Abordaje integral de infecciones respiratorias agudas virales y coqueluche / Comprehensive approach to acute viral respiratory infections and whooping cough

Informe sobre el objetivo del abordaje de estas patologías, desde el Ministerio de Salud de la Ciudad de Buenos Aires: Medidas de prevención; Priorización de diagnóstico; Estrategia integrada de vigilancia de la Infecciones Respiratorias Agudas de posible origen viral; Vigilancia Universal; Vigilancia epidemiológica de coqueluche (tos convulsa); y Recomendaciones sobre el uso de antivirales para influenza; (AU)

Challenges to global pertussis prevention and control / 中华流行病学杂志

Pertussis is an acute, highly infectious respiratory disease caused by Bordetella pertussis, and is one of the leading causes of infant disease and death worldwide. The pertussis vaccine has been used in the expanded program on immunization globally since 1974 and the vaccination coverage remains high. In recent years, the pertussis incidence rate increased, even pertussis outbreaks occurred, in more and more countries or areas after years with low incidence level. The disease burden of pertussis has been seriously underestimated, and the prevention and control of pertussis is facing many challenges. This article reviews the epidemic status of pertussis worldwide, the factors affecting the reemergence of pertussis, and the challenges in the prevention and control to provide a reference for prevention and control of pertussis.

Analysis of the time series of pertussis in Brazil from 2010 to 2019 / Análise da série temporal da coqueluche no Brasil no período de 2010 a 2019

Abstract Objectives: to analyze a decade of spatio-temporal behavior of pertussis in Brazil and its epidemiological characteristics. Methods: ecological time series study of pertussis cases and deaths from the Notifable Diseases Information System in Brazil (2010-2019). The method of generalized linear analysis of Prais-Winsten and the Kernel analysis were used. Results: 32,849 cases were reported, of which 466 (1.42%) evolved to death, with a prevalence of 1.63/100,000 inhabitants and a mortality rate of 0.023/100,000 inhabitants. In the temporal analysis, the cyclical behavior of pertussis was evidenced, with trend variations in the period in 2014. Most cases occurred in children under 1 year of age (60.16%, p<0.01), sex female (55.28%, p=0.066) and white (48.42%, p=0.14). The largest share of deaths was in children aged <1 year (98.07, p<0.01), females (56.01%, p=0.066) and whites (43.78%, p=0.14). In the Kernel of prevalence, the South, Southeast and Northeast regions stood out with high density; while for mortality, the Southeast and Northeast stood out. Conclusions: the cyclical behavior of pertussis was observed, with a decreasing trend in recent years and the concentration of cases in children. This reinforces the importance of strengthening the population's immunization process.

Resumo Objetivos: analisar uma década do comportamento espaço-temporal da coqueluche no Brasil e as suas características epidemiológicas. Métodos: estudo ecológico de série temporal dos casos e óbitos por coqueluche do Sistema de Informação de Agravos de Notificação no Brasil (2010-2019). Utilizou-se o método de análise linear generalizada de Prais-Winsten e a análise de Kernel. Resultados: notificaram-se 32.849 casos, desses 466 (1,42%) evoluíram para óbito, com prevalência de 1,63/100.000 habitantes e coeficiente de mortalidade de 0,023/100.000 habitantes. Na análise temporal, evidenciou-se o comportamento cíclico da coqueluche com variações de tendência no período em 2014. A maioria dos casos ocorreu em menores de 1 ano (60,16%, p<0,01), sexo feminino (55,28%, p=0,066) e brancos (48,42%, p=0,14). A maior parcela dos óbitos foi em crianças <1 ano (98,07, p<0,01), sexo feminino (56,01%, p=0,066) e brancos (43,78%, p=0,14). No Kernel da prevalência, destacaram-se as regiões Sul, Sudeste e Nordeste com alta densidade; enquanto para mortalidade, sobressaíram-se Sudeste e Nordeste. Conclusão: observou-se o comportamento cíclico da coqueluche, com tendência de decréscimo nos últimos anos e a concentração de casos no público infantil. O que reforça a importância de fortalecer o processo de imunização da população.

Artificial intelligence-based literature data warehouse for vaccine safety / 中华流行病学杂志

Objective: To establish a sustainable updated literature data warehouse for global vaccine safety assessment, and provide data support for evidence-based vaccine safety assessment. Methods: Semi-automated construction and updating of a literature data warehouse were achieved through the continuous integration of standard operating steps of evidence-based reviews with artificial intelligence technologies. Following the standard procedure of a systematic literature review, the literatures about vaccine safety assessment published before November 29, 2020 were retrieved from 9 databases including OVID, Scopus, Web of Science, Cochrane Library, and ClinicalTrails.org in English and Wanfang, CNKI, VIP, and SinoMed in Chinese. Literatures were screened for two rounds in a semi-automatic manner (by artificial intelligence literature processing system and manual work) according to the inclusion/exclusion criteria. Furthermore, the literatures were classified according to the types of vaccines and adverse events. The updating strategy was established, and the literature data warehouse was updated regularly. Experts were organized to select specific vaccine safety topics and carry out special demonstration studies. Results: More than 0.41 million articles were retrieved. According to the inclusion/exclusion criteria, 23 304 articles were included after two rounds of screening. At present, we have selected and completed three prior topics as demonstration studies, including the systematic review of "DPT (diphtheria, pertussis and tetanus) vaccine and encephalopathy/encephalitis", and the classified management of literatures about allergic purpura and brachial plexus neuritis. Conclusions: The sustainable updated literature data warehouse of vaccine safety can provide high-quality research data for vaccine safety research, including evidence support for immunization related policy-making and adjustment and vaccine safety-related methodological research or clinical tool development; and further demonstration studies can provide references for building a new methodological framework system for timely and efficient completion of the evidence-based assessment of vaccine safety.

Incidência de coqueluche em crianças menores de 1 ano e relação com a vacinação materna no Brasil, 2008 a 2018 / Incidencia de tos ferina en niños menores de 1 año y relación con la vacunación materna en Brasil, 2008 a 2018 / Pertussis incidence in children under 1 year old and relation with maternal vaccination in Brazil, 2008-2018

Objetivo: Analisar o impacto da vacina adsorvida difteria, tétano e coqueluche (pertússis acelular), tipo adulto (dTpa), materna, na incidência de coqueluche em crianças menores de 1 ano no Brasil, de 2008 a 2018. Métodos: Estudo de tipo ecológico, descritivo de tendência temporal, utilizando-se de dados dos sistemas de vigilância do Departamento de Informática do Sistema Único de Saúde (Datasus). Foram calculadas taxas de incidência e razão das taxas de incidência (IRR), com respectivos intervalos de confiança de 95% (IC95%). Resultados: O número de casos de coqueluche foi de 20.650. Houve redução na incidência de coqueluche no período pós-vacinal, de 26,6% (IRR = 0,73; IC95% 0,66;0,82) nas crianças de 3 meses a 1 ano incompleto, e de 63,6% (IRR = 0,36; IC95% 0,15;0,58) nas crianças de zero a 2 meses. Conclusão: O aumento da cobertura da vacinação com dTpa materna correspondeu à redução na incidência de coqueluche, principalmente na faixa etária de zero a 2 meses.

Objetivo: Analizar la incidencia de tos ferina en menores de 1 año y su relación con la cobertura de vacunación materna por la vacuna adsorbida contra la difteria, el tétanos y la tos ferina (tos ferina acelular) tipo adulto (dTpa), de 2008 a 2018, en Brasil. Métodos: Estudio ecológico descriptivo de tendencia temporal utilizando datos de los sistemas de vigilancia del Departamento de Informática do Sistema Único de Saúde (Datasus). Se calcularon los tasas de incidencia y las razones de tasas de incidencia (RTI) con los respectivos intervalos de confianza del 95% (IC95%). Resultados: El número de casos de tos ferina en el período de estudio fue de 20,650. Hubo una reducción en la incidencia de tos ferina en el período post-vacunación. En los niños de 3 meses a 1 año incompleto, la reducción fue del 26,6% (RTI = 0,73; IC95% 0,66;0,82), mientras que en el otro grupo la diferencia relativa fue del 63,6% (RTI = 0,36; IC95% 0,15;0,58)]. Conclusión: La vacunación materna con dTpa coincide con una reducción en la incidencia de tos ferina, especialmente en el grupo de edad de cero a 2 meses.

Objetive: To analyze the impact of maternal vaccination coverage with diphtheria-tetanus-acellular pertussis (Tdap) adsorbed vaccine for adults on pertussis incidence in children under 1 year old in Brazil from 2008 to 2018. Methods: This was a descriptive ecological temporal trend study using data from surveillance systems managed by the Brazilian National Health System Information Technology Department (DATASUS). Incidence rates and incidence rate ratios (IRR) were calculated with respective 95% confidence intervals (95%CI). Results: There were 20,650 pertussis cases in the study period. In the post-vaccination period there was a 26.6% reduction (IRR = 0.73; 95%CI 0.66;0.82) in pertussis incidence among children aged from 3 months up to but not including 1 year old, and a 63.6% reduction (IRR = 0.36; 95%CI 0.15;0.58) among children from birth to 2 months old. Conclusion: The increase in maternal Tdap vaccination coverage coincided with a reduction in pertussis incidence, especially in the birth to two-month-old age group.

Protective effect of exclusive breastfeeding and effectiveness of maternal vaccination in reducing pertussis-like illness

Abstract Objective: To assess the protective effect of exclusive breastfeeding and the effectiveness of maternal vaccination in reducing pertussis-like illness. Method: This was a case-control study conducted in sentinel hospitals for pertussis in Recife between July 2016 and July 2018. Cases included children aged under six months with symptoms compatible with pertussis (pertussis-like illness). Controls included children aged under six months, living in the metropolitan region of Recife with no diagnosis of pertussis-like illness and matched by the same hospital and birth date. Results: Seventy-three cases and 194 controls were included. The diagnosis of pertussis-like illness was predominantly clinical (97,2%). Amongst the main symptoms, paroxysmal cough was observed in 95.89% of cases and vomiting in 53.4%. There were 29 hospitalized cases and no deaths. Out of the 73 cases, 47 were born to mothers vaccinated against pertussis during pregnancy, and the mothers of 144 of the 194 controls had been vaccinated. The protective effect of breastfeeding was of 74% (95% CI;38%, 89%). Children younger than six months, who were exclusively breastfed and with mothers vaccinated against pertussis during pregnancy were 5 times less likely to develop pertussis-like illness, corresponding to a protection of 79% (95% CI;31%, 94%). The effectiveness of maternal vaccination against pertussis-like illness in children under six months was low (27%) and not statistically significant (CI 95%; −34% a 60%). Conclusions: Exclusive breastfeeding protects children under six months from pertussis-like illness and may be enhanced when associated with maternal vaccination. These strategies should be encouraged because they also protect against pertussis-like illnesses.

Factores que influyen en la adherencia a la vacuna contra la tosferina en mujeres embarazadas en Uruguay / Factors that influence the uptake of pertussis vaccine in pregnant women in Uruguay

Introducción: desde 2015 se ofrece la vacunación contra tosferina de modo universal y gratuito a mujeres embarazadas del Uruguay. Si bien es obligatoria, la cobertura vacunal, aún no es completa. Objetivos: conocer la prevalencia de mujeres embarazadas de dos hospitales públicos de Uruguay que recibieron vacuna dpaT en 2017 y determinar posibles factores que influyen en la adherencia a vacunarse. Métodos: estudio observacional, transversal, descriptivo, mediante encuestas a pacientes cursando puerperio inmediato. Resultados: se analizaron 884 encuestas (edad promedio 25,2 años; 16% adolescentes; la mayoría en pareja y educación secundaria incompleta). Se vacunaron 317 mujeres (36%). Dentro de los factores que se asociaron a la no vacunación se destacan: adolescencia (OR 1,88; IC 95% 1,24-2,85), no tener pareja (OR 1,40; IC 95% 1,04-1,85), no conocer la obligatoriedad de la vacuna (OR 9,44; IC 95% 6,63-13,45), no haber sido informada sobre los beneficios de la vacuna (OR 4; IC 95% 2,43-6,41) y no creer en el beneficio de las vacunas en el embarazo (OR 6,37; IC 95% 4,61-8,78). Discusión: la mayoría de las mujeres embarazadas no recibieron la vacuna dpaT ni tuvieron indicación médica. La falta de información sobre la obligatoriedad y su beneficio, y las creencias con respecto a la vacunación se asociaron a una disminución en la adherencia a la misma. Los profesionales de la salud que atienden mujeres gestantes deben recomendar e informar sobre el beneficio de la vacunación para ellas y el neonato y generar la percepción de riesgo necesaria, como una de las medidas para mejorar la cobertura vacunal.

Background: since 2015, pertussis vaccine has been offered universally and free of charge to pregnant women in Uruguay. Although it is mandatory, vaccination coverage is not yet complete. Aim: to study the pertussis vaccination coverage in 2017 in pregnant women in two state hospitals and to search for barriere for uptaking the vaccine. Methods: we conducted an observational, descriptive and transversal study, using a survey in patients undergoing immediate postpartum period. Results: 884 surveys were analyzed (mean age 25.2 years; 16% teenagers, most of them in a relationship and incomplete high school). 317 women (36%) were vaccinated. Main barriere for uptaking Tdap vaccine were: teenage and being single were associated with a greater risk for the uptake. Not being aware of the vaccine mandatoriness and not being informed about its benefits were associated with 9,44 and 4 higher risks for not uptaking the vaccine (IC 95% 6.63-13.45 and IC 95% 2.43-6.41, respectively). Not believing in the benefits of pertussis vaccine during pregnancy was associated with 6.37 higher risk (OR 6.37; IC 95% 4.61-8.78). Discussion: most pregnant women in this study during 2017 did not uptake pertussis vaccine and did not have medical indication for it. The lack of information about the obligation and benefits, and also patients' beliefs about the vaccination were identified as barriere. Health professionals who treat pregnant women should recommend and inform about the benefits of pertussis vaccine for women and the infant, and create the necessary perception of risk, in order to improve the vaccination coverage.

Factores que influyen en la adherencia a la vacuna contra la tosferina en mujeres embarazadas en Uruguay / Factors that influence the uptake of pertussis vaccine in pregnant women in Uruguay

INTRODUCCIÓN: Desde 2015 se ofrece la vacunación contra tosferina de modo universal y gratuito a mujeres embarazadas del Uruguay. Si bien es obligatoria, la cobertura vacunal, aún no es completa. OBJETIVOS: Conocer la prevalencia de mujeres embarazadas de dos hospitales públicos de Uruguay que recibieron vacuna dpaT en 2017 y determinar posibles factores que influyen en la adherencia a vacunarse. MÉTODOS: Estudio observacional, transversal, descriptivo, mediante encuestas a pacientes cursando puerperio inmediato. RESULTADOS: Se analizaron 884 encuestas (edad promedio 25,2 años; 16% adolescentes; la mayoría en pareja y educación secundaria incompleta). Se vacunaron 317 mujeres (36%). Dentro de los factores que se asociaron a la no vacunación se destacan: adolescencia (OR 1,88; IC 95% 1,24-2,85), no tener pareja (OR 1,40; IC 95% 1,04-1,85), no conocer la obligatoriedad de la vacuna (OR 9,44; IC 95% 6,63-13,45), no haber sido informada sobre los beneficios de la vacuna (OR 4; IC 95% 2,43-6,41) y no creer en el beneficio de las vacunas en el embarazo (OR 6,37; IC 95% 4,61-8,78). DISCUSIÓN: La mayoría de las mujeres embarazadas no recibieron la vacuna dpaT ni tuvieron indicación médica. La falta de información sobre la obligatoriedad y su beneficio, y las creencias con respecto a la vacunación se asociaron a una disminución en la adherencia a la misma. Los profesionales de la salud que atienden mujeres gestantes deben recomendar e informar sobre el beneficio de la vacunación para ellas y el neonato y generar la percepción de riesgo necesaria, como una de las medidas para mejorar la cobertura vacunal.

BACKGROUND: Since 2015, pertussis vaccine has been offered universally and free of charge to pregnant women in Uruguay. Although it is mandatory, vaccination coverage is not yet complete. AIM: To study the pertussis vaccination coverage in 2017 in pregnant women in two state hospitals and to search for barriere for uptaking the vaccine. METHODS: We conducted an observational, descriptive and transversal study, using a survey in patients undergoing immediate postpartum period. RESULTS: 884 surveys were analyzed (mean age 25.2 years; 16% teenagers, most of them in a relationship and incomplete high school). 317 women (36%) were vaccinated. Main barriere for uptaking Tdap vaccine were: teenage and being single were associated with a greater risk for the uptake. Not being aware of the vaccine mandatoriness and not being informed about its benefits were associated with 9,44 and 4 higher risks for not uptaking the vaccine (IC 95% 6.63-13.45 and IC 95% 2.43-6.41, respectively). Not believing in the benefits of pertussis vaccine during pregnancy was associated with 6.37 higher risk (OR 6.37; IC 95% 4.61-8.78). DISCUSSION: Most pregnant women in this study during 2017 did not uptake pertussis vaccine and did not have medical indication for it. The lack of information about the obligation and benefits, and also patients' beliefs about the vaccination were identified as barriere. Health professionals who treat pregnant women should recommend and inform about the benefits of pertussis vaccine for women and the infant, and create the necessary perception of risk, in order to improve the vaccination coverage.

Análisis económico de las vacunas del primer año de vida con componente pertussis en el contexto de la ini-ciativa mundial de erradicación de la poliomielitis en Argentina / Vaccination in children under 1 year with pertussis component in the context of the global initiative for the eradication of poliomyelitis in Argentina: economic analysis

INTRODUCCIÓN: La Iniciativa Mundial de Erradicación de la Polio promueve la introducción de vacuna de polio inactivada (IPV) en sus programas, con la posterior retirada de Sabin (bOPV). OBJETIVO: Construir un modelo de económico que compare diferentes esquemas de vacunación para la prevención de polio y tosferina en el primer año de vida. Material y MÉTODOS: Análisis de cuatro escenarios de vacunación del esquema primario para Argentina, en base a los precios de las vacunas, costos del programa y reactogenicidad de vacuna celular o acelular para Bordetella pertussis: - Escenario 1 (caso base): dos dosis de IPV, una dosis de bOPV y tres dosis de vacuna pentavalente (DTwP-HB-Hib); - Escenario 2: tres dosis IPV y de pentavalente; - Escenario 3: tres dosis de hexavalente (DTaP-HepB-IPV-Hib); - Escenario 4: dos dosis de hexavalente más una dosis de pentavalente más IPV. RESULTADOS: El costo incremental en base al escenario 1 fue de USD 3.716.671; 19.696.668 y 14.383.341 para los escenarios 2, 3 y 4, respectivamente. Para la reactogenicidad, la diferencia fue de USD -14.178.240 comparado el caso base con el escenario 3. DISCUSIÓN: La inversión de incorporación de full IPV y costos asociados se modifica según tipo de vacuna y reactogenicidad asociada al componente B. pertussis.

BACKGROUND: Global Polio Eradication Initiative promotes the introduction of inactivated polio vaccine (IPV) in its programs, with withdrawal of Sabin (bOPV). There is no an economic analysis of the investment related to the incorporation of IPV vaccines together with a whole cell Bordetella pertussis vaccine or combined with acellular hexavalent. AIM: An economic model that compares different vaccination schemes for the prevention of polio and pertussis in the first year of life was carried out. METHODS: Four vaccination scenarios for the primary scheme based on Argentina demographic and costs data were developed: - Scenario 1 (base case): two doses of IPV, one dose of bOPV and three doses of pentavalent (DTwP-HepB-Hib) vaccine; - Scenario 2: three doses of IPV plus three doses of pentavalent; - Scenario 3: three doses of hexavalent; - Scenario 4: two doses of hexavalent plus one dose of pentavalent plus IPV. RESULTS: The incremental cost based on scenario 1 was USD 3.716.671; 19.696.668 and 14.383.341 for scenarios 2, 3 and 4 respectively. In terms of reactogenicity savings was -14.178.240 compared base case with scenario 3. DISCUSSION: Full IPV introduction investment and costs associated were modified according to the type of vaccine and reactogenicity related with the B. pertussis component.

Cambios epidemiológicos y actualidades sobre vacunación contra Bordetella pertussis en Latinoamérica / Epidemiologic changes and novelties on vaccination against Bordetella pertussis in Latin America

Resumen A pesar de que la tosferina (coqueluche) es una enfermedad prevenible por vacunas (EPV), la epidemiología latinoamericana muestra que hay persistencia de brotes en la región. Esta persistencia se debe, al menos en parte, a factores tales como la cobertura vacunal, la presencia de movimientos anti vacunas, la diversidad de los sistemas locales de vigilancia y la falta de una definición de caso unificada para la región. Dada la importancia de la tosferina en Latinoamérica y los cambios ocurridos en las recomendaciones para la vacunación, este manuscrito tiene como objetivo revisar los datos epidemiológicos y los cambios recientes en los calendarios de vacunación y su impacto sobre la enfermedad pediátrica por Bordetella pertussis en Latinoamérica. Los datos epidemiológicos más recientes muestran que entre regiones, países, y segmentos dentro de cada país hay heterogeneidad en la cobertura vacunal, con distintos rebrotes. Esfuerzos en la región han tratado de mejorar esta situación al introducir vacunas acelulares (aP), menos reactogénicas que las vacunas de células enteras (wP) en los calendarios vacunales. Además, algunos países han mejorado la definición de caso confirmado, al introducir la reacción de polimerasa en cadena (RPC) como criterio diagnóstico. En respuesta a las heterogeneidades de cada país y a la epidemiología actual de la región, un Comité de Expertos de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE) y la Asociación Latinoamericana de Pediatría (ALAPE) propone una definición unificada de caso y recomendaciones para mejorar la cobertura vacunal y reducir los brotes de tosferina en Latinoamérica.

Abstract Although whooping cough is a vaccine-preventable disease (VPD), its epidemiologic characteristics in Latin America shows persistence of outbreaks in the region. This persistence is due, at least in part, to the presence of antivaccine movements, the diversity of the surveillance systems, and the lack of a uniform case definition for the region. Given the importance of whooping cough in Latin America and the changes in vaccine recommendations, this manuscript aims to review epidemiologic data and recent changes in the vaccination calendars and their impact on the pediatric disease by Bordetella pertussis in Latin America. Recent epidemiological data reveal that between regions, countries, and administrative units within each country there is a marked heterogeneity of vaccine coverage, with different outbreak patterns. Efforts in the region have tried to improve this situation by introducing acellular pertussis vaccines (aP) in the vaccine calendars, which are less reactogenic than whole-cell pertussis vaccines (wP). Moreover, some countries have improved the case definition. Some countries have implemented a confirmed case definition by introducing polymerase chain reaction (PCR) as a diagnostic criterion. As a response to the heterogeneities observed within and between countries and the regional epidemiologic profiles, a Steering Committee from the Latin American Society for Pediatric Infectiology (SLIPE) and the Latin American Association of Pediatrics (ALAPE) propose a unified case definition and recommendations to improve vaccine coverage and reduce the outbreaks of whooping cough in Latin America.

Effect of pertussis vaccination on clinical manifestations of infants and young children with pertussis / 中国当代儿科杂志

OBJECTIVE@#To study the effect of pertussis vaccination on the clinical manifestations of infants and young children with pertussis.@*METHODS@#A retrospective analysis was performed to investigate the differences in clinical manifestations and peripheral blood cell levels between pertussis children with different pertussis vaccination status.@*RESULTS@#A total of 1 083 children with pertussisat at age of < 3 years were enrolled, with 551 children in the unvaccinated group and 532 in the vaccinated group. Of all the children, 392 had an age of onset of < 3 months (372 were unvaccinated and 20 were vaccinated) and 691 children had an age of onset of ≥ 3 months (179 were unvaccinated and 512 were vaccinated). Compared with the vaccinated group, the unvaccinated group had a longer length of hospital stay and a higher incidence rate of respiratory failure (@*CONCLUSIONS@#Pertussis vaccination can reduce the incidence of severe pneumonia and respiratory failure and alleviate the severity of respiratory complications in infants and young children with pertussis.

Expert consensus on the China Pertussis Initiative / 中华预防医学杂志

Some countries with high coverage of diphtheria, tetanus and pertussis combined vaccines have experienced pertussis epidemics and/or local outbreaks since 1980s. This phenomenon is called "pertussis resurgence". In recent years, pertussis epidemics in several provinces of China have resurged dramatically, arousing great concern from all parties. By referring the working model of the Global Pertussis Initiative, the Chinese Preventive Medicine Association has organized and launched the China Pertussis Initiative. A group of experts in this field has analyzed data of current pertussis in China and identified problems posed by the disease. This expert consensus was completed based on the discussions of the latest national and international research progeress, epidemiological trends and immunization strategies of pertussis, with special aims to provide guidance for the surveillance, prevention and control of pertussis in China.

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.

Ocorrência de eventos adversos após o uso da vacina adsorvida difteria, tétano e pertussis (acelular) - dTpa -, São Paulo, SP, 2015-2016 / Aparecimiento de eventos adversos después del uso de la vacuna adsorbida difteria, tétanos y tosferina (acelular) - dTpa -, São Paulo, SP, Brasil, 2015-2016 / Adverse event occurrence following use of tetanus, diphtheria and acellular pertussis adsorbed vaccine - Tdap -, São Paulo, SP, Brazil, 2015-2016

Objetivo: descrever a ocorrência de eventos adversos pós-vacinação (EAPV) com a vacina dTpa durante a gestação. Métodos: estudo descritivo, com dados de relatos das participantes de estudo de efetividade e imunogenicidade realizado em dois hospitais de São Paulo, SP, Brasil, entre 2015 e 2016. Resultados: das 201 mães incluídas no estudo, 48 (23,9%) apresentaram pelo menos um EAPV; foram identificados 60 sintomas relacionados ao uso da dTpa - dor (22,4%), inchaço (2,5%), febre (1,5%), sono (1,0%), vermelhidão (0,5%), vômito (0,5%), dor de cabeça (0,5%), reação local (0,5%) e cansaço (0,5%); não foram registrados eventos adversos raros, muito raros ou extremamente raros; todos os eventos foram considerados esperados e estão descritos em bula; todos tiveram desfecho para cura sem sequelas. Conclusão: a dTpa, na forma adotada pelo Programa Nacional de Imunizações (PNI), é segura; não foram identificados eventos adversos inesperados entre as gestantes imunizadas com a vacina.

Objetivo: describir el aparecimiento de eventos adversos posvacunación (EAPV) con la vacuna dTpa durante el embarazo. Métodos: estudio descriptivo con datos de relatos de las participantes del estudio de efectividad e inmunogenicidad realizado en dos hospitales de São Paulo, SP, Brasil, entre 2015 y 2106. Resultados: de las 201 madres del estudio, 48 (23,9%) tuvieron al menos un EAPV; se identificaron 60 síntomas relacionados al uso de dTpa - dolor (22.4%), hinchazón (2.5%), fiebre (1.5%), somnolencia (1.0%), enrojecimiento (0.5%), vómitos (0.5 %), dolor de cabeza (0.5%), reacción local (0.5%) y cansancio (0.5%) -; no se informaron eventos adversos raros, muy raros o extremadamente raros; todos los eventos se consideraron esperados y se describen en el prospecto; todos tuvieron resultados curativos sin secuelas. Conclusión: el estudio mostró que la vacuna dTpa utilizada por el Programa Nacional de Inmunización (PNI) es segura y no se identificaron eventos adversos inesperados entre las mujeres embarazadas vacunadas.

Objective: to describe occurrence of adverse events following immunization (AEFI) with Tdap vaccine during pregnancy. Methods: this was a descriptive study using data from reports by participants in an effectiveness and immunogenicity study conducted in two hospitals in São Paulo, SP, Brazil, from 2015 to 2016. Results: of the 201 mothers included in the study, 48 (23.9%) had at least one AEFI; 60 symptoms related to Tdap use were identified - pain (22.4%), swelling (2.5%), fever (1.5%), somnolence (1.0%), redness (0.5%), vomiting (0.5%), headache (0.5%), local reaction (0.5%), and fatigue (0.5%); no rare, very rare, or extremely rare adverse events were reported; all events were considered to be expected, as they are described in the vaccine package insert; outcome of all events was recovery without sequelae. Conclusion: Tdap vaccine in the form adopted by the National Immunization Program is safe; no unexpected adverse events were identified among vaccinated pregnant women.

Serosurveillance for vaccine-preventable diseases: A look inside the pertussis experience / Serovigilancia de enfermedades prevenibles por vacunación: una mirada desde la experiencia con la tosferina

Abstract Introduction: Serological surveillance (serosurveillance) provides the most direct measure of herd immunity of vaccine-preventable diseases. Little is known about the opportunities and challenges of serosurveillance experiences, particularly pertussis. Objective: To describe the process of serosurveillance for vaccine-preventable diseases with an emphasis on the experience of pertussis in the metropolitan area of Antioquia (Valle de Aburrá) in 2015 and 2016 and analyze the contributions and challenges for its sustainability. Materials and methods: We described the planning and conduction of serosurveillance of pertussis antibodies of mothers and in the umbilical cord at the time of delivery in eight hospitals based on random sampling and their capacity to advance the serosurveillance periodically. We compared the contributions and the challenges of this experience with other probabilistic and non-probabilistic programs. Results: We achieved the participation of hospitals and mothers respecting the delivery care process. We established a serum bank following ethical and technical guidelines. This program based on the random selection of hospitals and mothers has enabled the estimation of antibodies prevalence in mothers and in the umbilical cord, which has been possible given the high coverage of hospital care during childbirth at a lower cost and fewer risks than a population-based survey in conflictive areas. The main challenges for the sustainability of this program are the creation of stable jobs and access to funding and legal and methodological long-term frameworks. Conclusions: Hospital serosurveillance as described is an option to monitor the impact of vaccination on the population. Our experience could be reproduced in other regions under similar conditions if the above-mentioned challenges are solved.

Resumen Introducción. La vigilancia serológica es la forma más directa de medir la inmunidad de rebaño frente a las enfermedades prevenibles por vacunación. Poco se sabe acerca de las oportunidades y los desafíos de las experiencias de serovigilancia, en general y, específicamente, la de la tosferina. Objetivo. Describir el proceso de serovigilancia de enfermedades prevenibles por vacunación con énfasis en la experiencia en el caso de la tosferina en el área metropolitana de Antioquia (Valle de Aburrá) en el 2015 y el 2016 y analizar lo que dicha experiencia ha aportado y los desafíos que persisten para su sostenibilidad. Materiales y métodos. Se describió el proceso de planeación y el desarrollo de la serovigilancia de tosferina en el momento del parto en ocho hospitales seleccionados al azar, así como la capacidad para adelantar el programa de manera periódica. Se compararon los aportes y los desafíos en el curso de esta experiencia con los de otros programas poblacionales probabilistas e institucionales no probabilistas. Resultados. Se logró la participación de los hospitales y de las madres con pleno respeto del proceso de atención del parto, y se conformó un banco de sueros siguiendo lineamientos éticos y técnicos. El programa permitió estimar la prevalencia de anticuerpos en la madre y en el cordón umbilical, lo que se facilitó por la alta cobertura de atención hospitalaria del parto, a un menor costo y menos riesgos que los programas poblacionales en zonas conflictivas. Los principales desafíos para la sostenibilidad del programa son la estabilidad laboral del personal de salud, así como normas y una financiación de largo plazo. Conclusiones. La serovigilancia hospitalaria es una opción para monitorizar el impacto poblacional de la vacunación. Esta experiencia se podría extender a otras regiones en condiciones similares si se resuelven los retos mencionados.

Características clínicas y epidemiológicas de tos ferina en pacientes hospitalizados en un hospital de tercer nivel de Perú / Clinical and epidemiological characteristics of whooping cough in hospitalized patients of a tertiary care hospital in Peru

RESUMEN Objetivo: Describir las características clínicas y epidemiológicas de los pacientes menores de 2 años hospitalizados con el diagnóstico de tos ferina en un hospital pediátrico de tercer nivel de Perú. Métodos: Serie de casos de pacientes menores de 2 años hospitalizados con diagnóstico de tos ferina durante el año 2012. Resultados: Fueron hospitalizados 121 pacientes. Se realizaron pruebas para confirmar el diagnóstico (inmunofluorescencia directa, reacción en cadena de la polimerasa, cultivo) al 53,72%. El 23,15% (n = 28) fueron casos confirmados, todos menores de 10 meses, ninguno había recibido 3 dosis de la vacuna contra pertussis, el 96,43% (n = 27) de ellos fueron menores de 6 meses y 42,86% (n = 12) menores de 3 meses; un 10,71% (n = 3) ingresaron a unidad de cuidados intensivos, todos menores de 2 meses, uno de los cuales falleció. Los síntomas más frecuentes en los casos confirmados fueron tos (96,43%), rubicundez facial (96,43%), tos paroxística (92,86%) y cianosis asociada a la tos (78,57%); el contacto epidemiológico probable más frecuente fue la madre (17,86%) y la mayoría de casos se presentaron en verano (46,43%). Conclusión: La tos ferina es causa de morbimortalidad sobre todo en los menores de 6 meses de edad y en los no inmunizados o parcialmente inmunizados. Se deben mejorar las tasas de vacunación y fomentar la confirmación de casos para no contribuir al infradiagnóstico de esta enfermedad.

ABSTRACT Objective: Describe the clinical and epidemiological characteristics of patients under 2 years of age hospitalized with whooping cough in a tertiary care children's hospital in Peru. Methods: This was a case series of patients under 2 years of age who were hospitalized with a diagnosis of whooping cough in 2012. Results: A total of 121 patients were hospitalized. Diagnostic testing (direct immunofluorescence, polymerase chain reaction, culture) was carried out in 53.72% of patients. Overall, 23.15% (n = 28) were confirmed cases, all of whom were patients less than 10 months old, and none of whom had received 3 doses of whooping cough vaccine. A total of 96.43% (n = 27) of cases were under 6 months of age, 42.86% (n = 12) were younger than 3 months, and 10.71% (n = 3) were admitted to the intensive care unit. Of these cases, all were younger than 2 months old, and one patient died. The most common symptoms in the confirmed cases were coughing (96.43%), facial redness (96.43%), paroxysmal coughing (92.86%), and coughing-related cyanosis (78.57%). The most frequent probable epidemiological contact was the mother (17.86%), and the majority of cases occurred in the summer (46.43%). Conclusion: Whooping cough is a cause of morbidity and mortality, especially in those younger than 6 months of age and in those who are not immunized or only partially immunized. Vaccination rates should be improved and case confirmation encouraged to prevent the underdiagnosis of this disease.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica de enfermedades inmunoprevenibles. No. 06 / Protocol of the National Epidemiological Surveillance System of immunoprevenible diseases. No. 06

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país. La vigilancia epidemiológica de las enfermedades prevenibles con vacuna, busca reducir la mortalidad y morbilidad por infecciones inmunoprevenibles. La vigilancia epidemiológica, es fundamental para evaluar el impacto de las intervenciones y la toma de decisiones de acuerdo al análisis permanente de la situación de salud.

What is the importance of vaccine hesitancy in the drop of vaccination coverage in Brazil? / Qual a importância da hesitação vacinal na queda das coberturas vacinais no Brasil?

ABSTRACT The successful Programa Nacional de Imunizações do Brasil (Brazilian National Immunization Program) has been experiencing a major challenge with regard to vaccination coverage for children, which has been dropping. Several aspects are related, but certainly vaccine hesitancy has been strengthening itself as one of the main concerns of Brazilian public administrators and researchers. Vaccine hesitancy is the delay in acceptance or refusal despite having the recommended vaccines available in health services, being a phenomenon that varies over time, over location and over types of vaccines. Hesitant individuals are between the two poles of total acceptance and refusal of vaccination. Vaccine hesitancy is nothing new in European and North-American countries, and even in Brazil, it has been studied even if under another name. The drop of vaccination coverage observed from 2016 on reiterates the relevance of the theme, which must be better understood through scientific research.

RESUMO O exitoso Programa Nacional de Imunizações do Brasil tem vivenciado grande desafio com relação às coberturas vacinais infantis, que têm apresentado queda. Diversos aspectos estão relacionados, mas certamente a hesitação vacinal vem se fortalecendo como uma das principais preocupações dos gestores e pesquisadores brasileiros. Hesitação vacinal é o atraso em aceitar ou a recusa das vacinas recomendadas quando elas estão disponíveis nos serviços de saúde, sendo um fenômeno que varia ao longo do tempo, do local e dos tipos de vacinas. Indivíduos hesitantes situam-se entre os dois polos de aceitação e recusa total da vacinação. A hesitação vacinal não é novidade em países europeus e norte-americanos e, mesmo no Brasil, ela já vem sendo estudada ainda que sob outra denominação. A queda das coberturas vacinais observadas a partir de 2016 reitera a relevância do tema, que deve ser mais bem compreendido por meio de investigações científicas.

Tos ferina asociado a morbimortalidad e inmunoprevención / Whooping cough associated with morbimortality and immunoprevention

Antecedentes: En Honduras han existido múl-tiples brotes de tos ferina, sin embargo, pocos se publican y reportan como diagnóstico la reacción en cadena de Polimerasa (PCR) en tiempo real. Debe tomarse en cuenta el subre-gistro y el infradiagnóstico debido al bajo índice de sospecha como factores importantes a considerar en la remergencia de la enferme-dad. Objetivo: Describir el Síndrome Coquelu-choide y tos ferina en el Hospital Nacional Dr. Mario Catarino Rivas (HNMCR) en el período de enero a mayo 2017. Pacientes y Métodos:Estudio descriptivo, transversal en niños cuyo cuadro clínico cumple con los criterios de caso probable de tos ferina. La muestra la confor-man 23 pacientes. Resultados: La Tosferina afecta a niños del sexo masculino, lactante menor, durante los meses de enero y marzo. La evolución de la enfermedad tiene una media de 12 días al momento del diagnóstico, el esquema de vacunación incompleto para la edad según PAI es un factor de riesgo impor-tante, La tos paroxística, ebre y apnea fueron el cuadro clínico predominante acompañado de hiperleucocitosis con PCR positivos. El 37% de los casos fallecieron por complicaciones asociadas. Conclusión: A pesar de los cambios epidemiológicos que ha habido durante el transcurso del tiempo con la introducción de la vacuna contra Bordetella Pertussis, sigue siendo una enfermedad prevalente, potencial-mente fatal, especialmente en lactantes menores y neonatos, se considera que laque la estrategia capullo debe ser incluida en el programa ampliado de inmunizaciones de nuestro país, recordando que la tos ferina es una enfermedad inmunoprevenible...(AU)

Seroprevalencia contra Bordetella pertussis en embarazadas vacunadas y no vacunadas y neonatos en un hospital universitario de la provincia de Buenos Aires / Seroprevalence of Bordetella pertussis among vaccinated and unvaccinated pregnant women and newborn infants in a university hospital of Buenos Aires

Introducción. La tos convulsa es una enfermedad altamente contagiosa causada por Bordetella pertussis. Tiene una alta tasa de morbilidad y mortalidad, especialmente, en los lactantes menores de seis meses de edad. En la Argentina, la incidencia y la mortalidad se han encontrado en aumento en las últimas 3 décadas. Objetivo. Determinar anticuerpos contra Bordetella pertussis en las mujeres embarazadas en el tercer trimestre de la gestación y en el recién nacido, medidos en la sangre del cordón. Métodos. Se disenó un estudio observacional, transversal. El estudio se inició en 2011 cuando la vacunación contra pertussis en la embarazada no estaba incluida en el Calendario Nacional de Vacunación y era opcional. Los anticuerpos se midieron en las madres en el tercer trimestre del embarazo y en la sangre del cordón umbilical al nacer. Las determinaciones de anticuerpos se realizaron con el kit de ELISA humano para IgG toxina pertussis ABCAMR. Se utilizó la prueba de chi² para comparar la prevalencia. Resultados. Se incluyó a 111 madres y a sus bebés, 35 hijos de madres no vacunadas (antes de la implementación de la vacuna en embarazadas) y 76 hijos de madres vacunadas. Los bebés de madres vacunadas presentaron anticuerpos IgG positivos en el 92% (70/76), mientras que los bebés de madres no vacunadas fueron negativos para anticuerpos IgG en el 100% (35/35) con una p < 0,001. Conclusión. En la población de vacunadas del estudio, se observó que sus hijos presentaron anticuerpos IgG positivos en el 92%. Este estudio apoya la necesidad de la inmunización materna contra Bordetella pertussis para proteger al recién nacido.

Introduction. Pertussis is a highly contagious disease caused by Bordetella pertussis. It poses a high morbidity and mortality rate, especially among infants younger than 6 months old. In Argentina, pertussis incidence and mortality have increased over the past three decades. Objective. To establish Bordetella pertussis antibody titers among pregnant women in their third trimester and among newborn infants, as measured in cord blood. Methods. This was an observational, crosssectional study. The study started in 2011; at that time, pertussis vaccination was not mandatory for pregnant women as per the national immunization schedule, only optional. Maternal antibodies were measured in the last trimester of pregnancy for women and in cord blood for newborn infants. Antibody titers were determined using Abcam's anti-Bordetella pertussis toxin (PT) IgG in vitro ELISA kit. The X2 test was used to compare prevalence rates. Results. The study included 111 mother-newborn infant dyads; 35 infants from unvaccinated mothers (before the introduction of the vaccine) and 76 from vaccinated mothers. Positive IgG antibodies were found in 92% (70/76) of infants born from vaccinated mothers whereas 100% (35/35) of infants born from unvaccinated mothers had negative results for antibodies; p < 0.001. Conclusion. In the vaccinated population of this study, 92% of infants had positive IgG antibodies. This study supports the need for maternal immunization against Bordetella pertussis to provide protection to newborn infants.