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Toscano C.M.,Federal University of Goais | Jauregui B.,ProVac Initiative | Janusz C.B.,ProVac Initiative | Sinha A.,Rutgers University | And 5 more authors.
Vaccine | Year: 2013

Background: The Pan American Health Organization's ProVac Initiative, designed to strengthen national decision making regarding the introduction of new vaccines, was initiated in 2004. Central to realizing ProVac's vision of regional capacity building, the ProVac Network of Centers of Excellence (CoEs) was established in 2010 to provide research support to the ProVac Initiative, leveraging existing capacity at Latin American and Caribbean (LAC) universities. We describe the process of establishing the ProVac Network of CoEs and its initial outcomes and challenges. Methods: A survey was sent to academic, not-for-profit institutions in LAC that had recently published work in the areas of clinical decision sciences and health economic analysis. Centers invited to join the Network were selected by an international committee on the basis of the survey results. Selection criteria included academic productivity in immunization-related work, team size and expertise, successful collaboration with governmental agencies and international organizations, and experience in training and education. The Network currently includes five academic institutions across LAC. Results: Through open dialog and negotiation, specific projects were assigned to centers according to their areas of expertise. Collaboration among centers was highly encouraged. Faculty from ProVac's technical partners were assigned as focal points for each project. The resulting work led to the development and piloting of tools, methodological guides, and training materials that support countries in assessing existing evidence and generating new evidence on vaccine introduction. The evidence generated is shared with country-level decision makers and the scientific community. Conclusions: As the ProVac Initiative expands to other regions of the world with support from immunization and public health partners, the establishment of other regional and global networks of CoEs will be critical. The experience of LAC in creating the current network could benefit the formation of similar structures that support evidence-based decisions regarding new public health interventions. © 2013 Elsevier Ltd.

Stecher D.,Programa Nacional de Control de Enfermedades Inmunoprevenibles | Gaiano A.,Programa Nacional de Control de Enfermedades Inmunoprevenibles | Biscayart C.,Programa Nacional de Control de Enfermedades Inmunoprevenibles | Gentile A.,Sociedad Argentina de Pediatria | And 6 more authors.
Vaccine | Year: 2014

In Argentina, the National Technical Advisory Group on Immunizations is represented by the National Immunization Commission (CoNaIn), an organization created by the Ministry of Health in 2000. Recently, the Argentine government has decided to prioritize vaccination as a state policy, emphasizing this strategy as a sign of social equity so CoNaIn was restructured to increase its capacity to formulate sound and evidence-based recommendations. The commission shall consist of a group of immunization experts, representatives of scientific societies, the immunization program and the Ministry of Health. Its functions include the formulation of recommendations on the introduction of vaccines into the immunization program. The recommendations are based on technical, programmatic and social criteria. This decision-making process transparent with the support and advice of experts and scientific societies and guided by available evidence decisions help strengthen the Ministry of Health immunization policy generating greater confidence and support from the population and health professionals. © 2014 Elsevier Ltd.

Markowitz L.E.,Centers for Disease Control and Prevention | Tsu V.,PATH | Deeks S.L.,University of Toronto | Cubie H.,Royal Infirmary | And 3 more authors.
Vaccine | Year: 2012

The availability of prophylactic human papillomavirus (HPV) vaccines has provided powerful tools for primary prevention of cervical cancer and other HPV-associated diseases. Since 2006, the quadrivalent and bivalent vaccines have each been licensed in over 100 countries. By the beginning of 2012, HPV vaccine had been introduced into national immunization programs in at least 40 countries. Australia, the United Kingdom, the United States, and Canada were among the first countries to introduce HPV vaccination. In Europe, the number of countries having introduced vaccine increased from 3 in 2007 to 22 at the beginning of 2012. While all country programs target young adolescent girls, specific target age groups vary as do catch-up recommendations. Different health care systems and infrastructure have resulted in varied implementation strategies, with some countries delivering vaccine in schools and others through health centers or primary care providers. Within the first 5 years after vaccines became available, few low- or middle-income countries had introduced HPV vaccine. The main reason was budgetary constraints due to the high vaccine cost. Bhutan and Rwanda implemented national immunization after receiving vaccine through donation programs in 2010 and 2011, respectively. The GAVI Alliance decision in 2011 to support HPV vaccination should increase implementation in low-income countries. Evaluation of vaccination programs includes monitoring of coverage, safety, and impact. Vaccine safety monitoring is part of routine activities in many countries. Safety evaluations are important and communication about vaccine safety is critical, as events temporally associated with vaccination can be falsely attributed to vaccination. Anti-vaccination efforts, in part related to concerns about safety, have been mounted in several countries. In the 5 years since HPV vaccines were licensed, there have been successes as well as challenges with vaccine introduction and implementation. Further progress is anticipated in the coming years, especially in low- and middle-income countries where the need for vaccine is greatest. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.

Oliveira L.H.D.,Comprehensive Family Immunization Project | Camacho L.A.B.,Oswaldo Cruz Foundation | Coutinho E.S.F.,Oswaldo Cruz Foundation | Ruiz-Matus C.,Comprehensive Family Immunization Project | Leite J.P.G.,Oswaldo Cruz Foundation
Vaccine | Year: 2015

Introduction: There are two group A rotavirus (RVA) vaccines available worldwide since 2006: monovalent (Rotarix®, RV1) and pentavalent (RotaTeq®, RV5). Currently, 16 countries and 1 territory in Latin America and the Caribbean (LAC) have introduced RVA vaccines and since their introduction several impact and effectiveness studies have been conducted in different countries. The purpose of this study was to assess RVA vaccine effectiveness in LAC countries. Methodology: We conducted a systematic review and meta-analysis of studies in children under-five who were admitted with laboratory-confirmed RVA diarrhea. We searched Medline, WOS, LILACS, Scopus, and other sources from 2006 to October 2013. Two independent evaluators identified the studies that met predefined selection criteria and extracted relevant information according to a protocol. Pooled estimates were obtained with fixed and random-effects models and stratified according to selected effect modifiers. Results: Of the 806 articles meeting the initial criteria, 8 case-control studies which involved 27,713 participants (6265 cases and 21,448 controls) were included in the final analyses. The pooled estimates were calculated using different types of controls, leading to different degrees of effectiveness. The effectiveness of two doses of RV1 against rotavirus-related hospitalizations ranged from 63.5% (95% CI: 39.2-78.0) to 72.2% (95%CI: 60.9-80.2). Effectiveness ranged from 75.4% (95%CI: 64.6-82.9) to 81.8% (CI 95%:72.3-88.1) among infants <12 months for RV1, and from 56.5% (95%CI: 26.2-74.3) to 66.4% (95%CI: 54.1-75.5) for infants >12 months. The RV5 effectiveness for diarrhea with a Vesikari score >11 in infants 6 to 11 months old ranged from 76.1% (95%CI: 57.6-86.6) to 88.8% (95%CI: 78.3-94.3). Also, it showed 63.5% (95%CI: 29.4-82.6) of effectiveness against G2P [4]. Conclusion: RVA vaccines consistently showed protection against diarrhea-related hospitalizations in LAC. Results were more robust for RV1. Effectiveness was shown with different types of controls, but appeared somewhat higher with community controls. Effectiveness was higher among infants <12 months and lower in older children. © 2015.

Barrera L.,National Immunization Program | Bravo-Alcantara P.,Comprehensive Family Immunization Project | Velandia-Gonzalez M.,Comprehensive Family Immunization Project | Danovaro-Holliday M.C.,Comprehensive Family Immunization Project
BMC Public Health | Year: 2014

Background: Immunization coverage levels in Guatemala have increased over the last two decades, but national targets of ≥95% have yet to be reached. To determine factors related to undervaccination, Guatemala's National Immunization Program conducted a user-satisfaction survey of parents and guardians of children aged 0-5 years. Variables evaluated included parental immunization attitudes, preferences, and practices; the impact of immunization campaigns and marketing strategies; and factors inhibiting immunization. Methods. Based on administrative coverage levels and socio-demographic indicators in Guatemala's 22 geographical departments, five were designated as low-coverage and five as high-coverage areas. Overall, 1194 parents and guardians of children aged 0-5 years were interviewed in these 10 departments. We compared indicators between low- and high-coverage areas and identified risk factors associated with undervaccination. Results: Of the 1593 children studied, 29 (1.8%) were determined to be unvaccinated, 458 (28.8%) undervaccinated, and 1106 (69.4%) fully vaccinated. In low-coverage areas, children of less educated (no education: RR = 1.49, p = 0.01; primary or less: 1.39, p = 0.009), older (aged >39 years: RR =1.31, p = 0.05), and single (RR = 1.32, p = 0.03) parents were more likely to have incomplete vaccination schedules. Similarly, factors associated with undervaccination in high-coverage areas included the caregiver's lack of education (none: RR = 1.72, p = 0.0007; primary or less: RR = 1.30, p = 0.05) and single marital status (RR = 1.36, p = 0.03), as well as the child's birth order (second: RR = 1.68, p = 0.003). Although users generally approved of immunization services, problems in service quality were identified. According to participants, topics such as the risk of adverse events (47.4%) and next vaccination appointments (32.3%) were inconsistently communicated to parents. Additionally, 179 (15.0%) participants reported the inability to vaccinate their child on at least one occasion. Compared to high-coverage areas, participants in low-coverage areas reported poorer service, longer wait times, and greater distances to health centers. In high-coverage areas, participants reported less knowledge about the availability of services. Conclusions: Generally, immunization barriers in Guatemala are related to problems in accessing and attaining high-quality immunization services rather than to a population that does not adequately value vaccination. We provide recommendations to aid the country in maintaining its achievements and addressing new challenges. © 2014 Barrera et al.; licensee BioMed Central Ltd.

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