Effectiveness of rotavirus vaccination against childhood diarrhoea in El Salvador: case-control study

Objective To evaluate the effectiveness of a monovalent rotavirus vaccine against severe rotavirus disease and to assess its impact on diarrhoea in children aged less than 2 years after national introduction in El Salvador, a low-middle income country in Central America

Estimating the future global dose demand for measles–rubella microarray patches

BackgroundProgress toward measles and rubella (MR) elimination has stagnated as countries are unable to reach the required 95% vaccine coverage. Microarray patches (MAPs) are anticipated to offer significant programmatic advantages to needle and syringe (N/S) presentation and increase MR vaccination coverage. A demand forecast analysis of the programmatic doses required (PDR) could accelerate MR-MAP development by informing the size and return of the investment required to manufacture MAPs.MethodsUnconstrained global MR-MAP demand for 2030–2040 was estimated for three scenarios, for groups of countries with similar characteristics (archetypes), and four types of uses of MR-MAPs (use cases). The base scenario 1 assumed that MR-MAPs would replace a share of MR doses delivered by N/S, and that MAPs can reach a proportion of previously unimmunised populations. Scenario 2 assumed that MR-MAPs would be piloted in selected countries in each region of the World Health Organization (WHO); and scenario 3 explored introduction of MR-MAPs earlier in countries with the lowest measles vaccine coverage and highest MR disease burden. We conducted sensitivity analyses to measure the impact of data uncertainty.ResultsFor the base scenario (1), the estimated global PDR for MR-MAPs was forecasted at 30 million doses in 2030 and increased to 220 million doses by 2040. Compared to scenario 1, scenario 2 resulted in an overall decrease in PDR of 18%, and scenario 3 resulted in a 21% increase in PDR between 2030 and 2040. Sensitivity analyses revealed that assumptions around the anticipated reach or coverage of MR-MAPs, particularly in the hard-to-reach and MOV populations, and the market penetration of MR-MAPs significantly impacted the estimated PDR.ConclusionsSignificant demand is expected for MR-MAPs between 2030 and 2040, however, efforts are required to address remaining data quality, uncertainties and gaps that underpin the assumptions in this analysis

Impact of vaccination against Haemophilus influenzae type b with and without a booster dose on meningitis in four South American countries

Fil: García, Salvador. Pan American Health Organization, Washington DC; Estados Unidos.Fil: Lagos, Rosanna. Centro para Vacunas en Desarrollo (CVD-Chile), Santiago; Chile.Fil: Muñoz, Alma. Centro para Vacunas en Desarrollo (CVD-Chile), Santiago; Chile.Fil: Picón, Teresa. National Immunization Program and Department of Epidemiologic Surveillance, Ministry of Health, Montevideo; Uruguay.Fil: Rosa, Raquel. National Immunization Program and Department of Epidemiologic Surveillance, Ministry of Health, Montevideo; Uruguay.Fil: Alfonso, Adriana. National Immunization Program and Department of Epidemiologic Surveillance, Ministry of Health, Montevideo; Uruguay.Fil: Abriata, Graciela. Instituto Nacional del Cáncer, Ministerio de Salud de la Nación, Buenos Aires; Argentina.Fil: Gentile, Angela. Hospital de Niños Ricardo Gutierrez, Epidemiología, Buenos Aires; Argentina.Fil: Romanin, Viviana. Hospital de Niños Ricardo Gutierrez, Epidemiología, Buenos Aires; Argentina.Fil: Regueira, Mabel. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Chiavetta, Laura. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Agudelo, Clara Inés. Instituto Nacional de Salud, Bogotá; Colombia.Fil: Castañeda, Elizabeth. Instituto Nacional de Salud, Bogotá; Colombia.Fil: De la Hoz, Fernando. Facultad de Medicina, Departamento de Salud Pública, Universidad Nacional de Colombia, Bogotá; Colombia.Fil: Higuera, Ana Betty. Secretaria de Salud de Bogotá, Bogotá; Colombia.Fil: Arce, Patricia. Secretaria de Salud de Bogotá, Bogotá; Colombia.Fil: Cohen, Adam L.. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; Estados Unidos.Fil: Verani, Jennifer. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; Estados Unidos.Fil: Zuber, Patrick. Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva; Suiza.Fil: Gabastou, Jean-Marc. Pan American Health Organization, Washington DC; Estados Unidos.Fil: Pastor, Desiree. Pan American Health Organization, Washington DC; Estados Unidos.Fil: Flannery, Brendan. Pan American Health Organization, Washington DC; Estados Unidos.Fil: Andrus, Jon. Pan American Health Organization, Washington DC; Estados Unidos.To inform World Health Organization recommendations regarding use of Haemophilus influenzae type b (Hib) vaccines in national immunization programs, a multi-country evaluation of trends in Hib meningitis incidence and prevalence of nasopharyngeal Hib carriage was conducted in four South American countries using either a primary, three-dose immunization schedule without a booster dose or with a booster dose in the second year of life. Surveillance data suggest that high coverage of Hib conjugate vaccine sustained low incidence of Hib meningitis and low prevalence of Hib carriage whether or not a booster dose was used

Impact of vaccination against Haemophilus influenzae type b with and without a booster dose on meningitis in four South American countries

Fil: García, Salvador. Pan American Health Organization, Washington DC; Estados Unidos.Fil: Lagos, Rosanna. Centro para Vacunas en Desarrollo (CVD-Chile), Santiago; Chile.Fil: Muñoz, Alma. Centro para Vacunas en Desarrollo (CVD-Chile), Santiago; Chile.Fil: Picón, Teresa. National Immunization Program and Department of Epidemiologic Surveillance, Ministry of Health, Montevideo; Uruguay.Fil: Rosa, Raquel. National Immunization Program and Department of Epidemiologic Surveillance, Ministry of Health, Montevideo; Uruguay.Fil: Alfonso, Adriana. National Immunization Program and Department of Epidemiologic Surveillance, Ministry of Health, Montevideo; Uruguay.Fil: Abriata, Graciela. Instituto Nacional del Cáncer, Ministerio de Salud de la Nación, Buenos Aires; Argentina.Fil: Gentile, Angela. Hospital de Niños Ricardo Gutierrez, Epidemiología, Buenos Aires; Argentina.Fil: Romanin, Viviana. Hospital de Niños Ricardo Gutierrez, Epidemiología, Buenos Aires; Argentina.Fil: Regueira, Mabel. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Chiavetta, Laura. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Agudelo, Clara Inés. Instituto Nacional de Salud, Bogotá; Colombia.Fil: Castañeda, Elizabeth. Instituto Nacional de Salud, Bogotá; Colombia.Fil: De la Hoz, Fernando. Facultad de Medicina, Departamento de Salud Pública, Universidad Nacional de Colombia, Bogotá; Colombia.Fil: Higuera, Ana Betty. Secretaria de Salud de Bogotá, Bogotá; Colombia.Fil: Arce, Patricia. Secretaria de Salud de Bogotá, Bogotá; Colombia.Fil: Cohen, Adam L.. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; Estados Unidos.Fil: Verani, Jennifer. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; Estados Unidos.Fil: Zuber, Patrick. Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva; Suiza.Fil: Gabastou, Jean-Marc. Pan American Health Organization, Washington DC; Estados Unidos.Fil: Pastor, Desiree. Pan American Health Organization, Washington DC; Estados Unidos.Fil: Flannery, Brendan. Pan American Health Organization, Washington DC; Estados Unidos.Fil: Andrus, Jon. Pan American Health Organization, Washington DC; Estados Unidos.To inform World Health Organization recommendations regarding use of Haemophilus influenzae type b (Hib) vaccines in national immunization programs, a multi-country evaluation of trends in Hib meningitis incidence and prevalence of nasopharyngeal Hib carriage was conducted in four South American countries using either a primary, three-dose immunization schedule without a booster dose or with a booster dose in the second year of life. Surveillance data suggest that high coverage of Hib conjugate vaccine sustained low incidence of Hib meningitis and low prevalence of Hib carriage whether or not a booster dose was used

Costos económicos de las neumonías en niños menores de 2 años de edad, en Colombia The economic costs of pneumonia in children under 2 years of age in Colombia

OBJETIVOS: Analizar los costos de las neumonías presuntamente virales y bacterianas diagnosticadas por radiografía en centros de referencia de tres ciudades colombianas. MÉTODOS: Se estudiaron 128 casos de neumonía, 64 bacterianas y 64 virales, que ingresaron consecutivamente a los hospitales del estudio en Cartagena, Medellín y Santa Fe de Bogotá entre julio de 2001 y enero de 2003. Los diagnósticos de neumonía se fundamentaron en la radiografía de tórax y la población de estudio se compuso de niños menores de 2 años que requirieron hospitalización. Para estimar los costos de cada intervención se utilizó el método de determinación de costos por actividad para cada caso, después de lo cual se estimaron los costos medios. RESULTADOS: Los costos de las neumonías presuntamente bacterianas fueron de 611,50 dólares estadounidenses (US$) (IC95$ (IC95%, 331,80-612,60). Las diferencias observadas se explican por los costos directos, en particular de los medicamentos (antibióticos), servicios especiales y pruebas diagnósticas. Dada la similar procedencia de las familias de ambas poblaciones, los costos indirectos no mostraron diferencias y su participación en los costos totales no se consideró relevante. CONCLUSIONES: El estudio reveló diferencias en los costos de la atención de las neumonías presuntamente bacterianas y virales, y se aproximó a los costos indirectos generados por estas entidades patológicas. Tales diferencias permiten inferir que el método de diagnóstico utilizado, que fue la radiografía de tórax, tuvo la capacidad de diferenciar los sucesos de interés. Puesto que en la Región son escasos los estudios económicos que valoren los costos de la neumonía en niños, el presente puede servir de referencia para futuras investigaciones sobre el impacto de las intervenciones en las neumonías.OBEJCTIVE: To analyze the costs of pneumonias presumed to be of viral or bacterial origin, as diagnosed by chest X ray, in four reference center hospitals in three cities in Colombia. METHODS: A total of 128 cases of pneumonia (64 bacterial cases and 64 viral cases) that had consecutively entered the hospitals in the study between July 2001 and January 2003 were investigated. The diagnosis of pneumonia was based on chest X rays. The study population was composed of children under 2 years of age who required hospitalization. In order to estimate the costs for bacterial pneumonias and viral pneumonias, the cost of each activity was determined for each case, and then average costs were calculated. RESULTS: The average cost of the presumably bacterial pneumonia cases was US$611.50 (95$ 532.20-690.80); that of the presumably viral cases was US$472.20 (95$ 331.80-612.60). The observed differences were due to direct expenses, especially drugs (antibiotics), special services, and diagnostic tests. In the two groups the families were similar in their incomes and the indirect costs that they had to bear, so the indirect costs were not considered relevant in terms of distinguishing between the costs caused by the two forms of pneumonia. CONCLUSIONS: The study found differences in the direct costs of care between the presumably bacterial cases and the presumably viral ones. The study results also gave an approximation of the indirect costs to the patients' families caused by the pneumonias. The differences found in the direct costs also indicate that X-ray diagnosis is useful for differentiating between viral and bacterial pneumonia. Few studies in Latin America have assessed the economic costs of pneumonia in children, so this study can serve as a reference for future research on the impact of interventions against pneumonia

Public health responses during measles outbreaks in elimination settings: Strategies and challenges

In late September 2016, the Americas became the first region in the world to have eliminated endemic transmission of measles virus. Several other countries have also verified measles elimination, and countries in all six World Health Organization regions have adopted measles elimination goals. The public health strategies used to respond to measles outbreaks in elimination settings are thus becoming relevant to more countries. This review highlights the strategies used to limit measles spread in elimination settings: (1) assembly of an outbreak control committee; (2) isolation of measles cases while infectious; (3) exclusion and quarantining of individuals without evidence of immunity; (4) vaccination of susceptible individuals; (5) use of immunoglobulin to prevent measles in exposed susceptible high-risk persons; (6) and maintaining laboratory proficiency for confirmation of measles. Deciding on the extent of containment efforts should be based on the expected benefit of reactive interventions, balanced against the logistical challenges in implementing them