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Objetivo: analisar o cenário de vacinação contra Covid-19 na população privada de liberdade em um estado do Nordeste brasileiro. Método: estudo do tipo observacional e ecológico, com os dados extraídos do Sistema de informações penitenciário brasileiro e dos boletins publicados pelo Conselho Nacional de Justiça, referentes a outubro de 2021 a junho de 2022, submetidos à análise estatística descritiva, por meio de frequências absolutas e relativas. Resultados: verificou-se que, entre 4.345 pessoas privadas de liberdade com a primeira dose de vacinação contra Covid-19, apenas 573 possuíam a segnda dose e nenhuma a terceira dose. Conclusão: evidenciou-se que, apesar da vacinação ser um benefício, ainda é um grande desafio para ser implementada para a população privada de liberdade, visto que, mesmo sendo considerados grupos prioritários, o acesso a esse direito foi prejudicado para esses indivíduos.
Objective: to analyze the Covid-19 vaccination scenario in the population deprived of liberty in a state in the Brazilian Northeast. Method: observational and ecological study, with data extracted from the Brazilian Penitentiary Information System and the bulletins published by the National Council of Justice, referring to October 2021 to June 2022, submitted to descriptive statistical analysis, using absolute and relative frequencies. Results: it was found that of the 4,345 people deprived of their liberty who had received the first dose of Covid-19 vaccination, only 573 had received the second dose and none had received the third dose. Conclusion: it was evident that, although vaccination is a benefit, it is still a major challenge to implement it for the population deprived of their liberty, since even though they are considered priority groups, access to this right has been hampered for these individuals.
Objetivo: analizar el escenario de vacunación contra el Covid-19 en la población privada de libertad en un estado del Nordeste brasileño. Método: estudio observacional y ecológico, con datos extraídos del Sistema de Información Penitenciaria de Brasil y boletines publicados por el Consejo Nacional de Justicia, correspondientes al periodo entre octubre de 2021 y junio de 2022, sometidos a análisis estadístico descriptivo, utilizando frecuencias absolutas y relativas. Resultados: se encontró que, de las 4.345 personas privadas de libertad con la primera dosis de la vacuna contra el Covid-19, solo 573 contaban con la segunda dosis y ninguna tenía la tercera dosis. Conclusión: se observó que, pese a que la vacunación es un beneficio, sigue siendo un gran desafío implementarla para la población privada de libertad, ya que, si bien se los consideran grupos prioritarios, el acceso a este derecho se vio afectado para estos individuos.
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Introducción. En la adolescencia, se comienzan a tomar decisiones autónomas sobre la salud. En la vacunación intervienen dimensiones contextuales, grupales y relativas a cada vacuna. Se busca conocer el proceso de información, confianza y decisión de vacunarse contra COVID-19 en adolescentes usuarios de un centro de salud en Buenos Aires. Objetivos. Identificar ámbitos y canales a través de los cuales los adolescentes accedieron a información sobre la vacuna contra COVID-19 en un centro de salud de Buenos Aires. Describir sus opiniones respecto a los distintos discursos sobre vacunación. Describir su participación en la vacunación contra COVID-19. Identificar barreras y facilitadores respecto del acceso a la vacunación contra COVID-19 en esta población. Población y métodos. Investigación cualitativa. Se hicieron entrevistas semiestructuradas a adolescentes usuarios del efector. La muestra fue heterogénea; su tamaño se definió por saturación teórica. Se realizó un análisis temático de los datos. Resultados. Se realizaron 14 entrevistas. Los entrevistados recibieron información sobre la vacuna contra COVID-19 de sus familias, la televisión y las redes sociales. Todos recibieron tanto publicidad oficial como discursos reticentes a la vacunación. Analizaron la información recibida y formaron opinión autónoma. Su decisión sobre vacunarse no siempre fue respetada. La desconfianza, la baja percepción del riesgo, el temor a las inyecciones, las barreras administrativas y geográficas fueron motivos de no vacunación. Conclusiones. Se requieren estrategias de comunicación destinadas a adolescentes que promuevan su participación en el acceso a la vacunación.
Introduction. During adolescence, individuals start to make autonomous decisions about their health. Vaccination involves contextual, group, and vaccine-specific dimensions. We sought to know the information, trust, and decision to receive the COVID-19 vaccine among adolescents who attended a healthcare center in Buenos Aires. Objectives. To identify settings and channels through which adolescents accessed information about the COVID-19 vaccine at a healthcare center in Buenos Aires. To describe their opinions about the different statements on vaccination. To describe their participation in COVID-19 vaccination. To identify barriers and facilitators to COVID-19 vaccination in this population. Population and methods. Qualitative study. Semi-structured interviews with adolescents who attended this healthcare facility. The sample was heterogeneous; the sample size was estimated by theoretical saturation. A thematic analysis of data was done. Results. A total of 14 interviews were conducted. Interviewees obtained information about the COVID-19 vaccine from their families, TV, and social media. All received information from both official campaigns and anti-vaccine communications. They analyzed the information they received and formed their own opinion. Their decision about the vaccine was not always respected. Hesitancy, a low perception of risk, fear of needles, administrative and geographic barriers were reasons for not receiving the vaccine. Conclusions. Communication strategies targeted at adolescents are required that encourage their involvement in access to vaccination.
Subject(s)
Humans , Male , Female , Adolescent , Trust , Qualitative Research , COVID-19 Vaccines/administration & dosage , Argentina , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Interviews as Topic , Vaccination/psychology , Vaccination/statistics & numerical data , Decision Making , COVID-19/prevention & control , Vaccination Hesitancy/psychology , Vaccination Hesitancy/statistics & numerical data , Health Facilities , Health Services AccessibilityABSTRACT
Introducción: Las infecciones respiratorias son las enfermedades respiratorias con mayor mortalidad en el mundo. Las causadas por Streptococcus pneumoniae, virus de influenza, Bordetella pertussis, SARS-CoV-2 y el Virus Sincitial Respiratorio, cuentan hoy día con vacunas seguras y efectivas. Este documento representa una guía de práctica clínica (GPC) de la Asociación Latinoamericana de Tórax (ALAT), elaborada por iniciativa de los departamentos de enfermedades infecciosas y pediatría, con el objetivo de establecer recomendaciones sobre vacunas respiratorias, utilizando la evidencia disponible. Método: Se estableció un grupo de desarrollo de las guías conformado por cinco médicos responsables globales del proyecto, se crearon cinco subgrupos de trabajo, uno por cada vacuna, con expertos neumólogos de adulto, pediatras e infectólogos invitados, que generaron preguntas clínicas. Se trabajó con un grupo de expertos metodólogos que transformaron preguntas clínicas en preguntas PICO, seleccionándose nueve preguntas por método DELPHI. Luego, se utilizó el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation) para evaluar la evidencia disponible. Resultados: Se obtuvieron recomendaciones para población adulta y pediátrica de las vacunas de neumococo, influenza, tos ferina, COVID-19 y Virus Respiratorio Sincitial basadas en preguntas PICO. También se agregaron recomendaciones basadas en preguntas narrativas relacionadas al uso de vacunas respiratorias en población con enfermedades respiratorias crónicas como asma, EPOC y fibrosis pulmonar.
Introduction: Respiratory infections are the leading cause of respiratory disease-related mortality worldwide. Infections caused by Streptococcus pneumoniae, influenza virus, Bordetella pertussis, SARS-CoV-2 and Respiratory Syncytial Virus (RSV) now have safe and effective vaccines available.This document represents a Clinical Practice Guideline (CPG) by the Latin American Thoracic Association (ALAT), developed through the initiative of the departments of in-fectious diseases and pediatrics, with the goal of establishing recommendations on respiratory vaccines using the available evidence. Method: A guideline development group was established, composed of five lead physicians responsible for the overall project. Five working subgroups were created, one for each vaccine, involving invited experts in adult pulmonology, pediatrics, and infectious diseases, who formulated clinical questions. A group of expert methodologists then transformed these clinical questions into PICO questions, with nine questions selected using the DELPHI method. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was then used to assess the available evidence. Results: Recommendations were obtained for the adult and pediatric populations for pneumococcal, influenza, pertussis, COVID-19 and Respiratory Syncytial Virus vaccines based on PICO questions. Additionally, recommendations based on narrative questions related to the use of respiratory vaccines in populations with chronic respiratory diseases such as asthma, COPD, and pulmonary fibrosis were included.
Subject(s)
Humans , Respiratory Tract Infections/prevention & control , Influenza Vaccines , Pertussis Vaccine , Pneumococcal Vaccines , Respiratory Syncytial Virus Vaccines , COVID-19 Vaccines , Comorbidity , Morbidity , Mortality , Delphi Technique , Immunization/methods , GRADE Approach/methodsABSTRACT
INTRODUCTION: During the SARS-CoV-2 pandemic, immune-mediated neurological events have been described in patients vaccinated against the virus or who have overcome the disease. Among these events is Idiopathic peripheral facial palsy or Bell's palsy. OBJECTIVES: To study the incidence of Bell's Palsy in the ENT emergency department of a tertiary hospital in Catalonia during the SARS-CoV-2 pandemic. METHODS: Retrospective historical cohort comparison study of patients diagnosed with Bell's palsy between January 2018 and December 2021. Crude incidence rates were calculated as the total number of events divided by person time at risk per 100.000 person-years. Observed (2020, 2021) and historical (2018, 2019) rates were compared using standardized incidence rates with corresponding 95% confidence intervals. RESULTS: Of the total number of ENT emergency department visits from 2018 to 2021 (22.658), there were 247 cases of Bell's palsy. The incidence rate of Bell's palsy in the pre-pandemic group was 12,2 and 10,9 per 100.000 person-years for 2018 and 2019, respectively. The 2020 standardized incidence rate of Bell's palsy was 0,70 [95% CI 0,49-1,01] and 1,25 [95% CI 0,93-1,67] for 2021. No significant differences were evident between the two groups. CONCLUSION: In our cohort, no association was found between vaccination or COVID-19 infection and the development of Bell's Palsy.
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La pandemia de COVID-19 demostró que las políticas públicas relacionadas con la propiedad intelectual y el derecho de la competencia no fueron adecuadas o suficientemente articuladas para permitir el acceso oportuno de la población a las vacunas de manera equitativa, debido a distorsiones en su fabricación, distribución y venta cuando éstas estuvieron disponibles durante la pandemia. Esta investigación tiene como objetivo analizar, desde una perspectiva jurídica, si los problemas observados se originan en una inadecuada aplicación de la legislación que regula la propiedad intelectual y su relación con otras políticas públicas vinculadas a la competencia, o, eventualmente, en el ejercicio abusivo de tales derechos, y que, como consecuencia, distorsionaría el proceso de competencia en los mercados nacionales y regionales.
The COVID 19 pandemic demonstrated that public policies related to intellectual property and competition law were not adequate or sufficiently articulated to allow timely access to vaccines in an equitable manner, due to distortions in the manufacture, distribution, and sale of COVID-19 vaccines when they were available during the pandemic. This research aims to analyze, from a legal perspective, whether the observed problems originate in an inadequate application of intellectual property legislation and its relationship with other public policies related to competition, or, eventually, in the abusive exercise of such rights, which, as a consequence, would distort the process of competition in national and regional markets.
A pandemia de COVID 19 demostrou que as políticas públicas relacionadas com a propriedade intelectual e o direito de competência não foram adequados ou suficientemente articulados para permitir o acesso oportuno da população às vacinas de maneira equitativa, devido a distorções na fabricação, distribuição e venda de vacinas COVID-19, quando estavam disponíveis durante a pandemia. Esta investigação tem como objetivo analizar, desde uma perspectiva jurídica, se os problemas observados se originam em uma inadequada aplicação da legislação que regula a propriedade intelectual e sua relação com outras políticas públicas vinculadas à competência ou, eventualmente, no exercício abusivo de tais direitos, e que, como consequência, distorceria o processo de competência nos mercados nacionais e regionais.
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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.
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INTRODUCTION: Almost 281 million people were living in a foreign country in 2022, and more than 100 million were displaced because of war conflicts and human right violations. Vaccination coverage of infectious diseases in migrants from some disadvantaged settings could be lower than reception countries populations, consequently seroprevalence studies and better access to vaccination could contribute to reducing these differences. METHODS: A descriptive retrospective cross-sectional study was conducted including migrants, living ≤5 years in the reception country and ≥16 years old, who requested a medical exam between January 1st, 2020 and January 31st, 2021. Seroprevalence assessment was performed, and vaccination was offered to those individuals without immunity to hepatitis B, hepatitis A, varicella, measles, mumps, and rubella. RESULTS: A total of 315 migrants were attended during the study period. Immunity protection at arrival was 252/296 (85.1%) for measles, 274/295 (92.9%) for rubella, 257/296 (86.8%) for mumps, 264/295 (89.5%) for varicella, 267/313 (85.3%) for hepatitis A, and 104/300 (34.6%) for hepatitis B. The final immunity protection after full vaccination schedules was 278/296 (93.9%) for measles, 287/295 (97.3%) for rubella, 274/296 (92.6%) for mumps, 276/295 (93.6%) for varicella, 280/313 (89.5%) for hepatitis A, and 139/300 (46.3%) for hepatitis B. CONCLUSIONS: The vaccination intervention has increased immunity rates for the studied diseases in the attended migrants in our center, however, such interventions should be maintained to reach local population immunization levels. Moreover, the collaboration between shelter and reference specialized health centers is fundamental to implement such vaccination programs.
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Con el fin de proteger la salud de la población y con el propósito de establecer procedimientos técnicos para la disposición final de medicamentos, vacunas, insumos y productos químicos peligrosos, deteriorados y vencidos, se ha identificado la necesidad de actualizar estos lineamientos técnicos. que describen los procedimientos para los diferentes niveles del Ministerio de Salud, para la disposición final de medicamentos, vacunas y otros químicos que se hayan deteriorado y caducado, causados ââpor situaciones de emergencia, desastres, o que se hayan acumulado por situaciones de dificultad en el proceso administrativo, para lo cual se han analizado los diferentes escenarios de intervención para realizar una disposición segura, según lo establecido en la Ley del Ministerio de Medio Ambiente y Recursos Naturales. MARN
In order to protect the health of the population and with the purpose of establishing technical procedures for the final disposal of dangerous, deteriorated and expired medicines, vaccines, supplies and chemicals, the need to update these technical guidelines has been identified. which describe the procedures for the different levels of the Ministry of Health, for the final disposal of medicines, vaccines and other chemicals that have deteriorated and expired, caused by emergency situations, disasters, or have accumulated due to situations of difficulty in the administrative process., for which the different intervention scenarios have been analyzed to make a safe disposal, as established in the Law of the Ministry of Environment and Natural Resources. MARN
Subject(s)
Terminal Disposal of Chemical Waste , Pharmaceutical Raw Material , El SalvadorABSTRACT
Objetivo: Identificar estratégias utilizadas para a gestão de imunobiológicos e as limitações para a adesão às vacinas pelos trabalhadores da área da saúde. Métodos: Revisão integrativa que selecionou publicações em cinco bases de dados, utilizando a estratégia PICo, no período de 2016 a 2020. Utilizou-se os softwares Endnote X5 e Rayyan para identificação de documentos duplicados e cegamento dos avaliadores. Resultados: Totalizaram 15 artigos, dos quais um foi classificado com grau de recomendação alto e 10 artigos com nível de evidência 4, em relação ao delineamento, foram encontrados sete estudos transversais. Constatou-se que 14 (93,3%) abordaram o imunobiológico contra o vírus Influenza. Os estudos foram agrupados em duas categorias para melhor organização das estratégias de gestão e das limitações na adesão às vacinas pelos trabalhadores da saúde. Conclusão: Observou-se como um fator concordante nos diversos estudos para superar as barreiras da hesitação vacinal é importante intensificar as campanhas de comunicação e divulgação, focadas em ações de educação em saúde. Tais estratégias podem ser difundidas e replicadas em diferentes contextos dos serviços de saúde ocupacional. Este estudo contribui para avançar e fortalecer a utilização de estratégias para o gerenciamento de vacinação na saúde do trabalhador. (AU)
Objective: The aim of the study was to identify vaccine management strategies and barriers of adherence to vaccination among healthcare workers. Methods: An Integrative Review was conducted using five databases. The selection of the studies that had been published from the years 2016 to 2020 was based on the PICo strategy. To allow blinded evaluation and exclude duplicate references, the softwares Endnote and Rayyan were used. Results: 15 articles were selected. One was classified as having a high degree of recommendation and 10 other studies received level of evidence 4. Regarding design, seven studies were cross-sectional. 14 of the total (93.3%) addressed Influenza vaccines. The studies were split in two categories: management strategies and barriers of adherence to vaccination among healthcare workers. Conclusion: Several studies agreed that, in order to overcome barriers of adherence to vaccination among healthcare workers, it is important to intensify strategies and campaigns focused on communicating and disseminating health education. Those strategies can be disseminated and replicated in different contexts of occupational health services. This study contributes to advancing and strengthening the use of occupational vaccination management strategies. (AU)
Objetivo: Identificar las estrategias utilizadas para la gestión de inmunobiológicos y las limitaciones para la adherencia a las vacunas por trabajadores de la salud. Métodos: Revisión integradora que seleccionó publicaciones en cinco bases de datos, utilizando la estrategia PICo, en el período de 2016 a 2020. Se utilizó el software Endnote X5 y Rayyan para identificar documentos duplicados y cegar a los evaluadores. Resultados: Un total de 15 artículos, uno de los cuales fue clasificado como de alto grado de recomendación y 10 artículos con nivel de evidencia 4, en relación al diseño, se encontraron siete estudios transversales. Se encontró que 14 (93,3%) abordaron la inmunobiología frente al virus Influenza. Los estudios se agruparon en dos categorías para una mejor organización de las estrategias de gestión y las limitaciones en la adherencia a las vacunas por parte de los trabajadores de la salud. Conclusión: Se observó como factor de concordancia en varios estudios para superar las barreras de la vacilación vacunal, es importante intensificar las campañas de comunicación y difusión, enfocadas en acciones de educación en salud. Estas estrategias pueden difundirse y replicarse en diferentes contextos de los servicios de salud ocupacional. Este estudio contribuye a avanzar y fortalecer el uso de estrategias de gestión de la vacunación en la salud del trabajador. (AU)
Subject(s)
Vaccination Coverage , Occupational Health Program , Vaccines , Nursing , Humanization of AssistanceABSTRACT
Objetivo: Avaliar os fatores associados à adesão à vacina contra hepatite B em gestantes expostas à sífilis. Métodos: Trata-se de uma pesquisa analítica, com abordagem quantitativa, realizada em uma capital do nordeste brasileiro. Participaram gestantes com diagnóstico de sífilis. Utilizou-se um instrumento previamente validado para coleta de dados. A pesquisa atendeu os aspectos éticos. Resultados: Do total de 73 participantes, 43,8% estavam no primeiro trimestre, 53,4% com faixa etária de 26 a 38 anos, 80,8% casadas ou em união estável, 57,5% com menos de 12 anos de estudos, 94,5% não brancas, 61,7% sem renda. À adesão à vacina contra hepatite B foi verificada em 57 gestantes (78%). E teve associação com escolaridade (p= 0,057) e ter um trabalho remunerado (p= 0,028). Conclusão: À adesão à vacinação contra Hepatite B foi elevada quando comparada com populações chaves, contudo abaixo da meta proposta pelo ministério da saúde. Gestantes mais esclarecidas e que tinha alguma remuneração iniciaram o prénatal no primeiro trimestre e tiveram maior adesão a vacina. Recomenda-se aproveitar oportunidades para atualização do cartão vacinal. (AU)
Objective: To evaluate the factors associated with adherence to the hepatitis B vaccine in pregnant women exposed to syphilis. Methods: This is analytical research, with a quantitative approach, carried out in a capital city in northeastern Brazil. Pregnant women diagnosed with syphilis participated. A previously validated instrument was used for data collection. The research met the ethical aspects. Results: Of the total of 73 participants, 43.8% were in the first trimester, 53.4% were aged between 26 and 38 years, 80.8% were married or in a stable relationship, 57.5% had less than 12 years of schooling, 94.5% non-white, 61.7% without income. Adherence to the hepatitis B vaccine was verified in 57 pregnant women (78%). And it was associated with schooling (p=0.057) and having a paid job (p=0.028). Conclusion: Hepatitis B vaccination adherence was high when compared to key populations, but below the target proposed by the Ministry of Health. More informed pregnant women who had some remuneration started prenatal care in the first trimester and had greater adherence to the vaccine. It is recommended to take advantage of opportunities to update the vaccination card. (AU)
Objetivo: Evaluar los factores asociados a la adherencia a la vacuna contra la hepatitis B en gestantes expuestas a sífilis. Métodos: Se trata de una investigación analítica, con enfoque cuantitativo, realizada en una ciudad capital del noreste de Brasil. Participaron mujeres embarazadas con diagnóstico de sífilis. Para la recolección de datos se utilizó un instrumento previamente validado. La investigación cumplió con los aspectos éticos. Resultados: Del total de 73 participantes, el 43,8 % se encontraba en el primer trimestre, el 53,4 % tenía entre 26 y 38 años, el 80,8 % estaba casado o en relación estable, el 57,5 % tenía menos de 12 años de escolaridad, el 94,5 % no -blanco, 61,7% sin ingresos. Se verificó la adherencia a la vacuna contra la hepatitis B en 57 gestantes (78%). Y se asoció con la escolaridad (p=0,057) y tener trabajo remunerado (p=0,028). Conclusión: La adherencia a la vacunación contra la Hepatitis B fue alta en comparación con las poblaciones clave, pero por debajo de la meta propuesta por el Ministerio de Salud. Las gestantes más informadas y con algún ingreso económico iniciaron el control prenatal en el primer trimestre y tuvieron mayor adherencia a la vacuna. Se recomienda aprovechar las oportunidades para actualizar el carné de vacunación. (AU)
Subject(s)
Hepatitis B Vaccines , Syphilis , Pregnant WomenABSTRACT
La vacunación ha sido tradicionalmente una de las actividades de prevención primaria a la que mayor esfuerzo se ha dedicado en las instituciones penitenciarias españolas. Una vez más, la pandemia de coronavirus de tipo 2 causante del síndrome respiratorio agudo severo (SARS-CoV-2) ha puesto de manifiesto la importancia de la vacunación en el control de las enfermedades inmunoprevenibles. Tras superar la emergencia sanitaria provocada por la enfermedad del coronavirus de 2019 (COVID-19), tenemos por delante el reto de recuperar las coberturas vacunales que teníamos antes de la pandemia, además de aumentar las de otras vacunas con menor implantación en nuestro medio. Entre las estrategias de mejora que se deben implementar, estaría la optimización de la transmisión de la información sanitaria entre centros penitenciarios dependientes de diferentes administraciones. También sería deseable poder acceder a los sistemas de información sobre vacunas de las diferentes comunidades autónomas, tanto para conocer el estado vacunal de los pacientes como para notificar las dosis administradas durante el periodo de internamiento, así como mejorar las estadísticas vacunales disponibles en prisión.(AU)
Vaccination has traditionally been one of the primary prevention activities to which most effort has been devoted in Spanish penitentiary institutions. Once again, the type 2 coronavirus pandemic causing severe acute respiratory syndrome (SARS-CoV-2) pandemic has highlighted the importance of vaccination in the control of immunopreventable diseases.After overcoming the health emergency caused by the coronavirus disease 2019 (COVID-19), we face the challenge of recovering the vaccination coverage we had before the pandemic, in addition to increasing the coverage of other vaccines with lesser implantation in our environment. Among the improvement strategies to be implemented would be the optimization of the transmission of health information between penitentiary centers dependent on different administrations. It would also be desirable to be able to access the vaccine information systems of the different autonomous communities, both to know the vaccination status of patients and to report the doses administered during the period of internment, as well as to improve the vaccine statistics available in prison.(AU)
Subject(s)
Humans , Male , Female , Public Health , Prisons/organization & administration , Vaccination Coverage , Vaccination , VaccinesABSTRACT
Respiratory syncytial virus (RSV) is a major public health problem that has undergone significant changes in recent years. First of all, it has become easier to diagnose with highly reliable and rapidly available confirmatory tests. This has led to a better understanding of its epidemiology and RSV has gone from being a disease of the pediatric age group, severe only in infants and immunosuppressed children, to being a common disease in people of all ages, particularly important in patients of advanced age or with immunosuppressive diseases. Recent therapeutic and prophylactic advances, both with long-lasting monoclonal antibodies and vaccines, are another reason for satisfaction. For these reasons, the COVID and Emerging Pathogens Committee of the Illustrious Official College of Physicians of Madrid (ICOMEM) has considered it pertinent to review this subject in the light of new knowledge and new resources for dealing with this infection. We have formulated a series of questions that we believe will be of interest not only to members of the College but also to any non-expert in this subject, with a particular focus on the situation of RSV infection in Spain. (AU)
El Virus Respiratorio Sincitial (VRS), es un problema de salud pública de primera magnitud que en años recientes ha experimentado cambios muy importantes. En primer lugar, se ha producido una mayor facilidad diagnóstica con pruebas confirmatorias altamente fiables y rápidamente disponibles. Esto ha permitido conocer mejor su epidemiología y VRS ha pasado de ser una enfermedad de la edad pediátrica, grave sólo en lactantes y niños inmunodeprimidos, a ser una enfermedad común en personas de toda edad, particularmente importante en pacientes de edades avanzadas o con enfermedades que inmunodeprimen. Los avances terapéuticos y profilácticos, recientes, tanto con anticuerpos monoclonales de larga duración como con vacunas, constituyen otro motivo de satisfacción. Por estos motivos, el Comité de COVID y de patógenos emergentes del Ilustre Colegio Oficial de Médicos de Madrid (ICOMEM) ha considerado pertinente revisar este tema, a la luz de los nuevos conocimientos y de los nuevos recursos para afrontar esta infección. Hemos formulado una serie de preguntas que creemos de interés no sólo para los colegiados si no para cualquier persona no experta en este tema, con una vista particular en la situación de la infección por VRS en España. (AU)
Subject(s)
Humans , Viruses , Pneumonia , Vaccines , Antibodies, Monoclonal , Ribavirin , Antibodies , Immunocompromised Host , SpainABSTRACT
La respuesta a las vacunas durante el embarazo puede ser variable, sin embargo, no tenemos evidencia de un descenso en la efectividad de estas. Además, el efecto protector de las vacunas durante el embarazo ha sido documentado desde hace más de un siglo. Las embarazadas son vulnerables a las infecciones por el virus de la gripe, presentando mayores tasas de morbilidad y mortalidad. Es recomendada la vacunación antigripal con vacuna inactivada no ayudada, preferentemente tetravalente, a todas las embarazadas en cualquier trimestre de gestación. La infección por Bordetella Pertussis y especialmente en los menores de 3 meses es de gran riesgo. La vacunación durante el embarazo tiene como objetivos la protección del neonato durante los primeros meses de vida, mediante la transferencia pasiva de anticuerpos y evitar que la mujer adquiera la tosferina y contagie al neonato. El embarazo es un factor de riesgo para una mayor gravedad de la infección por SARS-CoV-2, por lo tanto, las embarazadas constituyen un grupo prioritario para la vacunación. La vacuna se debe ofrecer a las embarazadas igual que al resto de la población, ya que los beneficios de su administración muy probablemente superen los riesgos de padecer la infección. Es especialmente importante ofrecerla a las gestantes con comorbilidades. Toda mujer embarazada debe ser asesorada sobre la importancia y beneficios de la vacunación en ellas y sus hijos. Hoy día están indicadas las vacunas contra influenza, la vacuna TDaP y la vacuna contra COVID-19. (provisto por Infomedic International)
The response to vaccines during pregnancy can be variable, however, we have no evidence of a decrease in their effectiveness. Furthermore, the protective effect of vaccines during pregnancy has been documented for more than a century. Pregnant women are vulnerable to influenza virus infections, presenting higher morbidity and mortality rates. Influenza vaccination with a non-adjuvanted inactivated vaccine, preferably quadrivalent, is recommended for all pregnant women in any trimester of pregnancy. Infection by Bordetella Pertussis, especially in children under 3 months of age, is of great risk. Vaccination during pregnancy aims to protect the newborn during the first months of life, through the passive transfer of antibodies and to prevent the woman from acquiring whooping cough and infecting the newborn. Pregnancy is a risk factor for greater severity of SARS-CoV-2 infection, therefore, pregnant women constitute a priority group for vaccination. The vaccine should be offered to pregnant women just as it is to the rest of the population, since the benefits of its administration most likely outweigh the risks of suffering from the infection. It is especially important to offer it to pregnant women with comorbidities. Every pregnant woman should be advised about the importance and benefits of vaccination for herself and her children. Today influenza vaccines, the TDaP vaccine and the COVID-19 vaccine are indicated. (provided by Infomedic International)
ABSTRACT
O objetivo deste estudo foi relatar a experiência do desenvolvimento de uma proposta de educação continuada executada pela equipe de enfermagem com agentes comunitários de saúde (ACS), considerando como foco a vacinação infantil. Trata-se de um relato de experiência elaborado e vivenciado por enfermeiro e acadêmico de enfermagem em novembro de 2019, com a participação de duas equipes pertencentes a uma Unidade Básica de Saúde do município de Arapiraca (AL). Através da metodologia de ensino da problematização por meio do Arco de Maguerez, foram realizadas oficinas e ações educativas para os ACS, a partir das necessidades relatadas por esses profissionais em relação à vacinação infantil. Tais atividades proporcionaram maior aproximação com a realidade vivenciada por quem ocupa a posição de educador e incentivador do cuidado da saúde durante a visita domiciliar. Além disso, enfatizaram a importância do enfermeiro enquanto responsável pela educação continuada da equipe. Verificou-se ainda que o diálogo aberto e horizontal, de modo empático, proporcionou a construção de uma ferramenta eficaz, de fácil manuseio e de baixo custo, que gerou uma melhor memorização e segurança não somente para os ACS nas visitas domiciliares, mas também nas atividades de outros profissionais atuantes no campo da promoção da saúde infantil.
This study reports the experience of developing an educational product based on continued education carried out by a nursing team with community health agents (CHA) considering childhood vaccination as the focus. This is an experience report that was prepared and experienced by a nurse and nursing student in November 2019, with the participation of two teams belonging to a basic health unit in the municipality of Arapiraca, Alagoas, Brazil. Using the problematization teaching methodology by Arco de Marguerez, workshops and educational actions were carried out for the CHA based on the needs they reported regarding childhood vaccination, which provided a greater approximation with the reality experienced by those in the position of educators and encouragers of health care during home visits. Furthermore, it emphasized the importance of nurses as responsible for the team's continuing education. It was also verified that open and horizontal dialogue empathetically provided the construction of an effective, easy to use, low cost tool, bringing better memorization and safety not only for community agents during home visits but also in activities from other professionals working in the field of child health promotion.
El objetivo de este estudio fue reportar la experiencia de desarrollo de una propuesta de educación continua realizada por el equipo de enfermería con agentes comunitarios de salud (ACS), considerando como enfoque la vacunación infantil. Este es un reporte de experiencia elaborado y vivido por un enfermero y un estudiante de enfermería en noviembre de 2019, con la participación de dos equipos de una unidad básica de salud de la ciudad de Arapiraca, Brasil. Utilizando la metodología de enseñanza de problematización del Arco de Maguerez, se realizaron talleres y acciones educativas para ACS a partir de las necesidades reportadas por estos profesionales con relación a la vacunación infantil. Estas actividades proporcionaron una mayor aproximación a la realidad vivida por quienes ocupan la posición de educador y motivador del cuidado de la salud durante la visita domiciliaria. Además, destacaron la importancia del enfermero como responsable de la formación continua del equipo. También se constató que el diálogo abierto y horizontal, de manera empática, propició la construcción de una herramienta efectiva, fácil de usar y de bajo costo, que generó una mejor memorización y seguridad no solo para los ACS durante las visitas domiciliarias, sino también en las actividades de otros profesionales que trabajan en el campo de la promoción de la salud infantil.
Subject(s)
Humans , Child , Immunization ProgramsABSTRACT
Conclusiones de los autores del estudio: la vacuna de proteína F prefusión contra el virus respiratorio sincitial, administrada a embarazadas en el último trimestre de embarazo, previene de infecciones respiratorias graves por dicho virus en sus lactantes, sin efectos adversos de importancia. Comentario de los revisores: la vacuna parece eficaz y segura, aunque las estimaciones de eficacia son imprecisas. Constituye una opción preventiva alternativa a la administración de nirsevimab en el recién nacido, con expectativas de impacto equiparables. (AU)
Authors´ conclusions: prefusion F protein vaccine against respiratory syncytial virus administered to pregnant women in the last trimester of pregnancy prevents this virus severe respiratory infections in their infants, without important adverse effects. Reviewers´ commentary: the vaccine appears effective and safe, although its efficacy estimates are imprecise. It constitutes an alternative preventive option to the administration of nirsevimab in the newborn, with comparable impact expectations. (AU)
Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Bronchiolitis/prevention & control , Respiratory Syncytial Virus Infections/prevention & controlABSTRACT
Al cumplirse sesenta años desde el inicio de la campaña de vacunación frente a la poliomielitis en España, se destaca el importante hito en el control de la enfermedad que ha supuesto el cambio desde una incidencia de más de 2.000 casos anuales en la década de los 60 a una ausencia mantenida de poliovirus (PV) salvaje desde 1988. A pesar del impacto negativo observado en las coberturas de vacunación de poliomielitis al inicio de la pandemia de COVID-19, estas se fueron recuperando, alcanzando un 98,2% en la primovacunación en 2022. En la última década, se han identificado dos elementos esenciales para mantener el objetivo de eliminación de la poliomielitis y que, además, refuerzan la importancia de mantener altas coberturas de vacunación: los sistemas de vigilancia epidemiológica robustos y la respuesta rápida a las alertas para proteger a la población vulnerable y evitar la circulación del virus. Es crucial interrumpir la transmisión a nivel internacional para lograr la erradicación, manteniendo una vigilancia continua de alta calidad y una coordinación efectiva entre los diferentes niveles frente a cualquier detección de PV, ya sea salvaje o derivado de la vacuna.(AU)
On the 60th anniversary of the initiation of the polio vaccination campaign in Spain, the significant milestone in achieving disease control is highlighted. There has been a shift from an incidence of over 2,000 yearly cases in the 1960s to a sustained absence of wild poliovirus (WPV) since 1988. Despite the observed negative impact on polio vaccination coverage at the onset of the COVID-19 pan-demic, these rates gradually recovered, reaching 98.2% in primary vaccination in 2022. Over the past decade, two essential elements have been identified to maintain the goal of polio elimination and that reinforces the importance of sustaining high vaccination co-verage: robust epidemiological surveillance systems and a swift response to alerts to protect the vulnerable population and prevent virus reintroduction. In order to achieve eradication, it is crucial to interrupt international transmission and maintain continuous high-quality surveillance and effective coordination across different levels in response to any detection of PV, wild or vaccine derived.This article aimed to provide a comprehensive view of the polio eradication situation in Spain, focusing on the key events that occu-rred in the last decade and the present and future challenges.(AU)
Subject(s)
Humans , Male , Female , Disease Eradication , Poliomyelitis/immunology , Vaccines , Immunization Programs , Poliovirus Vaccines , Spain , Public Health , Disease PreventionABSTRACT
Considerando-se a crescente importância do YouTube como fonte para busca de informações em saúde, o objetivo deste trabalho é analisar os fatores associados a um maior número de visualizações de vídeos sobre vacinas contra a covid-19. Para isso, usaram-se técnicas de Processamento de Linguagem Natural e modelagem estatística com base em 13.619 vídeos, abrangendo três tipos de variáveis: métricas gerais, conteúdo textual dos títulos e informações sobre os participantes dos vídeos. Entre os resultados, destacam-se os vídeos de duração média ou longa, postados durante a madrugada e nos fins de semana, com tags, descrição e títulos curtos, além de elementos controversos e presença de figuras masculinas e brancas em miniaturas. Os achados contribuem para uma melhor compreensão dos possíveis fatores a serem considerados na produção de conteúdo de comunicação em saúde sobre vacinas no YouTube.
Considering the growing importance of YouTube as a source for health information search, the aim of this study was to analyze the factors associated with a higher number of views in videos about covid-19 vaccines. For this purpose, Natural Language Processing techniques and statistical modeling were employed based on 13,619 videos, encompassing three types of variables: general metrics, textual content of titles, and information about the participants in the videos. Among the results, videos of medium or long duration, posted during late hours and on weekends, with tags, descriptions, and short titles, along with controversial elements and the presence of male and white figures in thumbnails stand out. These findings contribute to a better understanding of the potential factors to be considered in the production of health communication content about vaccines on YouTube.
Teniendo en cuenta la creciente importancia de YouTube como fuente de búsqueda de información en salud, el objetivo de este artículo es analizar los factores asociados a un mayor número de visualizaciones en videos sobre vacunas contra el covid-19. Para eso, se emplearon técnicas de Procesamiento del Lenguaje Natural y modelado estadístico basadas en 13,619 videos, que abarcan tres tipos de variables: métricas generales, contenido textual de títulos y información sobre los participantes en los videos. Entre los resultados, destacan los videos de duración media o larga, publicados durante altas horas de la noche y los fines de semana, con tags, descripciones y títulos cortos, junto con elementos controvertidos y la presencia de figuras masculinas y blancas en las miniaturas. Estos hallazgos contribuyen a una mejor comprensión de los posibles factores a tener en cuenta en la producción de contenido de comunicación de salud sobre vacunas en YouTube.
Subject(s)
Communications Media , Information Dissemination , Health Communication , Social Media , COVID-19 Vaccines , COVID-19 , Health Education , Access to Information , Disinformation , Mass MediaABSTRACT
Background and Objectives: Since its appearance in 2019, multiple risk factors have been identified for presenting a severe form of COVID-19 and different vaccines have also been developed to prevent severe manifestations. However, despite a vaccination history, some cases progress to complications or even death. The objective of this study was to determine the strength of the association between the severity of COVID-19 and the history of vaccination in patients treated at a public reference hospital in Mexico City. Methods: This was a non-experimental, retrospective, and analytical epidemiological study of cases and controls. The study population was people treated at a concentration hospital for COVID-19 care between July 1, 2021, and June 30, 2022, in Mexico City. Results: 132 participants (44 cases and 88 controls) were included in the study. The risk factors most strongly associated with COVID-19 severity were age greater than or equal to 60 years, presenting 22 breaths per minute at the first medical evaluation, systolic blood pressure greater than or equal to 140 millimeters of mercury, and a history of at least one chronic comorbidity. However, vaccination history was associated with 94% (OR 0.06) lower odds of developing severe COVID-19 compared to those without a history of vaccination, regardless of the presence of associated risk factors. Conclusion: Lacking a history of vaccination and presenting any of the identified risk factors confer higher odds of developing severe forms of the disease.(AU)
Justificativa e Objetivos: Desde o seu aparecimento em 2019, foram identificados múltiplos fatores de risco para a apresentação de uma forma grave de COVID-19 e foram desenvolvidas diferentes vacinas para prevenir o aparecimento de manifestações graves. No entanto, apesar de um histórico de vacinação, alguns casos podem evoluir para complicações ou mesmo para a morte. O objetivo deste estudo foi determinar a força de associação entre a gravidade da COVID-19 e o histórico de vacinação em pacientes atendidos em um hospital público de referência na Cidade do México. Métodos: Estudo epidemiológico não-experimental, retrospectivo e analítico, de casos e controles. A população do estudo foram indivíduos atendidos em um hospital de concentração para atendimento à COVID-19 entre 1 de julho de 2021 e 30 de junho de 2022, na Cidade do México. Resultados: 132 participantes (44 casos e 88 controles) foram incluídos no estudo. Os fatores de risco mais fortemente associados à gravidade da COVID-19 foram idade superior ou igual a 60 anos, apresentar 22 respirações por minuto na primeira avaliação médica, pressão arterial sistólica superior ou igual a 140 milímetros de mercúrio e histórico de pelo menos uma comorbidade crônica. No entanto, histórico de vacinação foi associado a uma probabilidade 94% (OR 0,06) menor de desenvolver COVID-19 grave em comparação com aqueles sem histórico de vacinação, independentemente da presença de fatores de risco associados. Conclusão: A ausência de histórico de vacinação e a presença de algum dos fatores de risco identificados conferem maiores probabilidades de desenvolver formas graves da doença.(AU)
Justificación y Objetivos: Desde su aparición en 2019, se han identificado múltiples factores de riesgo para presentar una forma grave de COVID-19 y también se han desarrollado distintas vacunas que previenen la aparición de manifestaciones de gravedad. Sin embargo, a pesar del antecedente de vacunación, algunos casos se complican o incluso fallecen. El objetivo del este estudio fue determinar la fuerza de asociación entre la gravedad de la COVID-19 con el antecedente de vacunación en pacientes atendidos en un hospital público de referencia de la Ciudad de México. Métodos: Estudio epidemiológico no experimental, retrospectivo y analítico, de casos y controles. La población de estudio fueron personas atendidas en un hospital de concentración para la atención de COVID-19 entre el 1 de julio de 2021 y el 30 de junio de 2022 en la Ciudad de México. Resultados: 132 participantes (44 casos y 88 controles) fueron incluidos en el estudio. Los factores de riesgo más fuertemente asociados con la gravedad de la COVID-19 fueron la edad mayor o igual a 60 años, presentar 22 respiraciones por minuto en la primera valoración médica, tensión arterial sistólica mayor o igual a 140 milímetros de mercurio y el antecedente de al menos una comorbilidad crónica. No obstante, el antecedente de vacunación se asoció con 94% (RM 0.06) menos posibilidades de desarrollar COVID-19 grave con respecto a aquellos sin antecedente vacunal, independientemente de la presencia de los factores de riesgo asociados. Conclusión: carecer del antecedente de vacunación y presentar alguno de los factores de riesgo identificados confieren las mayores posibilidades de presentar formas graves de la enfermedad.(AU)
Subject(s)
Public Health , Mass Vaccination , Vaccination , Patient Acuity , COVID-19 Vaccines , COVID-19/complicationsABSTRACT
Objetivos: estudiar los efectos secundarios y el riesgo de exacerbación de la en-fermedad después de la vacunación COVID-19 en una muestra de pacientes con lupus eritematoso sistémico (LES). Materiales y métodos: estudio retrospectivo que investigó 101 pacientes con LES. Se determinó la actividad de la enfermedad mediante el Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) antes y después de dos dosis de la vacuna contra el SARS-COv-2. Se registraron los efectos secundarios después de la vacunación. Resultados: los pacientes que recibieron dos dosis de la misma vacuna fue-ron el 10,3% para CoronaVAc, el 42,2% para Pfizer y el 47,3% para AstraZeneca. Se detectaron efectos secundarios en el 76,2% y la mayoría fue leve/moderado. Los más frecuentes fueron: dolor local (62,3%), cefalea (36,6%) y fatiga (34,6%). El cambio en la mediana del SLEDAI antes de la primera dosis y después de la segunda no fue estadísticamente significativo (p=0,68). Solo el 4,1% de los individuos aumentó el SLEDAI ≥ de 3 puntos. Conclusiones: la vacunación contra la COVID-19 fue bien tolerada y segura en pacientes con LES.
Objectives: to study the side effects and the risk of disease flare after COVID-19 vaccination in Brazilian patients with Systemic Lupus erythematosus (SLE). Materials and methods: this retrospective study investigated a sample of 101 SLE patients for disease activity through the SLE disease activity index (SLEDAI) prior to and after two vaccine doses against SARS-COv-2. Side effects after vaccination were recorded. Results: in this sample, patients receiving two doses of the same vaccine were 10.3% for CoronaVAc; 42.2% for Pfizer, and 47.3% for AstraZeneca. Side effects were detected in 76.2% of them, and most of them were mild and moderate; the most common were local pain (62.3%), headache (36.6%), and fatigue (34.6%). The SLEDAI prior to the first dose and after the second dose did not change significantly (p=0.68). Only 4.1% of individuals had increased in SLEDAI ≥than 3 points. Conclusions: vaccination against COVID-19 was well tolerated and safe in SLE patients
ABSTRACT
Despite having emerged from pandemic status, the incidence of COVID-19 episodes has recently increased in Spain, including pediatric cases and admissions to Intensive Care Units. Several recombinant variants are circulating among us, particularly XBB arising from two Omicron BA.2 sublineages with mutations in the genes encoding the spicule proteins that could increase binding to the ACE2 receptor and be more prone to immune escape. Faced with these, 3 pharmaceutical companies have developed vaccines adapted to the XBB.1.5 sublineage that are already available for administration in our setting with risks that should not be different from those of previous mRNA vaccines and with clearly favorable benefit/risk ratios. They should be applied to patients with potential for poor COVID-19 evolution and to collectives that have a particular relationship of proximity with them. Their application should be understood not only from a perspective of individual convenience but also from that of collective responsibility. The most convenient seems to be a simultaneous immunization of COVID-19 and influenza in our environment. In the therapeutic aspect, there is little to expect right now from antisera, but the already known antiviral drugs are still available and indicated, although their efficacy will have to be reevaluated due to their impact on populations that are mostly immunized and with a better prognosis than in the past. In our opinion, it is necessary to continue to make a reasonable and timely use of masks and other non-pharmacological means of protection. (AU)
Pese a haber salido de la situación de pandemia, la incidencia de episodios de COVID-19 ha aumentado recientemente en España, incluidos los casos pediátricos y los ingresos en Unidades de Cuidados Intensivos. Circulan entre nosotros diversas variantes recombinantes, particularmente la XBB surgidas de dos sublinajes Omicron BA.2 con mutaciones en los genes que codifican las proteínas de la espícula y que pudieran aumentar la unión al receptor ACE2 y ser más propensas al escape inmune. Frente a ellas, 3 empresas farmacéuticas han elaborado vacunas adaptadas al sublinaje XBB.1.5 que ya se encuentran disponibles para su administración en nuestro medio con riesgos que no deben ser diferentes a los de las vacunas mRNA previas y con relaciones beneficio/riesgos claramente favorables. Deben aplicarse a pacientes con potencial de mala evolución de COVID-19 y a los colectivos que tienen una particular relación de proximidad con ellos. Su aplicación debe ser entendida no sólo desde una perspectiva de conveniencia individual sino desde la de la responsabilidad colectiva. Lo más conveniente parece hacer una inmunización simultánea de COVID-19 y gripe en nuestro medio. En el aspecto terapéutico hay poco que esperar ahora mismo de los antisueros pero siguen estando disponibles e indicados los fármacos antivirales ya conocidos aunque su eficacia tendrá que reevaluarse por su impacto en poblaciones mayoritariamente inmunizadas y con pronóstico mejor que las de tiempos pasados. A nuestro juicio, es necesario seguir haciendo un uso razonable y puntual de mascarillas y otros medios no farmacológicos de protección. (AU)