The Way of Eradicating Vaccines
July 2nd, 2010 | 
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Eradication actions are usually intense and limited in time. This road has been initiated with varying degrees of progress with three diseases: smallpox, polio and measles. The model used is taken from the successful case (smallpox), in some cases with modification, in other constraints. On the other hand, there are three other diseases with elimination-eradication program with special features: neonatal tetanus, Hepatitis B and rubella.
Smallpox
The last case occurred in 1977 and was considered eradicated in 1978. It has a reservoir of virus stored in laboratories that would make vaccines as a precaution against the probability of occurrence in uncharted territory. Due to the risks of its use (in 1978 resulted in the death of a laboratory worker) have concentrated stocks at the CDC (USA). Slated for destruction, but rumors of wars microbial been postponing the decision. It was based on mass immunization, enhanced epidemiological surveillance and vaccination of contacts block the appearance of suspected cases. Its eradication was facilitated by a relatively limited transmissibility (direct contact), which allowed clear identification of contacts, the relative specificity of symptoms and a prolonged incubation period (greater than the latent period of the vaccine.) The model was then used for other enfermedades.
Poliomyelitis
Removed from Argentina in 1984 and America in 1991. In 1988, WHO launched the eradication program that drastically reduced the countries concerned and the number of cases. But its eradication, scheduled for 2000, has been delayed by financial constraints and war and in 2004 had six endemic countries (see Table 1) .6
Surveillance of suspected cases is highly specific and cases are striking (flaccid paralysis in children under 15 years). The blocking actions are less effective because more dispersed transmission and shorter incubation. The elimination was favored by the phenomenon of “contact immunization”, which allowed to achieve high coverage. Because the vaccinal virus is eliminated through the feces, in countries with poor sanitation, fecal contamination of water allowed the secondary immunization of unvaccinated persons. However, the situation in low coverage is a high risk. Because the virus vaccinal virulence increases with each passage intestinal increases the likelihood of vaccine-associated paralysis, as the incidents happened in the Dominican Republic, the Philippines and Madagascar. The evaluation of the quality of surveillance is done through the expected rate of reporting (target: 10/0000 under 15 years) and the proportion of cases studied within 48 hours. (Target: 80%).
Measles
Lost in America and some European countries (Spain, England). Due to the high transmissibility and primary failure in meeting the goal of high coverage (80%) was only possible spread of epidemics. In the early 90′s OPS (Ciro de Quadros-Galindo) 7 proposed a strategy of periodic mass revaccination: Implementation and Monitoring Day, with good results in countries which implement it correctly. Surveillance, armed with the smallpox model, presents two difficulties: defining “suspect case” and transmissibility nonspecific diffuse (airway), making it difficult to identify recipients of blocking contacts. The specificity was accentuated by including joint monitoring with rubella, since the definition was limited to “rash + fever.” The former should include at least one of the three colds.
Hepatitis B
It is part of a global program of reduction of all carriers, with possible elimination and eradication, with goals plazo.8 long been focused on the immunization of new cohorts of newborns (1999) and prepubertal (2003). Not accompanied by intensified surveillance.
Neonatal Tetanus
Activities oriented to coverage of pregnant women: control uptake and application of vaccine. The intensified surveillance is simple, but without practical effect, since there is no indication of vaccination of contacts.
Rubella
The introduction of the vaccine (1998) implies the risk of producing the phenomenon of interepidemic spacing and displacement of age, with increased risk of occurrence in women of childbearing age and thus of rubella congénita.9 To reduce this possibility has been accompanied revaccination at 6 and 11 years, and immunization of mothers (2003), although it should be ensured to secure the removal from circulation. As has already started, has created a situation of “forced eradication (or die). The monitoring has the same problems as measles surveillance, coupled with the highest proportion of cases oligosymptomatic. 3366 During 2002, reported clinical cases in 2003 were 2151 cases, of which 478 (22%) were considered as the norm 9 cases were confirmed and three clinical laboratory. In 2004 we studied 265 cases of suspected measles-rubella, with three confirmed (laboratory) 10
Immunizations and primary care
The immunizations are included as one of the services should provide the primary health care (Alma-Ata). The development of primary care services (CAPS, health workers) has significantly improved immunization coverage. This has been possible as they have been caring some essential aspects that tend to avoid lost opportunities:
• Commitment of staff. All members of the health team should be aware that each visit is an opportunity to complete immunizations. This also should banish prejudices about unsubstantiated contraindications
• Wide supply. Immunizations should be provided every day and throughout the hours of operation. For this it is necessary that the provision is sufficient, accepting waste rates logical.
But this primary care service that gives immunizations can be completed with two aspects of immunizations that can enable primary care population to improve their coverage.
Concept coverage
The quality of primary care centers will not be given only by the response to demands, but mainly for covering the needs of the people in charge (program area). The quality of the immunization program is not evaluated by the response to the demand but by the coverage achieved and the impact on the health of the community, can therefore provide a model for changing the concept of the mission’s main focus primary.
Extending coverage
The immunization program is simple to implement and has a quick responsiveness on the part of the population. Its smooth, including the population does not plaintiff, is an appropriate strategy links with the community, opening the doors of primary care to the population and enable progress in the organization, in response to other health needs. It also allows, in particular from data on vaccines given to the children, (d) have a very rough on the population to cover, in order to evaluate other coverage