Revista Panamericana De Salud Publica-pan American Journal of Public Health最新文献

Objective: To describe the implementation and pioneering work of a vaccine pharmacovigilance committee in the state of São Paulo, Brazil, for the analysis of events supposedly attributable to vaccination or immunization (ESAVI) during the COVID-19 pandemic.

Methods: This is a retrospective, mixed-methods (qualitative and quantitative) case study focusing on the work carried out by the pharmacovigilance committee in the years 2021 and 2022. The minutes of committee meetings were used to describe how the committee operates. ESAVI cases discussed and addressed at expert meetings were recorded. The number of vaccine doses applied during the period of analysis, as well as the number of ESAVIs reported within that period, was obtained from statewide information systems.

Results: Over 55 pharmacovigilance committee meetings held in 2021-2022, 118 ESAVI cases-most related to COVID-19 vaccines-were discussed. A total of 126,778,252 doses of COVID-19 vaccines were administered during this period, with 42,893 ESAVI reported. Among the cases selected for discussion, 71.2% occurred after the first dose of vaccine, 32.8% represented neurological events, and only 5% were deemed to have a causal relationship with the vaccine.

Conclusions: The pharmacovigilance committee played a significant role in the ESAVI surveillance system during the period of analysis by assisting in the evaluation of more complex cases. It shows potential to contribute positively to strengthening the immunization program, especially within the safe vaccination system framework.

Objective: To analyze the results of surveillance of adverse events of special interest (AESI) within the context of the COVID-19 vaccination campaign at a sentinel site in Argentina. The retrospective (pre-vaccination) period was compared with the prospective (vaccination) period to identify safety signals.

Methods: Retrospective and prospective search for AESI based on ICD-10 hospital discharge codes. A descriptive analysis, moving-averages trend smoothing, and control charts were used to detect changes in AESI behavior.

Results: A total of 1,586 AESI were identified. Analysis of the proportion of AESI codes at hospital discharge revealed an increase during the pandemic period (2020) and a progressive decrease during the vaccination period (2021-2022), accounted for by the incidence of acute respiratory distress syndrome (ARDS). Moving-average smoothing and control charts were compared to identify time points at which the proportion of AESI exceeded the upper limits of control. During the vaccination period, this occurred for ARDS, thrombosis, myocarditis, meningoencephalitis, multisystem inflammatory syndrome, and anaphylaxis. No differences were observed for Guillain-Barré syndrome, thrombocytopenia, or pericarditis. Acute disseminated encephalomyelitis, meningoencephalitis, and pericarditis events during the vaccination period all occurred in subjects with no history of vaccination.

Conclusion: Active sentinel-site surveillance allowed identification of AESI occurring at a higher frequency during the vaccination period compared to the pre-vaccination baseline. The protective effect of the vaccine against COVID -19 was clearly observed, as manifested especially by a reduction of ARDS cases in the post-vaccination period. This strategy is useful for assessing vaccine safety by identification of safety signals.

Objective: Describe good practices in epidemiological surveillance implemented in El Salvador between 2019 and 2023 to sustain the elimination of measles, rubella, and congenital rubella syndrome.

Methods: Special descriptive report on the implementation of good epidemiological and laboratory surveillance practices for measles, rubella, and congenital rubella syndrome from 2019 to 2023.

Results: During the period 2019 to 2023, El Salvador reported no confirmed cases of measles, rubella, or congenital rubella syndrome. The national measles and rubella notification rate was 8.4 per 100 000 population in 2023; 9 in 2022; 5.6 in 2021; 2.9 in 2020; and 8.2 in 2019. Between the report of the first confirmed case of COVID-19 in the country and the declaration of the end of the international health emergency by the World Health Organization on 5 May 2023, the rate of reported suspected cases of measles and rubella remained above the indicator.

Conclusions: The implementation of permanent and mandatory epidemiological surveillance strategies allowed the sustainability of measles and rubella elimination in El Salvador during the COVID-19 pandemic.

Objective: To describe the continuing education strategies implemented as part of the academic training of health workers; related barriers and facilitators; and the perceptions of health workers in sentinel hospitals in Honduras regarding changes in their knowledge.

Methods: The implemented continuing education strategies are described, as are the findings of a questionnaire given to assess health workers' perceptions of the effectiveness of these strategies in the acquisition of knowledge, skills, and competencies related to the surveillance of events supposedly attributable to vaccination, immunization, or adverse events of special interest. Barriers to participation in these strategies is also described.

Results: In the 2021-2023 period, 23 trainings were conducted with 384 participants, as well as two workshops with 134 participants, six rounds of awareness-raising with 242 professionals, 2 486 rounds of active searches twice a week in both sentinel hospitals, and an instant messaging system with 157 participants. The questionnaire obtained 154 responses from health workers. The main barriers were not realizing the questionnaire existed, limited availability of time, and no staff to replace them in the wards.

Discussion: The perception of health workers was that their knowledge increased and their ability to conduct sentinel surveillance improved. However, participation in continuing education strategies requires massive dissemination, the inclusion of topics that motivate professionals, and the implementation of an institutional policy that values the strategies and makes participation in them feasible.

Objective: This study aimed to explore the use of data from routine health information systems (RHIS) as a public good in Trinidad and Tobago, the challenges faced in doing this and opportunities for strengthening the health information system.

Methods: For this descriptive qualitative study, purposive sampling was utilized to recruit 19 people who used or produced RHIS data. Online interviews were conducted via Zoom, and all interviews were recorded and transcribed. Pseudonyms were used to protect participants' identity. Transcripts were cleaned and analyzed using Dedoose (v. 9.0.17; Dedoose, Los Angeles, CA, USA).

Results: There was significant underutilization of RHIS data as a public good, primarily due to challenges related to data access and quality. Access to the data was stymied by burdensome bureaucratic processes, paper-based recording and storage systems, and ownership and security concerns. Data quality was adversely affected by a lack of standardized data collection forms and processes, staff training, data completeness, and also by technological and infrastructural constraints. Key opportunities for increasing the use of Trinidad and Tobago's RHIS data would include addressing the need for a national electronic health information system, ensuring adequate training for staff involved in data management, and developing a comprehensive monitoring and evaluation plan.

Conclusions: Data quality and access must be improved to enable greater use of RHIS data as a public good in Trinidad and Tobago. The planned change from a paper-based to a national electronic data recording and storage system must be expedited, and it should be accompanied by the standardization of processes, and investments in adequate staffing and timely training. Appropriate technological and infrastructural support, as well as an improved data governance system, are also required.

The elimination of endemic rubella and measles transmission in the Region of the Americas was verified by the Pan American Health Organization's (PAHO) Regional Verification Commission in 2015 and 2016, respectively. Upon achieving this success, this Commission was disbanded. Shortly afterwards, the Region faced challenges in the post-elimination era, notably responding to and stopping transmission of imported measles cases. As a result, Brazil and Venezuela (Bolivarian Republic of) lost their measles-free status in February 2019 and July 2018, respectively. These events spurred PAHO to form the Measles and Rubella Elimination Regional Monitoring and Re-Verification Commission (MRE-RVC) focused on re-verifying these two countries and providing intensive evaluations of all countries in their efforts to sustain elimination. The MRE-RVC was tasked with advocacy to help revitalize the necessary political commitment to provide sufficient resources to sustain measles and rubella elimination in the Americas. Maintaining measles and rubella elimination in the Region is important, despite the challenges such as the global circulation of measles and rubella viruses elsewhere. This paper outlines the activities of the MRE-RVC to address the challenges and the lessons learnt, and provides insight on sustaining the gains. The main reasons to sustain efforts are: measles vaccine saves more lives than any other vaccine; congenital rubella syndrome is still the leading cause of infectious disease birth defects in the world; and measles vaccination performance remains an indicator of national capacity to maintain health security and a timely response to future infectious disease threats. A global target for measles and rubella elimination is crucial.

Objective: We describe the daily operations of the Cohorts Consortium of Latin America and the Caribbean (CC-LAC), detailing the resources required and offering tips to Caribbean researchers so this guide can be used to start a data pooling project.

Methods: The CC-LAC began by developing a steering committee - that is, a team of regional experts who guided the project's set up and operations. The Consortium invites investigators who agree to share individual-level data about topics of interest to become members and they then have input into the project's goals and operations; they are also invited to coauthor papers. We used a systematic review methodology to identify investigators with data resources aligned with the project and developed a protocol (i.e. a manual of procedures) to document all aspects of the project's operations.

Results: If a study recruited people from more than one country, then the sample from each country was counted as a separate cohort, thus in 2024 our combined data resources include >30 separate units from 13 countries, with a combined sample size of >174 000 participants. Using this unique resource, we have produced region-specific risk estimates for cardiometabolic risk factors (e.g. anthropometrics) and cardiovascular disease, and we have developed a region-specific cardiovascular risk score for use in clinical settings.

Conclusions: Data pooling projects are less expensive than collecting new data, and they increase the longer-term value and impact of the data that are contributed. Data pooling efforts require systematic and transparent methodology, and expertise in data handling and analytics are prerequisites. Researchers embarking on a data pooling endeavor should understand and be able to meet the various data protection standards stipulated by national data legislation as these standards will likely vary among jurisdictions.

The dissemination of biomedical research data beyond academia remains limited. In response, funding agencies now regularly require that the projects they fund make research data openly available for reuse. This emerging open data movement aims to democratize data access, often guided by the FAIR data technical standards, requiring that data should be findable, accessible, interoperable and reusable. Recently, participant communities have advocated the idea that improving data democracy does not address the inequities underlying the power dynamics of research enterprises. In contrast, the CARE principles of Indigenous data governance focus on collective benefit, authority to control, responsibility and ethics. We describe the data-sharing infrastructure and initiatives of the Eastern Caribbean Health Outcomes Research Network (ECHORN) for the ECHORN Cohort Study, which longitudinally examines risks and protective factors for noncommunicable diseases among community-dwelling adults in the United States and Caribbean locations. This work has been grounded in a community-engaged process, with the goal of developing robust, sustainable solutions for the dissemination of information. We highlight efforts towards operationalizing greater access to these longitudinal data resources, including the implementation of a regional survey to understand data needs and data-sharing capacities and the development of Explore ECHORN (https://exploreechorn.org), a free public data dashboard. Through these efforts, ECHORN has identified opportunities to expand initiatives that have the potential to encourage data-sharing to inform policy and strengthen the impact of research, particularly in the Caribbean. ECHORN also seeks to reconcile a community-engaged approach with the dissemination of data for secondary use.

Objective: Describe the challenges, strategies and lessons learned in Venezuela during the measles outbreak of 2017-2019, and discuss the mechanisms employed for its containment, which led to the interruption of endemic transmission.

Methods: Descriptive study of the actions taken by Venezuela to interrupt the outbreak.

Results: When the outbreak was confirmed, the Venezuelan government, with technical cooperation from the Pan American Health Organization, activated a plan to interrupt measles transmission. This plan consisted of vaccination activities, epidemiological surveillance, strengthening of laboratory diagnostic capacity, and the formation of rapid response teams.

Conclusions: The measles outbreak posed a significant challenge to the country, but a comprehensive approach and prioritized health actions were fundamental in achieving control of the outbreak and interrupting it after 111 weeks, with lessons learned for the containment of future outbreaks.

The CaribData project, funded by the Inter-American Development Bank and implemented by The University of the West Indies, aims to enhance data-handling, -sharing and reuse capabilities in the Caribbean. The project focuses on four main objectives: developing an online data-handling platform, creating a sustainable training and mentoring program, launching a data communication initiative and conducting data availability audits. To evaluate its progress, CaribData integrates two implementation science frameworks, RE-AIM (for Reach, Effectiveness, Adoption, Implementation, Maintenance) and the Consolidated Framework for Implementation Research. The evaluation will use quantitative and qualitative methods, including monitoring usage metrics, and surveys, interviews and thematic content analysis. Informed consent will be obtained for all evaluation activities. Positive outcomes would include enhanced regional data-sharing capabilities, improved data-handling skills among participants, increased production and dissemination of impactful data stories, and the identification of data gaps and priorities. The online platform is anticipated to streamline the processes of data collection and sharing, while the training program is expected to bolster regional expertise in data analytics and management. If successful, CaribData will bolster the Caribbean's data-sharing infrastructure, promoting regional data sovereignty and enhancing the utility of data for evidence-based decision-making. The project's technology, educational and communication strategies will lay a foundation for sustained impact. However, sustainability will depend on ongoing stakeholder engagement, ongoing funding from multiple sources and adapting to evolving data governance frameworks. Ensuring a robust sustainability plan and monitoring its implementation will be critical for maintaining the project's benefits beyond the initial funding period (2023-2025).