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En este trabajo se describen las acciones de vacunación contra el sarampión por el método de aerosol inhalado llevadas a cabo en la República Mexicana entre 1988 y 1990. Se hace mención pormenorizada del equipo simplificado que se empleó, del personal, de su adiestramiento, de la promoción y de la estructura de las campañas correspondientes. También se precisa la vacuna usada: cepa Edmonston-Zagreb cultivada en células diploides, del Instituto Nacional de Virología de la Secretaría de Salud en México, con un título que varió, de 10(4.5) unidades formadoras de placa/ml (PFU/ml) a 10(4.8) PFU/ml, administrada en 30 segundos de inhalación, con una descarga del nebulizador, durante este lapso, de 2 800 a 4 000 PFU por niño, estimándose la dosis retenida en 25%, por ejemplo, 700 a 1 000 PFU. En total se tiene documentada la vacunación de 3 760 684 niños prescolares y escolares en 13 de las 32 entidades federativas del país. No se observaron efectos indeseables de gravedad y los estudios limitados que se realizaron, tanto serológicos como de campo, avalan la efectividad y seguridad de este método que es, por otra parte, mucho más barato, rápido y aceptable por la población que el de inyección subcutánea..

Importance: In a previous study on booster vaccination, we reported that two aerosolized MMR vaccines were as safe and immunogenic as injectable vaccines containing the same antigens. We now present results of antibody persistence one year after immunization., Objective: To assess the antibody persistence for measles, mumps, and rubella one year following booster immunization., Methods: We performed clinical and serological follow-up of participants in a previous study of Mexican children aged 6-7years, in which participants were randomized to four groups receiving, by aerosolized or by injection, the MMR SII vaccine (Serum Institute of India), or the MMR II (Merck Sharp & Dhome). We evaluated the antibody persistence by PRN test for measles and by ELISA for rubella and mumps. The occurrence of clinical events was evaluated via periodic visits of a nurse team to children's schools and homes., Results: Of the 260 initial participants, 241 completed one-year follow-up. There were only statistically significant differences in baseline seropositivity for mumps. One year after immunization, seropositivity in all groups was 100% for measles and rubella. The seropositivity rank for mumps was from 90.3% for the injected vaccine MMR II to 96.6% for vaccine MMR SII applied by aerosol; these differences were not statistically significant. With exception of the aerosolized vaccine MMR SII for the geometric mean titer (GMT) for measles, all study groups presented declination of GMT for the three viruses. The difference between the aerosolized vaccines MMR SII and MMR RII was statistically significant for mumps antibodies. Only mild clinical events were identified., Conclusion: Under conditions of no endemic transmission for measles and rubella, and of low circulation of mumps virus, school-aged children remained seropositive to the three viruses one year following booster immunization. The study was registered under CMN 2010-005 number at COFEPRIS (National Regulatory Authority)., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The present work describes the anti-measles vaccination program by the inhaled aerosol method undertaken in Mexico between 1988 and 1990. Detailed descriptions are given of the equipment, staff, training programs, promotion and campaigns. The vaccine is specified: Edmonston-Zagreb strain cultured in diploid cells at the Instituto Nacional de Virología of the Secretaría de Salud in Mexico with titres varying from 1045 plaque forming units (PFU/ml) to 1048 PFU/ml administered in a 30 sec inhalation with aerosol. During this exposure period, 2800 to 4000 PFU per child are estimated to enter the child, of which approximately 25% is the retained doses, i.e. 700 to 1000 PFU/child. A total of 3760684 children of school and pre-school age have been vaccinated in 13 of the 32 federal entities of the country. No undesirable effects of any importance were observed, and the limited serological and field studies support the effectiveness and security of this method. On the other hand, the method is much cheaper, faster and better accepted by the population than the subcutaneous injection.

This paper discusses the right to health in Mexico. The authors present some ideas regarding equity and data which shows the existence of a deep inequity in the field of health in the country. The efforts of the social security agencies and of the Ministry of Health aimed at diminishing inequity in health are also described. The authors conclude that it is time to avoid retorical positions and attitudes of administrative solidarity and start to implement actions to improve the health conditions of those living in extreme poverty. These actions should include providing comprehensive health services to all the population, reinforcing specific preventive programs, improving certain basic health indicators and prompting intersectoral collaboration.

We present general comments on the epidemiology of measles considering the pre-vaccine era as well as the post-vaccine period in which some changes can be observed: the decrease in morbidity and mortality, the extension of the inter-epidemic interval, the increase in the mean age of infection, etc. We make some estimations about the vaccine coverage and the ideal age of immunization for the goal of eradication (assuming a lifelong immunity for the vaccinees). The technical problems in measles immunization are also revised explaining why no continental country has been able to eliminate the disease. We describe the epidemiological situation in North America, Mexico and Latin American countries. Lastly we present the Mexican experience with the inhaled aerosolised vaccine: the studies in Monterrey (Sabin et al, 1982), other investigation in Mexico, D.F. and in the State of Jalisco, as well as the mass campaigns in Aguascalientes in 1988 and in Coahuila and Nuevo León in 1989. We propose it as an effective, harmless, simple, inexpensive and practical method.

Inhalation of undiluted, aerosolized measles vaccine was immunogenic in 100% of 4- to 6-month-old and older children with and without residual maternal antibody when the human diploid cell (HDC) vaccine containing the Ikić (Edmonston-Zagreb) strain and 1% human albumin was used but in a smaller percentage of infants given a chick embryo fibroblast (CEF) vaccine, which contained the Edmonston-Schwarz strain, ten times more virus, and hypertonic sugar solution but no added protein. Prevaccination residual placentally transmitted plaque-neutralizing antibody titers of 25 to 512 that can prevent an immune response after subcutaneous injection of measles vaccine did not prevent an immune response after inhalation of aerosolized vaccine. There were no immediate clinical reactions in the 160 children who inhaled the aerosolized vaccines, and no significant subsequent reactions among the 96 children who were successfully immunized. There were no contact infections.

The evaluation of the state of respiratory function in asthmatic patients is useful for/the physician to decide on a certain therapeutic method, to determine how this function is modified by the action of a drug treatment schema, etc. The purpose of this work is to describe the behaviour of the results obtained by measurement of the values of peak flow reached for asthmatic patients attended in the allergology service. The measurement was applied to a hundred asthmatic patients of both sexes, selected at random from asthmatic patients seen in outpatient visits. The individuals were tested in a sitting position, using respiratory peak flow standard model equipment (M. 286, Airmed House). The measurements were done on each patient at minimum intervals of one minute. The results obtained in this way were averaged and the resulting value was compared with that foreseen for each individual, by age, sex and height. The patients were classified into four groups according to the presence or absence of positive symptomatology and the presence or absence of wheezing in the auscultation. Comparisons of these groups, both binary and for the four groups, were made as well as an analysis of whether or not the number of individuals with reduction of peak flow and without wheezing was significant in the sample. It was concluded that the use of subjective information obtained from the patient as well as the presence or not of wheezing constitute index of relative value for the evaluation of the functional status of the asthmatic patient, because there is a significant association between the presence of these signs and important obstruction of the airway.(ABSTRACT TRUNCATED AT 250 WORDS)

In 1959, oral poliovirus vaccine ( OPV ) was introduced as an antiepidemic measure in Mexico. As in many other developing countries, the vaccine was misused, coverages achieved were often poor, and an adequate cold chain was lacking. However, in 1972 a mass campaign reached 70% of children younger than five years of age, and consequently the reported cases declined sharply from 1.9 to 0.4 per 100,000 population. Due to economic restrictions, only single doses of monovalent type 1 OPV were administered to 80% of the target population in 1981, 1982, and 1983. The present incidence of poliomyelitis of 0.1 per 100,000 population represents a 96.7% reduction from the rate during the prevaccine era, when the annual average rate was 4.26 per 100,000. The present aim of poliomyelitis control is to maintain and decrease the present incidence of disease. Future plans are to continue mass vaccination in an attempt to reach small and isolated villages that have been without vaccination and limit possible rural foci of wild poliovirus.

In 4- and 5-month-old infants in whom the undiluted chick embryo fibroblast (CEF) Schwarz strain measles vaccine had a poor immunogenic effect, there was an increase in immunogenicity when the high sugar concentration was diminished without reference to added albumin. The human diploid cell (HDC) measles vaccine was still superior in this age group even in a lower concentration of the Ikić, Edmonston-Zagreb strain of virus. More aerosolized, HDC Ikić strain virus was required for high seroconversion rates in 4- and 5-month-old infants who had higher titers of prevaccination plaque-neutralizing (PN) antibodies. Some of these infants had a delayed immune response that was absent at six weeks but present at three months after vaccination. The data provided evidence that the PN and enzyme-linked immunosorbent assay techniques measured different antibodies that develop and persist in different ways in 4- to 5-month-old infants. The HDC lyophilized measles vaccine yielded unexpectedly high seroconversion rates after subcutaneous injection of 5,000 plaque-forming units (PFUs) in 4-, 5-, and 6-month-old infants: 69%, 89%, and 100% respectively, at 14 weeks. In 12- to 23-month-old infants there was seroconversion of 92% and 100% at six weeks after inhalation of an estimated 175 PFUs of the CEF vaccine and 375 PFUs of the HDC vaccine, respectively. Within six weeks after vaccination, the PN antibody titers were significantly higher with the CEF vaccine (geometric mean titer of 2,275) than with the HDC vaccine (geometric mean titer of 343).

Ten pregnancy toxemia patients, 10 pregnant patients with essential arterial hypertension and 12 normal pregnant women were studied between the weeks 37 and 40 of gestation. From them blood samples were obtained 24 hours before and 24 hours and three months after the delivery. In these samples proteolytic (P) and antiproteolytic (AP) activities and alpha-1-antitrypsin (A1-AT) concentration were determined. The P and the AP were measured by hydrolysis of BAPNA, and the A1-AT by radial immunodiffusion. The most interesting results were observed 24 hours before the delivery. Toxemic patients presented increase of P and AP, and hypertensive patients diminution of A1-AT when compared with normal controls. These results demonstrated that in toxemia and essential hypertension during pregnancy maladjustments in mechanisms of serum proteolysis and antiproteolysis, perhaps related with the activation of complement, clotting and circulating immune complexes formation systems, exist.

The high prevalence of alleles S and Z in relation to deficient states of alpha-1-antitrypsin (alpha-1-AT) in patients with allergic bronchial syndrome has been tested in a sample of the population in Havana City. Due to the high incidence of bronchial asthma in Cuba, it is important to study the factors that might be involved in its etiology, and that is why the probable relation of alpha-1-AT deficiency to bronchial asthma is analyzed in this work. The phenotype for alpha-1-antitrypsin (alpha-1-AT) and the maximum expiratory flow were determined in 174 male and female ambulatory asthmatics between 15 and 82 years of age, by means of a manual flow meter. The possible relationship between the age at which asthma crisis shows up and the phenotype for alpha-1-AT was taken into account. In 108 patients who showed neither dyspnea nor auscultatory signs at the time of expiratory flow measurement, the influence of the phenotype for alpha-1-AT and the age at which the crisis show up on the maximum flow values and eventual interaction of both factors were studied. The maximum flow values reached by patients bearing different phenotypes according to the time of asthma development were also compared. The results did not show significant differences in any comparison made among the subjects with normal phenotypes for alpha-1-AT and the deficient phenotypes beares. Nevertheless, there might be differences in the respiratory function between normal and deficient phenotypes of alpha-1-AT that might be hidden because of the simultaneous occurrence of other factors participating in the etiopathogenesis of bronchial asthma.(ABSTRACT TRUNCATED AT 250 WORDS)