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4.
Brasília, D.F.; OPAS; 2020-03-26. (OPAS/BRA/COVID-19/20-029).
em Português | PAHO-IRIS | ID: phr2-51989

RESUMO

[Introdução]: Este documento apresenta princípios norteadores e considerações para apoiar os países em suas decisões sobre a provisão de serviços de imunização durante a pandemia do vírus COVID-19, sendo endossado pelo Grupo Consultivo Estratégico de Especialistas em Imunização da OMS. O documento é complementado por uma série de materiais técnicos da OMS sobre medidas de resposta e mitigação para a COVID-194. Os países precisarão fazer avaliações de risco individuais com base na dinâmica local da transmissão do vírus COVID-19, características do sistema de saúde e da imunização, além da epidemiologia atual das doenças imunopreveníveis em seu contexto.


Assuntos
Infecções por Coronavirus , Imunização , Vacinação em Massa , Serviços de Saúde , Coronavirus
5.
Brasília, D.F.; OPAS; 2020-03-26. (OPAS/BRA/Covid-19/20-036).
em Português | PAHO-IRIS | ID: phr2-51984

RESUMO

[Objetivo]: Dar orientações sobre o funcionamento dos programas de imunização no contexto da pandemia de COVID-19.


Assuntos
Infecções por Coronavirus , Programas de Imunização , Orientação , Vacinação em Massa , Serviços de Vigilância Epidemiológica , Coronavirus
6.
Brasília, D.F.; OPAS; 2020-03-26. (OPAS/BRA/COVID-19/20-029).
em Português | PAHO-IRIS | ID: phr2-51978

RESUMO

[Introdução]: Este documento apresenta princípios norteadores e considerações para apoiar os países em suas decisões sobre a provisão de serviços de imunização durante a pandemia do vírus COVID-19, sendo endossado pelo Grupo Consultivo Estratégico de Especialistas em Imunização da OMS. O documento é complementado por uma série de materiais técnicos da OMS sobre medidas de resposta e mitigação para a COVID-19. Os países precisarão fazer avaliações de risco individuais com base na dinâmica local da transmissão do vírus COVID-19, características do sistema de saúde e da imunização, além da epidemiologia atual das doenças imunopreveníveis em seu contexto.


Assuntos
Infecções por Coronavirus , Imunização , Sistemas de Saúde , Serviços de Vigilância Epidemiológica , Vacinação em Massa
8.
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 Negl Trop Dis ; 14(1): e0008004, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31971943

RESUMO

Rabies is a devastating zoonotic disease causing nearly 60,000 deaths globally each year. The disease causes Malawi an economic loss of 13 million USD and kills almost 500 people annually. Domestic dogs are the main reservoir for rabies and vaccinating over 70% of the dog population is the most efficient method to reduce its incidence in both humans and canines. However, achieving such coverages is often difficult and depend on many geospatial factors. Rural and pastoral regions are considered difficult to vaccinate efficiently due to low dog densities, and reports of campaigns spanning large areas containing vastly different communities are lacking. This study describes a mass canine vaccination campaign covering rural and urban regions in southern Malawi. The campaign achieved an average vaccination coverage of 83.4% across 3 districts, and vaccinated over 89,000 dogs through a combined static point and door-to-door effort. A dog population of 107,574 dogs was estimated (dog:human ratio of 1:23). The canine population was found to be almost completely owned (99.2%) and mostly kept for security purposes (82.7%). The dogs were mainly adults, males, and not neutered. Regression analysis identified education level and proportion of young dogs as the only factors influencing (positively and negatively, respectively) whether vaccination coverage over 70% was achieved in a region, independently of variables such as population density or poverty. A second regression analysis was performed predicting absolute vaccination coverage. While education level and the proportion of confined dogs were associated with positive vaccination coverage, higher proportions of young animals and female dogs were associated with a decrease in coverage. This study confirms the feasibility of homogeneously vaccinating over 70% of the dogs in a large area including rural and urban communities. These findings can inform the logistics of future campaigns and might be used as a template to facilitate high-number, high-coverage vaccination campaigns to other regions in sub-Saharan Africa.


Assuntos
Doenças do Cão/prevenção & controle , Vacinação em Massa/veterinária , Vacinas Antirrábicas/imunologia , Raiva/veterinária , Distribuição Animal , Animais , Doenças do Cão/epidemiologia , Cães , Feminino , Malaui/epidemiologia , Masculino , Raiva/epidemiologia , Raiva/prevenção & controle , Vacinas Antirrábicas/administração & dosagem , População Rural , População Urbana , Zoonoses
12.
PLoS One ; 15(1): e0227413, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929584

RESUMO

Although rubella is usually a mild childhood disease, this infection in early pregnancy poses a serious problem due to its teratogenic effect. The goal of interrupted circulation and elimination of rubella virus was achieved in many countries in the world. The aim of this study was to determine the status of rubella immunity in Vojvodina and evaluate Serbia's progress toward this goal. A total of 3404 residual serum samples from patients of all ages (1 to 84 years) were included in the study. Samples were collected between May 2015 and December 2017 in Vojvodina. Rubella IgG antibodies were determined using an indirect chemiluminescent immunoassay. Percentage of participants seropositive for rubella antibodies was 92.9% in the entire sample. The highest number of seronegatives was in the youngest (1 year) age group (44.7%), followed by the group aged 24-49 (6.4%) and 2-11 years (6.2%). The absence of a higher percentage of children with protective anti-rubella antibodies in the group aged 2-11 can be explained by a lower immunization coverage during certain years. Participants in the group aged 24-49 were born during the pre-vaccination period with lower rubella incidence, leading to the conclusion that not all individuals of that age came into a contact with the virus. Comparing levels of anti-rubella IgG antibodies of seropositive males and females of different ages reveals that the immunity after a contact with the virus and a previously acquired infection is stronger than the immunity after the vaccination. Although the incidence rate of rubella in Vojvodina has been low for the last ten years, there is still a risk of an outbreak due to a decrease in immunization coverage. This study shows that the percentage of susceptible individuals is high, especially considering women aged 24-49, and that additional ("catch-up") immunization is required.


Assuntos
Anticorpos Antivirais/sangue , Imunoglobulina G/sangue , Vacinação em Massa , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Programas Nacionais de Saúde , Rubéola (Sarampo Alemão) , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Rubéola (Sarampo Alemão)/sangue , Rubéola (Sarampo Alemão)/epidemiologia , Rubéola (Sarampo Alemão)/prevenção & controle , Sérvia/epidemiologia , Estudos Soroepidemiológicos
13.
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
15.
PLoS Med ; 16(12): e1003003, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31825965

RESUMO

BACKGROUND: Cholera causes an estimated 100,000 deaths annually worldwide, with the majority of burden reported in sub-Saharan Africa. In May 2018, the World Health Assembly committed to reducing worldwide cholera deaths by 90% by 2030. Oral cholera vaccine (OCV) plays a key role in reducing the near-term risk of cholera, although global supplies are limited. Characterizing the potential impact and cost-effectiveness of mass OCV deployment strategies is critical for setting expectations and developing cholera control plans that maximize the chances of success. METHODS AND FINDINGS: We compared the projected impacts of vaccination campaigns across sub-Saharan Africa from 2018 through 2030 when targeting geographically according to historical cholera burden and risk factors. We assessed the number of averted cases, deaths, and disability-adjusted life years and the cost-effectiveness of these campaigns with models that accounted for direct and indirect vaccine effects and population projections over time. Under current vaccine supply projections, an approach optimized to targeting by historical burden is projected to avert 828,971 (95% CI 803,370-859,980) cases (equivalent to 34.0% of projected cases; 95% CI 33.2%-34.8%). An approach that balances logistical feasibility with targeting historical burden is projected to avert 617,424 (95% CI 599,150-643,891) cases. In contrast, approaches optimized for targeting locations with limited access to water and sanitation are projected to avert 273,939 (95% CI 270,319-277,002) and 109,817 (95% CI 103,735-114,110) cases, respectively. We find that the most logistically feasible targeting strategy costs US$1,843 (95% CI 1,328-14,312) per DALY averted during this period and that effective geographic targeting of OCV campaigns can have a greater impact on cost-effectiveness than improvements to vaccine efficacy and moderate increases in coverage. Although our modeling approach does not project annual changes in baseline cholera risk or directly incorporate immunity from natural cholera infection, our estimates of the relative performance of different vaccination strategies should be robust to these factors. CONCLUSIONS: Our study suggests that geographic targeting substantially improves the cost-effectiveness and impact of oral cholera vaccination campaigns. Districts with the poorest access to improved water and sanitation are not the same as districts with the greatest historical cholera incidence. While OCV campaigns can improve cholera control in the near term, without rapid progress in developing water and sanitation services or dramatic increases in OCV supply, our results suggest that vaccine use alone is unlikely to allow us to achieve the 2030 goal.


Assuntos
Cólera/epidemiologia , Vacinação em Massa/economia , Vacinação/economia , Administração Oral , Adulto , África ao Sul do Saara , Cólera/prevenção & controle , Análise Custo-Benefício , Feminino , Humanos , Incidência , Vacinação em Massa/métodos , Fatores de Risco
17.
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
18.
BMC Public Health ; 19(1): 1504, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711446

RESUMO

BACKGROUND: Bacille Calmette-Guérin (BCG) vaccination against tuberculosis (TB) is widespread in high-TB-burden countries, however, BCG vaccination policies in low-burden countries vary. Considering the uncertainties surrounding BCG efficacy and the lower likelihood of TB exposure in low-incidence countries, most have discontinued mass vaccination, choosing instead a targeted vaccination strategy among high-risk groups. Given the increased risk of TB infection in Canadian Indigenous communities compared to the general Canadian population, these communities are a pertinent example of high-incidence groups in an otherwise low-burden country, warranting particular consideration regarding BCG vaccination strategy. This systematic review aims to synthesise and critically appraise the literature on BCG vaccination strategies in high-risk groups in low-incidence settings to provide policy considerations relevant to the Canadian Indigenous context. METHODS: A literature search of the Medline and Embase databases was conducted, returning studies pertaining to BCG vaccine efficacy, TB incidence under specific vaccination policies, BCG-associated adverse events, and vaccination policy guidelines in low-burden countries. Study screening was tracked using the Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia), and data pertaining to the above points of interest were extracted. RESULTS: The final review included 49 studies, spanning 15 countries. Although almost all of these countries had implemented a form of mass or routine vaccination previously, 11 have since moved to targeted vaccination of selected risk groups, in most cases due to the low risk of infection among the general population and thus the high number of vaccinations needed to prevent one case in the context of low-incidence settings. Regarding identifying risk groups for targeted screening, community-based (rather than individual risk-factor-based) vaccination has been found to be beneficial in high-incidence communities within low-incidence countries, suggesting this approach may be beneficial in the Canadian Indigenous setting. CONCLUSIONS: Community-based vaccination of high-incidence communities may be beneficial in the Canadian Indigenous context, however, where BCG vaccination is implemented, delivery strategies and potential barriers to achieving adequate coverage in this setting should be considered. Where an existing vaccination program is discontinued, it is crucial that an effective TB surveillance system is in place, and that case-finding, screening, and diagnostic efforts are strengthened in order to ensure adequate TB control. This is particularly relevant in Canadian Indigenous and other remote or under-served communities, where barriers to surveillance, screening, and diagnosis persist.


Assuntos
Vacina BCG/uso terapêutico , Controle de Doenças Transmissíveis/organização & administração , Índios Norte-Americanos , Vacinação em Massa/estatística & dados numéricos , Tuberculose/prevenção & controle , Vacinação/estatística & dados numéricos , Canadá , Feminino , Humanos , Incidência , Tuberculose Latente/prevenção & controle , Políticas , Grupos Populacionais , Fatores de Risco , Tuberculose/epidemiologia
19.
Epidemiol Health ; 41: e2019044, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31623421

RESUMO

OBJECTIVES: The aim of this study was to estimate the medical surge capacity required for mass prophylaxis based on a hypothetical outbreak of smallpox. METHODS: We performed a simulation using the Bioterrorism and Epidemic Outbreak Response Model and varied some important parameters, such as the number of core medical personnel and the number of dispensing clinics. RESULTS: Gaps were identified in the medical surge capacity of the Korean government, especially in the number of medical personnel who could respond to the need for mass prophylaxis against smallpox. CONCLUSIONS: The Korean government will need to train 1,000 or more medical personnel for such an event, and will need to prepare many more dispensing centers than are currently available.


Assuntos
Surtos de Doenças/prevenção & controle , Vacinação em Massa/organização & administração , Vacina Antivariólica/administração & dosagem , Varíola/prevenção & controle , Competência Clínica , Simulação por Computador , Instalações de Saúde/provisão & distribução , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , República da Coreia/epidemiologia , Varíola/epidemiologia
20.
Rev Sci Tech ; 38(1): 213-224, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31564729

RESUMO

Since the emergence of rabies on Bali, Indonesia, in 2008, the Indonesian Government and other stakeholders have implemented disease control and prevention activities with the aim of re-securing Bali's freedom from dog-mediated rabies. The authors report on the lessons learned during these efforts, and their applicability to other regions where canine rabies is endemic, as well as to rabies-free populations that are at risk from incursions. To eliminate rabies from Bali will require time and commitment, as well as a combination of approaches employing the principle of One Health. Efforts should be directed towards well-coordinated, highcoverage, annual dog vaccination campaigns using high-quality vaccines, and enhanced surveillance focused on investigations of biting animals. Bali, an island, is an ideal target for achieving freedom from rabies, but the logistics of vaccinating its very large, free-roaming dog population are challenging. Lessons can be drawn from Bali for other large and dense dog populations, where dog management and rabies control appear difficult. Well-trained teams with nets can rapidly catch and vaccinate large numbers of dogs where central-point vaccination is insufficient, and post vaccination surveys of collared dogs can be used to evaluate coverage and target supplementary vaccination. However, careful planning is required to ensure that all communities are reached during such campaigns and that sufficient vaccine is available over the following years. Effective communication strategies are needed to coordinate intersectoral activities, and to keep communities engaged, particularly during the 'end game', when the risk of rabies appears only minimal. An effective One Health approach to eliminate rabies requires long-term planning, multisectoral communication and coordination, and sustained effort, using tried and tested methods.


Assuntos
Erradicação de Doenças , Doenças do Cão , Saúde Única , Vacinas Antirrábicas , Raiva , Animais , Doenças do Cão/prevenção & controle , Cães , Indonésia , Vacinação em Massa , Raiva/prevenção & controle
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