[Preventable diseases by vaccination. Coverage and impact]. / Enfermedades inmunoprevenibles. Coberturas e impactos de la vacunación.

OBJECTIVE: to evaluate the coverage and impacts of the vaccination component in Integrated Health Programs. MATERIAL AND METHODS: a descriptive study of secondary data analysis was carried out. We analyzed data generated by the Universal Vaccination Program (PROVAC) since 1991, the data compiled in the 2000 National Health Survey (ENSA) and the 2005 National Survey of Coverage of Integrated Health Programs (ENCOPREVENIMSS), as well as the IMSS Annual Epidemiological Gazettes since 1973. RESULTS: the coverage of the basic schemes of the Extended Immunization Program (PAI) in children from one to four years old increased from 46.0% in 1990 to 92.5% in 1992 and 98.2% in 2005. The coverage with booster doses was substantially lower, ranging between 57.0% and 97.3% depending on the type of vaccine and the number of doses. The coverage also varied, although to a lesser extent, among public healthcare institutions. In relation to the impact of the Universal Vaccination Program and the PREVENIMSS strategy among IMSS affiliates, we distinguished at least three situations: (1) illnesses in which a drop in incidence predates the Universal Vaccination Program: tuberculous meningitis, diphtheria, whooping cough, and tetanus; (2) illnesses in which the drop in incidence is clearly related to the program: measles, rubella, mumps, and meningitis due to H. influenzae b. (3) illnesses for which the impact has not yet been assessed: hepatitis B. In addition to a drop in the incidence of immunopreventable diseases, we observed changes in the age distribution of cases. CONCLUSIONS: the PREVENIMSS strategy has not interfered with, and in some case has helped to consolidate the achievements of the Universal Vaccination Program. The results of this investigation point to the need to modernize the current system of evaluating coverage and expanding vaccination schemes with booster doses.

Seroprevalence of hepatitis B in pregnant women in Mexico.

OBJECTIVE: To determine the seroprevalence of hepatitis B in pregnant women from several regions of Mexico, as well as the risk factors associated with its occurrence. MATERIAL AND METHODS: A cross-sectional study was conducted between May and August 2000. It included 9,992 pregnant women attending the health services of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social-IMSS) in five cities: Tijuana, Ciudad Juarez, Acapulco, Cancun, and Mexico City (northeast and southeast regions). RESULTS: The overall prevalence for confirmed cases was 1.65% (165/9,992). The prevalences for individual cities were as follows: Tijuana, 1.27%; Ciudad Juarez, 1.46%; Acapulco, 2.47%; Cancun, 0.93%; northeastern Mexico City, 1.20%, and southeastern Mexico City, 2.52%. The risk factors found to be associated with HBsAg were: age, age at first sexual intercourse, city (Acapulco and southeastern Mexico City), and marital status (single or divorced). CONCLUSIONS: The prevalence of HBsAg in pregnant women (1.65%) was greater than that reported in previous studies and showed geographical differences. This high prevalence suggests that a considerable amount of cases of hepatitis B occurs perinatally and through contact with carriers in the general population. Vaccination of newborns of high-risk pregnant women should be considered.

Seroprevalence of hepatitis B in pregnant women in Mexico

OBJECTIVE: To determine the seroprevalence of hepatitis B in pregnant women from several regions of Mexico, as well as the risk factors associated with its occurrence. MATERIAL AND METHODS: A cross-sectional study was conducted between May and August 2000. It included 9 992 pregnant women attending the health services of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social-IMSS) in five cities: Tijuana, Ciudad Juarez, Acapulco, Cancun, and Mexico City (northeast and southeast regions). RESULTS: The overall prevalence for confirmed cases was 1.65 percent (165/9 992). The prevalences for individual cities were as follows: Tijuana, 1.27 percent; Ciudad Juarez, 1.46 percent; Acapulco, 2.47 percent; Cancun, 0.93 percent; northeastern Mexico City, 1.20 percent, and southeastern Mexico City, 2.52 percent. The risk factors found to be associated with HBsAg were: age, age at first sexual intercourse, city (Acapulco and southeastern Mexico City), and marital status (single or divorced). CONCLUSIONS: The prevalence of HBsAg in pregnant women (1.65 percent) was greater than that reported in previous studies and showed geographical differences. This high prevalence suggests that a considerable amount of cases of hepatitis B occurs perinatally and through contact with carriers in the general population. Vaccination of newborns of high-risk pregnant women should be considered

Seroprevalencia de anticuerpos antirrubéola en adolescentes / Seroprevalence of antirubella antibodies in teenagers

Dentro de las enfermedades clasificadas como fibriles exantemáticas la rubéola ocupa un papel prepondente, aun cuando no se conoce su magnitud real. Por su trascendencia se le ha considerado un problema de salud pública, ya que existe el riesgo de que ocurra el síndrome de rubéola congénita durante el primer trimestre del embarazo. El Instituto Mexicano del Seguro Social realizó una seroencuesta con el propósito de reforzar el uso de la vacuna antirrubéola monovalente en el grupo de mujeres prepúberes y en edad fértil. Dicha encuesta se realizó durante el periodo comprendido de diciembre de 1994 a marzo de 1995, en adolescentes entre 11 y 17 años de edad, de escuelas secundaias de Reynosa, Tamaulipas. Se entrevistaron 2293 adolescentes, de las cuales sólo se obtuvo respusta en 2019, con una tasa de no respuesta de 1195 por ciento. La prevalancia global encontrada de seropositivas fue de 72.5 por ciento y de seronegativas de 27.5 por ciento. La mayor frecuencia de seronegatividad global según los grupos de edad fue en el de 13 años (9.56 por ciento)

Patología infecciosa en personal de quirófano / Infectious diseases in the surgical team

Las enfermedades infecciosas son uno de los principales riesgos a los que se expone el personal de quirófano. La probabilidad de adquirirlas es mayor en centros de investigación y hospitales, y está en relación a las categorías de trabajo y los servicios. Las principales son la hepatitis B, C y D, y el síndrome de inmunodeficiencia adquirida. Los principales factores de riesgo son el contacto frecuente con sangre y otros líquidos y secreciones de pacientes infectados, pérdida de la continuidad de la piel o mucosas, tipo y tiempo de la cirugía, y la perforación accidental de los guantes. El tamizaje para el virus de la inmunodeficiencia humana, de los pacientes sometidos a cirugía se ha postulado como medida para disminuir el riesgo. Su indicación como medida sistemática se ha cuestionado. Es probable que cambios en la técnica quirúrgica, como el evitar el contacto simultáneo del instrumental punzocortante por el instrumentista y el cirujano, sean una mejor medida para evitar la contaminación accidental en quirófano. El uso de campos estériles desechables e impermeables puede incrementar la protección. El uso de doble guante puede estar indicado en cirugías de larga duración o cuando se maneje hueso, pero es más importante el ajuste adecuado del guante. La vacunación contra la hepatitis B está indicada en todo el personal de quirófano. La observancia de las medidas preventivas debe ser sistemática y seguida por todo el equipo quirúrgico.