The feasibility of a school-based VI polysaccharide vaccine mass immunization campaign in Hue City, central Vietnam: streamlining a typhoid fever preventive strategy.

We report the coverage, safety, and logistics of a school-based typhoid fever immunization campaign that took place in Hue City, central Vietnam; a typhoid fever endemic area. A cluster-randomized evaluation-blinded controlled trial was designed where 68 schools (cluster) were randomly allocated the single dose Vi polysaccharide vaccine (Typherix) or the active control hepatitis A vaccine (Havrix). A safety surveillance system was implemented. A total of 32,267 children were immunized with a coverage of 57.5%. Strong predictors for vaccination were attending primary schools, peri-urban location of the school, and low family income. Human resources were mainly schoolteachers and the campaign was completed in about 1 month. Most adverse events reported were mild. Safe injection and safe sharp-waste disposal practices were followed. A typhoid fever school-based immunization campaign was safe and logistically possible. Coverage was moderate and can be interpreted as the minimum that could have been achievable because individual written informed consent procedures were sought for the first time in Hue City and the trial nature of the campaign. The lessons learned, together with cost-effectiveness results to be obtained by the end of follow-up period, will hopefully accelerate the introduction of Vi typhoid fever vaccine in Vietnam.

The role of epidemiology in the introduction of vi polysaccharide typhoid fever vaccines in Asia.

Despite the availability of at least two licensed typhoid fever vaccines--injectable sub-unit Vi polysaccharide vaccine and live, oral Ty21a vaccine--for the last decade, these vaccines have not been widely introduced in public-health programmes in countries endemic for typhoid fever. The goal of the multidisciplinary DOMI (Diseases of the Most Impoverished) typhoid fever programme is to generate policy-relevant data to support public decision-making regarding the introduction of Vi polysaccharide typhoid fever immunization programmes in China, Viet Nam, Pakistan, India, Bangladesh, and Indonesia. Through epidemiological studies, the DOMI Programme is generating these data and is offering a model for the accelerated, rational introduction of new vaccines into health programmes in low-income countries. Practical and specific examples of the role of epidemiology are described in this paper. These examples cover: (a) selection of available typhoid fever vaccines to be introduced in the programme, (b) generation of policy-relevant data, (c) providing the 'backbone' for the implementation of other multidisciplinary projects, and (d) generation of unexpected but useful information relevant for the introduction of vaccines. Epidemiological studies contribute to all stages of development of vaccine evaluation and introduction.

Current approaches to national health research systems analysis: a brief overview of the WHO health research system analysis initiative

O artigo apresenta a iniciativa da OMS conhecida como HRSA, sobre análise de sistemas de pesquisa em saúde, como contribuição ao Relatório Mundial da Saúde 2004: "Conhecimento para uma saúde melhor". Em seguida coloca o marco conceitual da HRSA para a descrição operacional e análise da pesquisa em saúde. Na parte 3 resume os projetos de pesquisa que lidam com questões transnacionais contemporâneas visando a: dar respostas a questões-chave, explorar áreas controvertidas dentro dos sistemas e melhorar processos decisórios em relação a alternativas de investimento em pesquisa. Na parte 4 resume estudos nacionais sobre sistemas de pesquisa. Na parte 5 delineia um estudo-piloto sobre as metodologias de estudo em 18 países, inclusive no Brasil. Na parte 6 conclui que o estudo-piloto e a fase principal do estudo devem demonstrar o compromisso da OMS em relação ao fortalecimento da capacidade de pesquisa em parceria com os países.