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1.
MMWR Morb Mortal Wkly Rep ; 68(48): 1105-1111, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31805033

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 less than five 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 updates a previous report (2) and describes progress toward WHA milestones and regional measles elimination during 2000-2018. During 2000-2018, estimated MCV1 coverage increased globally from 72% to 86%; annual reported measles incidence decreased 66%, from 145 to 49 cases per 1 million population; and annual estimated measles deaths decreased 73%, from 535,600 to 142,300. During 2000-2018, measles vaccination averted an estimated 23.2 million deaths. However, the number of measles cases in 2018 increased 167% globally compared with 2016, and estimated global measles mortality has increased since 2017. To continue progress toward the regional measles elimination targets, resource commitments are needed to strengthen routine immunization systems, close historical immunity gaps, and improve surveillance. To achieve measles elimination, all communities and countries need coordinated efforts aiming to reach ≥95% coverage with 2 doses of measles vaccine (3).


Assuntos
Erradicação de Doenças , Saúde Global/estatística & dados numéricos , Sarampo/prevenção & controle , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Programas de Imunização , Incidência , Lactente , Sarampo/epidemiologia , Sarampo/mortalidade , Vacina contra Sarampo/administração & dosagem , Adulto Jovem
2.
J Epidemiol Glob Health ; 9(4): 294-299, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31854172

RESUMO

Measles is a highly transmissible viral infection that may lead to serious illness, lifelong complications, and death. As there is no animal reservoir for measles, measles resurgence is due to human movement of viremic persons. Therefore, some have blamed the enormous migration into Europe in the past 5 years for the measles resurgence in this region. We set out to determine the main driver for measles resurgence in Europe by assessing vaccine coverage rates and economic status in European countries, number of migrants, and travel volumes. Data on measles vaccine coverage rates with two vaccine doses of measles, mumps and rubella (MMR) [Measles Containing Vaccine (MCV)2] and total number of measles cases in 2017 for Europe, including Eastern European countries, were obtained, in addition to Gross Domestic Product (GDP), and number of migrants and tourist arrivals. The outcome measured, incidence of measles per 100,000, was log transformed and subsequently analyzed using multiple linear regression, along with predictor variables: number of international migrants, GDP per capita, tourist arrivals, and vaccine coverage. The final model was interpreted by exponentiating the regression coefficients. Incidence of measles was highest in Romania (46.1/100,000), followed by Ukraine (10.8/100,000) and Greece (8.7/100,000). MCV2 coverage in these countries is less than 84%, with lowest coverage rate (75%) reported in Romania. Only vaccine coverage appears to be the significant predictor in the model (p < 0.001) for incidence of measles even after adjusting for international migrants, international tourist arrivals, and GDP per capita. With one unit increase in vaccination coverage, the incidence of measles decreased by 18% [95% confidence interval (CI): 10-25]. Our results showed that number of migrants and international tourist arrivals into any of the European countries were not the drivers for increased measles cases. Countries with high vaccine coverage rates regardless of economic status did not experience a resurgence of measles, even if the number of migrants or incoming travellers was high. The statistically significant sole driver was vaccine coverage rates. These analyses reemphasize the importance of strategies to improve national measles vaccination to achieve coverage greater than 95%.

4.
East Mediterr Health J ; 25(10): 667-668, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31774131

RESUMO

In 2019, upon reviewing countries' reports, the regional verification commission for measles and rubella elimination declared elimination of measles and rubella in Bahrain, Islamic Republic of Iran and Oman. This achievement in the Eastern Mediterranean Region (EMR) constitutes a major success, since it occurs at a time when there remain highly challenging situations in several countries of the Region. In addition, there are unprecedented high transmission rates of measles throughout the world, with other World Health Organization (WHO) regions either not progressing (status quo) or regressing. Indeed, the WHO Region of the Americas and several other countries have in fact lost the status of measles elimination.


Assuntos
Programas de Imunização/organização & administração , Sarampo/epidemiologia , Rubéola (Sarampo Alemão)/epidemiologia , Humanos , Sarampo/prevenção & controle , Vacina contra Sarampo/administração & dosagem , Oriente Médio/epidemiologia , Vigilância da População , Rubéola (Sarampo Alemão)/prevenção & controle , Vacina contra Rubéola/administração & dosagem , Cobertura Vacinal , Organização Mundial da Saúde
5.
MMWR Morb Mortal Wkly Rep ; 68(39): 855-859, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581161

RESUMO

Rubella is a leading cause of vaccine-preventable birth defects. Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine (RCV) can provide lifelong protection (1). In 2011, the World Health Organization (WHO) updated guidance on the use of RCV and recommended capitalizing on the accelerated measles elimination activities as an opportunity to introduce RCV (1). The Global Vaccine Action Plan 2011-2020 (GVAP) includes a target to achieve elimination of rubella in at least five of the six WHO regions by 2020 (2). This report on the progress toward rubella and CRS control and elimination updates the 2017 report (3), summarizing global progress toward the control and elimination of rubella and CRS from 2000 (the initiation of accelerated measles control activities) and 2012 (the initiation of accelerated rubella control activities) to 2018 (the most recent data) using WHO immunization and surveillance data. Among WHO Member States,* the number with RCV in their immunization schedules has increased from 99 (52% of 191) in 2000 to 168 (87% of 194) in 2018†; 69% of the world's infants were vaccinated against rubella in 2018. Rubella elimination has been verified in 81 (42%) countries. To make further progress to control and eliminate rubella, and to reduce the equity gap, introduction of RCV in all countries is important. Likewise, countries that have introduced RCV can achieve and maintain elimination with high vaccination coverage and surveillance for rubella and CRS. The two WHO regions that have not established an elimination goal (African [AFR] and Eastern Mediterranean [EMR]) should consider establishing a goal.§.


Assuntos
Erradicação de Doenças , Saúde Global/estatística & dados numéricos , Vigilância da População , Síndrome da Rubéola Congênita/prevenção & controle , Rubéola (Sarampo Alemão)/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Rubéola (Sarampo Alemão)/epidemiologia , Síndrome da Rubéola Congênita/epidemiologia , Vacina contra Rubéola/administração & dosagem
6.
BMJ Glob Health ; 4(5): e001713, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565416

RESUMO

Background: Several West African countries are unlikely to achieve the recommended Global Vaccine Action Plan (GVAP) immunisation coverage and dropout targets in a landscape beset with entrenched intra-country equity gaps in immunisation. Our aim was to assess and compare the immunisation coverage, dropout and equity gaps across 15 West African countries between 2000 and 2017. Methods: We compared Bacille Calmette Guerin (BCG) and the third dose of diphtheria-tetanus-pertussis (DTP3) containing vaccine coverage between 2000 and 2017 using the WHO and Unicef Estimates of National Immunisation Coverage for 15 West African countries. Estimated subregional median and weighted average coverages, and dropout (DTP1-DTP3) were tracked against the GVAP targets of ≥90% coverage (BCG and DTP3), and ≤10% dropouts. Equity gaps in immunisation were assessed using the latest disaggregated national health survey immunisation data. Results: The weighted average subregional BCG coverage was 60.7% in 2000, peaked at 83.2% in 2009 and was 65.7% in 2017. The weighted average DTP3 coverage was 42.3% in 2000, peaked at 70.3% in 2009 and was 61.5% in 2017. As of 2017, 46.7% of countries (7/15) had met the GVAP targets on DTP3 coverage. Average weighted subregional immunisation dropouts consistently reduced from 16.4% in 2000 to 7.4% in 2017, meeting the GVAP target in 2008. In most countries, inequalities in BCG, and DTP3 coverage and dropouts were mainly related to equity gaps of more than 20% points between the wealthiest and the poorest, high coverage regions and low coverage regions, and between children of mothers with at least secondary education and those with no formal education. A child's sex and place of residence (urban or rural) minimally determined equity gaps. Conclusions: The West African subregion made progress between 2000 and 2017 in ensuring that its children utilised immunisation services, however, wide equity gaps persist.

7.
MMWR Morb Mortal Wkly Rep ; 68(42): 937-942, 2019 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-31647786

RESUMO

Endorsed by the World Health Assembly in 2012, the Global Vaccine Action Plan 2011-2020 (GVAP) (1) calls on all countries to reach ≥90% national coverage with all vaccines in the country's national immunization schedule by 2020. Building on previous analyses (2) and using the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) global vaccination coverage estimates as of 2018, this report presents global, regional, and national vaccination coverage estimates and trends, including vaccination dropout rates. According to these estimates, global coverage with the first dose of diphtheria and tetanus toxoids and pertussis-containing vaccine (DTP1) remained relatively unchanged from 2010 (89%) to 2018 (90%). Global coverage with the third DTP dose (DTP3) followed a similar global trend to that of DTP1, remaining relatively consistent from 2010 (84%) to 2018 (86%) (3). Globally, 19.4 million children (14%) were not fully vaccinated in 2018, and among them, 13.5 million (70%) did not receive any DTP doses. Overall, dropout rates from DTP1 to DTP3 decreased globally from 6% in 2010 to 4% in 2018. Global coverage with the first dose of measles-containing vaccine (MCV1) remained between 84% and 86% during 2010-2018. Among countries that offer a second MCV dose (MCV2) during the second year of life, coverage increased from 19% in 2007 to 54% in 2018; among countries offering MCV2 to older age groups (children aged 3-14 years), coverage also increased, from 36% in 2007 to 69% in 2018 (3). Globally, the estimated difference in coverage with MCV1 and MCV2 in 2018 was 17%. However, among new and underused vaccines, global coverage increased from 2007 to 2018 for completed series of rotavirus vaccine, pneumococcal conjugate vaccine (PCV), rubella vaccine, Haemophilus influenzae type b vaccine (Hib), and hepatitis B vaccine (HepB). To reach global vaccination coverage goals for vaccines recommended during childhood, adolescence, and adulthood, tailored strategies that address local determinants for incomplete vaccination are needed, including targeting hard-to-reach and hard-to-vaccinate populations.


Assuntos
Saúde Global , Cobertura Vacinal/estatística & dados numéricos , Vacinas/administração & dosagem , Adolescente , Criança , Pré-Escolar , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Humanos , Programas de Imunização , Esquemas de Imunização , Lactente , Recém-Nascido , Organização Mundial da Saúde
8.
JMIR Public Health Surveill ; 5(4): e14664, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31663863

RESUMO

The many challenges in the Eastern Mediterranean region put the involved countries at risk of polio transmission and affect their ability to meet progress targets in eliminating vaccine-preventable diseases. The Global Health Development (GHD) and Eastern Mediterranean Public Health Network (EMPHNET) are working together on the project "Strengthening sustainable public health capacity in the Eastern Mediterranean region for polio eradication and routine immunization activities" with an overall goal of improving routine immunization, eradicating poliovirus, and controlling/eliminating or eradicating other vaccine-preventable diseases in the Eastern Mediterranean region. The aim of this manuscript is to describe the project and the achievements of GHD/EMPHNET over the last 3 years (2016-2018) to build effective surveillance and immunization systems in the Eastern Mediterranean region through the development of a sustainable and competent public health system to eradicate polio and control/eliminate vaccine-preventable diseases. This project assists the targeted Eastern Mediterranean region countries to build effective surveillance and immunization systems in an effort to expand their capacities to eradicate polio and control/eliminate other vaccine-preventable diseases. The project is streamlined with the Global Polio Eradication Initiative, the Centers for Disease Control and Prevention's Strategic Framework for Global Immunization 2016-2020, and the Polio Eradication and Endgame Strategic Plan 2013-2018. The project also supports the Global Health Security Agenda by focusing on efforts to accelerate progress toward a world safe and secure from infectious disease threats. Project activities were designed to respond to countries' needs and assist them in building their institutional and workforce capacity to effectively plan, implement, and evaluate activities to eradicate polio and strengthen routine immunization activities. The project activities covered a set of areas including surveillance of acute flaccid paralysis and other vaccine-preventable diseases, family and community engagement, workforce capacity building, improvement of data quality, management and use of information systems, use of polio assets to control/eliminate other vaccine-preventable diseases, support of countries to develop national strategies, piloting of innovative initiatives, program evaluation and accountability, and immunization strengthening. The project adopts the Global Polio Eradication Initiative strategies for assisting countries to strengthen routine immunization services, maintain highly sensitive acute flaccid paralysis surveillance, and sustain polio eradication functions.

9.
Vaccine ; 37(52): 7519-7526, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31623915

RESUMO

Every two years, the Global Vaccine and Immunization Research Forum takes stock of global research in vaccines and immunization. As in prior years, the 2018 meeting addressed vaccine discovery, development, decision-making, and deployment. This time, however, it also featured two overarching themes: "Innovating for Equity" and "End-to-End Integration." Significant advances have been made in the last two years, but participants noted that some important goals of the Global Vaccine Action Plan are not being met and called urgently for innovation in improving access to vaccines. Two factors were highlighted as crucial to improving coverage: a focus on equity and sustainability throughout the immunization ecosystem, and an enabling political environment that prioritizes health and immunization.

11.
Elife ; 82019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31477199

RESUMO

High-income countries are experiencing measles reemergence as the result of suboptimal vaccine uptake and marked immunity gaps among adults. In 2017, the Italian Government introduced mandatory vaccination at school entry for ten infectious diseases, including measles. However, sustainable and effective vaccination strategies targeting adults are still lacking. We use a data-driven model of household demography to estimate the potential impact on future measles epidemiology of a novel immunization strategy, to be implemented on top of the 2017 regulation, which consists of offering measles vaccine to the parents of children who get vaccinated. Model simulations suggest that the current vaccination efforts in Italy would not be sufficient to interrupt measles transmission before 2045 because of the frequency of susceptible individuals between 17 and 44 years of age. The integration of the current policy with parental vaccination has the potential to reduce susceptible adults by 17-35%, increasing the chance of measles elimination before 2045 up to 78.9-96.5%.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Programas de Imunização/organização & administração , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Vacinação/métodos , Doenças Transmissíveis Emergentes/prevenção & controle , Simulação por Computador , Humanos , Itália
12.
Vaccine ; 37(44): 6584-6587, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31537448

RESUMO

The Global Vaccine Action Plan 2011-2020 called for all countries to establish a National Immunization Technical Advisory Group (NITAG) by 2020. The Caribbean, with its unique geographical context of 22 countries/territories, had limited technical expertise to establish individual NITAGs in small countries. The Caribbean Immunization Technical Advisory Group (CITAG) was launched in 2018. This paper describes the Caribbean context for a common framework for policy and evidence-based decision-making for immunization. Challenges in immunization in the region are reviewed and potential solutions are outlined. A recent decline in immunization rates in the Caribbean, along with outbreaks of vaccine-preventable diseases globally, places the region, a premier tourist destination, in a vulnerable position. The CITAG aims to strengthen the policy and evidence-based decision-making process for immunization to enable the Caribbean to remain at the forefront of vaccine-preventable disease elimination.

14.
BMC Int Health Hum Rights ; 19(1): 24, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375116

RESUMO

BACKGROUND: Scholars have long been sceptical about the effectiveness of human rights treaties in changing the behaviour of states parties and prior empirical research has often justified that scepticism. However, only a few prior studies have considered the effects of adoption of core human rights treaties on health outcomes and only one prior study has analysed the effects of adoption of the Convention on the Rights of the Child (CRC) on children's health outcomes. METHODS: In this study, we estimated the effects of CRC adoption on child mortality rates and vaccination rates in less developed countries. In particular, we compared 43 less developed countries that adopted the CRC in 1990 with synthetic control groups drawn from 21 less developed countries that adopted it after 1992. RESULTS: We find that CRC adoption may be related to additional reductions in infant and under-5 mortality rates of about 1 to 2 deaths per 1000 live births, on average, during the first three years after adoption, although those relationships are not statistically significant. And we find that CRC adoption is related to additional increases in vaccination rates for the five vaccines that we considered of about 4 to 5%, on average, during the first three years after adoption and that those relationships remain significant for up to seven years after adoption. CONCLUSION: From a policy perspective, our results further support the effectiveness of CRC adoption in promoting children's right to health in less developed countries. And from a research perspective, our results show the advantages of using synthetic control methods in these types of studies, because our analyses using other methods that have most commonly been used in these studies did not find any consistent, significant relationships between CRC adoption and mortality or vaccination rates.


Assuntos
Mortalidade da Criança/tendências , Direitos Humanos , Mortalidade Infantil/tendências , Cooperação Internacional/legislação & jurisprudência , Vacinação/estatística & dados numéricos , Criança , Serviços de Saúde da Criança , Bem-Estar da Criança , Países em Desenvolvimento , Feminino , Política de Saúde , Direitos Humanos/legislação & jurisprudência , Humanos , Lactente , Nações Unidas
15.
Rev Esp Salud Publica ; 932019 Aug 08.
Artigo em Espanhol | MEDLINE | ID: mdl-31391453

RESUMO

OBJECTIVE: Healthcare professionals is one of the risk groups to which influenza vaccination is recommended. The main objective was to know the attitudes of healthcare professionals about influenza vaccination in the Principality of Asturias' reference centre during the campaign 2017-2018. METHODS: We carried out a cross-sectional study between September 2017 and May 2018, using a questionnaire. Sociodemographic variables and reasons for accepting or refuse the influenza vaccination were studied. For descriptive analysis we used the mean, mode, standard deviation, range, frequencies and percentages. The comparison between vaccinated and unvaccinated was made by the Chi square test, Saphiro-Wilk test and U Mann-Whitney test. RESULTS: The sample was formed by 518 participants, finally resulted a 29.53% vaccination rate. The principal reason for accepting the vaccine was its efficacy (average on the Likert scale of 4.11 out of 5), while the main reason for not vaccination was the lack of interest (mean=3.41 out of 5). It confirmed relationship between the type of contract and the professional category, the lower vaccination was in the temporary staff (p=0.003) and the nursing profession (p<0.001). We also found association between professionals that used to receive the vaccine in all the campaigns (p<0.001) and those who received the immunization in their workplace (p=0.002). Finally, the profession (p=0.014) and the family (p<0.001) also were influential in the decision of the immunized. CONCLUSIONS: The vaccination rate of the professionals who work in the Asturias´ reference hospital is similar to that of other health centres in Spain, but it is below the objective set by the World Health Organization. The previous contact with the influenza immunization, a positive working environment respecting the vaccine and the promotion of information, could be favourable factors in the vaccinal decision of the health workers.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/estatística & dados numéricos , Programas de Imunização , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Vacinação/estatística & dados numéricos , Local de Trabalho , Adulto , Estudos Transversais , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Inquéritos e Questionários , Centros de Atenção Terciária , Organização Mundial da Saúde
16.
Am J Trop Med Hyg ; 101(4): 891-898, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31392947

RESUMO

São Tomé and Príncipe (STP) uses a selective hepatitis B birth-dose vaccination (HepB-BD) strategy targeting infants born to mothers who test positive for hepatitis B virus (HBV) surface antigen. We conducted a field assessment and economic analysis of the HepB-BD strategy to provide evidence to guide development of cost-effective policies to prevent perinatal HBV transmission in STP. We interviewed national stakeholders and key informants to understand policies, knowledge, and practices related to HepB-BD, vaccine management, and data recording/reporting. Cost-effectiveness of the existing strategy was compared with an alternate approach of universal HepB-BD to all newborns using a decision analytic model. Incremental cost-effectiveness ratios (ICERs) were calculated in 2015 USD per HBV-associated death and per chronic HBV case prevented, from the STP health-care system perspective. We found that STP lacked national or facility-specific written policies and procedures related to HepB-BD. Timely HepB-BD to eligible newborns was considered a high priority, although timeliness of HepB-BD was not monitored. Compared with the existing selective vaccination strategy, universal HepB-BD would result in a 19% decrease in chronic HBV infections per year at overall cost savings of approximately 44% (savings of USD 5,441 each year). We estimate an ICER of USD 5,012 saved per HBV-associated death averted. The existing selective HepB-BD strategy in STP could be improved through documentation of policies, procedures, and timeliness of HepB-BD. Expansion to universal newborn HepB-BD without maternal screening is feasible and could result in cost savings if actual implementation costs and effectiveness fall within the ranges modeled.


Assuntos
Antígenos de Superfície da Hepatite B/imunologia , Vacinas contra Hepatite B/administração & dosagem , Hepatite B Crônica/prevenção & controle , Hepatite B/prevenção & controle , Programas de Imunização/economia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Vacinação , Análise Custo-Benefício , Medicina Baseada em Evidências , Feminino , Hepatite B/virologia , Hepatite B Crônica/virologia , Humanos , Recém-Nascido , Parto , Gravidez , Avaliação de Programas e Projetos de Saúde , São Tomé e Príncipe , Organização Mundial da Saúde
18.
Pan Afr Med J ; 32: 168, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303937

RESUMO

The recent outbreaks of diseases including Ebola reemergence in the Democratic Republic of Congo (DRC), Nipah virus outbreak in India, Lassa virus in Nigeria and the continued Influenza pandemic show that we cannot predict outbreaks, however, developing response plans could help alleviate the burden of diseases. Developing response plans involves strategies such as creating a repository of microbial agents as well as the implementation of the plans. In addition, zoonotic experts and policy makers should work together in order to succeed in fighting against any disease outbreaks. We should also not forget about the importance of vaccination because of the benefits it has brought to humankind preventing disease occurrence. Furthermore, the challenges that come with vaccination including vaccine delivery and vaccine uptake need to be overcome to make sure that this public health tool continues to be effective. Overcoming these vaccination challenges would play a significant role in decreasing the overuse of antimicrobials, hence avoiding resistance. The One Health Community (OHC) therefore has the responsibility to advocate for the use of vaccines and show that it has costs benefits; this strategy has the potential to fight against antimicrobial resistance.


Assuntos
Surtos de Doenças/prevenção & controle , Saúde Global , Saúde Única , Vacinação/métodos , Humanos , Pandemias/prevenção & controle , Saúde Pública , Vacinas/administração & dosagem
19.
PLoS Negl Trop Dis ; 13(7): e0007482, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31260441

RESUMO

The tetravalent dengue vaccine CYD-TDV (Dengvaxia) is the first licensed vaccine against dengue, but recent findings indicate an elevated risk of severe disease among vaccinees without prior dengue virus (DENV) exposure. The World Health Organization currently recommends CYD-TDV only for individuals with serological confirmation of past DENV exposure. Our objective was to evaluate the potential health impact and cost-effectiveness of vaccination following serological screening. To do so, we used an agent-based model to simulate DENV transmission with and without vaccination over a 10-year timeframe. Across a range of values for the proportion of vaccinees with prior DENV exposure, we projected the proportion of symptomatic and hospitalized cases averted as a function of the sensitivity and specificity of serological screening. Scenarios about the cost-effectiveness of screening and vaccination were chosen to be representative of Brazil and the Philippines. We found that public health impact depended primarily on sensitivity in high-transmission settings and on specificity in low-transmission settings. Cost-effectiveness could be achievable from the perspective of a public payer provided that sensitivity and the value of a disability-adjusted life-year were both high, but only in high-transmission settings. Requirements for reducing relative risk and achieving cost-effectiveness from an individual perspective were more restricted, due to the fact that those who test negative pay for screening but receive no benefit. Our results predict that cost-effectiveness could be achieved only in high-transmission areas of dengue-endemic countries with a relatively high per capita GDP, such as Panamá (13,680 USD), Brazil (8,649 USD), México (8,201 USD), or Thailand (5,807 USD). In conclusion, vaccination with CYD-TDV following serological screening could have a positive impact in some high-transmission settings, provided that screening is highly specific (to minimize individual harm), at least moderately sensitive (to maximize population benefit), and sufficiently inexpensive (depending on the setting).


Assuntos
Análise Custo-Benefício , Vacinas contra Dengue/economia , Dengue/prevenção & controle , Programas de Rastreamento/economia , Saúde Pública/economia , Vacinação/economia , Anticorpos Neutralizantes , Anticorpos Antivirais/sangue , Simulação por Computador , Dengue/economia , Humanos , Testes Sorológicos/economia , Fatores de Tempo , Vacinação/efeitos adversos , Cobertura Vacinal/estatística & dados numéricos , Organização Mundial da Saúde
20.
Vaccine ; 37(35): 4928-4936, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31326253

RESUMO

BACKGROUND: The pace of global progress must increase if the Global Vaccine Action Plan (GVAP) goals are to be achieved by 2020. We administered a two-phase survey to key immunization stakeholders to assess the utility and application of GVAP, including how it has impacted country immunization programs, and to find ways to strengthen the next 10-year plan. METHODS: For the Phase I survey, an online questionnaire was sent to global immunization stakeholders in summer 2017. The Phase II survey was sent to regional and national immunization stakeholders in summer 2018, including WHO Regional Advisors on Immunization, Expanded Programme on Immunization managers, and WHO and UNICEF country representatives from 20 countries. Countries were selected based on improvements (10) versus decreases (10) in DTP3 coverage from 2010 to 2016. RESULTS: Global immunization stakeholders (n = 38) cite global progress in improving vaccine delivery (88%) and engaging civil society organizations as advocates for vaccines (83%). Among regional and national immunization stakeholders (n = 58), 70% indicated reaching mobile and underserved populations with vaccination activities as a major challenge. The top ranked activities for helping country programs achieve progress toward GVAP goals include improved monitoring of vaccination coverage and upgrading disease surveillance systems. Most respondents (96%) indicated GVAP as useful for determining immunization priorities and 95% were supportive of a post-2020 GVAP strategy. CONCLUSIONS: Immunization stakeholders see GVAP as a useful tool, and there is cause for excitement as the global immunization community looks toward the next decade of vaccines. The next 10-year plan should attempt to increase political will, align immunization activities with other health system agendas, and address important issues like reaching mobile/migrant populations and improving data reporting systems.

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