Tipos de vacunas pediátricas / Types of pediatric vaccines

La autora describe las vacunas pediátricas de uso obligatorio en nuestro país en la actualidad. Se menciona su acción, vía de administración, efectos adversos y contraindicaciones

Sarampión 1998: una epidemia inquietante / Measles 1998: a disturbing epidemic

Se presenta una actualización de la enfermedad sarampionosa, desde la epidemiología y la clínica, mostrando por último una sinopsis de los síntomas con su correlación repertorial y terapéutica

Chile hacia la eliminación del sarampión 1992 - 1996 / Chile toward measles elimination program

Hasta la década de los 60, el sarampión era una importante causa de morbimortalidad en Chile. La vacunación programática, iniciada en 1963, tuvo un impacto real en disminuir tanto las tasas de morbilidad como las de mortalidad. Sin embargo, se produjo una epidemia entre los años 1988 y 1989 a pesar de una alta cobertura de vacunación; algunas razones para ello fueron la aplicación de la vacuna antes del año de edad y deficiencias documerytadas en la cadena de frío. Con posterioridad, un nuevo esquema de vacunación a los 12 meses de edad, la revacunación en edad escolar, mejorías en la cadena de frío, coberturas de vacunación superiores al 95 por ciento, y una campaña nacional de vacunación anti sarampión a menores de 15 años, durante 1992, permitieron cortar la transmisión del sarampión. Un programa especial de vigilancia, con estudio serológico de todos los casos sospechosos de sarampión, detectó un último paciente, infección adquirida en el exterior, en Enero de 1993. Durante 1996, se reforzó la inmunidad contra la enfermedad mediante una nueva campaña orientada a vacunar la población bajo 1 5 años de edad. Hoy en día, los adultos jóvenes constituyen la población susceptible, y en riesgo, de contraer el sarampión

Measles & malnutrition.

Measles is an important acute childhood viral infection having severe consequences on the nutritional status. The adverse nutritional effects of measles are experienced by both the well-nourished and the malnourished children. However, the severe nutritional deficiencies like kwashiorkor/marasmus are precipitated only in children who are already malnourished. As high as 3-4 per cent of children with measles suffered from these clinical nutritional syndromes in their post-measles period. Though malnutrition is widespread among Asian children also, measles appears to run a milder course with low mortality rates in developing Asian countries, as compared to African children. The associated secondary infections which apparently complicate the primary illness in malnourished children might be responsible for higher mortality and could be due to socioeconomic and environmental causes that are associated with poverty and malnutrition rather than due to malnutrition or measles per se. Measles related blindness is of multifactorial aetiology. While acute measles triggers corneal ulceration through viral proliferation in the cornea, nutritional keratomalacia is often the cause of blindness in the post-measles period. Measles vaccination is the major preventive measure. However, timely use of local antibiotic therapy to the eyes and administration of vitamin A supplements offer protection to the child who already has measles. Response of malnourished children to live attenuated measles vaccine has been found to be safe and effective. Neither malnutrition nor tuberculosis which are widespread among malnourished children of developing countries appear to be contraindications for measles vaccination. Thus, the beneficial effects of the measles vaccination should be fully exploited by adequate supply of potent vaccine and coverage of all susceptible children.

Suscetibilidade da linhagem de células Vero a cepas vacinais do vírus do sarampo / Susceptibility of Vero cell line to vaccine strains of the measles vírus

A suscetibilidade da linhagem de células Vero ao vírus do sarampo é bem conhecida e sua utilizaçäo no controle da potência da vacina contra o sarampo é amplamente difundida. Com o objetivo de comparar a suscetibilidade de células Vero empregadas em titulaçöes, amostras provenientes de dois laboratórios controladores (Vero IB e Vero INCQS), foram testadas frente a três cepas vacinais: Moraten Schwarz e Biken CAM-70. Foram titulados 72 lotes de vacinas contra o sarampo, sendo 25 produzidos com a cepa Moraten, 24 com a cepa Schwarz e 23 com a cepa Biken CAM-70. A análise estatística dos resultados obtidos nas titulaçöes, feita através dos testes Limites para uma Média e "t" de Student, mostrou que para as cepas Moraten e Biken CAM-70, as diferenças de títulos näo foram estatisticamente significantes, o mesmo näo ocorrendo com a cepa Schwarz, para a qual as células Vero IB se mostraram mais sensíveis

Re-evaluation of the basic procedures involved in the storage of measles vaccine in puplic health units of the municipality of niterói, state of Rio de Janeiro, Brazil

Quatro anos após a primeira visita, dezessete unidades Sanitárias do Município de Niterói - RJ foram visitadas novamente e reavaliadas de acordo com as normas técnicas específicas estabelecidas pelo Programa Nacional de Imunizaçäo. Constatou-se que em 100 por cento das Unidades visitadas os cuidados com os refrigeradores e a arrumaçäo das vacinas no interior dos aparelhos eram adequados ou regulares mas quanto ao controle de temperatura dos refrigeradores este percentual caía para 64,7 por cento. De todos os itens avaliados, o mais problemático foi o apoio técnico imediato frente a situaçöes de emergência, considerado insuficiente em 94,1 por cento dos casos. Em 55,2 por cento das amostras vacinais recolhidas das unidades sanitárias, os títulos estavam abaixo da potência mínima preconizada para tal produto no momento da aplicaçäo. Verifica-se, deste modo, a necessidade de uma contínua avaliaçäo dos fatores que intervêm na cadeia de frio evitando-se, assim, que seja comprometida a qualidade das vacinas a serem utilizadas

Low seroconversion rates to measles vaccine among children in Nigeria

The Nigerian Expanded Programme on Immunization (EPI) was assessed with particular reference to measles immunization. Of 150 children who received measles vaccine at the Institute of Child Health, University of Ibadan, Nigeria, 82 (54.7%) seroconverted. The immune response was directly related to the titre of the vaccines used. Vaccines whose titres were 10(-1) to 10(1.7) stimulated immune responses in 0-25% of vaccinees, those with titres in the range 10(-2.1) to 10(-2.5) stimulated responses in 12-47.6%, while those with titres of 10(-2.7) to 10(-3.4) stimulated responses in 87.5-100% of vaccinees. Only one of the vaccines used had a titre that met the minimum WHO required standard of log 10(-3) TCID50 at the point of vaccination

Lack of efficacy of the standard potency Edmonston-Zagreb live, attenuated measles vaccine in African infants

The efficacy of standard potency Edmonston-Zagreb (E-Z) measles vaccine was tested in a randomized trial of Black infants in a rural area of South Africa where a measles epidemic was occurring. The following immunization schedules were used: 48 infants aged 4-8.5 months who received 3.9 log 50 infectious units of E-Z vaccine (group A); 48 infants aged 4-8.5 months who received 3.28 log 50 infectious units of Schwarz vaccine (group B); and 28 infants aged greater than 9 months who received 3.28 log 50 infectious units of Schwarz vaccine and served as controls (group C). For infants aged less than 23 weeks who were given either the E-Z or Schwarz vaccine, the number of seropositives was low (28%), irrespective of the pre-vaccination level of measles antibody. There was a higher number of seropositives (68%) among those in the age range greater than 23 weeks to less than 36 weeks who received the E-Z vaccine rather than the Schwarz vaccine (36%). When administered to children aged greater than 36 weeks, the Schwarz vaccine produced a satisfactory, though suboptimal response rate (61%). There was no correlation between seropositivity and pre-vaccination measles antibody status. Use of the standard dose of E-Z vaccine may have been one of the factors for this poor response, and this supports the WHO recommendation that titres higher than the standard potency vaccine are needed if 6-month-old infants are to be successfully immunized against measles

Sero-epidemiology of measles--a three years prospective study in a rural population of Rajasthan.

A community based prospective study on measles was undertaken during 1986 to 1988 in Ramgarh village of Alwar district (Rajasthan) to elucidate epidemiological features of measles. The initial population of the village was 5258 with 2018 children (0-14 years) which rose to total population of 5923 with 2200 children in 1988. During the entire period of study, all the children (0-14 years) were covered regularly through monthly domicilliary visits by trained paramedical personnel under direct supervision of Medical Officers. A total of 208 measles cases were detected which gave an overall incidence rate of 31.5 per 1000 children (0-14 years) per year. Incidence rate was highest in children of 2-5 years of age group and lowest (4.6 per 1000) in 10-14 years of age group. The maximum number (86.5 per cent) of cases occurred during the first six months of year. The Kolmogrov-Smirnov statistical method validated the seasonal character of the disease (Vn = 5.36, p less than 0.01). A significant (P less than 0.005) rise in seropositivity with increase in age was observed in children (6-36 months) who had no previous history of measles and measles immunization during their life time. A higher rate of sero-conversion was observed in children vaccinated after 10-months of age than those before. No significant relationship of seroconversion following vaccination could be seen with age of vaccination (p greater than 0.50), sex and nutritional status (p greater than 0.10).

Field evaluation of measles vaccine efficacy in New Seemapuri, Shahdara Zone-Delhi during 1990.

A field evaluation of measles vaccine efficacy was undertaken in resettlement colonies in New Seemapuri, Shahdara Zone, Delhi, having an estimated population of 20,500 by case-reference method. The standard 30 cluster sampling technique was adopted and 261 measles vaccinated children were matched with 545 measles non-vaccinated children. The attack rate of measles was found to be 4.2 and 30.3 per cent in measles vaccinated and non-vaccinated children respectively, which is statistically highly significant (P less than 0.001). The relative risk of developing measles in non-vaccinated child is seven times more as compared to a vaccinated child. Vaccine efficacy (V.E.) evaluated by different epidemiological and laboratory methods was found to be 86.1 per cent +/- 11 at P = 0.05. Further, a large scale study on measles V.E. is recommended in different parts of the country by case-reference method, as it is found to be simple, reproducible and easy to undertake in a field situation.

Fotossensibilidade e termoestabilidade de vacinas contra o sarampo (CEPA BIKEN CAM-70) liofilizadas e/ou reconstituídas para administraçäo / Photosensitivity and stability of freeze-dried and reconstituted measles vaccines (Biken CAM-70 strain)

Três lotes de vacinas contra o sarampo, produzidos com a cepa de vírus Biken CAM-70, sob as formas liofilizada e reconstituída, pertencentes ao estoque da rede de vacinaçäo da Secretaria de Estado da Saúde de Säo Paulo, Brasil, foram submetidos a testes de sensibilidade a luz, a temperatura de 2 a 8§C, e de termoestabilidade (protegidos da luz) as temperaturas de 28, 36,5 e 45§C, objetivando verificar por quanto tempo retinham sua potência, isto é, a concentraçäo ideal recomendada para a cepa de vírus presente. A análise de retas de regressäo ajustadas demonstrou que, de modo geral, tanto os lotes de vacinas liofilizados como de potência no decorrer do experimento, a qual foi mais acentuada para vacinas expostas a luz. Reconstituídos e mantidos a 2 a 8§C, os lotes näo apresentaram homogeneidade no referente a sensibilidade a luz. Quando a fotossensibilidade de lotes de vacinas liofilizadas foi testada a 2 a 8§C eles mostraram-se mais sensíveis a degradaçäo térmica quando expostos a luz do que quando protegidos dela. Entretanto, expostos ou protegidos, a potência foi inferior a mínima aceita para a cepa Bikien CAM-70. As demais temperaturas, mesmo ao abrigo da luz, os dois lotes näo retiveram potência mínima. Quanto as vacinas do lote 3, conservadas a 2 a 8§C, mantiveram-se de acordo com os requerimentos mínimos de potência durante 60 dias quando protegidas da luz, e durante 40 dias quando expostas a ela. A degradaçäo térmica as demais temperaturas foi mais acentuada (28§C: 5 dias...

Análisis estadístico de la potencia de 7 lotes de vacuna antisarampionosa / Statistical analysis of potency of seven lots of measles vaccine

Se tomaron 7 lotes de vacuna antisarampionosa de diferentes centros de salud que prestan servicios de vacunación. Estos se analizaron para determinar si mantenían la potencia establecida por la Organización Mundial de la Salud después de un tiempo en nuestro país; la misma se determinó mediante el método cuantitativo de conteo de placas líticas en células Vero. Estos resultados y los obtenidos en 2 laboratorios de control de la URSS fueron comparados mediante análisis estadístico de Varianza de Clasificación Simple. No se observaron diferencias significativas entre los mismos