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1.
Lancet Gastroenterol Hepatol ; 6(5): 391-400, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33857445

RESUMO

Hepatitis C virus (HCV) is a global public health problem in correctional settings. The International Network on Health and Hepatitis in Substance Users-Prisons Network is a special interest group committed to advancing scientific knowledge exchange and advocacy for HCV prevention and care in correctional settings. In this Review, we highlight seven priority areas and best practices for improving HCV care in correctional settings: changing political will, ensuring access to HCV diagnosis and testing, promoting optimal models of HCV care and treatment, improving surveillance and monitoring of the HCV care cascade, reducing stigma and tackling the social determinants of health inequalities, implementing HCV prevention and harm reduction programmes, and advancing prison-based research.


Assuntos
Erradicação de Doenças/métodos , Hepatite C/prevenção & controle , Prisioneiros , Prisões , Erradicação de Doenças/organização & administração , Redução do Dano , Política de Saúde , Acesso aos Serviços de Saúde , Hepatite C/diagnóstico , Hepatite C/terapia , Humanos , Cooperação Internacional , Política , Determinantes Sociais da Saúde , Estigma Social
2.
Adv Ther ; 38(3): 1397-1403, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33590446

RESUMO

The availability of pangenotypic direct-acting antivirals for treatment of hepatitis C (HCV) has provided an opportunity to simplify patient pathways. Recent clinical practice guidelines have recognised the need for simplification to ensure that elimination of HCV as a public health concern remains a priority. Despite the move towards simplified treatment algorithms, there remains some complexity in the recommendations for the management of genotype 3 patients with compensated cirrhosis. In an era where additional clinical trial data are not anticipated, clinical guidance should consider experience gained in real-world settings. Although more experience is required for some pangenotypic therapeutic options, on the basis of published real-world data, there is already sufficient evidence to consider a simplified approach for genotype 3 patients with compensated cirrhosis. The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need to minimise the need for complex patient pathways and clinical practice guidelines need to continue to evolve in order to ensure that patient outcomes remain optimised.


Assuntos
Controle de Doenças Transmissíveis , Procedimentos Clínicos , Erradicação de Doenças , Hepatite C , Antivirais/farmacologia , /prevenção & controle , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Procedimentos Clínicos/normas , Procedimentos Clínicos/tendências , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Saúde Global/tendências , Hepatite C/epidemiologia , Hepatite C/terapia , Humanos , Guias de Prática Clínica como Assunto
3.
Risk Anal ; 41(2): 393-406, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33590521

RESUMO

Despite a strong global commitment, polio eradication efforts continue now more than 30 years after the 1988 World Health Assembly resolution that established the Global Polio Eradication Initiative (GPEI), and 20 years after the original target of the year 2000. Prior health economic analyses estimated incremental net benefits of the GPEI of 40-50 billion in 2008 U.S. dollars (US$2008, equivalent to 48-59 billion US$2019), assuming the achievement of polio eradication by 2012. Given the delays in achieving polio eradication and increased costs, we performed an updated economic analysis of the GPEI using an updated integrated global model, and considering the GPEI trajectory as of the beginning of 2020. Applying similar methods and assuming eradication achievement in 2023, we estimate incremental net benefits of the GPEI of 28 billion US$2019, which falls below the prior estimate. Delays in achieving polio eradication combined with the widescale introduction of relatively expensive inactivated poliovirus vaccine significantly increased the costs of the GPEI and make it less cost-effective, although the GPEI continues to yield expected incremental net benefits at the global level when considered over the time horizon of 1988-2029. The overall health and financial benefits of the GPEI will depend on whether and when the GPEI can achieve its goals, when eradication occurs, the valuation method applied, and the path dependence of the actions taken. Reduced expected incremental net benefits of the GPEI and the substantial economic impacts of the COVID-19 pandemic pose large financial risks for the GPEI.


Assuntos
Erradicação de Doenças/métodos , Economia Médica , Saúde Global , Poliomielite/economia , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado/economia , Vacina Antipólio Oral/economia , Algoritmos , /epidemiologia , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Programas de Imunização/economia , Modelos Teóricos , Pandemias , Poliomielite/epidemiologia , Estudos Retrospectivos , Estados Unidos
4.
Proc Natl Acad Sci U S A ; 118(1)2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33443170

RESUMO

Invasive organisms pose a global threat and are exceptionally difficult to eradicate after they become abundant in their new habitats. We report a successful multitactic strategy for combating the pink bollworm (Pectinophora gossypiella), one of the world's most invasive pests. A coordinated program in the southwestern United States and northern Mexico included releases of billions of sterile pink bollworm moths from airplanes and planting of cotton engineered to produce insecticidal proteins from the bacterium Bacillus thuringiensis (Bt). An analysis of computer simulations and 21 y of field data from Arizona demonstrate that the transgenic Bt cotton and sterile insect releases interacted synergistically to reduce the pest's population size. In Arizona, the program started in 2006 and decreased the pest's estimated statewide population size from over 2 billion in 2005 to zero in 2013. Complementary regional efforts eradicated this pest throughout the cotton-growing areas of the continental United States and northern Mexico a century after it had invaded both countries. The removal of this pest saved farmers in the United States $192 million from 2014 to 2019. It also eliminated the environmental and safety hazards associated with insecticide sprays that had previously targeted the pink bollworm and facilitated an 82% reduction in insecticides used against all cotton pests in Arizona. The economic and social benefits achieved demonstrate the advantages of using agricultural biotechnology in concert with classical pest control tactics.


Assuntos
/genética , Bacillus thuringiensis/genética , Erradicação de Doenças/métodos , Gossypium/genética , Mariposas/genética , Controle Biológico de Vetores/métodos , Animais , Animais Geneticamente Modificados , Arizona , Simulação por Computador , Erradicação de Doenças/economia , Infertilidade/genética , Inseticidas/metabolismo , México , Mariposas/crescimento & desenvolvimento , Mariposas/patogenicidade , Plantas Geneticamente Modificadas , Sudoeste dos Estados Unidos
6.
BMC Med ; 19(1): 2, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33397366

RESUMO

BACKGROUND: Through a combination of strong routine immunization (RI), strategic supplemental immunization activities (SIA) and robust surveillance, numerous countries have been able to approach or achieve measles elimination. The fragility of these achievements has been shown, however, by the resurgence of measles since 2016. We describe trends in routine measles vaccine coverage at national and district level, SIA performance and demographic changes in the three regions with the highest measles burden. FINDINGS: WHO-UNICEF estimates of immunization coverage show that global coverage of the first dose of measles vaccine has stabilized at 85% from 2015 to 19. In 2000, 17 countries in the WHO African and Eastern Mediterranean regions had measles vaccine coverage below 50%, and although all increased coverage by 2019, at a median of 60%, it remained far below levels needed for elimination. Geospatial estimates show many low coverage districts across Africa and much of the Eastern Mediterranean and southeast Asian regions. A large proportion of children unvaccinated for MCV live in conflict-affected areas with remote rural areas and some urban areas also at risk. Countries with low RI coverage use SIAs frequently, yet the ideal timing and target age range for SIAs vary within countries, and the impact of SIAs has often been mitigated by delays or disruptions. SIAs have not been sufficient to achieve or sustain measles elimination in the countries with weakest routine systems. Demographic changes also affect measles transmission, and their variation between and within countries should be incorporated into strategic planning. CONCLUSIONS: Rebuilding services after the COVID-19 pandemic provides a need and an opportunity to increase community engagement in planning and monitoring services. A broader suite of interventions is needed beyond SIAs. Improved methods for tracking coverage at the individual and community level are needed together with enhanced surveillance. Decision-making needs to be decentralized to develop locally-driven, sustainable strategies for measles control and elimination.


Assuntos
Erradicação de Doenças , Programas de Imunização , Imunização Secundária , Sarampo , Regionalização/organização & administração , Cobertura Vacinal/tendências , África/epidemiologia , Ásia Sudeste/epidemiologia , /prevenção & controle , Criança , Erradicação de Doenças/métodos , Erradicação de Doenças/estatística & dados numéricos , Humanos , Programas de Imunização/métodos , Programas de Imunização/organização & administração , Imunização Secundária/métodos , Imunização Secundária/estatística & dados numéricos , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vacina contra Sarampo/uso terapêutico , Região do Mediterrâneo/epidemiologia
8.
PLoS Negl Trop Dis ; 14(12): e0008877, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33370270

RESUMO

BACKGROUND: Lymphatic filariasis (LF) is targeted for elimination in Sierra Leone. Epidemiological coverage of mass drug administration (MDA) with ivermectin and albendazole had been reported >65% in all 12 districts annually. Eight districts qualified to implement transmission assessment survey (TAS) in 2013 but were deferred until 2017 due to the Ebola outbreak (2014-2016). In 2017, four districts qualified for conducting a repeat pre-TAS after completing three more rounds of MDA and the final two districts were also eligible to implement a pre-TAS. METHODOLOGY/PRINCIPAL FINDINGS: For TAS, eight districts were surveyed as four evaluation units (EU). A school-based survey was conducted in children aged 6-7 years from 30 clusters per EU. For pre-TAS, one sentinel and one spot check site per district (with 2 spot check sites in Bombali) were selected and 300-350 persons aged 5 years and above were selected. For both surveys, finger prick blood samples were tested using the Filariasis Test Strips (FTS). For TAS, 7,143 children aged 6-7 years were surveyed across four EUs, and positives were found in three EUs, all below the critical cut-off value for each EU. For the repeat pre-TAS/pre-TAS, 3,994 persons over five years of age were surveyed. The Western Area Urban had FTS prevalence of 0.7% in two sites and qualified for TAS, while other five districts had sites with antigenemia prevalence >2%: 9.1-25.9% in Bombali, 7.5-19.4% in Koinadugu, 6.1-2.9% in Kailahun, 1.3-2.3% in Kenema and 1.7% - 3.7% in Western Area Rural. CONCLUSIONS/SIGNIFICANCE: Eight districts in Sierra Leone have successfully passed TAS1 and stopped MDA, with one more district qualified for conducting TAS1, a significant progress towards LF elimination. However, great challenges exist in eliminating LF from the whole country with repeated failure of pre-TAS in border districts. Effort needs to be intensified to achieve LF elimination.


Assuntos
Albendazol/uso terapêutico , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Filaricidas , Ivermectina/uso terapêutico , Administração Massiva de Medicamentos , Animais , Brugia Malayi/isolamento & purificação , Criança , Pré-Escolar , Erradicação de Doenças/métodos , Filariose Linfática/diagnóstico , Filariose Linfática/tratamento farmacológico , Filaricidas/uso terapêutico , Humanos , Serra Leoa/epidemiologia , Wuchereria bancrofti/isolamento & purificação
9.
JAMA Netw Open ; 3(12): e2030427, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337496

RESUMO

Importance: In 2019, hepatitis C virus (HCV) infection contributed to more deaths in the US than 60 other notifiable infectious diseases combined. The incidence of and mortality associated with HCV infection are highest among American Indian and Alaska Native individuals. Objective: To evaluate the association of the Cherokee Nation (CN) HCV elimination program with each element of the cascade of care: HCV screening, linkage to care, treatment, and cure. Design, Setting, and Participants: This cohort study used data from the CN Health Services (CNHS), which serves approximately 132 000 American Indian and Alaska Native individuals residing in the 14-county CN reservation in rural northeastern Oklahoma. Data from the first 22 months of implementation (November 1, 2015, to August 31, 2017) of an HCV elimination program were compared with those from the pre-elimination program period (October 1, 2012, to October 31, 2015). The analysis included American Indian and Alaska Native individuals aged 20 to 69 years who accessed care through the CNHS between October 1, 2012, and August 31, 2017. Cure data were recorded through April 15, 2018. Exposure: The CN HCV elimination program. Main Outcomes and Measures: The main outcomes were the proportions of the population screened for HCV, diagnosed with current HCV infection, linked to care, treated, and cured during the initial 22 months of the elimination program period and the pre-elimination program period. Data from electronic health records and an HCV treatment database were analyzed. The cumulative incidence of HCV infection in this population was estimated using bayesian analyses. Results: Among the 74 039 eligible individuals accessing care during the elimination program period, the mean (SD) age was 36.0 (13.5) years and 55.9% were women. From the pre-elimination program period to the elimination program period, first-time HCV screening coverage increased from 20.9% to 38.2%, and identification of current HCV infection and treatment in newly screened individuals increased from a mean (SD) of 170 (40) per year to 244 (4) per year and a mean of 95 (133) per year to 215 (9) per year, respectively. During the implementation period, of the 793 individuals with current HCV infection accessing the CNHS, 664 were evaluated (83.7%), 394 (59.3%) initiated treatment, and 335 (85.0%) had documented cure. In less than 2 years, the 85% 3-year goal was reached for cure (85.0%), and the goal for linkage to care was nearly reached (83.7%), whereas screening (44.1%) and treatment initiation (59.3%) required more time and resources. Conclusions and Relevance: This cohort study found that after 22 months of implementation, the CNHS community-based HCV elimination program was associated with an improved cascade of care. The facilitators and lessons learned in this program may be useful to other organizations planning similar programs.


Assuntos
Erradicação de Doenças , Hepatite C , Programas de Rastreamento , Administração dos Cuidados ao Paciente , Adulto , Estudos de Coortes , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Erradicação de Doenças/estatística & dados numéricos , Feminino , Hepatite C/etnologia , Hepatite C/prevenção & controle , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Estados Unidos/epidemiologia
10.
PLoS One ; 15(12): e0243749, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370313

RESUMO

BACKGROUND: This study aimed to help the Namibian government understand the impact of Treat All implementation (started on April 1, 2017) on key antiretroviral therapy (ART) outcomes, and how this transition impacts progress toward the UNAIDS's 90-90-90 HIV targets. METHODS: We collected clinical records from two separate cohorts (before and after treat-all) of ART patients in 10 high- and medium-volume facilities in 6 northern Namibia districts. Each cohort contains 12-month data on patients' scheduled appointments and visits, health status, and viral load results. We also measured patients' wait time and perceptions of service quality using exit interviews with 300 randomly selected patients (per round). We compared ART outcomes of the two cohorts: ART initiation within 7 days from diagnosis, loss to follow-up (LTFU), missed scheduled appointments for at least 30 days, and viral suppression using unadjusted and adjusted analyses. RESULTS: Among new ART clients (on ART for less than 3 months or had not yet initiated treatment as of the start date for the ART record review period), rapid ART initiation (within 7 days from diagnosis) was 5.2 times higher after Treat All than that among clients assessed before the policy took effect [AOR: 5.2 (3.8-6.9)]. However, LTFU was higher after Treat All roll-out compared to before Treat All [AOR: 1.9 (1.3-2.8)]. Established ART clients (on ART treatment for at least three months at the start date of the ART record review period) had over 3 times greater odds of achieving viral suppression after Treat All roll-out compared to established ART clients assessed before Treat All [AOR: 3.1 (1.6-5.9)]. CONCLUSIONS AND RECOMMENDATIONS: The findings indicate positive effect of the "Treat All" implementation on ART initiation and viral suppression, and negative effect on LTFU. Additionally, by April 2018, Namibia seems to have reached the UNAIDS's 90-90-90 targets.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Erradicação de Doenças/normas , Epidemias/prevenção & controle , Infecções por HIV/tratamento farmacológico , Implementação de Plano de Saúde/estatística & dados numéricos , Adulto , Erradicação de Doenças/métodos , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Estudos Longitudinais , Perda de Seguimento , Masculino , Pessoa de Meia-Idade , Namíbia/epidemiologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Carga Viral/efeitos dos fármacos
11.
Glob Health Sci Pract ; 8(3): 396-412, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33008854

RESUMO

This article assesses the CORE Group Polio Project (CGPP) experience over a 20-year period in 5 countries. It examines how a program designed to provide social mobilization to eradicate one disease, and which did so effectively, functioned within the general framework of community health workers (CHWs). Vertical health programs often have limited impact on broader community health. CGPP has a 20-year history of social mobilization and effective program interventions. This history provided an opportunity to assess how CGPP community mobilizers (CMs) functioned in polio and maternal and child health. The Updated Program Functionality Matrix for Optimizing Community Health Programs tool of the CHW Assessment and Improvement Matrix (AIM) was used to examine CGPP CM roles across different contexts. The analysis determined that CGPP CMs met the basic level of functioning (level 3) for 6 of the 10 components of the AIM tool. This cross-country descriptive analysis of the CGPP demonstrates the importance of embracing the full range of CHW AIM components, even in a vertical program. Use of data, community involvement, local adaptation, and linkage with the health system are especially critical for success. This general lesson could be applied to other community mobilization and disease/epidemic control initiatives, especially as we face the issues of the COVID-19 pandemic.


Assuntos
Agentes Comunitários de Saúde , Erradicação de Doenças/métodos , Poliomielite/prevenção & controle , Avaliação de Programas e Projetos de Saúde/métodos , Serviços de Saúde Rural , África , Ásia , Humanos , População Rural
12.
BMC Infect Dis ; 20(1): 778, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081712

RESUMO

BACKGROUND: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme's performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. METHODS: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm's performance and sensitivity to surveillance quality. RESULTS: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. CONCLUSION: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions.


Assuntos
Erradicação de Doenças/métodos , Doenças do Cão/epidemiologia , Doenças do Cão/prevenção & controle , Controle de Infecções/métodos , Vírus da Raiva/genética , Raiva/epidemiologia , Raiva/prevenção & controle , Algoritmos , Animais , Brasil/epidemiologia , Cães , Genômica/métodos , Humanos , América Latina/epidemiologia , Vacinação em Massa , México/epidemiologia , Raiva/transmissão , Raiva/virologia , Estudos Retrospectivos , Cobertura Vacinal
13.
Lancet Glob Health ; 8(10): e1345-e1351, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32916086

RESUMO

On Aug 25 2020, the Africa Regional Commission for the Certification of Poliomyelitis Eradication declared that the WHO African region had interrupted transmission of all indigenous wild polioviruses. This declaration marks the African region as the fifth of the six WHO regions to celebrate this extraordinary achievement. Following the Yaoundé Declaration on Polio Eradication in Africa by heads of state and governments in 1996, Nelson Mandela launched the Kick Polio out of Africa campaign. In this Health Policy paper, we describe the long and turbulent journey to the certification of the interruption of wild poliovirus transmission, focusing on 2016-20, lessons learned, and the strategies and analyses that convinced the Regional Commission that the African region is free of wild polioviruses. This certification of the WHO African region shows the feasibility of polio eradication in countries with chronic insecurity, inaccessible and hard-to-reach populations, and weak health systems. Challenges have been daunting and the sacrifices enormous-dozens of health workers and volunteers have lost their lives in the pursuit of a polio-free Africa.


Assuntos
Erradicação de Doenças/métodos , Saúde Global , Poliomielite/prevenção & controle , Organização Mundial da Saúde , África , Humanos , Poliomielite/transmissão
16.
Am J Trop Med Hyg ; 103(5): 1871-1882, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32959760

RESUMO

Historic levels of funding have reduced the global burden of malaria in recent years. Questions remain, however, as to whether scaling up interventions, in parallel with economic growth, has made malaria elimination more likely today than previously. The consequences of "trying but failing" to eliminate malaria are also uncertain. Reduced malaria exposure decreases the acquisition of semi-immunity during childhood, a necessary phase of the immunological transition that occurs on the pathway to malaria elimination. During this transitional period, the risk of malaria resurgence increases as proportionately more individuals across all age-groups are less able to manage infections by immune response alone. We developed a robust model that integrates the effects of malaria transmission, demography, and macroeconomics in the context of Plasmodium falciparum malaria within a hyperendemic environment. We analyzed the potential for existing interventions, alongside economic development, to achieve malaria elimination. Simulation results indicate that a 2% increase in future economic growth will increase the US$5.1 billion cumulative economic burden of malaria in Ghana to US$7.2 billion, although increasing regional insecticide-treated net coverage rates by 25% will lower malaria reproduction numbers by just 9%, reduce population-wide morbidity by -0.1%, and reduce prevalence from 54% to 46% by 2034. As scaling up current malaria control tools, combined with economic growth, will be insufficient to interrupt malaria transmission in Ghana, high levels of malaria control should be maintained and investment in research and development should be increased to maintain the gains of the past decade and to minimize the risk of resurgence, as transmission drops.


Assuntos
Erradicação de Doenças/economia , Erradicação de Doenças/métodos , Malária/economia , Malária/epidemiologia , Modelos Econômicos , Política de Saúde , Humanos
18.
Am J Prev Med ; 59(4): 493-503, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778354

RESUMO

INTRODUCTION: Given the continuing COVID-19 pandemic and much of the U.S. implementing social distancing owing to the lack of alternatives, there has been a push to develop a vaccine to eliminate the need for social distancing. METHODS: In 2020, the team developed a computational model of the U.S. simulating the spread of COVID-19 coronavirus and vaccination. RESULTS: Simulation experiments revealed that to prevent an epidemic (reduce the peak by >99%), the vaccine efficacy has to be at least 60% when vaccination coverage is 100% (reproduction number=2.5-3.5). This vaccine efficacy threshold rises to 70% when coverage drops to 75% and up to 80% when coverage drops to 60% when reproduction number is 2.5, rising to 80% when coverage drops to 75% when the reproduction number is 3.5. To extinguish an ongoing epidemic, the vaccine efficacy has to be at least 60% when coverage is 100% and at least 80% when coverage drops to 75% to reduce the peak by 85%-86%, 61%-62%, and 32% when vaccination occurs after 5%, 15%, and 30% of the population, respectively, have already been exposed to COVID-19 coronavirus. A vaccine with an efficacy between 60% and 80% could still obviate the need for other measures under certain circumstances such as much higher, and in some cases, potentially unachievable, vaccination coverages. CONCLUSIONS: This study found that the vaccine has to have an efficacy of at least 70% to prevent an epidemic and of at least 80% to largely extinguish an epidemic without any other measures (e.g., social distancing).


Assuntos
Controle de Doenças Transmissíveis , Simulação por Computador , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Vacinação , Vacinas Virais/farmacologia , Betacoronavirus/isolamento & purificação , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Erradicação de Doenças/métodos , Erradicação de Doenças/estatística & dados numéricos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Resultado do Tratamento , Estados Unidos/epidemiologia , Vacinação/métodos , Vacinação/estatística & dados numéricos , Cobertura Vacinal , Vacinas Virais/normas
19.
PLoS Negl Trop Dis ; 14(8): e0007009, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32804967

RESUMO

Ghana has been implementing Mass Drug Administration (MDA) since the year 2001, and Lymphatic Filariasis transmission has been interrupted in 76 out of the 98 targeted districts. The remaining districts have a microfilaria prevalence above the 1% threshold needed for the interruption of transmission. This study assesses the level of lymphatic filariasis MDA coverage and explored factors affecting the quality of implementation of the MDA in the Bole and Central Gonja Districts of Northern Ghana. A concurrent mixed methods study design approach was used to provide both a quantitative and qualitative insight. A descriptive analysis was carried out, and the results are presented in tables and charts. The transcripts of the qualitative interviews were imported into Nvivo and framework methods of analysis were used. The results were summarized based on the themes and buttressed with narratives with key quotes presented within the texts. The overall MDA coverage in Central Gonja is 89.3% while that of Bole district is 82.9%. Refusal to ingest the drug and adverse drug reactions were higher in Bole district than the Central Gonja District. The persistent transmission of lymphatic filariasis in Bole District was characterized by poor community mobilization and sensitization, nonadherence to the directly observed treatment strategy, refusal to ingest the drug due to the fear of adverse drug reactions, inadequate knowledge and misconceptions about the disease. Reported mass drug administration coverage will not necessarily result into interruption of transmission of the disease without strict compliance to the directly observed treatment strategy, strong stakeholder engagement coupled with evidence-based context-specific multi-channel community education strategies with key educational messages on the cause of the disease and adverse drug reactions. While the clock for the elimination of lymphatic filariasis by the year 2020 and meeting of the Sustainable Development Goal 3 target 3.3 by 2030 is ticking, there is an urgent need for a concerted effort to improve the fidelity of the ongoing lymphatic filariasis MDA campaigns in the Bole District of Northern Ghana.


Assuntos
Filariose Linfática/prevenção & controle , Filaricidas/uso terapêutico , Administração Massiva de Medicamentos/estatística & dados numéricos , Adulto , Erradicação de Doenças/métodos , Erradicação de Doenças/normas , Feminino , Filaricidas/administração & dosagem , Filaricidas/efeitos adversos , Gana/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Administração Massiva de Medicamentos/efeitos adversos , Administração Massiva de Medicamentos/métodos , Pessoa de Meia-Idade , Recusa do Paciente ao Tratamento/estatística & dados numéricos
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