Impact of vaccination against Haemophilus influenzae type b with and without a booster dose on meningitis in four South American countries.

To inform World Health Organization recommendations regarding use of Haemophilus influenzae type b (Hib) vaccines in national immunization programs, a multi-country evaluation of trends in Hib meningitis incidence and prevalence of nasopharyngeal Hib carriage was conducted in four South American countries using either a primary, three-dose immunization schedule without a booster dose or with a booster dose in the second year of life. Surveillance data suggest that high coverage of Hib conjugate vaccine sustained low incidence of Hib meningitis and low prevalence of Hib carriage whether or not a booster dose was used.

[The economic costs of pneumonia in children under 2 years of age in Colombia]. / Costos económicos de las neumonías en niños menores de 2 años de edad, en Colombia.

OBJECTIVE: To analyze the costs of pneumonias presumed to be of viral or bacterial origin, as diagnosed by chest X ray, in four reference center hospitals in three cities in Colombia. METHODS: A total of 128 cases of pneumonia (64 bacterial cases and 64 viral cases) that had consecutively entered the hospitals in the study between July 2001 and January 2003 were investigated. The diagnosis of pneumonia was based on chest X rays. The study population was composed of children under 2 years of age who required hospitalization. In order to estimate the costs for bacterial pneumonias and viral pneumonias, the cost of each activity was determined for each case, and then average costs were calculated. RESULTS: The average cost of the presumably bacterial pneumonia cases was US $611.50 (95% confidence interval (95% CI), US $532.20-690.80); that of the presumably viral cases was US $472.20 (95% CI, US $331.80-612.60). The observed differences were due to direct expenses, especially drugs (antibiotics), special services, and diagnostic tests. In the two groups the families were similar in their incomes and the indirect costs that they had to bear, so the indirect costs were not considered relevant in terms of distinguishing between the costs caused by the two forms of pneumonia. CONCLUSIONS: The study found differences in the direct costs of care between the presumably bacterial cases and the presumably viral ones. The study results also gave an approximation of the indirect costs to the patients' families caused by the pneumonias. The differences found in the direct costs also indicate that X-ray diagnosis is useful for differentiating between viral and bacterial pneumonia. Few studies in Latin America have assessed the economic costs of pneumonia in children, so this study can serve as a reference for future research on the impact of interventions against pneumonia.

Effectiveness of Haemophilus influenzae type b vaccination against bacterial pneumonia in Colombia.

AIMS: To assess the effectiveness of a Hib vaccination program against X-ray defined bacterial pneumonia in children <2 years in Colombia. METHODS: 389 cases of radiologically confirmed pneumonia were recruited from hospitals in Bogota and Medellin, Colombia. Two controls per case, matched on age, sex, and socio-economic level, were selected from children attending child health services at the hospitals where pneumonia cases were admitted. RESULTS: The risk of having X-ray confirmed pneumonia decreased with each Hib dose received; the vaccine effectiveness was 47% (2-72%) among those receiving one dose; 52% for two doses received, and 55% for three doses. These effectiveness levels remained after adjusting for other factors associated with risk of pneumonia. CONCLUSIONS: This study indicates that trials may have underestimated the proportion of radiological pneumonia in the under 2s that is due to Hib. This suggests that the impact of the vaccination will be greater than expected if it can be extended to reach the poorest children, who are at the greatest risk.

Criterios diagnosticos y manejo farmacologico de la infeccion de vias urinarias en el Centro de Atencion Ambulatoria (CAA) Central, Seguro Social enero a marzo de 1999 / Diagnostic criteria and pharmacological therapy of urinary infection in Centro Atencion Ambulatoria (CAA) Central, Seguro Social january-march 1999

Las infecciones agudas de las vías urinarias son causa importante de morbilidad, con tendencia a las recidivas y resistencia; el no tratarlas prolonga la sintomatología y puede conducir a sepsis y deterioro de la función renal. Ocupan el segundo lugar entre las enfermedades infecciosas en países occidentales. Poco se conoce de su epidemiología en Colombia. La epidemia de la resistencia bacteriana se acompaña de un aumento en la morbimortalidad de origen infeccioso y de los costos sociales y económicos. La emergencia de resistencia bacteriana se debe enfrentar primordialmente desde la forma como se utilizan los antibióticos. Objetivo: describir los criterios de diagnóstico y la formulación prescrita para el manejo de la infección de vías urinarias en el Centro de Atención Ambulatoria Central del Seguro Social EPS en Bogotá, durante los meses de enero a marzo de 1999. Metodología: estudio descriptivo retrospectivo. Muestreo aleatorio estratificado. Se evaluaron 312 historias clínicas con diagnóstico de infección de vías urinarias.Resultados: el 85.3 por ciento de las infecciones de vías urinarias se clasificaron como altas y 57.1 por ciento como no complicadas. El 53.2 por ciento de los diagnósticos se hizo con base en criterios clínicos. Se prescribió adecuadamente en 9.9 por ciento de los pacientes; la dosis diaria fue adecuada en 57.5 por ciento de los casos. En los diagnosticados mediante urocultivo el microorganismo más frecuente fue la Escherichia coli, 74.1 por ciento. Discusión: se identifican tres aspectos críticos: 1) Un problema de registro que dificulta el estudio y tiene implicaciones de tipo legal y ético en la calidad de la atención para la salud pública. 2) La distribución por localización encontrada contradice el conocimiento actual de la enfermedad, probablemente debido a registro inadecuado. Los errores en la clasificación generan deficiencias en la atención pues ella determina el manejo, el seguimiento y el pronóstico. El diagnóstico mediante criterio clínico lleva a un mayor error en el mismo y expone al paciente a recibir tratamientos innecesarios, aumentando costos y riesgos. 3) El tratamiento inadecuado representa implicaciones individuales y poblacionales, ya sea por el uso exagerado o insuficente del antibiótico. Recomendaciones: desarrollar actividades de educación continuada sobre los tópicos críticos, construir el perfil epidemiológico propio de la institución y desarrollar una política de uso de medicamentos.