Ranking de los programas de vacunación en América Latina, 2020. Rev Panam Salud Publica / Ranking of immunization programs in Latin America, 2020 / Ranking dos programas de vacinação na América Latina, 2020

[RESUMEN]. Objetivo. Construir y comparar el ranking de los programas nacionales de inmunizaciones (PNI) de América Latina del año 2020 con el año anterior. Métodos. Se evaluaron 18 PNI con base en la información pública obtenida de sitios oficiales de los ministerios de salud de los países, la Organización Mundial de la Salud, la Organización Panamericana de la Salud, el Fondo de las Naciones Unidas para la Infancia y referentes locales. El ranking se elaboró con base en el calendario de vacunación del año 2020 en distintas etapas de la vida, situaciones especiales, vacunación antigripal, coberturas vacunales (CV) del 2019 y aspectos programáticos. Resultados. Las CV disminuyeron en la mayoría de los países. El puntaje promedio regional y de la mayoría de los países también bajó en el 2020 excepto en Chile y Colombia. Chile lidera el ranking, seguido por Uruguay, Panamá y Costa Rica, y se destaca por su calendario completo, mayores CV y logros programáticos. Conclusiones. El menor puntaje global del 2020 resalta que es necesario recuperar la CV en la Región. Este análisis busca motivar a los países a abordar los desafíos pendientes.

[ABSTRACT]. Objective. Construct a ranking of national immunization programs in Latin America in 2020 and compare it with the previous year. Methods. Eighteen national immunization programs were evaluated on the basis of public information obtained from official sites of the countries' ministries of health, the World Health Organization, the Pan American Health Organization, the United Nations Children's Fund, and local sources. The ranking was based on the 2020 vaccination schedule for different life stages, special situations, vaccination against influenza, 2019 vac- cination coverage, and programmatic aspects. Results. Vaccination coverage decreased in most countries. The average regional declined in 2020, as did the scores for most countries, except Chile and Colombia. Chile leads the ranking, followed by Uruguay, Panama, and Costa Rica. Chile stands out for its full calendar, higher vaccination coverage rates, and programmatic achievements. Conclusions. The lower overall score in 2020 highlights the need to recover the Region's vaccination cove- rage rates. This analysis seeks to motivate countries to address pending challenges.

[RESUMO]. Objetivo. Construir e comparar o ranking dos programas nacionais de imunização (PNIs) na América Latina em 2020 com o ano anterior. Métodos. Foram avaliados 18 PNIs com base em informações públicas obtidas de sites oficiais dos ministérios da Saúde dos países, da Organização Mundial da Saúde, da Organização Pan-Americana da Saúde, do Fundo das Nações Unidas para a Infância e de fontes locais. O ranking foi compilado com base no calendário de vacinação de 2020 para diferentes fases da vida, situações especiais, vacinação contra a gripe, cobertura vacinal (CV) de 2019 e aspectos programáticos. Resultados. As CVs diminuíram na maioria dos países. A pontuação média regional e a pontuação da maioria dos países também caíram em 2020, exceto no Chile e na Colômbia. O Chile lidera o ranking, seguido do Uruguai, do Panamá e da Costa Rica, e se destaca por ter um calendário completo, maiores CVs e êxitos programáticos. Conclusões. A pontuação global mais baixa em 2020 destaca a necessidade de recuperar a CV da região. Esta análise busca motivar os países a enfrentar os desafios pendentes.

Meningococcal burden of disease in Argentina: 10 years epidemiologic review.

Invasive meningococcal disease (IMD) is an uncommon but serious and potentially fatal condition, mainly affecting infants. In 2017, Argentina introduced a vaccination program against serogroups A, C, W and Y (MenACWY) for infants aged 3, 5 and 15 months and adolescents aged 11 years. The objective of this study was to review the burden of IMD in Argentina in 2010-2019. Data were obtained from national surveillance databases, and the study estimated IMD incidence, mortality, case-fatality rates, and serogroup distributions across age groups. A total of 1,972 IMD cases were reported in the study period, with the highest incidence in infants aged < 1 year. Incidence peaked in 2013 and subsequently declined. Mortality rates were 18 times higher in infants than in other age groups, reflecting the high impact of IMD in this age group. The case-fatality rate was 8.5% on average and increased with age. The proportion of notified cases with serogroup identification increased over the period, reaching 91% in 2019. The most common serogroups over the study period were serogroup B (48%) and serogroup W (42%), with an increase in B relative to W since 2015. In infants aged < 1 year, the proportion of serogroup B increased in recent years, reaching around 70% of characterized cases in 2018-2019. These results show the dynamism of IMD and indicate the importance of vaccination at an early age and offering protection against predominant serogroups. These data are valuable to support evidence-based decision-making in healthcare.

Real-World Evidence in Cost-Effectiveness Analysis of Enhanced Influenza Vaccines in Adults ≥ 65 Years of Age: Literature Review and Expert Opinion.

Influenza vaccination can benefit most populations, including adults ≥ 65 years of age, who are at greater risk of influenza-related complications. In many countries, enhanced vaccines, such as adjuvanted, high-dose, and recombinant trivalent/quadrivalent influenza vaccines (aTIV/aQIV, HD-TIV/HD-QIV, and QIVr, respectively), are recommended in older populations to provide higher immunogenicity and increased relative vaccine efficacy/effectiveness (rVE) than standard-dose vaccines. This review explores how efficacy and effectiveness data from randomized controlled trials and real-world evidence (RWE) are used in economic evaluations. Findings from published cost-effectiveness analyses (CEA) on enhanced influenza vaccines for older adults are summarized, and the assumptions and approaches used in these CEA are assessed alongside discussion of the importance of RWE in CEA. Results from many CEA showed that adjuvanted and high-dose enhanced vaccines were cost-effective compared with standard vaccines, and that differences in rVE estimates and acquisition price may drive differences in cost-effectiveness estimates between enhanced vaccines. Overall, RWE and CEA provide clinical and economic rationale for enhanced vaccine use in people ≥ 65 years of age, an at-risk population with substantial burden of disease. Countries that consider RWE when making vaccine recommendations have preferentially recommended aTIV/aQIV, as well as HD-TIV/HD-QIV and QIVr, to protect older individuals.

Ranking de los programas de inmunización en América Latina, 2019

[RESUMEN]. Objetivo. El objetivo del presente trabajo ha sido construir un ranking de los programas nacionales de inmu- nizaciones (PNI) de América Latina que compare las diversas realidades, identifique los desafíos y metas no alcanzadas, y estimule a los países a la búsqueda de estrategias superadoras. Métodos. Se seleccionaron 10 países con los calendarios nacionales de vacunación (CNV) más innovadores. Se utilizó la información publicada en sitios oficiales de los ministerios de salud, la Organización Mundial de la Salud (OMS), la Organización Panamericana de la Salud (OPS), el Fondo de las Naciones Unidas para la Infancia (UNICEF, por su sigla en inglés) y entrevistas a referentes de cada país. Se construyó un ranking con base en los dominios vinculados al CNV 2019 en diferentes etapas de la vida, vacunación antigripal, en situaciones especiales, coberturas de vacunación (CV) de 2018 y aspectos programáticos. Resultados. El ranking general lo lideran Chile y Panamá, con la vacunación del primer y segundo año de vida. Les siguen Argentina, Uruguay y Costa Rica, que se destacan en vacunación de otros grupos, antigripal y aspectos programáticos. Brasil, Colombia y México muestran CNV más atrasados, brechas programáticas y CV más bajas. Por último, Paraguay y Perú presentan carencias similares y mayores vacíos de información. Sin embargo, al analizar los dominios de manera individual, el ranking se modifica y no se repite un mismo patrón. Conclusiones. Este es el primer ranking de los PNI de América Latina en el que se destacan las fortalezas y debilidades de cada país. La periodicidad de este ejercicio será clave para comparar la evolución y el posi- cionamiento de estos programas en el tiempo.

[ABSTRACT]. Objective. To establish a ranking of national immunization programs in Latin America that compares the various realities, identifies challenges and unachieved goals, and encourages countries to search for strate- gies to overcome the obstacles they face. Methods. Ten countries with the most innovative national vaccination schedules (NVCs) were selected. Infor- mation published on official websites of ministries of health, the World Health Organization (WHO), the Pan American Health Organization (PAHO), and the United Nations Children's Fund (UNICEF) were used, as well as interviews with experts from each country. A ranking was constructed, based on domains linked to the 2019 NVC (vaccinations given at different life stages, influenza vaccination, and vaccination in special situations); vaccination coverage in 2018; and programmatic aspects. Results. The general ranking is led by Chile and Panama, due to vaccination in the first and second year of life. They are followed by Argentina, Uruguay, and Costa Rica, which stand out for vaccination of other groups, influenza vaccination, and programmatic aspects. Brazil, Colombia, and Mexico have more delays in their NVCs, as well as programmatic gaps and lower vaccination coverages. Finally, Paraguay and Peru have similar deficiencies and bigger information gaps. However, when the domains are analyzed individually, the ranking changes and the same pattern is not repeated. Conclusions. This is the first ranking of national immunization programs in Latin America that highlights stren- gths and weaknesses in each country. The periodicity of this exercise will be key when comparing the evolution and positioning of these programs over time.

[RESUMO]. Objetivo. O objetivo deste trabalho foi construir um ranking dos programas nacionais de imunização (PNI) da América Latina que comparasse as distintas realidades, identificasse os desafios e as metas não alcançadas e estimulasse os países a buscarem melhores estratégias. Métodos. Foram selecionados 10 países com os Calendários Nacionais de Vacinação (CNV) mais inovado- res. Foram utilizadas informações publicadas nos sites oficiais dos ministérios da Saúde, da Organização Mundial da Saúde (OMS), da Organização Pan-Americana da Saúde (OPAS) e do Fundo das Nações Unidas para a Infância (UNICEF), e entrevistas com lideranças de cada país. Foi construído um ranking com base nos domínios vinculados aos CNV de 2019 em diferentes fases da vida, vacinação contra influenza, situações especiais, cobertura vacinal (CV) em 2018 e aspectos programáticos. Resultados. O ranking geral é liderado pelo Chile e pelo Panamá, com a vacinação no primeiro e no segundo ano de vida. Seguem-se Argentina, Uruguai e Costa Rica, que se destacam na vacinação de outros grupos, na vacinação contra a influenza e em aspectos programáticos. Brasil, Colômbia e México apresentam CNV mais atrasados, lacunas programáticas e CV mais baixas. Por último, Paraguai e Peru apresentam deficiên- cias semelhantes e mais lacunas de informação. No entanto, ao se analisar os domínios individualmente, o ranking se modifica e não se repete um mesmo padrão. Conclusões. Este é o primeiro ranking dos PNI da América Latina em que são destacados os pontos fortes e fracos de cada país. A periodicidade deste exercício será fundamental para comparar a evolução e o posi- cionamento destes programas ao longo do tempo.

Cost-Effectiveness Analysis of Cell Versus Egg-Based Seasonal Influenza Vaccination in Children and Adults in Argentina.

Background: Quadrivalent cell-based influenza vaccines (QIVc) avoid egg-adaptive mutations and can be more effective than traditional quadrivalent egg-based influenza vaccines (QIVe). This analysis compared the cost-effectiveness of QIVc and QIVe in Argentinian populations < 65 years old from the payer and societal perspectives. Methods: A static decision tree model compared the costs and health benefits of vaccination with QIVc vs. QIVe using a one-year time horizon. The relative vaccine effectiveness of QIVc vs. QIVe was assumed to be 8.1% for children and 11.4% for adults. An alternative high egg-adaptation scenario was also assessed. Model inputs were sourced from Argentina or the international literature. Deterministic and probabilistic sensitivity analyses were performed. Results: Compared to QIVe, QIVc would prevent 17,857 general practitioner visits, 2418 complications, 816 hospitalizations, and 12 deaths per year. From the payers' perspective, the incremental cost-effectiveness ratio per quality-adjusted life years gained was USD12,214 in the base case and USD2311 in the high egg-adaptation scenario. QIVc was cost-saving from the societal perspective in both scenarios. Conclusions: QIVc in Argentina would be cost-effective relative to QIVe. The potential health benefits and savings would be even higher in high egg-adaptation seasons.

Cost-Effectiveness Analysis of Switching from Trivalent to Quadrivalent Seasonal Influenza Vaccine in Argentina.

The burden of seasonal influenza disease in Argentina is considerable. The cost-effectiveness of trivalent (TIV) versus quadrivalent influenza vaccine (QIV) in Argentina was assessed. An age-stratified, static, decision-tree model compared the costs and benefits of vaccination for an average influenza season. Main outcomes included: numbers of influenza cases; general practitioner (GP) visits; complicated ambulatory cases; hospitalizations; deaths averted; and costs per quality-adjusted life years (QALYs) gained. Epidemiological data from Argentina for 2014-2019 were used to determine the proportion of A and B strain cases, and the frequency of mismatch between vaccine and circulating B strains. To manage uncertainty, one-way and probabilistic sensitivity analyses were performed. Switching from TIV to QIV would prevent 19,128 influenza cases, 16,164 GP visits, 2440 complicated ambulatory cases, 524 hospitalizations, and 82 deaths. Incremental cost-effectiveness ratios (ICERs) per QALY were 13,590 and 11,678 USD from the payer's and societal perspectives, respectively. The greatest health benefits and direct medical cost savings would occur in ≥ 65-year-olds. One-way sensitivity analyses demonstrated the principal drivers of ICER to be vaccine acquisition costs, environmental B strain predominance, and B strain mismatch. Introducing QIV in Argentina would be beneficial and cost-effective relative to TIV, particularly in older adults.

Cost-effectiveness of introducing an MF59-adjuvanted trivalent influenza vaccine for older adults in Argentina.

INTRODUCTION: Influenza surveillance in Argentina reported influenza-like illness at a rate of 3500/100,000, a hospitalization rate of 15.5/100,000, and a death rate of 0.32/100,000 annually in adults aged over 65 years. The high burden of disease may be due to a combination of immunosenescence and the suboptimal clinical effectiveness of conventional, non-adjuvanted influenza vaccines in this age group. There is a clinical need for more effective influenza vaccines in this population. This study evaluated the cost-effectiveness of an MF59®-adjuvanted trivalent influenza vaccine (aTIV) in adults aged over 65 years in Argentina compared with the non-adjuvanted trivalent influenza vaccine (TIV) used under the current national vaccination policy. METHODS: A decision tree cost-effectiveness model was developed to estimate the cost-effectiveness of switching from TIV to aTIV in Argentinian older adults. The model compared cost and health benefits of vaccination in one influenza season from the payer perspective. The main predictions included survival, quality-adjusted survival, and costs. Model inputs were sourced from Argentina or internationally where local data was considered inaccurate. Vaccine efficacy assumptions were extracted from recently published, peer-reviewed scientific literature. RESULTS: Switching from TIV to aTIV would result in 170 deaths averted and 1310 incremental quality-adjusted life years (QALYs) gained. The incremental cost-effectiveness ratio per QALY was US $2660.59 from the payer perspective. In all sensitivity analyses, aTIV remained highly cost-effective. The probabilistic sensitivity analyses showed a 95% CI per QALY of US $113.74-7721.67. CONCLUSION: Introducing an adjuvanted influenza vaccine in Argentina is potentially beneficial and cost-effective relative to the currently-used TIV through the reduction of disease burden and utilization of healthcare resources.

[Assessment of the use in adults of four vaccines: a population survey in Argentina]. / Evaluación del uso en adultos de cuatro vacunas: una encuesta poblacional en Argentina.

Vaccination is one of the most effective strategies for disease prevention. Argentina initiated the transition from child vaccination to family vaccination through the incorporation of an adult schedule. One of the difficulties with this last group is to assess the percentage of use (PU) of the vaccines. With the aim of determining the PU of adult vaccines in Argentina, a vaccination module was included in the National Survey of Risk Factors carried out in 2013 by the National Ministry of Health. The sampling had a stratified multistage design. A total of 32 365 people = 18 year-old were surveyed about the use of four vaccines included in the National Vaccination Calendar: hepatitis B, tetanus, influenza, and pneumococcus. The entire population was surveyed for tetanus and hepatitis B while certain groups at risk were evaluated for influenza and pneumococcus, according to current recommendations. PU varied according to the vaccine analyzed: tetanus 49.8%, hepatitis B 21.7%, influenza 51.6% and pneumococcus 16.2%. The main information sources on adult vaccination were media (television, internet, etc.) followed by health personnel (70.8% and 27.9%, respectively). The survey is a suitable tool to assess the use of vaccines by adults, identify low coverage populations, and to plan and implement strategies to improve coverage.

Evaluación del uso en adultos de cuatro vacunas: una encuesta poblacional en Argentina / Assessment of the use in adults of four vaccines: a population survey in Argentina

La vacunación es una de las estrategias más efectivas para la prevención de enfermedades. Argentina inició la transición de la vacunación del niño a la de la familia, incorporando la vacunación del adulto. Una de las dificultades con este último grupo es determinar el porcentaje de utilización (PU) de las vacunas. Con el objetivo de caracterizar el PU de las vacunas en adultos en Argentina, la Encuesta Nacional de Factores de Riesgo que realizó el Ministerio de Salud de la Nación en 2013 incluyó un módulo de vacunación. El diseño muestral fue estratificado y multietápico. Fueron encuestadas 32 365 personas >18 años sobre el uso de cuatro vacunas incluidas en el Calendario Nacional de Vacunación: hepatitis B, tétanos, influenza y neumococo. Se consideró toda la población encuestada para tétanos y hepatitis B y ciertos grupos en riesgo para influenza y neumococo, de acuerdo con las recomendaciones. El PU varió según las vacunas analizadas: tétanos 49.8%, hepatitis B 21.7%, influenza 51.6% y neumococo 16.2%. Las principales fuentes de información sobre vacunas del adulto fueron, en primer lugar los medios públicos de comunicación (televisión, internet, etc.), y en segundo lugar el personal de salud (70.8% y 27.9%, respectivamente). Se concluye que la encuesta es una herramienta útil para evaluar el uso de vacunas por adultos, identificar poblaciones con baja cobertura, así como para planificar e implementar estrategias para mejorar la cobertura.

Vaccination is one of the most effective strategies for disease prevention. Argentina initiated the transition from child vaccination to family vaccination through the incorporation of an adult schedule. One of the difficulties with this last group is to assess the percentage of use (PU) of the vaccines. With the aim of determining the PU of adult vaccines in Argentina, a vaccination module was included in the National Survey of Risk Factors carried out in 2013 by the National Ministry of Health. The sampling had a stratified multistage design. A total of 32 365 people = 18 year-old were surveyed about the use of four vaccines included in the National Vaccination Calendar: hepatitis B, tetanus, influenza, and pneumococcus. The entire population was surveyed for tetanus and hepatitis B while certain groups at risk were evaluated for influenza and pneumococcus, according to current recommendations. PU varied according to the vaccine analyzed: tetanus 49.8%, hepatitis B 21.7%, influenza 51.6% and pneumococcus 16.2%. The main information sources on adult vaccination were media (television, internet, etc.) followed by health personnel (70.8% and 27.9%, respectively). The survey is a suitable tool to assess the use of vaccines by adults, identify low coverage populations, and to plan and implement strategies to improve coverage.

Cost-effectiveness analysis of rotavirus vaccination in Argentina.

BACKGROUND: Rotavirus is a leading cause of severe diarrhea in children under 5. In Argentina, the most affected regions are the Northeast and Northwest, where hospitalizations and deaths are more frequent. This study estimated the cost-effectiveness of adding either of the two licensed rotavirus vaccines to the routine immunization schedule. METHODS: The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (Version 2.0) was used to assess health benefits, costs savings, life-years gained (LYGs), DALYs averted, and cost/DALY averted of vaccinating 10 successive cohorts, from the health care system and societal perspectives. Two doses of monovalent (RV1) rotavirus vaccine and three doses of pentavalent (RV5) rotavirus vaccine were each compared to a scenario assuming no vaccination. The price/dose was US$ 7.50 and US$ 5.15 for RV1 and RV5, respectively. We ran both a national and sub-national analysis, discounting all costs and benefits 3% annually. Our base case results were compared to a range of alternative univariate and multivariate scenarios. RESULTS: The number of LYGs was 5962 and 6440 for RV1 and RV5, respectively. The cost/DALY averted when compared to no vaccination from the health care system and societal perspective was: US$ 3870 and US$ 1802 for RV1, and US$ 2414 and US$ 358 for RV5, respectively. Equivalent figures for the Northeast were US$ 1470 and US$ 636 for RV1, and US$ 913 and US$ 80 for RV5. Therefore, rotavirus vaccination was more cost-effective in the Northeast compared to the whole country; and, in the Northwest, health service's costs saved outweighed the cost of introducing the vaccine. Vaccination with either vaccine compared to no vaccination was highly cost-effective based on WHO guidelines and Argentina's 2011 per capita GDP of US$ 9090. Key variables influencing results were vaccine efficacy, annual loss of efficacy, relative coverage of deaths, vaccine price, and discount rate. CONCLUSION: Compared to no vaccination, routine vaccination against rotavirus in Argentina would be highly cost-effective with either vaccine. Health and economic benefits would be higher in the Northeast and Northwest regions, where the intervention would even be cost-saving.

Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina.

OBJECTIVE: Since the 10-valent pneumococcal conjugate vaccine (PCV-10) and 13-valent pneumococcal conjugate vaccine (PCV-13) were recently licensed for use in Argentina, both vaccines were evaluated to estimate the costs, health benefits and cost-effectiveness of adding a PCV to the routine child immunization schedule. METHODOLOGY: The integrated TRIVAC vaccine cost-effectiveness model from Pan American Health Organization's ProVac Initiative (Version 1.0.65) was used to assess the health outcomes of 20 successive cohorts from birth to 5 years of age. PCV-10 and PCV-13 were each compared to a scenario assuming no PCV vaccination. A 3+1 (three doses+booster) schedule and a vaccination price of US$ 20.75 per dose was assumed in the base case for both vaccines. RESULTS: Introduction of PCV-13 rather than PCV-10 would increase the number of life years gained (LYG) by at least 10%. The number of LYG (and LYG after adjustment for DALY morbidity weights) was 56,882 (64,252) for PCV-10 compared to 65,038 (71,628) for PCV-13. From the health system perspective, the cost per DALY averted was US$ 8973 and US$ 10,948 for PCV-10 and PCV-13 respectively, and US$ 8546 and US$ 10,510 respectively, after incorporating costs saved by households. When PCV13 was compared to PCV10 directly, the additional benefits of PCV-13 was conferred at a cost of US$ 28,147 per DALY averted. Cost-effectiveness was influenced mainly by vaccine price, serotype replacement, pneumonia mortality and discount rate. CONCLUSION: Routine vaccination against S. pneumoniae in Argentina would be cost-effective with either PCV-10 or PCV-13. PCV-13, with higher coverage of local serotypes, would prevent more cases of pneumonia, invasive pneumococcal disease, sequelae and deaths with a higher number of LYG and DALYs averted, but PCV-10, due its higher impact in the prevention of AOM, would save more costs to the healthcare system.