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1.
Nat Commun ; 12(1): 132, 2021 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-33420104

RESUMO

The use of pesticides to reduce mosquito vector populations is a cornerstone of global malaria control efforts, but the biological impact of most pesticides on human populations, including pregnant women and infants, is not known. Some pesticides, including carbamates, have been shown to perturb the human immune system. We measure the systemic absorption and immunologic effects of bendiocarb, a commonly used carbamate pesticide, following household spraying in a cohort of pregnant Ugandan women and their infants. We find that bendiocarb is present at high levels in maternal, umbilical cord, and infant plasma of individuals exposed during pregnancy, indicating that it is systemically absorbed and trans-placentally transferred to the fetus. Moreover, bendiocarb exposure is associated with numerous changes in fetal immune cell homeostasis and function, including a dose-dependent decrease in regulatory CD4 T cells, increased cytokine production, and inhibition of antigen-driven proliferation. Additionally, prenatal bendiocarb exposure is associated with higher post-vaccination measles titers at one year of age, suggesting that its impact on functional immunity may persist for many months after birth. These data indicate that in utero bendiocarb exposure has multiple previously unrecognized biological effects on the fetal immune system.


Assuntos
Poluentes Ambientais/efeitos adversos , Feto/imunologia , Exposição Materna/efeitos adversos , Sarampo/sangue , Praguicidas/efeitos adversos , Adulto , Anticorpos Antivirais/sangue , Pré-Escolar , Ensaios Clínicos Fase III como Assunto , Feminino , Sangue Fetal/química , Seguimentos , Humanos , Sistema Imunitário/efeitos dos fármacos , Imunogenicidade da Vacina , Imunoglobulina G/sangue , Lactente , Recém-Nascido , Malária/prevenção & controle , Troca Materno-Fetal/imunologia , Sarampo/imunologia , Sarampo/prevenção & controle , Vacina contra Sarampo/administração & dosagem , Vacina contra Sarampo/imunologia , Controle de Mosquitos/métodos , Praguicidas/análise , Fenilcarbamatos/efeitos adversos , Fenilcarbamatos/análise , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Vaccine ; 39(8): 1201-1204, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33334618

RESUMO

BACKGROUND: The COVID-19 pandemic and stay-at-home orders have caused an unprecedented decrease in the administration of routinely recommended vaccines. However, the impact of this decrease on overall vaccination coverage in a specific birth cohort is not known. METHODS: We projected measles vaccination coverage for the cohort of children becoming one year old in 2020 in the United States, for different durations of stay-at-home orders, along with varying catch-up vaccination efforts. RESULTS: A 15% sustained catch-up rate outside stay-at-home orders (compared to what would be expected via natality information) may be necessary to achieve projected vaccination coverage similar to previous years. Permanent decreases in vaccine administration could lead to projected vaccination coverage levels below 80%. CONCLUSION: Modeling measles vaccination coverage under a range of scenarios provides useful information about the potential magnitude and impact of under-immunization. Sustained catch-up efforts are needed to assure that measles vaccination coverage remains high.


Assuntos
Vacina contra Sarampo/administração & dosagem , Pandemias , Cobertura Vacinal , Criança , Pré-Escolar , Humanos , Lactente , Sarampo/prevenção & controle , Estados Unidos
3.
Ars pharm ; 61(4): 259-265, oct.-dic. 2020. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-195239

RESUMO

INTRODUCCIÓN: la vacunación es, en la historia de la medicina, una de las actuaciones más significativas en la reducción de la mortalidad infantil y la erradicación de enfermedades. Sin embargo, con el apogeo de los denominados grupos "antivacunas" ha aumentado la incidencia de enfermedades infecciosas, entre ellas, el sarampión, cuya erradicación no ha sido posible para el año 2015, como había propuesto la Organización Mundial de la Salud. OBJETIVO: hemos estudiado diferentes aspectos tecnológicos de las vacunas comercializadas en España, centrándonos en las utilizadas contra el sarampión, y su problemática actual a la hora de su administración. MÉTODO: se ha realizado un estudio de las fichas técnicas de las vacunas recogidas en la Agencia Española de Medicamentos y Productos Sanitarios. RESULTADOS: se obtuvieron resultados sobre diferentes aspectos: tipo de vacuna, sistema fisicoquímico, forma farmacéutica, vía de administración y dispositivo para su administración. Además, se han analizado las formulaciones de las vacunas existentes contra el sarampión, haciendo hincapié en los diversos excipientes que contienen: estabilizadores, antibióticos, medios de cultivo, etc. CONCLUSIONES: la mayoría de las vacunas comercializadas en España se presentan en forma de suspensión para administración intramuscular o subcutánea mediante jeringa precargada. En el caso de la vacuna contra el sarampión, encontramos tres medicamentos de preparación extemporánea, que se presentan en forma de polvo liofilizado en vial y vehículo en jeringa precargada, producidas a partir de diferentes virus vivos o atenuados, siendo por tanto vacunas combinadas


INTRODUCTION: in the history of medicine, vaccination is one of the most important operations in the reduction of infant mortality and the eradication of diseases. However, with the apogee of the so-called “anti-vaccine” groups has increased the incidence of infectious diseases, including measles, whose erad¬ication is not possible by the year 2015, as the World Health Organization had proposed. Objective: we have studied different vaccines existing in the Spanish market available to health profes¬sionals and we have analyzed the formulations of existing measles vaccines. METHOD: the data sheets of different vaccines available to health professionals collected at the Spanish Agency of Medicines and Health Products has been studied. RESULTS: the results have been obtained from different aspects: type of vaccine, physicochemical system, pharmaceutical form, way of administration or device for its administration. In addition, we have an¬alyzed formulations of existing measles vaccines, by emphasizing different excipients which contain: stabilizers, antibiotics, culture media, etc. CONCLUSIONS: the majority of vaccines marketed in Spain are sus¬pensions, to be administered by an intramuscular or subcutaneous injection, with a pre-filled syringe. In the case of the measles vac¬cine, we found three drugs of extemporaneous preparation that are presented as lyophilized powder in vial and vehicle in a pre-filled syringe. They are produced from different live or attenuated virus¬es so they are combined vaccines


Assuntos
Humanos , Vacina contra Sarampo/administração & dosagem , Vacina contra Sarampo/provisão & distribução , Composição de Medicamentos , Vacina contra Sarampo/normas , Espanha
4.
MMWR Morb Mortal Wkly Rep ; 69(45): 1700-1705, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33180759

RESUMO

In 2010, the World Health Assembly (WHA) set the following three milestones for measles control to be achieved by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district, 2) reduce global annual measles incidence to <5 cases per 1 million population, and 3) reduce global measles mortality by 95% from the 2000 estimate* (1). In 2012, WHA endorsed the Global Vaccine Action Plan,† with the objective of eliminating measles§ in five of the six World Health Organization (WHO) regions by 2020. This report describes progress toward WHA milestones and regional measles elimination during 2000-2019 and updates a previous report (2). During 2000-2010, estimated MCV1 coverage increased globally from 72% to 84% but has since plateaued at 84%-85%. All countries conducted measles surveillance; however, approximately half did not achieve the sensitivity indicator target of two or more discarded measles and rubella cases per 100,000 population. Annual reported measles incidence decreased 88%, from 145 to 18 cases per 1 million population during 2000-2016; the lowest incidence occurred in 2016, but by 2019 incidence had risen to 120 cases per 1 million population. During 2000-2019, the annual number of estimated measles deaths decreased 62%, from 539,000 to 207,500; an estimated 25.5 million measles deaths were averted. To drive progress toward the regional measles elimination targets, additional strategies are needed to help countries reach all children with 2 doses of measles-containing vaccine, identify and close immunity gaps, and improve surveillance.


Assuntos
Erradicação de Doenças , Saúde Global/estatística & dados numéricos , Sarampo/prevenção & controle , Objetivos , Humanos , Programas de Imunização , Incidência , Lactente , Sarampo/epidemiologia , Sarampo/mortalidade , Vacina contra Sarampo/administração & dosagem , Organização Mundial da Saúde
5.
Am J Public Health ; 110(S3): S312-S318, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33001718

RESUMO

Objectives. To understand changes in how Facebook pages frame vaccine opposition.Methods. We categorized 204 Facebook pages expressing vaccine opposition, extracting public posts through November 20, 2019. We analyzed posts from October 2009 through October 2019 to examine if pages' content was coalescing.Results. Activity in pages promoting vaccine choice as a civil liberty increased in January 2015, April 2016, and January 2019 (t[76] = 11.33 [P < .001]; t[46] = 7.88 [P < .001]; and t[41] = 17.27 [P < .001], respectively). The 2019 increase was strongest in pages mentioning US states (t[41] = 19.06; P < .001). Discussion about vaccine safety decreased (rs[119] = -0.61; P < .001) while discussion about civil liberties increased (rs[119] = 0.33; Py < .001]). Page categories increasingly resembled one another (civil liberties: rs[119] = -0.50 [P < .001]; alternative medicine: rs[84] = -0.77 [P < .001]; conspiracy theories: rs[119] = -0.46 [P < .001]; morality: rs[106] = -0.65 [P < .001]; safety and efficacy: rs[119] = -0.46 [P < .001]).Conclusions. The "Disneyland" measles outbreak drew vaccine opposition into the political mainstream, followed by promotional campaigns conducted in pages framing vaccine refusal as a civil right. Political mobilization in state-focused pages followed in 2019.Public Health Implications. Policymakers should expect increasing attempts to alter state legislation associated with vaccine exemptions, potentially accompanied by fiercer lobbying from specific celebrities.


Assuntos
Movimento contra Vacinação , Direitos Civis , Surtos de Doenças , Sarampo/epidemiologia , Mídias Sociais , Recusa de Vacinação , California/epidemiologia , Humanos , Vacina contra Sarampo/administração & dosagem , Saúde Pública , Estados Unidos/epidemiologia
6.
Vaccine ; 38(45): 7146-7155, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-32943265

RESUMO

BACKGROUND: COVID-19 pandemic has affected routine immunization globally. Impact will likely be higher in low and middle-income countries with limited healthcare resources and fragile health systems. We quantified the impact, spatial heterogeneity, and determinants for childhood immunizations of 48 million population affected in the Sindh province of Pakistan. METHODS: We extracted individual immunization records from real-time provincial Electronic Immunization Registry from September 23, 2019, to July 11, 2020. Comparing baseline (6 months preceding the lockdown) and the COVID-19 lockdown period, we analyzed the impact on daily immunization coverage rate for each antigen by geographical area. We used multivariable logistic regression to explore the predictors associated with immunizations during the lockdown. RESULTS: There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Cal-mette Guérin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. Pentavalent-3 (penta-3) immunization rates were higher in infants born in hospitals (RR: 1.09; 95% CI: 1.04-1.15) and those with mothers having higher education (RR: 1.19-1.50; 95% CI: 1.13-1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program. CONCLUSION: One out of every two children in Sindh province has missed their routine vaccinations during the provincial COVID-19 lockdown. The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. There is a need for tailored interventions to promote immunization visits and safe service delivery. Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.


Assuntos
Infecções por Coronavirus/psicologia , Sarampo/prevenção & controle , Pandemias , Pneumonia Viral/psicologia , Quarentena , Infecções por Rotavirus/prevenção & controle , Tuberculose Pulmonar/prevenção & controle , Vacinação/estatística & dados numéricos , Vacina BCG/administração & dosagem , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Processamento Eletrônico de Dados , Feminino , Humanos , Programas de Imunização/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , Sarampo/epidemiologia , Sarampo/imunologia , Vacina contra Sarampo/administração & dosagem , Paquistão/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Sistema de Registros , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/imunologia , Vacinas contra Rotavirus/administração & dosagem , População Rural , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/imunologia , População Urbana , Vacinação/psicologia , Cobertura Vacinal/estatística & dados numéricos , Vacinas Atenuadas/administração & dosagem
10.
BMC Public Health ; 20(1): 1221, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778085

RESUMO

BACKGROUND: Between 2010 and 2018, measles-related mortality had halved in India mainly with effective measles vaccination campaigns and widespread coverage across the states and population subgroups. Despite the commendable vaccination coverage, 2.9 million children in India missed the first dose of measles vaccine (MCV1) in 2017, and many of those vaccinated were not vaccinated at the recommended age (i.e. between 9 and 12 months). This study analyzed pattern and correlates of MCV1 coverage and MCV1 administration at recommended age among children aged 12-23 months in India. METHODS: We used the official data from the recent round of National Family Health Survey (NFHS-4), a nationally representative cross-sectional household survey in India conducted in 2015-16. Descriptive statistics and logistic regression analysis were applied to ascertain the influence of specified socio-demographic variables affecting measles vaccination coverage in India. RESULTS: The study revealed the distinct variations in coverage of MCV1 between the districts of India. There were also major challenges with age recommended vaccination, with about 15% of eligible children not vaccinated within the recommended age range, attributable to several socio-demographic factors. Significantly, antenatal care utilization of mothers strongly influenced MCV1 coverage and age recommended MCV1 coverage in India. The study also identified that children who missed MCV1 had one or more adverse health risks such as malnutrition, anemia and diarrhea disease. CONCLUSIONS: A socio-economic gradient exists in India's MCV1 coverage, mediated by antenatal visits, education of mothers, and highlighted socio-demographic factors. Infection with measles was significantly correlated with greater anthropometric deficits among the study cohort, indicating a wider range of benefits from preventing measles infection. Eliminating morbidity and mortality from measles in India is feasible, although it will require efficient expanded program on immunization management, enhanced health literacy among mothers, continuing commitment from central state and district political authorities.


Assuntos
Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Mães/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Programas de Imunização , Esquemas de Imunização , Índia/epidemiologia , Lactente , Masculino , Sarampo/epidemiologia , Fatores Socioeconômicos , Adulto Jovem
11.
Euro Surveill ; 25(31)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32762795

RESUMO

The number of measles cases declined in European Union/European Economic Area countries and the United Kingdom in 2020. Reported cases to The European Centre for Disease Prevention and Control decreased from 710 to 54 between January and May. Epidemic intelligence screening observed a similar trend. Under-diagnoses and under-reporting during the coronavirus disease (COVID-19) pandemic should be ruled out before concluding reduced measles circulation is because of social distancing and any community control measures taken to control COVID-19.


Assuntos
Infecções por Coronavirus , Coronavirus , Sarampo/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , União Europeia , Humanos , Sarampo/prevenção & controle , Vacina contra Sarampo/administração & dosagem , Pneumonia Viral/epidemiologia , Vigilância da População , Reino Unido/epidemiologia
12.
Value Health ; 23(7): 891-897, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32762991

RESUMO

OBJECTIVES: In many countries, measles disproportionately affects poorer households. To achieve equitable delivery, national immunization programs can use 2 main delivery platforms: routine immunization and supplementary immunization activities (SIAs). The objective of this article is to use data concerning measles vaccination coverage delivered via routine and SIA strategies to make inferences about the associated equity impact. METHODS: We relied on Demographic and Health Survey and Multiple Indicator Cluster Surveys multi-country survey data to conduct a comparative analysis of routine and SIA measles vaccination status of children by wealth quintile. We estimated the value of the angle, θ, for the ratio of the difference between coverage levels of adjacent wealth quintiles by using the arc-tangent formula. For each country/year observation, we averaged the θ estimates into one summary measurement, defined as the "equity impact number." RESULTS: Across 20 countries, the equity impact number summarized across wealth quintiles was greater (and hence less equitable) for routine delivery than for SIAs in the survey rounds (years) during, before, and after an SIA about 65% of the time. The equity impact numbers for routine measles vaccination averaged across wealth quintiles were usually greater than for SIA measles vaccination across country-year observations. CONCLUSIONS: This analysis examined how different measles vaccine delivery platforms can affect equity. It can serve to elucidate the impact of immunization and public health programs in terms of comparing horizontal to vertical delivery efforts and in reducing health inequalities in global and country-level decision-making.


Assuntos
Disparidades nos Níveis de Saúde , Programas de Imunização/organização & administração , Imunização/estatística & dados numéricos , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Criança , Países em Desenvolvimento , Inquéritos Epidemiológicos , Humanos , Imunização/economia , Cobertura Vacinal/economia , Cobertura Vacinal/estatística & dados numéricos
13.
Am J Public Health ; 110(10): 1532-1534, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816554

RESUMO

A measles outbreak involving 19 adults in a home for the intellectually disabled occurred in Singapore in 2019. Further investigation, including a serological survey, was conducted. Mass vaccination and infection control measures were implemented, terminating further secondary transmission. Seropositivity among residents aged 40 to 49 years (90.7%; 95% confidence interval = 78.4%, 96.3%) was lower than among the Singapore adult population (P < .001). This sheltered population, like others previously reported in the literature, had lower measles immunity than the general community, possibly because of limited social interaction. Targeted catch-up vaccination for similarly vulnerable populations should be considered.


Assuntos
Surtos de Doenças/prevenção & controle , Deficiência Intelectual/terapia , Vacinação em Massa/estatística & dados numéricos , Vacina contra Sarampo/administração & dosagem , Sarampo/epidemiologia , Sarampo/prevenção & controle , Adulto , Feminino , Humanos , Masculino , Sarampo/imunologia , Pessoa de Meia-Idade , Instituições Residenciais , Singapura/epidemiologia
14.
J Pregnancy ; 2020: 6532868, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32802510

RESUMO

Measles is a highly contagious airborne disease. Unvaccinated pregnant women are not only at risk of infection but also at risk of severe pregnancy complications. As measles causes a dysregulation of the entire immune system, we describe immunological variations and how immune response mechanisms can lead to adverse pregnancy outcomes. We evaluated data during the measles outbreak reported in the province of Catania, Italy, from May 2017 to June 2018. We controlled hospital discharge records for patients admitted to hospital obstetric wards searching the measles diagnostic code. We have indicated the case as "confirmed" when the IgM was found to be positive with the ELISA method. We registered 843 cases of measles and 51% were females (430 cases). 24 patients between the ages of 17 and 40 had measles while they were pregnant. Adverse pregnancy outcomes included 2 spontaneous abortions, 1 therapeutic abortion, 1 foetal death, and 6 preterm deliveries. Respiratory complications were more prevalent in pregnant women (21%) than in nonpregnant women with measles (9%). 14 health care workers (1.7%) were infected with measles, and none of these had been previously vaccinated. Immune response mechanisms were associated with adverse pregnancy outcomes in women with measles. To reduce the rate of measles complications, gynaecologists should investigate vaccination history and antibody test results in all women of childbearing age. During a measles outbreak, gynaecologists and midwives should be active proponents of vaccination administration and counteract any vaccine hesitancy not only in patients but also among health care workers.


Assuntos
Sarampo/epidemiologia , Sarampo/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Adolescente , Surtos de Doenças , Feminino , Humanos , Itália/epidemiologia , Sarampo/imunologia , Vacina contra Sarampo/administração & dosagem , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Resultado da Gravidez , Adulto Jovem
15.
Public Health ; 186: 8-11, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32736309

RESUMO

OBJECTIVES: Mumps is a highly contagious viral infection prevented by immunization with live attenuated vaccines. Mumps vaccines have proven to be safe and effective; however, rare cases of aseptic meningitis (AM) can occur after vaccination. The range of meningitis occurrence varies by different factors (strain, vaccine producer, and so on). Monovaccines or divaccines (mumps-measles vaccine), prepared from the strain Leningrad-3 (L-3), are used in Russia. Meningitis occurrence after vaccination has been established previously as very low. Nevertheless, with the number of children being vaccinated every year, vaccine-associated AM cases still occur. There is no official statistics on AM incidence after mumps vaccines, and information on AM features as an adverse event of mumps vaccination is limited and mostly devoted to vaccines, prepared from strains other than L-3. STUDY DESIGN: The study included patients with AM who were vaccinated against mumps in the previous 30 days before the present disease onset during 2009-2019. METHODS: Patients admitted to Infectious Clinical Hospital No. 1, Moscow, Russia, with AM were observed by a pediatrician and were screened for etiological agents of meningitis. RESULTS: Seven patients were enrolled, and clinical features and the course of infection are presented. CONCLUSIONS: Detection of only 7 cases of AM associated with mumps vaccination during the 10-year period supports very low occurrence of this adverse event after immunization with the L-3 strain-based mumps vaccines. Nevertheless, the annual number of AM cases that occur after mumps vaccination remains unknown and poorly diagnosed in practice because of the low awareness of physicians of this adverse reaction. Detection and objective coverage of such cases can lead to a weakening of 'antivaccination' moods in a society and to restoration of confidence in the healthcare system.


Assuntos
Meningite Asséptica/epidemiologia , Vacina contra Caxumba/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Imunização , Incidência , Masculino , Sarampo/prevenção & controle , Vacina contra Sarampo/administração & dosagem , Vacina contra Sarampo/efeitos adversos , Meningite Asséptica/etiologia , Caxumba/prevenção & controle , Vacina contra Caxumba/administração & dosagem , Federação Russa/epidemiologia , Vacinação , Vacinas Combinadas , Vacinas Virais
16.
BMC Public Health ; 20(1): 1086, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32652969

RESUMO

BACKGROUND: Inability to track children's vaccination history coupled with parents' lack of awareness of vaccination due dates compounds the problem of low immunization coverage and timeliness in developing countries. We evaluated the impact of two types of silicone immunization reminder bracelets for children in improving immunization coverage and timeliness of Pentavalent-3 and the Measles-1 vaccines. METHODS: Children < 3 months were enrolled in either of the 2 intervention groups (Alma Sana Bracelet Group and Star Bracelet Group) or the Control group. Children in the intervention groups were provided the two different bracelets at the time of recruitment. Each time the child visited the immunization center, a hole was perforated in the silicone bracelet to denote vaccine administration. Each child was followed up till administration of Measles-1 vaccine or till 12 months of age (if they did not come to the center for vaccination). Data was analyzed using the intention-to-treat population between groups. The unadjusted and adjusted Risk Ratios (RR) and 95% confidence interval (CI) for Pentavalent-3 and Measles-1 coverage at 12 months of age were estimated through bivariate and multivariate analysis. Time-to-Pentavalent-3 and Measles-1 immunization curves were calculated using the Kaplan-Meier method. RESULTS: A total of 1,445 children were enrolled in the study between July 19, 2017 and October 10, 2017. Baseline characteristics among the three groups were similar. Up-to-date coverage for the Pentavalent-3 /Measles-1 vaccine at 12 months of age was 84.6%/72.0%, 85.4%/70.5% and 83.0%/68.5% in Alma Sana Bracelet group, Star Bracelet group and Control group respectively but the differences were not statistically significant. In the multivariate analysis, neither the Alma Sana bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06), (adjusted RR: 1.05; 95% CI: 0.97-1.13) nor the Star bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06) (adjusted RR: 1.03; 95% CI: 0.95-1.11) was significantly associated with Pentavalent-3 vaccination or Measles-1 vaccination. CONCLUSION: Although we did not observe any significant impact of the bracelets on improved immunization coverage and timeliness, our findings add to the existing literature on innovative, low cost reminders for health and make several suggestions for enhancing practical implementation of these tools. TRIAL REGISTRATION: ClinicalTrials.gov NCT03310762 . Retrospectively Registered on October 16, 2017.


Assuntos
Promoção da Saúde/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Vacina contra Sarampo/administração & dosagem , Cooperação do Paciente/estatística & dados numéricos , Sistemas de Alerta/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Imunização , Lactente , Masculino , Sarampo/prevenção & controle , Paquistão , Projetos de Pesquisa , Vacinação/estatística & dados numéricos , Cobertura Vacinal
17.
Am J Trop Med Hyg ; 103(4): 1717-1725, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32618256

RESUMO

In Haiti, measles, rubella, and maternal and neonatal tetanus have been eliminated, but a diphtheria outbreak is ongoing as of 2019. We conducted a nationally representative, household-based, two-stage cluster survey among children aged 5-7 years in 2017 to assess progress toward maintenance of control and elimination of selected vaccine-preventable diseases (VPDs). We stratified Haiti into West region (West department, including the capital city) and non-West region (all other departments). We obtained vaccination history and dried blood spots, and measured antibody concentrations to VPDs on a multiplex bead assay. Among 1,146 children, national seropositivity was 83% (95% CI: 80-86%) for tetanus, 83% (95% CI: 81-85%) for diphtheria, 87% (95% CI: 85-89%) for measles, and 84% (95% CI: 81-87%) for rubella. None of the children had long-term immunity to tetanus or diphtheria (IgG concentration ≥ 1 international unit/mL). Seropositivity in the West region was lower than that in the non-West region. Vaccination coverage was 68% (95% CI: 61-74%) for ≥ 3 doses of tetanus- and diphtheria-containing vaccine (DTP3), 84% (95% CI: 80-87%) for one dose of measles-rubella vaccine (MR1), and 20% (95% CI: 16-24%) for MR2. The seroprevalence of measles, rubella, and diphtheria antibodies is lower than population immunity levels needed to prevent disease transmission, particularly in the West region; reintroduction of these diseases could lead to an outbreak. To maintain VPD control and elimination, Haiti should achieve DTP3 and MR2 coverage ≥ 95%, and include tetanus and diphtheria booster doses in the routine immunization schedule.


Assuntos
Difteria/epidemiologia , Vacina contra Sarampo/administração & dosagem , Sarampo/epidemiologia , Vacina contra Rubéola/administração & dosagem , Rubéola (Sarampo Alemão)/epidemiologia , Tétano/epidemiologia , Vacinação , Criança , Pré-Escolar , Feminino , Haiti/epidemiologia , Humanos , Masculino , Estudos Soroepidemiológicos , Cobertura Vacinal
19.
Aust N Z J Public Health ; 44(5): 346-348, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32697422

RESUMO

OBJECTIVE: To determine the proportion of healthcare workers (HCWs) in smaller Victorian public healthcare facilities with documented evidence of measles immunity. METHODS: A cross-sectional survey, developed by the Victorian Healthcare Associated Surveillance System Coordinating Centre, was completed by all eligible facilities. HCWs were reported as having evidence or no evidence of measles immunity. Those without evidence of immunity were sub-classified as incomplete, declined or unknown status. RESULTS: Seventy-five facilities reported measles immunity status of 17,522 employed HCWs. Of these, 11,751 (67.1%) had documented evidence of immunity. The proportion with evidence of immunity was lowest (45.6%) in facilities with ≤50 HCWs. The majority of HCWs without evidence of immunity (88.2%) had 'unknown' status. Declination or incomplete status comprised very low overall proportions (0.3% and 3.6%, respectively). CONCLUSIONS: Reported evidence of HCW measles immunity was moderate in surveyed facilities, with a large proportion having unknown status. HCW immunisation programs in some facilities require refinement to appropriately support public health responses to measles cases and prevention of occupational acquisition of measles. Implications for public health: Non-immune HCWs are at increased risk for acquiring and transmitting measles. Timely access to accurate HCW immunisation records is required to ensure that public health responses are effective.


Assuntos
Pessoal de Saúde/psicologia , Hospitais/estatística & dados numéricos , Imunização/estatística & dados numéricos , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Adulto , Austrália , Feminino , Fidelidade a Diretrizes , Pessoal de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Programas de Imunização , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Saúde do Trabalhador
20.
J Spec Oper Med ; 20(2): 136-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573751

RESUMO

Measles is a significant concern with approximately 10 million people infected annually causing over 100,000 deaths worldwide. In the US before use of the measles vaccine, there were estimated to be 3 to 4 million people infected with measles annually, causing 400 to 500 deaths. Complications of measles include otitis media, diarrhea, pneumonia, and acute encephalitis. Measles is a leading cause of blindness in the developing world, especially in those who are vitamin A deficient. Malnourished children with measles are also at higher risk of developing noma (or cancrum oris), a rapidly progressive gangrenous infection of the mouth and face. Most deaths due to measles are caused by pneumonia, diarrhea, or neurological complications in young children, severely malnourished or immunocompromised individuals, and pregnant women. A rare sequela of measles is subacute sclerosing panencephalitis.


Assuntos
Sarampo , Criança , Pré-Escolar , Feminino , Saúde Global/estatística & dados numéricos , Humanos , Sarampo/complicações , Sarampo/epidemiologia , Sarampo/mortalidade , Sarampo/prevenção & controle , Vacina contra Sarampo/administração & dosagem , Gravidez
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