RESUMO
BACKGROUND: Since the Russian Federation's invasion of Ukraine, millions of refugees have moved to neighbouring European countries. We assessed the burden of TB in these refugees and surveyed screening approaches. METHODS: We conducted a survey among 30 European Union/European Economic Area and 13 other European countries, requesting population data on migrant residents and refugees with country of birth (COB) Ukraine, the number of TB notifications among people with COB Ukraine and countries' screening policies for refugees from Ukraine. RESULTS: In 2021, the number of migrants born in Ukraine was 1.7 million in the 34 responding countries, and increased with 5.2 million refugees from Ukraine to 6.9 million in 2022. These countries notified 207 TB cases in people with COB Ukraine in 2021 (TB notification rate 12.0/100,000) and 887 in 2022 (TB notification rate 12.8/100,000), of which 228 (26%) had multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB). TB notification rates were higher in countries advising screening for all (16.9/100,000) or specific groups of refugees from Ukraine (14.7/100,000) compared to those without screening (7.2/100,000). CONCLUSION: TB rates found in people from Ukraine were lower than the expected rate of 44 per 100,000, but higher in host countries recommending screening. Our study underscores the need for adequate TB health services for refugees from Ukraine to ensure tailored diagnosis and treatment, especially for MDR/RR-TB.
CONTEXTE: Suite à l'invasion de l'Ukraine par la Fédération de Russie, des millions de réfugiés se sont installés dans les pays européens voisins. Notre étude a porté sur la prévalence de la TB parmi ces réfugiés et a examiné les différentes méthodes de dépistage. MÉTHODES: Nous avons réalisé une enquête auprès de 30 pays de l'Union européenne/de l'Espace économique européen et de 13 autres pays européens, en demandant des données démographiques sur les résidents migrants et les réfugiés dont le pays de naissance (COB, pour l'anglais « country of birth ¼) est l'Ukraine, le nombre de notifications de TB chez les personnes dont le COB est l'Ukraine et les politiques de dépistage des pays pour les réfugiés d'Ukraine. RÉSULTATS: En 2021, le nombre de migrants nés en Ukraine était de 1,7 million dans les 34 (79%) pays ayant répondu à l'enquête, et a augmenté à 5,2 millions en 2022. Ces pays ont notifié 207 cas de TB chez des personnes ayant le COB Ukraine en 2021 (taux de notification de la TB 12,0/100 000) et 887 en 2022 (taux de notification de la TB 12,8/100 000), dont 228 (26%) avaient une TB multirésistante/résistante à la rifampicine (MDR/RR-TB). Les pays qui recommandent le dépistage pour tous ont enregistré des taux de notification de la TB plus élevés (16,9/100 000) tandis que ceux qui ciblent des groupes spécifiques de réfugiés ukrainiens ont signalé (14,7/100 000). En revanche, les pays ne proposant pas de dépistage ont affiché un taux de notification de seulement (7,2/100 000). CONCLUSION: Les personnes originaires d'Ukraine présentaient des taux de TB inférieurs à ceux attendus, soit 44 pour 100 000, tandis que les pays d'accueil recommandant le dépistage affichaient des taux plus élevés. Notre étude met en évidence l'importance de fournir des services de santé appropriés pour la TB aux réfugiés ukrainiens, afin d'assurer un diagnostic et un traitement adaptés, en particulier pour la MDR/RR-TB.
Assuntos
Mycobacterium tuberculosis , Migrantes , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Antituberculosos/farmacologia , Humanos , Programas de Rastreamento , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologiaRESUMO
BACKGROUND: In France, human papillomavirus (HPV) vaccination coverage among adolescents and young women is low and decreasing. We analysed data from the 2012 Health, Health Care and Insurance Survey with the aim of identifying factors associated with this vaccination. We also compared the socioeconomic profile of unvaccinated young women to that of women who do not undergo cervical cancer screening (CCS). METHODS: Data were collected through interviews and self-administered questionnaires completed by a randomised sample of Health insurance beneficiaries. Two analyses were performed using Poisson regression: one to investigate the determinants of CCS uptake in women aged 25-65 years old (n=4508), the other to investigate the determinants of HPV vaccination in young women aged 16-24 years old (n=899). A sub-analysis was performed in 685 "daughter-mother" couples from the same household in order to analyse the association between participation to CCS in mothers and HPV vaccination in daughters. RESULTS: Factors significantly associated both to a lower CCS uptake and to an insufficient HPV vaccination were the lack of a complementary private health insurance (P=0.023 and P=0.037, respectively) and living in a family with a low household income (P<0.001 and P=0.005, respectively). A low education level was associated to a lower CCS uptake (P<0.001). The absence of CCS uptake in the last three years in mothers was associated to a lower level of HPV vaccination in their daughter (P=0.014). CONCLUSION: Women who do not undergo CCS and HPV unvaccinated young women tend to be of modest socioeconomic status. Unvaccinated young females tend to have mothers who do not undergo CCS and are therefore at risk of benefiting from none of the two cervical cancer preventive measures. The current implementation strategy concerning HPV vaccination in France may therefore increase inequalities regarding cervical cancer prevention.
Assuntos
Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , França/epidemiologia , Humanos , Seguro/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Papillomaviridae/imunologia , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: In 2007, French authorities changed mandatory BCG vaccination for all children into a strong recommendation to vaccinate only children considered at high risk of tuberculosis. Vaccination coverage (VC) data are insufficient in France. We estimated VC at approximately two months of age and identified socioeconomic factors associated with BCG vaccination. METHODS: The Elfe study (Étude Longitudinale Française depuis l'Enfance) included a random sample of about 18 000 children born in 2011 selected at birth from 320 maternity wards from mainland France. Information was collected through questionnaires and telephone interviews conducted approximately two months after delivery. Because BCG recommendations are different in the Paris region (Île-de-France [IDF]) and outside this region, VC was estimated separately in these two regions. We estimated VC for different levels of tuberculosis risk, approached by the geographical origin of the parents. Poisson regression was performed to analyze the association between socioeconomic factors and BCG vaccination status, and results expressed by prevalence ratios (PR). RESULTS: CV was higher in IDF (59.5%) compared to at-risk children outside IDF (46.7%) (p<0.001). VC in children with two parents from a tuberculosis highly endemic country was 80.5% in IDF and 60.4% outside IDF. In the multivariable model, having one or two parents from a tuberculosis highly endemic country (PR around 1.40) or consulting a private pediatrician (PR around 1.15) or a maternal and child health (MCH) center (PR around 1.40) after leaving the maternity ward were associated with a higher VC, whereas a university educational level in mothers was associated with a lower VC (PR=0.80). CONCLUSION: In France, BCG vaccination in infants is performed early after discharge from the maternity ward. A first consultation with a pediatrician or in a MCH center is associated with better vaccination coverage. Children at higher risk are probably well identified by physicians and better vaccinated.
Assuntos
Vacina BCG/uso terapêutico , Tuberculose/prevenção & controle , Vacinação/estatística & dados numéricos , Fatores Etários , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Gravidez , Fatores SocioeconômicosRESUMO
BACKGROUND: Sources of data used in France to routinely monitor vaccination coverage, such as the Child Health Certificates and school surveys, allow reliable estimations, but data are not made available with long delays. To rapidly identify recent changes, we have explored the feasibility and relevance of using vaccine reimbursement data. METHODS: We used the Permanent Sample of Beneficiaries, a representative sample of the National Health Insurance Information System, which contains data on health spending reimbursement of the vast majority of the population. We first validated this new source by comparing measles vaccine coverage between Child Health Certificates and the Permanent Sample of Beneficiaries. We present herein the results on hepatitis B, meningococcal C, and human papillomavirus vaccination (HPV) coverage. RESULTS: Measles vaccine coverage estimated with the Permanent Sample of Beneficiaries (91.4%) is very close to the estimation obtained through Child Health Certificates (90.6%). For children born in 2011, hepatitis B vaccination coverage at 24 months of age was 88.7% for one dose and meningococcal vaccination coverage was 56.4% for one dose in December 2013. Of girls born in 1997, 20.1% had received the full HPV vaccination series on their 16th birthday. CONCLUSION: This novel routine vaccination coverage monitoring tool provides regularly updated reactive and reliable vaccination coverage estimates in children.
Assuntos
Bases de Dados Factuais , Vacinas contra Hepatite B , Reembolso de Seguro de Saúde/estatística & dados numéricos , Vacina contra Sarampo , Vacina contra Sarampo-Caxumba-Rubéola , Vacinas Meningocócicas , Vacinas contra Papillomavirus , Vacinação/estatística & dados numéricos , Criança , Pré-Escolar , França , Humanos , LactenteRESUMO
Data on validity of self-reported vaccinations are scarce. This study, performed on healthcare students in Paris (France), aimed to evaluate this validity for occupational vaccinations. The validity of self-reported vaccination status was compared with written information. A total of 432 students were enrolled. Sensitivity rates for BCG, hepatitis B and measles were over 74%. For diphtheria-tetanus-polio and pertussis, sensitivity was below 50%. Specificity was between 70 and 95% for dTP-pertussis, and below 35% for all others. Overall, the validity of self-reported information was low, meaning that checking medical records remains the preferable strategy for assessing immunization status.
Assuntos
Métodos Epidemiológicos , Pessoal de Saúde , Autorrelato , Estudantes , Vacinação , Adulto , Feminino , França , Humanos , Masculino , Paris , Sensibilidade e Especificidade , Adulto JovemRESUMO
INTRODUCTION/OBJECTIVES: Socio-economic inequalities in access to vaccination are poorly documented in France. This study analyzed socio-economic inequalities in pneumococcal conjugate vaccine (PCV7) immunization coverage, the cost of which is about 180 for three doses. METHODS: We conducted a cross-sectional survey including children aged 0-5 years living in Paris and its immediate suburbs, selected by a stratified two-stage random sampling design. Data were collected in a face-to-face interview. Vaccination coverage, confirmed by a document, was measured for the first dose and the full primary vaccination series. Poisson regression was used to analyze the association between PCV7 vaccination coverage and several socio-economic and demographic factors. RESULTS: Vaccination coverage for the first dose was 93.7% and 76.7% for the full primary vaccination series. The first-dose vaccination coverage in children from lower income families (first quartile of income) was lower than that of children from higher income families (83.2% versus 97.3%, P=0.033). A similar result was also observed for the full primary vaccination series, although this result was not statistically significant (65.5% versus 87.6%, P=0.09). Full coverage was lower in children with only basic health insurance (70.2%) than in children with additional health insurance either through social assistance (81.4%) or through private insurance (76.1%), but these differences were not significant. CONCLUSIONS: The association of low PCV7 vaccination coverage with low family income suggests the existence of financial barriers to vaccination in the poorest families. However, the lack of a statistical association with the type of health insurance could also indicate the existence of obstacles to vaccination other than purely financial.
Assuntos
Vacinas Pneumocócicas/economia , Pobreza , Vacinação/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Feminino , França/epidemiologia , Acessibilidade aos Serviços de Saúde/economia , Humanos , Lactente , Recém-Nascido , Seguro Saúde , Entrevistas como Assunto , Masculino , Análise Multivariada , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: School-based triennial surveys have been implemented in France since 1999 in order to follow up indicators estimating children's health status, including vaccination coverage. METHODS: The survey was conducted in 2005-2006 in preschools, using a two-stage cross-sectional sampling design (first sampling schools, with pupils then randomly chosen). RESULTS: Among all the children targeted by the survey, 21,346 of them were selected to show their health booklet (carnet de santé) in which the vaccination part was completed. Vaccination coverage was high for vaccines against tuberculosis (BCG 96.8 %), diphtheria, tetanus, poliomyelitis (four doses: 95.6 %), pertussis (four doses: 95.0 %), Haemophilus influenzae type b (four doses: 89.9 %) and for the first dose of the measles, mumps, and rubella vaccine (MMR 93.7 %, 91.4 %, 91.4 %). It was low for the second dose of MMR (45.1 %, 43.2 %, and 43.3 %) and for hepatitis B (37.9 %). The region where the child attended school, the size of the urban unit, the school sector, the father's profession, and the child's birth rank were associated with MMR (second dose) and hepatitis B coverage. DISCUSSION - CONCLUSION: In 2005-2006, vaccination coverage for BCG, DTPolio, pertussis, and Hib was stable and satisfactory in 6-year-old children. MMR (first dose) and hepatitis B coverage were insufficient. MMR coverage (second dose) had increased since 2002 but still needs to be improved.
Assuntos
Vacinação/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , França , Inquéritos Epidemiológicos , Humanos , Masculino , Fatores de Tempo , VacinasRESUMO
The aim of the study was to assess factors influencing BCG vaccination among targeted children after the end of universal and mandatory BCG vaccination in France. A cross-sectional study was conducted in 2009 among general practitioners (GPs) of the French Sentinel Network. With the participation of 358 physician-investigators, 920 children were included. Of the 261 children (31%) identified to be at risk of tuberculosis, only 113 (44%) were vaccinated. The median number of French criteria for BCG vaccination correctly cited by the GPs was 3 of the existing 6. Of the 10 proposed, a median number of 5 regions in the world according to their level of tuberculosis risk were correctly classified by GPs. After adjustment using an alternating logistic model, 7 variables were found to be associated with the immunisation status of the target population. Six of these increased the probability of being vaccinated: children older than 6 months (OR=3.4 (CI 95% [1.4-8.6])), residents in central Paris or its suburbs (OR=14.7 [4.4-49.5]), children expected to travel to highly endemic regions (OR=3.5 [1.4-8.6]), those living in unfavourable conditions (OR=19.9 [6.2-63.9]), the GP's good knowledge of vaccination guidelines (OR=1.4 [1.1-1.9]) and the GP's perception of tuberculosis as a common disease (OR=2.2 [1.1-4.5]). Surprisingly, GPs with university training on infectious diseases tended to be more reluctant to follow vaccination guidelines (OR=0.14 [0.1-0.4]). Actions targeted at these factors could contribute to improving BCG immunisation coverage.
Assuntos
Vacina BCG/imunologia , Conhecimentos, Atitudes e Prática em Saúde , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Vacinação/estatística & dados numéricos , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , França/epidemiologia , Clínicos Gerais , Fidelidade a Diretrizes , Política de Saúde , Humanos , Programas de Imunização , Masculino , Inquéritos e QuestionáriosRESUMO
We report data on BCG vaccination coverage and paediatric tuberculosis (TB) incidence collected after the disappearance of the multipuncture device for BCG vaccination in January 2006 and the shift from universal to targeted vaccination in July 2007 in France.Vaccination coverage estimates in children for whom BCG is recommended allow assessing whether the recommendations are followed by doctors and/or accepted by the target population. In January and February 2006, BCG sales to the private sector in Îlede-France region were 74.2% and 41.3% of the ones for the same months the previous year. Total sales in 2006 amounted to 57.3% of those in 2005. Coverage decreased immediately after withdrawal of the multipuncture device, and remained generally insufficient in high risk children in the following years. However,the impact on paediatric TB incidence in 2008 seems very limited, although the duration of follow-up is still short. Training of doctors in intra-dermal vaccination and communication on the new vaccination policy should be strengthened
Assuntos
Vacina BCG/uso terapêutico , Política de Saúde/tendências , Vacinação em Massa/estatística & dados numéricos , Medição de Risco/métodos , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Adolescente , Criança , Pré-Escolar , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Fatores de RiscoRESUMO
The 2nd French Clinical Vaccinology conference held on 20th April 2009 in Paris (France) was a unique opportunity to discuss basic and translational research in vaccinology and its implications for patients for respiratory diseases. This conference is organized by the Clinical Research Center Cochin-Pasteur, that has been involved for several years clinical research in vaccines. We report on here the key findings of the conference, especially the immunization of the chronic respiratory diseases, the clinical effectiveness of vaccines and the development of new vaccines in pulmonology.
Assuntos
Pesquisa Biomédica/tendências , Imunização , Vacinas , Doença Crônica , Humanos , Vacinas contra Influenza , Vacinas Pneumocócicas , Transtornos Respiratórios , Vírus Sincicial Respiratório Humano/imunologia , Vacinas contra a Tuberculose , Vacinas ConjugadasRESUMO
OBJECTIVES: Compulsory BCG vaccination was replaced in July 2007 by a strong recommendation to vaccinate children at high risk of tuberculosis. We measured BCG vaccination coverage (VC) in children for whom BCG is recommended, who were born after the end of compulsory BCG vaccination and are usually followed at Maternal and Child Health Clinics (MCHC). METHODS: National sampling survey stratified by region and age group. Sample size was calculated in order to perform a separate analysis in Ile-de-France, region which has a specific vaccination policy and the highest tuberculosis incidence in mainland France. Children were selected through 2-stage random sampling in IDF and 3-stage random sampling outside IDF. They were recruited at the MCHC during the consultation where information was collected by the doctor through a structured questionnaire. RESULTS: BCG-VC was 89.8% (81.4-94.7) in IDF and 61.7% (53.8-69.0) outside IDF. In IDF, VC in children who had other criteria than solely residing in IDF was 92.4%. Outside IDF, children were on average vaccinated later than in IDF (i.e.: VC at the age of 3 months in children aged 2-12 months: 84% in IDF, 42% outside IDF). In both zones, children aged 2-12 months were vaccinated earlier compared to those aged >12 months. CONCLUSIONS: VC are high in children followed at MCHC in IDF, but can still be improved. They are insufficient in those followed at MCHC outside IDF where children are vaccinated too late. Efforts aimed at improving the dissemination of BCG vaccination recommendations and a better training of doctors in performing intradermal BCG vaccination could facilitate the implementation of this new BCG vaccination policy.
Assuntos
Vacina BCG/administração & dosagem , Maternidades/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Tuberculose Pulmonar/prevenção & controle , Criança , França/epidemiologia , Política de Saúde/legislação & jurisprudência , Inquéritos Epidemiológicos , Maternidades/legislação & jurisprudência , Hospitais Pediátricos/legislação & jurisprudência , Humanos , Programas de Imunização/estatística & dados numéricos , Vacinação em Massa/normas , Vigilância da População , Guias de Prática Clínica como Assunto , Medição de Risco , Tuberculose Pulmonar/epidemiologiaRESUMO
BACKGROUND: Every year, 15 to 20 tetanus cases are reported in France. The latest national figures showed that only 62% of adults were up-to-date for this vaccination. We tried to determine the factors associated with vaccination coverage and with knowledge of vaccination status. METHODS: We analyzed data from the "Santé et Protection sociale" survey (2002). We analyzed the association between factors and tetanus vaccination coverage. We then explored the association between these factors and knowledge of vaccination status. RESULTS: Two demographic variables were only associated with vaccination coverage (higher coverage in male individuals and in individuals living in some regions of the country). Two socioeconomic variables were only associated with knowledge of vaccination status (higher knowledge in people from high income families and in managers/private professionals and in office workers). Coverage and status awareness both decreased with lower education level, in residents of large urban centers and in individuals without private medical insurance, and these two indicators were both associated to age but in an opposite direction. CONCLUSION: Factors influencing vaccination coverage are rather demographic, whereas socioeconomic factors seem to influence more the knowledge of vaccination status. This distinction should help to target public health actions and adapt information for the least covered and the least informed groups.
Assuntos
Conhecimento , Toxoide Tetânico , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Escolaridade , Características da Família , Feminino , França , Humanos , Renda , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ocupações , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVES: In July 2007, compulsory BCG vaccination for all children was replaced by a strong recommendation to vaccinate children at high risk of tuberculosis (children who live in Ile-de-France [IDF] or Guyana regions, who were born or whose parents were born in tuberculosis endemic countries, with a family history of tuberculosis or living in conditions defined as at risk by the doctor). In the absence of tools to detect an early decrease in vaccine coverage (VC) in this specific group, we conducted a survey with the main objective of measuring BCG VC in high risk children for which BCG is now recommended and who were born after the change in BCG vaccine policy. METHODS: Cross-sectional survey performed amongst physicians registered at "Infovac-France", a network of general practitioners and paediatricians particularly aware of recent changes in the field of vaccinations. Each doctor was asked to recruit, during his medical consultation, between six and 12 children aged 2-7 months (born after the end of compulsory BCG vaccination in July 2007) and 8-23 months (born after the withdrawal from the market of the multipuncture form of BCG [Monovax] in January 2006 and before the end of compulsory BCG vaccination in July 2007). Doctors were asked to fill in a structured online questionnaire. Data were standardized and analysed with Stata 9.2. RESULTS: A total of 2536 children, recruited by 279 general practitioners and paediatricians (6.5% of all contacted doctors), were included. VC in the target group of high risk children for who BCG is still recommended and who were seen by doctors working in a private medical practice was: overall 68%; 58% in children born after the end of compulsory BCG vaccination (68% in IDF, 48% outside IDF); 77% in those born after the withdrawal of Monovax from the market and before the end of compulsory BCG vaccination; 90% in children living in IDF born after the end of compulsory vaccination and considered as particularly at risk of tuberculosis (presence of vaccination criteria other than residing in IDF) and 60% in the same category of children whose sole criteria for vaccination was residing in IDF. Of doctors who worked in a private medical practice: 75% used to perform the BCG vaccination themselves and 58% had recommended or suggested vaccination to children at risk who were not yet vaccinated. Seventy-six percent of parents of children at risk of tuberculosis not yet vaccinated accepted BCG vaccination when recommended by their doctor. CONCLUSION: Our survey showed, on the one hand, insufficient VC in children seen in a private medical practice and born after the end of compulsory vaccination for whom BCG is still recommended. This should encourage the Ministry of Health to reinforce its communication concerning this new policy. On the other hand, the survey showed encouraging results concerning both the coverage of children at particularly high risk in IDF and the adherence of doctors and families to the new vaccine policy. These results should be interpreted with caution, taking into account the methodological limitations of this survey.
Assuntos
Vacina BCG/uso terapêutico , Vacinação em Massa/legislação & jurisprudência , Prática Privada , Criança , Pré-Escolar , França , Política de Saúde , Humanos , Cooperação do Paciente/estatística & dados numéricos , Tuberculose/imunologiaRESUMO
Inadequate evaluation of vaccine coverage after mass vaccination campaigns, such as used in national measles control programmes, can lead to inappropriate public health responses. Overestimation of vaccination coverage may leave populations at risk, whilst underestimation can lead to unnecessary catch-up campaigns. The problem is more complex in large urban areas where vaccination coverage may be heterogeneous and the programme may have to be fine-tuned at the level of geographic subunits. Lack of accurate population figures in many contexts further complicates accurate vaccination coverage estimates. During the evaluation of a mass vaccination campaign carried out in N'Djamena, the capital of Chad, Lot Quality Assurance Sampling was used to estimate vaccination coverage. Using this method, vaccination coverage could be evaluated within smaller geographic areas of the city as well as for the entire city. Despite the lack of accurate population data by neighbourhood, the results of the survey showed heterogeneity of vaccination coverage within the city. These differences would not have been identified using a more traditional method. The results can be used to target areas of low vaccination coverage during follow-up vaccination activities.
Assuntos
Programas de Imunização/estatística & dados numéricos , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Garantia da Qualidade dos Cuidados de Saúde/métodos , Vacinação/métodos , Chade/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Sarampo/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde/normas , Estudos de Amostragem , Vacinação/normasRESUMO
BACKGROUND: Despite the comprehensive World Health Organization (WHO)/United Nations Children's Fund (UNICEF) measles mortality-reduction strategy and the Measles Initiative, a partnership of international organizations supporting measles mortality reduction in Africa, certain high-burden countries continue to face recurrent epidemics. To our knowledge, few recent studies have documented measles mortality in sub-Saharan Africa. The objective of our study was to investigate measles mortality in three recent epidemics in Niamey (Niger), N'Djamena (Chad), and Adamawa State (Nigeria). METHODS AND FINDINGS: We conducted three exhaustive household retrospective mortality surveys in one neighbourhood of each of the three affected areas: Boukoki, Niamey, Niger (April 2004, n = 26,795); Moursal, N'Djamena, Chad (June 2005, n = 21,812); and Dong District, Adamawa State, Nigeria (April 2005, n = 16,249), where n is the total surveyed population in each of the respective areas. Study populations included all persons resident for at least 2 wk prior to the study, a duration encompassing the measles incubation period. Heads of households provided information on measles cases, clinical outcomes up to 30 d after rash onset, and health-seeking behaviour during the epidemic. Measles cases and deaths were ascertained using standard WHO surveillance-case definitions. Our main outcome measures were measles attack rates (ARs) and case fatality ratios (CFRs) by age group, and descriptions of measles complications and health-seeking behaviour. Measles ARs were the highest in children under 5 y old (under 5 y): 17.1% in Boukoki, 17.2% in Moursal, and 24.3% in Dong District. CFRs in under 5-y-olds were 4.6%, 4.0%, and 10.8% in Boukoki, Moursal, and Dong District, respectively. In all sites, more than half of measles cases in children aged under 5 y experienced acute respiratory infection and/or diarrhoea in the 30 d following rash onset. Of measles cases, it was reported that 85.7% (979/1,142) of patients visited a health-care facility within 30 d after rash onset in Boukoki, 73.5% (519/706) in Moursal, and 52.8% (603/1,142) in Dong District. CONCLUSIONS: Children in these countries still face unacceptably high mortality from a completely preventable disease. While the successes of measles mortality-reduction strategies and progress observed in measles control in other countries of the region are laudable and evident, they should not overshadow the need for intensive efforts in countries that have just begun implementation of the WHO/UNICEF comprehensive strategy.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Sarampo/mortalidade , Adolescente , Chade/epidemiologia , Criança , Pré-Escolar , Diarreia/epidemiologia , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Sarampo/complicações , Vacina contra Sarampo/administração & dosagem , Morbidade , Níger/epidemiologia , Nigéria/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Vacinação/estatística & dados numéricosRESUMO
Since the characterization of the genome of the hepatitis E virus (HEV) in 1990, a large genetic diversity has been described. A single real-time reverse transcription (RT)-PCR assay with TaqMan technology has been validated which uses only one set of primers and probe within the ORF2 HEV region (nt 5207-5292) for the detection and quantification of the four major genotypes of HEV. This assay proved to be as efficient as the conventional RT-PCR methodology for the detection of HEV in clinical samples testing positive previously. The real-time RT-PCR and conventional RT-PCR were performed comparatively on 60 pairs of sera and stools collected during a recent outbreak of hepatitis E in Darfur. The real-time RT-PCR assay was 10- to 100-fold sensitive than for conventional RT-PCR assays used in this study with a range quantitation from 1.8 x 10(1) to 7.2 x 10(3) RNA copies/microl in clinical samples (serum and stools).
Assuntos
Vírus da Hepatite E/genética , Vírus da Hepatite E/isolamento & purificação , Hepatite E/virologia , Reação em Cadeia da Polimerase/métodos , Taq Polimerase/metabolismo , Genoma Viral , Genótipo , Vírus da Hepatite E/classificação , Humanos , Reprodutibilidade dos TestesAssuntos
Antimaláricos/administração & dosagem , Artemisininas/administração & dosagem , Etanolaminas/administração & dosagem , Fluorenos/administração & dosagem , Malária Falciparum/tratamento farmacológico , Cooperação do Paciente , Sesquiterpenos/administração & dosagem , Artemeter , Pré-Escolar , Gorduras na Dieta/administração & dosagem , Combinação de Medicamentos , Feminino , Humanos , Lactente , Lumefantrina , Malária Falciparum/epidemiologia , Masculino , Sudão/epidemiologia , Resultado do TratamentoRESUMO
To assess the local efficacy of chloroquine for the treatment of acute, uncomplicated, Plasmodium falciparum malaria, children and adults from Sekong province (an area of Laos with a low intensity of transmission) were tested in a 28-day, in-vivo study. Complete data were collected from 88 of the 102 subjects enrolled between October 1999 and September 2000. After genotypic analysis to distinguish recrudescing infections from re-infections, 35 (39.7%, with a 95% confidence interval of 29.5%-50.7%) of these 88 patients were considered treatment failures. These results seriously question the use of chloroquine as the first-line treatment for P. falciparum malaria in the study area.
Assuntos
Antimaláricos/uso terapêutico , Cloroquina/uso terapêutico , Malária Falciparum/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Feminino , Genótipo , Humanos , Lactente , Laos , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum/genética , Controle de Qualidade , Recidiva , Falha de Tratamento , Resultado do TratamentoRESUMO
A study was conducted to measure the overall performance of several rapid diagnostic tests for Plasmodium falciparum infection, in order to select the most appropriate test to be used in the field. A total of 742 patients attending the out-patient department of Mbarara Hospital with a clinical suspicion of malaria were included in the study. For each patient, a thick/thin film and 5 rapid tests based on the detection of histidine-rich protein II (HRP-II) (Paracheck Pf dipstick and device, ParaHIT f, Malaria Rapid and BIO P.F.) were performed. Outcomes were validity, inter-reader reliability and 'ease of use in the field', measured by both the general characteristics of the test and by the opinion of the readers. About half (57%) of the patients were positive for P. falciparum. The Paracheck Pf (dipstick and device) was considered as the most appropriate for the use in the field, being sensitive (97%), moderately specific (88%), reliable (kappa coefficient = 0.97), easy to use and cheap (about US$ 0.5/test). The ParaHIT f represented a good alternative.