RESUMO
Vaccination Week in the Americas (VWA) is an initiative of the countries and territories of the Americas that works to advance equity and access to vaccination. The initiative focuses on reaching populations with limited access to regular health services and promotes solidarity among countries. As the Expanded Program on Immunization is one of the world's best-established health programs, integrating other interventions with immunization services has been highly promoted. Using data available from the Pan American Health Organization, we explored the extent of integration of other interventions with immunization in Latin American and Caribbean (LAC) countries as part of VWA. At least 14 countries or territories have integrated other interventions with immunization during VWA. The most common integrated intervention is vitamin A supplementation, followed by deworming. However, a variety of other interventions have been integrated, such as educational activities, supplementation with vitamins and minerals, and provision of health services. Data on coverage of integrated interventions are limited. Integration of other interventions with immunization in LAC countries is widespread, and its impact and lessons learned merit further examination.
Assuntos
Prestação Integrada de Cuidados de Saúde , Vacinação , Humanos , Organização Pan-Americana da SaúdeRESUMO
BACKGROUND: The Region of the Americas set a goal of interrupting endemic measles virus transmission by the end of 2000. This decision was primarily based on rapid decreases in measles disease burden in pioneering countries that implemented Pan American Health Organization-recommended vaccination and surveillance strategies. Review of these strategies may inform measles elimination efforts in other regions. METHODS: Results from the implementation of the measles elimination strategy in the Americas were compiled and analyzed over a 30-year period, which was divided into 4 phases: the early years of the Expanded Program on Immunization (1980-1986); the start-up phase for elimination (1987-1994); the elimination phase (1995-2002); and the postelimination phase (2003-2010). Factors that contributed to elimination and the challenges confronted during the postelimination phase are discussed. RESULTS: An analysis of vaccination strategies over time highlights the transition from monovalent measles vaccine to the incorporation of measles-mumps-rubella vaccine administered in the routine program. Regional vaccination coverage increased during the period 1987-2010, sustained at ≥90% since 1998. Measles elimination efforts led to the implementation of 157 national vaccination campaigns, vaccinating a total of 440 million persons. Endemic measles virus transmission was interrupted in 2002. After elimination, measles importations and associated outbreaks occurred. Measles incidence has remained at <1 case per 1 million population since 2002. CONCLUSIONS: The success of measles elimination strategies in the Americas suggests that global measles eradication is attainable.
Assuntos
Doenças Endêmicas/prevenção & controle , Saúde Global , Vacina contra Sarampo/administração & dosagem , Sarampo/epidemiologia , Sarampo/prevenção & controle , América/epidemiologia , Genótipo , Humanos , Vírus do Sarampo/classificação , Vírus do Sarampo/genética , Fatores de TempoRESUMO
In 2003, the Pan American Health Organization (PAHO) adopted a resolution calling for rubella and congenital rubella syndrome (CRS) elimination in the Americas by the year 2010. To accomplish this goal, PAHO advanced a rubella and CRS elimination strategy including introduction of rubella-containing vaccines into routine vaccination programs accompanied by high immunization coverage, interruption of rubella transmission through mass vaccination of adolescents and adults, and strengthened surveillance for rubella and CRS. The rubella elimination strategies were aligned with the successful measles elimination strategies. By the end of 2009, all countries routinely vaccinated children against rubella, an estimated 450 million people had been vaccinated against measles and rubella in supplementary immunization activities, and rubella transmission had been interrupted. This article describes how the region eliminated rubella and CRS.
Assuntos
Controle de Doenças Transmissíveis/métodos , Síndrome da Rubéola Congênita/epidemiologia , Síndrome da Rubéola Congênita/prevenção & controle , Vacina contra Rubéola/imunologia , Adolescente , Adulto , América/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Cooperação Internacional , Vacinação em Massa , Vacina contra Rubéola/administração & dosagem , Fatores de TempoRESUMO
In the region of the Americas, goals for the elimination of endemic measles and rubella/congenital rubella syndrome (CRS) by the year 2000 and 2010, respectively were established. The successful implementation of measles elimination strategies in the region of the Americas resulted in the interruption of endemic measles transmission in 2002 and tremendous progress toward rubella and CRS elimination. In October 2007, the 27th Pan American Sanitary Conference adopted Resolution CSP27.R2 urging member states to begin documenting and verifying the interruption of endemic transmission of the measles and rubella viruses in the Americas. To ensure a standardized approach for the process of documentation and verification, the Pan American Health Organization/World Health Organization (PAHO/WHO) developed a regional plan of action to guide countries and their national commissions as they prepare and consolidate evidence of the interruption of endemic measles and rubella transmission. This article summarizes the plan of action including the essential criteria and components of the guidelines.
Assuntos
Documentação/métodos , Documentação/normas , Sarampo/epidemiologia , Sarampo/prevenção & controle , Síndrome da Rubéola Congênita/epidemiologia , Síndrome da Rubéola Congênita/prevenção & controle , América/epidemiologia , Controle de Doenças Transmissíveis , Doenças Endêmicas/prevenção & controle , Humanos , Cooperação InternacionalRESUMO
Countries in the World Health Organization Region of the Americas successfully interrupted endemic measles virus transmission 8 years after setting a regional measles elimination goal and have sustained this achievement since 2002. The vast experience from the region clearly demonstrates that measles elimination can be accomplished and maintained over time. This brief report summarizes the lessons learned and the best practices that evolved in the Americas during 3 measles elimination phases (ie, preelimination, elimination, and postelimination phases), as well as the contribution of rubella elimination to strengthening and maintaining measles elimination. The effective measures that have been implemented and adapted by the countries of the Americas to eliminate endemic measles and rubella will serve as an example to other countries and regions embarking on this endeavor.
Assuntos
Doenças Endêmicas/prevenção & controle , Vacina contra Sarampo , Sarampo/prevenção & controle , Rubéola (Sarampo Alemão)/prevenção & controle , América/epidemiologia , Benchmarking , Humanos , Sarampo/epidemiologia , Vacina contra Sarampo/administração & dosagem , Política , Rubéola (Sarampo Alemão)/epidemiologia , Fatores de TempoAssuntos
Infecções por Haemophilus/prevenção & controle , Vacinas Anti-Haemophilus/administração & dosagem , Haemophilus influenzae tipo b/imunologia , Programas de Imunização , Meningite por Haemophilus/prevenção & controle , Vacinação , América/epidemiologia , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/imunologia , Vacinas Anti-Haemophilus/imunologia , Humanos , Programas de Imunização/economia , Programas de Imunização/estatística & dados numéricos , Meningite por Haemophilus/epidemiologia , Meningite por Haemophilus/imunologia , Organização Pan-Americana da Saúde , Vacinação/economia , Vacinação/estatística & dados numéricosRESUMO
BACKGROUND: Countries in Latin America were among the first developing countries to introduce new vaccines, particularly rotavirus (RV) and pneumococcal conjugate vaccines (PCVs), into their national immunization schedules. Experiences and lessons learned from these countries are valuable to donors, immunization partners, and policy makers in other countries wishing to make informed decisions on vaccine introduction. OBJECTIVES: In order to enhance knowledge and promote understanding of the process of new vaccine introduction in the Latin American Region, with particular focus on RV and PCV, we conducted a systematic qualitative assessment. We evaluated the decision-making process, documented the structure in place, and reviewed key factors pertaining to new vaccine introduction. These include country morbidity and mortality data available prior to vaccine introduction, funding sources and mechanisms for vaccine introduction, challenges of implementation, and assessment of vaccine impact. METHODS: From March 2010 to April 2011, we evaluated a subset of countries that had introduced RV and/or PCV in the past five years through interviews with key informants at the country level and through a systematic review of published data, gray literature, official technical documents, and country-specific health indicators. Countries evaluated were Bolivia, Brazil, Nicaragua, Peru, and Venezuela. RESULTS: In all countries, the potential of new vaccines to reduce mortality, as established by Millennium Development Goal 4, was an important consideration leading to vaccine introduction. Several factors-the availability of funds, the existence of sufficient evidence for vaccine introduction, and the feasibility of sustainable financing-were identified as crucial components of the decision-making process in the countries evaluated. CONCLUSIONS: The decision making process regarding new vaccine introduction in the countries evaluated does not follow a systematic approach. Nonetheless, existing evidence on efficacy, potential impact, and cost-effectiveness of vaccine introduction, even if not local data, was important in the decision making process for vaccine introduction.
Assuntos
Tomada de Decisões Gerenciais , Documentação , Programas de Imunização , Bolívia , Brasil , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Política de Saúde , Humanos , Programas de Imunização/economia , Nicarágua , Organização Pan-Americana da Saúde , Peru , Vacinas Pneumocócicas , Vigilância em Saúde Pública , Vacinas contra Rotavirus , Vacinas Conjugadas , VenezuelaRESUMO
Para comprender el proceso de reforma del sector salud en el Ecuador, es necesario partir del marco normativo e ideológico sobre el cual se basa la transformación sanitaria de la última década. A partir del año 2008 Ecuador reconoce en su Constitución el derecho a la salud con una visión sistémica, vinculándolo con el ejercicio de otros derechos. La Carta Magna del 2008 establece al Estado como garante del derecho a la salud a través de la formulación de políticas, planes y programas orientados a brindar acceso a servicios de promoción y atención integral bajo los principios de equidad, universalidad, solidaridad, interculturalidad, calidad, eficiencia, eficacia, precaución y bioética, con enfoque de género y generacional (1). De este modo, el mandato constitucional determina la necesidad de iniciar el proceso de reforma y define el ámbito en el cual se conduciría dicho proceso para lograr que el Estado cumpla con las nuevas obligaciones establecidas en la Constitución [...] El sistema de salud ecuatoriano sin duda se ha fortalecido con el profundo y ambicioso proceso de reforma, el cual ha sido posible gracias a un apoyo político explícito y sostenido, expresado en la priorización de la salud como un derecho de todos y de todas. No obstante, existen grandes retos aún pendientes, entre los cuales se destacan la implementación de un modelo de financiamiento sostenible con un fondo mancomunado para el sistema público, que permita una mayor eficiencia en el gasto en salud y garantice la sostenibilidad del sistema en el mediano plazo; el fortalecimiento de la vigilancia epidemiológica y del sistema de información en salud, a fin de detectar de manera temprana y oportuna los brotes epidémicos y las enfermedades crónicas no transmisibles evitando que éstas se transformen en enfermedades catastróficas; la consolidación de las estrategias de prevención y control –las cuales requieren fortalecerse en el marco del proceso de reforma–; la implementación del MAIS y su materialización en rutinas de atención para los enfermos agudos pero sobre todo para los portadores de enfermedades crónicas no transmisibles, a fin de asegurar la continuidad de los cuidados; y la construcción efectiva de redes integradas de provisión de servicios de salud con mecanismos estables y eficientes de referencia y contrarreferencia. Estas son las tareas a abordar en el futuro inmediato como parte de la consolidación de la reforma sanitaria, y como parte de la ruta del sistema de salud ecuatoriano hacia la salud universal.
Assuntos
Equador , Reforma dos Serviços de Saúde , Cobertura de Serviços de Saúde , Política de SaúdeRESUMO
BACKGROUND: Two effective and safe rotavirus vaccines became available in 2006 and have been recommended for use in all countries by the World Health Organization. This article provides an update on the use of rotavirus vaccine in Latin American and Caribbean (LAC) countries. METHODS: Data reported by LAC countries to the Pan American Health Organization (PAHO) were reviewed. RESULTS: As of May 2010, 14 LAC countries and 1 territory have introduced the rotavirus vaccine into their national expanded program on immunization (EPI). Reported coverage levels for rotavirus vaccine are lower than those for other EPI vaccines recommended at the same age. A total of 15 LAC countries are part of the PAHO's LAC rotavirus surveillance network; 12 of them are using the vaccine. LAC countries are conducting several studies on rotavirus vaccine effectiveness, cost-effectiveness, and monitoring safety. Also, LAC countries are generating lessons learned on the public health implications of introducing a new vaccine into the EPI. Nine countries and the Cayman Islands pay for the entire cost of the vaccine using government funds. All but 2 countries purchase their rotavirus vaccine through PAHO's Revolving Fund. CONCLUSIONS: Rotavirus vaccine introduction in LAC has been faster than for other new vaccines, but coverage levels need to increase to maximize the effect of the intervention. Rotavirus surveillance needs to expand and be strengthened to better assess the effect of vaccine use. LAC countries will continue to provide useful data to monitor rotavirus trends and vaccine effect.
Assuntos
Vacinas contra Rotavirus/administração & dosagem , Vacinação/estatística & dados numéricos , Vacinação/tendências , Região do Caribe , Pré-Escolar , Análise Custo-Benefício , Humanos , Lactente , América Latina , Vacinas contra Rotavirus/efeitos adversos , Vacinas contra Rotavirus/economia , Vacinação/efeitos adversos , Vacinação/economiaRESUMO
The child mortality rate has been greatly reduced in Latin America and the Caribbean (LAC). More than half of the gains in reducing child mortality are attributable to immunization. The Revolving Fund of the Pan American Health Organization contributed to this achievement by catalyzing policy innovations that sustained national immunization programs, such as vaccine legislation and budgetary decrees to ensure delivery of services. In addition to measuring the impact of immunization on the child mortality reduction target of the Millennium Development Goals in the LAC region, this paper provides a policy framework to ensure that the rest of the target is reached.
Assuntos
Política de Saúde , Programas de Imunização , Região do Caribe/epidemiologia , Países em Desenvolvimento , Feminino , Prioridades em Saúde , Humanos , Programas de Imunização/estatística & dados numéricos , Programas de Imunização/tendências , Lactente , Recém-Nascido , América Latina/epidemiologia , Masculino , Sarampo/epidemiologia , Sarampo/prevenção & controle , Objetivos Organizacionais , Tétano/epidemiologia , Tétano/prevenção & controle , Coqueluche/epidemiologia , Coqueluche/prevenção & controleRESUMO
Since 1994, when the goal of interrupting indigenous measles transmission was adopted, important progress has been made toward the control of measles in the Americas. Thirty-nine (95%) of 41 countries reporting to the Pan American Health Organization (PAHO) conducted catch-up vaccination campaigns during 1989-1995 and follow-up measles campaigns every 4 years. Routine (keep-up) vaccination coverage in the Region increased from 80% in 1994 to 94% in 2000. Measles vaccination coverage ranged between 75% and 99% in 2000 and between 53% and 99% in 2001. As a result, in 2001, the total number of confirmed measles cases reached a record low of 537, 99% lower than the number reported in 1990. In 2002, only Venezuela and Colombia had known indigenous transmission. As of January 2003, no known indigenous measles transmission had occurred in the Region since November 2002. This is due to high political commitment and implementation of PAHO's recommendations, including strengthened supervision and monitoring to improve accountability at the local level.
Assuntos
Programas de Imunização/métodos , Sarampo/epidemiologia , Sarampo/prevenção & controle , Adolescente , América/epidemiologia , Criança , Pré-Escolar , Humanos , Programas de Imunização/normas , Incidência , Lactente , Vacina contra Sarampo/administração & dosagem , Vírus do Sarampo/crescimento & desenvolvimento , Organização Pan-Americana da Saúde , Vigilância da PopulaçãoRESUMO
BACKGROUND: In 1994, the Americas set a goal of interrupting indigenous measles transmission from the Western Hemisphere by 2000. To accomplish this goal, the Pan American Health Organization (PAHO) developed an enhanced measles vaccination strategy. METHODS: Cost data was collected at PAHO for Latin American and Caribbean (LAC) countries covering 96% of the region's population on components of the routine programs, and the 'follow-up' activities from member countries. In order to interpret our findings we have compared the present scenario regarding measles with one that would have ensued if past trends continued. RESULTS: For the entire LAC population, estimated cost of elimination program will be US$ 571 million in present value terms. INTERPRETATION: The vaccination strategy toward achieving elimination of measles costs USD 244 million, incremental from the cost of vaccination before the elimination program. Within 2000-2020, the current program will have prevented the occurrence of 3.2 million cases of measles and 16,000 deaths. Thus, vaccination strategy prevents a single case of measles at the cost of USD 71.75 and prevents a death due to measles at the cost of USD 15,000. The case fatality rate depends on a well functioning treatment program for measles cases. The vaccination strategy saves a total of USD 208 million in treatments costs due to reduced incidence of measles.
Assuntos
Vacina contra Sarampo/economia , Sarampo/prevenção & controle , Vacinação/economia , Adolescente , Região do Caribe , Criança , Pré-Escolar , Análise Custo-Benefício , Humanos , Lactente , América Latina , Sarampo/economia , Sarampo/imunologia , Estudos ProspectivosRESUMO
Data from the regional measles surveillance system have documented widespread rubella virus circulation in many different countries in the Americas. In response to the ongoing endemic incidence of the disease and the potential for a major rubella epidemics in the region, the Pan American Health Organization Technical Advisory Group on Vaccine Preventable Diseases recommended the implementation of a regional initiative to strengthen rubella and congenital rubella syndrome (CRS) preventive efforts in 1997. This article summarizes and highlights the progress toward accelerated rubella control and CRS prevention in the English-speaking Caribbean and in Chile, Costa Rica, and Brazil. Useful knowledge is being generated for the adaptation of similar rubella strategies elsewhere. The findings also document the feasibility of implementing the recommended strategies and their rapid impact on disease burden.
Assuntos
Programas de Imunização/métodos , Complicações Infecciosas na Gravidez/prevenção & controle , Síndrome da Rubéola Congênita/prevenção & controle , Vacina contra Rubéola/administração & dosagem , Rubéola (Sarampo Alemão)/prevenção & controle , Adulto , Brasil/epidemiologia , Região do Caribe/epidemiologia , Pré-Escolar , Chile/epidemiologia , Costa Rica/epidemiologia , Feminino , Humanos , Programas de Imunização/normas , Incidência , Lactente , Organização Pan-Americana da Saúde , Vigilância da População , Gravidez , Síndrome da Rubéola Congênita/diagnóstico , Síndrome da Rubéola Congênita/epidemiologia , Vírus da RubéolaRESUMO
The purpose of this paper is to discuss methods recommended and used by the Pan American Health Organization (PAHO) to monitor the interruption of indigenous measles transmission in the Region of the Americas. The methods used include house-to-house monitoring of vaccination coverage as a supervisory tool during both campaigns and routine vaccination; thoroughly investigating all measles outbreaks; performing routine surveillance, including weekly reporting from at least 80% of reporting units; and validating routine surveillance through active-case searches at health care institutions and schools and in the community. The strategies described have helped PAHO to increase the authority and accountability of vaccine program managers at the local, provincial, and national levels. Their efforts have permitted the Region of the Americas to reduce to three the number of countries with indigenous measles transmission and to reach a record low of 503 measles cases in 2001.
Assuntos
Vacinação em Massa/métodos , Sarampo/prevenção & controle , Vigilância da População/métodos , América/epidemiologia , Guias como Assunto , Humanos , Incidência , Vacinação em Massa/normas , Sarampo/epidemiologia , Vacina contra Sarampo/administração & dosagem , Organização Pan-Americana da SaúdeRESUMO
An outbreak of paralytic poliomyelitis occurred in the Dominican Republic (13 confirmed cases) and Haiti (8 confirmed cases, including 2 fatal cases) during 2000-2001. All but one of the patients were either unvaccinated or incompletely vaccinated children, and cases occurred in communities with very low (7 to 40%) rates of coverage with oral poliovirus vaccine (OPV). The outbreak was associated with the circulation of a derivative of the type 1 OPV strain, probably originating from a single OPV dose given in 1998-1999. The vaccine-derived poliovirus associated with the outbreak had biological properties indistinguishable from those of wild poliovirus.