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1.
J Infect Dis ; 224(Supplement_3): S161-S173, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34469555

RESUMO

BACKGROUND: The World Health Organization (WHO) coordinates the Global Invasive Bacterial Vaccine-Preventable Diseases (IB-VPD) Surveillance Network to support vaccine introduction decisions and use. The network was established to strengthen surveillance and laboratory confirmation of meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. METHODS: Sentinel hospitals report cases of children <5 years of age hospitalized for suspected meningitis. Laboratories report confirmatory testing results and strain characterization tested by polymerase chain reaction. In 2019, the network included 123 laboratories that follow validated, standardized testing and reporting strategies. RESULTS: From 2014 through 2019, >137 000 suspected meningitis cases were reported by 58 participating countries, with 44.6% (n = 61 386) reported from countries in the WHO African Region. More than half (56.6%, n = 77 873) were among children <1 year of age, and 4.0% (n = 4010) died among those with reported disease outcome. Among suspected meningitis cases, 8.6% (n = 11 798) were classified as probable bacterial meningitis. One of 3 bacterial pathogens was identified in 30.3% (n = 3576) of these cases, namely S. pneumoniae (n = 2177 [60.9%]), H. influenzae (n = 633 [17.7%]), and N. meningitidis (n = 766 [21.4%]). Among confirmed bacterial meningitis cases with outcome reported, 11.0% died; case fatality ratio varied by pathogen (S. pneumoniae, 12.2%; H. influenzae, 6.1%; N. meningitidis, 11.0%). Among the 277 children who died with confirmed bacterial meningitis, 189 (68.2%) had confirmed S. pneumoniae. The proportion of pneumococcal cases with pneumococcal conjugate vaccine (PCV) serotypes decreased as the number of countries implementing PCV increased, from 77.8% (n = 273) to 47.5% (n = 248). Of 397 H. influenzae specimens serotyped, 49.1% (n = 195) were type b. Predominant N. meningitidis serogroups varied by region. CONCLUSIONS: This multitier, global surveillance network has supported countries in detecting and serotyping the 3 principal invasive bacterial pathogens that cause pediatric meningitis. Streptococcus pneumoniae was the most common bacterial pathogen detected globally despite the growing number of countries that have nationally introduced PCV. The large proportions of deaths due to S. pneumoniae reflect the high proportion of meningitis cases caused by this pathogen. This global network demonstrated a strong correlation between PCV introduction status and reduction in the proportion of pneumococcal meningitis infections caused by vaccine serotypes. Maintaining case-based, active surveillance with laboratory confirmation for prioritized vaccine-preventable diseases remains a critical component of the global agenda in public health.The World Health Organization (WHO)-coordinated Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Network reported data from 2014 to 2019, contributing to the estimates of the disease burden and serotypes of pediatric meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis.

2.
Vaccine ; 39(30): 4013-4024, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34119350

RESUMO

Phase 3 randomized-controlled trials have provided promising results of COVID-19 vaccine efficacy, ranging from 50 to 95% against symptomatic disease as the primary endpoints, resulting in emergency use authorization/listing for several vaccines. However, given the short duration of follow-up during the clinical trials, strict eligibility criteria, emerging variants of concern, and the changing epidemiology of the pandemic, many questions still remain unanswered regarding vaccine performance. Post-introduction vaccine effectiveness evaluations can help us to understand the vaccine's effect on reducing infection and disease when used in real-world conditions. They can also address important questions that were either not studied or were incompletely studied in the trials and that will inform evolving vaccine policy, including assessment of the duration of effectiveness; effectiveness in key subpopulations, such as the very old or immunocompromised; against severe disease and death due to COVID-19; against emerging SARS-CoV-2 variants of concern; and with different vaccination schedules, such as number of doses and varying dosing intervals. WHO convened an expert panel to develop interim best practice guidance for COVID-19 vaccine effectiveness evaluations. We present a summary of the interim guidance, including discussion of different study designs, priority outcomes to evaluate, potential biases, existing surveillance platforms that can be used, and recommendations for reporting results.


Assuntos
COVID-19 , Vacinas , Vacinas contra COVID-19 , Humanos , SARS-CoV-2 , Organização Mundial da Saúde
4.
Vaccine ; 38(5): 1114-1119, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31771862

RESUMO

Several countries have started to introduce the HPV vaccine into their national immunisation programme, with the majority of these countries being high or upper-middle income countries. Currently, 91 countries have introduced the HPV vaccine globally. One of the regions lagging behind in the introduction of the HPV vaccine is the Eastern Mediterranean Region, with currently only Libya and the United Arab Emirates having introduced the HPV vaccine. In order to support countries in the Eastern Mediterranean Region with their decision-making process for HPV vaccine introduction, a regional workshop was organised to explore the current status of HPV vaccine introduction plans in the Eastern Mediterranean countries, gaps in information about HPV disease burden in the region and the need for quality HPV data to make an informed decision to introduce the HPV vaccine, socio-cultural and religious challenges with HPV vaccine introduction, and the role of NITAGs in formulating recommendations for HPV vaccine introduction. Participating countries reflected on their respective status of decision making process about HPV vaccine introduction; they discussed any needs for operational research to support the decision-making process; and highlighed technical and financial support that might be required from partners to assist with HPV vaccine introduction. Recommendations were made on how to advance the decision-making process for HPV vaccine introduction. The workshop increased the awareness of the need of data on burden of disease and the associated benefits of HPV vaccination in Eastern Mediterranean countries. The importance of collaboration between different programmes including: immunisation, adolescent health, school health, sexual and reproductive health and cancer control programmes was clearly emphasized.


Assuntos
Programas de Imunização/organização & administração , Infecções por Papillomavirus , Vacinas contra Papillomavirus/administração & dosagem , Tomada de Decisões , Humanos , Região do Mediterrâneo , Infecções por Papillomavirus/prevenção & controle
5.
Vaccine ; 37(30): 4177-4183, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31221562

RESUMO

INTRODUCTION: Home-based records (HBRs) (also known as vaccination cards) and caregivers' recall are the main means to ascertain vaccination status; however, data on the quality of HBRs and the validity of recall vaccination data compared to HBRs is scarce. This manuscript presents results from two analyses related to HBRs, one on HBR pictures taken during a vaccination coverage survey, including an assessment of the HBR quality and legibility, and an evaluation of the agreement between caregivers' recall and the vaccination information in the HBRs. METHODS: Using pictures from 500 randomly selected HBRs collected during the 2016 district-based immunization coverage evaluation survey in Lebanon, two independent researchers assessed the quality of the picture and then of the HBR itself against a pre-defined set of criteria. HBRs were classified into three types: private, public and all others. In addition, caregivers' recall was compared to data found in vaccination HBRs to assess measures of vaccination status agreement for 5713 children for whom both sources of data were available. RESULTS: Over 90% of the 500 HBR pictures reviewed were considered adequate to assess the HBR quality. In the sample, most cards were type 1 (41%), followed by type 2 (34%). Most HBRs met the set criteria for quality in terms of physical condition and legibility, while, among the 28 different types of cards, vaccination cards' content and design met a moderate level of quality. Concordance, sensitivity, specificity, positive and negative predictive values, and the Kappa statistic showed diverse levels of agreement for vaccination status per vaccine dose between caregivers' recall and vaccination HBRs. CONCLUSION: This study illustrates that taking pictures of HBRs in a coverage survey is feasible and useful to conduct secondary analyses related to HBRs, such as assessing their quality and comparing recall with HBRs when both sources of data are available.


Assuntos
Cuidadores/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Líbano , Masculino , Cobertura Vacinal/estatística & dados numéricos
6.
Lancet Glob Health ; 7(7): e893-e903, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31200889

RESUMO

BACKGROUND: Rotavirus vaccine use in national immunisation programmes has led to declines in hospital admissions for rotavirus gastroenteritis among children; however, the global impact of rotavirus vaccine introduction has not been described using primary data. We describe the impact of rotavirus vaccine introduction on admissions for acute rotavirus gastroenteritis in primarily low-income and middle-income countries, using 9 years of data from the WHO-coordinated Global Rotavirus Surveillance Network (GRSN). METHODS: Between Jan 1, 2008, and Dec 31, 2016, children younger than 5 years of age who were admitted to hospital with acute gastroenteritis were prospectively enrolled in GRSN sites. We included sites that enrolled children and collected stool specimens monthly and tested at least 100 specimens annually in the impact analysis, with a separate analysis taking into account site continuity. We compared proportions of acute gastroenteritis cases positive for rotavirus in the pre-vaccine and post-vaccine periods and calculated mean proportion changes for WHO regions, with 95% CIs; these findings were then compared with interrupted time series analyses. We did further sensitivity analyses to account for rotavirus vaccination coverage levels and sites that collected specimens for at least 11 months per year and tested at least 80 specimens per year. We also analysed the age distribution of rotavirus-positive cases before and after vaccine introduction. FINDINGS: 403 140 children younger than 5 years of age admitted to hospital with acute gastroenteritis from 349 sites in 82 countries were enrolled over the study period, of whom 132 736 (32·9%) were positive for rotavirus. We included 305 789 children from 198 sites in 69 countries in the impact analysis. In countries that had not introduced rotavirus vaccine in their national immunisation programmes, rotavirus was detected in 38·0% (95% CI 4·8-73·4) of admissions for acute gastroenteritis annually whereas in those that have introduced the vaccine, rotavirus was detected in 23·0% (0·7-57·7) of admissions for acute gastroenteritis, showing a 39·6% (35·4-43·8) relative decline following introduction. Interrupted time series analyses confirmed these findings. Reductions by WHO regions ranged from 26·4% (15·0-37·8) in the Eastern Mediterranean Region to 55·2% (43·0-67·4) in the European Region and were sustained in nine countries (contributing up to 31 sites) for 6-10 years. The age distribution of children with rotavirus gastroenteritis shifted towards older children after rotavirus vaccine introduction. INTERPRETATION: A significant and sustained reduction in the proportion of hospital admissions for acute gastroenteritis due to rotavirus was seen among children younger than 5 years in GRSN sites following rotavirus vaccine introduction. These findings highlight the need to incorporate rotavirus vaccines into immunisation programmes in countries that have not yet introduced them and underline the importance of high-quality surveillance. FUNDING: The GRSN receives funding from Gavi, the Vaccine Alliance and the US Centers for Disease Control and Prevention. No specific funding was provided for this Article.


Assuntos
Hospitalização/tendências , Internacionalidade , Vigilância da População , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus , Pré-Escolar , Bases de Dados Factuais , Humanos , Rotavirus
7.
BMC Public Health ; 19(1): 58, 2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642314

RESUMO

BACKGROUND: Following the Syrian crisis, a substantial influx of Syrian refugees into Lebanon posed new challenges to optimal vaccination coverage for all children residing in the country. In 2016, the district-based immunization coverage evaluation survey (CES) assessed routine immunization coverage at the district level in Lebanon among children aged 12-59 months. METHODS: A cross-sectional multistage cluster survey was conducted in all of Lebanon (with the exception of the Nabatieh district) using the World Health Organization (WHO) recommended Expanded Programme on Immunization (EPI) methodology adapted to the local context. A survey questionnaire consisting of closed and open-ended questions concerning demographic information and the child's immunization status was administered to collect immunization status information. RESULTS: Among surveyed children aged 12-59 months, irrespective of nationality, vaccination coverage at the national level for any recommended last dose was below the targeted 95%. Generally, vaccination coverage levels increased with age and were higher among Lebanese than Syrian children. However, large variations were revealed when coverage rates were analyzed at the district level. Vaccination was significantly associated with nationality, age, mother's educational status and the place of vaccination. Common reasons for undervaccination included the child's illness at the time of vaccine administration, vaccination fees, lack of awareness or a doctor's advice not to vaccinate during campaigns. CONCLUSIONS: Substantial variability exists in vaccination coverage among children aged 12-59 months residing in different districts in Lebanon. Immunization coverage reached 90% or above only for the first doses of polio and pentavalent vaccines. A considerable dropout rate from the first dose of any vaccine is observed. Efforts to optimize coverage levels should include increased vaccination initiatives targeting both refugee children and children from vulnerable host communities, increased cooperation between public and private vaccine providers, improved training for vaccine providers to adhere to complete vaccine administration recommendations, and increased awareness among caregivers.


Assuntos
Conflitos Armados , Imunização , Refugiados , Cobertura Vacinal , Vacinação/estatística & dados numéricos , Vacinas/administração & dosagem , Cuidadores , Pré-Escolar , Estudos Transversais , Grupos Étnicos , Feminino , Humanos , Programas de Imunização , Lactente , Líbano , Masculino , Pacientes Desistentes do Tratamento , Poliomielite , Vacinas contra Poliovirus/administração & dosagem , Vacinas contra Rotavirus/administração & dosagem , Inquéritos e Questionários , Síria , Vacinas Atenuadas/administração & dosagem
8.
Gates Open Res ; 2: 71, 2018 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-30734029

RESUMO

Background: The effect of immunization does not only depend on its completeness, but also on its timely administration. Routine childhood vaccinations schedules recommend that children receive the vaccine doses at specific ages. This article attempts to assess timeliness of routine vaccination coverage among a sub-sample of children from a survey conducted in 2016. Methods: This analysis was based on data from a cross-sectional multistage cluster survey conducted between December 2015 and June 2016 among caregivers of children aged 12-59 months in all of Lebanon using a structured survey questionnaire. The analysis used Kaplan-Meier curves and logistic regression to identify the predictors of age-appropriate immunization. Results: Among the 493 randomly selected children, timely administration of the third dose of polio vaccine, diphtheria-tetanus-pertussis (DTP)-containing vaccine and hepatitis B (HepB) vaccine occurred in about one-quarter of children. About two-thirds of children received the second dose of a measles-containing vaccine (MCV) within the age interval recommended by the Expanded Programme on Immunization (EPI). Several factors including socio-demographic, knowledge, beliefs and practices were found to be associated with age-appropriate vaccination; however, this association differed between the types and doses of vaccine. Important factors associated with timely vaccination included being Lebanese as opposed to Syrian and being born in a hospital for hepatitis B birth dose; believing that vaccination status was up-to-date was related to untimely vaccination. Conclusions: The results suggest that there is reason for concern over the timeliness of vaccination in Lebanon. Special efforts need to be directed towards the inclusion of timeliness of vaccination as another indicator of the performance of the EPI in Lebanon.

9.
J Infect Dis ; 216(suppl_1): S250-S259, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28838187

RESUMO

Nine polio areas of expertise were applied to broader immunization and mother, newborn and child health goals in ten focus countries of the Polio Eradication Endgame Strategic Plan: policy & strategy development, planning, management and oversight (accountability framework), implementation & service delivery, monitoring, communications & community engagement, disease surveillance & data analysis, technical quality & capacity building, and partnerships. Although coverage improvements depend on multiple factors and increased coverage cannot be attributed to the use of polio assets alone, 6 out of the 10 focus countries improved coverage in three doses of diphtheria tetanus pertussis containing vaccine between 2013 and 2015. Government leadership, evidence-based programming, country-driven comprehensive operational annual plans, community partnership and strong accountability systems are critical for all programs and polio eradication has illustrated these can be leveraged to increase immunization coverage and equity and enhance global health security in the focus countries.


Assuntos
Erradicação de Doenças , Programas de Imunização , Imunização/estatística & dados numéricos , Poliomielite/prevenção & controle , Saúde Global , Humanos
10.
J Infect Dis ; 216(suppl_1): S86-S93, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28838199

RESUMO

The Global Polio Eradication Initiative has reduced the global incidence of polio by 99% and the number of countries with endemic polio from 125 to 3 countries. The Polio Eradication and Endgame Strategic Plan 2013-2018 (Endgame Plan) was developed to end polio disease. Key elements of the endgame plan include strengthening immunization systems using polio assets, introducing inactivated polio vaccine (IPV), and replacing trivalent oral polio vaccine with bivalent oral polio vaccine ("the switch"). Although coverage in the Eastern Mediterranean Region (EMR) with the third dose of a vaccine containing diphtheria, tetanus, and pertussis antigens (DTP3) was ≥90% in 14 countries in 2015, DTP3 coverage in EMR dropped from 86% in 2010 to 80% in 2015 due to civil disorder in multiple countries. To strengthen their immunization systems, Pakistan, Afghanistan, and Somalia developed draft plans to integrate Polio Eradication Initiative assets, staff, structure, and activities with their Expanded Programmes on Immunization, particularly in high-risk districts and regions. Between 2014 and 2016, 11 EMR countries introduced IPV in their routine immunization program, including all of the countries at highest risk for polio transmission (Afghanistan, Pakistan, Somalia, and Yemen). As a result, by the end of 2016 all EMR countries were using IPV except Egypt, where introduction of IPV was delayed by a global shortage. The switch was successfully implemented in EMR due to the motivation, engagement, and cooperation of immunization staff and decision makers across all national levels. Moreover, the switch succeeded because of the ability of even the immunization systems operating under hardship conditions of conflict to absorb the switch activities.


Assuntos
Erradicação de Doenças , Programas de Imunização , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado , Vacina Antipólio Oral , Afeganistão , Vacinas contra Difteria, Tétano e Coqueluche Acelular , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Saúde Global , Humanos , Programas de Imunização/métodos , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , Região do Mediterrâneo , Paquistão , Vacina Antipólio de Vírus Inativado/administração & dosagem , Vacina Antipólio de Vírus Inativado/uso terapêutico , Vacina Antipólio Oral/administração & dosagem , Vacina Antipólio Oral/uso terapêutico , Somália
11.
Curr Sports Med Rep ; 9(5): 284-9, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20827093

RESUMO

Meniscal tears are common in sport medicine practice. Many articles and textbooks discuss the relative validity of the different components of the physical examination with respect to their sensitivity, specificity, and positive/negative predictive values as if they were diagnostic tests. In this article, we demonstrate why this approach is limited, including the heterogeneous nature of meniscal tear pathology (e.g., posterior vs anterior). Therefore, in this article, we categorize all the published tests in the literature with regards to the mechanism underlying a positive test. We believe our approach provides the clinician with additional tools to diagnose tears. Future research should explore predictive models based on the different components accounting for heterogeneous pathology and different patient contexts.


Assuntos
Compreensão , Traumatismos do Joelho/diagnóstico , Exame Físico/métodos , Lesões do Menisco Tibial , Humanos , Traumatismos do Joelho/terapia , Exame Físico/normas , Medicina Esportiva/métodos , Medicina Esportiva/normas
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