Spatial clusters and social inequities in COVID-19 vaccine coverage among children in Brazil / Aglomerados espaciais e desigualdades sociais na cobertura vacinal contra COVID-19 em crianças no Brasil

Abstract This study examined the spatial distribution and social inequalities in COVID-19 vaccine coverage among children aged 5-11 in Brazil. First and second dose vaccine coverage was calculated for all Brazilian municipalities and analyzed by geographic region and deciles based on human development index (HDI-M) and expected years of schooling at 18 years of age. Multilevel models were used to determine the variance partition coefficient, and bivariate local Moran's I statistic was used to assess spatial association. Results showed significant differences in vaccine coverage rates among Brazilian municipalities, with lower coverage in the North and Midwest regions. Municipalities with lower HDI and expected years of schooling had consistently lower vaccine coverage rates. Bivariate clustering analysis identified extensive concentrations of municipalities in the Northern and Northeastern regions with low vaccine coverage and low human development, while some clusters of municipalities in the Southeast and South regions with low coverage were located in areas with high HDI-M. These findings highlight the persistent municipal-level inequalities in vaccine coverage among children in Brazil and the need for targeted interventions to improve vaccine access and coverage in underserved areas.

Resumo O estudo analisou a distribuição espacial e as desigualdades sociais na cobertura vacinal para COVID-19 entre crianças de 5 a 11 anos no Brasil. As coberturas vacinais foram calculadas para os municípios brasileiros e analisadas por região geográfica e decis com base no Índice de Desenvolvimento Humano (IDH-M) e expectativa de escolaridade aos 18 anos. Modelos multiníveis foram usados ​​para determinar o coeficiente de partição da variância, e a estatística local bivariada de Moran I foi usada para avaliar a associação espacial. Os resultados mostraram diferenças significativas nas taxas de cobertura vacinal entre os municípios, com menor cobertura nas regiões Norte e Centro-Oeste. Municípios com menor IDH e anos de escolaridade esperados apresentaram menores taxas de cobertura vacinal. A análise de agrupamento bivariado identificou extensas concentrações de municípios nas regiões Norte e Nordeste com baixa cobertura vacinal e baixo desenvolvimento humano, enquanto alguns aglomerados de municípios nas regiões Sudeste e Sul com baixa cobertura localizavam-se em áreas com alto IDH-M. Essas descobertas destacam as desigualdades persistentes em nível municipal na cobertura vacinal entre crianças e a necessidade de intervenções para melhorar o acesso e a cobertura vacinal em áreas mais vulneráveis.

Reacciones adversas de las vacunas contra el SARS COV 2 en personales de salud, primer semestre del año 2021

El Ministerio de Salud Pública y Bienestar Social inició con el plan de vacunación contra el SARS COV 2, priorizando en la primera etapa a los grupos de mayor vulnerabilidad, quienes correspondían entre otros al personal de salud; en ese sentido el Programa Ampliado de Inmunizaciones (PAI) ha iniciado con el proceso de selección y capacitación de los personales de enfermería en los lineamientos técnicos y operativos del plan de vacunación, sistema de información y de vigilancia de eventos supuestamente atribuidos a la vacunación e inmunización. Objetivo: Determinar la incidencia de reacciones adversas de las vacunas contra el COVID 19 (CoronaVac®, Astrazeneca® y Covaxin®) en personal de salud de los sectores públicos y privados de la XIV Región Sanitaria Canindeyú. Metodología: Estudio cuantitativo, descriptivo de corte transversal. Resultados: Entre los efectos leves de mayor frecuencia fueron el dolor en el sitio de aplicación, siendo para la vacuna Covaxin® en un 63.6% y para la vacuna Astrazeneca® 62.8%. Con relación a los efectos generales la dispepsia fue la reacción más observada (86.6% para la vacuna Covaxin® y 83.3% para vacuna CoronaVac®), y falta de energía y motivación (vacuna Astrazeneca® con un 34.9%). Discusión: el estudio muestra claramente que existen diferencias en la observación de efectos leves provocados por diferentes vacunas. En esta oportunidad se han observado tres vacunas, resaltando que estos efectos leves son comunes, frecuentes y generalmente temporales en las vacunas.

The Ministry of Public Health and Social Welfare began the vaccination plan against SARS COV 2, prioritizing in the first stage the most vulnerable groups, which corresponded, among others, to health personnel; In this sense, the Expanded Immunization Program (PAI) has begun the process of selection and training of nursing personnel in the technical and operational guidelines of the vaccination plan, information system and surveillance of events supposedly attributed to vaccination and immunization. Objective: Determine the incidence of adverse reactions to COVID 19 vaccines (CoronaVac®, Astrazeneca® and Covaxin®) in health personnel from the public and private sectors of the XIV Canindeyú Health Region. Methodology: Quantitative, descriptive cross-sectional study. Results: Among the most frequent mild effects were pain at the application site, being 63.6% for the Covaxin® vaccine and 62.8% for the Astrazeneca® vaccine. In relation to the general effects, dyspepsia was the most observed reaction (86.6% for the Covaxin® vaccine and 83.3% for the CoronaVac® vaccine), and lack of energy and motivation (Astrazeneca® vaccine with 34.9%). Discussion: The study clearly shows that there are differences in the observation of mild effects caused by different vaccines. On this occasion, three vaccines have been observed, highlighting that these mild effects are common, frequent and generally temporary in vaccines.

#VACINAPARATODOS: sentidos atribuídos por brasileiros à primeira dose da imunização contra a covid-19 no Instagram / #VACINAPARATODOS: meanings attributed by Brazilians to the first dose of immunization against covid-19 on Instagram / #VACINAPARATODOS: significados atribuidos por brasileños a la primera dosis de inmunización contra covid-19 en InstagramAutor

Este artigo se baseia em uma pesquisa que teve como objetivoapreender os sentidos atribuídos por brasileiros à primeira dose da imunização contra a covid-19. Trata-se de uma análise netnográfica. Os dados foram coletados em 2021 por meio da hashtag VACINAPARATODOS no Instagram. Os métodos utilizados para análise de dados foram: análise de similitude, com auxílio do software IRAMUTEQ e da análise do Discourse of the collective subject (discurso do sujeito coletivo), de Lefevre. Os resultados apontaram como ideias centrais: a emoção positiva e o sentimento de gratidão; a emoção negativa e o sentimento atribuído às vidas perdidas e ao negacionismo; o significado da primeira dose e o sentimento de esperança; a imunização e o exercício da cidadania: ato de consciência, responsabilidade e respeito. Os sentidos atrelados à oportunidade de acesso à vacina mostraram a dualidade de sentimentos que vão desde sensações positivas de reconhecimento e valorização até sentimentos negativos, de revolta e indignação, diante da hesitação vacinal e dos discursos antivacina.

This article bases on a research that aimed to understand the meanings attributed by Brazilians to the first dose of immunization against covid-19. A netnographic analysis was carried out. The data was collected in 2021 using the hashtag VACINAPARATODOS on Instagram. The methods used analyse the data were: similarity analysis, with the aid of the IRAMUTEQ software and of the analysis of Discourse of the collective subject, developed by Lefevre. The results pointed out the following central ideas: positive emotion and a feeling of gratitude; the negative emotion and a feeling attributed to lost lives and to denialism; the meaning of the first dose and the feeling of hope; the immunization and the exercise of citizenship: an act of conscience, responsibility and respect. The meanings linked to the opportunity to access the vaccine showed a duality of feelings ranging from positive feelings of recognition and appreciation to negative feelings of revolt and indignation, in the face of vaccine hesitancy and of the anti-vaccine discourses.

Este artículo se basa en una investigación que tuvo como objetivo comprender los significados atribuidos por los brasileños a la primera dosis de inmunización contra la covid-19. Se realizó un análisis netnográfico. Los datos fueron recogidos en 2021 a través del hashtag VACINAPARATODOS en Instagram. Los métodos utilizados para el análisis de los datos fueron: análisis de similitud, con ayuda del softwareIRAMUTEQ y del análisis del Discourse of collective subject (Discurso del sujeto colectivo), de Lefevre. Los resultados evidenciaron como ideas centrales: la emoción positiva y el sentimiento de gratitud; la emoción negativa y el sentimiento atribuido a las vidas perdidas y al negacionismo; el significado de la primera dosis y el sentimiento de esperanza; la inmunización y el ejercicio de la ciudadanía: un acto de conciencia, responsabilidad y respeto. Los significados vinculados a la oportunidad de acceder a la vacuna mostraron la dualidad de sentimientos que van desde sentimientos positivos de reconocimiento y aprecio hasta sentimientos negativos de revuelta y indignación, frente a las dudas sobre las vacunas y los discursos antivacunas.

Estruturação do plano de imunização no combate a covid-19: (des)ordem nos acordos entre os poderes / Structuring the immunization plan to fight covid-19: (dis)order in agreements between the powers / Estructura del plan de inmunización para combatir el covid-19: (des)orden en acuerdos entre potencias

Objetivo: Fomentar o debate acerca da ordenação do plano de vacinação nacional, considerando os aspectos organizacionais entre união, estados e municípios. Métodos: Revisão de literatura, tendo como base os periódicos Cientific Electronic Library Online (SCIELO), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) e Biblioteca Virtual de Saúde (BVS), usando como descritores: Pandemia, Vacina e Plano de Imunização. Com essa busca foram encontradas, inicialmente, 48 publicações. Após a realização da análise, foram incluídos 11 artigos científicos na revisão. Os textos foram submetidos à análise de conteúdo semântica. Resultados: Foram levantadas duas categorias: estratégias de combate a pandemia do covid-19 no Brasil, e a manipulação da sociedade civil e a desordem da cobertura vacinal. Conclusão: as reflexões aqui apresentadas podem contribuir para que os profissionais de enfermagem desenvolvam uma postura reflexiva frente a demanda vacinal, processo de planejamento e percepções da sociedade civil, podendo desencadear uma melhora na preparação para a educação em saúde. (AU)

Objective: To encourage the debate about the ordering of the national vaccination plan, considering the organizational aspects between the union, states and municipalities. Methods: Literature review, based on scientific journals Electronic Library Online (SCIELO), Coordination for the Improvement of Higher Education Personnel (CAPES) and Virtual Health Library (VHL), using as descriptors: Pandemia, Vaccine and Immunization Plan. With this search, 48 publications were initially found. After the analysis, 11 scientific articles were included in the review. The texts were subjected to semantic content analysis. Results: Two categories were raised: strategies to combat the covid-19 pandemic in Brazil, and the manipulation of civil society and the disorder of vaccination coverage. Conclusion: The reflections presented here can contribute for nursing professionals to develop a reflexive posture in face of the vaccine demand, planning process and civil society perceptions, which can trigger an improvement in the preparation for health education. (AU)

Objetivo: Fomentar el debate sobre la ordenación del plan nacional de vacunación, considerando los aspectos organizativos entre sindicato, estados y municipios. Métodos: Revisión de la literatura, con base en revistas científicas Biblioteca Electrónica en Línea (SCIELO), Coordinación para el Perfeccionamiento del Personal de Educación Superior (CAPES) y Biblioteca Virtual en Salud (BVS), utilizando como descriptores: Pandemia, Vacuna y Plan de Inmunización. Con esta búsqueda se encontraron inicialmente 48 publicaciones. Después del análisis, se incluyeron 11 artículos científicos en la revisión. Los textos fueron sometidos a análisis de contenido semántico. Resultados: Se plantearon dos categorías: estrategias para combatir la pandemia de covid-19 en Brasil y la manipulación de la sociedad civil y el desorden de la cobertura de vacunación. Conclusión: Las reflexiones aquí presentadas pueden contribuir para que los profesionales de enfermería desarrollen una postura reflexiva ante la demanda de vacunas, el proceso de planificación y las percepciones de la sociedad civil, lo que puede desencadenar una mejora en la preparación para la educación en salud. (AU)

Imunização: planejamento e estrutura organizacional na atenção primária à saúde / Immunization: planning and organizational structure in primary health care / Inmunización: planificación y estructura organizativa en la atención primaria de salud

Objetivo: Identificar como acontece o planejamento das ações de enfermagem e a estrutura física nos serviços de vacinação. Métodos: Pesquisa de método misto. Foram aplicadas 18 entrevistas e 203 questionários aos enfermeiros responsáveis pelas salas de vacinas, em 14 municípios do estado do Ceará. Os dados foram coletados de julho a setembro de 2018, e organizados em categorias: planejamento das ações de imunização na atenção primária à saúde; e estrutura física, recursos humanos e materiais das salas de vacinas. Resultados: Evidenciou-se a responsabilidade do enfermeiro no planejamento das ações e envolvimento da equipe em todo o processo de vacinação, apesar dos enfermeiros desses municípios não serem exclusivos nos serviços de vacinação; os agentes comunitários de saúde são componentes da equipe atuantes neste serviço; e a estrutura física das salas de vacinas não condizem com as normas preconizadas pelo Programa Nacional de Imunizações. Conclusão: Evidenciou-se a responsabilidade do enfermeiro no planejamento das ações e envolvimento da equipe no processo de vacinação; e a importância de uma boa estrutura organizacional, recursos humanos e materiais para o desenvolvimento das ações. (AU)

Objective: To identify how the planning of nursing actions and the physical structure in vaccination services take place. Methods: Mixed method research. Eighteen interviews and 203 questionnaires were applied to nurses responsible for vaccine rooms in 14 municipalities in the state of Ceará. Data were collected from July to September 2018, and organized into categories: planning of immunization actions in primary health care; and physical structure, human and material resources of vaccine rooms. Results: The responsibility of the nurse in planning the actions and involvement of the team in the entire vaccination process was evidenced, although nurses in these cities are not exclusive in the vaccination services; community health agents are members of the team working in this service; and the physical structure of the vaccine rooms does not comply with the standards recommended by the National Immunization Program. Conclusion: The responsibility of the nurse in planning actions and involvement of the team in the vaccination process was evidenced; and the importance of a good organizational structure, human and material resources for the development of actions. (AU)

Objetivo: Identificar cómo se realiza la planificación de las acciones de enfermería y la estructura física en los servicios de vacunación. Métodos: Investigación de método mixto. Se aplicaron 18 entrevistas y 203 cuestionarios a enfermeras responsables de salas de vacunación en 14 municipios del estado de Ceará. Los datos se recopilaron de julio a septiembre de 2018 y se organizaron en categorías: planificación de acciones de inmunización en la atención primaria de salud; y estructura física, recursos humanos y materiales de las salas de vacunas. Resultados: Se evidenció la responsabilidad de la enfermera en la planificación de las acciones y la participación del equipo en todo el proceso de vacunación, aunque las enfermeras de estas ciudades no son exclusivas en los servicios de vacunación; los agentes comunitarios de salud son miembros del equipo que trabaja en este servicio; y la estructura física de las salas de vacunas no cumple con los estándares recomendados por el Programa Nacional de Inmunizaciones. Conclusión: Se evidenció la responsabilidad de la enfermera en la planificación de acciones y la participación del equipo en el proceso de vacunación; y la importancia de una buena estructura organizativa, recursos humanos y materiales para el desarrollo de las acciones. (AU)

Incidência de anafilaxia relacionada às vacinas do Programa Nacional de Imunizações / Incidence of vaccine-related anaphylaxis from Brazil's National Immunization Program

A incidência de anafilaxia pós-vacinal é um evento de saúde raro e carece de melhor detalhamento no Brasil. Neste estudo, objetivou-se descrever a incidência de anafilaxia como evento supostamente atribuído à vacinação e imunização (ESAVI) das vacinas do Programa Nacional de Imunizações (PNI).Foi realizado estudo retrospectivo com dados extraídos do sistema de notificação de ESAVI do PNI entre 01/2021 e 05/2023 com aceitação na Plataforma Brasil e aprovação ética. Foram identificados 84 casos encerrados com o descritor "anafilaxia" ou "choque anafilático" entre 290.101 eventos adversos notificados, concentrados principalmente nas regiões Sul e Sudeste. Crianças de 0 a 9 anos foram predominantemente afetadas, com maior incidência em mulheres e indivíduos brancos. A anafilaxia associou-se em números absolutos principalmente às vacinas COVID-19, destacando os fabricantes AstraZeneca/Fiocruz (vetor viral), Pfizer Comirnaty (RNAm) e CoronaVac (inativada), e a maior taxa de incidência foi com a vacina antirrábica (2,8 por milhão de doses aplicadas). A incidência global foi de 0,14/milhão de doses aplicadas. Entre os desfechos não foi relatado óbito. A subnotificação de casos é relevante e sublinha a importância de manter sistemas robustos de vigilância e manejo de reações alérgicas em programas de vacinação. Este estudo segue tendências mundiais da raridade da anafilaxia relacionada às vacinas. Os dados reforçam a segurança das vacinas COVID-19 e demais vacinas existentes no PNI, independente da demografia analisada.

Vaccine-related anaphylaxis is a rare health event, and its incidence requires further investigation in Brazil. The objective of this study was to describe the incidence of anaphylaxis as an event supposedly attributed to vaccination and immunization (ESAVI) associated with the Brazilian National Immunization Program (PNI). A retrospective study was conducted with data extracted from the PNI ESAVI notification system between January 2021 and May 2023, with ethical approval and registration in Plataforma Brasil. Among 290,101 adverse events reported, 84 cases closed with the descriptor "anaphylaxis" or "anaphylactic shock" were identified, mainly concentrated in the South and Southeast regions. Children aged 0 to 9 years were predominantly affected, with a higher incidence in women and white individuals. In absolute numbers, anaphylaxis was associated mainly with the AstraZeneca/Fiocruz (viral vector), Pfizer Comirnaty (mRNA), and CoronaVac (inactivated virus) COVID-19 vaccines, while the highest relative incidence was with the anti-rabies vaccine (2.8 cases per million doses administered). The overall incidence was 0.14 per million vaccine doses. No deaths were reported. Underreporting of vaccine-related anaphylaxis is relevant and highlights the importance of maintaining robust systems for surveillance and management of allergic reactions within vaccination programs. This study corroborates global trends in the rarity of vaccine-related anaphylaxis. The low incidence of this event, regardless of recipient demographics, provides further evidence of the safety of COVID-19 vaccines and other vaccines included in the PNI.

Mecanismo y diseño de vacunas para el sars-cov-2, revisión narrativa / Mechanism and design of vaccines against sars-cov-2, narrative review / Mecanismo e desenho de vacinas para sars-cov-2, revisão narrativa

La infección por el virus SARS-CoV-2, conocida como COVID-19, ha causado alta morbilidad y mortalidad en el mundo. Después de haber descifrado el código genético del virus y haber desarrollado un gran trabajo investigativo en la creación de vacunas, con diversas estrategias de acción, se ha logrado disminuir la morbi mortalidad. Fue necesario acelerar el proceso de producción de vacunas, lo cual estuvo facilitado por el avanzado conocimiento científico en el campo de la genética y la virología, para brindar a la especie humana una protección eficaz y segura contra la agresiva y progresiva infección. Las vacunas se clasifican de acuerdo con su mecanismo de acción, existen vacunas basadas en vectores virales que no se replican, vacunas recombinantes, otras basadas en virus atenuados y virus inactivos, y (la gran novedad de la ciencia actual) las vacunas basadas en ARN mensajero y ADN. Estas últimas han demostrado una gran eficacia y seguridad en la prevención de la infección por el SARS-CoV-2, también han impactado de manera fuerte, por lo que han reducido la infección y la mortalidad en la población. En consecuencia, cada día que pasa desde que se inició el periodo de vacunación mundial, se evidencia una reducción en la curva de contagio y mortalidad por COVID-19.

The infection produced by the SARS-CoV-2 virus, known as COVID-19, has caused high morbidity and mortality across the world. After having deciphered the virus's genoma and carried out investigative endeavors that led to the creation of a variety of vaccines with different mechanisms of action, it has been possible to decrease the morbidity and mortality associated with the virus. It was necessary to accelerate the vaccine production process, which was facilitated by advanced scientific knowledge within the disciplines of genetics and virology, in order to provide the human species with a safe and effective form of protection against the aggressive and progressive infection. Vaccines are classified differently depending on their action mechanisms: there are some based on non-replicating viral vectors, recombinant vaccines, ones that are based on attenuated or inactivated viruses, and (the greatest novelty of current scientific developments) vaccines based on DNA and messenger RNA. The latter has demonstrated significant efficacy and safety in the prevention of the SARS-CoV-2 infection as observed in preliminary studies, and they have meaningfully impacted the population by reducing the rates of infection and mortality. As a result, decreased levels of spread of and mortality from COVID-19 have been evidenced across the globe following the beginning of the vaccine distribution period.

A infecção pelo vírus SARS-CoV-2, conhecido como COVID-19, tem causado elevada morbidade e mortalidade no mundo. Depois de ter decifrado o código genético do virus e de ter realizado um grande trabalho de investigação na criação de vacinas, com diversas estratégias de ação, a morbilidade e a mortalidade foram reduzidas. Foi necessário acelerar o processo de produção de vacinas, facilitado por conhecimentos científicos avançados no domínio da genética e da virologia, para proporcionar à espécie humana uma proteção eficaz e segura contra a infecção agressiva e progressiva. As vacinas são classificadas de acordo com seu mecanismo de ação, existem vacinas baseadas em vetores virais que não se replicam, vacinas recombinantes, outras baseadas em virus atenuados e vírus inativos, e (a grande novidade da ciência atual) vacinas baseadas em RNA mensageiro e ADN. Estas últimas demonstraram grande eficácia e segurança na prevenção da infecção por SARS-CoV-2, mas também tiveram um forte impacto, razão pela qual reduziram a infecção e a mortalidade na população. Consequentemente, a cada dia que passa desde o início do período global de vacinação, fica evidente uma redução na curva de contágio e mortalidade por COVID-19.

Cadena de frío del programa nacional de inmunizaciones peruano en el contexto de la pandemia covid-19 / Cold chain of the peruvian national immunization program in the context of the covid-19 pandemic

RESUMEN Objetivo: Identificar aspectos críticos de la Cadena de Frío en el Perú Metodología: Estudio descriptivo. Se analizaron datos del Ministerio de Economía y Finanzas (MEF) y del Ministerio de Salud (MINSA) de los años 2020-2021, así como los registros administrativos de las Estrategias Sanitarias Regionales de inmunizaciones del MINSA en 2020. Se consideraron aspectos técnicos de la Norma Técnica de Manejo de cadena de frío, como es obsolescencia, dotación, funcionalidad y capacidad de almacenamiento. Resultados: En el año 2020, en términos de obsolescencia el 61.8% de los equipos de cadena de frío a nivel nacional presentaban obsolescencia, siendo regiones claves como Lima Metropolitana (capital del país) la más afectada con un 88%. En cuanto a la dotación de equipos, el 9% de los establecimientos de salud del primer nivel carecen de equipos de refrigeración, siendo Loreto la región con mayor déficit 46%, seguida de Huancavelica con un 21% de brecha. En términos de funcionamiento, se registra que el 84% de los equipos a nivel nacional funcionan, y el 16% reportan fallas técnicas, lo cual representa alto riesgo en la seguridad y potencia inmunogénica de las vacunas a prever. En términos de capacidad, al considerar el almacenamiento trimestral o mensual para las vacunas contra la COVID-19 u otras emergencias sanitarias se identificaron brechas significativas. Conclusiones: Existen riesgos en la operatividad, suministro y capacidad de almacenamiento de las vacunas del esquema nacional de inmunizaciones de Perú incluso ante emergencias sanitarias.

ABSTRACT Objective: The aim of this study was to identify critical aspects of the Cold Chain in the immunization process in Peru. Methodology: A descriptive study was conducted, analyzing data from the Ministry of Economy and Finance (MEF) and the Ministry of Health (MINSA) for the years 2020-2021, as well as administrative records from the MINSA's Regional Health Strategies for immunizations in 2020. Technical aspects established in the Health Technical Standard for Cold Chain Management, such as obsolescence, allocation, functionality, and storage capacity were taken into account. Results: In the year 2020, at the national level, 61.8% of the cold chain equipment showed obsolescence, with some regions exceeding 75%, with Lima's metropolitan region being the most affected at 88%. Concerning equipment allocation, 9% of the first-level health facilities lacked refrigeration equipment, with Loreto having the highest deficit (46%), followed by Huancavelica with a 21% gap. The overall equipment functionality nationwide was 84%, meaning that 16% of health facilities experienced technical failures, affecting vaccine's storage capacity and posing risks to their safety and immunogenicity. Significant gaps were identified when considering quarterly or monthly storage for COVID-19 vaccines or other health emergencies. Conclusions: This study highlights potential risks in the operability and storage capacity of the national immunization program's vaccines in Peru during contingencies such as the COVID-19 pandemic or other health emergencies.

Actualización de las recomendaciones de vacunación en adultos con enfermedades respiratorias. Documento de la Asociación Argentina de Medicina Respiratoria para los neumonólogos, 2023 / Recommendations in Adults with Respiratory Diseases. Document from the Argentinian Association of Respiratory Medicine for Pulmonologists, 2023

RESUMEN Los adultos fumadores, con comorbilidades, y los ancianos tienen mayor riesgo de contraer infecciones pulmonares y de tener peor evolución. La neumonía adquirida en la comunidad debida a virus, neumococo, además de otras bacterias y microorga nismos "atípicos" afecta tanto a adultos sanos como enfermos. La vacuna antigripal se diseña el verano anterior orientada a las cepas esperadas para la temporada siguiente. Su eficacia depende fundamentalmente de la variante viral que finalmente sea la responsable del brote. La vacuna anti-neumocócica polisacárida existe desde 1983 y será inexorablemente reemplazada por vacunas conjugadas de mayor eficacia, que previenen la infección por los serotipos presentes en la vacuna. La inmunización contra SARS-CoV-2 aceleró la reducción del contagio y la gravedad de COVID-19 notablemente. La vacuna acelular para Bordetella pertussis no está en el calendario de adultos, aun cuando vacunarlos fortalece el control del contagio infantil. La vacunas doble bacteriana (difteria y tétanos), y triple (doble + pertusis), y contra sarampión, varicela, rubeola, HPV, Haemophylus influenzae, meningococo, herpes zóster, fiebre hemorrágica argentina y fiebre amarilla están disponibles, pero son de uso limitado. Nuevas vacunas, como la recientemente aprobada por los CDC contra el virus sincicial respiratorio, pronto estarán disponibles.

ABSTRACT Adult smokers, subjects with comorbidities, and the elderly are at higher risk of pulmo nary infections and worse outcomes. Community-acquired pneumonia due to viruses, pneumococcus, other bacteria, and "atypical" microorganisms affects healthy and sick adults. The flu vaccine is designed the previous summer for the strains expected for the following season. Its effectiveness depends fundamentally on the viral variant ultimately responsible for the outbreak. The anti-pneumococcal polysaccharide vaccine has been available since 1983 and it is expected to be replaced by conjugate vaccines which are more effective in preventing infection due to serotypes present in the vaccine. Immuniza tion against SARS-CoV-2 diminished contagion and severity of COVID-19 remarkably. The acellular vaccine for Bordetella pertussis is not on the schedule for all adults, even when vaccinating them strengthens the control of contagion in children. Double bacterial (diphtheria and tetanus), triple (double + pertussis), measles, varicella, rubella, HPV, Haemophilus influenzae, meningococcal, herpes zoster, Argentine hemorrhagic fever, and yellow fever vaccines are available, but their use is limited. New vaccines such as the one recently approved by the CDC against respiratory syncytial virus will soon be available.

Safety study of 23-valent pneumococcal polysaccharide vaccine in Hebei Province / 公共卫生与预防医学

Objective To analyze the occurrence characteristics of adverse events following immunization (AEFI) of 23-valent pneumococcal polysaccharide vaccine (PPSV-23) in Hebei Province and to evaluate the safety of the vaccine. Methods AEFI cases related to vaccination of PPSV-23 in Hebei Province from January 1, 2020 to December 31, 2022 were collected through the AEFI surveillance module of Chinese Center for Disease Control and Prevention Information System. The incidence of reported AEFI cases were then analyzed and compared. Results The reported incidence rate of AEFI of PPSV-23 was 56.12 /100,000 doses, and the incidence rate of adverse reactions was 55.50 /100 000 doses. The incidence rate of common adverse reactions was 53.94/100 000 doses, and the incidence rate of rare adverse reactions was 1.56/100 000 doses. Most of the reported AEFI cases caused by PPSV-23 were common adverse reactions, which occurred mainly within one day after vaccination, and the overall regression was positive. Conclusion The 23-valent pneumococcal polysaccharide vaccine used in Hebei Province is safe，but its safety monitoring still needs to be strengthened.

Evaluation of safety and efficacy of basic immunization with different sequential immunization programs of polio vaccine / 中国生物制品学杂志

@#Objective To evaluate the safety and efficacy of basic immunization with different sequential immunization programs of oral live attenuated poliomyelitis vaccine(OPV)and inactivated poliomyelitis vaccine(IPV). Methods Infants above two months of age residing in Pudong New Area,Shanghai,were selected for the study,and the basic immunization program of OPV full course(O-O-O group),sequential IPV and OPV(I-I-O group),and IPV full course(I-I-I group)were administered at 2,3 and 4 months of age,respectively. Relevant adverse reactions were proactively monitored by the parents of the participants via completing their own self-observation form after immunization. Before and after immunization,blood samples were collected from the upper arm vein,and the serum was separated. The neutralizing antibody levels of poliovirus in serum were measured by micro neutralization test,and the antibody positive rate and geometric mean titer(GMT)were calculated. Logistic multivariate regression analysis was used to research the effects of group,gender,household registration,birth mass and positive rate of typeⅠ/Ⅲ antibody before immunizationon the positive rate of type Ⅰ/Ⅲ antibody after basic immunization. Results There were one case of lethargy and one case of crying in O-O-O group, one case of lethargy in I-I-O group,and one case of crying in I-I-I group. The GMTs of type I neutralizing antibody in the pre-immunization O-O-O group,I-I-O group,and I-I-I group were 41. 39,8. 21,and 12. 56,and those of type Ⅲ neutralizing antibody were 7. 57,4. 02 and 8. 08,respectively. There was no significant difference in GMT between groups for typeⅠandⅢneutralizing antibodies before immunization(F = 2. 815 and 0. 608,P = 0. 061 and 0. 545,respectively). The positive rates of type Ⅰ antibody before immunization were 24. 04%,34. 07% and 41. 00%,respectively,with significant difference between groups(χ~2= 13. 459,P = 0. 001). The positive rates of type Ⅲ antibody were 13. 94%,9. 89% and 18. 00%,respectively,with no significant difference(χ~2= 5. 188,P = 0. 075). After immunization,the GMTs of type Ⅰ neutralizing antibody were 1 311. 84,1 812. 59 and 833. 24,and those of type Ⅲ neutralizing antibody were 911. 97,1 752. 68 and 419. 50,respectively,with significant differences between groups(F = 76. 848 and 202. 632,respectively,each P < 0. 001). After immunization,the positive conversion rates of type Ⅰantibody were 98. 56%,100% and 100%,and those of type Ⅲ antibody were 99. 04%,100% and 99. 44%,respectively,with no significant difference between the two groups(χ~2= 2. 973 and 1. 045,P = 0. 122 and 0. 789,respectively). In addition,group,gender,household registration,birth mass and positive rate of typeⅠ/Ⅲantibody before immunization had no effect on the positive conversion rate of typeⅠ/Ⅲantibody after basic immunization. Conclusion All three sequential immunization programs achieved good safety and high antibody positive conversion rates after basic immunization.

Surveillance of adverse events following immunization in Shaanxi Province,2010-2021 / 中国生物制品学杂志

@#Objective To analyze the surveillance quality and characteristics of adverse events following immunization(AEFIs)in Shaanxi Province,from 2010 to 2021.Methods The vaccine doses administered data and AEFI data reported from 2010 to 2021 in Shaanxi Province were collected through the National Immunization Program Information Management System and AEFI information management system,and descriptive epidemiological methods were used for analysis.Results A total of 24 057 AEFIs were reported from 2010 to 2021 in Shaanxi Province.The average annual reported incidence of AEFI in 2014-2021 was 18.998 per 100 000 doses,with 17.998,0.702,and 0.112 per 100 000 doses for common vaccine reactions,rare vaccine reactions,and serious rare vaccine reactions,respectively.The incidence of AEFI was high from May to August,with an average of 26.304 per 100 000 doses.There were 69.83% of the cases reported by the children younger than 1 year old.In Expanded Program on Immunization vaccines,the incidence of AEFI in DTaP(diphtheria,tetanus and acellular pertussis combined vaccine)was the highest(57.948 per 100 000 doses),and the incidence of rare vaccine reactions in MR,MMR and MM(measles and rubella vaccine,measles mumps and rubella vaccine,measles and mumps combined vaccine)was the highest(1.875 per 100 000 doses).In non-Expanded Program on Immunization vaccines,the incidence of AEFI in DTaP-Hib(diphtheria,tetanus and acellular pertussis,inactivated poliomyelitis and haemophilus influenzae type b conjugate combined vaccine)was the highest(37.073 per 100 000 doses),and the incidence of rare vaccine reactions in MPV-ACYW135(group A,C,Y and W123 meningococcal polysaccharide vaccine)was the highest(2.392 per 100 000 doses).In common vaccine reactions,the fever/local redness and swelling/local induration were the main clinical diagnosis(22.481 per 100 000 doses).In rare vaccine reactions,allergic rash was the main clinical diagnosis(0.473 per 100 000 doses).Conclusion The sensitivity of AEFI surveillance system in Shaanxi Province is increasing year by year,and the vaccines have good safety,with common vaccine reactions as the main ones and serious rare vaccine reactions as the rare ones.There were differences in AEFI surveillance levels in different prefecture-level cities,so it is still necessary to strengthen the training.

Surveillance of adverse event following immunization with 13-valent pneumococcal polysaccharide conjugate vaccine in Jiaxing City / 预防医学

Objective@#To investigate the incidence of adverse event following immunization (AEFI) with 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) in Jiaxing City, Zhejiang Province, so as to provide insights into safety monitoring and evaluation of PCV13.@*Methods@#Surveillance data of AEFI with PCV13 in Jiaxing City from 2020 to 2022 were collected from the AEFI Monitoring Information Management System of the Immunization Planning System of Chinese Disease Prevention and Control Information System, including demographic information, vaccination time, time of AEFI occurrence and clinical symptoms, and the reported incidence, population and district distribution, and clinical symptoms of AEFI with PCV13 were descriptively analyzed.@*Results@#Totally 455 cases of AEFI with PCV13 were reported in Jiaxing City from 2020 to 2022, with a reported incidence rate of 232.33/105 doses. There were 431, 21 and 3 cases of general, abnormal, coincidence and psychogenic reactions, with reported incidence rates of 220.07/105 doses, 10.72/105 doses and 1.53/105 doses, respectively, and no reports of causal reaction, vaccine quality accident and vaccination accident. The AEFI cases included 258 boys and 197 girls, with a boy/girl ratio of 1.31∶1, and 288 children at ages of less than a year (63.30%). The largest number of AEFI was reported in Haining City (87 cases, 19.12%), and there were 349 AEFI cases (76.70%) within 24 hours following vaccination. The clinical symptoms mainly included redness and swelling, fever and induration, with reported incidence rates of 132.76/105 doses (260 cases), 109.27/105 doses (214 cases), and 55.66/105 doses (109 cases), respectively. There were 450 cases cured and 5 cases improved in 455 cases of AEFI.@*Conclusions@#General reaction is the predominant AEFI in Jiaxing City from 2020 to 2022, with mild symptoms. Most AEFI occurs within 24 hours following vaccination, and has a good prognosis.

Temporal trends in vaccination coverage in the first year of life in Brazil / Tendência temporal das coberturas vacinais no primeiro ano de vida no Brasil

ABSTRACT Objective: The aim of this study was to analyze the temporal trends in vaccination coverage (VC) during the first year of life of children in Brazil. Methods: Data on VC for the first year of life from 2011 to 2020 for Bacille Calmette-Guerin (BCG), hepatitis B, polio, pentavalent, and triple viral vaccines at the national, regional, and state levels were obtained from the Information System of the National Immunization Program. Trends were analyzed using Prais-Winsten generalized linear regression models and average annual percent change (APC) estimates. Results: Decreasing trends were observed for the BCG (APC −3.58%; p<0.05), pentavalent (APC −4.10%; p<0.05), polio (APC −2.76%; p<0.05), and triple viral (APC −2.56%; p<0.05) vaccines in the country. Hepatitis B vaccine was the only vaccine that displayed stationary behavior (APC −4.22%; p>0.05). During the study period, no increasing trends were observed in any territory or vaccine. Conclusions: This study shows a recent significant reduction and decreasing trends in VC during the first year of life of children in Brazil, indicating the need for interventions to curb this ongoing phenomenon and to recover acceptable VC rates in the country.

RESUMO Objetivo: Analisar a tendência temporal da cobertura vacinal (CV) em crianças com idade menor ou igual a um ano no Brasil. Métodos: Foram empregados dados da CV no primeiro ano de vida de 2011 a 2020 referentes às vacinas BCG, hepatite B, poliomielite, pentavalente e tríplice viral, obtidos do Sistema de Informação do Programa Nacional de Imunizações (SI-PNI). Os dados estão agregados em nível nacional, regional e estadual. Para a análise de tendência foi utilizado o modelo de regressão linear generalizado de Prais-Winsten e foi calculada a variação percentual média anual (APC). Resultados: As tendências de CV para as vacinas BCG (APC −3,58%; p<0,05), pentavalente (APC −4,10%; p<0,05), poliomielite (APC −2,76%; p<0,05) e tríplice viral (APC −2,56%; p<0,05) foram decrescentes no país. Apenas para a CV da vacina contra hepatite B foi identificado comportamento estacionário (APC −4,22%; p>0,05). Nenhum território ou vacina apresentou tendência crescente para cobertura vacinal no período estudado no Brasil. Conclusões: Este estudo alerta sobre a redução expressiva das CV no primeiro ano de vida nos últimos anos no Brasil e sua tendência decrescente, sendo imperativa a adoção de intervenções com o fim de frear o fenômeno em curso e de resgatar níveis aceitáveis de CV no país.

Ranking de los programas de vacunación en América Latina, 2020 / 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 vaccination 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 coverage 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.

Modelos de agendamento e o acesso a imunização na atenção primária a saúde / Appointment models and access to immunization in primary health care / Modelos de cita y acceso a inmunización en atención primaria de salud

A Atenção Primária à Saúde é caracterizada como a porta de entrada preferencial do sistema de saúde com território adscrito. Desta forma, deve prover ações de promoção, prevenção e reabilitação da saúde. Sendo assim, a escassez de investigações sobre o acesso à saúde e a imunização levanta questões sobre como os modelos de agendamento impactam a disponibilidade e a acessibilidade das vacinas. Trata-se de um estudo reflexivo conduzido no período de junho a agosto de 2023. O estudo tem como base a análise discursiva das orientações do Ministério da Saúde, assim como a aceitabilidade, satisfação e, consequentemente, adesão à vacinação por parte dos usuários. A pesquisa originou-se a partir das provocações e debates realizados pelo Grupo de Pesquisa "Abordagens Tecnológicas no Cuidado à Saúde e Promoção da Saúde" da Escola de Enfermagem da Universidade de São Paulo (EEUSP). Está dividido em três seções que abordam os principais pontos de reflexão. O estudo considerou que é notável que a maneira como o usuário é recebido e tratado pelo sistema influencia diretamente a aceitabilidade, satisfação e, consequentemente, adesão à vacinação. Portanto, ao escolher e planejar o método de agendamento do serviço de saúde, as particularidades da área de vacinação devem ser consideradas, contemplando a demanda espontânea e a abordagem e controle do usuário.

Primary Health Care is characterized as the preferred gateway to the health system with an assigned territory. In this way, it must provide health promotion, prevention and rehabilitation actions. Therefore, the scarcity of research on access to healthcare and immunization raises questions about how scheduling models impact the availability and accessibility of vaccines. This is a reflective study conducted from June to August 2023. The study is based on the discursive analysis of the Ministry of Health's guidelines, as well as the acceptability, satisfaction and, consequently, adherence to vaccination by users. The research originated from the provocations and debates carried out by the Research Group "Technological Approaches in Health Care and Health Promotion" at the School of Nursing of the University of São Paulo (EEUSP). It is divided into three sections that address the main points of reflection. The study considered that it is notable that the way the user is received and treated by the system directly influences acceptability, satisfaction and, consequently, adherence to vaccination. Therefore, when choosing and planning the health service scheduling method, the particularities of the vaccination area must be considered, considering spontaneous demand and user approach and control.

La Atención Primaria de Salud se caracteriza por ser la puerta de entrada preferente al sistema de salud con un territorio asignado. De esta manera, debe brindar acciones de promoción, prevención y rehabilitación de la salud. Por lo tanto, la escasez de investigaciones sobre el acceso a la atención sanitaria y la inmunización plantea interrogantes sobre cómo los modelos de programación afectan la disponibilidad y accesibilidad de las vacunas. Se trata de un estudio reflexivo realizado de junio a agosto de 2023. El estudio se basa en el análisis discursivo de las directrices del Ministerio de Salud, así como de la aceptabilidad, satisfacción y, en consecuencia, adherencia a la vacunación por parte de los usuarios. La investigación surgió de las provocaciones y debates realizados por el Grupo de Investigación "Enfoques Tecnológicos en Atención y Promoción de la Salud" de la Escuela de Enfermería de la Universidad de São Paulo (EEUSP). Se divide en tres apartados que abordan los principales puntos de reflexión. El estudio consideró que se destaca que la forma en que el usuario es recibido y tratado por el sistema influye directamente en la aceptabilidad, satisfacción y, en consecuencia, en la adherencia a la vacunación. Por lo tanto, en la elección y planificación del método de programación de los servicios de salud se deben considerar las particularidades del área de vacunación, considerando la demanda espontánea y el abordaje y control de los usuarios.

Determinantes del estado de vacunación infantil: abordando la brecha de equidad en República Dominicana-2019 / Determinants of childhood immunization status: addressing the equity gap in the Dominican Republic­2019

Introducción: Las desigualdades amenazan el progreso del país hacia la equidad y la cobertura de vacunación infantil. Siendo la cobertura inferior a la meta del 90% de la Organización Mundial de la Salud. Objetivo: Identificar los determinantes sociales y las desigualdades en el estado de vacunación infantil en República Dominicana, 2019. Métodos: Se realiza un análisis basado en la Encuesta de Indicadores Múltiples por Conglomerados. Incluyendo una muestra ponderada de 1674 niños de 12-23 meses. Se calcula la regresión logística multinomial para identificar factores asociados a la vacunación. Adoptando p<0,05 para significación estadística. Utilizando una razón de probabilidades ajustada con intervalo de confianza del 95%. Empleando HEAT 4.0 para medir desigualdades y SPSS.23 para gestión y análisis de datos. Resultados: La edad media de los niños fue 17,4±3,5 meses. El 33% de ellos estaban completamente vacunados. La cobertura fue significativamente menor entre hijos de madre sin educación [AOR= 7,27; IC95%= 2,98­17,74]. La mayor cobertura se concentra en niños con altos niveles de educación y riqueza. Conclusión: Para lograr una cobertura de vacunación completa y equitativa, las intervenciones de salud pública deben diseñarse para satisfacer las necesidades de grupos de alto riesgo.

Introduction: In the Dominican Republic, inequalities threaten progress towards childhood vaccination equity and coverage, the latter being inferior to the World Health Organization's 90% goal. Objective: Identify the social determinants and inequalities in the state of childhood vaccination in the Dominican Republic, 2019. Methods: An analysis based on the Multiple Indicator Cluster Surveys is conducted. Including a weighted sample of 1674 children aged 12-23 months. The multinomial logistic regression is calculated to identify factors associated with vaccination. Using p<0,05 for statistical significance and an adjusted probability ratio with a 95% confidence interval. Employing HEAT 4.0 to measure inequalities and SPSS.23 for data management and analysis. Results: The children's mean age was 17,4±3,5 months. 33% of them were completely vaccinated. Coverage was significantly lower in children of mothers without education [AOR= 7,27; CI95%= 2,98­17,74]. Coverage was the highest in kids with high levels of education and wealth. Conclusion: To achieve complete and equitable vaccine coverage, public health interventions should be designed to satisfy the needs of high-risk groups.

Oportunidades de abordagens sobre imunização durante o atendimento à demanda espontânea / Opportunities for immunization approaches when meeting spontaneous demand / Oportunidades para enfoques de inmunización al satisfacer la demanda espontánea

Tendo em vista o papel importante que os enfermeiros desempenham no processo de vacinação, o objetivo do presente estudo foi examinar a perspectiva desses profissionais em duas Unidades Básicas de Saúde (UBSs), que utilizam diferentes modelos de agendamento (Carve-Out e Acesso Avançado), com relação a como aproveitar as oportunidades de discutir a imunização durante o atendimento aos usuários que procuram ajuda sem agendamento prévio. Para realizar a comparação entre as unidades, foram utilizados dados secundários dos relatórios do Sistema de Informação do Programa Nacional de Imunizações e do e-SUS AB, no período de janeiro a dezembro de 2019. Foram realizadas entrevistas semiestruturadas com os enfermeiros dessas unidades sendo utilizada a Matriz SWOT para análise do ambiente interno. Com relação à escuta inicial, pode-se observar uma superioridade da UBS que segue o modelo de Acesso Avançado, porém não houve diferenças significativas quanto ao quantitativo de imunizações. A estratégia para diminuir as Oportunidades Perdidas de Vacinação (OPVs) mais citada, foi a abordagem do usuário no momento da procura na "demanda espontânea". No entanto, foi evidenciada como barreira a falta da caderneta de vacinação, já que o usuário não estaria na unidade para essa demanda e o pouco tempo disponível. Não houve diferenças significativas entre a percepção dos enfermeiros atuantes nos diferentes modelos de agendamento, Carve-Out e Acesso Avançado, no que se refere a oportunizar abordagens sobre imunização durante o atendimento à demanda espontânea.

Considering the important role that nurses play in the vaccination process, the objective of the present study was to examine the perspective of these professionals in two Basic Health Units (UBSs), which use different scheduling models (Carve-Out and Advanced Access), regarding how to take advantage of opportunities to discuss immunization during care for users who seek help without prior scheduling. To carry out the comparison between the units, secondary data from reports from the Information System of the National Immunization Program and e-SUS AB were used, from January to December 2019. Semi-structured interviews were carried out with nurses from these units. The SWOT Matrix for analyzing the internal environment. Regarding initial listening, we can observe the superiority of the UBS that follows the Advanced Access model, but there were no significant differences in terms of the number of immunizations. The most cited strategy to reduce Missed Vaccination Opportunities (OPVs) was the user approach when searching for "spontaneous demand". However, the lack of a vaccination booklet was highlighted as a barrier, as the user would not be at the unit for this demand and there was little time available. There were no significant differences between the perception of nurses working in the different scheduling models, Carve-Out and Advanced Access, with regard to providing opportunities for approaches to immunization when meeting spontaneous demand.

Considerando el importante papel que desempeña el enfermero en el proceso de vacunación, el objetivo del presente estudio fue examinar la perspectiva de estos profesionales en dos Unidades Básicas de Salud (UBS), que utilizan diferentes modelos de programación (Carve-Out y Acceso Avanzado), respecto a cómo aprovechar oportunidades para discutir sobre inmunización durante la atención a usuarios que buscan ayuda sin programación previa. Para realizar la comparación entre las unidades, se utilizaron datos secundarios de los informes del Sistema de Información del Programa Nacional de Inmunizaciones y del e-SUS AB, de enero a diciembre de 2019. Se realizaron entrevistas semiestructuradas a enfermeros de estas unidades. Matriz FODA para el análisis del entorno interno. En cuanto a la escucha inicial, se observa la superioridad de la UBS que sigue el modelo de Acceso Avanzado, pero no hubo diferencias significativas en cuanto al número de inmunizaciones. La estrategia más citada para reducir las Oportunidades de Vacunación Perdidas (OPV) fue el enfoque del usuario al buscar "demanda espontánea". Sin embargo, se destacó como una barrera la falta de cartilla de vacunación, ya que el usuario no estaría en la unidad para esta demanda y había poco tiempo disponible. No hubo diferencias significativas entre la percepción de las enfermeras que trabajan en los diferentes modelos de programación, Carve-Out y Advanced Access, con respecto a brindar oportunidades de enfoques de inmunización cuando se satisface la demanda espontánea.

Imunização da gestante em tempos de pandemia da COVID-19 / Inmunización de mujeres embarazadas en tiempos de pandemia de COVID-19 / Immunization of pregnant women in times of the COVID-19 pandemic

Objetivo: analisar e comparar a imunização de gestantes no período da pandemia da COVID-19 no Oeste do Paraná. Método: pesquisa analítica e transversal, realizada na nona e décima regionais de saúde do Paraná. Participaram 823 puérperas, a coleta de dados foi conduzida por inquérito e informações do prontuário entre setembro a dezembro de 2021. Utilizaram-se análise descritiva e teste de qui-quadrado com nível significância de 5%. Resultados: a nona regional apresentou melhor desempenho na imunização contra Hepatite-B, Influenza, Difteria, Tétano e Coqueluche em comparação à décima regional. A vacinação contra COVID-19 teve baixa adesão em ambas as regionais, cujos motivos foram: medo, opção própria, orientação médica e desejo de esperar o filho nascer. Conclusão: são necessárias novas estratégias e campanhas de sensibilização para aumentar o índice vacinal entre gestantes, sobretudo para a vacina contra COVID-19, considerando as complicações para a saúde materno-infantil.

Objective: analyze and compare the immunization of pregnant women during the COVID-19 pandemic in western Paraná. Method: this is an analytical, cross-sectional study carried out in the ninth and tenth regional health departments of Paraná. A total of 823 puerperal women took part, and data was collected using a survey and information from medical records between September and December 2021. Descriptive analysis and the chi-square test were used, with a significance level of 5%. Results: the ninth region performed better in immunization against Hepatitis-B, Influenza, Diphtheria, Tetanus and Pertussis compared to the tenth region. Vaccination against COVID-19 had low uptake in both regions, the reasons for which were: fear, own choice, medical advice and the wish to wait for the child to be born. Conclusion: new strategies and awareness campaigns are needed to increase the vaccination rate among pregnant women, especially for the COVID-19 vaccine, considering the complications for maternal and child health.

Objetivo: analizar y comparar la inmunización de mujeres embarazadas durante la pandemia de COVID-19 en el Oeste de Paraná. Método: investigación analítica y transversal, realizada en la novena y décima región sanitaria de Paraná. Participaron 823 puérperas. La recolección de datos se realizó mediante encuesta e información de historias clínicas entre septiembre y diciembre de 2021. Se utilizó análisis descriptivo y prueba de chi cuadrado con un nivel de significancia del 5%. Resultados: la novena región presentó mejor desempeño en inmunización contra Hepatitis B, Influenza, Difteria, Tétanos y Tos Ferina en comparación con la décima región. La vacunación contra la COVID-19 tuvo baja adherencia en ambas regiones y los motivos fueron: miedo, elección personal, consejo médico y deseo de esperar a que nazca el niño. Conclusión: son necesarias nuevas estrategias y campañas de sensibilización para aumentar la tasa de vacunación entre las mujeres embarazadas, especialmente de la vacuna contra la COVID-19, considerando las complicaciones para la salud materna e infantil.

Recomendaciones actualizadas para la vacunación de adultos con enfermedades respiratorias Asociación Argentina de Medicina Respiratoria, 2023 / Updated recommendations for vaccination in adults with respiratory diseases Argentine Association of Respiratory Medicine, 2023

Resumen Los adultos fumadores con comorbilidades, y los ancianos, corren mayor riesgo de contraer infecciones y sus complicaciones. Las infecciones respiratorias comu nitarias por virus, neumococo y otras bacterias afectan tanto a adultos sanos como enfermos. Existen vacunas que el neumonólogo debe conocer y prescribir. Las ce pas blanco de la vacuna contra influenza son definidas por la OMS para el hemisferio sur considerando a las implicadas en la temporada precedente de influenza en el hemisferio norte. Su efectividad depende de la virulencia, la concordancia entre las cepas circulantes y las vacunales y la cobertura de la población. La vacuna anti-neumocócica polisacárida disponible desde 1983 está siendo reemplazada por vacunas conjugadas más eficaces para prevenir infecciones relacionadas a sero tipos presentes en las mismas. La inmunización contra SARS-CoV-2 redujo el contagio, la gravedad y la letalidad de COVID-19. La vacuna acelular contra Bordetella pertussis para adultos está presente para situaciones puntuales en el calendario para adultos, vacunarlos fortalece el control del contagio infantil. Las vacunas doble bacte riana (difteria + tétanos), y triple (doble + pertussis), y contra sarampión, varicela, rubeola, virus del papiloma humano, Haemophylus influenzae, meningococo, herpes zóster, fiebre hemorrágica argentina y fiebre amarilla, son de uso más limitado. Pronto contaremos con nuevas vacunas, como la recientemente aprobada por la FDA contra el virus sincicial respiratorio. Revisamos a través de un consenso de expertos en infecciones respiratorias las nuevas evidencias acerca de la inmunización de adultos que consultan al neumonólogo, y actualizamos así las recomendaciones sobre vacunación realizadas ocho años atrás.

Abstract Adult smokers, those with comorbidities, and the elderly, are at greater risk of contracting infections and their complications. Community acquired respiratory infections due to viruses, pneumococcus and other bac teria, affect both healthy and sick adults. There are vac cines that the pulmonologist must know and prescribe. The target strains of the influenza vaccine are defined by the WHO for the Southern hemisphere considering those involved in the previous influenza season in the Northern hemisphere. Its effectiveness depends on virulence, concordance between circulating and vaccine strains, and population coverage. The anti-pneumococcal polysaccharide vaccine available since 1983 is being replaced by more effective conjugate vaccines to pre vent infections related to serotypes present in them. Immunization against SARS-CoV-2 reduced the conta gion, severity, and lethality of COVID-19. The acellular vaccine against Bordetella pertussis for adults is present for specific situations in the adult calendar; vaccinating them strengthens the control of childhood contagion. The double (diphtheria + tetanus), and triple (double + pertussis) bacterial vaccines, and the vaccines against measles, chickenpox, rubella, human papillomavirus, Haemophilus influenzae, meningococcus, herpes zoster, Argentine hemorrhagic fever and yellow fever, are of a more limited use. Soon we will have new vaccines such as the one recently approved by the FDA against respi ratory syncytial virus. Through a consensus of experts in respiratory infections, we review the new evidence regarding the immunization of adults who consult a pulmonologist, and thus update the recommendations on vaccination made eight years ago.