RESUMEN
Background: As part of the Immunisation Agenda 2030, the World Health Organization set a goal to reduce the number of children who did not receive any routine vaccine by 50% by 2030. We aimed to describe the patterns of vaccines received for children with zero, one, and up to full vaccination, while considering newly deployed vaccines (pneumococcal conjugate vaccine (PCV) and rotavirus (ROTA) vaccine) alongside longstanding ones such as the Bacille Calmete-Guérin (BCG), diphtheria, tetanus, and pertussis (DPT), and poliomyelitis vaccines, and measles-containing vaccines (MCVs). Methods: We used data from national household surveys (Demographic and Health Surveys and Multiple Indicator Cluster Surveys) carried out in 43 low- and middle-income countries since 2014. We calculated the immunisation cascade as a score ranging from zero to six, considering BCG, polio, DPT, and ROTA vaccines, and the MCV and PCV. We also described the most prevalent combination of vaccines. The analyses were pooled across countries and stratified by household wealth quintiles. Results: In the pooled analyses with all countries combined, 9.0% of children failed to receive any vaccines, 58.6% received at least one dose of each of the six vaccines, and 47.2% were fully vaccinated with all doses. Among the few children receiving 1-5 vaccines, the most frequent were BCG vaccines, polio vaccines, DPT vaccines, PCV, ROTA vaccines, and MCV. Conclusions: Targeting children with their initial vaccine is crucial, as those who receive a first vaccine are more likely to undergo subsequent vaccinations. Finding zero-dose children and starting their immunisation is essential to leaving no one behind during the era of Sustainable Development Goals.
Asunto(s)
Programas de Inmunización , Humanos , Lactante , Preescolar , Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Esquemas de Inmunización , Vacunas contra Rotavirus/administración & dosificación , Vacuna Antisarampión/administración & dosificación , Cobertura de Vacunación/estadística & datos numéricos , Vacuna BCG/administración & dosificación , Vacunas Neumococicas/administración & dosificación , Femenino , Masculino , Vacunación/estadística & datos numéricos , Países en DesarrolloRESUMEN
Measles is one of the main causes of morbidity and mortality in the pediatric population and it can be prevented with 100% effectiveness by vaccination. However, the disease remains active in throughout Brazil. The scope of this article is to evaluate the population's adherence to vaccination and the potential connection with hospitalizations and mortality in relation to measles in Brazil. This is an ecological study based on secondary data on mortality and hospitalizations due to measles and vaccination coverage against the disease in Brazil from 2013 to 2022. The peak of adherence to the measles vaccination schedule occurred in the 3 years that preceded the eradication of the disease in the country, which occurred in 2016. In this interval, there are the lowest hospitalization rates, with zero mortality from 2014 to 2017. On the other hand, there has been a marked drop in vaccination rates since 2019, when the disease resurfaced in Brazil. Concomitantly, hospitalization and mortality rates reach the highest recorded values. Population adherence to the complete measles vaccination schedule, which is essential to control the disease and related deaths, is insufficient, which is reflected in hospitalization and mortality rates.
O sarampo é uma das principais causas de morbidade e mortalidade na população pediátrica e pode ser prevenido com 100% de eficácia pela vacinação. No entanto, a doença permanece ativa no território brasileiro. O objetivo do artigo é avaliar a adesão da população à vacinação e a possível relação com hospitalização e mortalidade em relação ao sarampo no Brasil. Trata-se de um estudo ecológico realizado a partir de dados secundários de mortalidade e internações acerca do sarampo e da cobertura vacinal contra a doença no Brasil nos anos de 2013 a 2022. O ápice de adesão ao calendário vacinal contra o sarampo se deu nos três anos que precederam a erradicação da doença no país, ocorrida em 2016. Nesse intervalo, tem-se as menores taxas de internação, com a mortalidade zerada de 2014 a 2017. Em contrapartida, verifica-se, desde então, queda na taxas de vacinação, acentuadas a partir de 2019, quando a doença reaparece no Brasil. Concomitantemente, as taxas de internação e mortalidade atingem os valores mais altos registrados. A adesão populacional ao calendário vacinal completo contra o sarampo, essencial ao controle da doença e dos óbitos relacionados, está insuficiente, o que se reflete nas taxas de internações e mortalidade.
Asunto(s)
Hospitalización , Programas de Inmunización , Vacuna Antisarampión , Sarampión , Cobertura de Vacunación , Vacunación , Humanos , Sarampión/prevención & control , Sarampión/mortalidad , Sarampión/epidemiología , Brasil/epidemiología , Hospitalización/estadística & datos numéricos , Vacuna Antisarampión/administración & dosificación , Cobertura de Vacunación/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Esquemas de Inmunización , Niño , Preescolar , LactanteRESUMEN
INTRODUCTION: Measles, mumps, rubella, and even poliomyelitis outbreaks have recently perplexed infectious disease clinicians and epidemiologists globally due to the decline in vaccination coverage rates in children and adults. Measles and yellow fever (YF) have represented an increasing burden on the Brazilian public health system in recent decades. Both diseases are preventable by live-attenuated viral vaccines (LAVV), which have restricted use in hematopoietic cell transplant (HCT) recipients. METHODS: Autologous and allogeneic HCT recipients returning for regular appointments at the outpatient clinic were invited to participate in the study. Patients transplanted for at least 2 years and with a printed copy of the vaccination record were included. RESULTS: We assessed the vaccination records of 273 HCT recipients after the second year of HCT (193 allogeneic and 80 autologous) and observed lower compliance with the YF vaccine (58 patients, 21.2%) than with the measles vaccine (138 patients, 50.5%, p ≤ .0001). This is the largest published series of YF vaccination in HCT recipients so far. No severe adverse events occurred. Although expected, chronic graft-versus-host disease (GVHD) did not affect the compliance with measles (p = .08) or YF vaccination (p = .7). Indeed, more allogeneic recipients received measles vaccine in comparison with autologous patients (p < .0001), suggesting that chronic GVHD was not the main reason for not being vaccinated. Children and allogeneic HCT were more likely to receive measles vaccine. Time elapsed from HCT >5 years favored both measles and YF vaccination. CONCLUSION: A better understanding of the reasons for low compliance with LAVV is necessary to overcome this problem.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Sarampión , Vacuna contra la Fiebre Amarilla , Fiebre Amarilla , Adulto , Niño , Humanos , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Inmunización Secundaria , Sarampión/prevención & control , Vacuna Antisarampión/administración & dosificación , Vacunación , Vacunas Virales , Fiebre Amarilla/prevención & control , Vacuna contra la Fiebre Amarilla/administración & dosificaciónRESUMEN
In Haiti, measles, rubella, and maternal and neonatal tetanus have been eliminated, but a diphtheria outbreak is ongoing as of 2019. We conducted a nationally representative, household-based, two-stage cluster survey among children aged 5-7 years in 2017 to assess progress toward maintenance of control and elimination of selected vaccine-preventable diseases (VPDs). We stratified Haiti into West region (West department, including the capital city) and non-West region (all other departments). We obtained vaccination history and dried blood spots, and measured antibody concentrations to VPDs on a multiplex bead assay. Among 1,146 children, national seropositivity was 83% (95% CI: 80-86%) for tetanus, 83% (95% CI: 81-85%) for diphtheria, 87% (95% CI: 85-89%) for measles, and 84% (95% CI: 81-87%) for rubella. None of the children had long-term immunity to tetanus or diphtheria (IgG concentration ≥ 1 international unit/mL). Seropositivity in the West region was lower than that in the non-West region. Vaccination coverage was 68% (95% CI: 61-74%) for ≥ 3 doses of tetanus- and diphtheria-containing vaccine (DTP3), 84% (95% CI: 80-87%) for one dose of measles-rubella vaccine (MR1), and 20% (95% CI: 16-24%) for MR2. The seroprevalence of measles, rubella, and diphtheria antibodies is lower than population immunity levels needed to prevent disease transmission, particularly in the West region; reintroduction of these diseases could lead to an outbreak. To maintain VPD control and elimination, Haiti should achieve DTP3 and MR2 coverage ≥ 95%, and include tetanus and diphtheria booster doses in the routine immunization schedule.
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Difteria/epidemiología , Vacuna Antisarampión/administración & dosificación , Sarampión/epidemiología , Vacuna contra la Rubéola/administración & dosificación , Rubéola (Sarampión Alemán)/epidemiología , Tétanos/epidemiología , Vacunación , Niño , Preescolar , Femenino , Haití/epidemiología , Humanos , Masculino , Estudios Seroepidemiológicos , Cobertura de VacunaciónRESUMEN
OBJECTIVE: to report on Family Health Strategy action at a Primary Health Care Unit in addressing the measles epidemic in Fortaleza, CE, Brazil. METHODS: the actions were carried out between September 2013 and December 2015; nineteen suspected measles cases were registered, three of which were confirmed: two children under 1 year old and one 27-year-old man. RESULTS: 16,726 people between 5 and 29 years old were vaccinated, vaccination coverage in the target population was 82.6%; 101% coverage was achieved among children aged 5 to 11 and 76.8% coverage of people aged 12 to 29. CONCLUSION: the strategies used contributed to achieving the vaccination coverage target in the target population, resulting in the population registered in the Health Unit catchment area falling into the category of low risk of measles transmission.
Asunto(s)
Epidemias , Salud de la Familia , Sarampión , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Epidemias/prevención & control , Femenino , Humanos , Lactante , Masculino , Sarampión/epidemiología , Sarampión/prevención & control , Vacuna Antisarampión/administración & dosificación , Atención Primaria de Salud/organización & administración , Cobertura de Vacunación/estadística & datos numéricos , Adulto JovenRESUMEN
We aimed to (i) describe both the coverage and the homogeneity of coverage of the first and second doses of measles-containing vaccines (MCV) in Brazil in 2017, and (ii) to investigate the potential influence of contextual factors at municipal level. All 5570 Brazilian municipalities were included. The North and Center-West regions presented the lowest coverages of the first and second doses of MCV, respectively. We found significant associations of both first and second doses of MCV with population size, coverage of Family Health Strategy (FHS) and other indicators of living conditions and inequalities. Monitoring the homogeneity of MCV coverage at national, regional and state levels is essential, as it allows identifying areas at higher risk of measles spread that should be targeted for vaccination. Targeting large cities i.e. 100,000 or more inhabitants, especially poor neighborhoods and areas with low FHS coverage, could lead to improvements in coverage homogeneity.
Asunto(s)
Vacuna Antisarampión/administración & dosificación , Sarampión , Cobertura de Vacunación , Brasil , Disparidades en Atención de Salud , Humanos , Sarampión/epidemiología , Sarampión/prevención & control , Densidad de PoblaciónRESUMEN
RESUMEN Objetivos . Estimar la cobertura y determinar los factores asociados a la vacunación contra el sarampión en Perú. Materiales y métodos . Realizamos un estudio de fuente secundaria utilizando la Encuesta Demográfica y de Salud Familiar (ENDES) del 2017, la unidad informante fue una mujer en edad fértil de 15 a 49 años; la unidad de análisis fue un niño de 12 a 59 meses (para la primera dosis) o niño de 18 a 59 meses (para la dosis de refuerzo) y que contaba con datos de vacunación. Los datos de cobertura fueron obtenidos de la tarjeta de vacunación. Resultados . Según la tarjeta de vacunación, la cobertura para la primera dosis fue del 70,2% (IC95%: 68,8-71,6), para la dosis de refuerzo del 52,0% (IC95%: 50,5-53,6). Los niños de 24-35 meses tuvieron más probabilidades de ser vacunados para la primera dosis (OR: 1,59; IC95%: 1,28-1,97) y dosis de refuerzo (OR:2,04; IC95%: 1,62-2,56) comparado con los niños de 12-23 meses y 18-23 meses respectivamente. Los niños cuyo control de crecimiento y desarrollo fue en el sector privado tuvieron menores probabilidades de ser vacunados para la primera dosis (OR: 0,30; IC95%: 0,21-0,43) y dosis de refuerzo (OR: 0,26; IC95%: 0,17-0,40) comparado con los que se controlaron en el sector público. Conclusiones . Según la ENDES 2017, Perú y ninguna de sus regiones alcanzó una cobertura del 95,0% para la primera dosis y su refuerzo. El control de crecimiento y desarrollo en establecimientos del sector público está asociado con la vacunación de sarampión en su primera dosis y refuerzo.
ABSTRACT Objectives . To estimate coverage and determine factors associated with measles vaccination in Peru. Materials and Methods . We conducted a secondary source study using the 2017 Demographic and Family Health Survey (ENDES). The reporting unit was a woman of childbearing age, 15 to 49 years; the unit of analysis was a child, 12 to 59 months (for the first dose), or a child, 18 to 59 months (for the booster dose) who had vaccination information. Coverage data were obtained from the vaccination card. Results . According to the vaccination card, coverage for the first dose was 70.2% (95% CI: 68.8-71.6); for the booster dose, 52% (95% CI: 50.5-53.6). Children aged 24-35 months were more likely to be vaccinated for the first dose (OR 1.59, 95% CI: 1.28-1.97) and booster dose (OR 2.04, 95% CI: 1.62-2.56), compared with children aged 12-23 months and 18-23 months respectively. Children with growth and development check-ups performed in the private sector were less likely to be vaccinated for the first dose (OR 0.30, 95% CI: 0.21-0.43) and booster dose (OR 0.26, 95% CI: 0.17-0.40), compared to those being monitored in the public sector. Conclusions . According to ENDES 2017, Peru and none of its regions achieved 95.0% coverage for the first and booster doses. Growth and development monitoring in public sector facilities is associated with measles vaccination in terms of first and booster doses.
Asunto(s)
Adolescente , Adulto , Preescolar , Femenino , Humanos , Lactante , Persona de Mediana Edad , Adulto Joven , Vacuna Antisarampión/administración & dosificación , Vacunación/estadística & datos numéricos , Cobertura de Vacunación/estadística & datos numéricos , Sarampión/prevención & control , Perú , Salud de la Familia , Encuestas Epidemiológicas , Inmunización Secundaria/estadística & datos numéricosRESUMEN
Measles is still a major cause of child morbidity and mortality. In recent years, it has become a global public health problem, attributed to low vaccination coverage observed in different countries. In order to control it, a highly effective live virus vaccine is available, which was used for the first time in Chile in 1964, covering practically the whole country in a short period of time. This was the first world experience, which was later imitated by other countries leading to a significant drop in mor bidity and mortality rates. Its effectiveness has been amply demonstrated, but it requires coverage maintenance higher than 95%. In Chile, minor endemic situation persisted until 1993. In recent years, there have been some reduced outbreaks and sporadic cases linked to contacts with imported cases, however, according to recent data, measles is now circulating in more than 160 countries at an unprecedented spread level, where infected travelers are the main vehicle of transmission. In Chile, the Ministry of Health has decided to strengthen and update the vaccination of susceptible groups, especially travelers. This update reviews historical aspects and current information on this re-emer ging disease, showing its high epidemiological impact on the pediatric and adult population globally.
Asunto(s)
Brotes de Enfermedades/prevención & control , Vacuna Antisarampión/administración & dosificación , Sarampión/epidemiología , Adulto , Niño , Chile/epidemiología , Humanos , Sarampión/prevención & control , Salud Pública , Vacunación/métodosRESUMEN
Resumen: El sarampión sigue siendo una causa importante de morbilidad y mortalidad en el niño. Durante estos últimos años, se ha convertido en un problema de salud pública mundial, que se atribuye a bajas coberturas de vacunación observadas en diferentes países. Para su control se dispone de una vacuna a virus vivo, altamente eficaz, que fue empleada por primera vez en Chile en 1964, logrando cobertura en prácticamente todo el país en un breve plazo. Esta fue la primera experiencia mundial, imitada lue go por otros países que resulto en una importante caída de las tasas de morbilidad y de mortalidad. Su eficacia ha sido ampliamente demostrada, pero requiere de la mantención de coberturas superiores a 95%. En Chile persistió una situación de endemia de menor magnitud hasta el año 1993. En años recientes, ha habido algunos brotes reducidos y casos esporádicos vinculados a contactos con casos importados, sin embargo, según datos recientes, el sarampión está circulando ahora en más de 160 países en un nivel de propagación sin precedentes, siendo los viajeros infectados el principal vehículo de transmisión. En Chile, el Ministerio de Salud ha decidido reforzar y poner al día la vacunación de grupos susceptibles, en especial viajeros. En esta actualización se revisan aspectos históricos y la información actual de esta enfermedad que ha resurgido mostrando su alto impacto epidemiológico en la población pediátrica y adulta a nivel global.
Abstract: Measles is still a major cause of child morbidity and mortality. In recent years, it has become a global public health problem, attributed to low vaccination coverage observed in different countries. In order to control it, a highly effective live virus vaccine is available, which was used for the first time in Chile in 1964, covering practically the whole country in a short period of time. This was the first world experience, which was later imitated by other countries leading to a significant drop in mor bidity and mortality rates. Its effectiveness has been amply demonstrated, but it requires coverage maintenance higher than 95%. In Chile, minor endemic situation persisted until 1993. In recent years, there have been some reduced outbreaks and sporadic cases linked to contacts with imported cases, however, according to recent data, measles is now circulating in more than 160 countries at an unprecedented spread level, where infected travelers are the main vehicle of transmission. In Chile, the Ministry of Health has decided to strengthen and update the vaccination of susceptible groups, especially travelers. This update reviews historical aspects and current information on this re-emer ging disease, showing its high epidemiological impact on the pediatric and adult population globally.
Asunto(s)
Humanos , Niño , Adulto , Vacuna Antisarampión/administración & dosificación , Brotes de Enfermedades/prevención & control , Sarampión/epidemiología , Chile/epidemiología , Salud Pública , Vacunación/métodos , Sarampión/prevención & controlRESUMEN
We report an ongoing measles outbreak in Manaus, Amazonas state, Brazil. As at 3 November 2018, 1,631 cases were confirmed corresponding to an incidence of 75.3 per 100,000 inhabitants; all five sanitary districts presented confirmed cases. Reintroduction of measles virus in Manaus is likely related to the current outbreak in Venezuela and due to recent decline in measles vaccine coverage. Given the current scenario, prevention and control measures should target individuals aged 15-29 years.
Asunto(s)
Notificación de Enfermedades/estadística & datos numéricos , Brotes de Enfermedades , Inmunización/estadística & datos numéricos , Vacuna Antisarampión/administración & dosificación , Virus del Sarampión/aislamiento & purificación , Sarampión/epidemiología , Cobertura de Vacunación/estadística & datos numéricos , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Programas de Inmunización , Lactante , Masculino , Sarampión/diagnóstico , Sarampión/prevención & control , Virus del Sarampión/genética , Virus del Sarampión/inmunología , Persona de Mediana Edad , Venezuela/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: . To estimate coverage and determine factors associated with measles vaccination in Peru. MATERIALS AND METHODS: . We conducted a secondary source study using the 2017 Demographic and Family Health Survey (ENDES). The reporting unit was a woman of childbearing age, 15 to 49 years; the unit of analysis was a child, 12 to 59 months (for the first dose), or a child, 18 to 59 months (for the booster dose) who had vaccination information. Coverage data were obtained from the vaccination card. RESULTS: . According to the vaccination card, coverage for the first dose was 70.2% (95% CI: 68.8-71.6); for the booster dose, 52% (95% CI: 50.5-53.6). Children aged 24-35 months were more likely to be vaccinated for the first dose (OR 1.59, 95% CI: 1.28-1.97) and booster dose (OR 2.04, 95% CI: 1.62-2.56), compared with children aged 12-23 months and 18-23 months respectively. Children with growth and development check-ups performed in the private sector were less likely to be vaccinated for the first dose (OR 0.30, 95% CI: 0.21-0.43) and booster dose (OR 0.26, 95% CI: 0.17-0.40), compared to those being monitored in the public sector. CONCLUSIONS: . According to ENDES 2017, Peru and none of its regions achieved 95.0% coverage for the first and booster doses. Growth and development monitoring in public sector facilities is associated with measles vaccination in terms of first and booster doses.
OBJETIVOS: . Estimar la cobertura y determinar los factores asociados a la vacunación contra el sarampión en Perú. MATERIALES Y MÉTODOS: . Realizamos un estudio de fuente secundaria utilizando la Encuesta Demográfica y de Salud Familiar (ENDES) del 2017, la unidad informante fue una mujer en edad fértil de 15 a 49 años; la unidad de análisis fue un niño de 12 a 59 meses (para la primera dosis) o niño de 18 a 59 meses (para la dosis de refuerzo) y que contaba con datos de vacunación. Los datos de cobertura fueron obtenidos de la tarjeta de vacunación. RESULTADOS: . Según la tarjeta de vacunación, la cobertura para la primera dosis fue del 70,2% (IC95%: 68,8-71,6), para la dosis de refuerzo del 52,0% (IC95%: 50,5-53,6). Los niños de 24-35 meses tuvieron más probabilidades de ser vacunados para la primera dosis (OR: 1,59; IC95%: 1,28-1,97) y dosis de refuerzo (OR:2,04; IC95%: 1,62-2,56) comparado con los niños de 12-23 meses y 18-23 meses respectivamente. Los niños cuyo control de crecimiento y desarrollo fue en el sector privado tuvieron menores probabilidades de ser vacunados para la primera dosis (OR: 0,30; IC95%: 0,21-0,43) y dosis de refuerzo (OR: 0,26; IC95%: 0,17-0,40) comparado con los que se controlaron en el sector público. CONCLUSIONES: . Según la ENDES 2017, Perú y ninguna de sus regiones alcanzó una cobertura del 95,0% para la primera dosis y su refuerzo. El control de crecimiento y desarrollo en establecimientos del sector público está asociado con la vacunación de sarampión en su primera dosis y refuerzo.
Asunto(s)
Vacuna Antisarampión/administración & dosificación , Sarampión/prevención & control , Cobertura de Vacunación/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Preescolar , Salud de la Familia , Femenino , Encuestas Epidemiológicas , Humanos , Inmunización Secundaria/estadística & datos numéricos , Lactante , Persona de Mediana Edad , Perú , Adulto JovenRESUMEN
OBJECTIVE: to describe the results of Rapid Monitoring Vaccination monitoring conducted with the aim of interrupting the measles outbreak in the State of Ceará, Brazil, in 2015. METHODS: this was a descriptive study using data taken from 52,216 vaccination cards of children aged from 6 months to less than 5 years and data on vaccination coverage, homogeneity, and reasons for non-vaccination extracted from the National Immunization Program Information System (SI-PNI). RESULTS: vaccination coverage against measles reached 96.7% in Ceará; of the 21 Regional Health Offices in the State, four did not reach minimum coverage of 95% for the first dose, and two for the second dose; 836 children (1.6%) were not vaccinated and 1,388 vaccine doses were not used. CONCLUSION: Measles vaccination campaigns enabled the immunization coverage goal in the State of Ceará to be surpassed, despite the considerable number of unvaccinated children found.
Asunto(s)
Programas de Inmunización , Vacuna Antisarampión/administración & dosificación , Sarampión/prevención & control , Vacunación , Brasil/epidemiología , Preescolar , Brotes de Enfermedades/prevención & control , Humanos , Lactante , Sarampión/epidemiología , Cobertura de Vacunación/estadística & datos numéricosRESUMEN
El 28 de marzo de 2018 se confirmó un caso de sarampión en un bebe de 8 meses, residente de la Ciudad de Buenos Aires. En función de ello, y teniendo como escenario posible lo que está ocurriendo en la actualidad, desde el Ministerio de Salud de la CABA, se comenzaron a diseñar estrategias de abordaje de carácter preventivo, para promover el control de este evento en la población en general y, en particular, en los niños susceptibles: por un lado, todos los menores de 6 años que cuentan -o deberían contar- con al menos una dosis de triple viral (entre el año de vida y el inicio escolar) y, principalmente, aquellos que por calendario, no les corresponde vacunación (los menores de un año). El 19 de julio de 2018, a poco menos de 3 meses del caso confirmado previo (categorizado como "relacionado con la importación", luego de haber hallado la fuente de infección proveniente de Asia), se notificaron dos casos confirmados que se atendieron en efectores públicos de la Ciudad de Buenos Aires, un residente de CABA y otro de Provincia de Buenos Aires. En este apartado se actualiza la situación epidemiológica a la fecha y se detallan las acciones realizadas y por realizar para la prevención y control de este evento.(AU)
Asunto(s)
Vacuna Antisarampión/administración & dosificación , Vacuna Antisarampión/provisión & distribución , Sarampión/diagnóstico , Sarampión/inmunología , Sarampión/prevención & control , Sarampión/transmisión , Sarampión/epidemiología , Infecciones por Morbillivirus/prevención & control , Infecciones por Morbillivirus/transmisiónRESUMEN
Resurgent outbreaks of vaccine-preventable diseases that have previously been controlled or eliminated have been observed in many settings. Reactive vaccination campaigns may successfully control outbreaks but must necessarily be implemented in the face of considerable uncertainty. Real-time surveillance may provide critical information about at-risk population and optimal vaccination targets, but may itself be limited by the specificity of disease confirmation. We propose an integrated modelling approach that synthesizes historical demographic and vaccination data with real-time outbreak surveillance via a dynamic transmission model and an age-specific disease confirmation model. We apply this framework to data from the 1996-1997 measles outbreak in São Paulo, Brazil. To simulate the information available to decision-makers, we truncated the surveillance data to what would have been available at 1 or 2 months prior to the realized interventions. We use the model, fitted to real-time observations, to evaluate the likelihood that candidate age-targeted interventions could control the outbreak. Using only data available prior to the interventions, we estimate that a significant excess of susceptible adults would prevent child-targeted campaigns from controlling the outbreak and that failing to account for age-specific confirmation rates would underestimate the importance of adult-targeted vaccination.