Fatores associados à vacinação contra influenza entre trabalhadores de saúde de um complexo hospitalar de Salvador / Factors associated with influenza vaccination among health care workers in a hospital complex in Salvador

INTRODUÇÃO: Embora a vacina influenza seja anualmente recomendada para todos trabalhadores de saúde, estudos revelam que a cobertura vacinal desse grupo frequentemente é baixa. Diferentes fatores podem influenciar a vacinação contra a influenza, sendo necessário utilizá-los a favor da ampliação da cobertura vacinal.OBJETIVO: Identificar fatores que influenciam a prática de vacinar-se contra influenza entre trabalhadores de saúde. MATERIAIS E MÉTODOS: estudo transversal, ocorrido num Complexo Hospitalar de Salvador, Bahia. Utilizou-se um questionário autoaplicável, e os modelos "Conhecimento, Atitudes e Práticas" (CAP) e "Health Belief Model" (HBM). A vacinação contra influenza em 2014 (autorreferida)representou a variável principal, e fatores sociodemográficos,histórico de outras vacinas,conhecimentos e atitudes constituíram variáveis independentes.Considerou-se haver "conhecimento adequado", quando 75,0% ou mais dos indivíduos julgaram determinada informação corretamente. As análises foram feitas por regressão logística no Stata, versão 13, utilizando-se o teste qui-quadrado ao nível de 5% de significância, odds ratio, e intervalos de confiança de 95%. O modelo multivariado foi ajustado por sexo, idade e profissão, sendo composto pelas variáveis com p valor igual ou inferior a 0,20 na análise bivariada. A verificação de modelos alternativos mais adequados foi feita por retirada retrógrada, utilizando-se como parâmetro o "Critério de Informação de Akaike" (AIC). RESULTADOS: A amostra foi de 755 indivíduos, destacando-se técnicos de enfermagem (41,4%),enfermeiros (15,2%) e médicos (14,7%).Predominaram trabalhadores do sexo feminino (82,5%), entre 19 e 39 anos (82,4%), com 5 anos ou menos de experiência (67,5%). A cobertura vacinal global foi de 61,5%, sendo a maior entre enfermeiros (69,0%) e a menor entre médicos (49,1%). Os principais motivadores da vacinação foram conhecer a recomendação da vacina para si (49,0%), confiar em vacinas no geral (41,6%) e na eficácia da vacina influenza (35,4%). Os principais desmotivadores foram esquecimento (37,3%), inconveniência de locais/horários (22,5%) e não saber da campanha (16,3%). A principal estratégia que facilitaria a vacinação foi vacinar os trabalhadores no seu próprio setor de trabalho (56,6%). O conhecimento foi adequado no julgamento de 9/16 das informações, com destaque para médicos (15/16) e enfermeiros (13/16). A maior adequação (94,6% de acerto)refere-se à indicação da vacina para todo trabalhador de saúde, e o conhecimento menos adequado foi sobre a incapacidade da vacina causar a influenza (32,0% de acerto). Os fatores associados à vacinação foram: conhecer que pessoas saudáveis também precisam se vacinar contra influenza (OR=3,15 ; IC95%: 1,74 - 5,71); saber que a vacina não protege por muitos anos (OR=2,08 ; IC95%: 1,30 - 3,33); e não ter medo dos efeitos adversos pós-vacinais (OR=1,93 ; IC95%: 1,26 - 2,95). CONCLUSÕES: a vacinação contra influenza é influenciada por onhecimentos,atitudes e questões organizacionais/operacionais.Medidas educativas e de desmistificação de questões relacionadas à influenza e à vacina, bem como ampliação de dias/horários e locais de vacinação de acordo com a conveniência dos trabalhadores de saúde, devem compor as estratégias voltadas à elevação da cobertura da vacina influenza neste grupo.

INTRODUCTION: Although the influenza vaccine is recommended annually for all health workers, studies show that vaccination coverage of this group is often low. Different factors can influence the vaccination against influenza, it is necessary to use them in favor of the expansion of vaccination coverage. GOAL: To identify factors that influence the practice of vaccination against influenza among health workers. MATERIALS AND METHODS: A cross-sectional study, which took place in a hospital complex in Salvador, Bahia. We used a self-administered questionnaire, and the models "Knowledge, Attitudes and Practices"(CAP) and "Health Belief Model"(HBM). Influenza vaccination in 2014 (self-reported) was the main variable, and sociodemographic factors, history of other vaccines, knowledge and attitudes were independent variables. Considered to be "appropriate knowledge" as 75.0% or more of subjects judged certain information correctly. Analyses were performed by logistic regression using Stata, version 13, using the chi-squared test at 5% significance, odds ratio, and 95% confidence intervals. The multivariate model was adjusted for sex, age and profession, being composed of the variables that had a pvalue less than or equal to 0.20 in the bivariate analysis. The verification of most suitable alternative models was performed by backward withdrawal, using as a parameter the "Akaike Information Criteria" (AIC). RESULTS: The sample consisted of 755 individuals, mainly nursing technicians (41.4%), nurses (15.2%) and physicians (14.7%). There was a predominance of female workers (82.5%), between 19 and 39 years (82.4%), with five years or less experience (67.5%). The global vaccination coverage was 61.5%, the highest among nurses (69.0%) and lowest among physicians (49.1%). The main motivators to get vaccinated were to know the recommendation of the vaccine for themselves (49.0%), trust in vaccines in general (41.6%) and in the effectiveness of influenza vaccine (35.4%). The main demotivating were forgetfulness (37.3%), inconvenience locations/times (22.5%) and not knowing the campaign (16.3%). The main strategy would facilitate the vaccination was to inoculate workers in their own work sector (56.6%)...

Timerosal en las vacunas: ¿blanco, negro, o más bien todo lo contrario? / Thimerosal in vaccines: white, black, or quite the opposite?

El presente artículo tiene por objetivo analizar la controversia ocurrida en Chile, especialmente durante los últimos meses, en relación a un proyecto de ley que busca prohibir la fabricación, importación, comercialización o distribución de vacunas que contengan dentro de sus compuestos, en cualquier nivel de concentración, timerosal o compuestos organomercúricos. Sin constituir una síntesis formal de toda la investigación existente, se analiza la evidencia científica que los distintos actores han utilizado, las razones de la controversia y las anomalías en el proceso de toma de decisión sanitaria.

This article analyzes the recent controversy regarding the introduction of a bill to Chilean Congress that aims to ban thiomersal and/or any trace of organomercurial compounds from vaccines in the country. Rather than providing a formal overview of all available evidence, this analysis focuses on the reasons behind the controversy, the scientific evidence invoked by both sides in the debate, and the anomalies in the healthcare decision-making process.

J'accuse desde la bioética: análisis de la discusión sobre el timerosal en Chile / A bioethical j’accuse: analysis of the discussion around thiomersal in Chile

El Poder Legislativo chileno propone una ley que elimine el timerosal como preservante de las vacunas parenterales del Programa Nacional de Inmunizaciones, proyecto que el Poder Ejecutivo se ha propuesto vetar. El mundo científico informa mayoritariamente que la sospecha de neurotoxicidad atribuida al timerosal es infundada. Pese a ello, las autoridades médicas han oscilado entre sostener que la precaución sugiere apoyar la ley y en otros momentos han manifestando que es más precautorio mantener los programas de vacunación actualmente vigentes. Estas contradicciones y oposiciones ilustran que materias que conciernen a la ciudadanía, requieren una reflexión bioética acabada sobre las políticas públicas sanitarias. Han quedado claro las deficiencias de la deliberación política y la falta de participación social en decisiones que, dado el grado de incertidumbre involucrada en temas como inmunización, requieren no sólo la inclusión de la ciudadanía sino el respeto de la autonomía individual para aceptar o rechazar la inclusión en los programas de vacunación propuestos por las políticas sanitarias. La participación ciudadana en nuestro país se ve severamente limitada por la falta de instrumentos sociales como el plebiscito, el ombudsman y, especialmente, la desidia en crear la Comisión Nacional de Bioética exigida por la Ley 20.120 de 2006, una de cuyas funciones más importantes es mediar deliberativamente entre legos, expertos y políticos en la generación de políticas sanitarias legitimadas por la participación ciudadana.

Chilean legislators have voted to ban vaccines preserved with thiomersal, an initiative that the Executive has vetoed. Most scientific evidence has dismissed the alleged toxicity of this substance, in accordance with the formal and publicly expressed opinion of local experts, and yet, medical authorities have issued contradictory statements. Some have argued that the principle of precaution suggests eliminating thiomersal preserved vaccines; others have declared that current vaccines should be maintained to protect the population. From the perspective of bioethics, this polemic is another example of the shortcoming of the deliberation process leading to controversial laws in lieu of including citizens in the discussion of regulations that harbor uncertainties, and respect for individual autonomy to accept or reject public immunization programs. The Chilean legal system has been unwilling to implement participatory democratic procedures like plebiscites or institutions such as the ombudsman. In 2006 a law was enacted that creates a National Commission of Bioethics, but successive governments have failed to create such a commission, which is an efficient social instrument to conduct deliberation on bioethical issues that require a balanced participation of the public, experts, and politicians.

Streptomycin induced protein expression analysis in Mycobacterium tuberculosis by two-dimensional gel electrophoresis & mass spectrometry.

Background & objectives: The resistance of Mycobacterium tuberculosis to streptomycin, a core drug for treatment of category II tuberculosis (TB) has posed a major challenge to the health providers as well as research workers worldwide and has severely compromised the therapeutic options. A significant proportion of streptomycin resistant M. tuberculosis isolates failed to show mutations in conventional targets like rpsL and rrs. Although efflux, permeability, etc. are also known to contribute, yet a substantial proportion of isolates remains resistant suggesting involvement of other unknown mechanism. A resistant isolate may show altered gene as well as protein expression under drug induced conditions and a whole cell proteome analysis under induced conditions might help in further understanding the mechanisms of drug resistance. The present study was therefore designed with the objective to identify proteins related to streptomycin resistance in M. tuberculosis isolate grown in presence and absence of streptomycin (SM). Methods: A clinical isolate of M. tuberculosis from Mycobacterial Repository Centre at the Institute (NJIL & OMD), Agra was grown in Sauton’s medium for 36 h with/without subinhibitory concentration of the drug (2 μg/ml) and the cell lysate of isolates was prepared by sonication and centrifugation. Two-dimensional (2D) gel electrophoresis was employed to study the protein profile. The selected proteins were finally identified by MALDI-TOF mass spectrometry. Results: Our study revealed eight inducible proteins (DnaK, fabG4, DNA-binding, hypothetical, two 14 kDa antigen and two 10 kDa chaperonin) that were upregulated in the presence of drug. Interpretation & conclusion: This preliminary study has thrown light on whether or not and how the resistant isolate responds to streptomycin at its non-toxic but sub-inhibitory concentration. An in-depth study of the upregulated proteins will give an insight into probable sites of drug action other than established primary sites.