Carla Magda Allan S. Domingues

Effectiveness of ten-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in Brazil: a matched case-control study

BACKGROUND In March 2010, Brazil introduced the ten-valent pneumococcal conjugate vaccine (PCV10), which was licensed based on non-inferiority of immunological correlates of protection compared with the seven-valent vaccine. The schedule comprised three primary doses at ages 2 months, 4 months, and 6 months, and a booster dose at age 12 months. A single catch-up dose was offered for children aged 12-23 months at the time of introduction. We assessed PCV10 effectiveness against invasive pneumococcal disease in Brazilian children. METHODS Invasive pneumococcal disease, defined as isolation of Streptococcus pneumoniae from blood, cerebrospinal fluid, or another normally sterile site, was identified in children age-eligible for at least one PCV10 dose through laboratory-based and hospital-based surveillance in ten states in Brazil from March 1, 2010, until Dec 31, 2012. We aimed to identify four age-matched and neighbourhood-matched controls for each case. We used conditional logistic regression and calculated PCV10 effectiveness as (1-adjusted matched odds ratio) × 100% for vaccine-type and vaccine-related serotypes (ie, in the same serogroup as a vaccine serotype). FINDINGS In 316 cases (median age 13·2 months, range 2·6-53·1) and 1219 controls (13·3 months, 2·6-53·1), the adjusted effectiveness of an age-appropriate PCV10 schedule was 83·8% (95% CI 65·9-92·3) against vaccine serotypes, and 77·9% (41·0-91·7) against vaccine-related serotypes. Serotype-specific effectiveness was shown for the two most common vaccine serotypes-14 (87·7%, 60·8-96·1) and 6B (82·8%, 23·8-96·1)-and serotype 19A (82·2%, 10·7-96·4), a serotype related to vaccine serotype 19F. A single catch-up dose in children aged 12-23 months was effective against vaccine-type disease (68·0%, 17·6-87·6). No significant effectiveness was shown against non-vaccine serotypes for age-appropriate or catch-up schedules. INTERPRETATION In the routine immunisation programme in Brazil, PCV10 prevents invasive disease caused by vaccine serotypes. PCV10 might provide cross-protection against some vaccine-related serotypes. FUNDING Brazilian Ministry of Health, Pan-American Health Organization, and US Centers for Disease Control and Prevention.

Interruption of Measles Transmission in Brazil, 2000–2001

In 1992, Brazil adopted the goal of measles elimination by the year 2000; however, in 1997, after a 4-year period of good control, there was a resurgence of measles in Brazil. In 1999, to achieve the elimination goal, Brazil implemented the Supplementary Emergency Measles Action plan, with one measles surveillance technician designated to each state. Of 10,007 suspected measles cases reported during 1999, 908 (9.1%) were confirmed, and of them 378 (42%) were confirmed by laboratory analysis. Of 8358 suspected measles cases reported in 2000, 36 (0.4%) were confirmed (30 [83%] by laboratory); 92% of the discarded cases were classified on the basis of laboratory testing. In 2001, only 1 of 5599 suspected measles cases was confirmed, and it was an imported case from Japan. The last outbreak occurred in February 2000, with 15 cases. Current data suggest interruption of indigenous measles transmission in Brazil.

Coberturas vacinais e doenças imunopreveníveis no Brasil no período 1982-2012: avanços e desafios do Programa Nacional de Imunizações

Objective: to describe vaccination coverage (VC) and its homogeneity, dropout rates (DR) and the occurrence of vaccine-preventable diseases in Brazil. Methods: a descriptive cross-sectional study was conducted based on National Immunization Program (PNI) information systems data for the period 2002-2012 in order to calculate VC, its homogeneity and DR indicators, and also based on data provided by the Ministry of Health’s Communicable Diseases Coordination sector for the period 1982-2011 in order to calculate disease incidence. Results: VC was high in both routine vaccination and campaigns, resulting in the elimination or drastic reduction in preventable disease incidence, despite VC heterogeneity. Conclusion: the vaccination strategies adopted have increased vaccine availability in terms of territorial extension and, above all, in terms of population coverage. The establishment of the PNI as a public health policy priority has contributed to the reduction in vaccine-preventable disease incidence.

Indirect cohort analysis of 10-valent pneumococcal conjugate vaccine effectiveness against vaccine-type and vaccine-related invasive pneumococcal disease.

We applied the indirect cohort method to estimate effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) among young children in Brazil. Cases of invasive pneumococcal disease (IPD), i.e., Streptococcus pneumoniae, detected in normally sterile fluid identified through laboratory-based surveillance and previously enrolled in a matched case-control effectiveness study are included. We estimated PCV10 effectiveness using multivariable logistic regression comparing PCV10 vaccination among children with vaccine-type or vaccine-related IPD vs. children with non-vaccine-type disease. The adjusted effectiveness of ≥ 1 doses against vaccine-type (72.8%, 95% confidence interval [CI] [44.1, 86.7]) and vaccine-related (61.3%, 95%CI [14.5, 82.5]) IPD were similar to the effectiveness observed in the original case-control study (which required enrollment >1200 controls). We also found significant protection of ≥ 1 dose against individual vaccine serotypes (14, 6B, 23F, 18C) and against vaccine-related serotype 19A. The indirect cohort methods leverages existing surveillance is a feasible approach for evaluating pneumococcal conjugate vaccines, particularly in resource-limited settings.

Doenças dermatológicas de notificação compulsória no Brasil

The development of a Brazilian National Surveillance System in 1975 led to a compulsory reporting of selected infectious diseases aiming to reduce the burden of these events in the country. However, shifts in the epidemiology of these diseases associated with modern life style, demand constant revision of surveillance activities. In this manuscript we present the epidemiology, trends and differential diagnosis of the following compulsory notifiable diseases in Brazil: Aids, dengue fever, hanseniasis, American tegumentary leishmaniasis, measles, rubella and congenital rubella syndrome and syphilis. Additionally, the current challenges for control and prevention of each disease are presented

National immunization program: vaccination, compliance and pharmacovigilance

In Brazil, more than two centuries have passed since the first time (1804) the vaccine was administered as a control measure to prevent smallpox. Exactly a century later (1904), an epidemic of this disease led the President of the Republic Rodrigues Alves, to establish the obligation of the vaccination. In the same year, the hygienist Osvaldo Cruz coordinated the mass vaccination of the Rio de Janeiro`s population in order to control the epidemic. This movement generated a historical episode known as “The Vaccine Revolt” characterized by population rebellion and rejection to the measure adopted, culminating in the suspension of mandatory vaccination.

Introduction of Sequential Inactivated Polio Vaccine–Oral Polio Vaccine Schedule for Routine Infant Immunization in Brazil's National Immunization Program

In August 2012, the Brazilian Ministry of Health introduced inactivated polio vaccine (IPV) as part of sequential polio vaccination schedule for all infants beginning their primary vaccination series. The revised childhood immunization schedule included 2 doses of IPV at 2 and 4 months of age followed by 2 doses of oral polio vaccine (OPV) at 6 and 15 months of age. One annual national polio immunization day was maintained to provide OPV to all children aged 6 to 59 months. The decision to introduce IPV was based on preventing rare cases of vaccine-associated paralytic polio, financially sustaining IPV introduction, ensuring equitable access to IPV, and preparing for future OPV cessation following global eradication. Introducing IPV during a national multivaccination campaign led to rapid uptake, despite challenges with local vaccine supply due to high wastage rates. Continuous monitoring is required to achieve high coverage with the sequential polio vaccine schedule.

Uptake of pandemic influenza (H1N1)-2009 vaccines in Brazil, 2010

In 2010, the Brazilian Ministry of Health organized a mass vaccination campaign of selected priority groups in response to the 2009 H1N1 influenza pandemic. The campaign was conducted in six phases from March to July, 2010. Priority groups included healthcare professionals, indigenous persons, pregnant women, young children, persons with chronic illnesses and otherwise healthy adults 20-39 years of age. Over 89 million doses of pandemic influenza vaccines were administered, surpassing immunization targets among several priority groups, including healthcare professionals. We reviewed strategies used in Brazil to promote vaccination against pandemic influenza as well as factors external to the campaign that may have contributed to vaccine uptake among priority groups.

Classificação de risco de transmissão de doenças imunopreveníveis a partir de indicadores de coberturas vacinais nos municípios brasileiros

Resumo OBJETIVO: descrever a classificacao de risco de doencas imunopreveniveis nos municipios brasileiros. METODOS: estudo epidemiologico descritivo com dados do Sistema de Informacoes do Programa Nacional de Imunizacoes (SI-PNI) para 2014; os indicadores de coberturas vacinais foram utilizados para classificar o risco de transmissao de doencas imunopreveniveis nos municipios. RESULTADOS: dos 5.570 municipios brasileiros, 12,0% foram classificados como de risco muito baixo, 29,6% de risco baixo, 2,2% de risco medio, 54,3% de risco alto e 1,8% de risco muito alto. Conclusao: a vigilância das coberturas vacinais permitiu identificar a maioria dos municipios em situacao de alto risco e a minoria das criancas vivendo em municipios com cobertura adequada; a vigilância das coberturas utilizando indicadores pactuados no Sistema Unico de Saude (SUS) oferece nova ferramenta para identificacao de areas prioritarias, onde as acoes poderao ter maiores chances de acerto pelos gestores e melhorar a qualidade e o sucesso do PNI.OBJETIVO: describir la clasificacion de riesgo de enfermedades prevenibles en municipios brasilenos. METODOS: estudio epidemiologico descriptivo con datos del Sistema de informaciones del programa nacional de inmunizaciones (PNI) de 2014; los indicadores de cobertura fueron utilizados para clasificar el riesgo de transmision de enfermedades prevenibles en los municipios. RESULTADOS: de los 5.570 municipios brasilenos, 12,0% fueron clasificados de muy bajo riesgo, 29,6% de bajo riesgo, 2,2% de riesgo medio, 54,3% de alto riesgo y 1,8% de riesgo muy alto. CONCLUSION: la vigilancia de la cobertura de vacunacion permitio identificar la mayoria de los municipios en situaciones de alto riesgo y la minoria de ninos que viven en municipios con una cobertura adecuada; la vigilancia de la cobertura de vacunacion segun indicadores acordados en el sistema de salud publica ofrece una nueva herramienta para la identificacion de areas prioritarias en las que la accion pueda tener mayores posibilidades de exito por los administradores de salud para mejorar la calidad y el exito del programa de inmunizacion.OBJECTIVE to describe the transmission risk classification of vaccine-preventable diseases in Brazilian municipalities. METHODS this was a descriptive epidemiologic study using 2014 data of the Brazilian National Immunization Program Information System; the vaccine coverage indicators were used to classify the transmission risk of vaccine-preventable diseases in the municipalities. RESULTS of the 5,570 Brazilian municipalities, 12.0% were classified as very low risk, 29.6% as low risk, 2.2% as medium risk, 54.3% as high risk and 1.8% as very high risk. CONCLUSION the vaccination coverage surveillance allowed to identify most of the municipalities in high risk situation and the minority of children living in municipalities with appropriate coverage; the vaccination coverage surveillance using indicators of the Brazilian National Health System (SUS) is a new tool for identifying priority areas where the actions can be more successful for health managers and improve the quality and the success of the immunizations program.

Análise do Sistema de Informação da Vigilância de Eventos Adversos Pós-Vacinação no Brasil, 2014 a 2016

RESUMO Objetivo Descrever as características das notificações de eventos adversos pós-vacinação (EAPV) no Sistema de Informação da Vigilância de EAPV (SI-EAPV) on-line nos primeiros 2 anos de operação do sistema. Método Foi realizado um estudo descritivo dos registros de EAPV notificados no SI-EAPV entre julho de 2014 e junho de 2016. Resultados Durante o período do estudo, foram registradas 24 732 notificações. De 5 570 municípios brasileiros, 2 571 (46,2%) realizaram notificação de algum EAPV. Entretanto, somente 1 622 (6,6%) notificações estavam encerradas no momento do estudo; dessas, 89,9% não apresentaram gravidade. Entre as notificações encerradas, 19,7% não tiveram o preenchimento da variável “atendimento médico” e 98,7% não apresentaram registro de exames laboratoriais. As manifestações clínicas sistêmicas neurológicas foram as mais frequentes entre os eventos adversos graves encerrados, correspondendo a 59,5% dos sinais e sintomas. Em relação à idade, os maiores coeficientes de notificação foram registrados entre os menores de 4 anos. Conclusão O SI-EAPV mostra-se útil no monitoramento da segurança das vacinas. Contudo, os municípios precisam ampliar a adesão ao sistema, bem como realizar as investigações e notificações dos EAPV, preenchendo a ficha de notificação de forma adequada e oportuna. O conhecimento sobre EAPV pode ser aplicado na prática dos serviços de vigilância em saúde, melhorando a segurança de utilização dos imunobiológicos.