RESUMO
OBJECTIVE: To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. METHODS: Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. FINDINGS: Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3-85.6) in Peru, 88.9% (95% CI: 84.7-92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0-97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4-81.6) to 87.8% (95% CI: 84.3-91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4-73.4) to 83.3% (95% CI: 79.3-87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. CONCLUSION: High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake.
Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus , Avaliação de Programas e Projetos de Saúde , Adolescente , Criança , Análise por Conglomerados , Intervalos de Confiança , Estudos Transversais , Feminino , Saúde Global , Pesquisas sobre Atenção à Saúde , Humanos , Renda , Índia , Infecções por Papillomavirus/epidemiologia , Peru , Pobreza/estatística & dados numéricos , Desenvolvimento de Programas , Fatores Socioeconômicos , Uganda , Neoplasias do Colo do Útero/prevenção & controle , Vietnã , Saúde da MulherRESUMO
Operational research using a mixed method, cross-sectional, case-study approach assessed the feasibility and health system impact of large-scale implementation of human papillomavirus (HPV) vaccination into routine vaccine delivery by the Ministry of Health in Peru. The strategy was school-based vaccination of fifth grade girls in 527 primary schools in Piura region. Our evaluation showed that school-based HPV vaccination is feasible without major changes in existing health systems. This was reflected in the opinions of health personnel, the lack of impact on other vaccine coverage, and the high HPV vaccine coverage documented in routine records and by an independent community-based survey.
Assuntos
Pesquisa sobre Serviços de Saúde , Vacinas contra Papillomavirus/administração & dosagem , Vacinas contra Papillomavirus/imunologia , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/métodos , Criança , Feminino , Humanos , Peru , Instituições Acadêmicas , Neoplasias do Colo do Útero/imunologiaRESUMO
OBJECTIVE: Our study examines risk factors for severe varicella in an outbreak among Mexican-born adults, and it compares susceptibility to infection and reliability of self-reported varicella history for these individuals with that for adults born in the United States in the outbreak locale, which may guide vaccination strategies. METHODS: We interviewed case patients and non-case persons in the affected apartment complex and workplace, assessed disease history and susceptibility by testing for varicella-zoster virus immunoglobulin G antibodies, and reviewed the clinical data of case patients. RESULTS: Five of 18 case patients had serious complications for which they sought medical care; 1 was hospitalized for pneumonia, and 1 was hospitalized for Guillain-Barré syndrome. Only intense exposure (e.g., sharing a bed) was marginally associated with severe disease (P=.08). In the workplace, varicella susceptibility was higher among Mexican-born workers (20%) than among workers born in the United States (3%) (adjusted prevalence odds ratio, 5.4; 95% confidence interval, 2.3-14.8). Mexican-born persons had the highest positive predictive value of self-reported disease (100%) in predicting immunity, and those born in the United States had the lowest negative predictive value of self-reported history (10%) in predicting susceptibility. CONCLUSIONS: Varicella is a more serious disease among adults than among children, and Mexican-born adults living in the United States might have a higher risk of acquiring varicella than US-born adults. Varicella outbreaks involving adults should be prioritized for control efforts. Outbreaks can be prevented by vaccinating susceptible adults.