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

Objective: To assess the contribution of rapid vaccination monitoring to the achievement of vaccination coverage targets in catch-up vaccination campaigns.

Methods: Data on catch-up vaccination were obtained from the database of the Directorate of Vaccine-Preventable Diseases. Data analysis was performed in Stata V.15^®. Frequency and summary statistics were calculated; the p value was used to determine statistical significance. The change in mean coverage between interventions was assessed with Student's t-test.

Results: During the catch-up campaign, 815,482 children in 157 municipalities were immunized, and 2,431 rapid monitoring activities were carried out. Prior to rapid monitoring, measles and rubella (MR) vaccine coverage was 85.7%, while bivalent oral polio vaccine (bOPV) coverage was 89.9%; coverage was homogeneous in 78% of municipalities. After rapid monitoring, MR coverage rose to 98.7% and bOPV coverage to 100%. MR coverage increased by 14.6% and bOPV coverage by 11.7%; both changes were statistically significant (Student's t-test: 12.3 and 10.8, respectively; P = 0).

Conclusion: Rapid monitoring is a useful strategy for validating coverage during catch-up vaccination campaigns and should be carried out by outside teams. The reported data can be used to improve the accuracy of coverage data. Rapid monitoring is an appropriate strategy from a cost-benefit standpoint, and we recommend its use to assess data quality during catch-up vaccination campaigns.

Objective: To estimate the direct costs associated with the diagnosis, treatment, and control of measles cases in Brazil from 2018 to 2020.

Methods: This cost-of-illness study utilized a prevalence-based approach, considering direct costs incurred by the Brazilian Public Health System (SUS) related to measles outbreaks, including costs of inpatient care, outpatient care, and laboratory tests, as well as measles-containing vaccines and laboratory tests (viral isolation) used for outbreak control. Costs are presented in 2020 US dollars. Univariate and bivariate sensitivity analyses were performed.

Results: There were 36 236 confirmed measles cases from 2018 to 2020. The estimated outbreaks cost was USD 107 960 122, with the cost per case ranging from USD 2 601 to USD 3 654 (mean USD 2 979).

Conclusions: These findings highlight the substantial economic burden imposed by measles outbreaks in Brazil and emphasize the importance of measles prevention and control measures. Policymakers and public health authorities can use these results to plan and allocate resources, to mitigate the economic impact of future outbreaks.

Since the last case of indigenous rubella virus (RuV) was detected in 2009 in the Region of the Americas, sporadic rubella and congenital rubella cases have been confirmed, and subsequently, a low number of associated sequences have been reported. Fifty-one sequences of wild-type RuV, representing four genotypes (1E, 1G, 1J, and 2B), were reported from five countries, with confirmed sources of exposure for 46 cases. Phylogenetic analysis revealed the diversity of these viruses, showing no associations with sustained endemic transmission from previously endemic strains. Notably, 13 sequences were associated with travel from countries where no genetic information of wild-type viruses was available. In addition to sequences from postnatal and congenital infections, 23 sequences were collected from patients with diseases associated with RuV persistent infection. These findings highlight the Region's success in maintaining rubella elimination, emphasize its valuable contribution to global RuV molecular epidemiology, and address potential challenges in progressing toward the goal of rubella eradication.

Objective: To quantify three aspects of data-related developmental progress across 57 Small Island Developing States (SIDS) recognized by the United Nations: statistical capacity measured using the Statistical Performance Indicators (SPI), data availability using the Sustainable Development Goal (SDG) indicators, and gender-stratified indicators.

Methods: SIDS as a single country group were compared with other World Bank regions, using SPI, availability of SDG metrics, and availability of gender-stratified metrics. Using population size as a proxy for "smallness," its association with data capacity and availability was modeled.

Results: SPI among SIDS was lower than in any world region - broadly equivalent to Sub-Saharan Africa. Two-thirds of SDG indicators were available for SIDS in 2022; other world regions having between 71% and 87% availability. One-third of gender-stratified indicators were available for SIDS in 2022; other world regions having between 58% and 68% availability. Population size was strongly associated with each outcome, with SIDS having a statistical capacity 18.0 percentage points lower than other countries [95% CI (8.5, 27.4)], SDG data availability 17.4 percentage points lower [95% CI (13.1, 21.7)], and gender-stratified indicator availability 28.8 percentage points lower [95% CI (24.5, 33.0)].

Conclusions: As global demand and associated rewards for electronic data increase, our analysis highlights the challenges introduced by island "smallness" in the global push for digital transformation. Regional cooperation mechanisms, sustained international support, and systematic monitoring of data availability are urgently required to monitor capacity development.

Objective: To describe the impact of the new intervention model implemented by Paraguay across five districts of the Central Region in the last quarter of 2023, consisting of an integrated health services-based strategy to recover coverage with the tracer vaccine (pentavalent until April 2023, hexavalent thereafter) in children under 1 year of age; and the measles, mumps, and rubella (MMR) vaccine for the 1-year-old population.

Methods: Descriptive, cross-sectional study with comparative analysis before (epidemiological weeks [EW] 1 and 34 of 2023) and after (EW35 and EW52 of 2023) the intervention. Three indicators were assessed: a) coverage with all three doses of pentavalent or hexavalent vaccine and first and second doses of MMR; b) productivity, represented by third doses of pentavalent or hexavalent vaccine administered; and c) dropout rates for the pentavalent or hexavalent and MMR vaccines.

Results: After the intervention, average weekly coverage with the third dose of pentavalent or hexavalent vaccine was 1.2%, an increase of 1.0% from the pre-intervention average. Compared to 2022, coverage with the third dose of pentavalent or hexavalent vaccine increased by 3.5% in 2023, while coverage with the first and second doses of MMR increased 32.7% and 4%, respectively. The average number of weekly third doses of pentavalent or hexavalent vaccine administered increased to 257, up from 215 prior to the intervention. The dropout rate declined from 17.9% to 9.2% for pentavalent and hexavalent vaccine and from 55.0% to 46.5% for the MMR vaccine.

Conclusion: Implementation of the new intervention model had a positive impact on the indicators of interest, halting the downward trend in vaccination coverage recorded in recent years.

Objective: To measure the variation in number of doses, vaccination coverage (VC) of administered vaccines, and number of municipalities that achieved the VC target in Brazil with the implementation of microplanning for high-quality vaccination activities (HQVA) and decentralized multivaccination actions.

Methods: This quasi-experimental study used data from the National Live Birth Information System, the National Immunization Program Information System, and the National Health Data Network. The number of doses of hepatitis A (HA), meningococcal conjugate-C, oral poliomyelitis, 10-valent pneumococcal, diphtheria-tetanus-pertussis (DTP), and measles-mumps-rubella (MMR) vaccines administered to children under 2 years of age in 2022 (pre-microplanning) and 2023 (post-microplanning) was estimated. VC and the number of municipalities that achieved the VC target were also estimated.

Results: In 2022, 13 253 873 doses of the selected vaccines were recorded. In 2023, 13 570 346 doses were administered. An increase in VC was observed, especially for the DTP vaccine (increase > 12%); and for the HA and MMR vaccines (increase close to 10%). The number of municipalities that reached the VC target grew in 2023 (increase of 51.98% for MMR and 7.77% for the meningococcal vaccine).

Conclusion: Microplanning strengthened routine immunization and was a timely measure to address situations of declining VC. This favorable outcome also highlights the importance of continuing and expanding these actions to achieve and maintain positive results.

Objective: To describe the strategy implemented for interruption of the 2019-2020 measles outbreak in the Metropolitan Area of Buenos Aires (Argentina) and application of the Pan American Health Organization (PAHO) standardized outbreak closure criteria to verify interruption of viral circulation in an adverse setting (the COVID-19 pandemic).

Methods: Descriptive, retrospective observational study of the actions taken in response to the measles outbreak that occurred between epidemiological week (EW) 35 of 2019 and EW 12 of 2020. Interruption of viral circulation was documented through epidemiological, vaccination-coverage, and laboratory criteria. Data were obtained from the National Surveillance System, the Federal Vaccination Registry, and outbreak reports.

Results: The outbreak control strategy in Argentina focused on intensifying vaccination and strengthening epidemiological surveillance. The information thus obtained made it possible to analyze compliance with PAHO criteria and verify the interruption of viral circulation.

Conclusions: Outbreak interruption and verification thereof represented a challenge in the complex epidemiological scenario the country was facing. The application of standardized outbreak closure criteria allows planning of activities. However, in extraordinary circumstances, meeting the proposed criteria requires relative weighting according to technical priorities and implementation of innovative strategies adapted to the epidemiological context.

Objective: To document and compare risk factors and control measures for the largest measles outbreaks in the post-elimination era in the Region of the Americas.

Methods: Description of risk factors such as vaccination coverage, notification rate of suspected cases, measles incidence, and a summary of control measures for major measles outbreaks in six countries from 2017 to 2023. The analysis also includes a review of outbreak characteristics (time, place, and person).

Results: Between 2017 and 2023, 19 countries in the Americas reported a total of 50 082 cases and 121 deaths from measles. Of these cases, 49 738 (99.3%) were reported in six countries: Argentina, Brazil, Colombia, Mexico, the United States of America, and Venezuela. In two of these six countries, endemic transmission was reestablished due to the presence of risk factors that could not be managed with the control measures initially established. Between 2017 and 2019, the predominant genotypes and lineages were the MVi/Hulu Langat.MYS/26.11 (D8) lineage and the Gir Somnath.IND/42.16 (D8) lineage.

Conclusions: Countries that had better coverage with two doses of measles, rubella, and mumps vaccine, optimal notification rates, and incidence rates of less than 5 cases per million population responded better and faster to measles outbreaks and were able to interrupt virus transmission before 12 months of circulation.

The Caribbean small island developing states have limited resources for comprehensive health care provision and are facing an increasing burden of noncommunicable diseases which is driven by an aging regional population. Artificial intelligence (AI) and other digital technologies offer promise for contributing to health care efficiencies, but themselves are dependent on the availability and accessibility of accurate health care data. A regional shortfall in data professionals continues to hamper legislative recognition and promotion of increased data production in Caribbean countries. Tackling the data shortfall will take time and will require a sustainably wider pool of data producers. The data journey map is one approach that can contribute to overcoming such challenges. A data journey map is a process for organizing the collection of health data that focuses on interactions between patient and health care provider. It introduces the idea that data collection is an integral part of the patient journey and that interactions between patient and provider can be enhanced by building data collection into daily health care. A carefully developed and enacted data journey map highlights key points in the care pathway for data collection. These so-called data hotspots can be used to plan - then eventually implement - appropriate AI health care solutions. In this article we introduce the idea of journey mapping, offer an example using cervical cancer prevention and treatment, and discuss the benefits and challenges to implementing such an approach.

Objective: To determine measles and rubella IgG seropositivity in the post-elimination era, based on data generated by the Costa Rican National Reference Center for Virology laboratory at Inciensa from 2012 to 2023.

Methods: Cross-sectional, descriptive, observational study analyzing the frequency of measles IgG and rubella IgG reactivity by enzyme-linked immunofluorescence (ELISA) in 877 subjects.

Results: The average age of the studied individuals was 36 years; 51.8% were women. Measles and rubella IgG seropositivity was slightly higher in females. The average seropositivity over the study period was 74.8% for measles IgG antibodies and 84.5% for rubella. The age group 50 years and older exhibited the highest positivity for the both measles and rubella IgG, while the 20-to-39 age group had the lowest protective humoral response.

Conclusions: Descriptive studies of measles and rubella IgG seropositivity can identify age groups susceptible to these infections, which in turn can guide health authorities in directing supplementary immunization campaigns to strengthen the immune response of the population and prevent outbreaks of both diseases.