Strategic considerations on developing a CHIKV vaccine and ensuring equitable access for countries in need.

Chikungunya is an arboviral disease caused by the chikungunya virus (CHIKV) afflicting tropical and sub-tropical countries worldwide. It has been identified as a priority pathogen by the Coalition for Epidemics Preparedness Innovations (CEPI) and as an emerging infectious disease (EID) necessitating further action as soon as possible by the World Health Organization (WHO). Recent studies suggest that disability-adjusted life years (DALYs) due to CHIKV infection are as high as 106,089 DALYs lost globally. Significant progress has been made in the development of several vaccines, aimed at preventing CHIKV infections. This perspective article summarizes CEPI's efforts and strategic considerations for developing a CHIKV vaccine and ensuring equitable access for CHIKV endemic countries.

[One hundred years of the Pan American Journal of Public Health: visualizing its contentCem anos da Revista Pan-Americana de Saúde Pública: visualização do seu conteúdo]. / Cien años de la Revista Panamericana de Salud Pública: visualización de sus contenidos.

Objectives: Explore how the content of the articles published by the Pan American Journal of Public Health during its 100 years of existence has aligned with the key health issues of the Pan American Health Organization (PAHO). Methods: A bibliometric analysis was carried out, with visualization of its results. Information on articles published in the Journal was retrieved from PAHO's Institutional Repository for Information Sharing (IRIS) for the first 75 years and Scopus for the last 25 years, until February 2022; References to Governing Bodies documents and statements by the directors were used to establish PAHO's key themes. Results: Initially, 12 573 publications were obtained and 9 289 were considered for analysis for the period 1922 to 1996, and 3 208 for the period 1997 to 2022. For the bibliometric analysis of the Scopus information, indicators such as the authors and their origin, language of publication, and number and origin of citations were considered. For the visualizations, publications were divided into five periods so that they coincided with the periods established for the analysis of PAHO's priority themes. Keyword co-occurrence maps were made to observe the evolution of published topics and relate them to public health approaches in each period. Conclusion: The topics published in the Pan American Journal of Public Health and its precursor bulletins reflect the history of regional public health and its evolution over time, as well as the key health issues of the Pan American Health Organization.

Objetivos: Explorar o alinhamento do conteúdo dos artigos publicados na Revista Pan-Americana de Saúde Pública em seus 100 anos de existência com os principais temas de saúde da Organização Pan-Americana da Saúde (OPAS). Métodos: Fez-se uma análise bibliométrica com visualização de seus resultados. Informações sobre os artigos publicados na revista foram recuperadas do Repositório Institucional para o Intercâmbio de Informações (IRIS, na sigla em inglês) da OPAS para os primeiros 75 anos, e da base de dados Scopus para os últimos 25 anos, até fevereiro de 2022. Para estabelecer os principais temas da OPAS, foram usadas referências a documentos dos órgãos diretores e declarações dos diretores. Resultados: Inicialmente, foram obtidas 12 573 publicações ­ 9 289 foram consideradas na análise para o período de 1922 a 1996, e 3 208 para o período de 1997 a 2022. Para a análise bibliométrica das informações da Scopus, foram levados em consideração indicadores como os autores e sua procedência, o idioma das publicações e o número e a procedência das citações. Para as visualizações, as publicações foram divididas em cinco períodos para que coincidissem com os períodos estabelecidos para a análise dos temas prioritários da OPAS. Mapeou-se a co-ocorrência de palavras-chave para observar a evolução dos temas das publicações e para relacioná-los com os enfoques de saúde pública em cada período. Conclusão: Os temas publicados na Revista Pan-Americana de Saúde Pública e nos boletins que a antecederam refletem o histórico da saúde pública regional e sua evolução ao longo do tempo, bem como os principais temas de saúde da Organização Pan-Americana da Saúde.

Cien años de la Revista Panamericana de Salud Pública: visualización de sus contenidos / One hundred years of the Pan American Journal of Public Health: visualizing its content / Cem anos da Revista Pan-Americana de Saúde Pública: visualização do seu conteúdo

RESUMEN Objetivos. Explorar la alineación del contenido de los artículos publicados por la Revista Panamericana de Salud Pública durante sus 100 años de existencia, con los temas sanitarios claves de la Organización Panamericana de la Salud (OPS). Métodos. Se llevó a cabo un análisis bibliométrico con visualización de sus resultados. Se recuperó la información sobre los artículos publicados en la Revista a partir del Repositorio Institucional para Intercambio de Información (IRIS) de la OPS para los primeros 75 años y de Scopus para los últimos 25 años hasta febrero del 2022; para establecer los temas claves de la OPS se usaron referencias a documentos de los Cuerpos Directivos y declaraciones de los directores. Resultados. Se obtuvieron inicialmente 12 573 publicaciones y se consideraron para el análisis 9 289 para el período 1922 a 1996 y 3 208 para el período 1997 a 2022. Para el análisis bibliométrico de la información de Scopus se tuvieron en cuenta indicadores como los autores y su procedencia, el idioma de las publicaciones, y el número y la procedencia de las citas. Para las visualizaciones, se dividieron las publicaciones en cinco períodos a fin de que estos coincidieran con los períodos establecidos para el análisis de los temas prioritarios de la OPS. Se realizaron mapas de coocurrencia de palabras claves para observar la evolución de los temas de las publicaciones y relacionarlos con los enfoques de la salud pública en cada período. Conclusión. Las temáticas publicadas en la Revista Panamericana de Salud Pública y sus boletines precursores reflejan la historia de la salud pública regional y su evolución a lo largo del tiempo, así como los temas sanitarios claves de la Organización Panamericana de la Salud.

ABSTRACT Objectives. Explore how the content of the articles published by the Pan American Journal of Public Health during its 100 years of existence has aligned with the key health issues of the Pan American Health Organization (PAHO). Methods. A bibliometric analysis was carried out, with visualization of its results. Information on articles published in the Journal was retrieved from PAHO's Institutional Repository for Information Sharing (IRIS) for the first 75 years and Scopus for the last 25 years, until February 2022; References to Governing Bodies documents and statements by the directors were used to establish PAHO's key themes. Results. Initially, 12 573 publications were obtained and 9 289 were considered for analysis for the period 1922 to 1996, and 3 208 for the period 1997 to 2022. For the bibliometric analysis of the Scopus information, indicators such as the authors and their origin, language of publication, and number and origin of citations were considered. For the visualizations, publications were divided into five periods so that they coincided with the periods established for the analysis of PAHO's priority themes. Keyword co-occurrence maps were made to observe the evolution of published topics and relate them to public health approaches in each period. Conclusion. The topics published in the Pan American Journal of Public Health and its precursor bulletins reflect the history of regional public health and its evolution over time, as well as the key health issues of the Pan American Health Organization.

RESUMO Objetivos. Explorar o alinhamento do conteúdo dos artigos publicados na Revista Pan-Americana de Saúde Pública em seus 100 anos de existência com os principais temas de saúde da Organização Pan-Americana da Saúde (OPAS). Métodos. Fez-se uma análise bibliométrica com visualização de seus resultados. Informações sobre os artigos publicados na revista foram recuperadas do Repositório Institucional para o Intercâmbio de Informações (IRIS, na sigla em inglês) da OPAS para os primeiros 75 anos, e da base de dados Scopus para os últimos 25 anos, até fevereiro de 2022. Para estabelecer os principais temas da OPAS, foram usadas referências a documentos dos órgãos diretores e declarações dos diretores. Resultados. Inicialmente, foram obtidas 12 573 publicações - 9 289 foram consideradas na análise para o período de 1922 a 1996, e 3 208 para o período de 1997 a 2022. Para a análise bibliométrica das informações da Scopus, foram levados em consideração indicadores como os autores e sua procedência, o idioma das publicações e o número e a procedência das citações. Para as visualizações, as publicações foram divididas em cinco períodos para que coincidissem com os períodos estabelecidos para a análise dos temas prioritários da OPAS. Mapeou-se a co-ocorrência de palavras-chave para observar a evolução dos temas das publicações e para relacioná-los com os enfoques de saúde pública em cada período. Conclusão. Os temas publicados na Revista Pan-Americana de Saúde Pública e nos boletins que a antecederam refletem o histórico da saúde pública regional e sua evolução ao longo do tempo, bem como os principais temas de saúde da Organização Pan-Americana da Saúde.

Access to antivenoms in the developing world: A multidisciplinary analysis.

Access to safe, effective, quality-assured antivenom products that are tailored to endemic venomous snake species is a crucial component of recent coordinated efforts to reduce the global burden of snakebite envenoming. Multiple access barriers may affect the journey of antivenoms from manufacturers to the bedsides of patients. Our review describes the antivenom ecosystem at different levels and identifies solutions to overcome these challenges. At the global level, there is insufficient manufacturing output to meet clinical needs, notably for antivenoms intended for use in regions with a scarcity of producers. At national level, variable funding and deficient regulation of certain antivenom markets can lead to the procurement of substandard antivenom. This is particularly true when producers fail to seek registration of their products in the countries where they should be used, or where weak assessment frameworks allow registration without local clinical evaluation. Out-of-pocket expenses by snakebite victims are often the main source of financing antivenoms, which results in the underuse or under-dosing of antivenoms, and a preference for low-cost products regardless of efficacy. In resource-constrained rural areas, where the majority of victims are bitten, supply of antivenom in peripheral health facilities is often unreliable. Misconceptions about treatment of snakebite envenoming are common, further reducing demand for antivenom and exacerbating delays in reaching facilities equipped for antivenom use. Multifaceted interventions are needed to improve antivenom access in resource-limited settings. Particular attention should be paid to the comprehensive list of actions proposed within the WHO Strategy for Prevention and Control of Snakebite Envenoming.

Landscape of research, production, and regulation in venoms and antivenoms: a bibliometric analysis.

OBJECTIVES: To assess the productivity and visibility in research, clinical studies, treatment, use and production of antivenoms against poisonous snakes, scorpions and spiders. METHODS: Bibliometric analysis of research and other activities. Articles on venoms and antivenoms published between 2000 and 2020 were retrieved from the Scopus database. The records were analyzed by bibliometric indicators including number of documents per year, journals, authors, and citation frequency. VOSviewer® v.1.6.13 was used to construct bibliometric networks for country co-authorships and co-occurrence of terms. RESULTS: Australia, Brazil, Costa Rica and India were among the six top countries with most documents and were selected for more detailed analysis. Costa Rica was the country with the largest percentage of its publications dedicated to antivenom production and venomics. Only a few papers dealt with the issues of quality, safety, and efficacy of antivenoms or the role of the national regulatory authorities. The use of VOSviewer ® allowed visualization through joint publications of networking between countries. Visualization by co-occurrence of terms showed differences in the research carried out. CONCLUSIONS: Working in a collaborative and coordinated manner these four countries could have a major impact on envenoming globally. Attention should be given not only to antivenom production but also to strengthening regulatory oversight of antivenom products.

The direct effect of pneumococcal conjugate vaccines on invasive pneumococcal disease in children in the Latin American and Caribbean region (SIREVA 2006-17): a multicentre, retrospective observational study.

BACKGROUND: Streptococcus pneumoniae isolated from patients with invasive pneumococcal disease has been subjected to laboratory-based surveillance in Latin American and Caribbean countries since 1993. Invasive pneumococcal diseases remain a major cause of death and disability worldwide, particularly in children. We therefore aimed to assess the direct effect of pneumococcal conjugate vaccines (PCVs) on the distribution of pneumococcal serotypes causing invasive pneumococcal disease in children younger than 5 years before and after PCV introduction. METHODS: We did a multicentre, retrospective observational study in eight countries that had introduced PCV (ie, PCV countries) in the Latin American and Caribbean region: Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Paraguay, and Uruguay. Cuba and Venezuela were also included as non-PCV countries. Isolate data for Streptococcus pneumoniae were obtained between 2006 and 2017 from children younger than 5 years with an invasive pneumococcal disease from local laboratories or hospitals. Species' confirmation and capsular serotyping were done by the respective national reference laboratories. Databases from the Sistema Regional de Vacunas (SIREVA) participating countries were managed and cleaned in a unified database using Microsoft Excel 2016 and the program R (version 3.6.1). Analysis involved percentage change in vaccine serotypes between pre-PCV and post-PCV periods and the annual reporting rate of invasive pneumococcal diseases per 100 000 children younger than 5 years, which was used as a population reference to calculate percentage vaccine type reduction. FINDINGS: Between 2006 and 2017, 12 269 isolates of invasive pneumococcal disease were collected from children younger than 5 years in the ten Latin American and Caribbean countries. The ten serotypes included in ten-valent pneumococcal conjugate vaccine (PCV10) decreased significantly (p<0·0001) after any PCV introduction, except for the Dominican Republic. The percentage change for the ten vaccine serotypes in PCV10 countries was -91·6% in Brazil (530 [72·9%] of 727 before, 27 [6·1%] of 441 after); -85·0% in Chile (613 [72·6%] of 844 before, 44 [10·9%] of 404] after); -84·7% in Colombia (231 [63·1%] of 366 before, 34 [9·7%] of 352 after); and -73·8% in Paraguay (127 [77·0%] of 165 before, 22 [20·2%] of 109 after). In the 13-valent pneumococcal conjugate vaccine (PCV13) countries, the percentage change for the 13 vaccine serotypes was -59·6% in Argentina (853 [85·0%] of 1003 before, 149 [34·3%] of 434 after); -16·5% in the Dominican Republic (95 [80·5%] of 118 before, 39 [67·2%] of 58 after); -43·7% in Mexico (202 [73·2%] of 276 before, 63 [41·2%] of 153 after); and -45·9% in Uruguay (138 [80·7%] of 171 before, 38 [43·7%] of 87 after). Annual reporting rates showed a reduction from -82·5% (6·21 before vs 1·09 after per 100 000, 95% CI -61·6 to -92·0) to -94·7% (1·15 vs 0·06 per 100 000, -89·7 to -97·3) for PCV10 countries, and -58·8% (2·98 vs 1·23 per 100 000, -21·4 to -78·4) to -82·9% (7·80 vs 1·33 per 100 000, -76·9 to -87·4) for PCV13 countries. An increase in the amount of non-vaccine types was observed in the eight countries after PCV introduction together with an increase in their percentage in relation to total invasive strains in the post-PCV period. INTERPRETATION: SIREVA laboratory surveillance was able to confirm the effect of PCV vaccine on serotypes causing invasive pneumococcal disease in the eight PCV countries. Improved monitoring of the effect and trends in vaccine type as well as in non-vaccine type isolates is needed, as this information will be relevant for future decisions associated with new PCVs. FUNDING: None. TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

Landscape of research, production, and regulation in venoms and antivenoms: a bibliometric analysis / Panorama de la investigación, la producción y la regulación de venenos y antivenenos: un análisis bibliométrico / Panorama de pesquisa, produção e regulação de venenos e antivenenos: análise bibliométrica

ABSTRACT Objectives. To assess the productivity and visibility in research, clinical studies, treatment, use and production of antivenoms against poisonous snakes, scorpions and spiders. Methods. Bibliometric analysis of research and other activities. Articles on venoms and antivenoms published between 2000 and 2020 were retrieved from the Scopus database. The records were analyzed by bibliometric indicators including number of documents per year, journals, authors, and citation frequency. VOSviewer® v.1.6.13 was used to construct bibliometric networks for country co-authorships and co-occurrence of terms. Results. Australia, Brazil, Costa Rica and India were among the six top countries with most documents and were selected for more detailed analysis. Costa Rica was the country with the largest percentage of its publications dedicated to antivenom production and venomics. Only a few papers dealt with the issues of quality, safety, and efficacy of antivenoms or the role of the national regulatory authorities. The use of VOSviewer® allowed visualization through joint publications of networking between countries. Visualization by co-occurrence of terms showed differences in the research carried out. Conclusions. Working in a collaborative and coordinated manner these four countries could have a major impact on envenoming globally. Attention should be given not only to antivenom production but also to strengthening regulatory oversight of antivenom products.

RESUMEN Objetivos. Evaluar la productividad y la visibilidad en la investigación, los estudios clínicos, el tratamiento, el uso y la producción de antivenenos contra las picaduras de serpientes, arañas y escorpiones venenosos. Métodos. Análisis bibliométrico de la investigación y de las otras actividades. Se tomaron los artículos sobre venenos y antivenenos publicados entre el 2000 y el 2020 en la base de datos de Scopus. Estos documentos se analizaron mediante indicadores bibliométricos como el número de documentos por año, revistas, autores o frecuencia en las citas. Se utilizó VOSviewer® v.1.6.13 para crear una red bibliométrica para coautorías de países y coapariciones de términos. Resultados. Australia, Brasil, Costa Rica e India estaban entre los seis primeros países con más documentos y se seleccionaron para un análisis más detallado. Costa Rica fue el país con el mayor porcentaje de sus publicaciones dedicadas a la producción de antivenenos y la venómica. Solo unos pocos artículos trataban los temas de la calidad, la seguridad y la eficacia de los antivenenos, o la función de las autoridades regulatorias nacionales. Gracias a VOSviewer® pudimos visualizar las publicaciones conjuntas de las colaboraciones entre países. La visualización por la coaparición de términos arrojó diferencias en la investigación realizada. Conclusiones. Si estos cuatro países trabajasen de forma colaborativa y coordinada, podrían tener una repercusión mayor en los envenenamientos por picaduras en el mundo. El foco no debe ponerse solo en la producción de antivenenos, sino también en fortalecer la supervisión regulatoria de estos productos.

RESUMO Objetivos. Avaliar a produtividade e visibilidade em pesquisa, estudos clínicos, tratamento, uso e produção de antivenenos contra peçonhas de serpentes, escorpiões e aranhas. Métodos. Análise bibliométrica de pesquisas e outras atividades. Artigos sobre venenos e antivenenos publicados entre 2000 e 2020 foram obtidos da base de dados Scopus. O conteúdo foi analisado segundo indicadores bibliométricos, como número de artigos por ano, periódicos, autores e frequência de citação. Utilizou-se o software VOSviewer® v.1.6.13 para construir redes bibliométricas de coautoria de países e co-ocorrência de termos. Resultados. Austrália, Brasil, Costa Rica e Índia figuraram entre os seis principais países com o maior número de artigos e, assim, foram selecionados para uma análise mais aprofundada. A Costa Rica teve a maior porcentagem de publicações dedicadas à produção de antivenenos e pesquisa em venômica. Apenas um pequeno número de artigos tratou de questões relacionadas à qualidade, segurança e eficácia dos antivenenos ou ao papel das autoridades nacionais reguladoras. O software VOSviewer® permitiu visualizar, através das publicações conjuntas, as redes formadas entre diferentes países. A visualização por co-ocorrência de termos revelou diferenças nas pesquisas realizadas. Conclusões. Trabalhando de forma colaborativa e coordenada, esses quatro países tiveram uma influência importante em nível mundial no campo de acidentes por animais peçonhentos. Deve-se atentar não apenas à produção de antivenenos, mas também ao fortalecimento da fiscalização regulatória destes.

[Conceptual map of public health and intellectual property in Cuba: 2020 updateMapa conceitual sobre saúde pública e propriedade intelectual em Cuba: atualização de 2020]. / Mapa conceptual sobre salud pública y propiedad intelectual en Cuba: actualización 2020.

This study identifies and describes the changes introduced in Cuba's constitutional and legal framework, and the country's economic and social policy between 2015 and 2020, in terms of the effects on access to health. The conceptual map of public health and intellectual property in Cuba was also updated. A document search for the time period of the study was conducted in the Official Gazette of the Republic of Cuba and on the webpages of the Cuban Office of Industrial Property, Cuban government agencies, and the Cuban Biotechnology and Pharmaceutical Industries group (BioCubaFarma). The updated conceptual map reflects amendments to the new Constitution of the Republic of Cuba adopted in 2019, updated guidelines on economic and social policy for the quinquennium 2016-2021, and laws, decrees, and legal provisions adopted in the period 2015-2020 in relation to intellectual property. The approved policy on the industrial property system was strengthened with specific legislation to protect industrial property, especially for the protection of the results obtained by the Cuban biotechnology and pharmaceutical industry. The changes reflected in the updated conceptual map favor interactions and synergy among the various actors that affect the Cuban population's access to health in the broadest sense.

Neste estudo, procuramos identificar e descrever as mudanças introduzidas no quadro constitucional e legal e na política econômica e social de Cuba entre 2015 e 2020 que afetam o acesso à saúde, bem como atualizar o mapa conceitual sobre saúde pública e propriedade intelectual em Cuba (MC SPPIC). Realizamos uma busca em documentos, ajustada ao período analisado, no Diário Oficial da República de Cuba e nos sites do Escritório Cubano de Propriedade Industrial, dos órgãos da Administração Central do Estado e do grupo da indústria biotecnológica e farmacêutica BioCubaFarma. O MC SPPIC atualizado reflete as mudanças na nova Constituição da República de Cuba adotada em 2019, a atualização das Diretrizes de Política Econômica e Social para o quinquênio 2016-2021 e as leis, decretos-lei e outras disposições legais relacionadas à propriedade intelectual no período 2015-2020. A Política sobre o Sistema de Propriedade Industrial, adotada previamente, foi fortalecida com legislação específica para a proteção da propriedade industrial, especialmente no que diz respeito à proteção dos resultados obtidos pela indústria biotecnológica e farmacêutica cubana. As mudanças refletidas no MC SPPIC atualizado favorecem a interação e sinergia entre os diversos atores que influenciam o acesso à saúde ­ em seu sentido mais amplo ­ por parte da população cubana.

[Regional System for Vaccines (SIREVA), laboratory surveillance and vaccine development for Streptococcus pneumoniae: bibliometric analysis, 1993-2019]. / Sistema Regional de Vacunas (SIREVA), vigilancia por laboratorio y desarrollo de vacunas para Streptococcus pneumoniae: análisis bibliométrico, 1993-2019.

OBJECTIVE: To measure through bibliometric analysis the productivity, visibility and impact of the Regional System for Vaccines (SIREVA, a project by the Pan American Health Organization), including its two components laboratory surveillance and vaccine development. METHODS: Publications about laboratory surveillance and vaccine development were recovered from Scopus, including their references and citations, and their bibliometric indicators were analyzed. VOSviewer 1.6.13® was used to visualize the co-authorship networks, by country and authors, and to perform a cooccurrence analysis of terms included in the titles and abstracts of the publications. RESULTS: The criteria for laboratory surveillance and vaccine development were met by 173 and 128 publications, respectively. Ten countries in the Region of the Americas were responsible for 90.8% of the publications on laboratory surveillance and 8 for all publications on vaccine development. The 10 most cited publications on laboratory surveillance and on vaccine development were included in 855 and 503 articles, respectively, the main authors being from Australia, Belgium, Brazil, China, Germany, the United Kingdom and the United States of America. Network building and visualization by author and country co-authors, and co-occurrence of terms showed networking and intraregional collaboration, and allowed for the follow-up of study areas and evolution over time. CONCLUSIONS: The bibliometric analysis allowed to objectively record the productivity and visibility of the Regional System for Vaccines for Streptococcus pneumoniae in the Region.

Análisis del sistema de salud cubano y del modelo atención primaria orientada a la comunidad / Analysis of the Cuban Health System and the Model of Community-Oriented Primary Care

La integración del cuidado de la salud individual con el de la población a través de la salud pública se ha podido llevar a cabo de forma efectiva a partir del modelo de la atención primaria orientada a la comunidad. En Cuba, la atención primaria es la base del sistema nacional de salud, con acceso universal y cuidado de los individuos, sus familias y la comunidad. El sistema nacional de salud y la atención primaria orientada a la comunidad contribuyen a la mejora de la salud y a la disminución de desigualdades en salud e iniquidades en la provisión de servicios. Este artículo presenta su descripción y análisis(AU)

Individual healthcare integrated with population healthcare through public health has been effective and possible through the model of community-oriented primary care. In Cuba, primary healthcare is the supporting structure of the national health system, including universal coverage and the care for individuals, their families, and the community. The national health system and community-oriented primary care contribute with health improvement and the decrease in health inequalities and in inequities of provided care. This article presents their comprehensive description and analysis(AU)

[Vaccine rejection and vaccination management: the grey areasRecusa vacinal e gestão da imunização: nuances e contrastes]. / Rechazo y gestión en vacunaciones: sus claroscuros.

Vaccinating children has been an unquestioned tradition for many years. However, there is now great concern over the growing rejection of childhood vaccination, as well as other less evident obstacles that affect vaccination coverage.Multiple factors are involved in the rejection of a specific vaccine or vaccination in general, including actions by anti-vaccination groups, as well as disinformation or the dissemination of erroneous information. In some countries, delays in completing the immunization schedule may be due to poor program management. These factors compromise effective vaccination coverage, constituting a serious threat to public health.Susceptible populations constantly change, due to epidemiological shifts determined by phenomena such as globalization and various conflicts that interfere in the operation of health services. In recent years there have been outbreaks of previously controlled diseases such as diphtheria, whooping cough, and measles, resulting both from imported cases and from deficiencies in national immunization programs.This paper explores different aspects of the increasing frequency of vaccine rejection. There is a need for a review of its causes and for the design of innovative strategies and approaches to regain acceptance of vaccination and its place as the most cost-effective tool in public health.

Durante muitos anos, vacinar os filhos foi uma tradição inquestionável; atualmente, porém, há grande preocupação com a crescente recusa das vacinas da infância, além de outros obstáculos mais difíceis de visualizar que afetam a cobertura vacinal.Múltiplos fatores concorrem para influenciar a recusa a uma vacina específica ou à vacinação em geral, seja pela ação de grupos antivacina ou pela desinformação ou divulgação de dados incorretos. Em alguns países, a situação é complicada por atrasos no cumprimento do calendário vacinal devido a possíveis falhas na gestão dos programas. Tudo isso compromete o nível efetivo das coberturas de vacinação e constitui grave ameaça à saúde pública.As populações suscetíveis a doenças imunopreveníveis estão em constante mutação devido a mudanças epidemiológicas, determinadas por fenômenos como a globalização ou diferentes conflitos que interferem com as ações de saúde. Recentemente, foram registrados surtos de doenças antes controladas, como a difteria, a coqueluche e o sarampo, seja por casos importados ou por falhas nos programas nacionais de imunização.Este artigo visa explorar os diferentes componentes que contribuem para a frequência crescente da recusa vacinal, o que exige uma reanálise dos fatores causais e o delineamento de estratégias e enfoques inovadores para recuperar a aceitação das vacinas e de seu papel como a mais custo-efetiva das ferramentas em saúde pública.

Salud pública y propiedad intelectual en Cuba: mapa conceptual / Public health and intellectual property in Cuba: a conceptual map

OBJETIVO:El objetivo de este estudio es el análisis del marco legal de salud y propiedad intelectual en Cuba y su incidencia en las condiciones de acceso de la población a los recursos de salud y el papel de los diferentes actores sociales. METODOLOGÍA: Se utilizó la metodología desarrollada por la Organización Panamericana de la Salud para la ejecución del Proyecto Mapa Conceptual sobre Salud Pública y Propiedad Intelectual. RESULTADOS: La información recobrada en específico sobre el marco legal y su evolución en el tiempo en Cuba relacionado con el Sistema Nacional de Salud, el Sistema de Propiedad Intelectual y el fortalecimiento de la industria biofarmacéutica del país, fue procesada y analizada generando el Mapa Conceptual sobre Salud Pública y Propiedad Intelectual de Cuba. CONCLUSIONES: El análisis de la experiencia cubana en la adecuación de su marco legal y la evaluación de la interrelación de los actores sociales permite observar cómo la voluntad política existente a lo largo de varias décadas ha impactado de manera positiva en el acceso a la salud de la población.

OBJECTIVE: The objective of this study is to analyze the legal framework for health and intellectual property in Cuba and its impacton people's access to health resources and on the roles of different social actors. METHODS: The methods used were those developed by the Pan American Health Organization to implement the project of the Conceptual Map on Public Health and Intellectual Property. RESULTS: Information retrieved specifically on the legal framework for the National Health System, the Intellectual Property System and the strengthening of the country's biopharmaceutical industry-and on the framework's development over time-was processed and analyzed to generate Cuba's Conceptual Map on Public Health and Intellectual Property. CONCLUSIONS: Analysis of Cuba's adaptation of its legal framework and assessment of the interaction between the social actors involved show how the political will that has prevailed over several decades has had a positive impact on people's access to health resources.

[Public health and intellectual property in Cuba: a conceptual map]. / Salud pública y propiedad intelectual en Cuba: mapa conceptual.

OBJECTIVE: The objective of this study is to analyze the legal framework for health and intellectual property in Cuba and its impact on people's access to health resources and on the roles of different social actors. METHODS: The methods used were those developed by the Pan American Health Organization to implement the project of the Conceptual Map on Public Health and Intellectual Property. RESULTS: Information retrieved specifically on the legal framework for the National Health System, the Intellectual Property System and the strengthening of the country's biopharmaceutical industry-and on the framework's development over time-was processed and analyzed to generate Cuba's Conceptual Map on Public Health and Intellectual Property. CONCLUSIONS: Analysis of Cuba's adaptation of its legal framework and assessment of the interaction between the social actors involved show how the political will that has prevailed over several decades has had a positive impact on people's access to health resources.

Informe de la cooperación técnica 2012-2013 / Report of the Technical Cooperation PAHO / WHO Cuba 2012-2013

Durante el bienio la Representación de la OPS/OMS en Cuba obtuvo resultados satisfactorios en el trabajo de la cooperación técnica y una alta ejecución de fondos. Se ejecutaron tareasdirigidas principalmente a dar respuesta a las 10 prioridades de cooperación técnica acordadas en la Nota Estratégicapara el período 2012-2015.

Laboratory-based surveillance of Streptococcus pneumoniae invasive disease in children in 10 Latin American countries: a SIREVA II project, 2000-2005.

BACKGROUND: For the last 14 years the Pan American Health Organization has been promoting surveillance of invasive pneumococcal disease in Latin American children for better understanding of the disease tendencies regarding capsular types circulation in each country and susceptibility to antimicrobials. METHODS: Laboratory-based surveillance data from 10 Latin American countries collected from 2000 to 2005 were analyzed, including serotype distribution and susceptibility to beta-lactam antibiotics. RESULTS: Although 61 different capsular types were identified during the 6-year surveillance, 13 serotypes accounted for 86% of all isolates. These were consistently the most prevalent throughout the study period with serotype 14 predominating. Diminished susceptibility to penicillin was detected in 38% of all Streptococcus pneumoniae isolates, with the highest prevalence in Dominican Republic and Mexico. Decreased susceptibility to penicillin increased in Brazil and Colombia whereas decreased high resistance rates was recorded in Chile. CONCLUSIONS: These data indicate that 10 countries of the Region continue to have high quality laboratory-based surveillance for pneumococcal disease thus generating valuable information so that healthcare decision makers may prioritize interventions. The heptavalent vaccine will potentially cover from 52.4% to 76.5% of strains causing invasive pneumococcal disease and the 13 valent from 76.7% to 88.3%.

[Resistance to non-beta-lactam antibiotics in the clinical isolates of Streptococcus pneumoniae of children in Latin America. SIREVA II, 2000-2005]. / Resistencia a antibióticos no betalactámicos de aislamientos invasores de Streptococcus pneumoniae en niños latinoamericanos. SIREVA II, 2000-2005.

OBJECTIVE: To examine the development of resistance to erythromycin, chloramphenicol, trimethoprim-sulfamethoxazole (TMP-SMZ), and vancomycin of the invasive isolates of Streptococcus pneumoniae obtained from children in 10 Latin American/Caribbean countries during six years of surveillance. METHODS: Analysis of 8 993 isolates of S. pneumoniae recovered in 2000-2005 from children with invasive infections, who were less than 6 years of age, and from Argentina, Brazil, Chile, Colombia, Cuba, Dominican Republic, Mexico, Paraguay, Uruguay, or Venezuela. Antibiotic susceptibility was determined through the methods established and standardized by the SIREVA project. Multidrug resistance was defined as: resistance to three or more antibiotics of the same class; to the non-beta-lactams analyzed by this study; or, to the beta-lactams evaluated by a previous study, in which 37.8% of these isolates showed decreased susceptibility to penicillin. RESULTS: Some degree of resistance was found to TMP-SMZ and erythromycin (56.4% and 15.4% of the isolates studied, respectively), with 4.6% highly resistant to chloramphenicol. All isolates were susceptible to vancomycin. The highest prevalence of TMP-SMZ resistance was observed in the pneumonia isolates; and that of erythromycin, in cases of sepsis (61.6% and 25.5%, respectively; P < 0.01). The highest prevalence of TMP-SMZ resistance was found in Brazil (71.9%), and that of erythromycin, in Mexico (38.2%) and Venezuela (32.9%). The 14, 6B, 19F, and 23F serotypes were most often associated with resistance to the antibiotics in the study. CONCLUSIONS: High and increasing rates of isolates resistant to TMP-SMZ and erythromycin were observed, as well as a decreasing percentage of isolates resistant to chloramphenicol. These trends highlight differences among the countries studied.