READ-ing antimicrobial stewardship in the Caribbean: a tri-nation document review.

Objective: To explore the antimicrobial stewardship policy landscape in three English-speaking Caribbean countries (Barbados, Guyana, and Saint Lucia) and examine the key enablers and challenges to the design and implementation of formal antimicrobial stewardship programs. Methods: A document analysis that searched for existing policy, communications, and contributions on antimicrobial stewardship from these three countries, adapting the READ (Ready materials; Extract data; Analyze data; Distill findings) approach, a systematic procedure for health policy document review. Results: The search strategy identified 726 initial records. Of those, 15 (2%) met the inclusion criteria. The analysis included official policy documents (n = 3), scholarly works/reviews (n = 3), advocacy documents (n = 2), news articles (n = 4), and confidential reports (n = 3) from the three countries. Conclusions: Critical matters such as cross-programmatic coordination, the significance of individual action, and the need for bidirectional knowledge discourse are prominent in optimizing antimicrobial stewardship adaptation in these countries. CARICOM regional coordination has positively impacted the integration of infection prevention and control with antimicrobial stewardship across this knowledge network.

READ-ing antimicrobial stewardship in the Caribbean: a tri-nation document review

[ABSTRACT]. Objective. To explore the antimicrobial stewardship policy landscape in three English-speaking Caribbean countries (Barbados, Guyana, and Saint Lucia) and examine the key enablers and challenges to the design and implementation of formal antimicrobial stewardship programs. Methods. A document analysis that searched for existing policy, communications, and contributions on antimicrobial stewardship from these three countries, adapting the READ (Ready materials; Extract data; Analyze data; Distill findings) approach, a systematic procedure for health policy document review. Results. The search strategy identified 726 initial records. Of those, 15 (2%) met the inclusion criteria. The analysis included official policy documents (n = 3), scholarly works/reviews (n = 3), advocacy documents (n = 2), news articles (n = 4), and confidential reports (n = 3) from the three countries. Conclusions. Critical matters such as cross-programmatic coordination, the significance of individual action, and the need for bidirectional knowledge discourse are prominent in optimizing antimicrobial stewardship adaptation in these countries. CARICOM regional coordination has positively impacted the integration of infection prevention and control with antimicrobial stewardship across this knowledge network.

[RESUMEN]. Objetivo. Explorar el panorama de las políticas de optimización del uso de antimicrobianos en tres países caribeños de habla inglesa (Barbados, Guyana y Santa Lucía) y examinar los principales facilitadores y desafíos para elaborar y aplicar programas formales de optimización del uso de antimicrobianos. Métodos. Se adaptó el método READ (acrónimo en inglés de "materiales listos; extraer los datos; analizar los datos; destilar los resultados"), un procedimiento sistemático para la revisión de documentos sobre políticas de salud, a fin de realizar un análisis de documentos que buscó las políticas, comunicaciones y contribu- ciones existentes sobre la optimización del uso de antimicrobianos en esos tres países. Resultados. La estrategia de búsqueda permitió localizar 726 documentos iniciales. De ellos, 15 (el 2%) cumplían los criterios de inclusión. El análisis abarcó documentos oficiales de políticas (n = 3), trabajos académicos o revisiones (n = 3), documentos de promoción de la causa (n = 2), artículos de noticias (n = 4) e informes confidenciales (n = 3) de los tres países. Conclusiones. Varios aspectos críticos, como la coordinación interprogramática, la importancia de la acción individual y la necesidad de una comunicación bidireccional del conocimiento, son preponderantes para adaptar de la mejor manera la optimización del uso de antimicrobianos en estos países. La coordinación regional de la CARICOM ha influido positivamente para integrar la prevención y el control de infecciones con la optimización del uso de antimicrobianos en toda esta red de conocimientos.

[RESUMO]. Objetivo. Explorar o cenário da política para uso racional de antibióticos em três países anglófonos do Caribe (Barbados, Guiana e Santa Lúcia) e examinar os principais fatores facilitadores e desafios para a elaboração e implementação de programas formais de uso racional de antibióticos. Métodos. Análise de documentos em busca de políticas, comunicações e contribuições existentes sobre o uso racional de antibióticos nesses três países, adaptando a abordagem READ (sigla em inglês para preparar materiais, extrair e analisar dados e destacar os principais achados), um procedimento sistemático para a revisão de documentos de políticas de saúde. Resultados. A estratégia de busca identificou 726 registros iniciais. Desses, 15 (2%) atenderam aos critérios de inclusão. A análise incluiu documentos oficiais de políticas (n = 3), trabalhos acadêmicos/revisões (n = 3), documentos em defesa da causa (n = 2), reportagens (n = 4) e relatórios confidenciais (n = 3) dos três países. Conclusões. Questões críticas, como a coordenação interprogramática, a importância da ação individual e a necessidade de um discurso bidirecional de conhecimento, se destacam na adaptação otimizada das diretrizes de uso racional de antibióticos nesses países. A coordenação regional da Comunidade do Caribe (CARICOM) contribuiu para integrar a prevenção e o controle de infecções ao uso racional de antibióticos em toda essa rede de conhecimento.

Driving multisectoral antimicrobial resistance action in South America: Lessons learned from implementing an enhanced tripartite AMR country self-assessment tool.

As part of an innovative Tripartite-EU collaboration Project that supports seven South American countries, a Landscape Analysis Tool (LAT) was developed and implemented to collect data to complement the Tripartite AMR Country Self-Assessment Survey (TrACSS) process. The LAT enables collection of broader and deeper information to guide development of priority One Health activities, and strengthen national action plans to combat antimicrobial resistance. The Project developed the tool, trained a consultant pool in its use, and implemented it in conjunction with multi-sectoral country teams. The main results were seven priority-informed country workplans that proposed specific activities in line with the Strategic Objectives of each country's national action plan. LAT implementation clearly showed that the tool is a strong complement to the TrACSS process and that there can be considerable benefit to the process of collecting additional data layers, especially to strengthen country ownership of AMR-related information and solidifying multisectoral engagement. Countries elsewhere might consider implementing this complementary tool - either once to establish a baseline - or periodically to gain a better ongoing understanding of the situation on the ground.

READ-ing antimicrobial stewardship in the Caribbean: a tri-nation document review / El método READ y la administración de antimicrobianos en el Caribe: una revisión trinacional de documentos / Uso racional de antibióticos no Caribe com base na abordagem READ: revisão de documentos de três países

ABSTRACT Objective. To explore the antimicrobial stewardship policy landscape in three English-speaking Caribbean countries (Barbados, Guyana, and Saint Lucia) and examine the key enablers and challenges to the design and implementation of formal antimicrobial stewardship programs. Methods. A document analysis that searched for existing policy, communications, and contributions on antimicrobial stewardship from these three countries, adapting the READ (Ready materials; Extract data; Analyze data; Distill findings) approach, a systematic procedure for health policy document review. Results. The search strategy identified 726 initial records. Of those, 15 (2%) met the inclusion criteria. The analysis included official policy documents (n = 3), scholarly works/reviews (n = 3), advocacy documents (n = 2), news articles (n = 4), and confidential reports (n = 3) from the three countries. Conclusions. Critical matters such as cross-programmatic coordination, the significance of individual action, and the need for bidirectional knowledge discourse are prominent in optimizing antimicrobial stewardship adaptation in these countries. CARICOM regional coordination has positively impacted the integration of infection prevention and control with antimicrobial stewardship across this knowledge network.

RESUMEN Objetivo. Explorar el panorama de las políticas de optimización del uso de antimicrobianos en tres países caribeños de habla inglesa (Barbados, Guyana y Santa Lucía) y examinar los principales facilitadores y desafíos para elaborar y aplicar programas formales de optimización del uso de antimicrobianos. Métodos. Se adaptó el método READ (acrónimo en inglés de "materiales listos; extraer los datos; analizar los datos; destilar los resultados"), un procedimiento sistemático para la revisión de documentos sobre políticas de salud, a fin de realizar un análisis de documentos que buscó las políticas, comunicaciones y contribuciones existentes sobre la optimización del uso de antimicrobianos en esos tres países. Resultados. La estrategia de búsqueda permitió localizar 726 documentos iniciales. De ellos, 15 (el 2%) cumplían los criterios de inclusión. El análisis abarcó documentos oficiales de políticas (n = 3), trabajos académicos o revisiones (n = 3), documentos de promoción de la causa (n = 2), artículos de noticias (n = 4) e informes confidenciales (n = 3) de los tres países. Conclusiones. Varios aspectos críticos, como la coordinación interprogramática, la importancia de la acción individual y la necesidad de una comunicación bidireccional del conocimiento, son preponderantes para adaptar de la mejor manera la optimización del uso de antimicrobianos en estos países. La coordinación regional de la CARICOM ha influido positivamente para integrar la prevención y el control de infecciones con la optimización del uso de antimicrobianos en toda esta red de conocimientos.

RESUMO Objetivo. Explorar o cenário da política para uso racional de antibióticos em três países anglófonos do Caribe (Barbados, Guiana e Santa Lúcia) e examinar os principais fatores facilitadores e desafios para a elaboração e implementação de programas formais de uso racional de antibióticos. Métodos. Análise de documentos em busca de políticas, comunicações e contribuições existentes sobre o uso racional de antibióticos nesses três países, adaptando a abordagem READ (sigla em inglês para preparar materiais, extrair e analisar dados e destacar os principais achados), um procedimento sistemático para a revisão de documentos de políticas de saúde. Resultados. A estratégia de busca identificou 726 registros iniciais. Desses, 15 (2%) atenderam aos critérios de inclusão. A análise incluiu documentos oficiais de políticas (n = 3), trabalhos acadêmicos/revisões (n = 3), documentos em defesa da causa (n = 2), reportagens (n = 4) e relatórios confidenciais (n = 3) dos três países. Conclusões. Questões críticas, como a coordenação interprogramática, a importância da ação individual e a necessidade de um discurso bidirecional de conhecimento, se destacam na adaptação otimizada das diretrizes de uso racional de antibióticos nesses países. A coordenação regional da Comunidade do Caribe (CARICOM) contribuiu para integrar a prevenção e o controle de infecções ao uso racional de antibióticos em toda essa rede de conhecimento.

Reporting on antibiotic use patterns using the WHO Access, Watch, Reserve classification in the Caribbean.

Objective: To assess antibiotic use in three hospitals in three Caribbean countries based on data from 2013 and 2018 using the World Health Organization Essential Medicines List "Access, Watch, Reserve" (AWaRe) classification. Methods: A retrospective observational study, which analyzed the World Health Organization Point Prevalence Survey data from three hospitals in three Caribbean countries, to examine proportional AWaRe group antibiotic use for the top ten inpatient indications. The Access-to-Watch ratio was calculated, and the top three antibiotics prescribed in each hospital were determined. Results: The final data set included 376 prescriptions for the top ten indications in 766 inpatients. The hospital antibiotic use point prevalence for Hospital 1 was 35.6%, Hospital 2 was 48.6%, and Hospital 3 was 47.1%. The Access-to-Watch ratio for the top ten indications was 2.45, 1.36, and 1.72 in the three hospitals. Access group prevalence was 71.0% in Hospital 1, 57.6% in Hospital 2, and 63.2% in Hospital 3. There were no Reserve antibiotics prescribed in any of the institutions. The most common indication for Watch prescription was skin and soft tissue infections in Hospital 1 and pneumonia in Hospital 2 and 3. Conclusions: This study draws urgent attention to evidence of a high proportion of Watch antibiotic prescribing and lack of Reserve group antibiotics in three Caribbean countries. This research provides data that may inform national formulary and antimicrobial stewardship policy-making across the settings analyzed and the wider region.

Reporting on antibiotic use patterns using the WHO Access, Watch, Reserve classification in the Caribbean

[ABSTRACT]. Objective. To assess antibiotic use in three hospitals in three Caribbean countries based on data from 2013 and 2018 using the World Health Organization Essential Medicines List “Access, Watch, Reserve” (AWaRe) classification. Methods. A retrospective observational study, which analyzed the World Health Organization Point Prevalence Survey data from three hospitals in three Caribbean countries, to examine proportional AWaRe group antibiotic use for the top ten inpatient indications. The Access-to-Watch ratio was calculated, and the top three antibiot- ics prescribed in each hospital were determined. Results. The final data set included 376 prescriptions for the top ten indications in 766 inpatients. The hospital antibiotic use point prevalence for Hospital 1 was 35.6%, Hospital 2 was 48.6%, and Hospital 3 was 47.1%. The Access-to-Watch ratio for the top ten indications was 2.45, 1.36, and 1.72 in the three hospitals. Access group prevalence was 71.0% in Hospital 1, 57.6% in Hospital 2, and 63.2% in Hospital 3. There were no Reserve antibiotics prescribed in any of the institutions. The most common indication for Watch prescription was skin and soft tissue infections in Hospital 1 and pneumonia in Hospital 2 and 3. Conclusions. This study draws urgent attention to evidence of a high proportion of Watch antibiotic prescrib- ing and lack of Reserve group antibiotics in three Caribbean countries. This research provides data that may inform national formulary and antimicrobial stewardship policy-making across the settings analyzed and the wider region.

[RESUMEN]. Objetivo. Evaluar el consumo de antibióticos en tres hospitales de tres países del Caribe según datos del período 2013-2018 mediante la clasificación de acceso, control y reserva (AWaRe, por su sigla en inglés) de la lista de medicamentos esenciales de la Organización Mundial de la Salud. Métodos. Se realizó un estudio observacional retrospectivo, que analizó los datos de la encuesta de prevalencia puntual de la Organización Mundial de la Salud de tres hospitales en tres países del Caribe, a fin de evaluar el consumo proporcional de antibióticos por grupo de la clasificación AWaRe para las diez principales indicaciones en pacientes hospitalizados. Se calculó la relación entre los grupos de acceso y de control y se determinó cuáles eran los tres principales antibióticos prescritos en cada hospital. Resultados. El conjunto final de datos incluyó 376 recetas para las diez indicaciones principales en 766 pacientes hospitalizados. La prevalencia puntual del consumo de antibióticos en el hospital 1 fue 35,6%, en el hospital 2 fue 48,6% y en el hospital 3 fue 47,1%. La relación entre los grupos de acceso y de control correspondientes a las diez principales indicaciones fue 2,45, 1,36 y 1,72 en los tres hospitales. La prevalencia del grupo de acceso fue 71,0% en el hospital 1, 57,6% en el hospital 2 y 63,2% en el hospital 3. No se prescribieron antibióticos del grupo de reserva en ninguna de las instituciones. La indicación más común para la prescripción de antibióticos en el grupo de control fue infecciones en la piel y los tejidos blandos en el hospital 1 y neumonía en los hospitales 2 y 3. Conclusiones. Este estudio busca llamar la atención urgentemente sobre la evidencia de una alta proporción de prescripción de antibióticos del grupo de control y la carencia de antibióticos del grupo de reserva en tres países del Caribe. Esta investigación proporciona datos que pueden fundamentar el formulario nacional y la elaboración de políticas para la optimización del uso de antimicrobianos en los entornos analizados y en la región en general.

[RESUMO]. Objetivo. Avaliar o uso de antibióticos em três hospitais de três países do Caribe, com base em dados de 2013 e 2018, usando a classificação "Acesso, Vigilância e Reserva" (AWaRe) da Lista de Medicamentos Essenciais da Organização Mundial da Saúde. Métodos. Estudo observacional retrospectivo com análise de dados do Estudo de Prevalência Pontual da Organização Mundial da Saúde, coletados em três hospitais de três países do Caribe para examinar o uso proporcional de antibióticos dos grupos AWaRe para as dez indicações mais frequentes em pacientes internados. A razão entre os grupos Acesso e Vigilância foi calculada e determinou-se quais eram os três antibióticos mais prescritos em cada hospital. Resultados. O conjunto final de dados incluiu 376 medicamentos prescritos para as dez indicações mais frequentes em 766 pacientes internados. A prevalência pontual de uso de antibióticos foi de 35,6% no hospital 1, 48,6% no hospital 2 e 47,1% no hospital 3. A razão entre Acesso e Vigilância nas dez indicações mais frequentes foi 2,45, 1,36, e 1,72 nos três hospitais. A prevalência do grupo Acesso foi de 71,0% no hospital 1, 57,6% no hospital 2 e 63,2% no hospital 3. Nenhum antibiótico da categoria Reserva foi prescrito em nenhuma das instituições. A indicação mais comum dos medicamentos prescritos no grupo Vigilância foram infecções de pele e tecidos moles no hospital 1 e pneumonia nos hospitais 2 e 3. Conclusões. Este estudo chama urgentemente a atenção para evidências de uma grande proporção de antibióticos prescritos no grupo Vigilância e a carência de antibióticos do grupo Reserva em três países do Caribe. Esta pesquisa fornece dados que podem guiar a criação de políticas para o formulário terapêutico nacional e o uso racional de antimicrobianos nos cenários analisados e na região como um todo.

Increased Detection of Carbapenemase-Producing Enterobacterales Bacteria in Latin America and the Caribbean during the COVID-19 Pandemic.

During 2020-2021, countries in Latin America and the Caribbean reported clinical emergence of carbapenemase-producing Enterobacterales that had not been previously characterized locally, increased prevalence of carbapenemases that had previously been detected, and co-production of multiple carbapenemases in some isolates. These increases were likely fueled by changes related to the COVID-19 pandemic, including empirical antibiotic use for potential COVID-19-related bacterial infections and healthcare limitations resulting from the rapid rise in COVID-19 cases. Strengthening antimicrobial resistance surveillance, epidemiologic research, and infection prevention and control programs and antimicrobial stewardship in clinical settings can help prevent emergence and transmission of carbapenemase-producing Enterobacterales.

HPV vaccine introduction in the Americas: a decade of progress and lessons learned.

INTRODUCTION: Human papillomavirus (HPV) is an important public health concern due to its causative role in many cancers, especially cervical cancer, and other conditions that lead to serious health consequences in both men and women. In Latin America and the Caribbean, nearly 60,000 new cases of cervical cancer and another 7,000 HPV-associated cancers are diagnosed annually. AREAS COVERED: HPV vaccination combined with comprehensive cervical cancer control programmingis paving the way for eliminating cervical cancer as a major public health problem and drastically reducing other HPV-associated diseases. To date, 44 countries and territories in the Americas have introduced HPV vaccines as part of their national immunization programs and cervical cancer control strategies. Early lessons from HPV vaccine introduction suggest that transparent and credible evidence-based decision-making, information, education and communication about HPV and cervical cancer, coordination with existing cervical cancer control initiatives, and precise planning for ensuring effective uptake of the vaccine in target groups are all critical elements of success. EXPERT OPINION: There is an urgent need for strategies to increase HPV vaccine coverage, and as the integrated control programs evolve and other HPV-associated disease becomes important for public health, there will be a need for continued program and policy evaluation.

Effects of screening strategies to detect carbapenem-resistant gram-negative bacteria: A systematic review.

OBJECTIVE: This systematic review aims to summarize the evidence on the effects of screening strategies to detect carbapenem-resistant gram-negative bacteria (Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa). METHODS: Eligible studies were randomized trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series. We conducted searches in CENTRAL, PUBMED, Embase, Epistemonikos, and in multiple databases available in the Virtual Health Library (LILACS, Scielo, WHO IBECS, and PAHO IBECS). All the searches covered the period until 4 June 2021. No date or language restrictions were applied. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned standardized form. When possible, we intended to conduct meta-analyses using a random-effect model. We assessed the certainty of the evidence (CoE) and summarized the results using the GRADE approach. RESULTS: Our search strategy yielded 57,451 references. No randomized trials were identified. Sixteen studies (one controlled before-after study and 15 interrupted time series) met our inclusion criteria and were included in the review. Most studies were conducted in tertiary care general hospitals from the United States, Europe, and Asia. Eleven studies included adult patients hospitalized in general wards and intensive care units, one was carried out in a neonatal intensive care unit, two in hematology or oncology units, and one in a solid organ transplantation department. Eleven studies were conducted in the setting of an outbreak. Regarding the detection strategy used, all studies included screening strategies for high-risk patients at the moment of admission and 7 studies reported a contact surveillance strategy. Most studies were conducted in settings where infection prevention and control measures were concomitantly installed or reinforced. Data were not suitable for meta-analysis, so the results were presented as a narrative synthesis. Most studies showed a decline in the prevalence of both infection and colonization rates after the implementation of a policy of active surveillance, but the CoE is low. Screening strategies may result in little to no difference in the risk of all-cause mortality and the length of hospital stay. CONCLUSIONS: Existing evidence may favor the use of surveillance culture to carbapenem-resistant gram-negative bacteria, but its quality is poor, so solid conclusions cannot be drawn. Well-conducted randomized trials or high-quality quasi-experimental studies are needed to improve the certainty of the existing evidence. These studies should assess the effect of the addition of screening strategies as a single intervention and measure clinically important outcomes such as infection, length of hospital stay, and mortality.

Reporting on antibiotic use patterns using the WHO Access, Watch, Reserve classification in the Caribbean / Presentación de informes sobre los patrones de consumo de antibióticos mediante la clasificación de acceso, control y reserva (AWaRe) de la OMS en el Caribe / Relatório sobre padrões de uso de antibióticos no Caribe usando a classificação Acesso, Vigilância e Reserva da OMS

ABSTRACT Objective. To assess antibiotic use in three hospitals in three Caribbean countries based on data from 2013 and 2018 using the World Health Organization Essential Medicines List "Access, Watch, Reserve" (AWaRe) classification. Methods. A retrospective observational study, which analyzed the World Health Organization Point Prevalence Survey data from three hospitals in three Caribbean countries, to examine proportional AWaRe group antibiotic use for the top ten inpatient indications. The Access-to-Watch ratio was calculated, and the top three antibiotics prescribed in each hospital were determined. Results. The final data set included 376 prescriptions for the top ten indications in 766 inpatients. The hospital antibiotic use point prevalence for Hospital 1 was 35.6%, Hospital 2 was 48.6%, and Hospital 3 was 47.1%. The Access-to-Watch ratio for the top ten indications was 2.45, 1.36, and 1.72 in the three hospitals. Access group prevalence was 71.0% in Hospital 1, 57.6% in Hospital 2, and 63.2% in Hospital 3. There were no Reserve antibiotics prescribed in any of the institutions. The most common indication for Watch prescription was skin and soft tissue infections in Hospital 1 and pneumonia in Hospital 2 and 3. Conclusions. This study draws urgent attention to evidence of a high proportion of Watch antibiotic prescribing and lack of Reserve group antibiotics in three Caribbean countries. This research provides data that may inform national formulary and antimicrobial stewardship policy-making across the settings analyzed and the wider region.

RESUMEN Objetivo. Evaluar el consumo de antibióticos en tres hospitales de tres países del Caribe según datos del período 2013-2018 mediante la clasificación de acceso, control y reserva (AWaRe, por su sigla en inglés) de la lista de medicamentos esenciales de la Organización Mundial de la Salud. Métodos. Se realizó un estudio observacional retrospectivo, que analizó los datos de la encuesta de prevalencia puntual de la Organización Mundial de la Salud de tres hospitales en tres países del Caribe, a fin de evaluar el consumo proporcional de antibióticos por grupo de la clasificación AWaRe para las diez principales indicaciones en pacientes hospitalizados. Se calculó la relación entre los grupos de acceso y de control y se determinó cuáles eran los tres principales antibióticos prescritos en cada hospital. Resultados. El conjunto final de datos incluyó 376 recetas para las diez indicaciones principales en 766 pacientes hospitalizados. La prevalencia puntual del consumo de antibióticos en el hospital 1 fue 35,6%, en el hospital 2 fue 48,6% y en el hospital 3 fue 47,1%. La relación entre los grupos de acceso y de control correspondientes a las diez principales indicaciones fue 2,45, 1,36 y 1,72 en los tres hospitales. La prevalencia del grupo de acceso fue 71,0% en el hospital 1, 57,6% en el hospital 2 y 63,2% en el hospital 3. No se prescribieron antibióticos del grupo de reserva en ninguna de las instituciones. La indicación más común para la prescripción de antibióticos en el grupo de control fue infecciones en la piel y los tejidos blandos en el hospital 1 y neumonía en los hospitales 2 y 3. Conclusiones. Este estudio busca llamar la atención urgentemente sobre la evidencia de una alta proporción de prescripción de antibióticos del grupo de control y la carencia de antibióticos del grupo de reserva en tres países del Caribe. Esta investigación proporciona datos que pueden fundamentar el formulario nacional y la elaboración de políticas para la optimización del uso de antimicrobianos en los entornos analizados y en la región en general.

RESUMO Objetivo. Avaliar o uso de antibióticos em três hospitais de três países do Caribe, com base em dados de 2013 e 2018, usando a classificação "Acesso, Vigilância e Reserva" (AWaRe) da Lista de Medicamentos Essenciais da Organização Mundial da Saúde. Métodos. Estudo observacional retrospectivo com análise de dados do Estudo de Prevalência Pontual da Organização Mundial da Saúde, coletados em três hospitais de três países do Caribe para examinar o uso proporcional de antibióticos dos grupos AWaRe para as dez indicações mais frequentes em pacientes internados. A razão entre os grupos Acesso e Vigilância foi calculada e determinou-se quais eram os três antibióticos mais prescritos em cada hospital. Resultados. O conjunto final de dados incluiu 376 medicamentos prescritos para as dez indicações mais frequentes em 766 pacientes internados. A prevalência pontual de uso de antibióticos foi de 35,6% no hospital 1, 48,6% no hospital 2 e 47,1% no hospital 3. A razão entre Acesso e Vigilância nas dez indicações mais frequentes foi 2,45, 1,36, e 1,72 nos três hospitais. A prevalência do grupo Acesso foi de 71,0% no hospital 1, 57,6% no hospital 2 e 63,2% no hospital 3. Nenhum antibiótico da categoria Reserva foi prescrito em nenhuma das instituições. A indicação mais comum dos medicamentos prescritos no grupo Vigilância foram infecções de pele e tecidos moles no hospital 1 e pneumonia nos hospitais 2 e 3. Conclusões. Este estudo chama urgentemente a atenção para evidências de uma grande proporção de antibióticos prescritos no grupo Vigilância e a carência de antibióticos do grupo Reserva em três países do Caribe. Esta pesquisa fornece dados que podem guiar a criação de políticas para o formulário terapêutico nacional e o uso racional de antimicrobianos nos cenários analisados e na região como um todo.

The CAPACITI Decision-Support Tool for National Immunization Programs.

OBJECTIVES: Immunization programs in low-income and middle-income countries (LMICs) are faced with an ever-growing number of vaccines of public health importance recommended by the World Health Organization, while also financing a greater proportion of the program through domestic resources. More than ever, national immunization programs must be equipped to contextualize global guidance and make choices that are best suited to their setting. The CAPACITI decision-support tool has been developed in collaboration with national immunization program decision makers in LMICs to structure and document an evidence-based, context-specific process for prioritizing or selecting among multiple vaccination products, services, or strategies. METHODS: The CAPACITI decision-support tool is based on multi-criteria decision analysis, as a structured way to incorporate multiple sources of evidence and stakeholder perspectives. The tool has been developed iteratively in consultation with 12 countries across Africa, Asia, and the Americas. RESULTS: The tool is flexible to existing country processes and can follow any type of multi-criteria decision analysis or a hybrid approach. It is structured into 5 sections: decision question, criteria for decision making, evidence assessment, appraisal, and recommendation. The Excel-based tool guides the user through the steps and document discussions in a transparent manner, with an emphasis on stakeholder engagement and country ownership. CONCLUSIONS: Pilot countries valued the CAPACITI decision-support tool as a means to consider multiple criteria and stakeholder perspectives and to evaluate trade-offs and the impact of data quality. With use, it is expected that LMICs will tailor steps to their context and streamline the tool for decision making.

Moroccan National Immunization Technical Advisory Group: a valuable asset for the national immunization program and the immunization agenda in the EMRO region.

The main mission of a National Immunization Technical Advisory Group (NITAG) is to provide impartial, evidence-based recommendations on immunization to the Ministry of Health. We report on the findings from an evaluation of the Moroccan NITAG with emphasis on its functionality, quality of work processes and outputs, and its integration into the immunization policy process. We conducted a cross-sectional study from October to December 2019. We used the standardized, US-CDC/WHO-developed "simplified assessment tool for national immunization technical advisory groups". The evaluation included eight participants. The evaluation has shown that it fully complies with the WHO recommendations. Among its strengths, the Moroccan NITAG has a solid legal basis, diverse expertise and many years of combined experience. This composition contributed to the credibility and strength of its recommendations and facilitated their implementation. The NITAG could, however, benefit from implementing written declarations of interests and standardized operating procedures in addition to establishing a standardized methodology to guide and document the decision-making process. The Moroccan NITAG could also gain from inviting members with public health/epidemiology research experience and from exchanging with other NITAGs in the region and globally. Finally, ensuring sustainable funding for the NITAG's activities will be crucial, so that it can continue its valuable support to the national immunization program.

Influenza vaccine effectiveness against hospitalizations in children and older adults-Data from South America, 2013-2017. A test negative design.

BACKGROUND: In 2013, the Pan American Health Organization established a multi-site, multi-country network to evaluate influenza vaccine effectiveness (VE). We pooled data from five consecutive seasons in five countries to conduct an analysis of southern hemisphere VE against laboratory-confirmed influenza hospitalizations in young children and older adults. METHODS: We used a test-negative design to estimate VE against laboratory-confirmed influenza in hospitalized young children (aged 6─24 months) and older adults (aged ≥60 years) in Argentina, Brazil, Chile, Colombia, and Paraguay. Following country-specific influenza surveillance protocol, hospitalized persons with severe acute respiratory infections (SARI) at 48 sentinel hospitals (March 2013-December 2017) were tested for influenza virus infection by rRT-PCR. VE was estimated for young children and older adults using logistic random effects models accounting for cluster (country), adjusting for sex, age (months for children, and age-in-year categories for adults), calendar year, country, preexisting conditions, month of illness onset and prior vaccination as an effect modifier for the analysis in adults. RESULTS: We included 8426 SARI cases (2389 children and 6037 adults) in the VE analyses. Among young children, VE against SARI hospitalization associated with any influenza virus was 43% (95%CI: 33%, 51%) for children who received two doses, but was 20% (95%CI: -16%, 45%) and not statistically significant for those who received one dose in a given season. Among older adults, overall VE against SARI hospitalization associated with any influenza virus was 41% (95%CI: 28%, 52%), 45% (95%CI: 34%, 53%) against A(H3N2), 40% (95%CI: 18%, 56%) against A(H1N1)pdm09, and 20% (95%CI: -40%, 54%) against influenza B viruses. CONCLUSIONS: Our results suggest that over the five-year study period, influenza vaccination programs in five South American countries prevented more than one-third of laboratory confirmed influenza-associated hospitalizations in young children receiving the recommended two doses and vaccinated older adults.

Heterogeneity in influenza seasonality and vaccine effectiveness in Australia, Chile, New Zealand and South Africa: early estimates of the 2019 influenza season.

We compared 2019 influenza seasonality and vaccine effectiveness (VE) in four southern hemisphere countries: Australia, Chile, New Zealand and South Africa. Influenza seasons differed in timing, duration, intensity and predominant circulating viruses. VE estimates were also heterogeneous, with all-ages point estimates ranging from 7-70% (I2: 33%) for A(H1N1)pdm09, 4-57% (I2: 49%) for A(H3N2) and 29-66% (I2: 0%) for B. Caution should be applied when attempting to use southern hemisphere data to predict the northern hemisphere influenza season.

Patterns of influenza B circulation in Latin America and the Caribbean, 2010-2017.

OBJECTIVE: There are limited published data about the circulation of influenza B/Victoria and B/Yamagata in Latin America and the Caribbean (LAC) and most countries have a vaccine policy that includes the use of the trivalent influenza vaccine. We analyzed influenza surveillance data to inform decision-making in LAC about prevention strategies, such as the use of the quadrivalent influenza vaccine. METHODS: There are a total of 28 reference laboratories and National Influenza Centers in LAC that conduct influenza virologic surveillance according to global standards, and on a weekly basis upload their surveillance data to the open-access World Health Organization (WHO) platform FluNet. These data include the number of specimens tested for influenza and the number of specimens positive for influenza by type, subtype and lineage, all by the epidemiologic week of specimen collection. We invited these laboratories to provide additional epidemiologic data about the hospitalized influenza B cases. We conducted descriptive analyses of patterns of influenza circulation and characteristics of hospitalized cases. We compared the predominant B lineage each season to the lineage in the vaccine applied, to determine vaccine mismatch. A Chi-square and Wilcoxan statistic were used to assess the statistical significance of differences in proportions and medians at the P<0.05 level. FINDINGS: During 2010-2017, the annual number of influenza B cases in LAC was ~4500 to 7000 cases. Since 2011, among the LAC-laboratories reporting influenza B lineage using molecular methods, both B/Victoria and B/Yamagata were detected annually. Among the hospitalized influenza B cases, there were statistically significant differences observed between B/Victoria and B/Yamagata cases when comparing age and the proportion with underlying co-morbid conditions and with history of oseltamivir treatment (P<0.001). The proportion deceased among B/Victoria and B/Yamagata hospitalized cases did not differ significantly. When comparing the predominant influenza B lineage detected, as part of surveillance activities during 63 seasons among 19 countries, to the lineage of the influenza B virus included in the trivalent influenza vaccine used during that season, there was a vaccine mismatch noted during 32% of the seasons analyzed. CONCLUSIONS: Influenza B is important in LAC with both B/Victoria and B/Yamagata circulating annually in all sub regions. During approximately one-third of the seasons, an influenza B vaccine mismatch was identified. Further analyses are needed to better characterize the medical and economic burden of each influenza B lineage, to examine the potential cross-protection of one vaccine lineage against the other circulating virus lineage, and to determine the potential impact and cost-effectiveness of using the quadrivalent vaccine rather than the trivalent influenza vaccine.

Chile's National Advisory Committee on Immunization (CAVEI): Evidence-based recommendations for public policy decision-making on vaccines and immunization.

A National Immunization Technical Advisory Group (NITAG) provides independent, evidence-based recommendations to the Ministry of Health for immunization programmes and policy formulation. In this article, we describe the structure, functioning and work processes of Chile's NITAG (CAVEI) and assess its functionality, quality of work processes and outputs, and integration of the committee into the Ministry of Health policy process using the Assessment tool for National Immunization Technical Advisory Groups. Among its strengths, CAVEI's administrative and work plasticity allows it to respond in a timely manner to the Ministry of Health's requests and proactively raise subjects for review. Representation of multiple areas of expertise within the committee makes CAVEI a robust and balanced entity for the development of evidence-based comprehensive recommendations. High ranking profile of the Secretariat structure furthers CAVEI's competences in policymaking and serves as a bridge between the committee and international initiatives in the field of immunizations.

Severe acute respiratory infections (SARI) from influenza in adult patients in Chile: the experience of a sentinel hospital

[ABSTRACT]. Objective. To 1) describe clinical characteristics of adult patients in Chile with severe acute respiratory infections (SARI) associated with influenza viruses, and 2) analyze virus subtypes identified in specimens collected from those patients, hospital resources used in clinical management, clinical evolution, and risk factors associated with a fatal outcome, using observational data from the SARI surveillance network (SARInet). Methods. Adults hospitalized from 1 July 2011 to 31 December 2015 with influenza-associated SARI at a SARI sentinel surveillance hospital in Santiago were identified and the presence of influenza in all cases confirmed by reverse transcription polymerase chain reaction (RT-PCR), using respiratory samples. Results. A total of 221 patients (mean age: 74.1 years) were hospitalized with influenza-associated SARI during the study period. Of this study cohort, 91.4% had risk factors for complications and 34.3% had been vaccinated during the most recent campaign. Pneumonia was the most frequent clinical manifestation, occurring in 57.0% of the cohort; other manifestations included influenza-like illness, exacerbated chronic bronchitis, decompensated heart failure, and asthmatic crisis. Cases occurred year-round, with an epidemic peak during autumn–winter. Both influenza A (H1N1pdm09 and H3N2) and B virus co-circulated. Critical care beds were required for 26.7% of the cohort, and 19.5% needed ventilatory assistance. Multivariate analysis identified four significant factors associated with in-hospital mortality: 1) being bedridden (adjusted odds ratio (aOR): 22.3; 95% confidence interval (CI): 3.0–164); 2) admission to critical care unit (aOR: 8.9; CI: 1.44–55); 3) Pa02/Fi02 ratio < 250 (aOR: 5.8; CI: 1.02–33); and 4) increased serum creatinine concentration (> 1 mg/dL) (aOR: 5.47; CI: 1.20–24). Seasonal influenza vaccine was identified as a significant protective factor (aOR: 0.14; CI: 0.021–0.90). Conclusions. Influenza-associated SARI affected mainly elderly patients with underlying conditions. Most patients evolved to respiratory failure and more than one-quarter required critical care beds. Clinical presentation was variable. Death was associated with host characteristics and disease-associated conditions, and vaccine was protective. Virus type did not influence outcome.

[RESUMEN]. Objetivos. 1) Describir las características clínicas de los pacientes adultos con infección respiratoria aguda grave relacionada con virus gripales en Chile, y 2) analizar los subtipos de los virus identificados en las muestras recogidas de estos pacientes, los recursos hospitalarios empleados en el tratamiento clínico, la evolución clínica y los factores de riesgo asociados a un desenlace mortal, mediante los datos de observación de la red de vigilancia de las infecciones respiratorias agudas graves (SARInet). Métodos. Se identificaron los adultos hospitalizados entre el 1 de julio del 2011 y el 31 de diciembre del 2015 con infección respiratoria aguda grave relacionada con la gripe en un hospital de vigilancia centinela de esta afección en Santiago y se confirmó la presencia de gripe en todos los casos por medio de la reacción en cadena de la polimerasa con transcriptasa inversa realizada en muestras de las vías respiratorias Resultados. Un total de 221 pacientes (con una media de edad de 74,1 años) fueron hospitalizados con infección respiratoria aguda grave relacionada con la gripe durante el período de estudio. En esta cohorte de estudio, 91,4 % presentó factores de riesgo de complicaciones y 34,3 % había recibido la vacuna en la campaña más reciente. La neumonía fue la manifestación clínica más frecuente y afectó a 57,0 % de la cohorte; otras manifestaciones fueron el síndrome gripal, la bronquitis crónica exacerbada, la insuficiencia cardíaca descompensada y la crisis asmática. Los casos se presentaron durante todo el año y alcanzaron un pico epidémico durante el otoño y el invierno. Tanto el virus de la gripe de tipo A (H1N1pdm09 y H3N2) y tipo B circularon simultáneamente. En 26,7 % de la cohorte se precisaron cuidados intensivos y en 19,5 % fue necesario recurrir a la respiración asistida. El análisis multifactorial detectó cuatro factores fundamentales relacionados con la mortalidad hospitalaria: 1) la postración (razón de posibilidades ajustada [ORA]: 22,3; intervalo de confianza [IC] de 95 %: 3,0–164); 2) la admisión en la unidad de cuidados intensivos (ORA: 8,9; IC: 1,4 4–55); 3) un coeficiente Pa02/Fi02 inferior a 250 (ORA: 5,8; IC: 1,02–33), y 4) una mayor concentración de creatinina sérica (> 1 mg/dL) (ORA: 5,47; IC: 1,20–24). Se determinó que la vacuna contra la gripe estacional era un factor protector significativo (ORA: 0,14; IC: 0,021–0,90). Conclusiones. La infección respiratoria aguda grave asociada a la gripe afectó a pacientes predominantemente ancianos con afecciones subyacentes. La mayoría de los pacientes evolucionó en una insuficiencia respiratoria y más de una cuarta parte precisó cuidados intensivos. El cuadro clínico fue variable. La mortalidad estuvo relacionada con las características del huésped y los trastornos relacionados con la enfermedad, y la vacuna tuvo un efecto protector. El tipo vírico no influyó en los desenlaces.

[RESUMO]. Objetivo. Descrever as características clínicas de pacientes adultos com infecção respiratória aguda grave (SARI) associada ao vírus da influenza e analisar os subtipos virais identificados em amostras coletadas destes pacientes, os recursos hospitalares empregados no tratamento clínico, a evolução clínica e os fatores de risco clínicos associados a um desfecho fatal, a partir de dados observacionais da rede de vigilância de SARI (SARInet) no Chile. Métodos. Foram identificados os adultos hospitalizados com SARI associada a influenza em um hospital-sentinela de vigilância de SARI, em Santiago, de 1o de julho de 2011 a 31 de dezembro de 2015. A ocorrência de influenza foi confirmada em amostras respiratórias em todos os casos com a reação em cadeia da polimerase via transcriptase reversa (RT-RCP). Resultados. Ao todo, 221 pacientes (idade média de 74,1 anos) foram hospitalizados com SARI associada a influenza no período de estudo. Nesta coorte, 91,4% apresentavam fatores de risco para complicação e 34,3% haviam sido vacinados na última campanha de vacinação. Pneumonia foi a manifestação clínica mais frequente, ocorrendo em 57,0% da coorte. Outras manifestações foram doença gripal, bronquite crônica exacerbada, insuficiência cardíaca descompensada e crise asmática. Os casos estiveram distribuídos ao longo do ano, com pico epidêmico no outono–inverno. Houve circulação simultânea dos vírus da influenza A (H1N1pdm09 e H3N2) e B. Leitos de terapia intensiva foram necessários em 26,7% da coorte e suporte ventilatório, em 19,5%. Na análise multivariada, quatro fatores importantes associados à mortalidade hospitalar foram identificados: estar restrito ao leito (odds ratio ajustado [ORaj] 22.3; intervalo de confiança de 95% [IC 95%] 3.0–164); ser admitido na unidade de terapia intensiva (ORaj 8.9, IC 95% 1.4 4–55); relação Pa02/Fi02 <250 (ORaj 5.8; IC 95% 1.02–33) e aumento da creatinina sérica (>1 mg/dl) (ORaj 5.47; IC 95% 1.20–24). A vacinação sazonal contra influenza foi identificada como importante fator de proteção (ORaj 0.14; IC 95% 0.021–0.90). Conclusões. A SARI associada a influenza acometeu sobretudo pacientes idosos com doenças preexistentes. A maioria dos pacientes evoluiu com insuficiência respiratória e mais de um quarto precisou de cuidados intensivos. O quadro clínico foi variável. Morte foi associada às características do hospedeiro e problemas relacionados à doença. A vacinação teve efeito protetor e o tipo viral não influiu no desfecho.

Seasonal influenza vaccine effectiveness against laboratory-confirmed influenza hospitalizations - Latin America, 2013.

BACKGROUND: Despite widespread utilization of influenza vaccines, effectiveness (VE) has not been routinely measured in Latin America. METHODS: We used a case test-negative control design to estimate trivalent inactivated influenza VE against laboratory-confirmed influenza among hospitalized children aged 6months-5years and adults aged ≥60years which are age-groups targeted for vaccination. We sought persons with severe acute respiratory infections (SARI), hospitalized at 71 sentinel hospitals in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Honduras, Panama, and Paraguay during January-December 2013. Cases had an influenza virus infection confirmed by real-time reverse transcription PCR (rRT-PCR); controls had a negative rRT-PCR result for influenza viruses. We used a two-stage random effects model to estimate pooled VE per target age-group, adjusting for the month of illness onset, age and preexisting medical conditions. RESULTS: We identified 2620 SARI patients across sites: 246 influenza cases and 720 influenza-negative controls aged ≤5years and 448 cases and 1206 controls aged ≥60years. The most commonly identified subtype among participants (48%) was the influenza A(H1N1)pdm09 virus followed by influenza A(H3N2) (34%) and influenza B (18%) viruses. Among children, the adjusted VE of full vaccination (one dose for previously vaccinated or two if vaccine naïve) against any influenza virus SARI was 47% (95% confidence interval [CI]: 14-71%); VE was 58% (95% CI: 16-79%) against influenza A(H1N1)pdm09, and 65% (95% CI: -9; 89%) against influenza A(H3N2) viruses associated SARI. Crude VE of full vaccination against influenza B viruses associated SARI among children was 3% (95% CI: -150; 63). Among adults aged ≥60years, adjusted VE against any influenza SARI was 48% (95% CI: 34-60%); VE was 54% (95% CI: 37-69%) against influenza A(H1N1)pdm09, 43% (95% CI: 18-61%) against influenza A(H3N2) and 34% (95% CI: -4; 58%) against B viruses associated SARI. CONCLUSION: Influenza vaccine provided moderate protection against severe influenza illness among fully vaccinated young children and older adults, supporting current vaccination strategies.

Progress towards a comprehensive approach to maternal and neonatal immunization in the Americas

[ABSTRACT]. Maternal and neonatal immunization (MNI) is a core component of the new immunization model in the Americas, which transitioned from immunization of children to that of the entire family. Immunization during pregnancy protects the mother and the fetus by providing the neonate with maternal antibodies against disease. It has the potential to impact early childhood morbidity and mortality, and thus MNI has gained visibility and priority on the global health agenda. The Region of the Americas is a leader in MNI, as seen by its elimination of congenital rubella syndrome in 2015 and the progress made toward neonatal tetanus elimination. In the Americas, 31 countries currently target pregnant women for influenza vaccination; and 21 countries—over 90% of the Region’s birth cohort—have nationwide newborn hepatitis B vaccination. This paper describes the status of MNI in the Americas and identifies gaps in the evidence, obstacles to optimal implementation, and opportunities for future improvements. Catalysts for MNI in the Region have been political commitment, endorsement by scientific societies, an established “culture of vaccination,” widespread access to antenatal care, and context-specific communications; however, universal and equitable access for pregnant women and their newborns continues to be a formidable challenge, and additional vaccine safety and effectiveness evidence is needed. Continued efforts to integrate MNI with maternal and child health services will be critical to furthering the MNI platform as well.

[RESUMEN]. La inmunización materna y neonatal es un componente central del nuevo modelo de inmunización en la Región de las Américas, que pasó de la inmunización infantil a la de toda la familia. La inmunización durante el embarazo protege a la madre y el feto dando al recién nacido los anticuerpos maternos contra las enfermedades. Tiene el potencial de repercutir en la morbilidad y la mortalidad en la primera infancia, por lo que la inmunización materna y neonatal ha adquirido visibilidad y prioridad en la agenda mundial de salud. La Región de las Américas ocupa una posición de liderazgo en materia de inmunización materna y neonatal, como lo demuestra la eliminación del síndrome de rubéola congénita en el 2015 y los avances logrados para la eliminación del tétanos neonatal. Actualmente en 31 países de la Región se da prioridad a las embarazadas para que reciban vacunación antigripal y en 21 países —más de 90% de la cohorte de nacimiento de la Región— se incluye la vacunación de los recién nacidos contra la hepatitis B a nivel nacional. En este documento se describe la situación de la inmunización materna y neonatal en la Región de las Américas y se señalan las lagunas en la evidencia, los obstáculos a la implementación óptima y las oportunidades para las mejoras futuras. Los catalizadores de la inmunización materna y neonatal en la Región han sido el compromiso político, el aval de las sociedades científicas, una “cultura de vacunación” establecida, el acceso generalizado a la atención prenatal y las comunicaciones específicas para cada contexto; sin embargo, el acceso universal y equitativo de las embarazadas y los recién nacidos sigue siendo un reto enorme y se necesitan más datos científicos sobre la seguridad y efectividad de las vacunas. La continuación de los esfuerzos para integrar la inmunización materna y neonatal en los servicios de salud maternoinfantil será fundamental para promover también la plataforma a favor de esta inmunización.

[RESUMO]. A imunização materna e neonatal é peça fundamental do novo modelo de imunização nas Américas, com a transição da vacinação de crianças à vacinação de toda a família. A vacinação da gestante protege a mãe e o feto ao proporcionar ao recém-nascido anticorpos maternos contra doenças. A imunização materna e neonatal possivelmente repercute na primeira infância reduzindo a morbidade e a mortalidade e, portanto, ganhou visibilidade sendo considerada prioritária na agenda global de saúde. A Região das Américas é líder em imunização materna e neonatal, tendo alcançado a eliminação da síndrome da rubéola congênita em 2015 e avançado para a eliminação do tétano neonatal. Existem atualmente programas de vacinação contra influenza para gestantes em 31 países e programas nacionais de vacinação contra hepatite B para recém-nascidos em 21 países (com uma cobertura superior a 90% da coorte de nascidos vivos na Região). Este artigo apresenta um panorama da imunização materna e neonatal nas Américas, destaca as lacunas nas evidências científicas e os obstáculos à implementação ideal dos programas de vacinação e aponta oportunidades futuras para melhorias. Entre os fatores responsáveis pelo incentivo à imunização materna e neonatal na Região estão o compromisso político, o endosso das sociedades científicas, uma “cultura de vacinação” estabelecida, o amplo acesso à assistência pré-natal e a comunicação contextualizada. Porém, o acesso universal e equitativo das gestantes e seus recém- -nascidos à vacinação é ainda um grande desafio e se fazem necessárias mais evidências sobre a segurança e a efetividade das vacinas. Além disso, é imprescindível o empenho contínuo para integrar a imunização materna e neonatal aos serviços de saúde materno-infantil e seguir promovendo a plataforma de imunização materna e neonatal.

Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies.

OBJECTIVES: Summary evidence of influenza vaccine effectiveness (IVE) against hospitalized influenza is lacking. We conducted a meta-analysis of studies reporting IVE against laboratory-confirmed hospitalized influenza among adults. METHODS: We searched Pubmed (January 2009 to November 2016) for studies that used test-negative design (TND) to enrol patients hospitalized with influenza-associated conditions. Two independent authors selected relevant articles. We calculated pooled IVE against any and (sub)type specific influenza among all adults, and stratified by age group (18-64 and 65 years and above) using random-effects models. RESULTS: We identified 3411 publications and 30 met our inclusion criteria. Between 2010-11 and 2014-15, the pooled seasonal IVE was 41% (95%CI:34;48) for any influenza (51% (95%CI:44;58) among people aged 18-64y and 37% (95%CI:30;44) among ≥65 years). IVE was 48% (95%CI:37;59),37% (95%CI:24;50) and 38% (95%CI:23;53) against influenza A(H1N1)pdm09, A(H3N2) and B, respectively. Among persons aged ≥65 year, IVE against A(H3N2) was 43% (95%CI:33;53) in seasons when circulating and vaccine strains were antigenically similar and 14% (95%CI:-3;30) when A(H3N2) variant viruses predominated. CONCLUSIONS: Influenza vaccines provided moderate protection against influenza-associated hospitalizations among adults. They seemed to provide low protection among elderly in seasons where vaccine and circulating A(H3N2) strains were antigenically variant.