La pobreza extrema es prioridad: Un argumento sobre la distribución equitativa de la vacuna contra el COVID-19 en Perú

La humanidad ya dispone de vacunas eficaces contra el COVID-19. En Perú se administraron 86 millones de dosis para cubrir la demanda de 33 millones de peruanos. Para ello, se ha priorizado la vacunación en grupos clave: personal de salud, sujetos con condiciones de salud preexistentes y mayores de 65 años. Sin embargo, dada la problemática social y la situación de la salud pública en Perú, este trabajo defiende que la prioridad de la vacunación debe centrarse en la población que vive en extrema pobreza. El método utilizado fue una argumentación ética sobre la distribución de la vacuna contra el COVID-19 en Perú. Esta argumentación se basa en el análisis de la población peruana que vive en extrema pobreza, la cual presenta diferentes estratos de vulnerabilidad, y que, ante una eventual infección por SARS-CoV-2, se irían agravando uno tras otro, a través de un efecto en cascada. Este escenario daría lugar a nuevas vulnerabilidades de las ya existentes, causando mayores daños. Los esfuerzos de vacunación en esta población clave les brindaría oportunidad de seguir encontrando formas de llevar alimentos a sus hogares, reduciendo significativamente el riesgo de contagio en su entorno y mitigando el efecto devastador de las enfermedades locales a las que ya está expuesta. Se plantean cuatro objeciones relacionadas con este argumento, con sus correspondientes respuestas. El acceso prioritario a la vacuna reduciría significativamente el daño a las personas que viven en la extrema pobreza, haciendo prevalecer los principios de justicia y equidad.

Risk Perceptions Regarding COVID-19 and Compliance with Protective Measures of Midwifery and Nursing Senior Students

OBJECTIVE

This study aims to examine the risk perceptions of midwifery and nursing senior students regarding COVID-19 and compliance with vaccination and protective measures.

METHOD

This cross-sectional study was conducted in two academic years on senior midwifery and nursing students (n = 358). In the present study, the descriptive characteristics of the students and the COVID-19 risk perception scale were used.

RESULTS

The students' COVID-19 Risk Perception Scale scores were at a moderate level and a similar level in both years of this study. More than 80% of the students were fully vaccinated, and the family history of COVID-19 was positive in approximately half of them. In the second year of the pandemic, they paid less attention to social distance and avoidance of being indoors.

CONCLUSION

Although the COVID-19 risk perceptions of future health professional students remained at a similar level during the examined period, it was found that in the second year of the pandemic, they started to get used to the process and paid less attention to social protective measures.

Coverage and determinants of childhood vaccination during the COVID-19 pandemic in Fortaleza, Northeastern Brazil: a longitudinal analysis

Brazil has seen a decrease in vaccination coverage since 2016. This study analyzes the immunization status of children born during the COVID-19 pandemic in Fortaleza, Northeastern Brazil. This is a longitudinal analysis that included vaccination data of 313 children aged 12 and 18 months. Vaccination cards were checked for dose application considering the schedule of immunization recommended by the Brazilian Ministry of Health. Factors associated with no retention of vaccination cards and incomplete immunization by 18 months were identified by Tobit regression analysis. About 73% of mothers presented their child's vaccination card. Non-availability of vaccination cards was associated with maternal age < 25 years and mothers with paid jobs. Only 33% and 45% of the children aged 12 and 18 months had all vaccines up to date, respectively. For 3-dose vaccines, the delay rate was around 10% for the first dose application, but 40% for the third dose. Despite delays, most children with available vaccine cards had coverage above 90% by 18 months of age. Adjusted factors associated with incomplete vaccination included living in a household with more than one child (p = 0.010) and monthly income of less than one minimum wage (p = 0.006). Therefore, delays in child vaccine application were high during the COVID-19 pandemic but a considerable uptake by 18 months of age was found. Poorer families with more than one child were particularly at risk of not fully immunizing their children and should be the target of public policies.

[Online survey on the reasons for vaccine hesitancy against COVID-19 in children and adolescents in Brazil]

The objective is to unveil the reasons for vaccine hesitancy among parents and/or guardians of children and adolescents toward the prevention of COVID-19. This is a descriptive study, with a qualitative approach that seeks to analyze the answers to the open question "Why will you not vaccinate or have not vaccinated or are in doubt about vaccinating the children and adolescents under your responsibility, for the prevention of COVID-19?". The research included adult individuals, Brazilians, living in the country, responsible for children and adolescents under 18 years of age. Data collection took place electronically in November and December 2021. The answers were organized and processed with the support of the software Iramuteq. The textual corpus of this research was composed of the response of 1,896 participants, consisting of 87% who were hesitant (1,650) and 13% (246) of parents who intend to vaccinate but who outlined some doubts and considerations about the vaccination of children and adolescents. These are reasons why parents and/or guardians have not vaccinated or are in doubt about vaccinating the children and adolescents under their responsibility for the prevention of COVID-19: fears about vaccination regarding the conception that the vaccine is in the experimental phase, fear of adverse reactions and long-term effects. The reasons for the lack of intention to vaccinate stem from the understanding of the participants that COVID-19 in children is not serious, the risks of vaccination are greater than the benefits, and the right of choice not to vaccinate.

Standard Operating Procedure validity on intramuscular vaccine administration in adults: a methodological study

OBJECTIVE

to validate a Standard Operating Procedure on the intramuscular vaccine administration technique in adults using high frequency vibration associated with cryotherapy.

METHODS

a literature review on intramuscular vaccination practice using a vibration device associated with cryotherapy. Then, a form was created to validate the instrument, detailing the items that were assessed by judges following recommendations in the literature. Judges' answers were assessed using the Content Validity Index, with items whose index was greater than or equal to 0.80 being validated.

RESULTS

twenty-five nurses participated in validity, identifying judges' opinion regarding item relevance, clarity and accuracy. Judges validated the instrument, according to the values that remained between 0.88 and 1.0.

CONCLUSIONS

the instrument developed and validated is a tool capable of guaranteeing safety and standardizing immunization practice in vaccine rooms.

Clinical trials of COVID-19 vaccine development: a global overview

This study aims to report analyses regarding the global distribution of institutions involved in clinical trials of COVID-19 vaccines throughout February 2022. We retrieved global data from the World Health Organization report on vaccine development. These data allowed us to identify project institutions and plot their geographic coordinates. We produced a georeferenced map using an R programming environment and, based on the geographical location of vaccine developers, we analyzed the subcontinental distribution of clinical trials and the nature of the vaccines. Regionally, South-Southeast Asian countries carried out more clinical trials than any other region, proportionally, although this happened solely for mature technologies. Few trials were under implementation in Latin America and Africa. Our findings confirm previous studies on the regional concentration in the development of technology. However, our contribution lies in showing these phenomena for COVID-19 vaccines in specific subcontinents and technologies, at a country level. Our data underscores which subcontinents perform very few clinical trials for COVID-19 and seem to be ill-prepared for future disease outbreaks, and if these become epidemics or even pandemics and require domestic vaccine development or production. We also consider the case of Brazil, which did not finish the complete cycle of COVID-19 vaccine development in the indicated period; but, with favorable policies, it has potential to engage further in COVID-19 vaccine technology.

Vaccines against monkeypox

The monkeypox virus is a virus that has 90% genomic homology with the human (smallpox), but it is naturally transmitted between different wild animal reservoirs and is considered a zoonosis. Throughout the 20th century, different vaccines based on the vaccinia poxvirus were developed and used for vaccination against smallpox. After the eradication of smallpox, these vaccines were no longer used. Current vaccines against monkeypox virus are classified by the WHO as replicative (ACAM2000), minimally replicative (LC16m8) and non-replicative (MVA-BN), the latter being the one currently used. The 2022 extra-African monkeypox virus epidemic has highlighted the lack of vaccines with proven efficacy and low reactogenicity. It is considered that the use of this vaccine in the current outbreak may play a role in the prevention or attenuation of the disease as pre-exposure prophylaxis in close contacts of confirmed cases.

Lessons from SENCOVAC: A prospective study evaluating the response to SARS-CoV-2 vaccination in the CKD spectrum

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has negatively impacted on patients of the whole CKD spectrum, causing high rates of morbi-mortality. SARS-CoV-2 vaccines opened a new era, but patients with CKD (including kidney transplant, hemodialysis and peritoneal dialysis) were systematically excluded from pivotal clinical trials. The Spanish Society of Nephrology promoted the multicentric national SENCOVAC study aimed at assessing immunological responses after vaccination in patients with CKD. During the first year after vaccination, patients with non-dialysis CKD and those on hemodialysis and peritoneal dialysis presented good anti-Spike antibody responses to vaccination, especially after receiving the third and fourth doses. However, kidney transplant recipients presented suboptimal responses after any vaccination schedule (initial, third and fourth dose). Especially worrisome is the situation of a patients with a persistently negative humoral response that do not seroconvert after boosters. In this regard, monoclonal antibodies targeting SARS-CoV-2 have been approved for high-risk patients, although they may become obsolete as the viral genome evolves. The present report reviews the current status of SARS-CoV-2 vaccination in the CKD spectrum with emphasis on lessons learned from the SENCOVAC study. Predictors of humoral response, including vaccination schedules and types of vaccines, as well as the integration of vaccines, monoclonal antibodies and antiviral agents are discussed.

IE-7919. Reticencias vacunales COVID-19

Las reticencias vacunales frente a COVID-19 en España han ido evolucionando de un 32 a un 10%, causando que España sea uno de los países con mayores tasas de vacunación sin ser obligatoria. De febrero a mayo del 2022 se observó un levantamiento de restricciones y uso de medidas no farmacológicas, dejándose de exigir también el certificado digital, no obstante, una parte de la población continuó iniciando la vacunación frente al COVID-19. El objetivo es evaluar las causas que conducen a la vacunación en las personas vacunadas de forma tardía.

Métodos

El presente es un estudio cualitativo, descriptivo y prospectivo, con entrevistas telefónicas individuales a personas vacunadas frente a COVID-19 de forma tardía, entre febrero y mayo del 2022. El cuestionario se realizó telefónicamente, se efectuaron 2 llamadas por identificador y se utilizaron preguntas cerradas, obteniendo información de datos sociodemográficos, así como relacionados con la COVID-19 y su vacunación.

Resultados

La población vacunada de primera dosis durante el período de estudio fue de 1.768, contactando con 801, accediendo a contestar la encuesta 338 personas. Las variables sociodemográficas de la población encuestada se encuentran recogidos en la tabla, los resultados de los motivos de no vacunación en la tabla 2 y los motivos que conducen a la vacunación en la tabla 3.Unlabelled ImageUnlabelled ImageUnlabelled Image

Conclusiones

Una prioridad de la Estrategia Nacional de Vacunación frente a COVID-19 es iniciar la vacunación en las personas no vacunadas. Para las campañas hacia este colectivo es necesario diseñar estudios específicos para conocer a las personas reticentes frente a esta vacunación. Uno de los motivos que han fomentado la vacunación es considerar «ya» segura la vacuna, siendo fundamental reforzar los mensajes de seguridad. Además, viajar es un motivo reiterado para la vacunación, siendo importante no olvidar la posibilidad de exigir la vacunación para alguna actividad.

Papel protector de las actuales vacunas para las variantes del virus SARS-CoV-2 y la COVID persistente

Puntos para una lectura rápida•La COVID-19 persistente es un complejo plurisintomático de difícil manejo clínico. •La vacunación por sí sola no es suficiente para controlar la pandemia. •La aparición de variantes del SARS-CoV-2 puede condicionar la respuesta vacunal. •La variante de mayor interés epidemiológico y la predominante actualmente es la delta. •Las vacunas con tecnología ARNm son efectivas contra las variantes. •La mejor estrategia contra las variantes es estar correctamente vacunado.

Efectividad y seguridad de las vacunas para el SARS-CoV-2 actualmente disponibles

•Actualmente se están administrando cuatro vacunas en España con dos tecnologías diferentes: ARNm (Comirnaty y Moderna) y de vectores (Vaxzevria y Janssen). •Se habían administrado hasta junio de 2021 más de 38 millones de dosis y 15 millones de ciudadanos tenían la pauta vacunal completa. •Las vacunas han demostrado en los ensayos clínicos ser eficaces tanto para prevenir la infección como la hospitalización y el fallecimiento. •Los datos más concluyentes de su efectividad son en población mayor de 65 años ingresados en residencias. •Aún no disponemos de información para conocer la efectividad vacunal en otros segmentos poblacionales. •En general, las vacunas son seguras, aunque aparecen efectos adversos poco frecuentes, pero potencialmente graves, que requieren alta sospecha clínica y seguimiento: síndrome trombosis-trombocitopenia, síndrome de fuga capilar, miocarditis, cuadros anafilácticos, adenopatías. •Los sanitarios tienen un papel fundamental en la aceptabilidad y seguridad vacunal por la sospecha y notificación de posibles efectos adversos y la información dada a la ciudadanía.

[Vaccine-related adverse reactions in immunocompromised patients and in special situations of a hospital Vaccine Unit]

OBJECTIVE

The aim of the study was to describe the type of vaccines administered in the Vaccine Unit at a reference hospital. Calculate the overall and specific reporting rate of adverse reactions.

METHODS

Retrospective observational study for the period between November 2014 and November 2017, on patients who developed an adverse drug reaction (ADR) after the administration of a vaccine and who were notified to the Spanish Pharmacovigilance System. The variables analyzed were age, sex, risk group, vaccine class, co-administration and type of ADR. A univariate and bivariate analysis was performed. The global and vaccine specific rate of ADR notification was calculated.

RESULTS

A total of 18,123 vaccines were administered, of which 20.7% corresponded to hepatitis B virus vaccine. Fifty-three RAM suspects were reported. In 64.2% of cases only one vaccine was administered. Inactivated vaccines accounted for 88.7% of notifications. The highest number of notifications was generated by the 23 serotypes pneumococcal polysaccharide vaccine. The overall reporting rate was 0.42%. The hexavalent vaccine had the highest reporting rate (2.81%). 49.1% of the ADR were systemic.

CONCLUSIONS

The overall reporting rate was low but higher than that of other authors. Proper reporting of possible adverse post-vaccine reactions is essential to contribute to vaccine safety and to increase public confidence in vaccines.

Cost-Utility Study of PCV13 Versus PPSV23 in Adults in Chile

INTRODUCTION

Pneumococcal infections are a public health problem in older adults. In Chile there are two vaccines at this time, PPSV23 and PCV13. The first has lower immunogenicity and effectiveness in preventing pneumococcal pneumonia and a lower cost than PCV13.

OBJECTIVE

To determine the cost-effectiveness of PCV13 versus PPSV23 in adults 18 years old and over in the Chilean Health System.

MATERIAL AND METHOD

A cost-utility study was performed using the Markov model (population data for a time horizon of 10 years). Utilities and epidemiological data were obtained from the literature and costs from the Chilean Public sector. Vaccine's costs and quality-adjusted life years (QALYs) were determined and compared.

RESULTS

PCV13 vaccination program in adults (≥18 years), generated savings of $42,195 USD and an increase of 6,820 QALYs, avoiding 107 cases of bacteremia, 13 meningitis, 6,706 inpatient pneumonia, 4,509 outpatient pneumonia and 1,189 deaths compared to PPSV23 without variation on sensitivity analysis on high impact variables. For the subgroup of patients over 65 years old PCV13 generates savings of $ 32,105.94USD and produces 5,430 QALYs more compared to PPSV23.

CONCLUSION

PCV13 is dominant. A PCV13 vaccination program saves costs to the public system, reduces mortality and morbidity; these results are robust.

Rotavirus vaccines contribute towards universal health coverage in a mixed public-private healthcare system

OBJECTIVES

To evaluate rotavirus vaccination in Malaysia from the household's perspective. The extended cost-effectiveness analysis (ECEA) framework quantifies the broader value of universal vaccination starting with non-health benefits such as financial risk protection and equity. These dimensions better enable decision-makers to evaluate policy on the public finance of health programmes.

METHODS

The incidence, health service utilisation and household expenditure related to rotavirus gastroenteritis according to national income quintiles were obtained from local data sources. Multiple birth cohorts were distributed into income quintiles and followed from birth over the first five years of life in a multicohort, static model.

RESULTS

We found that the rich pay more out of pocket (OOP) than the poor, as the rich use more expensive private care. OOP payments among the poorest although small are high as a proportion of household income. Rotavirus vaccination results in substantial reduction in rotavirus episodes and expenditure and provides financial risk protection to all income groups. Poverty reduction benefits are concentrated amongst the poorest two income quintiles.

CONCLUSION

We propose that universal vaccination complements health financing reforms in strengthening Universal Health Coverage (UHC). ECEA provides an important tool to understand the implications of vaccination for UHC, beyond traditional considerations of economic efficiency.

Seroepidemiology: an underused tool for designing and monitoring vaccination programmes in low- and middle-income countries

Seroepidemiology, the use of data on the prevalence of bio-markers of infection or vaccination, is a potentially powerful tool to understand the epidemiology of infection before vaccination and to monitor the effectiveness of vaccination programmes. Global and national burden of disease estimates for hepatitis B and rubella are based almost exclusively on serological data. Seroepidemiology has helped in the design of measles, poliomyelitis and rubella elimination programmes, by informing estimates of the required population immunity thresholds for elimination. It contributes to monitoring of these programmes by identifying population immunity gaps and evaluating the effectiveness of vaccination campaigns. Seroepidemiological data have also helped to identify contributing factors to resurgences of diphtheria, Haemophilus Influenzae type B and pertussis. When there is no confounding by antibodies induced by natural infection (as is the case for tetanus and hepatitis B vaccines), seroprevalence data provide a composite picture of vaccination coverage and effectiveness, although they cannot reliably indicate the number of doses of vaccine received. Despite these potential uses, technological, time and cost constraints have limited the widespread application of this tool in low-income countries. The use of venous blood samples makes it difficult to obtain high participation rates in surveys, but the performance of assays based on less invasive samples such as dried blood spots or oral fluid has varied greatly. Waning antibody levels after vaccination may mean that seroprevalence underestimates immunity. This, together with variation in assay sensitivity and specificity and the common need to take account of antibody induced by natural infection, means that relatively sophisticated statistical analysis of data is required. Nonetheless, advances in assays on minimally invasive samples may enhance the feasibility of including serology in large survey programmes in low-income countries. In this paper, we review the potential uses of seroepidemiology to improve vaccination policymaking and programme monitoring and discuss what is needed to broaden the use of this tool in low- and middle-income countries.

[New guidelines in regard to cervical cancer screening]

Cancer screening programs have been successful in reducing the incidence and mortality due to cervical cancer. For more than a decade, the human papillomavirus test has been recommended as part of these programs, however, Pap tests is not currently recommended for women 65 years of age who participated adequately in screening programs, continuing with these screening programs is not needed. Screening programs will be different in special populations at greatest risk where tests are frequently needed or use of alternative methods.

Non-specific effects of diphtheria-tetanus-pertussis and measles vaccinations? An analysis of surveillance data from Navrongo, Ghana

OBJECTIVES

Studies from low-income countries have suggested that routine vaccinations may have non-specific effects on child mortality; measles vaccine (MV) is associated with lower mortality and diphtheria-tetanus-pertussis (DTP) with relatively higher mortality. We used data from Navrongo, Ghana, to examine the impact of vaccinations on child mortality.

METHODS

Vaccination status was assessed at the initiation of a trial of vitamin A supplementation and after 12 and 24 months of follow-up. Within the placebo group, we compared the mortality over the first 4 months and the full 2 years of follow-up for different vaccination status groups with different likelihoods of additional vaccinations during follow-up. The frequency of additional vaccinations was assessed among children whose vaccination card was seen at 12 and 24 months of follow-up.

RESULTS

Among children with a vaccination card, more than 75% received missing DTP or MV during the first 12 months of follow-up, whereas only 25% received these vaccines among children with no vaccination card at enrollment. Children without a card at enrollment had a significant threefold higher mortality over the 2-year follow-up period than those fully vaccinated. The small group of children with DTP3-4 but no MV at enrollment had lower mortality than children without a card and had the same mortality as fully vaccinated children. In contrast, children with 1-2 DTP doses but no MV had a higher mortality during the first 4 months than children without a card [MRR = 1.65 (0.95, 2.87)]; compared with the fully vaccinated children, they had significantly higher mortality after 4 months [MRR = 2.38 (1.07, 5.30)] and after 2 years [MRR = 2.41 (1.41, 4.15)]. Children with 0-2 DTP doses at enrollment had higher mortality after 4 months (MRR = 1.67 (0.82, 3.43) and after 2 years [MRR = 1.85 (1.16, 2.95)] than children who had all three doses of DTP at enrollment.

CONCLUSIONS

As hypothesised, DTP vaccination was associated with higher child mortality than measles vaccination. To optimise vaccination policies, routine vaccinations need to be evaluated in randomised trials measuring the impact on survival.

[Health information on the Internet and trust marks as quality indicators: vaccines case study]

OBJECTIVES

To find out the prevalence of quality trust marks present in websites and to analyse the quality of these websites displaying trust marks compared with those that do not display them, in order to put forward these trust marks as a quality indicator.

DESIGN

Cross-sectional study.

SETTING

Internet.

PARTICIPANTS

Websites on vaccines.

MAIN MEASURES

Using "vacunas OR vaccines" as key words, the features of 40 web pages were analysed. These web pages were selected from the page results of two search engines, Google and Yahoo!

RESULTS

Based on a total of 9 criteria, the average score of criteria fulfilled was 7 (95% CI 3.96-10.04) points for the web pages offered by Yahoo! and 7.3 (95% CI 3.86-10.74) offered by Google. Amongst web pages offered by Yahoo!, there were three with clearly inaccurate information, while there were four in the pages offered by Google. Trust marks were displayed in 20% and 30% medical web pages, respectively, and their presence reached statistical significance (P=0.033) when fulfilling the quality criteria compared with web pages where trust marks were not displayed.

CONCLUSIONS

A wide variety of web pages was obtained by search engines and a large number of them with useless information. Although the websites analysed had a good quality, between 15% and 20% showed inaccurate information. Websites where trust marks were displayed had more quality than those that did not display one and none of them were included amongst those where inaccurate information was found.

[Carriers of hepatitis C: should they all be vaccinated for hepatitis A?]

AIM

To investigate the prevalence of immunization against hepatitis A virus (HAV) in persons with hepatitis C virus (HCV) infection, in order to determine who should be vaccinated for the former.

DESIGN

Descriptive, cross-sectional study.

SETTING

Urban health center serving 12 000 inhabitants.

PARTICIPANTS

Patients older than 14 years positive for HCV infection.

MAIN MEASURES

VARIABLES

presence of chronic liver disease, serological indications of hepatitis B, A, and immune deficiency virus (HIV) infection, vaccination for hepatitis B.

RESULTS

A total of 134 persons (70.9% men and 29.1% women) comprised the sample of patients positive for HCV infection. Mean age was 41.75 years (SD, 16.55 years). Nearly all patients (93.3%) had chronic liver disease, 56.7% were intravenous drug users, 56% were positive for Hbc antibodies and 32.8% were positive for HIV. Serological testing for HAV was done in 75 patients (56%); the result was positive in 86.7%. Mean age in this subgroup was 50.4 years (SD, 17.8 years). In the HAV-negative subgroup, mean age was 36.6 years (SD, 15 years; P=.02). Serological testing for HAV could not be done in 44% of the patients: 33.6% did not respond to attempts to contact them by telephone or in writing, 6% were temporarily away from home, and 1 patient declined to be tested. The response to requests to obtain blood samples was better in women (66.7%), HIV-negative patients (34.7%), persons who were not intravenous drug users (43.3%) and persons with chronic liver disease (60%).

CONCLUSIONS

In persons younger than 40 years, the proportion of seronegative individuals is similar to that in the general population. Vaccination should be considered for all patients positive for HCV infection. In persons older than 40 years with chronic liver disease, the decision to vaccinate for HAV should be made in the light of serological findings.