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Las vacunas orales frente al cólera (OCV) precalificadas por la OMS establecen un régimen de dos dosis con un intervalo de 2 semanas, planteando desafíos para las campañas de vacunación reactivas. Nuestra revisión sistemática y metaanálisis de las OCV sugiere que una dosis de OCV proporciona al menos una protección a corto plazo. En abril de 2016, se organizó una campaña de vacunación de emergencia con una dosis de OCV dentro de las medidas de respuesta al brote de cólera que comenzó en Zambia en febrero de 2016. La efectividad vacunal de una dosis de OCV que estimamos fue del 88,9%. En diciembre de 2016, se realizó una segunda ronda de vacunación, con el objetivo de incrementar la duración de la protección vacunal, antes del período de alto riesgo para la transmisión del cólera. La cobertura vacunal con dos dosis fue del 33,9% . El 69,9% reportó haber recibido al menos una dosis de OCV., Departamento de Anatomía Patológica, Microbiología, Medicina Preventiva y Salud Pública, Medicina Legal y Forense, Doctorado en Investigación en Ciencias de la Salud

We conducted a matched case-control (MCC), test-negative case-control (TNCC) and case-cohort study in 2016 in Lusaka, Zambia, following a mass vaccination campaign. Confirmed cholera cases served as cases in all three study designs. In the TNCC, control-subjects were cases with negative cholera culture and polymerase chain reaction results. Matched controls by age and sex were selected among neighbours of the confirmed cases in the MCC study. For the case-cohort study, we recruited a cohort of randomly selected individuals living in areas considered at-risk of cholera. We recruited 211 suspected cases (66 confirmed cholera cases and 145 non-cholera diarrhoea cases), 1055 matched controls and a cohort of 921. Adjusted vaccine effectiveness of one dose of oral cholera vaccine (OCV) was 88.9% (95% confidence interval (CI) 42.7–97.8) in the MCC study, 80.2% (95% CI: 16.9–95.3) in the TNCC design and 89.4% (95% CI: 64.6–96.9) in the case-cohort study. Three study designs confirmed the short-term effectiveness of single dose OCV. Major healthcare-seeking behaviour bias did not appear to affect our estimates. Most of the protection among vaccinated individuals could be attributed to the direct effect of the vaccine.

International audience; objective To assess the performance of the SD Bioline Cholera Ag O1/O139 rapid diagnostic test (RDT) compared to a reference standard combining culture and PCR for the diagnosis of cholera cases during an outbreak.methods RDT and bacterial culture were performed on site using fresh stools collected from cholera suspected cases, and from stools enriched in alkaline peptone water. Dried stool samples on filter paper were tested for V. cholerae by PCR in Lusaka (as part of a laboratory technology transfer project) and at a reference laboratory in Paris, France. A sample was considered positive for cholera by the reference standard if any of the culture or PCR tests was positive for V. cholerae O1 or O139. results Among the 170 samples tested with SD Bioline and compared to the reference standard, the RDT showed a sensitivity of 90.9% (95% CI: 81.3–96.6) and specificity of 95.2% (95% CI: 89.1–98.4). After enrichment, the sensitivity was 95.5% (95% CI: 87.3–99.1) and specificity 100% (95% CI: 96.5–100). conclusion The observed sensitivity and specificity were within recommendations set by the Global Task Force for Cholera Control on the use of cholera RDT (sensitivity = 90%; specificity = 85%). Although the sample size was small, our findings suggest that the SD Bioline RDT could be used in the field to rapidly alert public health officials to the likely presence of cholera cases when an outbreak is suspected.

Producción Científica, Killed oral cholera vaccines (OCVs) are part of the standard response package to a cholera outbreak, although the two-dose regimen of vaccines that has been prequalified by the World Health Organization (WHO) poses challenges to timely and efficient reactive vaccination campaigns.1 Recent data suggest that the first dose alone provides short-term protection, similar to that of two doses, which may largely dictate the effect of OCVs during epidemics

To describe the implementation and feasibility of an innovative mass vaccination strategy - based on single-dose oral cholera vaccine - to curb a cholera epidemic in a large urban setting.In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign - 2.31 United States dollars (US$) per dose - included the relatively low cost of local delivery - US$ 0.41 per dose.We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.Rendre compte de la mise en œuvre et de la faisabilité d'une stratégie de vaccination de masse innovante – fondée sur un vaccin anticholérique oral à dose unique – pour enrayer une épidémie de choléra dans une vaste zone urbaine.En avril 2016, aux premiers stades d'une flambée de choléra à Lusaka, en Zambie, le ministère de la Santé a collaboré avec Médecins Sans Frontières et l'Organisation mondiale de la Santé pour organiser une campagne de vaccination de masse fondée sur un vaccin anticholérique oral à dose unique. Pendant 17 jours, ces partenaires ont fait appel à 1700 membres du personnel du ministère de la Santé et bénévoles communautaires pour mener des activités de sensibilisation des communautés, de mobilisation sociale et de vaccination dans 10 municipalités. Chaque jour, des doses de vaccins ont été livrées sur les sites de vaccination et une estimation de la couverture administrative a été effectuée.En tout, les équipes de vaccination ont administré 424 100 doses de vaccins à une population cible estimée à 578 043 individus, ce qui se traduit par une couverture administrative estimée à 73,4%. Après la campagne, seuls de rares cas de choléra ont été signalés et aucun signe de propagation de la maladie dans les zones de vaccination n'a été noté. Le coût total de la campagne – 2,31 dollars des États-Unis ($US) par dose – incluait le coût relativement bas de la livraison locale – 0,41 $US par dose.L'organisation d'une campagne de vaccination réactive précoce, ciblée et à grande échelle – fondée sur un vaccin oral à dose unique – pour répondre à une épidémie de choléra dans une grande ville s'est avérée faisable et efficace. Alors que les vaccins anticholériques demeurent rares, il convient d'envisager la maximisation du nombre de vaccins pour faire face à une épidémie de choléra à travers l'utilisation d'une seule dose par membre d'une communauté vulnérable.describir la aplicación y la viabilidad de una estrategia innovadora de vacunación masiva, basada en una vacuna oral contra el cólera de una sola dosis, para frenar una epidemia de cólera en un entorno urbano grande.en abril de 2016, en las primeras etapas de un brote de cólera en Lusaka, Zambia, el Ministerio de Salud colaboró con Médecins Sans Frontières y la Organización Mundial de la Salud en la organización de una campaña masiva de vacunación basada en una vacuna oral contra el cólera de una sola dosis. Durante un período de 17 días, los socios movilizaron a 1700 voluntarios de personal sanitario y voluntarios de la comunidad para sensibilizar a la comunidad y para actividades de vacunación y movilización social en 10 municipios. Cada día, las dosis de la vacuna se entregaron en los lugares de vacunación y se estimó la cobertura administrativa.en general, los equipos de vacunación administraron 424.100 dosis de la vacuna a una población objetivo de unos 578.043 habitantes, lo que resultó en una cobertura administrativa estimada del 73,4%. Después de la campaña, se registraron pocos casos de cólera y no hubo pruebas de propagación de la enfermedad dentro de las zonas vacunadas. El costo total de la campaña (2,31 dólares estadounidenses (USD) por dosis) incluyó el coste relativamente bajo de la entrega local (0,41 $ por dosis).se descubrió que una campaña reactiva temprana dirigida y en gran escala con una vacuna oral de dosis única, organizada en respuesta a una epidemia de cólera dentro de una gran ciudad, era factible y aparentemente efectiva. Si bien las vacunas contra el cólera siguen siendo escasas, se debe considerar la maximización del número de vacunados en respuesta a una epidemia de cólera, mediante el uso de una sola dosis por miembro de una comunidad en riesgo.وصف لإجراءات تنفيذ استراتيجية مبتكرة للتطعيم الجماعي وإمكانية تطبيقها – إذ تقوم الاستراتيجية على تقديم جرعة واحدة من لقاح الكوليرا يتم تلقيها عبر الفم – وذلك للحد من انتشار وباء الكوليرا في منطقة حضرية واسعة النطاق.شهد عام 2016، مع المراحل الأولى لظهور مرض الكوليرا في مدينة "لوساكا" في زامبيا، تعاونًا بين وزارة الصحة بالبلاد من جهة ومنظمة أطباء بلا حدود (Médecins Sans Frontières) ومنظمة الصحة العالمية من جهة أخرى بشأن تنظيم حملة تطعيم جماعي تقوم على تقديم جرعة واحدة عبر الفم من لقاح الكوليرا. وخلال فترة تبلغ 17 يومًا، عملت الأطراف المتعاونة على حشد 1700 فرد من العاملين بوزارة الصحة والمتطوعين في الخدمات المجتمعية من أجل تحقيق التوعية المجتمعية والتعبئة الاجتماعية وتنفيذ أنشطة التطعيم في 10 أقاليم. وتم توفير جرعات التطعيم في كل يوم في مواقع التطعيم وجرى تقييم للتغطية المتعلقة بالجرعات المقدمة.قدمت فرق التطعيم بوجه عام 424100 جرعة من اللقاح لمجموعة مستهدفة من السكان بلغ عددها 578043 فردًا حسب التقديرات، مما أثمر عن وجود تغطية للجرعات المقدمة تم تقديرها بنسبة ‏73.4%. وبعد الحملة، قل العدد الذي يتم الإبلاغ به من حالات الإصابة بالكوليرا، ولم يوجد أي دليل على انتشار المرض في المناطق التي تم فيها التطعيم. وكانت التكلفة الإجمالية للحملة – التي بلغت 2.31 دولارًا أمريكيًا للجرعة الواحدة، شاملةً التكلفة المنخفضة نسبيًا لتوفير الجرعة محليًا – قد بلغت 0.41 دولارًا أمريكيًا للجرعة الواحدة.تبين لنا أن تنفيذ حملة موجهة واسعة النطاق في مرحلة مبكرة للتصدي للمرض باستخدام جرعة واحدة من لقاح فموي – وهي الحملة التي تم تنظيمها لمواجهة وباء الكوليرا على نطاق مدينة كبرى – أمر يمكن تحقيقه وبدت له نتائج مجدية. وبالرغم من استمرار المعاناة من النقص في الموارد المتاحة للقاح الكوليرا، يجب النظر في تحقيق أقصى استفادة ممكنة من عدد اللقاحات المتاحة للتصدي لوباء الكوليرا، وذلك عن طريق استخدام جرعة واحدة فقط لكل فرد من أفراد المجتمع المهدد بالإصابة بالمرض.旨在说明基于单剂量口服霍乱疫苗的创新型大规模接种策略的实施和可行性，以遏制大型城市环境中的霍乱疫情。.2016 年 4 月，在赞比亚卢萨卡霍乱爆发的早期阶段，卫生部门与无国界医生组织和世界卫生组织合作组织了基于单剂量口服霍乱疫苗的大规模疫苗接种活动。在 17 天的时间里，合作方共动员了 1700 名卫生部工作人员和社区志愿者在 10 个乡镇开展社区宣传、社会动员和疫苗接种活动。每天将疫苗剂量送到疫苗接种处并估计接种覆盖率。.总体而言，疫苗接种小组对估计的目标人群 578043 人进行了 424100 剂疫苗接种，估计接种覆盖率为 73.4％。此项活动后，报告的霍乱案例很少，没有证据表明疫苗接种区域内有传染病。活动的总费用——每剂量 2.31 美元，包括相对较低的本地交付成本（每剂量 0.41 美元）。.我们发现，使用单剂量口服疫苗的早期大规模针对性反应性活动是为了应对大城市内的霍乱疫情而组织起来的，可行且有效。尽管霍乱疫苗仍然供不应求，但每一名处于危险社区中的成员只需一个剂量，应对霍乱疫情所需的最大接种疫苗数量应该考虑在内。.Описать реализацию и осуществимость инновационной стратегии массовой вакцинации, основанной на применении однодозовой пероральной противохолерной вакцины, для борьбы с эпидемией холеры в условиях крупных городов.В апреле 2016 года на ранних стадиях вспышки холеры в Лусаке, Замбия, Министерство здравоохранения сотрудничало с организацией «Врачи без границ» и Всемирной организацией здравоохранения при проведении кампании массовой вакцинации, основанной на применении однодозовой пероральной противохолерной вакцины. В течение 17 дней партнеры мобилизовали 1700 сотрудников Министерства здравоохранения и общинных добровольцев для повышения информированности населения, социальной мобилизации и вакцинации в 10 поселках. Ежедневно на участки вакцинации доставлялись дозы вакцины и оценивался административный охват вакцинацией.В целом группами вакцинации были введены 424 100 доз вакцины в предполагаемой целевой популяции в количестве 578 043 человек, в результате чего административный охват оценивался как 73,4%. После кампании сообщалось о редких случаях заболевания холерой и не было признаков распространения болезни в вакцинированных районах. Общие расходы на кампанию составили 2,31 доллара США (US$) на 1 дозу, включая относительно низкую стоимость местной доставки — 0,41 доллара США на 1 дозу.Мы обнаружили, что ранняя и крупномасштабная целевая реактивная кампания с применением однодозовой пероральной вакцины, организованная в ответ на эпидемию холеры в крупном городе, осуществима и эффективна. Поскольку по-прежнему имеется дефицит противохолерных вакцин, следует рассмотреть вопрос об увеличении числа доступных вакцин в ответ на эпидемию холеры за счет использования только одной дозы на одного члена сообщества, находящегося в зоне риска.

Objectives Some saliva-based HIV testing programmes have resulted in an unacceptable percentage of false positives. Many countries require blood-based testing programmes to have doctors/nurses. The authors evaluate whether, after brief training and under the supervision of a skilled counsellor, blood-based self-sample collection and rapid test performance could be a valuable alternative. Methods 208 Spanish-speaking attendees at a street-based HIV testing programme in Madrid participated in the study. Participants were tested twice, first in the study and then in the programme, using the same finger-stick whole-blood rapid test (Determine HIV-1/2 Ag/Ab Combo®). Based on previously adapted instructions, the study counsellor explained the procedure to follow throughout the test. Participants then performed the test under the guidance of the counsellor. Demographic and risk behaviour data were collected by a self-administered questionnaire. The test results in the programme and the study were read by the study counsellor. Results 99.0% (95% CI 96.6% to 99.9%) of participants had a valid result in the study test, the same percentage as in the programme test conducted by the doctor/nurse. Two persons had invalid test results in both the study and the programme, but they were not the same persons. Conclusion The study provides clear evidence that this methodology is a valuable alternative to saliva for HIV testing programmes when medical or nursing staff required to take blood samples is not available.

BACKGROUND: Although oral cavity, pharyngeal, oesophageal and gastric cancers share some risk factors, no comparative analysis of mortality rate trends in these illnesses has been undertaken in Spain. This study aimed to evaluate the independent effects of age, death period and birth cohort on the mortality rates of these tumours. METHODS: Specific and age-adjusted mortality rates by tumour and sex were analysed. Age-period-cohort log-linear models were fitted separately for each tumour and sex, and segmented regression models were used to detect changes in period- and cohort-effect curvatures. RESULTS: Among men, the period-effect curvatures for oral cavity/pharyngeal and oesophageal cancers displayed a mortality trend that rose until 1995 and then declined. Among women, oral cavity/pharyngeal cancer mortality increased throughout the study period whereas oesophageal cancer mortality decreased after 1970. Stomach cancer mortality decreased in both sexes from 1965 onwards. Lastly, the cohort-effect curvature showed a certain degree of similarity for all three tumours in both sexes, which was greater among oral cavity, pharyngeal and oesophageal cancers, with a change point in evidence, after which risk of death increased in cohorts born from the 1910-1920s onwards and decreased among the 1950-1960 cohorts and successive generations. This latter feature was likewise observed for stomach cancer. CONCLUSIONS: While the similarities of the cohort effects in oral cavity/pharyngeal, oesophageal and gastric tumours support the implication of shared risk factors, the more marked changes in cohort-effect curvature for oral cavity/pharyngeal and oesophageal cancer could be due to the greater influence of some risk factors in their aetiology, such as smoking and alcohol consumption. The increase in oral cavity/pharyngeal cancer mortality in women deserves further study. The study was funded by a research grant from the Spanish Health Research Fund (FIS PI11/00871). DSM was funded by the Galician Health Service; NA, EF, JGP, PFN, RPB and GLA were funded by the Carlos III Institute of Health, Madrid, Spain; and MCA was funded by the CIBER in Epidemiology and Public Health, Spain (CIBERESP). The study design and research findings are the responsibility of the authors. Sí

Background A total of 2,514,346 metric tons (Mt) of asbestos were imported into Spain from 1906 until the ban on asbestos in 2002. Our objective was to study pleural cancer mortality trends as an indicator of mesothelioma mortality and update mortality predictions for the periods 2011–2015 and 2016–2020 in Spain., Methods Log-linear Poisson models were fitted to study the effect of age, period of death and birth cohort (APC) on mortality trends. Change points in cohort- and period-effect curvatures were assessed using segmented regression. Fractional power-link APC models were used to predict mortality until 2020. In addition, an alternative model based on national asbestos consumption figures was also used to perform long-term predictions., Results Pleural cancer deaths increased across the study period, rising from 491 in 1976–1980 to 1,249 in 2006–2010. Predictions for the five-year period 2016–2020 indicated a total of 1,319 pleural cancer deaths (264 deaths/year). Forecasts up to 2020 indicated that this increase would continue, though the age-adjusted rates showed a levelling-off in male mortality from 2001 to 2005, corresponding to the lower risk in post-1960 generations. Among women, rates were lower and the mortality trend was also different, indicating that occupational exposure was possibly the single factor having most influence on pleural cancer mortality., Conclusion The cancer mortality-related consequences of human exposure to asbestos are set to persist and remain in evidence until the last surviving members of the exposed cohorts have disappeared. It can thus be assumed that occupationally-related deaths due to pleural mesothelioma will continue to occur in Spain until at least 2040., The study was partially supported by a research grant from the Spanish Health Research Fund (FIS PI11/00871) and the HAR2009-07543 project of the Ministry of Science and Innovation. The Department of Labour of the Government of Catalonia provided the asbestos consumption data.

Some saliva-based HIV testing programmes have resulted in an unacceptable percentage of false positives. Many countries require blood-based testing programmes to have doctors/nurses. The authors evaluate whether, after brief training and under the supervision of a skilled counsellor, blood-based self-sample collection and rapid test performance could be a valuable alternative.208 Spanish-speaking attendees at a street-based HIV testing programme in Madrid participated in the study. Participants were tested twice, first in the study and then in the programme, using the same finger-stick whole-blood rapid test (Determine HIV-1/2 Ag/Ab Combo®). Based on previously adapted instructions, the study counsellor explained the procedure to follow throughout the test. Participants then performed the test under the guidance of the counsellor. Demographic and risk behaviour data were collected by a self-administered questionnaire. The test results in the programme and the study were read by the study counsellor.99.0% (95% CI 96.6% to 99.9%) of participants had a valid result in the study test, the same percentage as in the programme test conducted by the doctor/nurse. Two persons had invalid test results in both the study and the programme, but they were not the same persons.The study provides clear evidence that this methodology is a valuable alternative to saliva for HIV testing programmes when medical or nursing staff required to take blood samples is not available.