128 research outputs found
Immunogenicity and immunization costs of adjuvanted versus non-adjuvanted hepatitis B vaccine in chronic kidney disease patients
Hepatitis B virus (HBV) vaccination is recommended for all
susceptible chronic pre-hemodialysis and hemodialysis patients.
This study assessed the immunogenicity of HBV vaccines
(adjuvanted and non-adjuvanted) in chronic kidney disease
patients vaccinated at the Hospital Clinic of Barcelona (Spain)
between January 2007 and July 2012. In addition, the costs for
the health system were evaluated according to the proportion of
vaccine responders after receiving either vaccine. Patients
receiving three doses of hepatitis B adjuvanted vaccine were
three times more likely to seroconvert than patients immunized
with non-adjuvanted vaccines, OR 3.56 (95% CI 1.84-6.85). This
resulted in fewer patients requiring a second course of HBV
vaccination and fewer outpatient visits, saving more than
euro9,500 per 100 patients. The higher immunogenicity of the
adjuvanted HBV vaccine would counterbalance the lower costs
associated with the non-adjuvanted vaccine
Rubella susceptibility in pregnant women and results of a postpartum immunization strategy in Catalonia, Spain
BACKGROUND: Elimination of congenital rubella syndrome depends
not only on effective childhood immunization but also on the
identification and immunization of rubella susceptible women. We
assessed rubella susceptibility among pregnant women and
evaluated the adherence and response to postpartum immunization
with measles, mumps and rubella (MMR) vaccine. METHODS:
Cross-sectional study of women who gave birth at the Hospital
Clinic de Barcelona (Spain) between January 2008 and December
2013. Antenatal serological screening for rubella was performed
in all women during pregnancy. In rubella-susceptible women, two
doses of MMR vaccine were recommended following birth. We
evaluated rubella serological response to MMR vaccination in
mothers who complied with the recommendations. RESULTS: A total
of 22,681 pregnant women were included in the study. The mean
age was 32.3 years (SD 5.6), and 73.6% were primipara. The
proportion of immigrants ranged from 43.4% in 2010 to 38.5% in
2012. The proportion of women susceptible to rubella was 5.9%
(1328). Susceptibility to rubella declined with increasing
maternal age. Immigrant pregnant women were more susceptible to
rubella (7.6%) than women born in Spain (4.6%). Multivariate
analyses showed that younger age (</=19 years) aOR 1.7 (95%
CI 1.1-2.5), primiparas aOR 1.3 (95% CI 1.1-1.5) and immigrant
women aOR 1.6 (95% CI 1.4-1.8) were more likely to be
susceptible. The second dose of MMR vaccine was received by
57.2% (718/1256) of rubella-susceptible women, with the highest
proportion being immigrant women compared with women born in
Spain. After vaccination, all women showed rubella immunity.
CONCLUSIONS: The higher rubella susceptibility found in the
three youngest age groups and in immigrant women highlights the
relevance of antenatal screening, in order to ensure
identification and postpartum immunization. The postpartum
immunization strategy is an opportunity to protect women of
childbearing age and consequently prevent occurrence of CRS, and
to increase vaccination coverage against rubella and other
vaccine-preventable diseases
Pregnant women's perspectives about maternal immunization in Latin America
Background: Maternal immunization rates and vaccine uptake in Latin America vary from country to country. This variability stems from factors related to pregnant women, vaccine recommendations from healthcare providers and the health system. The aim of this paper is to describe women's knowledge and attitudes to maternal immunziation, and barriers to access and vaccination related decision-making processes in Latin American countries. Methods: We conducted focus group discussions (FGD) with pregnant women in five middle-income countries: Argentina, Brazil, Honduras, Mexico and Peru, between July 2016 and July 2018. The FGDs were conducted by trained qualitative researchers in diverse clinics located in the capital cities of these countries. Results: A total of 162 pregnant women participated in the FGDs. In general, participants were aware of the recommendation to receive vaccines during pregnancy but lacked knowledge regarding the diseases prevented by these vaccines. Pregnant women expressed a desire for clearer and more detailed communication on maternal vaccines by their healthcare professionals instead of relying on other sources of information such as the internet. Overall, participants had positive attitudes towards maternal immunization and were open to receiving vaccines in pregnancy based on general trust they have in recommendations made by their healthcare providers. The main obstacles pregnant women said they encounter were mainly centered around their clinical experience: long waiting times, vaccine shortages, and impolite behavior of healthcare providers or clinical staff. Conclusion: Important advances have been made in Latin America to promote maternal immunization. Results from this study show that an important aspect that remains to be addressed, and is crucial in improving vaccine uptake in pregnancy, is women's clinical experience. We recommend pregnant women to be treated as a priority population for providing immunization and related healthcare education. It is imperative to train healthcare providers in health communication so they can effectively communicate with pregnant women regarding maternal vaccines and can fill knowledge gaps that otherwise might be covered by unreliable sources dispensing inaccurate information.Fil: Fauzia Malik, A.. University of Yale. School of Medicine; Estados UnidosFil: Belizan, MarĂa. Instituto de Efectividad ClĂnica y Sanitaria; ArgentinaFil: Gutierrez, Mariana. University of Emory; Estados UnidosFil: Vilajeliu, Alba. Pan American Health Organization; Estados UnidosFil: Sanclemente, Lauren N.. University of Emory; Estados UnidosFil: Gonzalez Casanova, Ines. Indiana University; Estados Unidos. University of Emory; Estados UnidosFil: Jones, Daniel Eduardo. Instituto de Efectividad ClĂnica y Sanitaria; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Omer, Saad. University of Yale; Estados Unidos. University of Yale. School of Medicine; Estados UnidosFil: Maria Ropero, Alba. Pan American Health Organization; Estados UnidosFil: Alonso, Juan Pedro. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentina. Instituto de Efectividad ClĂnica y Sanitaria; Argentin
Health care providers perspectives about maternal immunization in Latin America
Background: Antenatal care providers have a key role in providing appropriate information and immunization recommendations to improve pregnant women's vaccine uptake. The objective of this study is to describe health care providers' perspectives and experience regarding the implementation of maternal immunization programs in Latin America. Methods: We conducted 33 in-depth interviews of health care providers from Argentina, Brazil, Honduras, Mexico, and Peru (6–7 per country). Qualitative data analysis was conducted using a combination of both manual techniques and the computer software program NVivo. We identified and coded main themes related to maternal immunization. Results: The main themes identified in this analysis were practices related to maternal immunization, knowledge and training, resource availability and interactions with pregnant women. Healthcare providers knew that recommendations exists but some did not know their content; they expressed concerns about insufficient training. Providers from all five countries expressed the need for additional human resources and supplies. They also expressed a desire for women to be more proactive and ask more questions during the health visits. Conclusion: This is the first multi-country study assessing the perspectives of health care providers about maternal immunization practices at the facility level in Latin America. Recommendations based on the results from this study include implementing additional trainings around maternal immunization, especially targeting obstetricians and midwives. These trainings should be conducted in coordination with improvements to supply chain and other structural issues.Fil: Malik, Fauzia A.. University of Yale; Estados UnidosFil: Alonso, Juan Pedro. Instituto de Efectividad ClĂnica y Sanitaria; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Sanclemente, Lauren N.. University of Emory; Estados UnidosFil: Vilajeliu, Alba. OrganizaciĂłn Panamericana de la Salud; Estados UnidosFil: Gutierrez, Mariana. University of Emory; Estados UnidosFil: Gonzalez Casanova, Ines. University of Emory; Estados Unidos. Indiana University; Estados UnidosFil: Jones, Daniel Eduardo. Instituto de Efectividad ClĂnica y Sanitaria; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Omer, Saad. University of Yale; Estados UnidosFil: Ropero, Alba-Maria. OrganizaciĂłn Panamericana de la Salud; Estados UnidosFil: Belizán, MarĂa Melina Eleonora. Instituto de Efectividad ClĂnica y Sanitaria; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentin
Weak surveillance and policy attention to cancer in global health: the example of Mozambique
Cancer is an emerging public health problem in sub-Saharan
Africa due to population growth, ageing and westernisation of
lifestyles. The increasing burden of cancer calls for urgent
policy attention to develop cancer prevention and control
programmes. Cancer surveillance is an essential prerequisite.
Only one in five low-income and middle-income countries have the
necessary data to drive policy and reduce the cancer burden. In
this piece, we use data from Mozambique over a 50-year period to
illustrate cancer epidemiological trends in low-income and
middle-income countries to hypothesise potential circumstances
and factors that could explain changes in cancer burden and to
discuss surveillance weaknesses and potential improvements. Like
many low-income and middle-income countries, Mozambique faces
the dual challenge of a still high morbidity and mortality due
to infectious diseases in rural areas and increased incidence of
cancers associated with westernisation of lifestyles in urban
areas, as well as a rise of cancers related to the HIV epidemic.
An increase in cancer burden and changes in the cancer profile
should be expected in coming years. The Mozambican healthcare
and health-information systems, like in many other low-income
and middle-income countries, are not prepared to face this
epidemiological transition, which deserves increasing policy
attention
Trends in Cancer Incidence in Maputo, Mozambique, 1991-2008
BACKGROUND: Very limited information is available regarding the
incidence of cancer in sub-Saharan Africa. We analyzed changes
in cancer patterns from 1991 to 2008 in Maputo (Mozambique).
METHODS: We calculated the rates of incidence of different
cancer sites by sex in the 5-year age-group of the population of
Maputo city as well as age-standardized rates (ASRs) and average
annual percentage changes (AAPC). RESULTS: Over the 18-year
study period a total of 12,674 cases of cancer (56.9% females)
were registered with an overall increase in the risk of cancer
in both sexes. In males, the most common cancers were those of
the prostate, Kaposi sarcoma (KS) and the liver. Prostate cancer
showed the most dramatic increase over the whole study period
(AAPC +11.3%; 95% CI: 9.7-13.0), with an ASR of 61.7 per 105 in
2003-2008. In females, the most frequent cancers were of the
uterine cervix, the breast and KS, with the former increasing
along the whole study period (AAPC + 4.7%; 95% CI: 3.4-6) with
an ASR of 62.0 per 105 in 2003-2008 as well as breast cancer
(AAPC +6.5%; 95%CI: 4.3-8.7). CONCLUSIONS: Overall, the risk of
cancer rose in both sexes during the study period, particularly
among cancers associated with westernization of lifestyles
(prostate, breast), combined with increasingly rising incidences
or limited changes in cancers associated with infection and
poverty (uterine cervix, liver). Moreover, the burden of
AIDS-associated cancers has shown a marked increase
The impact of maternal RSV vaccine to protect infants in Gavi-supported countries: Estimates from two models.
BACKGROUND: Interventions to protect young infants against respiratory syncytial virus (RSV) are in advanced phases of development and are expected to be available in the foreseeable future. Gavi, the Vaccine Alliance, included maternal vaccines and infant monoclonal antibodies for RSV as part of the 2018 vaccine investment strategy (VIS) and decided to support these products subject to licensure, World Health Organization prequalification, Strategic Advisory Group of Experts recommendation, and meeting the financial assumptions used as the basis of the investment case. Impact estimates reported in this manuscript were used to inform the Gavi VIS. METHODS: We compared two independent vaccine impact models to evaluate a potential maternal RSV vaccine's impact on infant health in 73 Gavi-supported countries. Key inputs were harmonized across both models. We analyzed various scenarios to evaluate the effect of uncertain model parameters such as vaccine efficacy, duration of infant protection, and infant disease burden. Estimates of averted cases, severe cases, hospitalizations, deaths, and disability-adjusted life years (DALYs) were calculated over the 2023-2035 horizon. FINDINGS: A maternal RSV vaccine with 60% efficacy offering 5Â months of infant protection implemented across 73 low- and middle-income countries could avert 10.1-12.5 million cases, 2.8-4.0 million hospitalizations, 123.7-177.7 thousand deaths, and 8.5-11.9 million DALYs among infants under 6Â months of age for the duration of analysis (2023-2035). Maternal RSV vaccination was projected to avert up to 42% of estimated RSV deaths among infants under 6Â months in year 2035. Alternative scenario analyses with higher disease burden assumptions showed that a maternal vaccine could avert as many as 325-355 thousand deaths among infants under 6Â months. INTERPRETATION: RSV maternal immunization is projected to substantially reduce mortality and morbidity among young infants if introduced across Gavi-supported countries. FUNDING: This work was supported by Bill & Melinda Gates Foundation, Seattle, WA, and Respiratory Syncytial Virus Consortium in Europe. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation or of the Respiratory Syncytial Virus Consortium. LW is supported by Research Foundation-Flanders (1234620Â N)
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