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1.
Immunity ; 52(5): 737-741, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32433946

RESUMO

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease, COVID-19, has demonstrated the devastating impact of a novel, infectious pathogen on a susceptible population. Here, we explain the basic concepts of herd immunity and discuss its implications in the context of COVID-19.


Assuntos
Infecções por Coronavirus/imunologia , Imunidade Coletiva , Modelos Imunológicos , Pneumonia Viral/imunologia , Número Básico de Reprodução , Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Saúde Global , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Vacinação , Cobertura Vacinal
2.
MMWR Morb Mortal Wkly Rep ; 69(20): 630-631, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32437340

RESUMO

On March 13, 2020, the United States declared a national state of emergency to control the pandemic spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). Public health response measures to mitigate the pandemic have centered on social distancing and quarantine policies, including shelter-in-place and stay-at-home orders. Michigan implemented a stay-at-home order on March 23, 2020, to facilitate social distancing (2). Such strategies might result in decreased accessibility to routine immunization services, leaving children at risk for vaccine-preventable diseases and their complications (3). To evaluate whether vaccination coverage has changed during the pandemic, data from the Michigan Care Improvement Registry (the state's immunization information system) (MCIR) were analyzed. Changes in vaccine doses administered to children and the effects of those changes on up-to-date status were examined for vaccinations recommended at milestone ages corresponding to the end of an Advisory Committee on Immunization Practices (ACIP) recommendation period for one or more vaccines (4).


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Cobertura Vacinal/estatística & dados numéricos , Pré-Escolar , Humanos , Lactente , Michigan/epidemiologia , Melhoria de Qualidade , Sistema de Registros
3.
Salud Publica Mex ; 62(2): 215-224, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32237565

RESUMO

OBJECTIVE: To analyze the validity of the official vaccination figures according to the available information and to identify opportunities for improvement. MATERIALS AND METHODS: We estimated vaccination coverage and dropout rates (for multi-dose vaccines) for one-year-old children, based on public information from the dynamic cubes of the Ministry of Health, for the years 2015 to 2017. R. RESULTS: We observed variations in the vaccination monthly reports, which indicate low rates of vaccination, as well as high dropout rates when comparing first and third doses applied. For children 1 year of age, the national complete coverage was estimated at 48.9. CONCLUSIONS: There is no reliable information to estimate the actual vaccination coverage. Government documents report a constant overestimation of vaccination coverage that creates a "false sense of security". This has become a barrier for the critical analysis of the Universal Vaccination Program.


Assuntos
Vacinas contra Influenza/provisão & distribução , Cobertura Vacinal , Vacinação , Criança , Seguimentos , Humanos , Lactente , México
4.
Saude e pesqui. (Impr.) ; 13(1): 105-113, jan/mar 2020. ilus, tab
Artigo em Português | LILACS | ID: biblio-1052906

RESUMO

O estudo objetivou analisar a situação vacinal de crianças matriculadas em Centros Municipais de Educação Infantil da Zona Sul de Natal (RN), para as vacinas pneumocócica 10 valentes e meningocócica C. Trata-se de uma pesquisa epidemiológica e retrospectiva de abordagem quantitativa, realizada a partir de levantamento dos dados de 733 cartões de vacina junto aos 15 Centros Municipais de Educação Infantil na Zona Sul de Natal. Para a vacina meningocócica C, 500 (63,75%) crianças apresentaram esquema vacinal completo, 224 (30,64%) esquema vacinal incompleto, 43 (5,61%) não foram imunizadas e 6 (0,78%) falhas de registro. Em relação à vacina pneumocócica 10 valentes, 470 (60,63%) crianças estão com o esquema vacinal completo, 273 (36,88%) esquema incompleto, 19 (2,49%) não foram vacinadas e 11 (1,42%) falhas de registro. Os achados apontam uma situação vacinal abaixo da meta estabelecida pelo Programa Nacional de Imunização.


The vaccine situation of children enrolled in the Municipal Centers of children education in the south zone of Natal, Brazil, is investigated, with regard to meningococcal c and pneumococcal 10 conjugate vaccines. Current epidemiological and retrospective research was undertaken with 733 vaccine charts from 15 Municipal Centers of Children Education in the south zone of Natal, Brazil. In the case of meningococcal C vaccine, 500 (63.75%) of the children had a complete vaccine chart; 224 (30.64%) presented an incomplete one; 43 (5.61%) had not been immunized and 6 (0.78%) presented blacks in the register. In the case of the pneumococcal 10 vaccine, 470 (60.63%) children had a complete vaccine chart; 273 (36.88%) presented an incomplete one; 19 (2.49%) were not immunized and 11 (1.42%) had gaps in the register. Research revealed a vaccine situação lower than average established by the Brazilian Immunization Program.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Imunização , Cobertura Vacinal , Criança , Educação Infantil
5.
BMC Infect Dis ; 20(1): 240, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32197591

RESUMO

BACKGROUND: The current national influenza vaccination schedule in Mexico does not recommend vaccination in the school-aged population (5-11 years). Currently, there are limited data from middle-income countries analysing the cost-effectiveness of influenza vaccination in this population. We explored the clinical effects and economic benefits of expanding the current national influenza vaccination schedule in Mexico to include the school-aged population. METHODS: A static 1-year model incorporating herd effect was used to assess the cost-effectiveness of expanding the current national influenza vaccination schedule of Mexico to include the school-aged population. We performed a cross-sectional epidemiological study using influenza records (2009-2018), death records (2010-2015), and discharge and hospitalisation records (2010-2016), from the databases of Mexico's Influenza Surveillance System (SISVEFLU), the National Mortality Epidemiological and Statistical System (SEED), and the Automated Hospital Discharge System (SAEH), respectively. Cost estimates for influenza cases were based on 7 scenarios using data analysed from SISVEFLU; assumptions for clinical management of cases were defined according to Mexico's national clinical guidelines. The primary health outcome for this study was the number of influenza cases avoided. A sensitivity analysis was performed using conservative and optimistic parameters (vaccination coverage: 30% / 70%, Vaccine effectiveness: 19% / 68%). RESULTS: It was estimated that expanding the influenza immunisation programme to cover school-aged population in Mexico over the 2018-2019 influenza season would result in 671,461 cases of influenza avoided (50% coverage and 50% effectiveness assumed). Associated with this were 262,800 fewer outpatient consultations; 154,100 fewer emergency room consultations; 97,600 fewer hospitalisations, and 15 fewer deaths. Analysis of cases avoided by age-group showed that 55.4% of them were in the school-aged population, and the decrease in outpatient consultations was largest in this population. There was an overall decrease in the economic burden for the Mexican health care system of 111.9 million US dollars; the immunization programme was determined to be cost-saving in the base, conservative and optimistic scenarios. CONCLUSIONS: Vaccinating school-aged population in Mexico would be cost-effective; expansion of the current national vaccination schedule to this age group is supported.


Assuntos
Análise Custo-Benefício/métodos , Vacinas contra Influenza/economia , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Vacinação/economia , Criança , Pré-Escolar , Estudos Transversais , Assistência à Saúde , Feminino , Hospitalização/economia , Humanos , Programas de Imunização/economia , Esquemas de Imunização , Incidência , Influenza Humana/mortalidade , Masculino , México/epidemiologia , Alta do Paciente , Cobertura Vacinal
6.
BMC Infect Dis ; 20(1): 197, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32138688

RESUMO

BACKGROUND: The incidence rate of measles in China reached a nadir in 2012 after 2 supplementary immunization activities (SIAs) were undertaken in 2009 and 2010. However, the disease began re-emerging in 2013, with a high prevalence rate observed in 2013-2014 in the southern province of Guangdong. In this study, we assessed the changes that occurred in measles epidemiology during 2009-2016, particularly between 2009 and 2011 (when the influence of the SIAs were in full effect) and between 2012 and 2016 (when this influence subsided). METHODS: Data from 22,362 patients with measles diagnosed between 2009 and 2016, and whose diagnoses were confirmed clinically and/or with laboratory testing, were extracted from the National Infectious Disease Monitoring Information System. Descriptive analyses were performed, and changes in epidemiological characteristics between 2009 and 2011 and 2012-2016 were compared. RESULTS: There was a substantial surge in 0-8-month-old patients after 2012; the incidence rate increased from 4.0 per 100,000 population in 2011 (10.3% of the total) to 280 per 100,000 population in 2013 (32.8% of the total). Patients aged 0-6 years represented 73.4% of the total increase between 2011 and 2013. Compared with 2009-2011, adults aged ≥25 years accounted for a higher proportion of patients in 2013 and after (p < 0.01), and were highest in 2016 (31% of the patient total). CONCLUSION: Despite the remarkable results achieved by SIAs in terms of providing herd immunity, the 2013 resurgence of measles revealed insufficient immunization coverage among children. Therefore routine immunization programs should be strengthened, and supplementary vaccinations targeting adults should also be contemplated.


Assuntos
Sarampo/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Imunidade Coletiva , Programas de Imunização/métodos , Programas de Imunização/tendências , Incidência , Lactente , Recém-Nascido , Masculino , Sarampo/imunologia , Vacina contra Sarampo/administração & dosagem , Vacina contra Sarampo/imunologia , Estudos Retrospectivos , Cobertura Vacinal/estatística & dados numéricos , Cobertura Vacinal/tendências , Adulto Jovem
7.
East Mediterr Health J ; 26(2): 152-160, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32141592

RESUMO

Background: Despite the wide use of vaccination, measles outbreaks still occur. Aims: This study assessed cases notified during a measles outbreak in northern Sudan in 2011 and the response of the health authorities to contain the outbreak. Methods: The records of all measles cases reported to the River Nile State health ministry in 2011 from the Abu Hamad locality, a gold-mining area, were reviewed together with the actions of the health authorities at the time of the outbreak. Seventeen gold-mining clusters were included. Data on demographic, clinical, geographic and chronological characteristics of the cases were extracted. Results: The outbreak occurred from 27 January to 3 May 2011 with the peak in epidemiological week 9. A total of 445 measles cases were recorded, giving an incidence of 27.1 per 10 000 of the mining and resident population. Most cases (87.4%) were aged between 15 and 34 years. High fever was the most common symptom (99.3% of the cases), followed by conjunctivitis (80.4%); haemorrhage was recorded in 29.4%. Most cases (84.9%) were unvaccinated. Six deaths occurred (case fatality: 1.3%); two from cerebral coma and four from haemorrhagic shock. Severity of disease was significantly associated with place of origin of the cases (P = 0.003). Conclusion: The measles outbreak in the gold-mining areas in Abu Hamad had serious consequences attributed to poor environmental conditions, overcrowding, poor nutrition and lack of vaccination. The health authority response helped end the outbreak. The local health authority should consider the gold-mining areas as a potential risk to public health in their future plans.


Assuntos
Vacina contra Sarampo/administração & dosagem , Sarampo/epidemiologia , Saúde Pública , Adolescente , Adulto , Criança , Pré-Escolar , Demografia , Surtos de Doenças , Feminino , Humanos , Programas de Imunização , Masculino , Sarampo/prevenção & controle , Sudão/epidemiologia , Cobertura Vacinal , Adulto Jovem
8.
BMC Public Health ; 20(1): 228, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054484

RESUMO

BACKGROUND: Monitoring of the expanded program on immunization's performance is not only limited to routine periodic reports but equally includes surveys. Based on unpublished national EPI surveillance data from the past 5 years in Cameroon, the Foumban health district has reported a high number of vaccine preventable disease suspected cases. Contradictory information on the immunization coverage in this district exists from both administrative data and published literature. As a result, the objective of this study was to estimate the immunization coverage and dropout rate in age group 12-23 months and timeliness in age group 0-59 months among children in Foumban Health District (Cameroon), in 2018. METHOD: This was a descriptive cross-sectional study targeting randomly selected children aged 0-59 months from Foumban health district. Data were collected by trained and supervised surveyors using a pretested questionnaire to describe the immunization coverage, timeliness and dropout rate in eighty clusters of about thirty buildings selected by stratified random sampling in July 2018. RESULTS: In total, 80 clusters covering 2121 buildings were selected and all were reached (100%). A total of 1549 (81.2%) households accepted to participate in the survey and 1430 children aged 0-59 months including 294 (20.6%) aged 12-23 months were enrolled into the study. Of these 1430 children, 427 [29.9 (27.4-32.2)%] aged 0-59 months were vaccinated with evidence. In the age group 12-23 months, the immunization coverage with evidence of BCG, DPT-Hi + Hb 3 and measles/rubella were 28.6(23.4-33.9)%, 22.8 (18.1-27.6)% and 14.3 (10.3-18.1)% respectively. Within age group 0-59 months; the proportion of children who missed their vaccination appointments increased from 23.3 to 31.7% for the vaccine planned at birth (BCG) and last vaccine planned (Measles/Rubella) for the EPI program respectively. In age group 12-23 months; the specific (DPT-Hi + Hb1-3) and general (BCG-Measles/Rubella) dropout rates of vaccination with evidence were 14.1 and 50.0% respectively. CONCLUSION: Documented immunization coverage, dropout rate and timeliness in Foumban Health district are lower than that targeted by the Cameroon EPI. Competent health authorities have to take necessary actions to ensure the implementation of national guidelines with regards to children access to immunization. Also, studies have to be conducted to identify determinants of low immunization coverage and delays in immunization schedules as well as high dropout rates.


Assuntos
Programas de Imunização/organização & administração , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Vacinas/administração & dosagem , Camarões , Pré-Escolar , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Esquemas de Imunização , Lactente , Recém-Nascido , Masculino , Avaliação de Programas e Projetos de Saúde , Fatores de Tempo
9.
PLoS One ; 15(2): e0228942, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32059029

RESUMO

BACKGROUND: Prior to vaccine introduction in 2006, rotavirus was the leading cause of severe diarrhea in children under five years of age in the U.S. Vaccination of infants has led to major reductions in disease burden, a shift in the seasonal peak and the emergence of a biennial pattern of disease. However, rotavirus vaccine coverage has remained relatively low (70-75%) compared to other infant immunizations in the U.S. Part of the reason for this lower coverage is that children whose care is provided by family practitioners (FP) have considerably lower probability of being vaccinated compared to those seen be pediatricians (PE). We used a dynamic transmission model to assess the impact of improving rotavirus vaccine coverage by FP and/or PE on rotavirus gastroenteritis (RVGE) incidence and seasonal patterns. METHODS: A deterministic age-structured dynamic model with susceptible, infectious, and recovered compartments (SIRS model) was used to simulate rotavirus transmission and vaccination. We estimated the reduction of RVGE cases by 2 doses of rotavirus vaccine with three vaccination scenarios: (Status Quo: 85% coverage by pediatricians and 45% coverage by family practitioners; Improved FP: 85% coverage by pediatricians and family practitioners; Improved FP+PE: 95% coverage by pediatricians and family practitioners). In addition, we tested the sensitivity of the model to the assumption of random mixing patterns between children visiting pediatricians and children visiting family practitioners. RESULTS: In this model, higher vaccine coverage provided by family practitioners and pediatricians leads to lower incidence of severe RVGE cases (23% averted in Improved FP and 57% averted in Improved FP+PE compared to Status Quo) including indirect effects. One critical impact of higher total vaccine coverage is the effect on rotavirus epidemic patterns in the U.S.; the biennial rotavirus epidemic patterns shifted to reduced annual epidemic patterns. Additionally, assortative mixing patterns in children visiting pediatricians and family practitioners amplify the impact of increasing vaccine coverage. CONCLUSION: Other high-income countries that introduced vaccine have not experienced biennial patterns, like the U.S. Our results suggest that increasing overall vaccine coverage to 85% among infants would lead to an overall reduction in incidence with annual epidemic patterns.


Assuntos
Vacinas contra Rotavirus/administração & dosagem , Cobertura Vacinal/tendências , Vacinação/tendências , Criança , Pré-Escolar , Diarreia/epidemiologia , Feminino , Gastroenterite/virologia , Humanos , Imunização/tendências , Incidência , Lactente , Masculino , Modelos Teóricos , Rotavirus/imunologia , Rotavirus/patogenicidade , Infecções por Rotavirus/epidemiologia , Vacinas contra Rotavirus/imunologia , Estados Unidos/epidemiologia , Cobertura Vacinal/métodos , Vacinas Virais/administração & dosagem
10.
PLoS Negl Trop Dis ; 14(1): e0007967, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32004316

RESUMO

Oral cholera vaccine (OCV) has increasingly been used as an outbreak control measure, but vaccine shortages limit its application. A two-dose OCV campaign targeting residents aged over 1 year was launched in three rural Communes of Southern Haiti during an outbreak following Hurricane Matthew in October 2016. Door-to-door and fixed-site strategies were employed and mobile teams delivered vaccines to hard-to-reach communities. This was the first campaign to use the recently pre-qualified OCV, Euvichol. The study objective was to estimate post-campaign vaccination coverage in order to evaluate the campaign and guide future outbreak control strategies. We conducted a cluster survey with sampling based on random GPS points. We identified clusters of five households and included all members eligible for vaccination. Local residents collected data through face-to-face interviews. Coverage was estimated, accounting for the clustered sampling, and 95% confidence intervals calculated. 435 clusters, 2,100 households and 9,086 people were included (99% response rate). Across the three communes respectively, coverage by recall was: 80.7% (95% CI:76.8-84.1), 82.6% (78.1-86.4), and 82.3% (79.0-85.2) for two doses and 94.2% (90.8-96.4), 91.8% (87-94.9), and 93.8% (90.8-95.9) for at least one dose. Coverage varied by less than 9% across age groups and was similar among males and females. Participants obtained vaccines from door-to-door vaccinators (53%) and fixed sites (47%). Most participants heard about the campaign through community 'criers' (58%). Despite hard-to-reach communities, high coverage was achieved in all areas through combining different vaccine delivery strategies and extensive community mobilisation. Emergency OCV campaigns are a viable option for outbreak control and where possible multiple strategies should be used in combination. Euvichol will help alleviate the OCV shortage but effectiveness studies in outbreaks should be done.


Assuntos
Vacinas contra Cólera/administração & dosagem , Cólera/prevenção & controle , Vacinação em Massa/métodos , Cobertura Vacinal , Adolescente , Adulto , Criança , Pré-Escolar , Cólera/epidemiologia , Vacinas contra Cólera/provisão & distribução , Análise por Conglomerados , Coleta de Dados , Surtos de Doenças , Características da Família , Feminino , Haiti/epidemiologia , Humanos , Lactente , Masculino , População Rural
11.
PLoS One ; 15(1): e0218239, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31951608

RESUMO

BACKGROUND: We explored the contributions of the Family Health Days (FHDs) concept, which was developed by the Uganda Ministry of Health (MOH) and UNICEF as a supplementary quarterly outreach program in addition to strengthening the routine expanded program for immunization (EPI), with the aim to increase coverage, through improved access to the unimmunized or unreached and under-immunized children under 5 years. METHOD: A cross-sectional descriptive study of the Uganda MOH, Health Management Information Systems (HMIS) and UNICEF in house FHDs data was conducted covering six quarterly implementations of the program between April 2012 and December 2013. The FHDs program was implemented in 31 priority districts with low routine vaccination coverage from seven sub-regions in Uganda in a phased manner using places of worship for service delivery. RESULTS: During the six rounds of FHDs in the 31 districts, a total of 178,709 and 191,223 children received measles and Diphtheria-Pertussis-Tetanus (DPT3) vaccinations, respectively. The FHDs' contributions were 126% and 144% for measles and 103% and 122% for DPT3 in 2012 and 2013, respectively of the estimated unreached annual target populations. All implementing sub-regions after two rounds in 2012 attained over and above the desired target for DPT3 (85%) and measles (90%). The same was true in 2013 after four rounds, except for Karamoja and West Nile sub-regions, where in some districts a substantial proportion of children remained unimmunized. The administrative data for both DPT3 and measles immunization showed prominent and noticeable increase in coverage trend in FHDS regions for the months when the program was implemented. CONCLUSION: The FHDs program improved vaccination equity by reaching the unreached and hard-to-reach children and bridging the gap in immunization coverage, and fast tracking the achievement of targets recommended by the Global Vaccine Action Plan (GVAP) for measles and DPT3 (85% and 90% respectively) in implementing sub-regions and districts. The FHDs is an innovative program to supplement routine immunizations designed to reach the unreached and under immunized children.


Assuntos
Vacina contra Difteria, Tétano e Coqueluche/uso terapêutico , Sarampo/prevenção & controle , Vacinação , Criança , Pré-Escolar , Estudos Transversais , Saúde da Família , Feminino , Humanos , Programas de Imunização , Lactente , Masculino , Sarampo/epidemiologia , Sarampo/patologia , Uganda/epidemiologia , Cobertura Vacinal
12.
BMC Public Health ; 20(1): 123, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996184

RESUMO

BACKGROUND: In 2017, about 20% of the world's children under 1 year of age with incomplete DPT vaccination lived in Nigeria. Fully-immunised child coverage (FIC), which is the percentage of children aged 12-23 months who received all doses of routine infant vaccines in their first year of life in Nigeria is low. We explored the associations between child, household, community and health system level factors and FIC, in particular focussing on urban formal and slum, and rural residence, using representative Nigeria Demographic Health Survey (NDHS) data from 2003, 2008 and 2013. METHOD: Multilevel logistic regression models were applied for quantitative analyses of NDHS 2003, 2008 and 2013 data, singly, pooled overall and stratified by rural/urban, and within urban by formal and slum. We also quantify Population Attributable Risk (PAR) of FIC. RESULTS: FIC for rural, urban formal and slum rose from 7.4, 25.6 and 24.9% respectively in 2003 to 15.8, 45.5 and 38.5% in 2013, and varied across sociodemographics. In pooled NDHS analysis, overall and stratified, final FIC adjusted odds (aOR) were: 1. Total population - delivery place (health facility vs home, aOR = 1.13, 95% CI = 0.73-1.73), maternal education (higher vs no education, aOR = 3.92, 95% CI = 1.79-8.59) and place of residence (urban vs rural, aOR = 1.69, 95% CI = 0.89-3.22). 2. Rural, urban formal and slum stratified: A.Rural - delivery place (aOR = 1.47, 95% CI = 1.12-1.94), maternal education (aOR = 4.99, 95% CI = 2.48-10.06). B.Urban formal - delivery place (aOR = 2.62, 95% CI = 1.43-4.79), maternal education level (aOR = 9.18, 95% CI = 3.05-27.64). C.Slums - delivery place (aOR = 5.39, 95% CI = 2.18-13.33), maternal education (aOR = 5.03, 95% CI = 1.52-16.65). The PAR revealed the highest percentage point increase in FIC would be achieved in all places of residence by maternal higher education: rural-38.15, urban formal-22.88 and slum 23.76, while non-attendance of antenatal care was estimated to lead to the largest reduction in FIC. CONCLUSION: Although low FIC in rural areas may be largely due to lack of health facilities and immunisation education, the intra-urban disparity is mostly unexplained, and requires further qualitative and interventional research. We show the FIC point increase that can be achieved if specific sociodemographic variable (risk) are addressed in the various communities, thus informing prioritisation of interventions.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Masculino , Nigéria
13.
MMWR Morb Mortal Wkly Rep ; 69(3): 72-76, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31971934

RESUMO

Infants are at increased risk for pertussis-associated morbidity and mortality, and pregnant women and their infants are more likely than other patient populations to experience severe influenza-related illness (1,2). The Advisory Committee on Immunization Practices (ACIP) recommends that all women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, preferably during the early part of gestational weeks 27-36 (3). ACIP also recommends that women who are or might be pregnant during the influenza season receive the inactivated influenza vaccine at any time during pregnancy (4). Despite these recommendations, coverage with Tdap and influenza vaccines during pregnancy has been low, with approximately one half of women receiving each vaccine and only one third receiving both, based on a survey during March-April 2019 (5). Data obtained through a retrospective chart review of randomly selected pregnant women who delivered at the University of Florida Health Shands Hospital in Gainesville, Florida, from January 1, 2016, to December 31, 2018, were analyzed to assess vaccination coverage by insurance type. Because the Florida Medicaid policy at that time did not cover these vaccines during pregnancy, the hospital system offered Tdap and influenza vaccines at no additional cost to mothers during the immediate postpartum hospital stay. Among 341 women, 68.6% of privately insured and 13.4% with Medicaid received Tdap during pregnancy, and among 316 women, 70.4% of privately insured and 35.6% with Medicaid received influenza vaccine during pregnancy. Many women, especially those with Medicaid, were vaccinated in the immediate postpartum period, when vaccination was available at no cost, increasing Tdap vaccination rates to 79.3% for privately insured and 51.7% for women with Medicaid; influenza vaccination rates rose to 72.0% for privately insured and 43.5% for women with Medicaid. These data suggest that the state Medicaid policy to not cover these vaccines during pregnancy might have significantly reduced coverage among its enrollees.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Vacinas contra Influenza/administração & dosagem , Seguro Saúde/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Feminino , Florida , Humanos , Medicaid/estatística & dados numéricos , Gravidez , Setor Privado/estatística & dados numéricos , Estados Unidos , Adulto Jovem
14.
Medicine (Baltimore) ; 99(1): e18540, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895791

RESUMO

Infection with influenza virus increases morbidity and mortality in patients with risk factors, including cardiovascular disease (CVD). This study aimed to evaluate factors associated with influenza vaccination coverage in Korean CVD patients.We included 19,599 adults from the 2010 to 2012 Korea National Health and Nutrition Examination Survey. Influenza vaccination rates were compared in subjects with and without CVD. Logistic regression analysis was performed to identify factors associated with influenza vaccination in Korean adults with CVD before and after stratification for age (<65 and ≥65 years).Significantly higher vaccination rates were observed in individuals with CVD than in those without CVD (61.4% vs 31.0%, P < .001). However, young individuals (19-49 years) had decreased influenza vaccination rates, with no difference based on CVD status (20.3% vs 21.6%, P = .859). A lack of private insurance (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23-0.98) and recent health screening (OR, 4.56; 95% CI, 1.90-10.92) were independent factors for influenza vaccination in CVD patients aged <65 years, whereas female sex (OR, 3.71; 95% CI, 1.24-11.07) and less education (OR, 4.59; 95% CI, 1.27-16.61) were independent factors in CVD patients aged ≥65 years.Improving influenza vaccination coverage for Korean adults with CVD is important, especially in young patients. For young patients with CVD, influenza vaccination status is independently associated with the presence of private insurance and recent health screening. This finding could help establish public health policies to promote influenza vaccination in this population.


Assuntos
Doenças Cardiovasculares/virologia , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Cobertura Vacinal/estatística & dados numéricos , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , República da Coreia/epidemiologia , Fatores de Risco
15.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31932361

RESUMO

BACKGROUND: Mandatory vaccination has been effective in maintaining high vaccination coverage in countries such as the United States. However, there are no peer-reviewed analyses of the association between mandates and both coverage and subsequent incidence of vaccine-preventable disease in Europe. METHODS: Using data from the European Centre for Disease Prevention and Control and the World Health Organization, we evaluated the relationship between country-level mandatory vaccination policies and (1) measles and pertussis vaccine coverage and (2) the annual incidence of these diseases in 29 European countries. Multivariate negative binomial and linear regression models were used to quantify these associations. RESULTS: Mandatory vaccination was associated with a 3.71 (95% confidence interval [CI]: 1.68 to 5.74) percentage point higher prevalence of measles vaccination and a 2.14 (95% CI: 0.13 to 4.15) percentage point higher prevalence of pertussis vaccination when compared with countries that did not have mandatory vaccination. Mandatory vaccination was only associated with decreased measles incidence for countries without nonmedical exemptions (adjusted incidence rate ratio = 0.14; 95% CI: 0.05 to 0.36). We did not find a significant association between mandatory vaccination and pertussis incidence. CONCLUSIONS: Mandatory vaccination and the magnitude of fines were associated with higher vaccination coverage. Moreover, mandatory vaccination was associated with lower measles incidence for countries with mandatory vaccination without nonmedical exemptions. These findings can inform legislative policies aimed at increasing vaccination coverage.


Assuntos
Programas Obrigatórios/estatística & dados numéricos , Vacina contra Sarampo/administração & dosagem , Sarampo/epidemiologia , Vacina contra Coqueluche/administração & dosagem , Cobertura Vacinal/estatística & dados numéricos , Coqueluche/epidemiologia , Intervalos de Confiança , Europa (Continente)/epidemiologia , Humanos , Incidência , Programas Obrigatórios/economia , Sarampo/prevenção & controle , Cobertura Vacinal/economia , Coqueluche/prevenção & controle
16.
Mayo Clin Proc ; 95(1): 169-183, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902413

RESUMO

In vaccinating adults, clinicians face 2 types of challenges: (1) staying current on recommendations for influenza, pneumococcal, hepatitis A and B, zoster, and other vaccines and (2) addressing systemic barriers to implementing practices that increase vaccination rates. Although adult immunization rates remain suboptimal, there has been much good news in adult vaccination recently. New high-dose and adjuvanted influenza vaccines help improve immune response and may reduce influenza complications in older adults. The new recombinant zoster vaccine offers significantly more efficacy against zoster outbreaks and postherpetic neuralgia than zoster vaccine live. Pertussis vaccine given during the third trimester of pregnancy may prevent between 50% and 90% of pertussis infections in infants. Shorter time for completion (1 vs 6 months) of new, adjuvanted hepatitis B vaccine may increase adherence. Clinicians can address systemic barriers to increasing vaccination rates in their clinics and health care systems by following the Centers for Disease Control and Prevention's Standards for Adult Immunization Practice. Clinicians can help increase vaccination rates by writing standing orders and by advocating for nurses or medical assistants to receive training and protected time for assessing and documenting vaccination histories and administration. Strong recommendations that presume acceptance of vaccination are effective with most patients. Communication techniques similar to motivational interviewing can help with vaccine-hesitant patients. Clinicians, as experts on providing preventive services, can educate community leaders about the benefits of immunization and can inform vaccine experts about challenges of implementing vaccination recommendations in clinical practice and strategies that can work to raise vaccination rates.


Assuntos
Vacinação em Massa , Infecções Pneumocócicas/prevenção & controle , Viroses/prevenção & controle , Adulto , Humanos , Vacinação em Massa/métodos , Vacinação em Massa/organização & administração , Infecções Pneumocócicas/epidemiologia , Serviços Preventivos de Saúde/normas , Estados Unidos , Cobertura Vacinal/métodos , Cobertura Vacinal/estatística & dados numéricos , Viroses/epidemiologia
17.
Int J Infect Dis ; 90: 77-83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31634615

RESUMO

OBJECTIVE: The 2009 province-wide and 2010 nationwide supplementary immunization activities (SIAs) greatly reduced measles prevalence in Guangdong, a province in southern China with the largest migrant population. However, during 2013-2014, Guangdong experienced a resurgence of the measles epidemic. This study was performed to examine the association between infections in migrants and the resurgence of the measles epidemic. METHODS: The records of 22 362 clinically and laboratory-confirmed measles cases from the years 2009 to 2014 were extracted from the National Infectious Disease Monitoring Information System. The epidemiological characteristics of infections in migrants during 2009-2012 were compared to those during 2013-2014. RESULTS: Infections in migrants were not significantly associated with the resurgence of the measles epidemic in 2013-2014 (p=0.98). Nevertheless, for infections among locals and migrants during 2009-2012 and 2013-2014, substantial increases in the proportion of infection were detected among children aged <8 months and the unvaccinated population (p<0.01). CONCLUSIONS: The study findings suggest that infections in migrants might not have been the major cause of the epidemic resurgence of measles. Instead, the resurgence was likely due to infections among children aged <8 months and the unvaccinated. Thus, officials are advised to give higher priority to appropriate populations when formulating control measures, and to strengthen routine surveillance of vaccination coverage among them.


Assuntos
Epidemias , Sarampo/epidemiologia , Migrantes , Adolescente , Adulto , Criança , Pré-Escolar , China/epidemiologia , Análise de Dados , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Vacina contra Sarampo , Estudos Retrospectivos , Cobertura Vacinal , Adulto Jovem
18.
BMC Public Health ; 19(1): 1673, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31830944

RESUMO

BACKGROUND: Despite policy intention to reach disadvantaged populations, inequalities in health care resource use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016. METHODS: Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens: Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of full vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities. RESULTS: Full vaccination coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from - 32.3 [- 45.5,-19.1] in 2001 to an SII of-8.4 [- 18.6,-1.7] in 2016. Similarly, the SII for education decreased from - 61.8 [- 73.5,-50.1] in 2001 to an SII of - 30.5 [- 40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full vaccination coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (- 0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period. CONCLUSION: Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.


Assuntos
Cobertura Vacinal/tendências , Demografia , Escolaridade , Feminino , Humanos , Lactente , Masculino , Nepal , Fatores Socioeconômicos
19.
Rev Med Chil ; 147(6): 776-786, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859831

RESUMO

Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.


Assuntos
Implementação de Plano de Saúde/métodos , Vacinação em Massa/métodos , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Chile/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Neisseria meningitidis Sorogrupo W-135 , Estações do Ano , Cobertura Vacinal , Adulto Jovem
20.
Tohoku J Exp Med ; 249(4): 265-273, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31852852

RESUMO

In Japan, some measles outbreaks were initiated by a tourist from oversea and foreign workers recently. Moreover, rubella outbreak emerged since July 2018 mainly in the South Kanto, and the outbreak is currently ongoing in 2019. It is important to maintain a high measles-rubella combined vaccine (MR) coverage for measles-rubella control. Vaccination coverage for the second dose of MR (MR2) is 90.8% in Tokyo in 2016, which was the third worst among all prefectures in Japan. The purpose of this study was to clarify determinant factors of vaccination coverage for MR2 in Tokyo. Data were obtained for 49 wards and cities in Tokyo in 2016. We regressed vaccination coverage of MR2 on the times of notification by mail, the proportion of households receiving welfare payments, and the proportion of non-Japanese elementary school students. In addition to the simplest specification, five factors were included separately as explanatory variables: the proportion of public health nurses; the ratio of the number of pediatric medical facilities to the number of preschool and elementary school children; the moving-in rate; the proportion of households with a single parent; and the proportion of households with husband and wife both working. Results show that a high proportion of households receiving welfare payments, notification by two or more letters, and moving-in rate or a lower proportion of non-Japanese elementary school students improve coverage. In conclusion, the health authorities can exert efforts to reduce burden of time spent for vaccination and provide sufficient information to improve coverage.


Assuntos
Vacina contra Sarampo/imunologia , Vacina contra Rubéola/imunologia , Cobertura Vacinal , Criança , Pré-Escolar , Relação Dose-Resposta Imunológica , Humanos , Fatores de Tempo , Tóquio
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