A campanha de vacinação contra o SARS-CoV-2 no Brasil e a invisibilidade das evidências científicas / The SARS-CoV-2 vaccination campaign in Brazil and the invisibility of science evidences

Resumo O presente texto trata de refletir sobre a campanha de vacinação contra COVID-19 no Brasil à luz da consideração das evidências científicas no processo de tomada de decisão. O Brasil possui um dos maiores e mais completos programas de vacinação do mundo, o Programa Nacional de Imunizações (PNI). Infelizmente, no contexto atual, com as interferências políticas do governo federal, o PNI perdeu seu protagonismo na condução da campanha de vacinação contra a COVID-19. Apesar de ser uma campanha de vacinação com muito potencial e uma das mais aceitas pela população entre os países no mundo, apresentou muitos problemas e deixou diversas lacunas no cenário brasileiro. Nesse sentido, é fundamental que as evidências científicas de qualidade produzidas nesse período possam guiar uma remodelagem constante da estratégia de vacinação. Quatro pontos merecem ser destacados: 1) o intervalo entre as doses; 2) a intercambialidade entre vacinas; 3) a vacinação em adolescentes; e 4) a necessidade de melhores evidências para definir a estratégia de vacinação em certos grupos e faixas etárias.

Abstract This paper reflects on the vaccination campaign against COVID-19 in Brazil in light of the consideration of scientific evidence in the decision-making process. Brazil has one of the largest and most complete vaccination programs in the world, the National Immunization Program (Programa Nacional de Imunizações or PNI). Unfortunately, in the current context, with the political interference of the federal government, the PNI lost its role in conducting the vaccination campaign against COVID-19. Despite being a vaccination campaign with a lot of potential and one of the most accepted by the population among countries in the world, it presented many problems and left several gaps in the Brazilian scenario. In this sense, it is essential that the quality scientific evidence produced during this period can guide a constant remodeling of the vaccination strategy. Four points deserve to be highlighted: 1) the interval between doses; 2) the interchangeability between vaccines; 3) vaccination in children and adolescentes; and 4) the need for better evidence to define the vaccination strategy in certain groups and age groups.

Campaña influenza 2020 en contexto de pandemia por SARS-CoV-2: una experiencia inédita de salud pública en Chile / Seasonal influenza campaign 2020 in the context of SARS-CoV-2 pandemic: an unprecedented public health experience in Chile

Resumen Desde 1982, cada año el Departamento de Inmunizaciones del Ministerio de Salud de Chile lleva a cabo la campaña de vacunación contra influenza junto con las Secretarías Regionales Ministeriales-SEREMI, Servicios de Salud y centros de atención primaria de salud. Con los objetivos de prevenir mortalidad y morbilidad grave en grupos de mayor riesgo y de preservar la integridad de los servicios de salud, hasta el 2020 las campañas de vacunación contra influenza serían las más grandes implementadas en Chile, para dar paso, el 2021, a la vacunación contra SARS-CoV-2. Obedeciendo a cambios demográficos y epidemiológicos locales y acogiendo los avances científicos sobre seguridad e inmunogenicidad de la vacuna, el incremento de las vacunas influenza disponibles en Chile forma parte de la planificación anual de la campaña. El 2020, sin embargo, la Campaña Influenza tuvo que ser re-planificada en curso como consecuencia de la incorporación de nuevos grupos a vacunar según dispuso la modificación de la alerta sanitaria por brote de SARS-CoV-2 del 6 de marzo de 2020. Así, de 6.799.800 de dosis, el Departamento de Inmunizaciones logró en menos de dos meses aumentar la disponibilidad a 8.480.325, y cumplir con el compromiso de garantizar el acceso de los grupos de riesgo al beneficio de la vacunación estatal gratuita.

Abstract In Chile, the Immunization Department of the Ministry of Health has carried out the seasonal influenza vaccination campaign annually since 1982 in collaboration with the national health services, regional health offices, and primary health care centres. With the aim of preventing deaths and serious morbidity in high-risk groups and preserving the integrity of health services, the seasonal influenza campaign had been the largest implemented in Chile until 2020, since in 2021 the vaccination campaign against SARS-CoV-2 is expected to become the largest ever implemented. In response to local demographic and epidemiological changes, and taking into account the new scientific evidence on the safety and immunogenicity of vaccines, the influenza vaccines available in Chile would increase annually as a result of campaign planning. In 2020, the influenza campaign had to be re-planned while in progress due to the addition of new high-risk groups to be vaccinated in accordance with the SARS-CoV-2 pandemic health alert modification of March 6th, 2020. Over the course of three weeks, the Immunization Department managed to increase the doses of available influenza vaccines from 6,799,800 previously agreed upon to 8,480,325 and thus serve high-risk groups, guaranteeing their access to state funded influenza vaccination.

Covid-19 vaccine management (Comirnaty and mrna-1273 Moderna) in a teaching hospital in Italy: a short report on the vaccination campaign

OBJECTIVES@#In this article, we aim to share our experience in the hospital reorganization made to conduct the SARS-CoV-2 vaccination campaign, based on the principles of flexibility and adaptability.@*STUDY DESIGN@#A descriptive study.@*METHODS@#The data concerning the organization of the vaccination campaign were taken from the operative protocol developed by the hospital dedicated task force, composed by experts in hygiene, public health, occupational medicine, pharmacists, nurses, hospital quality, and disaster managers. Data about the numbers of vaccine administered daily were collected by the Innovation and Development Operative Unit database.@*RESULTS@#Vaccinations against COVID-19 started across the EU on the 27th of December 2020. The first phase of the vaccination campaign carried out in our hospital was directed to healthcare workers immunization including medical residents, social care operators, administrative staff and technicians, students of medicine, and health professions trainees. The second phase was enlarged to the coverage of extremely fragile subjects. Thanks to the massive employment of healthcare workers and the establishment of dynamic pathways, it was possible to achieve short turnaround times and a large number of doses administered daily, with peaks of 870 vaccines per day. From the 27th of December up to the 14th of March a total of 26,341 doses of Pfizer have been administered. 13,584 were first doses and 12,757 were second doses. From the 4th to the 14th of March, 296 first doses of Moderna were dispensed. It was necessary to implement adequate spaces and areas adopting anti-contagion safety measures: waiting area for subjects to be vaccinated, working rooms for the dilution of the vaccine and the storage of the material, vaccination rooms, post-vaccination observation areas, room for observation, and treatment of any adverse reactions, with an emergency cart available in each working area.@*CONCLUSIONS@#The teaching hospital of Pisa faced the beginning of the immunization campaign readjusting its spaces, planning an adequate hospital vaccination area and providing an organization plan to ensure the achievement of the targets of the campaign. This represented a challenge due to limited vaccine doses supplied and the multisectoral teams of professionals to coordinate in the shortest time and the safest way possible. The organizational model adopted proved to be adequate and therefore exploited also for the second phase aimed to extremely fragile subjects.

Knowledge and perceptions regarding immunization among mothers of under five children: a community study from South Kerala

Background: Immunization coverage is undisputedly the most effective health status and outcome indicator.' Though India is effectively organizing vaccination campaigns, a large majority of children are often left out. Strong anti-vaccination propaganda is influencing the decision of parents. This study was initiated in the context of vaccine-preventable disease outbreak rising recently in Kerala to assess the knowledge and practices of mothers of children less than five years regarding immunization.Methods: A cross sectional study was conducted among 140 women with children less than 5 years. Sample was drawn from the rural and urban field practice areas of a tertiary care teaching hospital. A pilot tested interviewer administered questionnaire was used to assess the knowledge and practices of immunization among mothers of under-five children. Chi-Square test was used to find the association between dichotomous variables.Results: In the study group 96.4% of the children were fully immunized. Mean score on knowledge regarding immunization among the study population was 6.45 (SD=1.84). Majority (89%) of the mothers agreed on the importance of vaccination. More than half (57.1%) had heard of anti-vaccination campaign and 24.3% were influenced by it at one time or the other. Higher knowledge score was associated with mothers residing in urban area, better occupation of mother and educational status of father. Age of child, sex, religion, type of family did not influence knowledge level. Factors influencing the perceived importance of vaccination are better occupation of father, higher education status of father and mother.Conclusions: Vaccination was perceived significant for child's health. Immunization coverage in the study population was high. The level of knowledge regarding immunization among the study population was poor. Anti-vaccination campaign has influenced the population at one time or the other.

Communication and awareness on a new vaccine: a cross-sectional study in a tertiary care hospital of West Bengal

Background: Japanese encephalitis (JE) vaccination in India started in 2006 with SA-14-14-2 live attenuated JE vaccine (JEV) following large outbreaks of JE in some districts of Eastern Uttar Pradesh and Bihar in 2005. Age groups 1-15 yrs are first vaccinated with a single dose of JEV in a campaign mode followed by integration of this vaccine in routine immunization. It is beyond doubt that added to vaccination campaigns, proper awareness on JE can play significant role in controlling the disease.Methods: An observational study with cross sectional design was conducted in Kolkata Medical College and Hospital, Kolkata during JE Vaccination campaign during January, 2018 among 85 respondents, to assess the awareness on JE, among care-givers who brought their children for vaccination at the immunization clinic.Results: It was found that only 37.6% the respondents attending the campaign knew the name of the disease; 17.6% respondents were aware about disease transmission, and 5.9% could state two or more clinical features that might be associated with Japanese Encephalitis. 69.4% had no knowledge of up to what age JE vaccines can be administered; 23.5% said it can be administered till the beneficiaries attain fifteen years of age.Conclusions: IEC activities during JE vaccination campaign was not able raise awareness on JE to the desired level. However beneficiaries were informed about service availability and could be mobilised to come for vaccination.

Lessons learnt from a measles outbreak in Madang Province, Papua New Guinea, June 2014 – March 2015

Objective: This study examined measles vaccine wastage during an outbreak response in Madang Province of Papua New Guinea from June 2014 to March 2015. Methods: Vaccine wastage was defined as the number of doses received by a health centre minus the total number of doses administered during and returned following the outbreak vaccination campaign. Vaccine data were collected from the Provincial Health Information Office, the Provincial Vaccine Store register and clinic and health centre immunization registers for calculating the vaccine wastage. Interviews were conducted with all 48 health centres involved in the outbreak response using a structured questionnaire to explore the reasons for vaccine wastage. Results: Of the 154 110 doses issued by Madang Province during the outbreak, a total of 85 236 (55%) doses were wasted. The wastage varied by district from 31% to 90%. The total cost of the vaccine wastage was estimated to be 589 810 Kina (US$ 196 604). None of the health centres maintained vaccine stock registers. Most health centres indicated multiple failures in cold chain logistics. Almost 40% of health centres reported incorrectly diluting vaccines. The same percentage of health centres reported using incorrect injection techniques. Discussion: Regular audits of cold chain logistics, staff training and improved processes for recording vaccine administration and wastage will decrease vaccine wastage during vaccine-preventable disease outbreaks and also benefit routine immunization activities.

Kinetics of rabies antibodies as a strategy for canine active immunization

Rabies, a zoonosis found throughout the globe, is caused by a virus of the Lyssavirus genus. The disease is transmitted to humans through the inoculation of the virus present in the saliva of infected mammals. Since its prognosis is usually fatal for humans, nationwide public campaigns to vaccinate dogs and cats against rabies aim to break the epidemiological link between the virus and its reservoirs in Brazil. During 12 months we evaluated the active immunity of dogs first vaccinated (booster shot at 30 days after first vaccination) against rabies using the Fuenzalida-Palácios modified vaccine in the urban area of Botucatu city, São Pauto state, Brazil. Of the analyzed dogs, 54.7% maintained protective titers (≥0.5 IU/mL) for 360 days after the first vaccination whereas 51.5% during all the study period. The present results suggest a new vaccination schedule for dogs that have never been vaccinated. In addition to the first dose of vaccine, two others are recommended: the second at 30 days after the first and the third dose at 180 days after the first for the maintenance of protective titers during 12 months.

Kinetics of rabies antibodies as a strategy for canine active immunization

Background Rabies, a zoonosis found throughout the globe, is caused by a virus of theLyssavirus genus. The disease is transmitted to humans through the inoculation of the virus present in the saliva of infected mammals. Since its prognosis is usually fatal for humans, nationwide public campaigns to vaccinate dogs and cats against rabies aim to break the epidemiological link between the virus and its reservoirs in Brazil.Findings During 12 months we evaluated the active immunity of dogs first vaccinated (booster shot at 30 days after first vaccination) against rabies using the Fuenzalida-Palácios modified vaccine in the urban area of Botucatu city, São Pauto state, Brazil. Of the analyzed dogs, 54.7% maintained protective titers (≥0.5 IU/mL) for 360 days after the first vaccination whereas 51.5% during all the study period.Conclusions The present results suggest a new vaccination schedule for dogs that have never been vaccinated. In addition to the first dose of vaccine, two others are recommended: the second at 30 days after the first and the third dose at 180 days after the first for the maintenance of protective titers during 12 months.(AU)

Review of Mass Vaccination Campaign after the Disaster Lessons Learned from the Vaccination Campaign in Haiti Earthquake, 2010 / 国際保健医療

In the aftermath of disasters in areas where populations live in close proximity and where sanitation and water supplies are compromised, an environment is created which is conducive to epidemics of vaccine-preventable diseases.<br>A strong earthquake occurred in Haiti in January 2010, severely affecting Port au Prince, the capital of the country, and the Government was functionally damaged. Over 220,000 people lost their lives and over 300,000 were injured.<br>Around 1.3 million people are living in temporary shelters in the Port-au-Prince metropolitan area and over 500,000 people have left the disaster areas to seek refuge in the rest of the country.<br>In Haiti, one of the world's most impoverished countries, the weak routine vaccination coverage was noted and the vaccination campaign was concerned as one of the first priorities.<br>The Japanese Red Cross (JRC) sent a medical team, called an ERU (Emergency Response Unit) right after the earthquake and provided medical services such as clinics in affected areas.<br>At the same time, we were involved in the vaccination campaign as one of the key players in the International Federation of the Red Cross and Red Crescent Societies (IFRC) in responding to the mass vaccination campaign by the Ministry of Health supported by WHO (World Health Organization) and UNICEF.<br>More than 150,000 people were vaccinated in 1 month by all Red Cross members. 35,217 of them were by JRC and the coverage was 75.5% according to the random survey. Including all the activities, it took more than 3 months and 62% of initially estimated population was vaccinated until the end.<br>After disasters, people typically move to other places seeking a better environment so mass vaccination campaign has to be carried out immediately, once it is decided upon. The selection of target populations, vaccines and good cooperation with other organizations is the key to success.

Effectiveness of an immunization campaign with group A and C meningococcal polysaccharide vaccine in controlling an outbreak of group C meningococcal disease / 中华流行病学杂志

Objective To assess the safety, immunogenicity and efficacy of group A and C meningococcal polysaccharide vaccine (A/C MPV) in response to an outbreak of group C meningococcal disease. Methods A vaccination campaign with A/C MPV was prompted 6 weeks after the use of group A MPV in Laibin city, Guangxi, where an outbreak of group C meningococcal meningitis occurred in 2002.Vaccinees were observed for local and systemic reactions after the vaccination and followed up for the meningococcal disease for 5 years. Blood samples were collected from 71 people in the epidemic and 43 in the non-epidemic areas before and 1 month after the vaccination and examined by ELISA to detect IgG antibodies to group A and C polysaccharides. Results The vaccination coverage was 97%. No significant adverse reactions were observed. The positive rates of group C antibodies after vaccination was between 97.67% and 100% among the populations in the epidemic and non-epidemic areas, as well as among those negative and positive for group C antibodies prior to the vaccination.The geometric mean anti-C concentrations ranged 30.81 μg/ml to 37.44 μg/ml, showing no significant difference between groups. The incidence rate of meningococcal disease in students with timely immunization (218.58/100 000) dropped by 69.02% , when compared to that in those with delayed immunization (705.72/100 000). No clinical cases were identified during the follow-up period of 15 760 person-years. Conclusion The vaccination campaign with the Chinese group A/C MPV seemed successful in controlling the group C meningococcal outbreak.The vaccine was shown to be safe even administered after the group A vaccine only 6 weeks apart. It could induce high levels of antibodies in vulnerable population and significantly increase antibody levels in seropositive individuals, thus providing a protection of at least 5 years.