Peter Carrasco

Eradication of poliomyelitis: progress in the Americas.

In the span of 5 years since the eradication initiative was launched and only 3 years since external funds were made available, PAHO has been able to develop and implement a comprehensive program strategy for polio eradication that includes the following components: achievement and maintenance of high immunization levels (which include the supplemental strategies of national immunization days and mop-up operations); effective surveillance to detect all new cases; and a rapid response to the occurrence of new cases. Despite yearly increases in the number of cases of acute flaccid paralysis reported to the surveillance system, a decline in reported confirmed cases of polio has occurred since 1986 to record low levels in 1989. Cases in 1989 were reported from only 0.7% of the counties in the Americas. The occurrence of 24 wild-type virus isolates in 1989 were limited to only three geographic areas: northwestern Mexico; the northern Andean Region; and northeastern Brazil. At this writing the clock is ticking with only 3 months left to achieve the goal of interrupting transmission by the end of 1990. If the current level of effort is sustained and special efforts are directed at the remaining foci of infection, the eradication of the transmission of wild-type poliovirus from the Americas can be achieved. Continued external financial support will be critical if the effort is to succeed. The prospect of poliomyelitis eradication in the Americas led the 41st World Health Assembly of WHO to adopt a resolution in May, 1988, to eradicate the indigenous transmission of wild-type poliovirus from the world by the year 2000.(ABSTRACT TRUNCATED AT 250 WORDS)

The first influenza pandemic in the new millennium: lessons learned hitherto for current control efforts and overall pandemic preparedness

Influenza viruses pose a permanent threat to human populations due to their ability to constantly adapt to impact immunologically susceptible individuals in the forms of epidemic and pandemics through antigenic drifts and antigenic shifts, respectively. Pandemic influenza preparedness is a critical step in responding to future influenza outbreaks. In this regard, responding to the current pandemic and preparing for future ones requires critical planning for the early phases where there is no availability of pandemic vaccine with rapid deployment of medical supplies for personal protection, antivirals, antibiotics and social distancing measures. In addition, it has become clear that responding to the current pandemic or preparing for future ones, nation states need to develop or strengthen their laboratory capability for influenza diagnosis as well as begin preparing their vaccine/antiviral deployment plans. Vaccine deployment plans are the critical missing link in pandemic preparedness and response. Rapid containment efforts are not effective and instead mitigation efforts should lead pandemic control efforts. We suggest that development of vaccine/antiviral deployment plans is a key preparedness step that allows nations identify logistic gaps in their response capacity.

Monitoring Measles Eradication in the Region of the Americas: Critical Activities and Tools

The purpose of this paper is to discuss methods recommended and used by the Pan American Health Organization (PAHO) to monitor the interruption of indigenous measles transmission in the Region of the Americas. The methods used include house-to-house monitoring of vaccination coverage as a supervisory tool during both campaigns and routine vaccination; thoroughly investigating all measles outbreaks; performing routine surveillance, including weekly reporting from at least 80% of reporting units; and validating routine surveillance through active-case searches at health care institutions and schools and in the community. The strategies described have helped PAHO to increase the authority and accountability of vaccine program managers at the local, provincial, and national levels. Their efforts have permitted the Region of the Americas to reduce to three the number of countries with indigenous measles transmission and to reach a record low of 503 measles cases in 2001.

2009 Pandemic Influenza A Virus Subtype H1N1 Vaccination in Africa—Successes and Challenges

To provide vaccination against infection due to 2009 pandemic influenza A virus subtype H1N1 (A[H1N1]pdm09) to resource-constrained countries with otherwise very little access to the A(H1N1)pdm09 vaccine, the World Health Organization (WHO) coordinated distribution of donated vaccine to selected countries worldwide, including those in Africa. From February through November 2010, 32.2 million doses were delivered to 34 countries in Africa. Of the 19.2 million doses delivered to countries that reported their vaccination activities to WHO, 12.2 million doses (64%) were administered. Population coverage in these countries varied from 0.4% to 11%, with a median coverage of 4%. All countries targeted pregnant women (median proportion of all vaccine doses administered [mpv], 21% [range, 4%-72%]) and healthcare workers (mpv, 9% [range, 1%-73%]). Fourteen of 19 countries targeted persons with chronic conditions (mpv, 26% [range, 5%-66%]) and 10 of 19 countries vaccinated children (mpv, 54% [range, 17%-75%]). Most vaccine was distributed after peak A(H1N1)pdm09 transmission in the region. The frequency and severity of adverse events were consistent with those recorded after other inactivated influenza vaccines. Pandemic preparedness plans will need to include strategies to ensure more-rapid procedures to identify vaccine supplies and distribute and import vaccines to countries that may bear the brunt of a future pandemic.

Expanded Program On Immunization In The Americas: Update

EXPANDED PROGRAM ON IMMUNIZATION IN THE AMERICAS: UPDATE Jean-Marc Olive;Claudio da Silveira;Peter Carrasco;Ciro de Quadros; Infectious Diseases in Clinical Practice

Respuesta en México al actual brote de influenza AH1N1

tipo de cambios antigénicos menores o deslizamientos antigénicos resulta de la acumulación de mutaciones puntuales de los genes que transcriben para estas proteínas. La presencia de inmunidad en las poblaciones a los antígenos de superficie reduce el riesgo de infección y en el caso de que se establezca la infección, disminuye la severidad de la enfermedad. Los anticuerpos dirigidos contra un determinado tipo o subtipo del virus de la influenza ofrecen protección limitada o ninguna contra otro tipo o subtipo. Los subtipos H1N1, H1N2, y H3N2 de la influenza A son los que han circulado en los últimos años, mientras que el subtipo H2N2 circuló en humanos en la década de los noventa. Sin embargo, cepas de influenza A en aves pueden contener combinaciones de alguno de los 15 posibles subtipos de hemaglutininas y de los 9 subtipos de neuraminidasas. Esta es la razón para la incorporación de tres cepas diferentes en la vacuna correspondiente a cada periodo de actividad de influenza. Y es por ello que el dinámico proceso de variaciones antigénicas asegura la renovación constante de huéspedes susceptibles en las poblaciones y constituye también la base virológica para las epidemias.2-4 En ocasiones pueden ocurrir cambios antigénicos mayores en el caso de la influenza A con la aparición de combinaciones de hemaglutinina y neuraminidasa que no han afectado previamente a las poblaciones, lo cual se ha asociado a pandemias, como fue el caso durante la pandemia de la “influenza española” en 1918-1919, o las de 1957 y 1968, con resultados catastróficos. Los virus de la influenza pueden causar pandemias durante las cuales las tasas de infección y muerte por complicaciones relacionadas con la enfermedad se incrementan considerablemente a nivel mundial (cuadro I). La influenza tiende a afectar gravemente a todos los grupos etarios durante estos episodios.3 Es por ello que en anticipación a la aparición de una pandemia de influenza y su potencial para desencadenar graves consecuencias de Editorial

Inaugural conference of the International Association of Immunization Managers (IAIM), Istanbul Turkey, 3-4 March 2015.

For more than 35 years, most national immunization programs have established managerial structures and processes for delivering vaccination services to their populations. These days, immunization managers are facing an increasing number of challenges due to the introduction of new vaccines, shifting demographic patterns, complex networks of service providers, and maintaining the gains achieved with previous vaccination efforts. To confront these challenges, better program performance will require better managerial practices, which incorporates new technologies. To that end, the International Association of Immunization Managers (IAIM) is the first global professional association launched to promote superior leadership and management skills among health professionals involved with vaccination efforts worldwide. From 3 to 4 March 2015, approximately 132 members from 70 countries representing six regions, gathered in Istanbul, Turkey for the inaugural conference of IAIM. In the two-day program, members selected thirteen peers to constitute the Governing Council. The 12 articles of the bylaws of the Association were also ratified. This conference was a forum for sharing managerial best practices through networking sessions, breakout sessions, and presentations. Members also learned about IAIM sponsored training opportunities to deepen their managerial competencies through peer-to-peer exchanges and scholarship training programs. We believe that the IAIM inaugural conference was an appropriate platform for equipping managers with tools and professional network of peers to support them in achieving national, regional and global immunization goals, including those of the Global Vaccine Action Plan of the World Health Organization.