XI Reunión Ad Hoc del Grupo Técnico Asesor (GTA) sobre Enfermedades Prevenibles por Vacunación. 21 de noviembre del 2023. Reunión virtual

La Región de las Américas está recuperando sus tasas de cobertura de inmunización para la mayoría de los antígenos. En el 2022, la tasa de cobertura de la tercera dosis de la vacuna contra la difteria, el tétanos y la tos ferina (DTP3) fue del 90%, frente al 86% en 2021. En total, 1,3 millones de niños menores de 1 año siguen sin vacunar, frente a los 1,9 millones de 2021. Por supuesto, el camino hacia la recuperación de la pandemia de COVID-19 es largo, pero las Américas están mostrando signos de progreso. En 2002, los casos de dengue superaron el millón, mientras que en 2013 se registraron más de 2 millones, y más de 3 millones en 2019. Aunque la tasa regional de letalidad por dengue se mantiene por debajo del 0,05%, el aumento de la transmisión está socavando los esfuerzos de recuperación social y económica de los países. En septiembre de 2023, el Grupo de Expertos en Asesoramiento Estratégico (SAGE) sobre Inmunización de la Organización Mundial de la Salud (OMS) recomendó el uso de la serie de dos dosis de la vacuna contra el dengue TAK-003 producida por Takeda para niños de 6 a 16 años que viven en entornos con alta carga de enfermedad por dengue y alta intensidad de transmisión. Durante esta XI reunión del Grupo Técnico Asesor (GTA), la Secretaría de la Organización Panamericana de la Salud (OPS) pidió a los miembros del GTA que consideraran la evidencia sobre la seguridad y eficacia de esta vacuna y propusieran recomendaciones para su uso en las Américas. Asimismo, el virus sincitial respiratorio (VSR) es motivo de gran preocupación en las Américas. Los datos notificados por los Estados Miembros a la red integrada de vigilancia respiratoria SARInet Plus de la OPS indican que el VSR contribuye significativamente a la carga de enfermedades respiratorias en la Región. Por grupos de edad, los casos y hospitalizaciones asociados al VSR se han notificado principalmente entre lactantes menores de 2 años. En los últimos meses, tanto la Administración de Alimentos y Medicamentos de EE.UU. (FDA) como la Agencia Europea del Medicamento (EMA) han aprobado la vacuna Abrysvo contra el VRSpreF producida por Pfizer para mujeres embarazadas, con el objetivo de reducir la incidencia del VRS entre los recién nacidos menores de 6 meses. Una vez más, los miembros del GAT fueron convocados para proporcionar sus recomendaciones a la OPS sobre el uso de esta vacuna en las Américas.

Effectiveness of interventions to increase healthcare workers' adherence to vaccination against vaccine-preventable diseases: a systematic review and meta-analysis, 1993 to 2022.

BackgroundVaccination adherence among healthcare workers (HCWs) is fundamental for the prevention of vaccine-preventable diseases (VPDs) in healthcare. This safeguards HCWs' well-being, prevents transmission of infections to vulnerable patients and contributes to public health.AimThis systematic review and meta-analysis aimed to describe interventions meant to increase HCWs' adherence to vaccination and estimate the effectiveness of these interventions.MethodsWe searched literature in eight databases and performed manual searches in relevant journals and the reference lists of retrieved articles. The study population included any HCW with potential occupational exposure to VPDs. We included experimental and quasi-experimental studies presenting interventions aimed at increasing HCWs' adherence to vaccination against VPDs. The post-intervention vaccination adherence rate was set as the main outcome. We included the effect of interventions in the random-effects and subgroup meta-analyses.ResultsThe systematic review considered 48 studies on influenza and Tdap vaccination from database and manual searches, and 43 were meta-analysed. A statistically significant, positive effect was seen in multi-component interventions in randomised controlled trials (relative risk (RR) = 1.37; 95% CI: 1.13-1.66) and in observational studies (RR = 1.43; 95% CI: 1.29-1.58). Vaccination adherence rate was higher in community care facilities (RR = 1.58; 95% CI: 1.49-1.68) than in hospitals (RR = 1.24; 95% CI: 0.76-2.05).ConclusionInterventions aimed at increasing HCWs' adherence to vaccination against VPDs are effective, especially multi-component ones. Future research should determine the most effective framework of interventions for each setting, using appropriate study design for their evaluation, and should compare intervention components to understand their contribution to the effectiveness.

Prevalence of infectious diseases, immunity to vaccine-preventable diseases and chronic medical conditions among Ukrainian refugees in Germany - A cross sectional study from the German Network University Medicine (NUM).

BACKGROUND: Vulnerability to infectious diseases in refugees is dependent on country of origin, flight routes, and conditions. Information on specific medical needs of different groups of refugees is lacking. We assessed the prevalence of infectious diseases, immunity to vaccine-preventable diseases, and chronic medical conditions in children, adolescents, and adult refugees from Ukraine who arrived in Germany in 2022. METHODS: Using different media, we recruited Ukrainian refugees at 13 sites between 9-12/2022. An antigen test for acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, serologies for a range of vaccine-preventable diseases, as well as interferon gamma release assays (IGRAs) for tuberculosis (TB), and SARS-CoV-2 were performed. We assessed personal and family history of chronic medical conditions, infectious diseases, vaccination status, and conditions during migration. RESULTS: Overall, 1793 refugees (1401 adults and 392 children/adolescents) were included. Most participants were females (n = 1307; 72·3%) and from Eastern or Southern Ukraine. TB IGRA was positive in 13% (n = 184) of the adults and in 2% (n = 7) of the children. Serology-based immunological response was insufficient in approximately 21% (360/1793) of the participants for measles, 32% (572/1793) for diphtheria, and 74% (1289/1793) for hepatitis B. CONCLUSIONS: We show evidence of low serological response to vaccine-preventable infections and increased LTBI prevalence in Ukrainian refugees. These findings should be integrated into guidelines for screening and treatment of infectious diseases in migrants and refugees in Germany and Europe. Furthermore, low immunity for vaccine-preventable diseases in Ukrainians independent of their refugee status, calls for tailor-made communication efforts.

Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020-30: a modelling study.

BACKGROUND: There have been declines in global immunisation coverage due to the COVID-19 pandemic. Recovery has begun but is geographically variable. This disruption has led to under-immunised cohorts and interrupted progress in reducing vaccine-preventable disease burden. There have, so far, been few studies of the effects of coverage disruption on vaccine effects. We aimed to quantify the effects of vaccine-coverage disruption on routine and campaign immunisation services, identify cohorts and regions that could particularly benefit from catch-up activities, and establish if losses in effect could be recovered. METHODS: For this modelling study, we used modelling groups from the Vaccine Impact Modelling Consortium from 112 low-income and middle-income countries to estimate vaccine effect for 14 pathogens. One set of modelling estimates used vaccine-coverage data from 1937 to 2021 for a subset of vaccine-preventable, outbreak-prone or priority diseases (ie, measles, rubella, hepatitis B, human papillomavirus [HPV], meningitis A, and yellow fever) to examine mitigation measures, hereafter referred to as recovery runs. The second set of estimates were conducted with vaccine-coverage data from 1937 to 2020, used to calculate effect ratios (ie, the burden averted per dose) for all 14 included vaccines and diseases, hereafter referred to as full runs. Both runs were modelled from Jan 1, 2000, to Dec 31, 2100. Countries were included if they were in the Gavi, the Vaccine Alliance portfolio; had notable burden; or had notable strategic vaccination activities. These countries represented the majority of global vaccine-preventable disease burden. Vaccine coverage was informed by historical estimates from WHO-UNICEF Estimates of National Immunization Coverage and the immunisation repository of WHO for data up to and including 2021. From 2022 onwards, we estimated coverage on the basis of guidance about campaign frequency, non-linear assumptions about the recovery of routine immunisation to pre-disruption magnitude, and 2030 endpoints informed by the WHO Immunization Agenda 2030 aims and expert consultation. We examined three main scenarios: no disruption, baseline recovery, and baseline recovery and catch-up. FINDINGS: We estimated that disruption to measles, rubella, HPV, hepatitis B, meningitis A, and yellow fever vaccination could lead to 49 119 additional deaths (95% credible interval [CrI] 17 248-134 941) during calendar years 2020-30, largely due to measles. For years of vaccination 2020-30 for all 14 pathogens, disruption could lead to a 2·66% (95% CrI 2·52-2·81) reduction in long-term effect from 37 378 194 deaths averted (34 450 249-40 241 202) to 36 410 559 deaths averted (33 515 397-39 241 799). We estimated that catch-up activities could avert 78·9% (40·4-151·4) of excess deaths between calendar years 2023 and 2030 (ie, 18 900 [7037-60 223] of 25 356 [9859-75 073]). INTERPRETATION: Our results highlight the importance of the timing of catch-up activities, considering estimated burden to improve vaccine coverage in affected cohorts. We estimated that mitigation measures for measles and yellow fever were particularly effective at reducing excess burden in the short term. Additionally, the high long-term effect of HPV vaccine as an important cervical-cancer prevention tool warrants continued immunisation efforts after disruption. FUNDING: The Vaccine Impact Modelling Consortium, funded by Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation. TRANSLATIONS: For the Arabic, Chinese, French, Portguese and Spanish translations of the abstract see Supplementary Materials section.

14a Reunión de la Comisión Regional de Certificación (RCC) de la Erradicación de la Poliomielitis en la Región de las Américas: Informe final. 6 al 8 de julio del 2022. Ciudad de México, México

La 14ª Reunión de la Comisión Regional de Certificación de la Erradicación de la Poliomielitis en la Región de las Américas se llevó a cabo del 6 al 8 de julio del 2022 en la Ciudad de México (México). Durante la reunión, la Comisión Regional de Certificación (RCC, por su sigla en inglés) analizó y validó 25 informes anuales que incluyen información del desempeño del programa de polio y el estatus de erradicación de la enfermedad de 31 países y 9 territorios en el 2021. Todos los miembros de la RCC analizaron y aprobaron los resultados de validación y el informe final de la reunión. Los objetivos de la reunión eran revisar, analizar y validar el informe anual correspondiente al 2021 de los países y el estatus de erradicación de la polio. Los objetivos secundarios incluían: 1. Proveer recomendaciones específicas a los países para mantener el estatus libre de polio de la Región; 2. Actualizar el análisis de riesgo regional. La metodología de la reunión fue muy similar a la que ha utilizado previamente la RCC. Los dos miembros de la RCC asignados al país y el Secretariado revisaron y analizaron todos los informes. Se presentó el resultado al resto de la Comisión y este fue discutido y validado por toda la RCC. Al inicio de la reunión, se presentó la actualización sobre la situación mundial y regional de la polio. La RCC recibió 25 informes anuales de los 29 que esperaba: 24 informes de países (incluidos 5 de los países más grandes del Caribe) y el informe de la subregión del Caribe (que consolida la información de 7 países y 9 territorios).

A Review of the Resurgence of Measles, a Vaccine-Preventable Disease, as Current Concerns Contrast with Past Hopes for Measles Elimination.

On 22 February 2024, the World Health Organization (WHO) stated that, following the recent resurgence of measles cases in Europe, more than half the world's countries could expect significant measles outbreaks this year. Measles is a highly infectious virus with a primary case reproduction number (R0) of 12-18. Measles infection can be severe, resulting in pneumonia, and also more rarely in subacute sclerosing panencephalitis (SSPE), which occurs in 1 child out of every 1,000 and can be fatal. Until the 1990s, the hope of eliminating measles seemed possible following the successful development of effective vaccines, given individually or in the combined measles, mumps, and rubella (MMR) vaccine. Vaccine hesitancy due to misinformation about possible vaccine side effects, reduced vaccine uptake during and after the COVID-19 pandemic, and lack of awareness of the severe consequences of measles infection have contributed to low vaccine uptake, resulting in vulnerable communities. This article aims to review the recent resurgence of measles cases in the US, Europe, and the UK, to provide a reminder of the potential severity of measles, and to consider the causes of the failure to eliminate this vaccine-preventable viral infection.

Impact of a research-action on vaccination indicators in the state of Minas Gerais, Brazil.

OBJECTIVE: Analyze the impact of the state research-action project on immunization indicators (vaccination coverage - VC, homogeneity of vaccination coverage - HVC, dropout rate - DR, and risk rating) before and after the intervention in municipalities and priority Regional Health Administrations/Regional Health Superintendencies (RHA/RHS). METHODS: The state research-action project was a before-after community clinical trial conducted in 212 municipalities belonging to eight RHA/RHS in the state of Minas Gerais, Brazil. The study sample comprised RHA/RHS with a decreasing trend for routine vaccination coverage in children under one year from 2015 to 2020. This study used secondary VC and DR data from 10 immunobiologicals recommended for children younger than two years from January to December 2021 (pre-intervention period, prior to the state research-action project) and from January to December 2022 (post-intervention period). The categorical variables were presented in proportions, and initially, a comparison was made between those of DR, HVC, and the risk rating for the transmission of vaccine-preventable diseases, according to the two periods (2021 and 2022), using the McNemar test. RESULTS: All immunization indicators increased after conducting the research-action project. In 2021, 80.66% of the state's municipalities had a risk rating for the transmission of vaccine-preventable diseases as "high and very high." In 2022, the value reduced to 68.40%. CONCLUSIONS: Risk rating for the transmission of vaccine-preventable diseases is an important mechanism to assist managers in defining priorities. The state research-action project used a method that enabled the construction and execution of unique action plans for each municipality, directing the improvement of immunization indicators in the state.

Investigating sources of non-response bias in a population-based seroprevalence study of vaccine-preventable diseases in the Netherlands.

BACKGROUND: PIENTER 3 (P3), conducted in 2016/17, is the most recent of three nationwide serological surveys in the Netherlands. The surveys aim to monitor the effects of the National Immunisation Programme (NIP) by assessing population seroprevalence of included vaccine preventable diseases (VPDs). The response rate to the main sample was 15.7% (n = 4,983), following a decreasing trend in response compared to the previous two PIENTER studies (P1, 55.0%; 1995/1996 [n = 8,356] and P2, 33.0%; 2006/2007 [n = 5,834]). Non-responders to the main P3 survey were followed-up to complete a "non-response" questionnaire, an abridged 9-question version of the main survey covering demographics, health, and vaccination status. We assess P3 representativeness and potential sources of non-response bias, and trends in decreasing participation rates across all PIENTER studies. METHODS: P3 invitees were classified into survey response types: Full Participants (FP), Questionnaire Only (QO), Non-Response Questionnaire (NRQ) and Absolute Non-Responders (ANR). FP demographic and health indicator data were compared with Dutch national statistics, and then the response types were compared to each other. Random forest algorithms were used to predict response type. Finally, FPs from all three PIENTERs were compared to investigate the profile of survey participants through time. RESULTS: P3 FPs were in general healthier, younger and higher educated than the Dutch population. Random forest was not able to differentiate between FPs and ANRs, but when predicting FPs from NRQs we found evidence of healthy-responder bias. Participants of the three PIENTERs were found to be similar and are therefore comparable through time, but in line with national trends we found P3 participants were less inclined to vaccinate than previous cohorts. DISCUSSION: The PIENTER biobank is a powerful tool to monitor population-level protection against VPDs across 30 years in The Netherlands. However, future PIENTER studies should continue to focus on improving recruitment from under-represented groups, potentially by considering alternative and mixed survey modes to improve both overall and subgroup-specific response. Whilst non-responder bias is unlikely to affect seroprevalence estimates of high-coverage vaccines, the primary aim of the PIENTER biobank, other studies with varied vaccination/disease exposures should consider the influence of bias carefully.

2022 Polio outbreak, Rockland County, NY: Cost evaluation of strategies to prevent future outbreaks of vaccine-preventable diseases.

In 1994, the World Health Organization Region of the Americas was declared polio-free. In July 2022, a confirmed case of paralytic polio in an unvaccinated adult resident of Rockland County, New York was reported by the New York State Department of Health (NYSDOH) and Rockland County Department of Health (RCDOH). While only one case was identified, a single case of paralytic polio represents a public health emergency in the United States. The patient's county of residence was identified to have low vaccination coverage indicating that the community was at risk for additional cases. Disease outbreaks are resource-intensive and incur high costs to the patient, local health departments, and to society. These costs are potentially avoidable for vaccine-preventable diseases and thus, highlight the urgency to not only interrupt transmission but to prevent future vaccine-preventable disease outbreaks by improving vaccination coverage. Following case confirmation, an investigation and response was initiated by NYSDOH, along with local health departments and the Centers for Disease Control and Prevention (CDC). After the initial investigation and response, collaborative efforts to mitigate risk and strengthen routine immunization continued, which included provider outreach and immunization record assessments of Head Start and licensed childcare facilities (primarily those with missing or incomplete required vaccination coverage reports from the previous year) in Rockland County. We estimated the costs of (1) provider outreach and (2) childcare and pre-kindergarten immunization record assessments of select licensed childcare and Head Start facilities in Rockland County. The total labor cost incurred for these activities was $138,514 with a total of 2,555 h incurred. Often there are unique opportunities in the midst of an outbreak for public health to implement activities to proactively address low vaccination and strengthen vaccination coverage and possibly prevent future outbreaks. Understanding the cost of these activities might help inform future outbreak planning.

Vaccine-preventable diseases: Immune response in a large population of healthcare students.

BACKGROUND: Students in medicine and other health professions are exposed to numerous occupational hazards, primarily biological hazards, during their academic careers at university. The aim of the present study was to investigate the seroprevalence characteristics of anti-HBsAg, anti-Measles, anti-Mumps, anti-Rubella and anti-Varicella IgG antibodies in healthcare students of a large teaching hospital in Rome. METHODS: To accomplish the study's aims, antibody serology data were gathered from students of Medicine and Surgery, Dentistry, and Health Professions at the Catholic University of the Sacred Heart (Rome Campus) during their first Health Surveillance visit, that took place from 2013 to 2023. RESULTS: Our study sample included 2523 students, 44.4 % were protected against Hepatitis B, 87.3 % against measles, 85.5 % against mumps, 94.6 % rubella and 95.2 % against varicella. Differences in antibody coverage between age groups were statistically significant (p < 0.001), except for mumps. It found a lower probability of having seronegative anti-HBVs with an older date since the presumed primary vaccination. CONCLUSION: In our sample, seropositivity rate against vaccine-preventable diseases, especially for Hepatitis B, was often inadequate to prevent possible biological risks connected with the activities carried out on the ward.

Cost of illness of the vaccine-preventable diseases influenza, herpes zoster and pneumococcal disease in France.

BACKGROUND: The incidence of certain vaccine-preventative diseases, such as influenza, herpes zoster and pneumococcal infection, continues to be high despite the availability of vaccines, resulting in a substantial health and economic burden on society, particularly among older adults aged ≥65 years. METHODS: A cost calculator was developed to assess the cost of illness of influenza, herpes zoster and pneumococcal disease in France. Direct medical costs related to diagnosis and treatment in the older adult population in both inpatient and outpatient settings were modelled over a 1-year time horizon. Scenario analyses were conducted to determine the impact of hospitalizations on the results by considering only influenza-attributed diagnoses. RESULTS: In France, influenza has the highest incidence, followed by herpes zoster and pneumococcal disease. Similarly, influenza poses the greatest cost burden among all older adults, while pneumococcal disease poses the greatest cost burden among those aged 65-74 years. When considering only influenza-attributed diagnoses, the number of inpatient visits and associated costs was reduced by 63% in the overall older adult population. In the low-incidence season, the number of inpatient visits and associated costs were reduced by 69%, while in the high-incidence season, the number of inpatient visits and associated costs increased by 63%. CONCLUSION: Influenza remains a leading vaccine-preventable disease among older adults in France, resulting in a substantial economic burden that could be prevented by increasing vaccine uptake.

Italian oncologists and vaccinations against infectious diseases: Results of a survey of the Italian Association of Medical Oncology.

BACKGROUND: Patients with cancer present a higher risk of vaccine-preventable diseases. Recommended vaccinations are the most cost-effective measure to reduce the risk of transmission and related complications. Nevertheless, vaccination rates are inadequate. Oncologists have a central role in tailored vaccine communication to their patients. We present the results of a survey conducted by AIOM in 2022, focusing on the perception of the problem by oncologists. MATERIALS AND METHODS: An anonymous 31-item online questionnaire was shared on 15 September 2022 on the AIOM website. The objectives of this survey were to examine the perception of Italian oncologists on vaccine-preventable diseases and the main available vaccines, their attitude towards recommending vaccines and the COVID-19 pandemic impact on their habits regarding vaccine-preventable diseases. RESULTS: Between September 2022 and January 2023, 114 medical oncologists (5% of the members) completed the anonymous questionnaire. At the first oncological visit, only 30% of respondents usually propose a vaccination schedule to all their patient, 41% do not usually discuss vaccinations at the first visit and 29% recommend vaccines exclusively to specific categories of patients. For 56% of respondents, patients are more aware of the benefits of vaccines, whereas 36% reported that patients are worried of receiving too many vaccines. CONCLUSION: This is the first survey conducted among Italian oncologists to better understand the perception and attitudes towards the vaccination. It highlights the urgent issues of educating and training oncologists in vaccine-preventable diseases and vaccine awareness and the need to build (or implement) a network of multidisciplinary collaborations.

XIe réunion spéciale du Groupe consultatif technique (GCT) de l'OPS sur les maladies évitables par la vaccination, 21 novembre 2023. Réunion virtuelle

La Région des Amériques retrouve ses taux de couverture vaccinale pour la plupart des antigènes. En 2022, le taux de couverture pour la troisième dose du vaccin contre la diphtérie, le tétanos et la coqueluche (DTC3) était de 90 %, contre 86 % en 2021. Dans l'ensemble, 1,3 million d'enfants de moins d'un an ne sont pas vaccinés, contre 1,9 million en 2021. En 2002, les cas de dengue ont dépassé le million, alors que plus de 2 millions ont été enregistrés en 2013, et plus de 3 millions en 2019. Alors que le taux de létalité de la dengue dans la région reste inférieur à 0,05 %, l'augmentation de la transmission compromet les efforts de redressement social et économique des pays. En septembre 2023, le Groupe consultatif stratégique d'experts (SAGE) de l'OMS sur la vaccination a recommandé l'utilisation de la série de deux doses du vaccin contre la dengue TAK-003 produit par Takeda pour les enfants âgés de 6 à 16 ans qui vivent dans des environnements où la charge de morbidité et l'intensité de la transmission de la dengue sont élevées. Au cours de cette XIe réunion du groupe consultatif technique (GCT), le secrétariat de l'OPS a demandé aux membres du GCT d'examiner les preuves de l'innocuité et de l'efficacité de ce vaccin et de proposer des recommandations pour son utilisation dans les Amériques. Par ailleurs, le virus respiratoire syncytial suscite (VRS) de vives inquiétudes dans les Amériques. Les données communiquées par les États membres au réseau intégré de surveillance respiratoire SARInet Plus de l'OPS indiquent que le VRS contribue de manière significative à la charge de morbidité respiratoire dans la région. Par groupe d'âge, les cas et les hospitalisations associés au VRS ont été principalement signalés chez les nourrissons de moins de 2 ans. Ces derniers mois, la Food and Drug Administration des États-Unis et l'Agence européenne des médicaments ont toutes deux approuvé le vaccin RSVpreF Abrysvo produit par Pfizer pour les femmes enceintes, dans le but de réduire l'incidence du VRS chez les nouveau-nés de moins de 6 mois.

Strategies for expanding childhood vaccination in the Americas following the COVID-19 pandemic / Estrategias para ampliar la vacunación infantil en la Región de las Américas después de la pandemia de COVID-19 / Estratégias para ampliar a vacinação infantil nas Américas depois da pandemia de COVID-19

[ABSTRACT]. Objective. To provide an overview of the status of the childhood vaccination schedule in the Americas, outline program structures, and identify updated implementation strategies to improve vaccination coverage following the COVID-19 pandemic. Methods. A group of experts in pediatrics, epidemiology, vaccines, and global and public health discussed the current status of the childhood vaccination schedule in the Americas, describing the program structure and identifying new implementation strategies that have the potential to improve vaccination coverage in the post-pandemic context, after the challenges COVID-19 presented for more than two years. Results. The Americas currently face a high risk of resurgence of diseases that were previously controlled or eliminated. Therefore, it is important to find new strategies to educate citizens on the risks associated with lower vaccination rates, especially in children. Conclusions. New strategies along with strong mobilization of the population and advocacy by citizens are necessary to prevent antivaccination groups from gaining a stronger presence in the region and jeopardizing the credibility of the Expanded Program on Immunization.

[RESUMEN]. Objetivo. Presentar un panorama general de la situación del calendario de vacunación infantil en la Región de las Américas, describir la estructura de los programas y encontrar estrategias actualizadas para su ejecución a fin de mejorar la cobertura de vacunación después de la pandemia de COVID-19. Métodos. Un grupo de expertos en pediatría, epidemiología, vacunas y salud pública y mundial analizó la situación actual del calendario de vacunación infantil en la Región de las Américas, mediante la descripción de la estructura de los programas y la búsqueda de nuevas estrategias de ejecución capaces de mejorar la cobertura de vacunación en el contexto posterior a la pandemia de COVID-19, una vez superados los desafíos planteados por esta durante más de dos años. Resultados. En este momento, en la Región de las Américas hay un riesgo alto de reaparición de enferme- dades previamente controladas o eliminadas. En consecuencia, es importante contar con nuevas estrategias para la educación de salud de la ciudadanía sobre los riesgos asociados a las tasas bajas de vacunación, especialmente en la población infantil. Conclusiones. Es necesario contar con nuevas estrategias, acompañadas de una fuerte movilización de la población y una promoción por parte de la ciudadanía, para evitar que los grupos que generan mensajes antivacunas aumenten su presencia en la Región y pongan en peligro la credibilidad del Programa Ampliado de Inmunización.

[RESUMO]. Objetivo. Apresentar um panorama da situação do calendário de vacinação infantil nas Américas, definir a estrutura do programa e identificar estratégias de implementação atualizadas para melhorar a cobertura vacinal depois da pandemia de COVID-19. Métodos. Um grupo de especialistas em pediatria, epidemiologia, vacinas e saúde pública e global discutiu a situação atual do calendário de vacinação infantil nas Américas, descrevendo a estrutura dos programas e identificando novas estratégias de implementação que poderiam melhorar a cobertura vacinal no contexto pós-pandemia, na sequência dos desafios impostos pela COVID-19 durante mais de dois anos. Resultados. Atualmente, as Américas enfrentam um grande risco de ressurgimento de doenças já controla- das ou eliminadas. Desse modo, é importante identificar novas estratégias para conscientizar os cidadãos sobre os riscos decorrentes da queda das taxas de vacinação, sobretudo em crianças. Conclusões. É necessário adotar novas estratégias, aliadas a uma forte mobilização da população e pro- moção da causa pelos cidadãos, a fim de impedir que os grupos antivacinas fortaleçam sua presença na região e coloquem em risco a credibilidade do Programa Ampliado de Imunização.

XI Ad Hoc Meeting of the PAHO Technical Advisory Group (TAG) on Vaccine-Preventable Diseases, 21 November 2023. Virtual

The Region of the Americas is recovering its immunization coverage rates for most antigens. In 2022, the coverage rate for the third dose of the vaccine against diphtheria, tetanus, and pertussis (DTP3) was 90% – up from 86% in 2021. Overall, 1.3 million children younger than 1 year remain unvaccinated, compared to 1.9 million in 2021. Of course, the road to recovery from the COVID-19 pandemic is long, but the Americas are showing signs of progress. However, this progress is under threat from persistent infections that cause heavy burdens of disease in the Americas. Especially heavy is the burden of dengue virus. In 2002, dengue cases exceeded 1 million, whereas more than 2 million were recorded in 2013, and more than 3 million in 2019. While the regional dengue case fatality rate remains below 0.05%, the increased transmission is undermining countries’ efforts for social and economic recovery. In September 2023, the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization recommended the use of the two-dose TAK-003 dengue vaccine series produced by Takeda for children ages 6 to 16 years who live in settings with high dengue disease burden and high transmission intensity. During this XI Technical Advisory Group (TAG) meeting, the Pan American Health Organization (PAHO) Secretariat asked TAG members to consider the evidence on the safety and effectiveness of this vaccine and propose recommendations for its use in the Americas. Also, respiratory syncytial virus (RSV) is cause for great concern in the Americas. Data reported from Member States to the PAHO integrated respiratory surveillance network SARInet Plus indicate that RSV contributes significantly to the burden of respiratory diseases in the Region. By age group, RSV-associated cases and hospitalizations have been primarily reported among infants younger than 2 years. In recent months, both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) approved the RSVpreF vaccine Abrysvo produced by Pfizer for pregnant women, with the goal of reducing RSV incidence among newborns younger than 6 months. Again, TAG members were called to provide their recommendations to PAHO on the use of this vaccine in the Americas.

Імунiзацiя на практиці: практичний посібник для медичного персоналу: оновлений випуск 2015 року

Цей практичний посібник містить сім модулів, орієнтованих на персонал району тамедичного закладу. Він має намір задовольнити вимоги щодо покращення послугз імунізації, щоб охопити більшу кількість немовлят у довгостроковій перспективі,спираючись на досвід ліквідації поліомієліту. Він містить матеріал щодо плануван-ня, моніторингу та використання даних для покращення обслуговування, які можнавикористовувати на будь-якому рівні.У першому модулі розглядаються цільові захворювання для програм імунізації таописуються вакцини, що використовуються для їх профілактики.Другий модуль містить рекомендації для працівників медичних закладів. Він охо-плює використання обладнання холодового ланцюга та моніторингу температури,а також основне технічне обслуговування обладнання холодового ланцюга.У третьому модулі обговорюються практики, яких мають дотримуватися медичніпрацівники, щоб забезпечити найбезпечніше проведення ін’єкцій імунізації.У четвертому модулі обговорюється процес мікропланування для забезпечення до-ступу до послуг імунізації в кожній громаді.У пʼятому модулі описані завдання, які повинен виконати медичний працівник, щобзабезпечити якісне проведення сесії імунізації. Він охоплює підготовку, питання ко-мунікації з особами, які здійснюють догляд, під час сесії, оцінювання немовлят передвакцинацією, правильну техніку введення вакцин, а також інструкції щодо закриттясесій і запису даних. Цей модуль також включає контрольний список, який можеслугувати нагадуванням про гарантування безпеки до, під час і після сесій імунізації.У шостому модулі пояснюється, як збирати та повідомляти дані для моніторингу по-слуг з імунізації та епідеміологічного нагляду за вакцинокерованими захворюван-нями та про несприятливі події після імунізації.Сьомий модуль містить інформацію, яка допоможе медичним працівникам і грома-дам у спільній роботі над плануванням, наданням і просуванням послуг, поліпшен-ням якості цих послуг, відстеженням дітей, які підлягають імунізації, та подоланнямопору до імунізації.

Estudio de caso: brote de sarampión en la era poseliminación. Versión para participantes

La pandemia COVID-19 impactó negativamente en los programas de inmunización de rutina y de vigilancia epidemiológica de las enfermedades prevenibles por vacunación. A ello se suma el hecho de que el virus del sarampión continúa circulando en otras regiones del mundo, lo cual pone a la Región de las Américas en permanente riesgo de importación y diseminación del virus, en caso de que no se actúe de forma organizada y veloz. En este sentido, el Programa Especial de Inmunización de la Organización Panamericana de la Salud (OPS) pone a disposición de los Estados Miembros el presente material formativo, bajo la modalidad de estudio de caso, desarrollado a partir de un brote de sarampión que ocurrió en la vida real, aunque en esta versión se han introducido algunos elementos ficticios. El objetivo de este estudio de caso es fortalecer las capacidades nacionales y subnacionales de los países para organizar e implementar una respuesta rápida a un brote de sarampión en la era poseliminación, que permita interrumpir rápidamente la circulación del virus. Esta publicación ha sido concebida para ser empleada en talleres de capacitación presencial, en dos versiones: una para los facilitadores y otra para los participantes. Esta es la versión para los participantes. El estudio de caso concluye con la implementación de un ejercicio de simulación en el que se recrean tres situaciones hipotéticas de brotes de sarampión. Con la simulación se busca que los participantes aprendan a organizarse como un equipo de respuesta rápida, conducir la investigación epidemiológica para el estudio del brote, analizar e interpretar los hallazgos, y diseñar las medidas de respuesta.

Estudio de caso: brote de sarampión en la era poseliminación. Versión para facilitadores

La pandemia COVID-19 impactó negativamente en los programas de inmunización de rutina y de vigilancia epidemiológica de las enfermedades prevenibles por vacunación. A ello se suma el hecho de que el virus del sarampión continúa circulando en otras regiones del mundo, lo cual pone a la Región de las Américas en permanente riesgo de importación y diseminación del virus, en caso de que no se actúe de forma organizada y veloz. En este sentido, el Programa Especial de Inmunización de la Organización Panamericana de la Salud (OPS) pone a disposición de los Estados Miembros el presente material formativo, bajo la modalidad de estudio de caso, desarrollado a partir de un brote de sarampión que ocurrió en la vida real, aunque en esta versión se han introducido algunos elementos ficticios. El objetivo de este estudio de caso es fortalecer las capacidades nacionales y subnacionales de los países para organizar e implementar una respuesta rápida a un brote de sarampión en la era poseliminación, que permita interrumpir rápidamente la circulación del virus. Esta publicación ha sido concebida para ser empleada en talleres de capacitación presencial, en dos versiones: una para los facilitadores y otra para los participantes. Esta versión, entonces, ha sido diseñada para los facilitadores. El estudio de caso concluye con la implementación de un ejercicio de simulación en el que se recrean tres situaciones hipotéticas de brotes de sarampión. Con la simulación se busca que los participantes aprendan a organizarse como un equipo de respuesta rápida, conducir la investigación epidemiológica para el estudio del brote, analizar e interpretar los hallazgos, y diseñar las medidas de respuesta.