Carga de neumonía en adultos hospitalizados / Pneumonia loading in hospitalized adults / Pneumonia carregando em adultos hospitalizados

La neumonía adquirida en la comunidad en adultos, es un importante problema de salud pública. En América Latina son muy escasas las publicaciones que documenten su incidencia. Esta comunicación breve proporciona datos preliminares sobre la incidencia (105 persona/año) de neumonías en adultos hospitalizados. La base de datos de una institución médica privada de Uruguay, posibilitó la estimación de la incidencia de esa patología, antes de la implementación de la vacuna conjugada neumocóccica (VCN) en la infancia y luego de su aplicación. En 1.688 pacientes con neumonía los mayores de 64 años predominaron y su incidencia fue de 1.938 en el período prevacunación, descendiendo significativamente a 1.365 luego de la VCN. A pesar de la posible protección indirecta de la vacunación, la información presentada alerta sobre la persistencia de morbimortalidad por neumonía en adultos mayores.

Pneumonia in adults poses severe health risks, but data on its burden still lacks in Latin American countries including Uruguay. To fill this gap preliminary information on hospitalized pneumonia incidence in adults was analyzed. A data base from a private medical institution enabled to estimate, pre and post pneumococcal conjugate vaccine incidences (105 person/year), by age groups. Out of 1 688 adults hospitalized due to pneumonia, the group aged >64 yers predominated. For the same age group, a significant difference (1.938 vs. 1.365) was observed on incidences before and after conjugate vaccine application in children. Although more robust information on adult pneumonia hospitalizations are required to confirm indirect vaccine effect, these data alert on pneumonia persistence which requires preventive measures.

A pneumonia adquirida na comunidade em adultos é um grande problema de saúde pública. Na América Latina existem muito poucas publicações que documentam sua incidência. Esta breve comunicação fornece dados preliminares sobre a incidência (105 pessoas / ano) de pneumonias em adultos hospitalizados. O banco de dados de uma instituição médica privada no Uruguai possibilitou estimar a incidência dessa patologia, antes da implementação da vacina conjugada pneumocócica (VCN) na infância e após sua aplicação. Em 1.688 pacientes com pneumonia, aqueles com mais de 64 anos de idade predominaram e sua incidência foi de 1.938 no período de pré-vacinação, descendo significativamente para 1.365 após a VCN. Apesar da possível proteção indireta da vacinação, as informações apresentadas alertam sobre a persistência da morbimortalidade por pneumonia em idosos.

Impact of pneumococcal conjugate vaccines on the incidence of pneumonia in hospitalized children after five years of its introduction in Uruguay.

BACKGROUND: Data on the burden of pneumococcal disease and the most frequent serotypes demonstrated that invasive disease and pneumonia were important manifestations affecting children under 5 years of age. Therefore, pneumococcal diseases prevention became a public health priority. Uruguay was the first Latin American country to incorporate PCV7 into its National Immunization Program. The aim of this study is to compare the incidence rates for hospitalized pneumonia in children from the pre PCV introduction period and the following five years of PCVs application in Uruguay. METHODS AND FINDINGS: Population-based surveillance of pneumonia hospitalization rates, in children, less than 14 years of age, had been performed prior pneumococcal vaccination, and continued following PCV7 introduction and PCV13 replacement, using the same methodology. Hospitalized children with pneumonia were enrolled from January 1, 2009 through December 31st, 2012. The study was carried out in an area with a population of 238,002 inhabitants of whom 18, 055 were under five years of age. Patients with acute lower respiratory infections for whom a chest radiograph was performed on admission were eligible. Digitalized radiographs were interpreted by a reference radiologist, using WHO criteria. Pneumonia was confirmed in 2,697 patients, 1,267 with consolidated and 1,430 with non consolidated pneumonia of which incidence decrease, between 2009 and 2012, was 27.3% and 46.4% respectively. 2001-2004 and 2009-2012 comparison showed a significant difference of 20.4% for consolidated pneumonia hospitalizations. A significant incidence decline was recorded among children 6 to 35 months of age. CONCLUSIONS: An overall significant reduction in pneumonia hospitalizations was observed following the introduction of PCV7 and furthermore following the change to PCV13.

Hospitalized children with pneumonia in Uruguay: pre and post introduction of 7 and 13-valent pneumococcal conjugated vaccines into the National Immunization Program.

INTRODUCTION: Streptococcus pneumoniae pneumonia burden in children was poorly defined in Uruguay. A three-year population-based surveillance demonstrated the impact of the pneumonia in hospitalized children of less than five years of age. To control these diseases in March 2008, Uruguayan health authorities decided to incorporate PCV7 to the National Immunization Program administered at 2, 4 and 12 months of age (2+1 schedule). OBJECTIVE: To compare the incidence of consolidated pneumonia hospitalization in children less than five years of age before and after pneumococcal conjugate vaccine implementation. METHODS: Same methodology of the prevaccination study was employed. The surveillance was carried out at the same four hospitals covering a population of 229,128 inhabitants (2004 Census) of whom 10.2% were under five years of age. Clinical data, vaccination status and digitization of their chest X-rays were recorded. A pediatric radiologist blinded to the clinical diagnosis interpreted the digital images according WHO definitions. Bacterial etiology was investigated in blood and/or in pleural fluid. RESULTS: Between January 1st 2009 and June 30th 2011 patients were enrolled. Out of 23,445 children<5 years of age, 1224 were hospitalized with pneumonia (430 consolidated pneumonias and 794 non consolidated pneumonias). Pleural effusion was recorded in 89 patients. In 48 consolidated pneumonias S. pneumoniae etiology was recognized. Post vaccination incidence rate of consolidated pneumonia in patients aged 12-23 months showed a significant reduction (44.9%) if we compare it with the incidence of pneumonia hospitalization in the previous study. In March 2010, PCV13 replaced PCV7. Compliance of PCV7/13 globally was 92% but the vaccination status varied among the surveyed patients because two catch-ups were carried out in addition to the routine cohort vaccination. From 2009 1st semester to 2011 1st semester incidence rates decline reached 59%. CONCLUSION: To date, the ongoing surveillance documented a significant decline on incidence of hospitalizations for consolidated pneumonia in children younger than 24 months of age, confirming the success of the 2+1 vaccination schedule.

Assessment of the quality of immunization data produced by the national individual registration system in Uruguay, 2006.

OBJECTIVE: The nominal registration system of Uruguay's national immunization program (NIP) tracks administered vaccines on a paper form filled out after each vaccination and collated into a national database, thus allowing for individual follow-up. This study performed a comprehensive assessment of the quality of Uruguay's immunization data in November 2006 to evaluate the validity of the information and to confirm the high national immunization coverage reported by the program. METHODS: The research team analyzed the concordance of the operational-level numerators (infant immunization data from 18 public and private vaccination centers in six country departments) with department- and national-level data, and compared the national-level (NIP) infant denominators with other official sources. A standardized questionnaire was used to evaluate system performance at the operational (vaccination center), department, and national level. Rapid house-to-house monitoring was conducted to generate additional coverage estimates. RESULTS: Numerator accuracy throughout the data flow was 100%, and national-level denominators appeared to be exhaustive. Overall system performance was excellent (proper archiving and recording of form data, sufficient supply of forms, timely flow of information, adequate defaulter tracing practices and computer system security). The main weaknesses were the degree of data analysis and feedback to peripheral levels. House-to-house monitoring showed high overall immunization coverage (97%). CONCLUSION: Uruguay's NIP registration system produces remarkably reliable information, ensuring valid measurement of immunization coverage. In addition, by allowing for monitoring of each child's current vaccination status, it facilitates management of interventions designed to reduce vaccination default and thus helps achieve the country's high level of coverage.

Assessment of the quality of immunization data produced by the national individual registration system in Uruguay, 2006 / Evaluación de la calidad de los datos de vacunación generados por el sistema nacional de registro individual en Uruguay, 2006

OBJECTIVE: The nominal registration system of Uruguay's national immunization program (NIP) tracks administered vaccines on a paper form filled out after each vaccination and collated into a national database, thus allowing for individual follow-up. This study performed a comprehensive assessment of the quality of Uruguay's immunization data in November 2006 to evaluate the validity of the information and to confirm the high national immunization coverage reported by the program. METHODS: The research team analyzed the concordance of the operational-level numerators (infant immunization data from 18 public and private vaccination centers in six country departments) with department- and national-level data, and compared the national-level (NIP) infant denominators with other official sources. A standardized questionnaire was used to evaluate system performance at the operational (vaccination center), department, and national level. Rapid house-to-house monitoring was conducted to generate additional coverage estimates. RESULTS: Numerator accuracy throughout the data flow was 100 percent, and national-level denominators appeared to be exhaustive. Overall system performance was excellent (proper archiving and recording of form data, sufficient supply of forms, timely flow of information, adequate defaulter tracing practices and computer system security). The main weaknesses were the degree of data analysis and feedback to peripheral levels. House-to-house monitoring showed high overall immunization coverage (97 percent). CONCLUSION: Uruguay's NIP registration system produces remarkably reliable information, ensuring valid measurement of immunization coverage. In addition, by allowing for monitoring of each child's current vaccination status, it facilitates management of interventions designed to reduce vaccination default and thus helps achieve the country's high level of coverage.

OBJETIVOS: El sistema de registro nominal del programa nacional de vacunación (PNV) de Uruguay registra las vacunas administradas en un modelo en papel que se llena después de cada vacunación y se introduce en una base de datos nacional, lo que permite el seguimiento individual. En este estudio, realizado en noviembre de 2006, se hizo un análisis integral de la calidad de los datos de vacunación en Uruguay para evaluar la validez de la información y confirmar la alta cobertura nacional de vacunación informada por el programa. MÉTODOS: Se analizó la concordancia de los numeradores operacionales (datos de vacunación infantil de 18 centros de vacunación públicos y privados de seis departamentos del país) con los datos departamentales y nacionales, y se compararon los denominadores del PNV infantil a nivel nacional con los de otras fuentes oficiales. Se empleó un cuestionario estandarizado para evaluar el desempeño del sistema en los niveles operacional (centros de vacunación), departamental y nacional. Se realizó un monitoreo rápido de casa en casa para obtener estimados adicionales de la cobertura. RESULTADOS: La precisión de los numeradores en todo el flujo de datos fue de 100 por ciento y los denominadores a nivel nacional al parecer eran exhaustivos. El desempeño general del sistema fue excelente (archivo y registro adecuados de los datos, suministro suficiente de modelos, flujo oportuno de información, práctica adecuada de rastreo de fallas y sistema apropiado de seguridad informática). Las principales debilidades fueron el grado de análisis de los datos y la retroalimentación a las instancias periféricas. El monitoreo de casa en casa mostró una alta cobertura general de vacunación (97 por ciento). CONCLUSIONES: El sistema uruguayo de registro del PNV genera una información notablemente confiable, lo que asegura la validez de la medición de la cobertura de vacunación. Además, al permitir el monitoreo del estado de vacunación actual ...

Vacunación contra Haemophilus influenzae tipo b en el Uruguay : experiencia e impacto / Vaccination against Haemophilus influenzae type b in Uruguay : experience and impact

Between 1979 and 1994, epidemiological surveillance of meningitides in Uruguay showed a progressive increase in suppurative meningitides due mainly to Neisseria meningitidis and Haemophilus influenzae type b (Hib). The cases were concentrated in children under 5; however, among the cases caused by Hib, 70 per cent affected children from 1 to 11 months old. Facing this situation, the Ministry of Public Health resolved, as of August 1994, to include the Hib vaccine in the country's Expanded Program on Immunization, which has been in place since 1982. The Hib vaccination is done without charge and is obligatory for all children under 5 years of age. It is done using the following series of vaccinations: a) three doses, given at 2, 4, and 6 months, with a booster dose at age 1; b) children from 7 to 11 months old receive two doses two monts apart and a booster dose a year later; and c) a single dose for children 12 months to 4 years old. Between August and December 1994 a coverage rate of 76.6 per cent was reached among children between 2 months and 4 years old, and the coverage has remained above 80 per cent in the new cohorts. In Uruguay, this vaccination strategy had a spectacular impact on morbidity and mortality due to meningitides caused by Hib. One of the results was that the incidence of 15.6 per 100 000 registered in children under 5 in the prevaccination years declined to 0.03 per 100 000 in 1996

Vacunación contra Haemophilus influenzae tipo b en el Uruguay: experiencia e impacto / Vaccination against Haemophilus influenzae type b in Uruguay: experience and impact

Between 1979 and 1994, epidemiological surveillance of meningitides in Uruguay showed a progressive increase in suppurative meningitides due mainly to Neisseria meningitidis and Haemophilus influenzae type b (Hib). The cases were concentrated in children under 5; however, among the cases caused by Hib, 70 per cent affected children from 1 to 11 months old. Facing this situation, the Ministry of Public Health resolved, as of August 1994, to include the Hib vaccine in the country's Expanded Program on Immunization, which has been in place since 1982. The Hib vaccination is done without charge and is obligatory for all children under 5 years of age. It is done using the following series of vaccinations: a) three doses, given at 2, 4, and 6 months, with a booster dose at age 1; b) children from 7 to 11 months old receive two doses two monts apart and a booster dose a year later; and c) a single dose for children 12 months to 4 years old. Between August and December 1994 a coverage rate of 76.6 per cent was reached among children between 2 months and 4 years old, and the coverage has remained above 80 per cent in the new cohorts. In Uruguay, this vaccination strategy had a spectacular impact on morbidity and mortality due to meningitides caused by Hib. One of the results was that the incidence of 15.6 per 100 000 registered in children under 5 in the prevaccination years declined to 0.03 per 100 000 in 1996