RESUMEN
Deployment of oral cholera vaccine (OCV) on the Island of Hispaniola has been considered since the emergence of the disease in October of 2010. At that time, emergency response focused on the time-tested measures of treatment to prevent deaths and sanitation to diminish transmission. Use of the limited amount of vaccine available in the global market was recommended for demonstration activities, which were carried out in 2012. As transmission continues, vaccination was recommended in Haiti as one component of a comprehensive initiative supported by an international coalition to eliminate cholera on the Island of Hispaniola. Leveraging its delivery to strengthen other cholera prevention measures and immunization services, a phased OCV introduction is pursued in accordance with global vaccine supply. Not mutually exclusive or sequential deployment options include routine immunization for children over the age of 1 year and campaigns in vulnerable metropolitan areas or rural areas with limited access to health services.
Asunto(s)
Vacunas contra el Cólera/inmunología , Cólera/prevención & control , Política de Salud/legislación & jurisprudencia , Vacunación/legislación & jurisprudencia , Administración Oral , Vacunas contra el Cólera/administración & dosificación , Brotes de Enfermedades/prevención & control , República Dominicana/epidemiología , Haití/epidemiología , Humanos , Organización Mundial de la SaludRESUMEN
The burden of pneumococcal disease in Latin America is most pronounced in children aged <6 years. The increasing rate of resistance of Streptococcus pneumoniae to penicillin and other antibiotics has generated concern among health authorities, since infection by antibiotic-resistant serotypes may be associated with increased mortality. Increased resistance is due to a number of factors including high antibiotic usage in this region. Vaccination with pneumococcal conjugate vaccines offers an effective approach to counter resistant disease due to covered serotypes. Existing surveillance systems must be continued to recognise changes in patterns of resistance and the serotypes that cause pneumococcal disease.
Asunto(s)
Infecciones Neumocócicas/epidemiología , Niño , Preescolar , Farmacorresistencia Bacteriana , Humanos , Lactante , América Latina/epidemiología , Pruebas de Sensibilidad Microbiana , Penicilinas/farmacología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/administración & dosificación , Vigilancia de la Población , Factores de Riesgo , Streptococcus pneumoniae/efectos de los fármacos , Vacunas Conjugadas/administración & dosificaciónRESUMEN
OBJECTIVE: To conduct a comprehensive review of data on pneumococcal disease incidence in Latin America and the Caribbean and project the annual number of pneumococcal disease episodes and deaths among children < 5 years of age in the region. METHODS: We carried out a systematic review (1990 to 2006) on the burden of pneumococcal disease in children < 5 years of age in the region. We summarized annual incidence rates and case fatality ratios using medians and interquartile ranges for invasive pneumococcal disease (IPD) (including all-IPD and separately abstracting pneumococcal meningitis, pneumonia, bacteremia, and sepsis data), pneumonia (all cause and radiologically confirmed), and acute otitis media by age group: < 1 year, < 2 years, and < 5 years. We modeled age-specific cumulative incidence of disease obtained from standard Kaplan-Meier analysis and projected data to obtain regional estimates of disease burden. We adjusted burden estimates by serotype coverage, vaccination coverage, and vaccine efficacy to estimate the number of cases and deaths averted. RESULTS: Of 5 998 citations identified, 26 papers from 10 countries were included. The estimated annual burden of pneumonia, meningitis, and acute otitis media caused by pneumococcus in children < 5 years of age ranged from 980 000 to 1 500 000, 2 600 to 6 800, and 980 000 to 1 500 000, respectively. An estimated 12 000 to 28 000 deaths due to pneumococcal disease occur in the region annually. Pneumococcal conjugate vaccine could save 1 life per 1 100 and prevent 1 case per 13 children vaccinated. CONCLUSION: A substantial burden of pneumococcal disease in the region is potentially preventable with pneumococcal conjugate vaccines and should be considered in regional vaccine decision making. Results are limited by the very few studies, conducted in selected settings, included in this review.
Asunto(s)
Infecciones Neumocócicas/epidemiología , Región del Caribe/epidemiología , Preescolar , Costo de Enfermedad , Humanos , Lactante , América Latina/epidemiología , Infecciones Neumocócicas/prevención & controlRESUMEN
Cervical cancer control in the Latin America and Caribbean (LAC) region has been, and remains, a priority and a major public health challenge. It also provides the opportunity for the advancement of research into novel cervical cancer preventative tools including the use of prophylactic human papillomavirus (HPV) vaccines, HPV-based screening options and low technology visual inspection methods. The challenges for prevention are compounded because cervical cancer cases continue to cluster in the low socio-economic and rural populations, thus requiring strong political and social commitments to ensure effective implementation in the region. Although cytology-based screening activities exist in the majority of LAC countries, these have been largely based on opportunistic screening services. Evaluation of the impact of screening is often focused on assessing coverage of the population with Pap smears. However, regardless of the chosen technology a screening program requires a complex set of activities that must also be of high quality such us ensuring access of the underserved populations to the program, maintaining routine quality controls of the screening procedures and organizing the proper follow-up of women with abnormal screening results. The cost of the HPV vaccine and of the delivery infrastructure required is currently a significant obstacle for widespread introduction that will require collaborative resolve between public health organizations, governments and vaccine manufacturers. It is important to ensure that HPV vaccines are made available to the wider public, not only to those who can afford it. This monograph and the associated regional reports have carefully identified and discussed the many challenges and opportunities to be considered for policy decisions, in particular the complex interplay between vaccination strategies and subsequent screening requirements. An advanced cost-benefit analysis, using models calibrated to specific countries in the region, presents the range of options and relative costs thus providing evidence-based scientific guidance to governments and providers in the context of a significant and systematic international review effort.
Asunto(s)
Infecciones por Papillomavirus/prevención & control , Neoplasias del Cuello Uterino/prevención & control , Región del Caribe/epidemiología , Análisis Costo-Beneficio , Femenino , Humanos , Programas de Inmunización/tendencias , América Latina/epidemiología , Tamizaje Masivo/organización & administración , Tamizaje Masivo/tendencias , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/epidemiología , Vacunas contra Papillomavirus/uso terapéutico , Neoplasias del Cuello Uterino/diagnósticoRESUMEN
OBJECTIVE. In Latin America and the Caribbean, routine vaccination of infants against Streptococcus pneumoniae would need substantial investment by governments and donor organizations. Policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering these investments. Our aim was to incorporate vaccine, demographic, epidemiologic, and cost data into an economic analysis of pneumococcal vaccination of infants in Latin America and the Caribbean. METHODS. We previously used a structured literature review to develop regional estimates of the incidence of disease. Cost data were collected from physician interviews and public fee schedules. We then constructed a decision analytic model to compare pneumococcal conjugate vaccination of infants with no vaccination across this region, examining only vaccines direct effects on children. RESULTS. Pneumococcal vaccination at the rate of diphtheria-tetanus-pertussis vaccine coverage was projected to prevent 9 500 deaths per year in children aged 0 to 5 years in the region, or approximately one life saved per 1 100 infants vaccinated. These saved lives as well as averted cases of deafness, motor deficit, and seizure result in 321 000 disability-adjusted lifeyears (DALYs) being averted annually. At vaccine prices between US$5 and US$53 per dose, the cost per DALY averted from a societal perspective would range from US$154 to US$5 252. CONCLUSION. Pneumococcal conjugate vaccine was highly cost-effective up to $40 per dose. Introduction of pneumococcal vaccine in the Latin American and Caribbean region is projected to reduce childhood mortality and to be highly cost-effective across a range of possible costs.
Asunto(s)
Recién Nacido , Lactante , Niño , Humanos , Streptococcus pneumoniae/efectos de los fármacos , Vacunas Neumococicas/economía , Costos y Análisis de Costo/estadística & datos numéricosRESUMEN
OBJECTIVE: In Latin America and the Caribbean, routine vaccination of infants against Streptococcus pneumoniae would need substantial investment by governments and donor organizations. Policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering these investments. Our aim was to incorporate vaccine, demographic, epidemiologic, and cost data into an economic analysis of pneumococcal vaccination of infants in Latin America and the Caribbean. METHODS: We previously used a structured literature review to develop regional estimates of the incidence of disease. Cost data were collected from physician interviews and public fee schedules. We then constructed a decision analytic model to compare pneumococcal conjugate vaccination of infants with no vaccination across this region, examining only vaccine's direct effects on children. RESULTS: Pneumococcal vaccination at the rate of diphtheria-tetanus-pertussis vaccine coverage was projected to prevent 9500 deaths per year in children aged 0 to 5 years in the region, or approximately one life saved per 1 100 infants vaccinated. These saved lives as well as averted cases of deafness, motor deficit, and seizure result in 321000 disability-adjusted life years (DALYs) being averted annually. At vaccine prices between US$5 and US$53 per dose, the cost per DALY averted from a societal perspective would range from US$154 to US$5252. CONCLUSION: Pneumococcal conjugate vaccine was highly cost-effective up to $40 per dose. Introduction of pneumococcal vaccine in the Latin American and Caribbean region is projected to reduce childhood mortality and to be highly cost-effective across a range of possible costs.
Asunto(s)
Humanos , Streptococcus pneumoniae , Vacunas Neumococicas , Costos y Análisis de Costo , Árboles de Decisión , Otitis Media , Neumonía , Sepsis , Meningitis , América Latina , Región del CaribeRESUMEN
Measles is one of the most infectious diseases. Before the introduction of the measles vaccine, nearly all children contracted measles. By the end of the 1980s, most countries of the world had incorporated the measles vaccine into their routine vaccination programs. Globally, some 345,000 deaths due to measles still occur every year. Eradication of measles would play an important role in improving child survival. The goal to eradicate measles from the Americas was set by the Pan-American Sanitary Conference in 1994. Progress to date has been remarkable. Measles is no longer an endemic disease in the Americas and interruption of transmission has been documented in most countries. As of December 2007, 5 years have elapsed since the detection of the last endemic case in Venezuela in November 2002. This experience demonstrates that interruption of measles transmission can be achieved and sustained over a long period of time. Global eradication should be feasible if the appropriate strategies are implemented. Even in a new paradigm in which eradication is not followed by the discontinuation of vaccination, eradication of measles should be a good investment to avoid expensive epidemics and save those children that would potentially die due to infection with the measles virus. It is not only a dream to think that we will see a world free of measles by the year 2015.
Asunto(s)
Salud Global , Sarampión/prevención & control , Sarampión/transmisión , Humanos , Programas de Inmunización/métodos , Programas de Inmunización/tendencias , América Latina/epidemiología , Sarampión/epidemiología , Vacuna Antisarampión/uso terapéutico , América del Sur/epidemiologíaRESUMEN
Measles is one of the most infectious diseases. Before measles vaccine was introduced, nearly everyone contracted the disease at some point in childhood. By the late 1980s, most countries had incorporated measles vaccine into their routine immunization programmes. Globally, about 800 000 children nevertheless still die from measles annually, half of them in Africa. Eradicating measles would therefore play an important role in improving children's survival. The 24th Pan American Sanitary Conference in 1994 established a goal of eradicating measles from the Americas. Progress to date has been remarkable and the disease is no longer endemic in the Americas, with most countries having documented interruption of transmission. As of November 2003, 12 months had elapsed since the last indigenous case was detected in Venezuela. This experience shows that measles transmission can be interrupted, and that this can be sustained over a long period of time. Global eradication is feasible if an appropriate strategy is implemented. Even under a new paradigm in which immunization is not discontinued after measles is eradicated, eradication will be a good investment to avoid expensive epidemics and save the lives of almost one million children annually. A world free of measles by 2015 is not a dream.
Asunto(s)
Salud Global , Programas de Inmunización/organización & administración , Vacuna Antisarampión/administración & dosificación , Sarampión/prevención & control , Vigilancia de la Población , Trazado de Contacto , Humanos , Sarampión/epidemiología , Sarampión/transmisión , Organización Panamericana de la Salud , Desarrollo de Programa , América del Sur/epidemiologíaRESUMEN
The Division of Vaccines and Immunization of the Pan American Health Organization (PAHO) is promoting epidemiological surveillance of bacterial pneumonias in children in Latin America in order to generate scientific evidence to support future decisions concerning using vaccines to control such pneumonias in the countries of the Region of the Americas. The diagnosis of these diseases rarely includes bacteriological documentation of the causative agent. Therefore, studies of this type that are carried out around the world accept radiological images of alveolar consolidation as a confirmatory criterion for a presumptively bacterial pneumonia. This piece examines the theoretical rationale and requirements for using thorax radiology as an instrument for epidemiological surveillance of bacterial pneumonias. The piece also summarizes the activities carried out during 2 years of joint efforts between the Center for Vaccine Development (Centro para Vacunas en Desarrollo) of Chile and PAHO's Division of Vaccines and Immunization. During those 2 years, the two groups encouraged the epidemiological study of bacterial pneumonias in Latin American children, using internationally accepted criteria and definitions as well as tools and practical solutions adapted to the reality of the Region of the America. The activities carried out so far show both the need for and the feasibility of standardizing the interpretation of chest radiographs so that they can be used in epidemiological studies.
Asunto(s)
Neumonía Bacteriana/diagnóstico por imagen , Vigilancia de la Población/métodos , Niño , Chile/epidemiología , Estudios de Factibilidad , Infecciones por Haemophilus/diagnóstico por imagen , Infecciones por Haemophilus/epidemiología , Humanos , América Latina/epidemiología , Organización Panamericana de la Salud/organización & administración , Infecciones Neumocócicas/diagnóstico por imagen , Infecciones Neumocócicas/epidemiología , Neumonía Bacteriana/clasificación , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/epidemiología , Intensificación de Imagen Radiográfica , Radiografía Torácica/normas , Radiografía Torácica/estadística & datos numéricos , Terminología como AsuntoRESUMEN
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.
Asunto(s)
Programas de Inmunización/métodos , Complicaciones Infecciosas del Embarazo/prevención & control , Síndrome de Rubéola Congénita/prevención & control , Vacuna contra la Rubéola/administración & dosificación , Rubéola (Sarampión Alemán)/prevención & control , Adulto , Brasil/epidemiología , Región del Caribe/epidemiología , Preescolar , Chile/epidemiología , Costa Rica/epidemiología , Femenino , Humanos , Programas de Inmunización/normas , Incidencia , Lactante , Organización Panamericana de la Salud , Vigilancia de la Población , Embarazo , Síndrome de Rubéola Congénita/diagnóstico , Síndrome de Rubéola Congénita/epidemiología , Virus de la RubéolaRESUMEN
In 1988, the Ministers of Health in the Caribbean Community resolved to eliminate cases of indigenous measles. Specific performance indicators were developed to regularly monitor the program. In 1998, selected countries in the Caribbean elected to accelerate rubella control. As a first step, surveillance for both measles and rubella was integrated, using the measles eradication system as a template. Between 1995 and 2000, 98%-99% of the surveillance sites reported weekly. During that time, the number of suspected measles and rubella cases that were disqualified by laboratory testing remained relatively constant at 94%-99%; however, the indicator for suspected cases investigated within 48 h improved from 89% in 1996 to 95% in 2000. This integrated surveillance system has thus proven to be as effective and efficient as the measles surveillance system alone. Limited changes were made to the initial measles system, and the transition was relatively smooth. The integrated system has been crucial to the control of rubella and for the maintenance of measles elimination in the Caribbean.
Asunto(s)
Sarampión/prevención & control , Vigilancia de la Población/métodos , Rubéola (Sarampión Alemán)/prevención & control , Región del Caribe/epidemiología , Humanos , Incidencia , Sarampión/diagnóstico , Sarampión/epidemiología , Organización Panamericana de la Salud , Rubéola (Sarampión Alemán)/diagnóstico , Rubéola (Sarampión Alemán)/epidemiologíaRESUMEN
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.
Asunto(s)
Brotes de Enfermedades , Poliomielitis/epidemiología , Poliomielitis/virología , Vacuna Antipolio Oral/efectos adversos , Poliovirus/genética , Poliovirus/patogenicidad , Regiones no Traducidas 5' , Adolescente , Animales , Cápside/genética , Proteínas de la Cápside , Niño , Preescolar , República Dominicana/epidemiología , Femenino , Genes Virales , Haití/epidemiología , Humanos , Programas de Inmunización , Lactante , Masculino , Ratones , Datos de Secuencia Molecular , Mutación Puntual , Poliomielitis/prevención & control , Poliomielitis/transmisión , Poliovirus/clasificación , Poliovirus/aislamiento & purificación , Vigilancia de la Población , Recombinación Genética , Vacunación , VirulenciaRESUMEN
In October 2000, the Ministries of Helth of the Dominican Republic and Haiti notified two cases of acute flaccid paralyis (AFP) in rural areas, one of them in a 9-month-old female, and the other in a 2-year-old female, respectively. Stool samples that were obtained from these cases, which occured in July and August 2000, after a 9-year interruption of wild poliovirus circulation in the Western Hemisphere, revealed the presence of type 1 poliovirus. Genetic sequencing, which was later performed at the CEnters for Disease Control and Prevention, in Atlanta, Georgia, United States of America, revealed an atypical descendant of the virus used in the manufacture of the oral polio vaccine (OPV), but with 3 percent genetic divergence with respect to the parent strain. Normally, viral isolates that derive from vaccine components show 99.5 percent genetic agreement with the parent strain; in wild polioviruses, on the other hand, this agreement is usually less than 82.0 percent. Thus, the 3 percent genetic divergence detected in this study suggests that, in areas with low vaccine coverage, the virus used in the vaccine remained in circulation for at least two years, during which it recovered the neurovirulence and communicability of wild poliovirus type 1. This report describes the characteristics and results of the active search for cases of AFP that was sparked by the detection of the two index cases. It also looks at the public health implications of this outbreak for the entire Region of the Americas (AU)
Asunto(s)
Lactante , Humanos , Poliomielitis/transmisión , Américas , Brotes de Enfermedades , Haití , Poliovirus/aislamiento & purificación , República Dominicana , Vacuna Antipolio de Virus Inactivados/análisisAsunto(s)
Humanos , Personal de Salud , Inmunización/normas , Vacuna contra la Varicela/administración & dosificación , Guías como Asunto , Hepatitis B/prevención & control , Mycobacterium bovis , Región del Caribe , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Vacuna contra la Fiebre Amarilla/administración & dosificación , Vacunas contra Hepatitis B/administración & dosificaciónRESUMEN
In October 1977, the Directing Council of the Pan American Health Organisation (PAHO) approved a resolution concerning the formal inauguration of the Expanded Programme on Immunisation of the Americas. Subsequently, the EPI entered full implementation in those countries that were members of the Caribbean Epidemiology Centre (CAREC) during 1978-80. The establishment of the programme in these countries resulted in focused activities, including training and the development of operational guidelines. The immunisation programmes in the CAREC member countries (CMCs) continues to be very exciting. The eradication of poliomyelitis, the interruption of measles transmission (8 years measles-free), and the implementation of strategies for the elimination of rubella and congenital rubella syndrome (CRS), have presented many challenges to public health practitioners in the region. The success of all these initatives is a reflection of the deep commitment and strong partnerships, which have been developed between the governments, health practitioners, and people of the region (AU)
Asunto(s)
Humanos , Programas de Inmunización , Vacuna contra la Rubéola/inmunología , Sarampión/epidemiología , Sarampión/inmunología , Vacunación Masiva , VacunaciónRESUMEN
Rubella is a viral disease with minor morbidity and few complications unless it is contacted by a pregnant woman. Rubella infection during the first trimester of pregnancy often leads to fetal death or severe congenital defects (congenital rubella syndrome, CRS). Rubella remains endemic in many countries of Latin America and the Caribbean. It has been estimated that 20,000 or more infants are perhaps born with CRS each year in Latin American and Caribbean countries. While the inclusion of rubella vaccination into routine childhood immunization decrease rubella virus circulation among young children, it will not have immediate impact on the transmission of rubella amongst adults or the occurrence of CRS. A one-time mass compaign targeting both males and females 5 to 39 years of age with measles-mumps-rubella vaccination or measles-rubella vaccine followed by the use of measles-mumps-rubella vaccine in routine early childhood vaccination will prevent and control both rubella and CRS promptly. In April 1988, the Ministers of Health of the English-speaking Caribbean countries targeted rubella for elimination by the end of year 2000 using the vaccination strategy outlined above. The rubella elimination experience of these countries will provide useful information for the eventual elimination of rubella virus from the Americas.(AU)
Asunto(s)
Adulto , Niño , Femenino , Humanos , Masculino , Embarazo , Adolescente , Síndrome de Rubéola Congénita/epidemiología , Vacuna contra la Rubéola/administración & dosificación , América Latina/epidemiología , Región del Caribe/epidemiología , Esquemas de Inmunización , Recién NacidoRESUMEN
The strategy currently used to control measles in most countries has been to immunize each successive birth cohort through the routine health services delivery system. While measles vaccine coverage has increased markedly, significant measles outbreaks have continued to recur. During the past five years, experience in the Americas suggests that measles transmission has been interrupted in a number of countries (Cuba, Chile, and countries in the English-Speaking Caribbean and successfully controlled in all remaining countries. Since 1991 these countries have implemented one-time "catch-up" vaccination campaigns (conducted during a short period, usually 1 week to 1 month, and targeting all children 9 months through 14 years of age, regardless of previous vaccination status or measles disease history). These campaigns have been followed by improvements in routine vaccination services and in surveillance systems, so that the progress of the measles elimination efforts can be sustained and monitored. Follow-up mass vaccination campaigns for children younger than 5 years are planned to take place every 3 to 5 years (AU)
Asunto(s)
Niño , Preescolar , Humanos , Lactante , Programas de Inmunización , Sarampión/epidemiología , Sarampión/prevención & control , Vacuna Antisarampión , Américas/epidemiología , Brotes de Enfermedades/prevención & control , Organización Panamericana de la Salud , Vigilancia de la Población , Vacunación/estadística & datos numéricosRESUMEN
Progress in the campaign against neonatal tetanus in South and Central America and the Caribbean is reviewed. The main emphasis is on immunizing women of childbearing age who live in high-risk areas, although importance also attaches to routine tetanus toxoid treatment, adequate care during the prenatal period and delivery, and epidemiological surveillance. (AU)