting patients and health care personnel who are not vaccinated or in conditions where they can not develop sufficient immunity against infectious agents. Furthermore, the immunization of the health care workers represents a reference and an example of motivation to other parts of the population.