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Objetivo. Validar la aplicabilidad de la prueba de rosa de bengala (RB), enzimoinmunoensayo (ELISA) indirecto IgG o IgM y la prueba Brucellacapt® al contexto local, determinar la seroprevalencia de brucelosis y evaluar el conocimiento sobre la enfermedad en personas a riesgo en una zona lechera de La Maica, Cochabamba (Estado Plurinacional de Bolivia). Métodos. La validación de las pruebas se realizó inicialmente en un grupo de 76 personas, la población de estudio final fue de 330 personas, que además participaron en una encuesta socioepidemiológica. Resultados. De 330 muestras analizadas, 12,7 % fueron positivas, ya sea por la prueba de rosa de bengala (RB) o por Brucellacapt®. El ELISA indirecto IgG dio resultados falsos positivos, lo que indica que se debe adaptar el punto de corte a la situación epidemiológica local. Casi la totalidad de casos positivos por RB fueron asintomáticos. La encuesta socioepidemiológica resalta la falta de información y de conciencia sobre la naturaleza zoonótica, el modo de transmisión y los síntomas de la brucelosis. Conclusión. Este estudio reveló una seroprevalencia elevada de brucelosis en la zona lechera La Maica en Cochabamba (Estado Plurinacional de Bolivia), con muchos casos asintomáticos y un número elevado de falsos positivos con ELISA indirecto IgG. Se recomienda realizar campañas de concientización sobre los riesgos de esta enfermedad y desalentar el consumo de leche cruda.

Objective. To conduct a point prevalence survey (PPS) of antibiotic use in the main pediatric tertiary-level hospital in Panama City to establish antibiotic prevalence and identify key areas for addressing antimicrobial resistance. Methods. This point prevalence survey (PPS) conducted in a tertiary-level hospital in Panama followed the Pan American Health Organization’s adaptation of the methodology proposed by the World Health Organization for PPSs on antibiotic use. Information obtained included patients’ demographic characteristics, antimicrobial prescriptions, indication for antimicrobial use, and prescription’s adherence to guidelines. Results. Of 298 patients surveyed from August to September 2023, 176 (59.0%) were treated with antibiotics. The pediatric ward (86.3%) and the neonatal intensive unit (80.0%) had the highest prevalence of antibiotic use. Hospital-acquired infections accounted for 32.6% of antibiotic prescriptions, with piperacillin/tazobactam (29.4%), meropenem (15.3%), amikacin (15.3%), and ampicillin/sulbactam (10.2%) being the most prescribed. Treatment for community-acquired infections represented 55.9% of antibiotic prescriptions, with ampicillin (24.6%), gentamicin (22.6%), and ampicillin/sulbactam (14.0%) being the most frequently used. Of the prescriptions considered in the analysis, 61.0% adhered to hospital guidelines. Conclusions. This PPS observed a high prevalence of antibiotic use. The findings suggest it is necessary to assess the need for ampicillin, gentamicin, and piperacillin-tazobactam use in patients admitted to pediatric critical care units, with special emphasis on children with pneumonia and sepsis diagnosis, the most common pathologies for which an antimicrobial was prescribed.

Objetivo. Describir el funcionamiento del sistema de vigilancia de los eventos supuestamente atribuibles a la vacunación o inmunización (ESAVI) en Colombia con las herramientas de evaluación propuestas por la Organización Mundial de la Salud (OMS). Métodos. Se realizó un estudio descriptivo sobre el funcionamiento del sistema de vigilancia de ESAVI por vacunas contra la COVID-19, entre el 17 de febrero del 2021 y el 30 de setiembre del 2023. Se adaptaron los indicadores de la OMS tipo estructura, proceso y resultados. La información cualitativa se obtuvo de documentos oficiales y consultas técnicas, mientras que los datos cuantitativos de VigiFlow® y del Sistema Integrado de Información de la Protección Social. Resultados. El Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA) colaboró como autoridad regulatoria con el Ministerio de Salud y Protección Social y el Instituto Nacional de Salud en la farmacovigilancia de vacunas contra la COVID-19. Se establecieron comités de expertos a nivel nacional y subnacional para evaluar los ESAVI. Se implementó VigiFlow® para notificar y gestionar los casos, se promovieron capacitaciones, así como la detección de señales y acciones regulatorias, con base en los protocolos de la OPS y la Organización Mundial de la Salud. La información sobre ESAVI se difundió a través de boletines y se fortaleció la cooperación técnica entre el INVIMA y la OPS. Conclusiones. Se cumplieron con los indicadores de vigilancia de los ESAVI contra la COVID-19. Las regulaciones y funciones de las autoridades sanitarias proporcionaron una base sólida para las actividades de farmacovigilancia de vacunas, lo que permitió un uso efectivo de recursos técnicos. Es necesario una estructura de requisitos legales para las vacunas no COVID-19, capacitación continua y un enfoque automatizado para mejorar la capacidad del programa de seguridad de vacunas.

Objectives. To describe and analyze a community participation process to develop recommendations for adequate communication of mental health risks among the Wayuú people of Colombia. Methods. This qualitative study conducted focus groups in the Indigenous cities of Albania and Uribia, Colombia, from January to June 2024, to assess perspectives on mental health risk communication. Participants were adults (>18 years) residing in two municipalities in La Guajira (Uribia and Albania [the Indigenous capital of Colombia]) and included youth group leaders, Indigenous representatives, migrant population representatives, and representatives of official institutions in the region. Thematic analysis was used for data analysis. Results. In total, 42 participants (mean [SD] age, 20.1 years; 24 [57.1%] women and 18 [42.9%] men) participated in four focus groups (two in Albania and two in Uribia). Three main themes were identified in the thematic analysis: consequences of poor communication; community advice for social communication; and recommendations for public mental health in health communication. Based on the data analysis, recommendations for mental health risk communication were proposed for both municipalities and for the territory of La Guajira, Colombia. Conclusions. The findings of this qualitative study highlight the need to improve mental health communication among the Indigenous community by leveraging their perspectives. The involvement of community leaders and the development of mental health communication strategies are needed.

La equinococosis quística (EQ) es un problema grave de salud pública en América del Sur; la Organización Panamericana de la Salud la incluye en su Plan de acción para el control de las enfermedades infecciosas desatendidas. Se definió un marco lógico para su control, que incluye establecer el objetivo a alcanzar (la erradicación o su eliminación como problema de salud pública) y determinar niveles de endemicidad que puedan servir de guía para establecer las frecuencias de intervención: alta endemicidad, endémico y baja endemicidad según tasas en los diferentes hospedadores. Para ello, existen dos herramientas validadas: la desparasitación sistemática de perros con praziquantel (PZQ) y la vacunación sistemática de ovinos con proteína recombinante EG95, o una combinación de ambas. Existen estrategias complementarías, como el desarrollo de infraestructura sanitaria en estancias, educación en salud, y la búsqueda activa de casos asintomáticos y su tratamiento oportuno. La disminución de la prevalencia en el perro y el ovino lleva asociada una pérdida de la inmunidad adquirida, por lo que los animales se vuelven susceptibles a la infección. A pesar de que se cuenta con herramientas listas para su utilización, el control de EQ aún presenta dificultades. El apoyo del Centro Panamericano de Fiebre Aftosa, Unidad de Salud Pública Veterinaria, Organización Panamericana de la Salud (PANAFTOSA/SPV-OPS/OMS) a los programas nacionales y a los esfuerzos locales desde la Iniciativa sudamericana para el control y la vigilancia de la EQ es vital para impulsar estrategias novedosas de control y de diagnóstico temprano en las personas con un enfoque de Una Salud.

Objective. To describe the Brazilian experience of responding to public health emergencies in 2023, the organizational structure, and epidemiological characteristics. Methods. Three emergencies (case studies) that occurred during the study year were analyzed according to the actions implemented during the response and the impacts on the population. The public health emergencies were summarized and analyzed through research on official documents and websites of the Ministry of Health and local health authorities. Results. Case 1 – Emergency due to lack of assistance, considered by the Brazilian government to be a public health emergency of national importance, required an Emergency Operations Center (EOC) for the response due to the complexity of the actions. Case 2 – Emergency due to zoonoses (arboviruses and avian influenza) used the EOC response structure to develop activities aimed at stopping the emergence of arboviruses and preventing an avian influenza emergency in the country. Finally, case 3 – Emergencies due to disasters required local response structures and used the EOC to coordinate their actions with the federal government’s support. Conclusions. The Brazilian experience highlights the importance of intrasectoral and intersectoral coordination in managing response actions, constant monitoring and communication to improve response measures, national support for local response efforts, and adaptation of the EOC structure to the different contexts and complexities of the emergencies faced.

Objetivo: Documentar as ações de farmacovigilância das vacinas contra a covid-19 que foram desenvolvidas pelo Programa Nacional de Imunizações do Brasil. Métodos: Pesquisa documental informativa no período de 2020 a 2023. Foram utilizadas fontes documentais do Ministério da Saúde durante a vacinação contra a covid-19 para análise e interpretação das ações realizadas. A análise foi subdividida nas etapas de preparação e operacionalização. As publicações foram organizadas de acordo com o título, data da publicação, descrição e link de acesso. Resultados: Foram encontrados e avaliados 86 documentos publicados durante a preparação e operacionalização da vacinação. Na fase de preparação, foi constituída a Câmara Técnica de Assessoramento em Imunizações e publicadas notas técnicas específicas para as vacinas contra covid-19 e introdução do novo sistema de informação. Na etapa de operacionalização, foi instituído o Comitê Interinstitucional de Farmacovigilância de Vacinas e outros Imunobiológicos e implementados sistemas de vigilância sentinela hospitalar para Eventos Adversos de Interesse Especial e a vigilância da segurança da vacinação contra a covid-19 em gestantes. Conclusão: A farmacovigilância foi fortalecida no contexto da vacinação contra a covid-19 no Brasil. Frente às lacunas do conhecimento e infodemia sobre as novas vacinas, fez-se necessária a adoção de estratégias complementares ao sistema de vigilância passiva para o monitoramento da segurança da vacinação. Colaborações interinstitucionais, disponibilidade de recursos adicionais, flexibilidade e oportunidade dos sistemas de informação contribuíram para que as ações de preparação e resposta da farmacovigilância de vacinas contra a covid-19 fossem efetivadas de forma abrangente no Brasil.

This paper delineates the development of the Caribbean Research for Action Agenda which aims to empower Caribbean Small Island Developing States to reduce their vulnerabilities to the effects of climate change on health. The Caribbean Research for Action Agenda emerged from collaboration between nongovernmental organizations, academic institutions, and multilateral agencies that organized a conference on climate change and health in the Caribbean. This Agenda was formulated by prioritizing research areas, synthesizing evidence from conference presentations and scientific literature, and holding consultations with stakeholders and experts. The Agenda provides information on 18 priority areas for research and action categorized into four domains: climate change health impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; and resources and engagement for climate change and health action. Cross-cutting findings underscore the need for: greater public and professional awareness; a more climate-literate health workforce; interdisciplinary collaboration to address institutional silos; attention to social and economic mediating factors; equitable interventions for vulnerable groups; and enhanced monitoring and surveillance of climate-sensitive health outcomes. The Caribbean Research for Action Agenda is a foundational tool to inform research, guide multisectoral collaboration and capacity-building, develop evidence-based policy, and inspire community action-based advocacy related to climate change and health.

Objective. To provide an overview of hospital-based health technology assessment (HB-HTA) activities in Latin America and the Caribbean, including the technologies assessed, resources utilized, evaluation methods employed, and challenges encountered. Methods. A scoping review focused on HB-HTA using frameworks from the Joanna Briggs Institute was conducted across databases and gray literature. Results. Seventeen studies were identified, and another two documents were retrieved manually at a conference, totaling 19 files. Brazil emerged as a key player in HB-HTA activities in Latin America and the Caribbean, with public teaching hospitals leading the efforts. The primary focus of HB-HTA units was assessing medicines/pharmaceuticals and medical devices, using budget impact and cost-effectiveness/utility analyses as the main appraisal tools. The review also identified challenges such as limited human resources and financial support. Conclusions. The study highlights a growing interest in HB-HTA in Latin America and the Caribbean, driven primarily by public institutions. The findings underscore the need for tailored approaches to strengthen evidence-based decision-making in healthcare settings and address the challenges of the region’s limited resources and financial constraints.

Abstract Background Extemporaneous compounding for dermatological use is an important therapeutic alternative for patients whose clinical needs are not met by approved drug products circulated in the market. Evaluating patients’ perceptions and levels of satisfaction towards such services is an important factor for the adherence of patients and maintaining the quality of healthcare services. The current study aimed to assess patients’ perception and level of satisfaction with the compounding service and extemporaneous preparations rendered at ALERT hospital. Methods An institution-based cross-sectional study was conducted among patients receiving compounding pharmacy services at ALERT hospital, Addis Ababa, Ethiopia from 10th April to 10th May 2023. A consecutive sampling technique was used to recruit the study participants. Data were collected using an interviewer-administered structured questionnaire, entered into the EPI info, exported and analyzed using SPSS. Multivariate linear regression analysis was performed to determine possible predictors of patient satisfaction and p-value

Introduction: The world is experiencing increase in geriatric population due to increase in life expectancies at global level. The complex issues leading to nutritional risk and malnutrition are inadequate food intake, social, economic, psychological and pathological factors. Objective: To assess the nutrition status of the elderly and to determine the factors associated with it. Method: A Cross-sectional study was done in the rural areas of Warangal, Telangana among 280 elderly people (≥ 60 years) using systematic random sampling. A pretested semi-structured questionnaire and the Mini Nutrition Assessment tool were used for data collection. Anthropometric measurements were also estimated. Data entry was done in MS Excel and analysed using SPSS 20.0. Chi-square and Correlation tests were applied. Results: Among the 280 elderly, malnutrition was seen in 13.2% of subjects, 51.4% were at risk of malnutrition and 35.4% were adequately nourished. Females, unemployment, smoking habits, presence of comorbidities, inadequate vegetable intake and lack of social support were significantly associated with malnutrition. A strong positive correlation (r= 0.4) was observed between nutrition score and weight, waist circumference, and calf circumference. The difference was statistically significant. Conclusion: Most of the elderly (51.4%) were at risk of malnutrition thus emphasizing the need for effective nutritional interventions.

Introduction: Globally malnutrition remains the one of the leading causes of mortality contributing to 60% of deaths in under five children. Severely acute malnutrition children are admitted to Nutritional rehabilitation centre for promoting their clinical and psychological growth. Objective: To describe the sociodemographic profile of severely malnourished children admitted in NRC. Method: The study was observational cross sectional study conducted in a Nutritional Rehabilitation Centre (NRC) of a District Hospital of Thane in Maharashtra among the under five children of age group 6 to 60 months who were admitted in NRC and were presently staying in Thane block were included in the study. Complete enumeration method was used . A Total Sample size of 96(based on the inclusion criteria) was obtained for the purpose of record based data, while for interview sample size was 73(20 cases were non traceable and 3 death were reported) with the parents/guardians of the children. Data was collected using a pre-validated semi structured interview guide via face to face interview. The study was conducted during the 18 month period from March 2017 to August 2018. Data was analysed by using SPSS software version 22.0. Results: Majority of the children admitted to the NRC were male (55.2%). Majority of the mothers were educated till middle school (34.3%) as were the majority fathers (37%). Majority of children had birth order 3 (76.7%). Acute respiratory infection (34.4%), acute gastroenteritis (26%) and acute febrile illness (19.8%) were the most common comorbidities observed among the children. Pre-lacteal feed was given in 5.1% children and colostrum was given to 56.1%, exclusive breast feeding was not done in majority of the children (65.8%).Conclusion: Severe acute malnutrition appears to be more prevalent among households belonging to middle and lower middle class. Educational status of parents was found to be low among majority of the study participants. Exclusive breast feeding was also lacking in majority of the children.

Introduction: Certain social determinants like poverty, malnutrition, indoor air pollution, male gender, diabetes, and cancer are some identified risk factors of TB. The tea garden population as it is socio- economically backward are more vulnerable to get infected. Objective: To estimate the determinants of tuberculosis treatment outcomes among patients belonging to the tea tribe community in Dibrugarh District of Assam and to assess the quality of life using WHO-QoL (BREF) instrument. Method: A Community-based cross-sectional study was conducted in Dibrugarh District of Assam. A sample size of 930was calculated using nMaster2.0 software, CMC, Vellore, India. From the list of registered TB cases whose treatment was assigned hailing from tea estates,a required sample was selected using a computerized random number. Predesigned, pretested questionnaire was used to assess the demographic, socio-economic, environmental and health- seeking behaviour of the participants. Univariate and bivariate analysis was done. Results: Total participation was 785. Regarding environmental determinants, ventilation was very poor and 98.5% used firewood as fuel for cooking. The risk of passive smoking was present in 7.6% of households. Respondents who had a history of family members with chronic cough were present in 5.9%. Loss to follow up rate was 2.9% (23/786). Lack of energy and fatigue was experienced by 83.6%. Marital status, occupation, monthly income, type of family and ventilation were associated with treatment outcome. Gender and socio-economic status of the respondents were associated with knowledge attitude and practice on Hepatitis B among participants which was found to be statistically significant (p-value < 0.0001). Conclusion: Certain social and environmental determinants like monthly income, type of family, and inadequate ventilation influence the treatment outcome in the tea garden population. Knowledge and practice pattern for tuberculosis needs to be improved to prevent transmission and alteration in quality of life.

Introduction: The increasing global consumption of medications has led to a significant rise in the improper disposal of unused and expired drugs, posing risks to both human health and the environment. Objective: This study aims to evaluate the understanding, beliefs, and behaviours related to the disposal of such medications within the rural community of Sarojini Nagar, Lucknow. Method: A cross-sectional study was conducted in June 2024 with 317 participants from rural Sarojini Nagar, including patients and attendants visiting the General and NCD OPD of PHC Sarojininagar, chosen purposively. Participants aged 18 years and above who provided consent were included, while those with cognitive or communication issues were excluded. Participants were interviewed by Junior Residents and Data was gathered using a structured questionnaire to evaluate demographic characteristics, knowledge, perceptions, attitudes, and practices related to the disposal of unused and expired medications. Results: The study revealed a lack of awareness about proper disposal methods, with 77.3% of participants reporting no prior information on the subject. Only 14.8% were aware of drug take-back policies. A majority (87.9%) recognized the harmful effects of improper disposal, and 93.7% agreed that such practices negatively impact the environment. Despite this, 69.4% of participants reported keeping unused medications at home, and 78.0% disposed of expired medications by throwing them in household trash. Conclusion: The findings highlight a significant gap in knowledge and practices regarding safe drug disposal among rural community of Sarojini Nagar. There is an urgent need for targeted educational programs and the implementation of effective drug take-back systems to mitigate the risks associated with improper disposal. Raising awareness and providing clear guidance on safe disposal methods are crucial steps towards protecting public health and the environment in these communities.

Introduction: As with other non-communicable diseases, chronic kidney disease (CKD) also is in a way at the top among the younger population. Apart from diabetes, hypertension, old age, family history of CKD other risk factors like smoking, alcohol, pesticide exposure, heavy metals also made them vulnerable to CKD. The focus on CKD in younger age groups is often overlooked; therefore, this study has been planned to address this gap. Objective: To determine the risk factors for chronic kidney disease among young adult patients

Introduction: There is a need to incorporate Artificial Intelligence (AI) in medical education which may help in expanding awareness on role of AI in healthcare among the students. Objectives: To assess the awareness and opinions on role of AI in healthcare among undergraduate medical students of a Tertiary Care Institute of Kolkata and to identify any associated sociodemographic factors with their awareness on AI. Method: Descriptive study was conducted using consecutive sampling among 288 undergraduate medical students using a pretested questionnaire, from August - October (2023). Participants with an 'overall awareness score on AI' equal to or above median were categorized as having 'high awareness'. Association of sociodemographic profile with awareness was assessed using binary logistic regression. Results: Almost half (51%) of the students belonged to Phase III of MBBS. Around 70.8% believed AI will reduce medication errors, while 83.3% opined AI will aid in healthcare-oriented research. 53.5% had low awareness on role of AI. Higher odds of low awareness were found among students whose parents were involved in healthcare. Conclusion: Almost half of the students had high awareness on role of AI in healthcare. More seminars, workshops etc., may be helpful in generating further awareness and orientation among the undergraduate medical students for appropriate use of AI applications in future.

Introduction: Type 2 diabetes mellitus is a disease of epidemic proportions and has emerged as a major healthcare problem. Compliance to medication plays a crucial role in achieving success in medical treatment and preventing complications. Objective: To assess the treatment compliance among the study participants and explore its perceived barriers and facilitators. Method: A descriptive cross-sectional study was carried out using Morisky’s Medication Adherence Scale (MMAS) among 308 type 2 diabetes mellitus patients who were selected through systematic random sampling. Qualitative data was collected though in-depth interviews and were analysed by manual content analysis Results: Out of the 308 study participants 47% were found to have high treatment compliance and 20% and 35% were found to have medium and low compliance, respectively. On binomial logistic regression, age, duration since diagnosis, family support and current treatment regimen were found to be significantly associated with treatment compliance. Multiple facilitators of compliance could be identified of which, self-awareness of disease, fear of complications and family support were most pronounced. Whereas inability to purchase the medicines, forgetfulness, and lack of satisfaction with health services, were among the identified barriers of treatment compliance. Conclusion: High Compliance to diabetes medication was found among 47% of the study participants. Tailored interventions against the perceived barriers are necessary to promote compliance and improve glycemic control.

Introduction: Workplace violence (WPV) against healthcare professionals is a global concern, encompassing threats, verbal abuse, physical assaults, and even homicide. Objectives: This study aimed to determine the prevalence and types of WPV experienced by doctors in Goa from January 2023 to December 2023, assess its psychosocial impact, and evaluate its influence on the quality of patient care. Method: A cross-sectional study was conducted in December 2023 involving 270 Doctors of Modern Medicine practicing in Goa for at least one year. Participants were randomly selected and had a minimum qualification of a Bachelor of Medicine and Bachelor of Surgery. Data was collected through a semi-structured anonymous questionnaire administered via Google Forms. Statistical significance was determined using Chi-square and Fisher’s Exact tests. Results: The prevalence of WPV among doctors was 38.5%, with the highest occurrence in the 20–30 years age group (63.4%). Verbal abuse (36.2%) and threats (7.03%) were the most frequent forms of violence. Government-sector doctors (68.2%) faced higher incidences of WPV compared to their private-sector counterparts. Half of the participants who experienced WPV reported negative impacts on their personal and mental well-being. However, nearly all respondents stated that WPV did not compromise the quality of care they provided to patients. Conclusion: WPV is a significant issue for doctors in Goa, particularly among younger and government-sector practitioners. While WPV affects personal well-being, it does not seem to impact patient care, highlighting the urgent need for targeted preventive strategies.

Antimicrobials are medicines used to prevent and treat infectious diseases in humans, animals, and plants. They include antibiotics, antivirals, antifungals, and antiparasitics. However, the effectiveness of these medicines is under threat due to the growing issue of Antimicrobial Resistance (AMR). Antimicrobial Resistance occurs when bacteria, viruses, fungi, and parasites evolve and no longer respond to antimicrobial treatments, rendering these drugs ineffective. This makes infections increasingly difficult, or even impossible, to treat, thereby raising the risk of disease spread, severe illness, disability, and death. Although AMR is a natural process driven by genetic changes in pathogens, its acceleration is largely fueled by human activity, particularly the misuse and overuse of antimicrobials across various sectors. As AMR continues to pose a global health threat, coordinated efforts to combat it have become crucial. Hence we are exploring the pivotal role of community medicine / preventive and social medicine (PSM) in addressing the global challenge of antimicrobial resistance.

Industrialization has been a driving force behind India’s economic growth, transforming the nation into one of the world’s largest industrial economies. Over the past few decades, the expansion of industries ranging from manufacturing to construction has contributed significantly to employment opportunities, infrastructure development, and technological advancements. According to the International Labour Organization (ILO), India has one of the highest rates of work-related fatalities in the world, with tens of thousands of deaths reported annually due to industrial accidents and occupational diseases. There is a need for urgent attention to occupational safety and health issues.

En las últimas décadas se ha producido una expansión importante del sector privado en el área de la salud, tanto en América Latina como en otras regiones. Los gobiernos y los organismos internacionales han enfrentado este proceso de manera heterogénea. Se requiere un abordaje de políticas y, en especial, de regulación que ponga en el centro los objetivos de salud y el derecho a la salud, por sobre el lucro que anima su participación. Este trabajo se centra en una revisión de los marcos de análisis sobre el desempeño de los sistemas de salud y el papel que allí se le otorga a la regulación del financiamiento y la provisión de los servicios, sobre todo (aunque no de manera exclusiva) por parte del sector privado. Esta revisión incluye la producción de los principales organismos de salud a nivel internacional (Organización Panamericana de la Salud y Organización Mundial de la Salud), organismos internacionales de desarrollo (Banco Mundial y Organización de Cooperación y Desarrollo Económicos) e integrantes del ámbito académico vinculados a los debates internacionales de políticas sanitarias. Se identifican aspectos comunes en los diferentes marcos, así como algunas divergencias sustantivas. La finalidad de este artículo, que es parte de un proyecto de mayor alcance, es contribuir al debate sobre la regulación de los sistemas de salud en la Región de las Américas, asumir sus particularidades y describir el contexto actual.

Introduction: The fresh amnion membrane is a popular option for wound healing. After cryopreservation, fibroblasts and epithelial cells in the amnion membrane remain viable, but their viability decreases when the membrane is freeze dried. This study focuses on how the storage time of gamma-irradiated freeze-dried human amniotic membrane impacts the levels of important growth factors for wound healing: epidermal growth factor (EGF), transforming growth factor beta (TGF-β), and basic fibroblast growth factor (bFGF). Methods: This was a post-test group experimental design, in which we used enzyme-linked immunosorbent assay tests to measure three growth factor (EGF, TGF-β, bFGF) levels in gamma-irradiated, freeze-dried human amnion membrane derived from three storage groups of fresh human amnion membrane (1 week, 3 months, and 9 months). Results: The 1-week storage group, EGF levels were too low to detect. However, at 3 months, the levels rose to 3.393 pg/mL, and at 9 months, they reached 6.503 pg/mL. Statistical analysis (Mann–Whitney test) showed no significant difference between the 3-month and 9-month groups (P = 0.689). For bFGF, levels were 61.396 pg/mL at 1 week, 36.005 pg/mL at 3 months, and 132.233 pg/mL at 9 months, with no significant differences across groups (P = 0.134). TGF-β levels were 17.469 pg/mL for 1 week, 34.812 pg/mL for 3 months, and 35.449 pg/mL for 9 months, again showing no significant changes (P = 0.069). Conclusion: The study found no significant differences in the levels of EGF, TGF-β, and bFGF in gamma-irradiated freeze-dried human amnion membrane after storage periods of 1 week, 3 months, and 9 months, suggesting that the storage duration does not adversely affect these growth factors. This could have implications for the use of amnion membranes in clinical settings.

Solitary plasmacytoma has a variable prognosis, with some patients recovering and others developing multiple myeloma years later. This case report describes a case of solitary plasmacytoma that develops into multiple myeloma after cervical laminectomy. A 55-year-old woman came to the hospital with complaints of pain in the neck approximately 5 years ago, and the complaint felt worse during activity and improved when resting. The patient has a history of cervical laminectomy after being diagnosed with plasmacytoma. Pathological examination found a malignant round-cell tumor with a definitive diagnosis of plasmacytoma. The results of serum protein electrophoresis showed an increase in the beta fraction with a tapered shape. Bone marrow aspiration examination revealed hypoplastic multiple myeloma. To help provide better health services, early diagnosis, treatment, and careful monitoring can be carried out, thereby improving the quality of life of those affected by this disease.

Objective. To map the reasons why individuals oppose or refuse organ and tissue donation, from an international perspective. Methods. A scoping review was conducted from May 2022 to February 2024 using a three-stage search strategy across five databases and Google Scholar. Data analysis involved categorizing information based on similarities and populations studied. Results. The analysis included 92 articles and national reports. The data collected were classified into two categories. Category 1 included the reasons why individuals oppose deceased donation: lack of knowledge about the donation process, 22 (16.5%); religious beliefs, 21 (15.8%); fear of mutilation or damage to body integrity, 17 (12.8%); conflicts with health care professionals during hospitalization or distrust of professionals or the organ donation process, 11 (8.3%); and unknown reasons, 11 (8.3%). Category 2 included the reasons why individuals refuse to donate a deceased relative’s organs and tissues after the family interview for deceased donation: previous written or verbal expression by the potential donor, 42 (10.1%); fear of mutilation or damage to body integrity, 41 (9.9%); conflicts with health care professionals during hospitalization or distrust of professionals or the organ donation process, 38 (9.2%); religious beliefs, 37 (8.9%); and individual motivations, 36 (8.7%). Conclusions. This scoping review found that there were two main categories of reasons behind being opposed to or declining organ and tissue donation, with 23 subcategories. By mapping these reasons across international contexts, these findings provide insights for future research and can be used to inform the development of educational initiatives on organ and tissue donation.

Objetivo. Documentar los hechos históricos y desafíos que la Región de las Américas enfrentó para alcanzar y sostener los grandes logros de la eliminación del sarampión, la rubéola y el síndrome de rubéola congénita (SRC) entre el 2013 y el 2023. Métodos. Informe especial que incorpora la descripción narrativa de los principales logros, desafíos y lecciones aprendidas durante ese período y el análisis de coberturas de vacunación, indicadores de vigilancia y brotes de sarampión mediante datos de la Organización Panamericana de la Salud y del Fondo de las Naciones Unidas para la Infancia, entre otros. Resultados. Entre el 2003 y el 2016, la cobertura de vacunación regional con la primera dosis de vacuna contra el sarampión, la rubéola y la parotiditis estuvo entre 92% y 94%; después del 2017 tuvo un descenso marcado determinado por las coberturas de países de mayor población. La tasa de notificación regional de casos sospechosos se mantuvo en el nivel esperado con diferencias en cada subregión. Entre el 2017 y el 2023, los brotes de sarampión pusieron a prueba las fortalezas y las debilidades en la calidad de la respuesta de cada país. La pandemia de COVID-19 tuvo un impacto negativo a partir del 2020, tanto en coberturas de vacunación como en la calidad de la vigilancia epidemiológica. Conclusiones. Los grandes logros de la Región de las Américas fueron la eliminación del sarampión en el 2016 y la rubéola en el 2015. Entre el 2017 y el 2020, el primer desafío fueron los brotes de sarampión que ocasionaron el restablecimiento de la transmisión endémica en dos países, y el segundo desafío fue el impacto negativo de la pandemia de COVID-19 entre el 2020 y el 2023, en el descenso de coberturas de vacunación e indicadores de vigilancia.

O desempenho dos sistemas de saúde está relacionado à garantia do direito à saúde, um importante componente dos direitos humanos, que inclui o direito à proteção da saúde. A ação regulatória do Estado visa diminuir riscos à saúde, contribuindo para melhorar o desempenho dos sistemas de saúde, especialmente no que tange aos princípios da integralidade e da equidade. Este artigo tem por objetivo discutir a resiliência na perspectiva das agências reguladoras nacionais, especialmente frente às Emergências de Saúde Pública (ESP) e sua contribuição para a resiliência dos sistemas de saúde, tomando como modelo a atuação da agência reguladora brasileira, a Agência Nacional de Vigilância Sanitária (Anvisa). A regulação sanitária, no contexto das ESP, vem aperfeiçoando suas práticas regulatórias e atuando em diversas frentes. As agências reguladoras se utilizaram de instrumentos regulatórios específicos para agilizar o acesso a produtos eficazes e seguros para o enfrentamento de pandemias, para a assistência de qualidade e para a comunicação com a sociedade, e, no caso da Anvisa, também atuou sobre novos objetos, como o acompanhamento do desenvolvimento de respiradores pulmonares. É crucial reconhecer a interdependência entre o aprimoramento da capacidade de resposta e o desempenho para enfrentar as ESP. São exemplos a rápida aprovação de vacinas contra a Covid-19, permitindo acelerar a vacinação, bem como a colaboração das agências reguladoras e, no caso brasileiro, a atuação da Anvisa para reforçar o papel do Sistema Único de Saúde (SUS) e do direito à saúde face à desinformação e ao negacionismo.

Objetivo. Evaluar las diferencias en la letalidad del dengue entre las distintas subregiones de las Américas en el período 2014-2023 y explorar su relación con el índice de desarrollo humano (IDH) de cada región. Método. Estudio ecológico longitudinal realizado a partir de datos de acceso libre de cada país, que se agruparon en las subregiones correspondientes para calcular los distintos indicadores. Además, se realizó una regresión lineal entre la letalidad media en cada región y el IDH regional ponderado. Resultados. Existen grandes diferencias en la letalidad por dengue según la subregión y una variabilidad considerable según el año. Estas diferencias de letalidad no están directamente correlacionadas con la incidencia registrada en cada región. El IDH regional muestra una estrecha relación con la letalidad: un mayor IDH se asocia generalmente a una menor letalidad. Conclusiones. Las diferencias subregionales de letalidad y su relación con el nivel de desarrollo señalan que la estrategia de control del dengue debe ser diseñada desde una perspectiva amplia y multifactorial.

Objetivo. Describir el proceso de la reestructuración del Comité Nacional de Expertos y su impacto en el análisis de causalidad de eventos supuestamente atribuibles a la vacunación o inmunización (ESAVI) en el contexto del seguimiento de la seguridad de las vacunas durante la pandemia de COVID-19, en el período 2020-2023. Método. Informe sobre la experiencia de conformación y operación del Comité Nacional de Expertos de México durante el período mencionado. Resultados. Durante el período 2020-2023 se notificaron 1 293 ESAVI graves posteriores a la vacunación para la COVID 19; una vez evaluados y clasificados 98,6% (1 275) de ellos, se conformaron 10 subcomités por especialidades. Conclusiones. La reestructuración y evaluación a través una serie de pasos previos, junto con la herramienta de análisis de causalidad de la Organización Mundial de la Salud, han posibilitado la generación de documentos científicos que respaldan la seguridad de las vacunas y mantener la confianza en la vacunación.

This study searched grey literature and PubMed for strategies to sustain the elimination of measles, rubella, and congenital rubella syndrome and prevent their reintroduction in the Caribbean. Strategies were categorized at the macro, meso, and micro health levels. Macro strategies include: strong, clear, unified political and technical leadership and support; country ownership and subregional coordination of resources, policies, and programs; government investment in national immunization programs; and timely payment to the Pan American Health Organization Revolving Fund for affordable, good-quality vaccines. Including the private health sector and health workers in the tourism industry to identify and manage suspected imported cases, and finding and vaccinating every unvaccinated child, university student or frontline worker are key meso strategies. Strong social and communication programs are the key micro strategies needed to promote vaccine confidence and gain public trust. Priority macro strategies include a strengthened legislative framework supporting immunization, and policies to ring-fence the immunization budget, mitigate the rapid turnover of staff, and train new immunization managers. Establishing infrastructure to vaccinate adolescents and adults, including through the private sector, increasing the capacity to test for measles and rubella, and updating digital surveillance systems for timely decision-making are also critical meso strategies to prevent the reintroduction of these diseases. Partnerships, commitment, and collaborative efforts that contribute to elimination must be sustained, and health strategies strengthened to keep the Caribbean free of endemic transmission of measles, rubella, and congenital rubella syndrome.

Objective. This study aimed to explore the use of data from routine health information systems (RHIS) as a public good in Trinidad and Tobago, the challenges faced in doing this and opportunities for strengthening the health information system. Methods. For this descriptive qualitative study, purposive sampling was utilized to recruit 19 people who used or produced RHIS data. Online interviews were conducted via Zoom, and all interviews were recorded and transcribed. Pseudonyms were used to protect participants’ identity. Transcripts were cleaned and analyzed using Dedoose (v. 9.0.17; Dedoose, Los Angeles, CA, USA). Results. There was significant underutilization of RHIS data as a public good, primarily due to challenges related to data access and quality. Access to the data was stymied by burdensome bureaucratic processes, paper-based recording and storage systems, and ownership and security concerns. Data quality was adversely affected by a lack of standardized data collection forms and processes, staff training, data completeness, and also by technological and infrastructural constraints. Key opportunities for increasing the use of Trinidad and Tobago’s RHIS data would include addressing the need for a national electronic health information system, ensuring adequate training for staff involved in data management, and developing a comprehensive monitoring and evaluation plan. Conclusions. Data quality and access must be improved to enable greater use of RHIS data as a public good in Trinidad and Tobago. The planned change from a paper-based to a national electronic data recording and storage system must be expedited, and it should be accompanied by the standardization of processes, and investments in adequate staffing and timely training. Appropriate technological and infrastructural support, as well as an improved data governance system, are also required.

The elimination of endemic rubella and measles transmission in the Region of the Americas was verified by the Pan American Health Organization’s (PAHO) Regional Verification Commission in 2015 and 2016, respectively. Upon achieving this success, this Commission was disbanded. Shortly afterwards, the Region faced challenges in the post-elimination era, notably responding to and stopping transmission of imported measles cases. As a result, Brazil and Venezuela (Bolivarian Republic of) lost their measles-free status in February 2019 and July 2018, respectively. These events spurred PAHO to form the Measles and Rubella Elimination Regional Monitoring and Re-Verification Commission (MRE-RVC) focused on re-verifying these two countries and providing intensive evaluations of all countries in their efforts to sustain elimination. The MRE-RVC was tasked with advocacy to help revitalize the necessary political commitment to provide sufficient resources to sustain measles and rubella elimination in the Americas. Maintaining measles and rubella elimination in the Region is important, despite the challenges such as the global circulation of measles and rubella viruses elsewhere. This paper outlines the activities of the MRE-RVC to address the challenges and the lessons learnt, and provides insight on sustaining the gains. The main reasons to sustain efforts are: measles vaccine saves more lives than any other vaccine; congenital rubella syndrome is still the leading cause of infectious disease birth defects in the world; and measles vaccination performance remains an indicator of national capacity to maintain health security and a timely response to future infectious disease threats. A global target for measles and rubella elimination is crucial.

Objetivo. Evaluar el aporte de los monitoreos rápidos de vacunación (MRV) en el logro de las metas de coberturas de vacunación (CV) en las campañas de vacunación de seguimiento (CVS). Método. Los datos se obtuvieron de la base de datos disponible en la Dirección de Inmunoprevenibles por Vacunas sobre las CVS. El análisis de los datos se realizó en Stata V.15®. Se calcularon medidas de frecuencia y de resumen; la significancia estadística se evaluó con valor de P. El cambio en la media de las coberturas entre las intervenciones se evaluó con la prueba t de Student. Resultados. Durante la CVS se vacunaron 815 482 niños en 157 municipios, y se realizaron 2 431 MRV. Antes de los MRV, la cobertura de la vacuna doble viral contra el sarampión y la rubéola (SR) fue de 85,7%, en tanto que para la vacuna antipoliomielítica oral bivalente (bOPV) fue de 89,9%; las coberturas fueron homogéneas en 78% de los municipios. Luego del MRV, la cobertura con SR fue de 98,7% y la de bOPV, de 100%. La cobertura de SR aumentó 14,6% y la bOPV, 11,7%; ambos valores fueron estadísticamente significativos (prueba t de Student 12,3 y 10,8, respectivamente; P = 0). Conclusión. El MRV es una estrategia útil para validar coberturas en CVS y deben ser realizados por equipos externos. Los datos informados permiten mejorar la imprecisión de los datos de cobertura. Se recomienda evaluar calidad de los datos en CVS mediante MRV, considerada una estrategia adecuada desde el punto de vista costo-beneficio.

Data sharing increasingly underpins collaborative research to address complex regional and global public health problems. Advances in analytic tools, including machine learning, have expanded the potential benefits derived from large global repositories of open data. Participating in open data collaboratives offers opportunities for Caribbean researchers to advance the health of the region’s population through shared data-driven science and policy. However, ethical challenges complicate these efforts. Here we discuss fundamental challenges that threaten to impede progress if not strategically addressed, including power dynamics among funders and researchers in high-income countries and Caribbean stakeholders; research and health equity; threats to privacy; and risk of stigma. These challenges may be exacerbated by resource and infrastructure limitations often seen in small island developing states (SIDS) and low- and middle-income countries. We propose a framework for Safeguarding Health And Research data sharing by promoting Equity (SHARE) for Caribbean researchers and communities participating in shared data science. Using the SHARE framework can support regionally relevant and culturally responsive work already underway in the region and further develop capacity for intentional sharing and (re)use of Caribbean health data.

Objective. To quantify three aspects of data-related developmental progress across 57 Small Island Developing States (SIDS) recognized by the United Nations: statistical capacity measured using the Statistical Performance Indicators (SPI), data availability using the Sustainable Development Goal (SDG) indicators, and gender-stratified indicators. Methods. SIDS as a single country group were compared with other World Bank regions, using SPI, availability of SDG metrics, and availability of gender-stratified metrics. Using population size as a proxy for “smallness,” its association with data capacity and availability was modeled. Results. SPI among SIDS was lower than in any world region – broadly equivalent to Sub-Saharan Africa. Two-thirds of SDG indicators were available for SIDS in 2022; other world regions having between 71% and 87% availability. One-third of gender-stratified indicators were available for SIDS in 2022; other world regions having between 58% and 68% availability. Population size was strongly associated with each outcome, with SIDS having a statistical capacity 18.0 percentage points lower than other countries [95% CI (8.5, 27.4)], SDG data availability 17.4 percentage points lower [95% CI (13.1, 21.7)], and gender-stratified indicator availability 28.8 percentage points lower [95% CI (24.5, 33.0)]. Conclusions. As global demand and associated rewards for electronic data increase, our analysis highlights the challenges introduced by island “smallness” in the global push for digital transformation. Regional cooperation mechanisms, sustained international support, and systematic monitoring of data availability are urgently required to monitor capacity development.

The Caribbean small island developing states have limited resources for comprehensive health care provision and are facing an increasing burden of noncommunicable diseases which is driven by an aging regional population. Artificial intelligence (AI) and other digital technologies offer promise for contributing to health care efficiencies, but themselves are dependent on the availability and accessibility of accurate health care data. A regional shortfall in data professionals continues to hamper legislative recognition and promotion of increased data production in Caribbean countries. Tackling the data shortfall will take time and will require a sustainably wider pool of data producers. The data journey map is one approach that can contribute to overcoming such challenges. A data journey map is a process for organizing the collection of health data that focuses on interactions between patient and health care provider. It introduces the idea that data collection is an integral part of the patient journey and that interactions between patient and provider can be enhanced by building data collection into daily health care. A carefully developed and enacted data journey map highlights key points in the care pathway for data collection. These so-called data hotspots can be used to plan – then eventually implement – appropriate AI health care solutions. In this article we introduce the idea of journey mapping, offer an example using cervical cancer prevention and treatment, and discuss the benefits and challenges to implementing such an approach.

Objetivo. Documentar y comparar los factores de riesgo y medidas de control de los brotes de sarampión de mayor magnitud en la era poseliminación en la Región de las Américas. Método. Descripción de los factores de riesgo como coberturas de vacunación, tasa de notificación de casos sospechosos e incidencia de sarampión, y un resumen de las medidas de control de los principales brotes de sarampión en seis países, entre el 2017 y el 2023. El plan de análisis también incluye la revisión de las características de los brotes en tiempo, lugar y persona. Resultados. Entre los años 2017 y 2023, 19 países de las Américas notificaron un total de 50 082 casos y 121 muertes por sarampión. De esos casos, 49 738 (99,3%) se notificaron en seis países: Argentina, Brasil. Colombia, Estados Unidos de América, México y Venezuela. En dos de estos seis países se restableció la transmisión endémica por la presencia de factores de riesgo que no pudieron resolverse con las medidas de control inicialmente establecidas. Entre el 2017 y el 2019, los genotipos y linajes predominantes fueron el D8 linaje MVi/Hulu Langat.MYS/26.11 y el D8 linaje Gir Somnath.IND/42.16. Conclusiones. Los países que tuvieron mejores coberturas con dos dosis de vacuna contra sarampión, rubéola y parotiditis, tasas de notificación de casos sospechosos óptimas y tasas de incidencia

Objective. We describe the daily operations of the Cohorts Consortium of Latin America and the Caribbean (CC-LAC), detailing the resources required and offering tips to Caribbean researchers so this guide can be used to start a data pooling project. Methods. The CC-LAC began by developing a steering committee – that is, a team of regional experts who guided the project’s set up and operations. The Consortium invites investigators who agree to share individual-level data about topics of interest to become members and they then have input into the project’s goals and operations; they are also invited to coauthor papers. We used a systematic review methodology to identify investigators with data resources aligned with the project and developed a protocol (i.e. a manual of procedures) to document all aspects of the project’s operations. Results. If a study recruited people from more than one country, then the sample from each country was counted as a separate cohort, thus in 2024 our combined data resources include >30 separate units from 13 countries, with a combined sample size of >174 000 participants. Using this unique resource, we have produced region-specific risk estimates for cardiometabolic risk factors (e.g. anthropometrics) and cardiovascular disease, and we have developed a region-specific cardiovascular risk score for use in clinical settings. Conclusions. Data pooling projects are less expensive than collecting new data, and they increase the longer-term value and impact of the data that are contributed. Data pooling efforts require systematic and transparent methodology, and expertise in data handling and analytics are prerequisites. Researchers embarking on a data pooling endeavor should understand and be able to meet the various data protection standards stipulated by national data legislation as these standards will likely vary among jurisdictions.

Objetivo. Analizar los resultados de la vigilancia de eventos adversos de interés especial (EVADIE) en contexto de la campaña de vacunación contra la COVID-19 en una unidad centinela (UC) de Argentina; se comparó el período retrospectivo (prevacunación) con el prospectivo (vacunal) para identificar señales de alerta. Método. Búsqueda de EVADIE en forma retrospectiva y prospectiva a partir de los códigos CIE-10 de egreso hospitalario. Se realizó un análisis descriptivo, suavizamiento de la tendencia por media móvil y cartas de control para detección de cambios en el comportamiento de EVADIE. Resultados. Se identificaron 1 586 EVADIE. El análisis de la proporción según egresos reveló un aumento durante el período pandémico (2020) con descenso progresivo en el período de vacunación (2021-2022), a expensas de síndrome de dificultad respiratoria aguda (SDRA). Se comparó el suavizamiento por media móvil y cartas de control, y se destacaron momentos en los que la proporción de EVADIE superó los límites de control superior. En el período vacunal esto ocurrió para SDRA, trombosis, miocarditis, meningoencefalitis, síndrome inflamatorio multisistémico y anafilaxia. No se observaron diferencias para síndrome de Guillain-Barré, trombocitopenia ni pericarditis. Los eventos de encefalomielitis diseminada aguda, meningoencefalitis y pericarditis en el período vacunal no tenían antecedente de vacunación. Conclusión. La vigilancia activa en la UC permitió identificar los EVADIE que presentaron mayor frecuencia en el período vacunal en comparación con la línea de base prevacunal, como así también se observó el efecto protector de la vacuna contra la COVID -19, en especial en la disminución de los casos del SDRA en el período posvacunal. Esta estrategia es útil para evaluar la seguridad de las vacunas identificando señales de alerta.

Measles and rubella have long been recognized as priorities for disease prevention because of their devastating consequences for child health; hence, all World Health Organization (WHO) regions currently have a goal to eliminate measles and four out of six WHO regions have a goal to eliminate rubella. Significant global progress has been made in the twenty-first century, with more than 40% of countries in the world verified by a Regional Verification Commission as having eliminated measles and more than 50% of countries having sustained rubella elimination. Making further progress will require addressing fundamental gaps in health systems, a particular challenge in the current global context where many countries face multiple barriers to both sustaining and achieving measles and rubella elimination. These challenges require a strategic shift toward a holistic approach that embeds immunization at the center of primary health care at all levels, which will have broad benefits beyond preventing measles and rubella. Progress will be supported through technological innovations such as microarray patch vaccines. Whether this holistic approach will be more effective than vertical initiatives at achieving measles and rubella elimination remains to be seen. Measles is so infectious and its immediate impact so visible on individuals and health systems that any weaknesses in global or national strategy are immediately evident. The tools exist to prevent every death from measles and every case of congenital rubella syndrome. Countries and partners – at all levels – share accountability for ensuring children are protected from these entirely preventable diseases.

Objetivo. Verificar a variação no número de doses, na cobertura vacinal (CV) das vacinas aplicadas e no número de municípios que atingiram a meta da CV no Brasil com a implementação de microplanejamento para atividades de vacinação de alta qualidade (AVAQ) e ações de multivacinação descentralizadas. Método. Este estudo quase-experimental utilizou dados do Sistema de Informação sobre Nascidos Vivos, do Sistema de Informações do Programa Nacional de Imunizações e da Rede Nacional de Dados em Saúde. Estimou-se o número de doses de vacinas de hepatite A (HA), meningocócica conjugada - C, oral poliomielite, pneumocócica 10-valente, tríplice bacteriana (DTP) e tríplice viral (SCR) aplicadas em crianças menores de 2 anos de idade nos anos de 2022 (pré-microplanejamento) e 2023 (pós-microplanejamento). Também foram estimados a CV e o número de municípios que atingiram a meta da CV. Resultados. Em 2022, foram registradas 13 253 873 doses das vacinas selecionadas. Em 2023, foram aplicadas 13 570 346 doses. Observou-se aumento nas CV, com destaque para a vacina adsorvida DTP (incremento > 12%); e para as vacinas contra HA e SRC (aumento próximo a 10%). Cresceu o número de municípios que alcançaram a meta de CV em 2023 (incremento de 51,98% para a SCR e 7,77% para a vacina contra o meningococo). Conclusão. O microplanejamento fortaleceu a imunização de rotina e foi oportuno para enfrentar situações de queda das CV. Esse resultado favorável serve também para ressaltar a importância da continuidade e da ampliação dessas ações, com o objetivo de alcançar e manter resultados positivos.

The dissemination of biomedical research data beyond academia remains limited. In response, funding agencies now regularly require that the projects they fund make research data openly available for reuse. This emerging open data movement aims to democratize data access, often guided by the FAIR data technical standards, requiring that data should be findable, accessible, interoperable and reusable. Recently, participant communities have advocated the idea that improving data democracy does not address the inequities underlying the power dynamics of research enterprises. In contrast, the CARE principles of Indigenous data governance focus on collective benefit, authority to control, responsibility and ethics. We describe the data-sharing infrastructure and initiatives of the Eastern Caribbean Health Outcomes Research Network (ECHORN) for the ECHORN Cohort Study, which longitudinally examines risks and protective factors for noncommunicable diseases among community-dwelling adults in the United States and Caribbean locations. This work has been grounded in a community-engaged process, with the goal of developing robust, sustainable solutions for the dissemination of information. We highlight efforts towards operationalizing greater access to these longitudinal data resources, including the implementation of a regional survey to understand data needs and data-sharing capacities and the development of Explore ECHORN (https://exploreechorn.org), a free public data dashboard. Through these efforts, ECHORN has identified opportunities to expand initiatives that have the potential to encourage data-sharing to inform policy and strengthen the impact of research, particularly in the Caribbean. ECHORN also seeks to reconcile a community-engaged approach with the dissemination of data for secondary use.

The widespread digitization of information, advances in data processing and the emergence of internet-connected devices have led to a proliferation of data, often loosely referred to as big data. With this digital transformation, offering open data – that is, data freely available for modification and reuse – has emerged as a key strategy for encouraging transparency and innovation. Data reuse holds particular importance in the small island developing states of the Caribbean, which have a limited resource pool from which to tackle the landscape of social priorities. Efforts made towards data-sharing must consider privacy, security and the ethical use of information, and the tension between data as a social good and data for commercial gain can be a determinant of data-sharing decisions. A multidisciplinary approach is needed to realize the potential of data-sharing. In this article, we describe techniques (or pathways) for growing the Caribbean’s stock of open data, classifying these into four types. Initiative pathways are techniques to broaden the range of data producers that share data. Infrastructure pathways deal with the practicalities of making data publicly available. Governance pathways are regulations and frameworks that guide data producers, including in meeting their legal data obligations. Training and communication pathways are efforts to raise awareness and knowledge about the benefits and practices of data-sharing. Data-sharing can offer a cost-effective evidence base for the Caribbean’s continuing digital transformation. Sustainable sharing is key, and it must include robust technical infrastructure and governance, and ongoing communication.

Objetivo. Describir las buenas prácticas en vigilancia epidemiológica implementadas en El Salvador entre el 2019 y el 2023 para sostener la eliminación de sarampión, rubéola y síndrome de rubéola congénita. Método. Informe especial descriptivo de la implementación de las buenas prácticas de vigilancia epidemiológica y de laboratorio para sarampión, rubéola y síndrome de rubéola congénita, durante los años 2019 a 2023. Resultados. Durante el período 2019 a 2023, El Salvador no registró casos confirmados de sarampión, rubéola y síndrome de rubéola congénita. La tasa nacional de notificación de sarampión y rubéola para el año 2023 fue de 8,4 por 100 000 habitantes, para el 2022 fue de 9, para 2021 fue de 5,6, para el 2020 de 2,9 y para el 2019, de 8,2 por cada 100 000 habitantes. Desde la notificación del primer caso confirmado de COVID-19 en el país hasta la declaración del fin de la emergencia sanitaria internacional el 5 de mayo del 2023 por la Organización Mundial de la Salud, la tasa de notificación de casos sospechosos de sarampión y rubéola se mantuvo por arriba del estándar establecido para la vigilancia de sarampión, rubéola y rubéola congénita. Conclusiones. La implementación de estrategias de vigilancia epidemiológica de forma permanente y obligatoria permitió la sostenibilidad de la eliminación del sarampión y rubéola en El Salvador durante la pandemia de COVID-19.

Objetivo. Describir el impacto del nuevo modelo de actuación que Paraguay implementó en cincos distritos de la Región Central en el último trimestre del 2023, con base en una estrategia integrada desde los servicios de salud para recuperar coberturas con la vacuna trazadora en menores de un año (pentavalente hasta abril del 2023 y hexavalente desde entonces), y la vacuna contra sarampión, parotiditis y rubéola (SPR) para la población de un año. Método. Estudio descriptivo de corte transversal con análisis comparativo entre el período previo (semanas epidemiológicas [SE] 1 y 34 de 2023) y posterior (SE 35 y 52 de 2023) a la intervención de tres indicadores: a) coberturas con las tres dosis de pentavalente o hexavalente, y primera y segunda dosis de SPR; b) productividad en la administración de la tercera dosis de pentavalente o hexavalente y; c) tasas de deserción en la vacunación con pentavalente o hexavalente y SPR. Resultados. Con la intervención, la cobertura promedio semanal con la tercera dosis de pentavalente o hexavalente fue de 1,2%, con un incremento del promedio de 1,0% registrado preintervención. En comparación con el 2022, en el 2023 se incrementó la cobertura con la tercera dosis de vacuna pentavalente o hexavalente en 3,5%, mientras que el incremento con la primera y la segunda dosis de SPR fue de 32,7% y 4%, respectivamente. El promedio de dosis semanales de la tercera dosis de pentavalente o hexavalente se incrementó a 257, y superó las 215 dosis que se administraban previo a la intervención. La tasa de deserción con vacuna pentavalente o hexavalente pasó de 17,9% a 9,2%, mientras que la de SPR pasó de 55,0% a 46,5%. Conclusión. La implementación del nuevo modelo de actuación impactó positivamente en los indicadores, logrando detener la tendencia descendente de coberturas de vacunación registrados en los últimos años.

Objective. To estimate the direct costs associated with the diagnosis, treatment, and control of measles cases in Brazil from 2018 to 2020. Methods. This cost-of-illness study utilized a prevalence-based approach, considering direct costs incurred by the Brazilian Public Health System (SUS) related to measles outbreaks, including costs of inpatient care, outpatient care, and laboratory tests, as well as measles-containing vaccines and laboratory tests (viral isolation) used for outbreak control. Costs are presented in 2020 US dollars. Univariate and bivariate sensitivity analyses were performed. Results. There were 36 236 confirmed measles cases from 2018 to 2020. The estimated outbreaks cost was USD 107 960 122, with the cost per case ranging from USD 2 601 to USD 3 654 (mean USD 2 979). Conclusions. These findings highlight the substantial economic burden imposed by measles outbreaks in Brazil and emphasize the importance of measles prevention and control measures. Policymakers and public health authorities can use these results to plan and allocate resources, to mitigate the economic impact of future outbreaks.

Objetivo. Describir la estrategia implementada para la interrupción del brote de sarampión en el período 2019-2020 en el Área Metropolitana de Buenos Aires (Argentina) y la aplicación de los criterios estandarizados de cierre de brotes de la Organización Panamericana de la Salud (OPS) para documentar la interrupción de la circulación viral en el escenario adverso de la pandemia de COVID-19. Método. Se realizó un estudio observacional descriptivo y retrospectivo de las acciones realizadas ante el brote de sarampión ocurrido entre las semanas epidemiológicas 35 del 2019 y 12 del 2020. Se documentó la interrupción de la circulación viral mediante la aplicación de criterios epidemiológicos, de vacunación y de laboratorio. Los datos se obtuvieron del Sistema Nacional de Vigilancia, del Registro Federal de Vacunación y de los informes de brote. Resultados. La estrategia de control del brote en Argentina tuvo como ejes las acciones de vacunación intensificadas y el fortalecimiento de la vigilancia epidemiológica. La información obtenida permitió analizar el cumplimiento de los criterios de la OPS para verificar la interrupción de la circulación viral. Conclusiones. La interrupción del brote y su demostración representó un desafío en el escenario epidemiológico complejo que atravesaba el país. La aplicación de los criterios estandarizados de cierre de brotes permite planificar las actividades. Sin embargo, en situaciones extraordinarias es necesario realizar una ponderación con base en un sentido de priorización técnica e implementar estrategias innovadoras y adaptadas al contexto epidemiológico para cumplir con los criterios propuestos.

El objetivo de este estudio fue analizar el papel de la comunicación de riesgo en la respuesta a casos de eventos supuestamente adversos atribuibles a la vacunación e inmunización en países de las Américas.

Since the last case of indigenous rubella virus (RuV) was detected in 2009 in the Region of the Americas, sporadic rubella and congenital rubella cases have been confirmed, and subsequently, a low number of associated sequences have been reported. Fifty-one sequences of wild-type RuV, representing four genotypes (1E, 1G, 1J, and 2B), were reported from five countries, with confirmed sources of exposure for 46 cases. Phylogenetic analysis revealed the diversity of these viruses, showing no associations with sustained endemic transmission from previously endemic strains. Notably, 13 sequences were associated with travel from countries where no genetic information of wild-type viruses was available. In addition to sequences from postnatal and congenital infections, 23 sequences were collected from patients with diseases associated with RuV persistent infection. These findings highlight the Region’s success in maintaining rubella elimination, emphasize its valuable contribution to global RuV molecular epidemiology, and address potential challenges in progressing toward the goal of rubella eradication.

Objetivo. Describir la experiencia de México en la campaña de vacunación de seguimiento de alta calidad (CVS) contra sarampión y rubéola en niños de 1 a 4 años, y acciones de recuperación de coberturas con otros biológicos durante la emergencia sanitaria por COVID-19. Método. Uso de la herramienta de microplanificación en el diseño e implementación de CVS para proteger a 8 604 781 niñas y niños de 1 a 4 años, y completar esquemas con otras vacunas, seguida de la ejecución de monitoreo rápido de vacunación (MRV). Resultados. Se aplicaron 8 026 184 dosis de vacuna SR en niños de 1 a 4 años, con una cobertura de 93,3%; además, se aplicaron 3 058 201 dosis de vacuna SRP y 2 361 021 dosis de vacuna hexavalente. Se ejecutaron 78 MRV en municipios seleccionados del país, donde se detectó que no estaban vacunados 30% (18 692 niños) de 62 308 niños de 1-4 años contactados. Los motivos de la no vacunación fueron “no saber que era necesario” (28,5%), “no haber tenido tiempo” (21,2%), “otros motivos” (principalmente miedo a enfermar por COVID-19 en centros de salud) (12,9%), “creer tener dos dosis de vacuna triple viral” (9,1%), o “no saber dónde vacunarse” (8,7%); 19,6% no respondieron. Conclusiones. La campaña de vacunación de alta calidad fue exitosa, lo que permitió favorecer la sostenibilidad de eliminación de sarampión, rubéola y poliomielitis, así como el control de otras enfermedades prevenibles por vacunación, lo cual muestra la relevancia de la microplanificación.

Objetivo. Determinar la seropositividad de la IgG para el sarampión y la rubéola en la era poseliminación, a partir de los datos generados por laboratorio del Centro Nacional de Referencia Virología, Inciensa, entre 2012-2023. Metodología. Estudio observacional descriptivo transversal que analiza frecuencias de los resultados de las pruebas de ELISA de IgG antisarampión e IgG antirrubéola de 877 personas. Resultados. El promedio de la edad de las personas estudiadas fue de 36 años; 51,8% eran mujeres. La seropositividad de las IgG para sarampión y rubéola es un poco mayor en las mujeres. La seropositividad promedio en los años de estudio fue de 74,8% para los anticuerpos IgG antisarampión y de 84,5 % para rubéola. El grupo de edad de 50 años y más presentó la mayor positividad para los dos tipos de IgG antisarampión e IgG antirrubéola, y el grupo de menor respuesta humoral protectora fue el de 20 a 39 años. Conclusiones. Los estudios descriptivos de seropositividad de anticuerpos IgG antisarampión y antirrubéola pueden identificar grupos etarios susceptibles para estas enfermedades, lo cual puede orientar a las autoridades de salud a dirigir las campañas suplementarias de vacunación, que permitan reforzar la respuesta inmune de la población, con el fin de evitar los brotes de ambas enfermedades.