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Rotavirus infection is the leading cause of acute diarrhea in children and is preventable with a vaccine. Malnutrition increases the risk for the development of enteric and respiratory diseases, but also diarrhea increases the risk for stunting, having a negative effect in height-for-age Z score (HAZ). Therefore, Rotavirus can be considered as one of the contributing factors to stunting. The objective was to determine if vaccination against rotavirus was associated with changes in HAZ of children aged 6-60 months. We analyzed the data of Demographic and Health Survey (DHS) 2015-2017 for Peru, which is a nationwide representative. We fitted linear regression models controlling for complex sampling. The vaccine coverage was close to 75.5%, and the mean HAZ was -0.76 standard deviations. After adjusting by demographic, health, and household characteristics, children who received rotavirus vaccine, had a mean HAZ 0.06 standard deviations higher than children who did not receive it. Additionally, BCG vaccination, a higher education level of the mother, a higher wealth index, and treating water for drinking were positively associated with HAZ. On the other hand, we found low birth weight, lack of flush toilet, and altitude higher than 2500 m above sea level negatively associated with HAZ. Rotavirus vaccine is associated with better anthropometric measurements.

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Resumen: Objetivo: Evaluar el impacto de la vacunación contra rotavirus (RV) a 10 años de su universalización sobre la morbimortalidad por enfermedad diarreica aguda (EDA) en niños mexicanos menores de cinco años. Material y métodos: Se compararon las medianas anuales de casos nuevos, defunciones y hospitalizaciones por EDA del periodo pre y posuniversalización; se calcularon reducciones absolutas y relativas, considerando significativos valores de p<0.05. Resultados: La mortalidad, hospitalizaciones y casos nuevos por EDA en menores de cinco años disminuyeron 52.6, 46 y 15.5% respectivamente, en el periodo posuniversalización. Durante la temporada de RV las reducciones en la mortalidad, hospitalizaciones y casos nuevos fueron de 66.9, 64.7 y 28.7%, respectivamente. Conclusiones: A partir de la universalización de la vacuna de RV en México, se aprecian reducciones importantes y sostenidas en la mortalidad, hospitalizaciones e incidencia por EDA, con menor impacto en esta última. El mayor impacto se observa durante la temporada de RV.

Abstract: Objective: To evaluate the impact of rotavirus (RV) vaccination after 10 years of it´s universalization on morbidity and mortality from Acute Diarrheal Disease (ADD) in mexican children under five years of age. Materials and methods: Annual median numbers for ADD new cases, hospitalizations and deaths were compared between pre and post universalization periods; absolute and relative reductions were calculated, considering p<0.05 values as significant. Results: Mortality, hospitalizations and new cases from ADD in children under five decreased 52.6, 46, and 15.5% respectively, in the posuniversalization period. During rotavirus seasons, reduction in mortality, hospitalizations and new cases was 66.9, 64.7, and 28.7% respectively. Conclusions: As of the universal introduction of RV vaccination in Mexico, significant and sustained reductions are appreciated for mortality and hospitalizations from ADD, less so for incidence. A most prominent effect is observed during the winter season.

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OBJECTIVE: To evaluate the impact of rotavirus (RV) vaccination after 10 years of it´s universalization on morbidity and mortality from Acute Diarrheal Disease (ADD) in mexican children under five years of age. MATERIALS AND METHODS: Annual median numbers for ADD new cases, hospitalizations and deaths were compared between pre and post universalization periods; absolute and relative reductions were calculated, considering p<0.05 values as significant. RESULTS: Mortality, hospitalizations and new cases from ADD in children under five decreased 52.6, 46, and 15.5% respectively, in the posuniversalization period. During rotavirus seasons, reduction in mortality, hospitalizations and new cases was 66.9, 64.7, and 28.7% respectively. CONCLUSIONS: As of the universal introduction of RV vaccination in Mexico, significant and sustained reductions are appreciated for mortality and hospitalizations from ADD, less so for incidence. A most prominent effect is observed during the winter season.

OBJETIVO: Evaluar el impacto de la vacunación contra rotavirus (RV) a 10 años de su universalización sobre la morbimortalidad por enfermedad diarreica aguda (EDA) en niños mexicanos menores de cinco años. MATERIAL Y MÉTODOS: Se compararon las medianas anuales de casos nuevos, defunciones y hospitalizaciones por EDA del periodo pre y posuniversalización; se calcularon reducciones absolutas y relativas, considerando significativos valores de p<0.05. RESULTADOS: La mortalidad, hospitalizaciones y casos nuevos por EDA en menores de cinco años disminuyeron 52.6, 46 y 15.5% respectivamente, en el periodo posuniversalización. Durante la temporada de RV las reducciones en la mortalidad, hospitalizaciones y casos nuevos fueron de 66.9, 64.7 y 28.7%, respectivamente. CONCLUSIONES: A partir de la universaliza- ción de la vacuna de RV en México, se aprecian reducciones importantes y sostenidas en la mortalidad, hospitalizaciones e incidencia por EDA, con menor impacto en esta última. El mayor impacto se observa durante la temporada de RV.

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Estudo de coorte, retrospectivo,que utilizou dados obtidos na Vigilância Epidemiológica da cidade de Franca, no interior do Estado de São Paulo, com o objetivo de analisar o tipo de reação e a cobertura da Vacina Oral de Rotavírus Humano (VORH). Este estudo foi realizado por discentes do curso de Medi-cina da Universidade de Franca, e analisado estatisticamente com teste de normalidade de D'Agostino e Pearson. As informações foram obtidas no SIPNI Web (Sistema de Informação do Programa Nacional de Imunização), e são referentes aos períodos de Janeiro/2007 a Novembro/2017. Notou-se uma baixa incidência de reações a VORH no período analisado equivalente a 0,077%, e quando presentes são de baixa morbidade, raramente cursando com complicações. A maioria dos casos ocorreu no sexo masculino e na primeira dose da vacina. No entanto, há ainda muito receio acerca da mesma, sendo, por essa razão, motivo de recusa da imunização por uma parte da população (AU)

A retrospective cohort study, which used data obtained from the Epidemiological Surveillance in the city of Franca, in the interior of the State of São Paulo, aiming at analyzing the type of reaction and the coverage of the Human Rotavirus Oral Vaccine (HROV). This study was performed by students of the Medicine course of the University of Franca and analyzed statistically with the normality test of D'Agostino and Pearson. The information was obtained from the SIPNI Web (Information System of the National Immunization Program), and refer to the period from January 2007 to November 2017. There was a low incidence of HROV reactions in the period analyzed, equivalent to 0.077%, and when present, they are of low morbidity, rarely presenting complications. The majority of cases occurred in males and the first dose of the vaccine. However, there is still a lot of fear about it, and for this, it is a reason to refuse immunization by part of the population (AU)

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Resumo 22. Objetiva-se analisar a situação vacinal da Vacina Oral do Rotavírus Humano em crianças da educação infantil. Utilizou-se o método de estudo epidemiológico, descritivo, retrospectivo e de abordagem quantitativa realizado a partir de informações coletadas em 1 434 cópias de cartões de vacinas de crianças matriculadas em Centros Municipais de Educação Infantil de Natal/RN. Os dados foram coletados de março e dezembro de 2015 por meio de lista de verificação. Os resultados expressam que 78,4% dos cartões analisados foram classificados como esquema vacinal completo quando possuíam duas doses da vacina e 11,9% apresentaram esquema vacinal incompleto, quando possuíam apenas uma dose e outros 9,7% classificados como não vacinado quando não apresentaram registro desta vacina. Conclui-se que houve aumento no número de doses administradas nos últimos anos. No entanto observou-se um número maior de crianças não imunizadas em faixa-etária maiores.

Resumen 26. El objetivo de este estudio fue analizar la situación vacunal de la Vacuna Oral del Rotavirus Humano en niños de la educación infantil. Se utilizó el método de estudio epidemiológico, descriptivo, retrospectivo y de abordaje cuantitativo realizado a partir de informaciones recogidas en 1 434 copias de tarjetas de vacunas de niños matriculados en Centros Municipales de Educación Infantil de Natal/RN. Los datos fueron recolectados de marzo y diciembre de 2015 a través de lista de chequeo. Los resultados expresan que el 78,4% de las tarjetas analizadas fueron clasificadas como esquema vacunal completo cuando tenían dos dosis de la vacuna y el 11,9% presentó un esquema vacunal incompleto, cuando poseían sólo una dosis y otro 9,7% clasificados como no vacunados cuando no presentaron registro de esta vacuna. Se concluye que hubo aumento en el número de dosis administradas en los últimos años. Sin embargo, se observó un número mayor de niños no inmunizados en grupo de mayor edad.

Abstract 30. The objective of this study was to analyze the vaccination status of the Human Rotavirus Oral Vaccine in children in early childhood education. The epidemiological, descriptive, retrospective and quantitative approach method was carried out based on information collected on 1 434 copies of vaccination cards of children enrolled in Natal / RN Municipalities for Early Childhood Education. Data were collected from March and December 2015 through the check list. The results show that 78,4% of the analyzed cards were classified as complete vaccination schedule when they had two doses of the vaccine and 11,9% had an incomplete vaccination schedule when they had only one dose and another 9,7% classified as not vaccinated when not registered this vaccine. It was concluded that there was an increase in the number of doses administered in the last years. However, a larger number of unimmunized children in the larger age group were observed.

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To better understand underlying causes of lower rotavirus vaccine effectiveness in low-middle income countries (LMICs), we measured innate antiviral factors in Nicaraguan mothers' milk and immune response to the first dose of the pentavalent rotavirus vaccine in corresponding infants. No relationship was found between concentrations of innate factors and rotavirus vaccine response.

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BACKGROUND: Rotavirus was the leading cause of childhood diarrhoea-related hospitalisations and death before the introduction of rotavirus vaccines. METHODS: We describe the effectiveness of rotavirus vaccines to prevent rotavirus infections and hospitalizations and the main rotavirus strains circulating before and after vaccine introduction through a systematic review and meta-analysis of studies published between 1990 and 2014. 203 studies were included to estimate the proportion of infections due to rotavirus and 10 to assess the impact of the vaccines. 41 of 46 studies in the post-vaccination period were used for meta-analysis of genotypes, 20 to calculate VE against infection, eight for VE against hospitalisation and seven for VE against severe rotavirus-diarrhoea. RESULTS: 24.3 % (95 % CI 22.1-26.5) and 16.1 % (95 % CI 13.2-19.3) of cases of diarrhoea were due to rotavirus before and after vaccine introduction, respectively. The most prevalent G types after vaccine introduction were G2 (51.6 %, 95 % CI 38-65), G9 (14.5 %, 95 % CI 7-23) and G1 (14.2 %, 95 % CI 7-23); while the most prevalent P types were P[4] (54.1 %, 95 % CI 41-67) and P[8] (33 %, 95 % CI 22-46). G2P[4] was the most frequent genotype combination after vaccine introduction. Effectiveness was 53 % (95 % CI 46-60) against infection, 73 % (95 % CI, 66-78) against hospitalisation and 74 % (95 % CI, 68.0-78.0) against severe diarrhoea. Reductions in hospitalisations and mortality due to diarrhoea were observed in countries that adopted universal rotavirus vaccination. CONCLUSIONS: Rotavirus vaccines are effective in preventing rotavirus-diarrhoea in children in Latin America. The vaccines were associated with changes in genotype distribution.

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BACKGROUND: Mexico implemented routine childhood vaccination against rotavirus in 2007. We describe trends in hospitalization and deaths from diarrhea among children aged <5 years in Mexico before and 7 years after implementation of rotavirus vaccination. METHODS: We obtained data on deaths and hospitalizations from diarrhea, from January 2003 through December 2014, in Mexican children <5 years of age. We compared diarrhea-related mortality and hospitalizations in the postvaccine era with the prevaccine baseline from 2003 to 2006. RESULTS: Compared with the prevaccine baseline, we observed a 53% reduction (95% confidence interval [CI], 47%-58%) in diarrhea-related mortality and a 47% reduction (95% CI, 45%-48%) in diarrhea-related hospitalizations in postvaccine years, translating to 959 deaths and 5831 hospitalizations averted every year in Mexican children aged <5 years. Prevaccine peaks in diarrhea-related mortality and hospitalizations during the rotavirus season months were considerably diminished in postvaccine years, with greater declines observed during the rotavirus season compared with non-rotavirus season months. CONCLUSIONS: We document a substantial and sustained decline in diarrhea-related hospitalizations and deaths in Mexican children associated with implementation of rotavirus vaccination. These results highlight the public health benefits that could result in countries that adopt rotavirus vaccination into their national immunization programs.

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Abstract Objective: Intussusception surveillance was initiated after the nationwide introduction of live attenuated monovalent rotavirus vaccine (RV1). The objective is to assess the epidemiology of intussusception and compare the number of cases before and after the introduction of rotavirus vaccine. Methods: Cases of intussusception occurring between March 2006 and January 2008 were identified through a prospective enhanced passive surveillance system established in sentinel state hospitals. Retrospective review of medical records was used to identify cases, which occurred in sentinel hospitals between January 2001 and February 2006. Results: From 2001 to 2008, 331 intussusception cases were identified, 59.5% were male, with peak incidence among those 18–24 weeks of age. Overall <10% of cases were among infants 6–14 weeks of age (when the first dose of RV1 is administered). The most frequently observed signs or symptoms of intussusception included vomiting (89.4%), bloody stool (75.5%), and abdominal distention (71.8%). A majority (92.1%) of the case-patients required surgery for treatment; 31.8% of those who underwent surgery required bowel resection, and 13 (3.9%) died. Among the 21 hospitals that reported cases throughout the entire surveillance period (2001–2008), the number of intussusception events during 2007 (n = 26) and 2008 (n = 19) was not greater than the average annual number (n = 31, range 24–42) during baseline years 2001–2005. Conclusions: Although this analysis did not identify an increase in intussusception cases during the two years after RV1 introduction, these results support the need for special epidemiologic methods to assess the potential link between rotavirus vaccine and this very rare adverse event.

Resumo Objetivo: A vigilância da intussuscepção foi iniciada após a introdução da vacina monovalente viva atenuada contra rotavírus (RV1) em todo o país. O objetivo é avaliar a epidemiologia da intussuscepção e comparar a quantidade de casos antes e depois da introdução da vacina contra rotavírus. Métodos: Os casos de intussuscepção entre março de 2006 e janeiro de 2008 foram identificados por meio de um sistema de vigilância passivo prospectivo aprimorado estabelecido em hospitais-sentinela estaduais. A análise retrospectiva de prontuários médicos foi usada para identificar os casos que ocorreram em hospitais-sentinela entre janeiro de 2001 e fevereiro de 2006. Resultados: De 2001-2008, identificamos 331 casos de intussuscepção, 59,5% dos quais ocorreram em pacientes do sexo masculino, com pico de incidência entre aqueles com 18-24 semanas de idade. Em geral, < 10% dos casos ocorreram entre neonatos com 6-14 semanas de idade (quando a 1a dose de RV1 é administrada). Os sinais ou sintomas de intussuscepção observados com mais frequência incluíam vômito (89,4%), fezes com sangue (75,5%) e distensão abdominal (71,8%). A maioria (92,1%) dos pacientes precisou de cirurgia para o tratamento; 31,8% dos que se submeteram à cirurgia precisaram de ressecção intestinal e 13 (3,9%) vieram a óbito. Entre os 21 hospitais que relataram casos durante todo o período de vigilância (2001-2008), a quantidade de casos de intussuscepção em 2007 (n = 26) e 2008 (n = 19) não foi maior do que a quantidade média anual (31, faixa de 24-42) durante os anos-base de 2001-2005. Conclusões: Embora esta análise não tenha identificado um aumento nos casos de intussuscepção nos dois anos após a introdução da RV1, esses resultados justificam a necessidade de métodos epidemiológicos especiais para avaliar a possível associação entre a vacina contra rotavírus e esse evento adverso muito raro.

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OBJECTIVE: Intussusception surveillance was initiated after the nationwide introduction of live attenuated monovalent rotavirus vaccine (RV1). The objective is to assess the epidemiology of intussusception and compare the number of cases before and after the introduction of rotavirus vaccine. METHODS: Cases of intussusception occurring between March 2006 and January 2008 were identified through a prospective enhanced passive surveillance system established in sentinel state hospitals. Retrospective review of medical records was used to identify cases, which occurred in sentinel hospitals between January 2001 and February 2006. RESULTS: From 2001 to 2008, 331 intussusception cases were identified, 59.5% were male, with peak incidence among those 18-24 weeks of age. Overall <10% of cases were among infants 6-14 weeks of age (when the first dose of RV1 is administered). The most frequently observed signs or symptoms of intussusception included vomiting (89.4%), bloody stool (75.5%), and abdominal distention (71.8%). A majority (92.1%) of the case-patients required surgery for treatment; 31.8% of those who underwent surgery required bowel resection, and 13 (3.9%) died. Among the 21 hospitals that reported cases throughout the entire surveillance period (2001-2008), the number of intussusception events during 2007 (n=26) and 2008 (n=19) was not greater than the average annual number (n=31, range 24-42) during baseline years 2001-2005. CONCLUSIONS: Although this analysis did not identify an increase in intussusception cases during the two years after RV1 introduction, these results support the need for special epidemiologic methods to assess the potential link between rotavirus vaccine and this very rare adverse event.

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The success of Gavi, the Vaccine Alliance depends on the vaccine markets providing appropriate, affordable vaccines at sufficient and reliable quantities. Gavi's current supplier base for new and underutilized vaccines, such as the human papillomavirus (HPV), rotavirus, and the pneumococcal conjugate vaccine is very small. There is growing concern that following globalization of laws on intellectual property rights (IPRs) through trade agreements, IPRs are impeding new manufacturers from entering the market with competing vaccines. This article examines the extent to which IPRs, specifically patents, can create such obstacles, in particular for developing country vaccine manufacturers (DCVMs). Through building patent landscapes in Brazil, China, and India and interviews with manufacturers and experts in the field, we found intense patenting activity for the HPV and pneumococcal vaccines that could potentially delay the entry of new manufacturers. Increased transparency around patenting of vaccine technologies, stricter patentability criteria suited for local development needs and strengthening of IPRs management capabilities where relevant, may help reduce impediments to market entry for new manufacturers and ensure a competitive supplier base for quality vaccines at sustainably low prices.

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Objetivos: Avaliar a incidência de doença diarreica aguda registrada em Caxias do Sul, em um período de 10 anos, investigando suas correlações com a vacinação contra rotavírus, com a precipitação pluviométrica e com o número de internações hospitalares. Métodos: Foi realizado um estudo descritivo dos registros de doença diarreica aguda, disponibilizados pelo setor de Vigilância Epidemiológica da Secretaria Municipal de Saúde de Caxias do Sul. Resultados: Entre 2004 e 2013 foram registrados 61.246 casos de doença diarreica aguda, sendo que os maiores números ocorreram em bairros de baixa renda. Durante o período de avaliação foram identificados cinco surtos epidêmicos de doença diarreica aguda, em meses de verão e inverno. Não foram encontradas relações entre doença diarreica aguda e precipitação pluviométrica. O número de internações hospitalares por doença diarreica aguda em crianças de zero a quatro anos decresceu a partir de 2006, coincidindo com o início do programa de vacinação contra rotavírus na rede pública, enquanto que os óbitos de todas as idades sofreram flutuações durante o período estudado. Conclusões: A avaliação da incidência de doença diarreica aguda, por longo período, mostra que houve flutuações ao longo do tempo no número de registros e de óbitos em Caxias do Sul. Este estudo revelou também uma redução no número de internações devidas a doença diarreica aguda no período que sucedeu à introdução do programa de vacinação contra rotavírus na rede pública de saúde.

Aims: To evaluate the incidence of acute diarrheal disease (ADD) recorded over a 10-year period in Caxias do Sul, southern Brazil, and its correlations with the vaccination against rotavirus, with rainfall, and with the number of hospitalizations. Methods: A descriptive study was conducted, analyzing the ADD records obtained from the Epidemiological Surveillance sector of the Local Health Department of Caxias do Sul. Results: A total of 61,246 cases of ADD were recorded between 2004 and 2013, most of which occurred in low-income neighborhoods. There were five outbreaks of ADD in the summer and winter months during the study period. No correlations were found between ADD and rainfall. The number of children aged between zero and four years hospitalized for ADD decreased from 2006 onwards, when vaccination against rotavirus was implemented in the public health network whereas the number of deaths across all age groups fluctuated during the study period. Conclusions: The assessment of the long-term incidence of ADD showed a fluctuation in the number of cases and deaths in Caxias do Sul. In addition, hospitalizations for ADD decreased after the implementation of rotavirus vaccination in the public health network.

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ABSTRACT OBJECTIVE To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and rotavirus vaccines in Latin America and the Caribbean. METHODS For this narrative review, we searched for the terms "rotavirus", "pneumococcal", "conjugate vaccine", "vaccination", "program", and "impact" in the databases Medline and LILACS. The search was extended to the grey literature in Google Scholar. No limits were defined for publication year. Original articles on the health impact assessment of pneumococcal and rotavirus vaccination programs in Latin America and the Caribbean in English, Spanish or Portuguese were included. RESULTS We identified 207 articles. After removing duplicates and assessing eligibility, we reviewed 33 studies, 25 focusing on rotavirus and eight on pneumococcal vaccination programs. The most frequent studies were ecological, with time series analysis or comparing pre- and post-vaccination periods. The main data sources were: health information systems; population-, sentinel- or laboratory-based surveillance systems; statistics reports; and medical records from one or few health care services. Few studies used primary data. Hospitalization and death were the main outcomes assessed. CONCLUSIONS Over the last years, a significant number of health impact assessments of pneumococcal and rotavirus vaccination programs have been conducted in Latin America and the Caribbean. These studies were carried out few years after the programs were implemented, meet the basic methodological requirements and suggest positive health impact. Future assessments should consider methodological issues and challenges arisen in these first studies conducted in the region.

RESUMO OBJETIVO Descrever métodos e desafios enfrentados na avaliação do impacto de programas de vacinação, com foco nas vacinas pneumocócica conjugada e de rotavírus nos países da América Latina e Caribe. MÉTODOS Para esta revisão narrativa, foi realizada busca nas bases de dados Medline e Lilacs, usando os termos "rotavirus", "pneumococcal", "conjugate vaccine", "vaccination", "program", e "impact". A busca foi estendida à literatura cinza no Google Acadêmico. Não houve limitação por ano de publicação. Foram incluídos estudos originais de avaliação do impacto dos programas de vacinação de pneumococo e rotavírus na América Latina e Caribe, publicados em inglês, espanhol ou português. RESULTADOS Foram identificados 207 artigos. Após remover duplicatas e avaliar elegibilidade, 33 estudos foram revisados, 25 sobre programas de vacinação de rotavírus e oito de pneumococo. Estudos ecológicos, com análise de série temporal ou comparação de períodos antes e após a vacinação, foram mais frequentes. As principais fontes de dados foram: sistemas de informação em saúde; sistemas de vigilância de base populacional, sentinela ou laboratorial; relatórios estatísticos; e prontuários médicos de um ou poucos serviços de saúde. Poucos estudos utilizaram dados primários. Hospitalizações e mortes foram os principais desfechos avaliados. CONCLUSÕES Nos últimos anos, número significativo de avaliações do impacto dos programas de vacinação de pneumococo e rotavírus foram realizados nos países da América Latina e Caribe. Esses estudos foram conduzidos poucos anos após a implementação dos programas, preenchem os requisitos metodológicos básicos e sugerem impacto positivo dos programas. Futuras avaliações devem considerar questões metodológicas e desafios que surgiram nesses primeiros estudos conduzidos na região.

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A doença causada pelo rotavirus é umas das principais causas de morbidade e mortalidade relacionadas à diarreia aguda em crianças no mundo causando, antes da introdução das vacinas,aproximadamente 453.000 mortes anualmente, particularmente nos países em desenvolvimento. No ano de 2006, duas vacinas foram licenciadas para prevenir os casos graves de diarreia por rotavirus do grupo A (RVA) e mortalidade por esta doença. Estas duas vacinas, monovalente (Rotarix®- RV1) e pentavalente (RotaTeq®– RV5), foram recomendadas pela Organização Mundial da Saúde (OMS) para sua utilização nos programas de imunizações em 2007. Os países da América Latina e Caribe (ALC) e os Estados Unidos da América (EUA) foram os primeiros a incorporarem esta vacina na rotina de imunizações. Atualmente, 16 países da ALC introduziram estas vacinas no esquema de vacinação. O objetivo deste estudo é documentar o processo de introdução das vacinas de RVA em alguns países da ALC através de uma avaliação qualitativa –observacional, medir a efetividade da vacina RV1na Bolívia, e realizar uma meta-análise para estimar a efetividade das vacinas RVA, segundo diferentes variáveis, na ALC. As evidencias da eficácia da vacina, seu potencial impacto e custo-efetividade de sua introdução,mesmo sem dados locais, foram importantes para a decisão de introdução dessa vacina. Tanto no estudo da Bolívia como na meta-análise, as estimativas de efetividade variaram em grau de acordo ao grupo controle utilizado. No estudo caso-controle da Bolívia, e a efetividade de RV1 para o esquema completo foi de 77,0% e 69,0% utilizando controles de hospital (outras doenças) e diarreias ELISA negativo para RVA, respectivamente. A efetividade para uma dose da vacina foi de 56,0% com controles de hospital (outras doenças) e 36,0% com controles de diarreia ELISA - negativo...

The Rotavirus disease is one of the most significant causes of morbidity and mortality in relation toacute diarrhea in children around the world and there were approximately 453,000 deaths annually beforethe introduction of the vaccines, especially in developing countries. In 2006, two group A rotavirus (RVA)vaccines were licensed to prevent severe diarrhea and mortality due to rotavirus. The monovalent(Rotarix®, RV1) and pentavalent (RotaTeq®, RV5) were recommended by the World Health Organization(WHO) in 2007. Countries from Latin America, the Caribbean (LAC), and the United States were the firstones in the world to introduce these vaccines. Currently, 16 countries in LAC have introduced RVAvaccines in their immunization programs. The objective of this study is to document the RVA vaccinesintroduction process in some LAC countries through an observational-quality study measuring theeffectiveness of the vaccine in a specific country, Bolivia, and to conduct a meta-analyse for estimatingthe vaccine’s effectiveness according different variables in LAC. The evidence on efficacy, potentialimpact, and cost-effectiveness of vaccine introduction, even without local data, were important in thedecision making process for vaccine introduction. The vaccine effectiveness, using different types ofcontrols, leads to different degrees of effectiveness in the Bolivia study and in the meta-analysis too. ABolivia case-control study shows RV1 effectiveness for a complete schedule of 77.0% and 69.0% withnon-diarrhea controls and diarrhea ELISA negative test, respectively. For one dose of vaccine,effectiveness ranged from 56.0% using non-diarrhea hospital control to 36.0% using diarrhea ELISA negative test...

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OBJETIVO: Estimar la efectividad de la vacuna monovalente antirrotavírica para prevenir la hospitalización por enfermedad diarreica aguda en niños menores de 2 años en cinco ciudades de Colombia. MÉTODOS: Se realizó una encuesta poblacional sobre una muestra probabilística de niños mayores de 2 meses y menores de 24 meses de edad en cinco ciudades de Colombia (Barranquilla, Bogotá, Cali, Cartagena y Riohacha) en el período de agosto a octubre de 2010. La vacuna fue introducida en el Programa Ampliado de Inmunizaciones en enero de 2009. Se estimaron las coberturas de vacunación contra rotavirus por grupos de edad y la incidencia acumulada de hospitalización por diarrea severa, y se evaluó la magnitud de la asociación entre la vacunación con una o dos dosis de vacuna antirrotavírica y la hospitalización por diarrea, utilizando la razón de probabilidades (RP) ajustada por edad y otros factores de importancia epidemiológica. La efectividad de la vacunación se estimó usando la expresión 1 - RP. RESULTADOS: La cobertura de vacunación con una dosis de vacuna fue de 87,3%. En los 12 meses previos a la encuesta 43,2% (1 453 niños) de menores de 24 meses presentaron diarrea, y de ellos, 5,2% (174 niños) fueron hospitalizados por esta causa. La efectividad de dos dosis de vacuna antirrotavírica para prevenir la hospitalización por diarrea severa fue de 68% (intervalo de confianza de 95%: 55%-77%). CONCLUSIONES: La vacunación contra rotavirus en Colombia protege contra la hospitalización por diarrea por cualquier causa. El uso de encuestas transversales se mostró adecuado para evaluar rápidamente la efectividad de un programa de vacunación con una nueva vacuna.

OBJECTIVE: Estimate the effectiveness of the monovalent rotavirus vaccine in preventing the need to hospitalize children under 2 years old for acute diarrheal disease in five Colombian cities. METHODS:A population survey was conducted based on a probability sample of children over 2 months and under 24 months of age in five Colombian cities (Barranquilla, Bogotá, Cali, Cartagena, and Riohacha) over the period from August through October 2010. The vaccine had been introduced in the Expanded Program on Immunization in January 2009. Rotavirus vaccination coverage was estimated by age group; the cumulative incidence of hospitalization for severe diarrhea was determined; and the magnitude of correlation between vaccination with one or two doses of rotavirus vaccine and hospitalization for diarrhea was calculated using the age-adjusted probability ratio (PR) and other epidemiologically significant factors. Effectiveness of the vaccine was estimated using the expression 1-PR. RESULTS: Coverage with a single dose of the rotavirus vaccine was 87.3%. During the 12 months prior to the survey, 1 453 of the children under 24 months old in the study areas (43.2%) had presented with diarrhea, and of these, 174 (5.2%) had been hospitalized for this cause. The effectiveness of two doses of the vaccine in preventing hospitalization for severe diarrhea was 68% (CI 95% = 55%−77%). CONCLUSIONS: In Colombia, rotavirus vaccination protects against hospitalization for diarrhea due to any cause. The use of cross-sectional surveys appeared to be adequate for rapid evaluation of an immunization program's effectiveness with a new vaccine.

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OBJETIVOS: Avaliar a prevalência e a circulação dos genótipos de rotavírus, antes e após a introdução da vacina oral contra rotavírus humano, bem como verificar uma possível mudança na faixa etária de ocorrência da infecção pelo RV-A. MÉTODOS: Trata-se de um estudo transversal realizado no período de 2002 a 2011, em Juiz de Fora, MG. Foram avaliados 1.144 espécimes fecais diarreicos, obtidos de crianças de 0 a cinco anos não hospitalizadas, que foram analisadas por PAGE e RT-PCR. Os dados relativos à prevalência e distribuição etária dos casos de rotavirose foram analisados pelo teste χ2 (p < 0,05), utilizando-se o programa SPSS, versão 13.0. RESULTADOS: Infecções por rotavírus foram detectadas em 9,35% (107/1.144) das amostras, com prevalências variando de 11,12% (90/809) no período pré-vacinal a 5,07% (17/335) no pós-vacinal (p = 0,001). Dentre as amostras caracterizadas, os genótipos mais frequentemente detectados foram G1P[6] (6/33 = 18,2%) no período 2002-2005 e G2P[4] no ano de 2006 (11/33 = 33,3%) e no período 2007-2011 (5/33 = 15,2%). Observou-se, ainda, uma redução significativa no número de casos de rotavirose em crianças de 0 a 36 meses, após a introdução da vacina. CONCLUSÕES: O estudo revelou queda significativa na prevalência de rotavírus, principalmente na faixa etária de 0 a 36 meses, no período 2007-2011, bem como redução na circulação do genótipo G1.

OBJECTIVES: To evaluate the prevalence and circulation of rotavirus genotypes before and after the introduction of oral vaccine against human rotavirus (OVHR), and to check for a possible change in the age of occurence of the infection by RV-A. METHODS: This was a cross-sectional study conducted between 2002-2011, in the city of Juiz de Fora, state of Minas Gerais, Brazil. A total of 1,144 diarrheal stool specimens were obtained from nonhospitalized children aged between 0 and 5 years, and analyzed by polyacrylamide gel electrophoresis and reverse-transcription polymerase chain reaction for genotype characterization. Data on prevalence and age distribution of rotavirus cases were analyzed through the chi-squared test (p < 0.05), using SPSS, release 13.0. RESULTS: Rotavirus infection was detected in 9.35% (107/1,144) samples, with prevalence rates ranging from 11.12% (90/809) in the pre-vaccine to 5.07% (17/335) in the post-vaccine period (p = 0.001). Among the samples tested, the most frequently detected genotypes were G1P[6] (6/33 = 18.2%) in the period between 2002 and 2005 and G2P[4] in 2006 (11/33 = 33.3%) and in the period between 2007 and 2011 (5/33 = 15.2%). There was also a significant reduction in the number of cases of rotavirus disease in children aged between 0 and 36 months after the vaccine introduction. CONCLUSIONS: The study evidenced a significant decrease in the prevalence of rotavirus, mainly in children aged between 0 and 36 months in the 2007-2011 period, as well as a reduction in G1 genotype circulation.

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OBJECTIVES: To evaluate the prevalence and circulation of rotavirus genotypes before and after the introduction of oral vaccine against human rotavirus, and to check for a possible change in the age of occurence of the infection by RV-A. METHODS: This was a cross-sectional study conducted between 2002-2011, in the city of Juiz de Fora, state of Minas Gerais, Brazil. A total of 1,144 diarrheal stool specimens were obtained from nonhospitalized children aged between 0 and 5 years, and analyzed by polyacrylamide gel electrophoresis and reverse-transcription polymerase chain reaction for genotype characterization. Data on prevalence and age distribution of rotavirus cases were analyzed through the chi-squared test (p < 0.05), using SPSS, release 13.0. RESULTS: Rotavirus infection was detected in 9.35% (107/1,144) samples, with prevalence rates ranging from 11.12% (90/809) in the pre-vaccine to 5.07% (17/335) in the post-vaccine period (p = 0.001). Among the samples tested, the most frequently detected genotypes were G1P[6] (6/33 = 18.2%) in the period between 2002 and 2005 and G2P[4] in 2006 (11/33 = 33.3%) and in the period between 2007 and 2011 (5/33 = 15.2%). There was also a significant reduction in the number of cases of rotavirus disease in children aged between 0 and 36 months after the vaccine introduction. CONCLUSIONS: The study evidenced a significant decrease in the prevalence of rotavirus, mainly in children aged between 0 and 36 months in the 2007-2011 period, as well as a reduction in G1 genotype circulation.

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BACKGROUND: In January 2010, surveillance detected a rotavirus gastroenteritis outbreak in Chiapas, Mexico. We aimed to identify risk and protective factors for developing rotavirus gastroenteritis of any severity among children in the epidemic setting. METHODS: A case-control study was conducted, comparing case patients (defined as children <36 months of age with acute gastroenteritis of any severity whose stool tested positive for rotavirus by enzyme immunoassay) with age- and municipality-matched controls. Information was obtained through face-to-face interviews on clinical outcome, demographics, breastfeeding history, rotavirus immunization status, and indicators of socioeconomic status. RESULTS: Eighty-five case patients and 170 controls were enrolled. Factors associated with lower risk of rotavirus gastroenteritis included current breastfeeding, owning a refrigerator, and being immunized with 1 or 2 doses of a live-attenuated monovalent rotavirus vaccine. History of previous diarrheal episodes and living with 7 or more people in the same household were associated with higher risk of developing rotavirus gastroenteritis. CONCLUSION: During this outbreak, dietary, socioeconomic, and environmental factors were independently associated with risk of developing rotavirus disease. Rotavirus vaccine also offered significant protection against rotavirus disease of any severity, emphasizing the value of vaccination as a simple and highly effective public health strategy for prevention of rotavirus illness.

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OBJECTIVE: To assess factors influencing perspectives on Brazil's national Family Health Program (PSF) by exploring satisfaction with PSF units and home-visit community health agents and perceptions about PSF unit accessibility among frequent users (primary caretakers of children under age 5) in Vespasiano, Minas Gerais. METHODS: Data were collected though cross-sectional household surveys to determine pro grammatic and demographic factors affecting user satisfaction with the PSF. Multivariate logistic modeling was used to estimate users' satisfaction with PSF units and agents and perceived access to PSF unit services. Chi-square and analysis of variance (ANOVA) tests were used to estimate statistical differences. RESULTS: The majority of caretakers were satisfied with both their PSF unit and their PSF community health agent and had received at least one monthly home visit from the health agent. Satisfaction with both the health agent and the unit was positively associated with per ceived access to the unit and frequency of agent home visits. Caretakers who reported that their PSF agent made one or more home visits per month were more likely to perceive the PSF unit as being "accessible" (or "sometimes accessible"). CONCLUSIONS: The current data are important indicators of population health in Minas Gerais, Brazil, and suggest that users' satisfaction with the PSF and perceptions about its accessibility can be improved by ensuring that all households receive at least one health agent home visit per month. These results could be applied to other parts of Brazil or Latin America to improve understanding of user perceptions of health systems.

OBJETIVO: Evaluar los factores que influyen en las perspectivas sobre el Programa de Salud Familiar (PSF) del Brasil, mediante el análisis de la satisfacción de los usuarios frecuentes del PSF (cuidadores primarios de niños menores de 5 años) con las unidades y los agentes de salud comunitarios que efectúan las visitas a domicilio, y de la percepción de dichos usuarios respecto de la accesibilidad a la unidad del PSF en Vespasiano, Minas Gerais. MÉTODOS: Se recopilaron datos mediante encuestas transversales de hogares para determinar los factores programáticos y demográficos que afectaban la satisfacción de los usuarios con el PSF. Para estimar la satisfacción de los usuarios con las unidades y los agentes de salud del PSF y su percepción sobre el acceso a los servicios prestados por la unidad del PSF se usó un modelo logístico multifactorial. Para calcular las diferencias estadísticas se usaron las pruebas de ji al cuadrado y análisis de la varianza (ANOVA). RESULTADOS: La mayoría de los cuidadores estuvieron satisfechos tanto con su unidad del PSF como con su agente de salud comunitario del programa, de quien habían recibido al menos una visita a domicilio mensual. La satisfacción con este y con la unidad se asoció positivamente con la percepción de acceso a la unidad y con la frecuencia de las visitas a domicilio del agente. Los cuidadores que informaron que su agente del PSF hizo una o más visitas al domicilio por mes presentaron mayores probabilidades de considerar a la unidad del PSF como "accesible" (o "a veces accesible"). CONCLUSIONES: Los datos actuales son indicadores importantes del estado de salud de la población en Minas Gerais, Brasil, y sugieren que la satisfacción de los usuarios con el PSF y su percepción acerca de la accesibilidad a este pueden mejorarse si se garantiza que todos los hogares reciban al menos una visita a domicilio mensual del agente de salud. Estos resultados podrían aplicarse a otras zonas del Brasil o de América Latina para comprender mejor la percepción de los usuarios sobre los sistemas de salud.

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Introdução: O rotavírus apresenta distribuição universal, determinando episódios de gastrenterite aguda, endêmica em regiões de clima tropical. A forma mais eficaz de evitá-la é por meio da imunização. Crianças vindas de ambiente com melhores condições e mais elevado nível sociocultural tendem a ter melhor prognóstico, enquanto aquelas vindas de famílias carentes apresentam maior risco de gravidade da doença. Objetivo: Avaliar o perfil socioeconômico das famílias das crianças que não aderiram ao esquema da vacina contra o rotavírus. Métodos: Por meio do cartão-sombra, cópia do cartão vacinal de cada criança em poder dos agentes comunitários de saúde do Centro de Saúde Cecy Fortes, analisou-se a situação vacinal das crianças nascidas no período de abril de 2009 a janeiro de 2011. O prontuário de família das crianças, que não realizaram o esquema completo da vacina contra rotavírus, foi avaliado com base nos dados assentados nos mesmos, relativos ao seu perfil socioeconômico. Resultados e discussão: De 183 cartões-sombra avaliados, 25 encontravam-se com esquema incompleto ou ausente da vacina e tiveram os prontuários de família avaliados. Sessenta e oito por cento dessas famílias têm renda inferior a dois salários mínimos, o que representa risco de agravo de doenças diarreicas. Porém, 96% dos pais são alfabetizados, e 100% das famílias vivem em habitações com condições satisfatórias de saneamento, que inferem bom prognóstico. Conclusão: As famílias dessas crianças são, em sua maioria, compostas por pais alfabetizados, têm renda familiar inferior a dois salários mínimos e as condições de habitação e saneamento são satisfatórias.

Introduction: Rotavirus has a universal distribution, causing episodes of acute gastroenteritis, endemic in tropical regions. Immunization is the most effective way to avoid it. Children from an environment with better conditions and higher socioeconomic factors have better prognosis, while those coming from poor families have more risk of disease severity. Objective: To evaluate the socioeconomic profile of children's families that did not join the rotavirus vaccine schedule. Methods: Through the shade card, used by community health agents of the Cecy Fortes Health Center, the vaccination status of children born from April 2009 to January 2011 was analyzed. The family files of children who did not join the rotavirus vaccine schedule were evaluated, based on the data on these files, about their socioeconomic profile. Results and discussion: From the 183 cards shadow included in the study, 25 were incomplete or missing the vaccine schedule and had their family files evaluated. Sixty-eight percent of these families have incomes below two minimum wages, which represents risk of gravity of the diarrheal diseases. However, 96% of the parents are illiterate, and 100% of families live in houses with adequate conditions of sanitation, which infer a good prognosis. Conclusion: The children's families are largely composed of literate parents, have family income below two minimum wages, and satisfactory conditions of housing and sanitation.

Introducción: El rotavirus tiene una distribución universal, causando episodios de gastroenteritis aguda, endémica en regiones tropicales. La manera más eficaz de evitarlo es mediante la inmunización. Los niños de un mejor ambiente y con condiciones socioeconómicas superiores tienden a tener un mejor pronóstico, mientras que los procedentes de familias pobres están en mayor riesgo de severidad de la enfermedad. Objetivo: Evaluar el perfil socio-económico de las familias de los niños que no cumplan con el régimen de la vacuna contra el rotavirus. Métodos: A través de la tarjeta de sombra, el uso de la salud de la comunidad en el Centro de Salud Cecy Fortes, se analizó el estado de vacunación de los niños nacidos entre abril de 2009 a enero de 2011. Los registros de la familia de los niños que no realizaron la descripción completa de la vacuna contra el rotavirus fue evaluado sobre la base de los datos sentados en la misma en relación a su perfil socioeconómico. Resultados y discusión: De 183 tarjetas de sombra evaluados, 25 fueron incompletos o ausentes en un régimen de la vacuna y los registros de la familia fueron evaluados. Sesenta y ocho por ciento de las familias perciben ingresos inferiores a dos salarios mínimos, lo que representa un riesgo de lesión a causa de enfermedades diarreicas. Sin embargo, el 96% de los padres saben leer y escribir, y el 100% de las familias viven en casas con condiciones adecuadas de saneamiento, lo que infiere un buen pronóstico. Conclusión: Las familias de estos niños son en su mayoría compuestas por padres que saben leer y escribir, tienen ingresos familiares inferiores a dos salarios mínimos y las condiciones de la vivienda y el saneamiento son satisfactorias.

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