Inmunización en las Américas. Resumen 2021

Los países de las Américas, con apoyo de la Organización Panamericana de la Salud (OPS), han logrado avances notables al proporcionar a los niños y las niñas una protección general contra las enfermedades prevenibles mediante vacunación. Los niveles sostenidos de elevadas coberturas nacionales de vacunación, la erradicación de la poliomielitis, la interrupción de la transmisión endémica del virus del sarampión y las iniciativas más recientes en favor de la eliminación de la rubéola y el síndrome de rubéola congénita son hitos continentales de este progreso. En la actualidad, los países administran vacunas a grupos etarios distintos de los incluidos en los programas tradicionales de inmunización infantil. La introducción de la vacuna estacional contra la gripe en los adultos en riesgo; la vacunación de adolescentes y adultos, hombres y mujeres, para la eliminación de la rubéola, y la definición de la carga de enfermedad del cáncer cervicouterino son las actividades que apoyan la necesidad fundamental de efectuar una transición de los programas nacionales de inmunización infantil a programas de inmunización de la familia. Una de las funciones de la OPS en su apoyo a los países es difundir información que destaque el progreso de la Región y los desafíos que enfrenta. Con ese fin, publica varios documentos técnicos relacionados con la inmunización, tales como los boletines de inmunización, los módulos de capacitación en inmunización y la serie de guías prácticas sobre rubéola, sarampión, tétanos neonatal, poliomielitis, vacuna pentavalente y fiebre amarilla.

Inmunización en las Américas. Resumen 2020

Los países de la Región de las Américas, con el apoyo de la Organización Panamericana de la Salud (OPS), han logrado avances notables en la protección general de los niños y las niñas contra las enfermedades prevenibles mediante vacunación básicas. Los niveles sostenidos de altas coberturas de vacunación a nivel nacional, la erradicación de la poliomielitis, la interrupción de transmisión endémica del virus del sarampión y las iniciativas más recientes en aras de la eliminación de la rubéola y del síndrome de rubéola congénita se cuentan entre los hitos continentales de este progreso. Asimismo, la vacunación abarca ahora a grupos de edad más amplios que los reflejados en los programas tradiciconales de inmunización infantil, lo que pone de manifiesto la necesidad fundamental de pasar de un modelo basado en los programas nacionales de inmunización infantil a un modelo centrado en los programas de inmunización de la familia. En el contexto actual de la pandemia de COVID-19, los países de la Región han puesto en marcha medidas de calado para aplicar estrategias innovadoras y para mantener el elevado compromiso de los trabajadores de salud en los programas naciconales de inmunización. Si bien estas estrategias han mejorado el acceso a los servicios, la pandemia y las políticas de confinamiento han mermado la demanda de servicios de vacunación. Una de las funciones de la OPS en su apoyo a países es difundir información que destaca el progreso y los desafíos enfrentados en la Región. Este folleto destaca algunos de los logros y retos en materia de inmunización y resume los datos regionales más relevantes de 2020 en la Región de las Américas.

Salud hoy, Febrero 2018 

[Editorial], La principal estrategia en el control de la malaria es el diagnóstico y tratamiento completo. En ese sentido, las Pautas de tratamiento en Casos de Malaria y los flujogramas —resultado del trabajo conjunto entre el MPPS, sociedades científicas y OPS/OMS—, ya difundidos a las redes de salud, buscan un correcto manejo de los casos de malaria para evitar complicaciones y muertes. El reto principal sigue siendo la disponibilidad de medicamentos en los establecimientos de salud en zonas de transmisión de malaria. La capacitación a los trabajadores de salud en el manejo de la malaria grave será un prioridad, así como apoyar la gestión de compras de medicamentos que realiza el MPPS vía el Fondo Estratégico de la OPS. Por su parte, el brote de difteria continua activo en Venezuela, desde que se confirmaran los primeros casos en junio de 2016. En diciembre pasado se publicó la última actualización de difteria en la región, reportándose casos confirmados en Brasil, Haití y la República Dominicana. Venezuela reportó a la OPS/OMS a través del Centro Nacional de Enlace (CNE) del MPPS, y hasta la SE 48 -2017, un total de 933 casos probables, de los cuales 227 fueron confirmados. La difteria es una enfermedad bacteriana, aguda, grave y que lamentablemente produce defunciones. En el año 2016, un comité de expertos, externos a la OPS, certificó que la región de las Américas había logrado eliminar el sarampión, luego de más de 20 años de esfuerzos conjuntos de todos los países, como la Semana de Vacunación de Las Américas, donde se hacen campañas para alcanzar las coberturas de vacunación a nuestras poblaciones. Cuando una región como nuestro continente alcanza este logro considerable se debe asegurar, aún más, que los esfuerzos de vacunación continúen de igual forma, para lo cual el Fondo Rotatorio de la OPS, creado hace 40 años, garantiza la disponibilidad de vacunas a todos los países, previa planificación de necesidades. Pero mientras en otras regiones del mundo persista la transmisión de sarampión, y si las coberturas de vacunación no son mayores a 95 %, la probabilidad del ingreso de un caso importando y que genere trasmisión local, es muy alto. Y eso fue lo que ocurrió en Venezuela. El primer caso se notificó en Bolívar en julio pasado y, según la actualización epidemiológica del sarampión, difundida por la OPS el 6 de febrero de 2018, el MPPS ha reportado un total de 1.703 casos sospechosos, 952 de los cuales fueron confirmados por técnicas de laboratorio y se ha registrado transmisión en nueve estados. Los estudios genéticos confirmaron que la cepa procede de otro continente, donde existe transmisión, como en Europa que ha registrado entre noviembre de 2016 y diciembre de 2017 un total de 17.584 casos. Frente a los desafíos que enfrenta la salud pública en el país, la OPS/OMS reitera su compromiso de apoyo al MPPS en su tarea de control y, muy especialmente a la población venezolana. Para poder detener la transmisión de difteria y sarampión, solo queda vacunar, seguir vacunando de manera permanente, en puestos fijos, en las escuelas y casa por casa. Debemos redoblar este esfuerzo a nivel nacional y con la participación de todos los actores comunitarios. Durante 2017, Venezuela adquirió cerca de 9 millones de dosis de DPT y dT, vacunas que protegen contra la difteria, el tétanos y la tos convulsiva y, en setiembre pasado, la OPS incrementó el crédito del Fondo Rotatorio para que el país disponga de más de 6 millones de dosis de SRP y SR, vacunas contra el sarampión, la rubeola y la parotiditis. Vacunar a la población objetivo, tratar los casos adecuadamente, tratar lo contactos, hacer control del foco, del barrio, allí donde se detectan los casos, investigar, notificar y analizar la información, son las tareas que nos corresponden a los trabajadores de salud y para eso debemos contar con el apoyo de los padres, madres de familia, los profesores y la comunidad.

What is the importance of vaccine hesitancy in the drop of vaccination coverage in Brazil? / Qual a importância da hesitação vacinal na queda das coberturas vacinais no Brasil?

ABSTRACT The successful Programa Nacional de Imunizações do Brasil (Brazilian National Immunization Program) has been experiencing a major challenge with regard to vaccination coverage for children, which has been dropping. Several aspects are related, but certainly vaccine hesitancy has been strengthening itself as one of the main concerns of Brazilian public administrators and researchers. Vaccine hesitancy is the delay in acceptance or refusal despite having the recommended vaccines available in health services, being a phenomenon that varies over time, over location and over types of vaccines. Hesitant individuals are between the two poles of total acceptance and refusal of vaccination. Vaccine hesitancy is nothing new in European and North-American countries, and even in Brazil, it has been studied even if under another name. The drop of vaccination coverage observed from 2016 on reiterates the relevance of the theme, which must be better understood through scientific research.

RESUMO O exitoso Programa Nacional de Imunizações do Brasil tem vivenciado grande desafio com relação às coberturas vacinais infantis, que têm apresentado queda. Diversos aspectos estão relacionados, mas certamente a hesitação vacinal vem se fortalecendo como uma das principais preocupações dos gestores e pesquisadores brasileiros. Hesitação vacinal é o atraso em aceitar ou a recusa das vacinas recomendadas quando elas estão disponíveis nos serviços de saúde, sendo um fenômeno que varia ao longo do tempo, do local e dos tipos de vacinas. Indivíduos hesitantes situam-se entre os dois polos de aceitação e recusa total da vacinação. A hesitação vacinal não é novidade em países europeus e norte-americanos e, mesmo no Brasil, ela já vem sendo estudada ainda que sob outra denominação. A queda das coberturas vacinais observadas a partir de 2016 reitera a relevância do tema, que deve ser mais bem compreendido por meio de investigações científicas.

Salud hoy, Noviembre 2017 

En la sexta edición de "Salud hoy", boletín digital de la Representación de la OPS/OMS para Venezuela, Aruba, Curazao, Sint Maarten y los Territorios Insulares del Reino de Holanda encontrará contenido sobre Malaria, Brote de sarampión y difteria en Venezuela, medicamentos para la lucha antimalárica en Venezuela Estrategias en para reducir morbilidad grave, mortalidad materna y perinatal desde un enfoque de curso de vida.

Incidência de episódios hipotônicos-hiporresponsivos associados à vacina combinada DTP/Hib usada no Programa Nacional de Imunizações / Incidence of hypotonic-hyporesponsive episodes associated to the combined DTP/Hib vaccine used in Brazilian National Immunizations Program

OBJETIVO: Avaliar a segurança da vacina combinada de difteria-tétano-coqueluche de células inteiras e Haemophilus influenzae tipo b usada no Programa Nacional de Imunizações, e em especial a incidência de episódios hipotônicos-hiporresponsivos. MÉTODO: Acompanhamento de uma coorte de 21.064 lactentes (20.925 ou 99,7 por cento aderiram ao protocolo de estudo), nas 48 horas após a aplicação da vacina de difteria, tétano, coqueluche de células inteiras e Haemophilus influenzae tipo b em centros de saúde na cidade do Rio de Janeiro, para determinar e investigar eventos adversos graves, espontâneos e solicitados. Cada criança foi monitorada durante somente uma dose. RESULTADOS: A incidência de episódios hipotônicos-hiporresponsivos foi de 1:1.744 doses (casos confirmados) e de 1:1.495 doses (casos confirmados mais casos suspeitos). A taxa de incidência de convulsões foi de 1:5.231 doses. Não foram detectados casos de apnéia. Esses resultados são comparáveis àqueles relatados na literatura para a vacina contra difteria-tétano-coqueluche de células inteiras. CONCLUSÃO: A vacina contra difteria, tétano, coqueluche de células inteiras e Haemophilus influenzae tipo b em estudo pode ser usada com segurança no Programa Nacional de Imunizações, de acordo com as precauções e contra-indicações correntes.

OBJECTIVE:To evaluate the safety of a combined diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine used on the Brazilian National Immunizations Program, chiefly the incidence of hypotonic-hyporesponsive episodes. METHOD: Follow-up of a cohort of 21,064 infants (20,925 or 99.7 percent adhered to the study protocol), within 48 hours of vaccination with diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine in health care units in the City of Rio de Janeiro, to ascertain and investigate spontaneous and solicited severe adverse events. Each child was followed-up for one dose only. RESULTS: The rate of hypotonic-hyporesponsive episodes was 1/1,744 doses (confirmed cases) and 1/1,495 doses (confirmed plus suspect cases). The rate of convulsions was 1/5,231 doses. No cases of apnea were detected. These results are comparable to those found in the literature with diphtheria-tetanus-whole cell pertussis vaccine. CONCLUSION: The diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine under study can be safely used in the National Immunizations Program, according to the current precautions and contraindications.

Vaccine-preventable diseases and immunization programme : programme report and future initiatives 2001-2005

Vaccine-preventable diseases remain an important cause of avoidable disease morbidity and mortality among children the WHO European Region. Although immunization programmes in Member States have been integral parts of their public health services, the success of these programmes has led to the perception that continued strong support might not be necessary to maintain their strength. The challenges facing immunization programmes in the Region include: 1) access to vulnerable groups of children, who may have very little contact with primary health care services; 2) changes to primary health care services in many countries that can affect who delivers vaccines and the reimbursement for this service; 3) availability of underused vaccines against additional diseases, which can further improve the health status of children but for which national policy makers require detailed cost justification; and 4) frequent appearance of messages by groups opposed to vaccination that are effectively communicated through the media and the internet. The Vaccine-Preventable Diseases and Immunization programme (VPI), of the WHO European Region, has developed a number of important initiatives to support Member States to strengthen their immunization programmes and these are described in this report, as well as the progress that has been achieved to date

Sub-regional meeting of national immunization programme managers (Central and Eastern Europe, Turkey and NIS) : report on a WHO meeting, Vienna, Austria 26-28 February 2002

The purpose of the meeting was to brief national immunization programme managers on immunization activities in the WHO European Region and to introduce the plan of action for 2002-2003. Participants received information on global, regional and selected national immunization programmes; measles surveillance and supplementary immunization activities; the introduction of new vaccines and the Global Alliance for Vaccines and Immunization (GAVI); and activities leading up to the declaration of the Region as poliomyelitis-free. The participants formulated recommendations to European countries and WHO on future strengthening of immunization systems, including the surveillance of vaccine-preventable diseases; vaccine management and safety of immunization; measles elimination; and the prevention of congenital rubella infection. They also asked WHO to continue the development of immunization policy; to be an advocate with the governments of participating Member States to provide appropriate financial support to immunization programmes as a priority within primary health care delivery; to promote and provide technical support towards the development and implementation of policies for ensuring safety of injections related to immunization, use of quality vaccines and cold chain management; and to finalize the Strategic plan for measles and congenital rubella infection in the European Region of WHO, 2002-2007, including technical supporting documents

Informe Programa Ampliado de Inmunización, Segunda Generación / Report Expandend Program on Inmunization, Second Generation

El objetivo es hacer notar que la circulación del virus es fundamental el sostenimiento de la vacunación regular en forma homogénea,investigar en forma completa y oportuna todos los casos sospechosos reportados,mantener un adecuado stock de vacunas e insumos en forma permanente,ya que el desabastecimiento de vacunas fue un factor preponderante para la extensión de la epidemia en el país.(au)

Atualização do Programa Estadual de Imunização - 1999 / São Paulo State Program of Immunization - 1999

A Secretaria de Saúde do Estado de Säo Paulo, através de seus diversos órgäos de assessoria, estabelece novas normas de vacinaçäo que os autores atualizam, salientando-se a implantaçäo da vacinaçäo contra a hepatite B dos menores de um ano. Neste artigo de revisäo säo apresentadas as normas atualizadas, incluindo agentes imunizantes, pessoas a serem imunizadas, associaçäo de vacinas, situaçöes especiais, eventos adversos pós-imunizaçäo, bem como o Calendário de Vacinaçäo até os seis anos e acima dessa idade. Os detalhes de vacinaçäo para tuberculose, hepatite B, difteria, coqueluche e tétano, poliomielite, sarampo, caxumba e rubeóla, além de febre amarela e raiva, säo também apresentados detalhadamente

Coberturas de inmunizaciones Perú 1997 / Immunizations cover Peru 1997

Contiene: 1. Serie histórica de coberturas de vacunación en menores de un año en los últimos diez años; 2. Dosis aplicadas y coberturas por tipo de biológico, según región, sub-región y provincia; 3. Dosis y cobertura de antisarampión; 4. Dosis aplicadas de Toxoide tetánico en distrito de riesgo; 5. Coberturas y dosis aplicadas de vacuna antihepatitis B en zonas de alta, mediana endemicidad y silentes; 6. Coberturas alcanzadas con vacuna antiamarílica en zonas de riesgo y silentes; 7. Población estimada por grupos de edad a nivel provincial

Expanded Programme on Immunization : report on the seventh WHO meeting of national programmes managers, Berlin 10-12 November 1997

The purposes of the Meeting were to introduce the European health for all policy for the twenty-first century, to discuss measles elimination, to advocate the strengthening of disease surveillance and development of laboratory networks, to present cost-benefit analysis models as tools for decision-makers, to discuss the systems of reporting on diseases covered by the WHO Expanded Programme on Immunization (EPI) and to present progress on poliomyelitis eradication/certification and diphtheria control. Essential components of a measles elimination plan for the WHO European Region were presented and the national programme managers endorsed the previous recommendation of the EPI European Advisory Group, that the elimination strategy, based on identification of susceptibility, was the most appropriate approach for the Region. Countries would need to categorize the control achieved through their current measles strategies, make appropriate analyses to estimate susceptibility and identify the appropriate way forward. The national programme managers agreed that continued efforts were needed to improve surveillance, especially for poliomyelitis, measles, hepatitis B and diphtheria. They acknowledged the progress towards poliomyelitis elimination, recognized the obstacles and reviewed the certification process

European Advisory Group on the Expanded Programme on Immunization : report on the 12th meeting, Copenhagen, Denmark, 21 November 1996

At its twelfth meeting, the European Advisory Group (EAG) confirmed that the first priority for measles control was the achievement of high coverage with a single dose of vaccine, though this would not serve to eliminate the disease. The interruption of transmission needed to be maintained, and this could be achieved with supplementary vaccination, either through repeated campaigns or by the administration of second doses. Whichever approach was used, it was essential that the reaccumulation of susceptibles was prevented. The EAG endorsed the importance of achieving very high coverage of primary immunization with DTP vaccine. This should be completed before six months of age. The first booster could be given at 16-36 months of age, with another (DT) before school entry and a third (Td) on leaving school. This recommendation applied to all European countries. In a number of countries, especially those presently experiencing or having recently experienced epidemic diphtheria, a further booster should be given during the school years. Where the risk of diphtheria was considered high, periodic booster doses for adults would be necessary to prevent resurgence of the disease as immunity waned. On poliomyelitis, the EAG noted the significant impact of Operation MECACAR and the increasing awareness that remaining outbreaks of poliomyelitis in the Region had often followed importation of the disease. The EAG endorsed the plan of action for 1997 proposed by the Regional Office. In countries where poliomyelitis was still endemic or had become nonendemic within the past three years, the surveillance of acute flaccid paralysis (AFP) remained the recommended form of surveillance, especially for certification purposes. However, in countries where polioviruses had not been detected for many years, and AFP surveillance was not appropriate, other means of surveillance would need to be used. The EAG recommended that the Regional Office commission a position paper to review the options for laboratory-based or other surveillance techniques, so that appropriate guidelines could be issued

Expanded Programme on Immunization : report on the sixth Meeting of National Programme Managers, Veyrier du Lac France, 23-26 October 1995

Previously controlled infectious diseases, notably diphtheria and poliomyelitis, are re-emerging in part of the WHO European Region. Epidemic control efforts have been only partially successful, and the Region is now falling behind some other WHO regions in the control of vaccine-preventable infections. The main aims of the Sixth Meeting of European National Programme Managers on the Expanded Programme on Immunization (EPI) were to accelerate progress towards full implementation of national vaccine programmes and to review diphtheria and poliomyelitis control activities. Substantial progress towards poliomyelitis control has been made through Operation MECACAR. In contrast, the diphtheria epidemic in the NIS of the former USSR continues to grow; substantial efforts and resources are now required to bring it under control. Some countries are now implementing hepatitis B and Haemophilus influenzae type b vaccines in the EPI schedule. The strengthening of surveillance systems for vaccine-preventable infections is a high priority for all countries

Expanded programme on immunization : report on the 11th meeting of the European Advisory Group, Paris, France 4-6 March 1996

The 11th meeting of the European Advisory Group (EAG) was held in Paris from 4 to 6 March 1996. The EAG reviewed its role, function and membership and identified the following priorities: to review the progress and define the constraints of immunization programmes; to recommend approaches for strategies and modifications based on new scientific and practical findings; to advise the Regional office and the Interagency Immunization Coordinating Committee (IICC) on priority areas for action and on matters of special importance for submission to the Regional Committee. The EAG also examined opportunities for its recommendations to be made available widely

Programa Nacional de imunizaçöes - 20 anos / Nacional Program of Immunizations - 20 years

O Programa Nacional de Imunizaçôes(PNI) foi formulado em 1973, pode determinaçäo do Ministro da Saúde, como parte de um conjunto de medidadas que se destinavam a redirecionar a atuaçäo governamental no setor. A proposta básica para o programa, constante de documento elaborado por técnicos do Departamento Nacional de Profilaxia e Controle de Doenças(Ministério da Saúde) e da Central de Medicamentos (CEME- Presidência da República), foi aprovada em reuniäo realizada em Brasília, no dia 18 de setembro de 1973, presidida pelo próprio Ministro e que contou com a participaçäo de renomados sanitaristas e infectologistas, bem como de representantes de diversas instituiçôes. A institucionalizaçäo do PNI foi resultante de um somatório de fatores, de âmbito nacional e internacional, que convergiam para estimular e expandir a utilizaçäo de agentes imunizantes no País

Estudo da morbidade e da mortalidade por difteria na cidade do Recife, de 1973 a 1982 por grupos de idade / Morbidity and mortality due to diphteria in the city of Recife, from 1973 to 1982, by age groups

Estuda-se a evoluçäo da morbidade e da mortalidade por difteria, distribuídos por grupos de idade, na cidade do Recife, no período de 1973-82. Säo utilizados para análise, dados fornecidos pelas Diretorias de Informática e de Epidemiologia da Secretaria de Saúde do Estado de Pernambuco/Fundaçäo de Saúde Amaury de Medeiros. A distribuiçäo etária apresentada é a existente na Instituiçäo: menores de 1 ano, 1 a 4 anos e 5 a 14 anos. Observa-se que a incidência näo apresenta maiores modificaçöes. Os valores da equaçäo da linha reta mostram o comportamento no período. Os dados referentes à cobertura vacinal evidenciam uma utilizaçäo inadequada deste recurso. A queda da mortalidade observada no período deve-se a uma reduçäo na letalidade verificada principalmente em crianças de 1 a 4 e 5 a 14 anos. Esta reduçäo pode traduzir uma melhor assistência ao doente