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Showing posts with label usa. Show all posts
Showing posts with label usa. Show all posts

Tuesday, December 29, 2015

POLIO VACCINATION / IPV / OPV or Oral Polio Vaccines has not been used in the USA since 2000

Polio Vaccination is highly recommended with Inactivated Polio Vaccine. Parenteral Polio Vaccination. OPV or Oral Polio Vaccines has not been used in the United States since 2000. OPV or Oral Polio Vaccines is used worldwide!

Carlos E Mijares, MD Allergist / Immunologist, pediatrician.

Vaccines and Immunizations

Polio Vaccination

Pronounced [PO-lee-oh]

At a Glance

Polio vaccination Polio is an infectious disease caused by a virus that lives in the throat and intestinal tract. It is most often spread through person-to-person contact with the stool of an infected person and may also be spread through oral/nasal secretions. Polio used to be very common in the United States and caused severe illness in thousands of people each year before polio vaccine was introduced in 1955. Most people infected with the polio virus have no symptoms; however, for the less than 1% who develop paralysis it may result in permanent disability and even death.
There are two types of vaccine that protect against polio: inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV). IPV is given as an injection in the leg or arm, depending on the patient's age. Polio vaccine may be given at the same time as other vaccines. Most people should get polio vaccine when they are children. Children get 4 doses of IPV at these ages: 2 months, 4 months, 6-18 months, and a booster dose at 4-6 years. OPV has not been used in the United States since 2000 but is still used in many parts of the world.

What You Should Know

About the Disease

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Vaccine Information

A person is considered to be fully immunized if he or she has received a primary series of at least three doses of inactivated poliovirus vaccine (IPV), live oral poliovirus vaccine (OPV), or four doses of any combination of IPV and OPV. Until recently, the benefits of OPV use (i.e. intestinal immunity, secondary spread) outweighed the risk for vaccine-associated paralytic poliomyelitis (VAPP) which occurred in one child out of every 2.4 million OPV doses distributed. To eliminate the risk of vaccine-associated paralytic poliomyelitis (VAPP), as of January 1, 2000, OPV was no longer recommended for routine immunization in the United States. However, OPV continues to be used in the countries where polio is endemic or the risk of importation and transmission is high. OPV is recommended for global polio eradication activities in polio-endemic countries due to its advantages over IPV in providing intestinal immunity and providing secondary spread of the vaccine to unprotected contacts.
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Beliefs & Concerns

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Vaccine Safety

As with all vaccines, there can be minor reactions, including pain and redness at the injection site, headache, fatigue or a vague feeling of discomfort.
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Who Should Not be Vaccinated?

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For Health Professionals

Clinical Information on Polio

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Vaccine Recommendations

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References and Resources

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Materials for Patients


Global Initiatives

Global Polio Eradication

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Related Pages


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Also Known As & Abbreviations

  • Polio=poliomyelitis
  • IPV=inactive polio vaccine
  • OPV=oral polio vaccine

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Thursday, November 12, 2015

MORBIDITY and MORTALITY Weekly Report (MMWR) USA

Carlos E. Mijares MD highly recommend this Medical Weekly Report

www.centromedicodecaracas.com.ve

Global Routine Vaccination Coverage, 2014

Weekly

November 13, 2015 / 64(44);1252-1255

Saleena Subaiya, MD1,2; Laure Dumolard, PhD3; Patrick Lydon, MPH3; Marta Gacic-Dobo, MSc3; Rudolf Eggers, MMed(Civ)3; Laura Conklin, MD1
The year 2014 marked the 40th anniversary of the World Health Organization's (WHO) Expanded Program on Immunization, which was established to ensure equitable access to routine immunization services (1). Since 1974, global coverage with the four core vaccines (Bacille Calmette-Guérin vaccine [BCG; for protection against tuberculosis], diphtheria-tetanus-pertussis [DTP] vaccine, poliovirus vaccine, and measles vaccine) has increased from <5% to ≥85%, and additional vaccines have been added to the recommended schedule. Coverage with the 3rd dose of DTP vaccine (DTP3) by age 12 months is an indicator of immunization program performance because it reflects completion of the basic infant immunization schedule; coverage with other vaccines, including the 3rd dose of poliovirus vaccine (polio3); the 1st dose of measles-containing vaccine (MCV1) is also assessed. Estimated global DTP3 coverage has remained at 84%–86% since 2009, with estimated 2014 coverage at 86%. Estimated global coverage for the 2nd routine dose of measles-containing vaccine (MCV2) was 38% by age 24 months and 56% when older age groups were included, similar to levels reported in 2013 (36% and 55%, respectively). To reach and sustain high immunization coverage in all countries, adequate vaccine stock management and additional opportunities for immunization, such as through routine visits in the second year of life, are integral components to strengthening immunization programs and reducing morbidity and mortality from vaccine preventable diseases.
Vaccination coverage represents the percentage of persons in a target age group that received a vaccine dose. Administrative coverage is calculated by dividing the number of vaccine doses administered to those in a specified target age group by the estimated target population. Countries report administrative coverage annually to WHO and the United Nations Children's Fund (UNICEF) through the Joint Reporting Form (JRF).* Vaccine stock management information, including availability and supply, is also reported through the JRF. Vaccination coverage surveys estimate vaccination coverage by visiting a representative sample of households with children in a specified target age group to obtain information on vaccination status. WHO and UNICEF derive national coverage estimates through an annual country-by-country review of all available data, including administrative and survey-based coverage. As new data are incorporated, revisions of past coverage estimates (2,3) and updates are published on the WHO and UNICEF websites (4,5). The WHO/UNICEF estimates of national immunization coverage, on which this report is based, are revised annually and include retrospective changes in estimates if new data become available.
In 2014, estimated DTP3 coverage was 86% worldwide among infants aged ≤12 months, ranging from 77% in the WHO African Region to 96% in the Western Pacific Region, and representing 115.2 million vaccinated children (Table 1). Approximately 18.7 million eligible children did not complete the 3-dose series; among whom 11.5 million (61%) did not receive the 1st DTP dose, and 7.2 million (39%) started, but did not complete the 3-dose series. Estimated global coverage with BCG, polio3, and MCV1 was 91%, 86%, and 85%, respectively. During 2014, a total of 129 (66%) of 194 WHO countries achieved ≥90% national DTP3 coverage; and 57 (29%) achieved ≥80% DTP3 coverage in every district. National DTP3 coverage was 80%–89% in 30 countries, 70%–79% in 20 countries, and <70% in 15 countries. Among the 18.7 million children who did not receive 3 DTP doses during the first year of life, 9.3 million (50%) lived in five countries (India [22%], Nigeria [12%], Pakistan [6%], Indonesia [5%] and Ethiopia [4%]); 11.4 million (61%) lived in 10 countries (Figure).
Additional vaccines are increasingly being introduced into national immunization schedules. By the end of 2014, hepatitis B vaccine was included in the routine immunization schedule in 184 (95%) countries, 96 (49%) of which included a dose administered within 24 hours of birth to prevent perinatal hepatitis B virus transmission. Worldwide (including countries that have not introduced the vaccine) coverage with 3 doses of hepatitis B vaccine in 2014 was 82%, and hepatitis B vaccine birth-dose coverage was 38% (Table 1). Rubella vaccine has been introduced into the routine immunization schedule in 140 (72%) countries, with an estimated coverage of 46% globally. Coverage with 3 doses of Haemophilus influenzae type b vaccine, which had been introduced in 192 (99%) countries† by 2014, was 56%. By 2014, rotavirus vaccine had been introduced in 74 (38%) countries, and pneumococcal conjugate vaccine (PCV) in 117 (60%) countries. Coverage with the completed rotavirus vaccination series (2 or 3 doses, depending on the vaccine used) was 19% globally, and coverage with 3 doses of PCV was 31%. MCV2 was included in the routine immunization schedule in 154 (79%) countries, with global coverage reaching 56% in 2014. In general, coverage for all vaccines varied greatly by WHO region.
MCV2 and booster doses for DTP and poliovirus vaccine are administered after the first year of life in 163 countries. A total of 159 (82%) countries now have at least one routinely scheduled vaccination during the second year of life. The most common vaccines administered during the second year of life are MCV2 (66 countries), rubella-containing vaccine (69 countries), diphtheria-tetanus–containing boosters (107 countries), and poliovirus vaccine boosters (100 countries) (Table 2).
During 2014, a total of 50 (26%) of the 194 WHO countries reported experiencing a national level stockout, or shortage of supply, of at least one vaccine lasting at least 1 month. Overall 110 national stockout events were reported in 2014, with a mean of 2.2 events per country and a maximum of six events per country. DTP-containing vaccine shortages represented 40% of the reported stockout events, followed by BCG (25%), and MCV (14%). At the subnational level, 88% of countries with a national level stockout experienced a district level stockout. In 38 (86%) countries with a district level stockout, the primary cause identified was a national level stockout.

Discussion

The Global Vaccine Action Plan, 2011–2020 (GVAP), endorsed by the World Health Assembly in 2012, is a framework to provide more equitable access to vaccines. The plan calls on all countries to reach a target of 90% national coverage for all vaccines and 80% coverage in all districts by 2015, with sustained coverage levels for 3 years by 2020 (6). The number of children who had not received a 3rd dose of DTP vaccine reached an all-time low of 18.7 million in 2014. However, global DTP3 coverage has remained unchanged at 86% since 2013, with 65 (34%) countries having not yet met the GVAP target of 90% national coverage. In 18% of countries, national DTP3 coverage is <80%. The same six countries (India, Nigeria, Pakistan, Indonesia, Ethiopia, and the Democratic Republic of the Congo) have been home to more than half the world's population of unvaccinated children for the past 19 years. GVAP highlights the need to identify barriers to vaccine delivery and to ensure accountability through annual reporting of actions taken to improve immunization programs for countries experiencing stagnation in coverage.
One key element to addressing the progress toward achieving global vaccination coverage goals is improving vaccine stock management, which is a critical component to ensuring vaccine access. The large proportion of countries experiencing district level stockouts as a result of a national level stockout provides evidence that shortage of vaccines at the national level can affect the supply chain and interrupt immunization services. Improved and timely demand forecasts to the vaccine industry are integral to help secure sufficient supplies of vaccines.
Delivering vaccination services during the second year of life provides an opportunity to fully protect children by providing booster doses, as well as vaccinating children who were missed during the first year of life. These missed opportunities leave children insufficiently protected against vaccine-preventable diseases such as diphtheria, tetanus, pertussis, and measles into adolescence and adulthood. Establishing a routine visit for administering vaccines during the second year of life requires appropriate training of health care workers to implement new policies, ongoing support to ensure adequate reporting practices, and careful communication and social mobilization efforts to inform caregivers of the need for additional vaccines beyond infancy. Countries that already have an established health intervention visit during the second year of life might be better poised to introduce or add vaccines because of the opportunity to synergize between programs while minimizing the burden on health care workers and systems (7).
Strategies that promote vaccination beyond infancy can help create a safety net to improve coverage after service interruptions. Additionally, countries with established health care visits in the second year of life have an opportunity to work more broadly toward a life course vaccination strategy, whereby all persons are protected through routine immunization visits from infancy through adulthood, and important vaccine and health messages are reinforced at each visit.

1Global Immunization Division, CDC; 2Epidemic Intelligence Service, CDC; 3Department of Immunization, Vaccines and Biologicals, World Health Organization.
Corresponding author: Saleena Subaiya, yzv3@cdc.gov, 404-718-6596.

References

  1. Uwizihiwe JP, Block H. 40th anniversary of introduction of Expanded Immunization Program (EPI): a literature review of introduction of new vaccines for routine childhood immunization in Sub-Saharan Africa. Int. J Vaccines Vaccin 2015;1:00004.
  2. Burton A, Monasch R, Lautenbach B, et al. WHO and UNICEF estimates of national infant immunization coverage: methods and processes. Bull World Health Organ 2009;87:535–41.
  3. Burton A, Kowalski R, Gacic-Dobo M, Karimov R, Brown D. A formal representation of the WHO and UNICEF estimates of national immunization coverage: a computational logic approach. PLoS One 2012;7:e47806.
  4. World Health Organization. WHO/UNICEF coverage estimates. Available at http://www.who.int/immunization/monitoring_surveillance/enExternal Web Site Icon.
  5. United Nations Children's Fund. Statistics by topic (child/health/immunization). Available at http://data.unicef.org/child-health/immunization.htmlExternal Web Site Icon.
  6. Global Vaccine Action Plan. Strategic Advisory Group of Experts on Immunization. 2014 assessment report of the Global Vaccine Action Plan. Available at http://www.who.int/immunization/global_vaccine_action_plan/SAGE_DoV_GVAP_Assessment_report_2014_English.pdf?ua=1External Web Site Icon.
  7. Sodha SV, Dietz V. Strengthening routine immunization systems to improve global vaccination coverage. Br Med Bull 2015;113:5–14.

* Administrative data reported to WHO and UNICEF annually are available at http://www.who.int/immunization/monitoring_surveillance/data/administrative_coverage.xls Microsoft Excel fileExternal Web Site Icon.
† Includes parts of Belarus, India and Russian Federation.

Summary
What is already known on this topic?
In 1974, the World Health Organization established the Expanded Program on Immunization to ensure that all children have access to routinely recommended vaccines. Since then, global coverage with vaccines to prevent tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, and measles has increased from <5% to ≥85%, and additional vaccines have been added to the recommended schedule. Coverage with the 3rd dose of diphtheria-tetanus-pertussis vaccine by age 12 months is an indicator of immunization program performance.
What is added by this report?
The number of countries offering vaccination in the second year of life is increasing. However, substantial barriers to improving coverage still remain, including national vaccine stockouts, or shortage of supplies.
What are the implications for public health practice?
Administering vaccines during the second year of life is a critical opportunity to provide catch up vaccinations and allows countries to progress toward a life course immunization strategy. Establishing a routine visit for administering vaccines during the second year of life requires appropriate training of health care workers to implement new policies, ongoing support to ensure adequate reporting practices, and careful communication and social mobilization efforts to inform caregivers of the need for additional vaccines beyond infancy.

FIGURE. Estimated number of children who did not receive 3 doses of diphtheria-tetanus-pertussis vaccine (DTP3) during the first year of life among 10 countries with the largest number of incompletely vaccinated children and cumulative percentage of all incompletely vaccinated children worldwide accounted for by these 10 countries, 2014
The figure above is a bar chart showing the estimated number of children who did not receive 3 doses of diphtheria-tetanus-pertussis vaccine during the first year of life among 10 countries with the largest number of incompletely vaccinated children and cumulative percentage of all incompletely vaccinated children worldwide accounted for by these 10 countries during 2014.
Abbreviations: DTP1 = 1st dose of diphtheria-tetanus-pertussis vaccine; DTP3 = 3 doses of diphtheria-tetanus-pertussis vaccine; DR Congo = Democratic Republic of the Congo.
Alternate Text: The figure above is a bar chart showing the estimated number of children who did not receive 3 doses of diphtheria-tetanus-pertussis vaccine during the first year of life among 10 countries with the largest number of incompletely vaccinated children and cumulative percentage of all incompletely vaccinated children worldwide accounted for by these 10 countries during 2014.

TABLE 1. Vaccination coverage by vaccine and World Health Organization (WHO) region — worldwide, 2014*
WHO region
Vaccination coverage (%)
BCG
HepB BD
HepB3
DTP3
Hib3
Polio3
Rota last
PCV3
Rubella
MCV1
MCV2
Total (worldwide)
91
38
82
86
56
86
19
31
46
85
56
African
84
10
77
77
77
77
30
50
10
73
11
Americas
95
69
88
90
90
90
71
83
92
92
51
Eastern Mediterranean
89
24
83
82
72
82
22
45
42
77
66
European
94
39
82
95
85
95
7
44
94
94
84
South-East Asia
92
29
75
84
30
83
0
0
12
84
59
Western Pacific
97
80
92
96
21
97
1
2
91
97
93
Abbreviations: BCG = Bacille Calmette-Guérin; HepB BD = birth dose of hepatitis B vaccine; HepB3 = 3 doses of hepatitis B vaccine; DTP3 = 3 doses of diphtheria-tetanus-pertussis vaccine; Hib3 = 3 doses of Haemophilus influenzae type b vaccine; Polio3 = 3 doses of poliovirus vaccine; Rota last = last dose of rotavirus series; PCV3 = 3 doses of pneumococcal conjugate vaccine; MCV1 = 1st dose of measles-containing vaccine; MCV2 = 2nd dose of measles-containing vaccine.
* Weighted regional average.

TABLE 2. Number and percentage of countries with ≥1 vaccination recommended during the second year of life, by vaccine and World Health Organization (WHO) region — worldwide, 2014
WHO region
No. of countries (%)
Total no. countries
≥1 vaccination during second year*
Measles-containing vaccine†
Rubella-containing vaccine†
DT-containing vaccine†
Polio-containing vaccine†,§
PCV
Other
1st dose
2nd dose
Total (worldwide)
194
159 (82)
32 (16)
66 (34)
69 (36)
107 (55)
100 (52)
28 (14)
49 (25)
African
47
22 (47)
1 (2)
17 (36)
3 (6)
11 (23)
11 (23)
0 (0)
0 (0)
Americas
35
34 (97)
3 (9)
6 (26)
9 (26)
33 (94)
29 (83)
7 (20)
17 (49)
Eastern Mediterranean
21
21 (100)
0 (0)
16 (76)
11 (52)
16 (76)
17 (81)
4 (19)
4 (19)
European
53
50 (94)
24 (45)
8 (15)
29 (55)
35 (66)
35 (66)
11 (21)
20 (38)
South-East Asia
11
9 (82)
0 (0)
7 (64)
2 (18)
4 (36)
3 (27)
0 (0)
0 (0)
Western Pacific
27
23 (85)
4 (15)
12 (44)
15 (56)
8 (22)
5 (19)
6 (22)
8 (30)
Abbreviations: DT = diphtheria-tetanus; PCV = pneumococcal conjugate vaccine.
* Excludes Vitamin A supplementation.
† These vaccines might contain more than 1 antigen; thus these columns are not mutually exclusive.
§ Including diphtheria-tetanus-pertussis–containing combinations.
Hepatitis A, Haemophilus influenzae type b, varicella, meningococcal, yellow fever, pneumococcal polysaccharide, and Japanese encephalitis.


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Tuesday, September 22, 2015

EXAMEN DE MEDICINA USA ECFMG 2015




ECMFG, BOARDS, FLEX 2015

Autor: Carlos E Mijares, MD.

Former resident at University of Kansas, Allergy & Immunology, pediatrics, Kansas City, Kansas. USA. Program Director: Frederic Speer, M.D. USA.

***Encontrandome en Atlanta y en Milledgeville, Georgia haciendo estudios de Medicina para entrar al Merit System americano como médico general, despues de haber aprobado el ECFMG en Miami. Obtuve 75 puntos, el limite minimo para aprobar, indicando que quiza el mejor examen obtuvo una calificacion alrededor de mas de 80 - o,  menos de 90 puntos; de lo contrario pude haber quedado fuera de APROBADO. Todos los venezolanos aprobaron. Fue un examen en el Miami Convention Center, auspiciado por la Universidad de Miami, y dririgido por el eminente profesor, cubano, Dr. Rafael A. Peñalver, M. D. The University of Miami School of Medicine Office of International Medical Education. Program for foreign Medical Graduates hereby certifies that Dr. Carlos E. Mijares Completed an intense course of Postgraduate Medicine offered by the Faculty of the University of Miami School of medicine, 1971-1972. Register Number 23-023. Faculty Members, at glance: Hermanos Portuondo, Rene Montero, American Physician Staff, Dr, Chediak, Rafael Peñalver, y todo un cortejo ded profesores escogidos de la Medicina americana  y expertos en Ingles como una monja de Canada que eseñaba a pronuciar el Ingles de cada uno de los Estados de la Union Americana - porque había un día de examen cuando las preguntas eran hechas a traves de parlantes, por medicos  americanos con diferentres acentos y modismos...

***Este preambulo es necesario porque aquel esfuerzo estaba dedicado a la emigracion masiva de medicos cubanos a Estados Unidos. Yo aproveché la ocasión para aprobar el ECFMG, Educational Council for Foreign Medical Graduates. Sponsored by: American Hospital Association. American Medical Association. Association of American Medical Colleges. Association for Hospital Medical Education. Federation of State Medical Boards of the United States, certifies that Carlos Eduardo Mijares Ramos has satisfied all the requirementes of the Council, has successfully passed its Examination and has been Awarded Certificate No. 163 236 3. 1972

***El maestro Rafael Peñalver es un Icono de la Medicina cubana y americana. Hasta los medicos guajiros, abandonaron Cuba, huyendo del Comunismo. El Ingles -como siempre era un obstáculo insalvable. Medicos cubanos, de otros países y americanos graduados en Europa estaban en el escenario, tratando de estudiar y de aprobar el ECFMG; un examen tan difícil que hoy, su último día de los 3 días de examen, el médico se enfrenta a 20 robots vivos, entrenados para simular enfermedades y certificar la habilidad medica del aspirante. Los estudiantes de Medicina americanos presentan este examen en dos partes, a media carrera y al final. Los profesores americanos comentan que hoy por hoy, ellos no podrían aprobar este examen sobre todo con la carga de las nuevas disciplinas, como el cancer, el Sida, la Biotecnología, la Genética y la Inmunología, la robótica, nanología, y la Medicina Espacial...

***Si no apruebas este examen no puedes estudiar posgrados medicos en Estados Unidos ni ejercer, la Medicina, ni recetar de una Farmacia, porque tu No de Licencia depende de este examen, los Boards y el celebre FLEX.

***Los BOARDS son las especialidades o Fellowship de los estudios de posgrado que, una vez culminados, originan estos examenes que son parecidos al ECFMG.

***El FLEX, igualmente es un examen nacional que certifica para ejercer en todo el país y que se parece al ECFMG, con las salvedades como en los BOARDS.

***Con estos Diplomas en el pecho, tienes que solicitar al Colegio Medico de cada Estado para aprobar tu derecho a ejercer la Medicina en Estados Unidos. Y, todavía, eres discriminado o considerado aledaño.

***Despues de leer esto, como puede hablarse de Medicina Holística, religiosa, acupuntura, alternativa, quiropracticos, iridólogos, homeopáticos, abortólogos, curanderos, brujos, chamanes, caciques, et, etc...


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