José Fernando de Souza Verani

Impact of vaccination on the incidence of measles in Mozambique in the period 2000 to 2011

This study aimed to evaluate associations among variables in hospital pharmacy services. Thirty variables were used from the project Diagnosis of Hospital Pharmacies in Brazil pertaining to the overall description of the hospital, overall characterization of the hospital pharmacy service, and stages in pharmaceutical care. The statistical techniques were multiple correspondence and cluster analysis. Dimension 1 of the multiple correspondence analysis explained 90.6% of variance, differentiating between hospital pharmacy services based on the presence of certain activities, thus suggesting an axis of characterization for the hospital pharmacy services. The results indicate a direct relationship between compliance with the activities and the type of hospital and pharmacists with specialized training. Cluster analysis identified six clusters related to hospital size; greater compliance with the activities was associated with large hospitals and those with a pharmacist (more time dedicated to the hospital pharmacy service and higher level of training). The study concludes that the techniques were able to identify associations and a concise range of variables for a comprehensive evaluation of hospital pharmacy services in Brazil.

Impacto da vacinação sobre a incidência de sarampo em Moçambique no período de 2000-2011

The aim of this study was to contribute to the better planning of measles elimination actions in Mozambique, by considering the impact of vaccination actions over the period 2000 to 2011. Descriptive and ecological studies and case records made available by the Ministry of Health were used to analyze measles vaccination coverage. Statistical analysis was performed using time series and spatial analysis. Vaccine coverage rates ranged from 82% to 99%. Coverage rates in Maputo city were under 70% and in Niassa province they were over 100%. Coverage showed a clustered pattern in the districts. The measles incidence rate was 1.58 per 100,000 inhabitants (0.00-40.08 per 100,000 inhabitants); districts bordering neighboring countries presented high incidence rates. Although measles morbidity and mortality has decreased in Mozambique, vaccine coverage has been insufficient to interrupt measles transmission. Enhanced surveillance, including investigation of cases and outbreaks, and improvements in measles vaccination are recommended in order to achieve a homogenous coverage rate of ≥ 95% for both routine and mass vaccination campaigns.O objetivo deste estudo foi analisar as acoes de eliminacao do sarampo em Mocambique, considerando o impacto do programa de vacinacao ao longo do periodo de 2000-2011. Foram revisados os dados de vacinacao e os casos de sarampo disponiveis no Ministerio da Saude. Analise de series temporais e tecnicas estatisticas de analise espacial foram aplicadas. As coberturas variaram entre 82% e 99%. Nas provincias, a cidade de Maputo teve as coberturas abaixo de 70%, e a provincia de Niassa teve as coberturas acima de 100%. As coberturas apresentaram um padrao espacial que se modificou com o tempo. A taxa de incidencia de sarampo no pais foi de 1,58 (0,00-40,08 distritos) por 100 mil habitantes. Os distritos que fazem fronteiras com os paises vizinhos tiveram as elevadas taxas de incidencia. As coberturas de rotina sao insuficientes, e a circulacao de sarampo continua em Mocambique. O pais necessita alcancar coberturas homogeneas e maiores que 95% em criancas menores de um ano, manter as campanhas de vacinacao e melhorar a vigilância e o tratamento de casos.

A erradicação da Poliomielite no contexto dos programas de imunização

Este debate foi organizado pelo Departamento de Epidemiologia da Escola Nacional de Saude Publica e realizado em 28 de junho de 1989. Foram debatidos os principais fatores e razoes que conduziram a resolucao da Assembleia Mundial de Saude de erradicar a poliomielite do planeta. Primeiramente, foi discutido, a luz das estrategias de dias nacionais de vacinacao e da vacinacao rotineira, o tremendo declinio na incidencia de casos paraliticos devidos a infeccao por poliovirus selvagem, como resultado da aceleracao das coberturas vacinais nas Americas. Em segundo lugar, a vigilância epidemiologica, a melhoria da vacina OPV e metodos de mobilizacao social foram considerados fatores-chaves para se chegar a erradicacao. Em terceiro lugar, foram discutidos os impactos das imunizacoes no estado nutricional das criancas, em certas areas do Brasil. As discussoes consideraram, tambem, a situacao do Programa de Imunizacoes e perspectivas da erradicacao da polio em varias regioes do globo. Durante o debate, os pontos considerados chaves foram abordados, tendo em vista a experiencia adquirida no programa global de erradicacao da variola. Finalmente, debateu-se sobre a importância da erradicacao de doencas e seu impacto sobre as condicoes de saude da populacao.

Avaliação da vigilância epidemiológica ampliada do rotavírus

Objective: To assess the practices of Rotavirus surveillance, identifying the positive aspects and the difficulties found through the evaluation model from the Enhanced Surveillance of Rotavirus Diarrheal Diseases. Method: This is an evaluative and qualitative research performed in two different Brazilian states between March and November 2010. Participated in the evaluation 14 subjects in total (from central, state and municipal level), which were submitted to tape-recorded interviews using semi-structured questionnaires, along with conduction of document analysis and direct observation of routine service within their respective units. This information allowed to feed a judgment matrix, thus highlighting the various aspects comprising the system operation. Results: Positive aspects were observed (the sensitivity to capture cases, the system acceptability by the technicians involved, the proper physical structure and the training and updating of technicians), and operational difficulties when conducting surveillance activities (the shortage of human and financial resources and the low opportunity of the information system). Conclusion: The results suggest the low effectiveness of the monitoring system adopted, indicating that the sentinel type of surveillance may not be the most appropriate for the health system in the studied states. doi:10.5020/18061230.2014.p140

The development of epidemiological surveillance systems for smallpox and poliomyelitis: changing concepts in operational categories

This article describes the process by which some concepts of epidemiological surveillance are elaborated and turned into operational categories to comprise the so-called epidemiological surveillance system for two specific diseases. The authors describe some epidemiological concepts and categories which were elaborated over the course of the smallpox eradication program and more recently in the poliomyelitis eradication program. Such concepts and categories as outbreak containment, cross-notification, and case definitions are described as they fit into a series of actions which make up the epidemiological surveillance system. Finally, it is worth noting that the description developed in this article is based on personal observations, since the authors participated in the smallpox eradication program in Bangladesh and Somalia as well as in the regional poliomyelitis eradication program in the Americas.