The recent resurgence of measles in the United States provides an impetus to compare and contrast health and health systems here and in Cuba. We believe that there is much for the two countries to ...learn from each other despite the deep differences in the political and ideological conceptions between the governments, the cultural differences between their populations, and the differences in the application of principles of social and health equity. The health systems are an integral component of each society and dictate the health complexities of each country.From January 1 to December 31, 2019, 1282 cases of measles were confirmed in 31 states in the United States, more than in any single year since 1992.1 The most recent data from the Centers for Disease Control and Prevention (CDC) on US childhood vaccination completion rates indicate that only 70.4% of children aged 19 to 35 months had received all recommended vaccines; 91.5% had received at least one dose of measles vaccine.2 By contrast, Cuba has not experienced a single case of measles since 1993, and childhood vaccination completion rates (for all recommended vaccines) are over 99%.3 These differences between the United States and Cuba should be analyzed using a multilevel approach, considering the obligations of families and communities, but also the health care requirements and government health policies, as health system structural differences likely play a major role as well.
Full text
Available for:
CEKLJ, DOBA, FSPLJ, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The process of research and evaluation of new products and technologies requires a combination of transdisciplinary theoretical and methodological approaches for managing and achieving objectives. ...The research, development and evaluation strategy of the new Cuban pneumococcal vaccine combines the approaches of team science and accelerated vaccine introduction. These frameworks are proposed for discussions regarding biotech product evaluation, using their application to the Pneumococcus Project as an example. Emphasis is on the use of team science to eliminate obstacles to obtaining a product of great scientific and technological complexity while establishing robust scientific evidence to support its use and marketing. All of this is in support of opportune and efficient decisions for accelerated introduction of new vaccines in Cuba.
Knowing the national disease burden of severe influenza in low-income countries can inform policy decisions around influenza treatment and prevention. We present a novel methodology using locally ...generated data for estimating this burden.
This method begins with calculating the hospitalized severe acute respiratory illness (SARI) incidence for children <5 years old and persons ≥5 years old from population-based surveillance in one province. This base rate of SARI is then adjusted for each province based on the prevalence of risk factors and healthcare-seeking behavior. The percentage of SARI with influenza virus detected is determined from provincial-level sentinel surveillance and applied to the adjusted provincial rates of hospitalized SARI. Healthcare-seeking data from healthcare utilization surveys is used to estimate non-hospitalized influenza-associated SARI. Rates of hospitalized and non-hospitalized influenza-associated SARI are applied to census data to calculate the national number of cases. The method was field-tested in Kenya, and validated in Guatemala, using data from August 2009-July 2011. In Kenya (2009 population 38.6 million persons), the annual number of hospitalized influenza-associated SARI cases ranged from 17,129-27,659 for children <5 years old (2.9-4.7 per 1,000 persons) and 6,882-7,836 for persons ≥5 years old (0.21-0.24 per 1,000 persons), depending on year and base rate used. In Guatemala (2011 population 14.7 million persons), the annual number of hospitalized cases of influenza-associated pneumonia ranged from 1,065-2,259 (0.5-1.0 per 1,000 persons) among children <5 years old and 779-2,252 cases (0.1-0.2 per 1,000 persons) for persons ≥5 years old, depending on year and base rate used. In both countries, the number of non-hospitalized influenza-associated cases was several-fold higher than the hospitalized cases.
Influenza virus was associated with a substantial amount of severe disease in Kenya and Guatemala. This method can be performed in most low and lower-middle income countries.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To estimate the incidence of influenza-virus-associated severe pneumonia among Salvadorian children aged < 5 years.
Data on children aged < 5 years admitted with severe pneumonia to a sentinel ...hospital in the western region were collected weekly. Nasal and oropharyngeal swab specimens were collected from a convenience sample of case patients for respiratory virus testing. A health-care utilization survey was conducted in the hospital catchment area to determine the proportion of residents who sought care at the hospital. The incidence of influenza-virus-associated severe pneumonia among all Salvadorian children aged < 5 years was estimated from surveillance and census data, with adjustment for health-care utilization. Influenza virus strains were characterized by the United States Centers for Disease Control and Prevention to determine their correspondence with northern and southern hemisphere influenza vaccine formulations.
Physicians identified 2554 cases of severe pneumonia. Samples from 608 cases were tested for respiratory viruses and 37 (6%) were positive for influenza virus. The estimated incidence of influenza-virus-associated severe pneumonia was 3.2 cases per 1000 person-years (95% confidence interval, CI: 2.8-3.7) overall, 1.5 cases per 1000 person-years (95% CI: 1.0-2.0) during 2008, 7.6 cases per 1000 person-years (95% CI: 6.5-8.9) during 2009 and 0.6 cases per 1000 person-years (95% CI: 0.3-1.0) during 2010. Northern and southern hemisphere vaccine formulations matched influenza virus strains isolated during 2008 and 2010.
Influenza-virus-associated severe pneumonia occurred frequently among young Salvadorian children during 2008-2010. Antigens in northern and southern hemisphere influenza vaccine formulations corresponded to circulating strains.
Full text
Available for:
CEKLJ, DOBA, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Summary A new pneumococcal conjugate vaccine is currently undergoing advanced clinical evaluation prior to its planned introduction in Cuba. The implementation of the pneumococcal vaccination ...strategy has been designed with consideration of the need to maximize both its direct and indirect effects. A novel approach is suggested, which addresses preschool children as the first-line target group to generate herd immunity in infants and to have an impact on transmission at the community level. The clinical evaluation pipeline is described herein, including evaluations of effectiveness, cost-effectiveness, and impact. The scientific contribution of the Cuban strategy could support a paradigm shift from individual protection to a population effect based on a rigorous body of scientific evidence.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Background: The study of the hospitalization costs for rotavirus gastroenteritis is a strategic issue given the dilemma of introducing or not a rotavirus vaccine in Cuba.
Objective: to estimate the ...institutional cost of hospitalization of patients younger than five years of age because of gastroenteritis due to rotavirus.
Methods: descriptive study, specifically a partial economic evaluation of the costs description type. Modeled cost per care protocol adjusted to standard practice was used. The normative documents were reviewed and an adjustment exercise was applied to routine practice by consulting experts. The cost was expressed in 2018 Cuban pesos.
Results: admission to the Gastroenterology ward was estimated for 93.1% of the patients, of which 99.4% would solve the health problem. The salary was the item with the highest contribution to spending, although in the Gastroenterology ward it was the complementary examinations. The average cost of hospitalization modeled for rotavirus gastroenteritis was 435.13 Cuban pesos; this varied according to the clinical condition with which the patient arrives, between 415.72 pesos and 1057.60 pesos. The cost was sensitive to the variation of the stay in the services.
Conclusion: Hospitalization of a patient younger than five years of age for gastroenteritis due to rotavirus represents high costs for the hospital. The attention service to critical patients and the previous admission to a clinical room other than that of Gastroenterology, increase the cost of care.
The World Health Organization (WHO) recommends that pneumococcal conjugate vaccines (PCVs) be included in immunization programs worldwide. In China, the 7-valent pneumococcal conjugate vaccine ...(PREVNAR 7®) was authorized in 2008 but was not included in the national immunization programs. In 2016, PREVNAR 13®, a 13-valent pneumococcal conjugate vaccine (PCV13), was licensed for optional use in China. We will conduct a scoping review of the distribution of serotypes and antimicrobial resistance of
Streptococcus pneumoniae in children aged under 5 years in China since the introduction of PCV13. We will obtain data from PubMed, the China National Knowledge Infrastructure (CNKI), and Wanfang Med Online. We will also review epidemiological data from WHO and the China Antimicrobial Surveillance Network (CHINET). Our analysis will include the condition of interest, the intervention, and the geographical region. All types of studies will be eligible for inclusion in the study database if they meet the inclusion criteria. This scoping review is intended to outline how
S. pneumoniae serotypes are distributed, and it will map their antimicrobial resistance in children aged under 5 years in China. The results of this study will provide useful information on the impact of PCV13 in China.
Inequalities in health in Mexico Linares-Pérez, Nivaldo; López-Arellano, Oliva
Gaceta médica de México,
2012 Nov-Dec, 20121101, Volume:
148, Issue:
6
Journal Article
Peer reviewed
This study presents a critical approach on health sector reform in Mexico and its impact on access and equity in state health systems. We discuss the main strategies adopted and made an assessment of ...its contribution to achieving equity in health, using socioeconomic indicators of health services and interventions for two moments, 1990 y 2002. We conclude that the dynamics of deepening inequalities in the period and the transformation of state health systems do not contribute to the achievement of equity in access.
BACKGROUND:A new vaccine candidate against pneumococcus is being developed in Cuba, and it is a priority of the national health system. There is limited information on nasopharyngeal colonization ...burden, though it is essential for monitoring the impact of the vaccine. The study aims to estimate the prevalence of nasopharyngeal colonization in children 2–18 months of age and identify circulating serotypes, antimicrobial resistance and its association with selected risk factors.
METHODS:A cross-sectional study was conducted between October and December 2013 in Cienfuegos municipality. Inclusion criteria were evaluated, and informed consent was obtained from the parents. Clinical and epidemiologic data were collected through a semistructured questionnaire. Nasopharyngeal swabs according to established protocols were taken. Data analysis included frequency distributions and comparison of proportions. The association between colonization and selected risk factors was assessed by multivariate analysis.
RESULTS:A total of 984 children (87.2% living in urban areas) were included. The overall prevalence of colonization was 21.6%. The most frequent serotypes isolated were 6A (23.1%), 23F (10.8%), 6B (10.3%), 19F (8.5%) and 14 (3.3%). We found no resistance to β-lactamases in circulating serotypes. Living with sibling younger than 5 years, previous respiratory infections, previous hospitalization and day-care attendance were determinants of nasopharyngeal carriage.
CONCLUSIONS:The findings suggest that the burden of pneumococcal disease and colonization in Cuba could be significantly affected after vaccine introduction.
El objetivo de este estudio es identificar los posibles efectos que sobre la equidad en salud pueden ser vinculados con las "intervenciones de reforma" desarrolladas en México durante 1995 y 2002. Se ...analizaron las desigualdades en salud entre las entidades federativas del país y se identificaron aquellas que constituyen inequidades. La medición de las desigualdades en salud se hizo a través del Índice de Inequidades en Salud (INIQUIS) con ayuda del paquete EPIDAT 3.1. El análisis de la inequidad incluyó la comparación de los indicadores sobre resultados de salud y acceso a servicios con indicadores básicos del mismo tipo para América Latina y la valoración de las desigualdades que aludían a evitabilidad, injusticia e inaceptabilidad según los criterios reconocidos de la definición de inequidad. Los valores del INIQUIS mostraron que la desigualdad relativa global entre los estados del país tuvo un incremento superior al 30% entre 1995 y 2002. La desigualdad relativa en las condiciones de vida disminuyó 12%; mientras que en los resultados de salud y en el acceso a servicios se incrementó en 30% y 10% respectivamente. El comportamiento del INIQUIS sugirió que los niveles de desigualdad-inequidad en salud entre las entidades federativas no parecen haber sido influidas significativamente por las intervenciones de la reforma sanitaria desarrolladas en México entre 1995 y 2002.
PDF
