Objetivos de la vigilancia dentro de SIREVA
Desde 1993, la importancia de las neumonías y meningitis bacterianas impulsó a la Organización Panamericana de la Salud a implementar un programa regional de vigilancia basado en una red de hospitales y laboratorios centinelas, SIREVA (Sistema Regional de Vacunas) y luego, SIREVA II (Sistema de Redes de Vigilancia de los Agentes Responsables de Neumonías y Meningitis Bacterianas), para proveer una información prospectiva sobre los datos de distribución de serotipos y susceptibilidad de S. pneumoniae a los antibióticos, así como información epidemiológica para la estimación de la carga de estas enfermedades y la formulación de vacunas cada vez más eficientes.
- Producir una información de calidad aceptada por la comunidad científica internacional.
- Crear una red intra e interregional que sirviera de plataforma modelo acorde con los principios de gestión de la calidad.
- Crear un banco de material biológico que, asociado con la información epidemiológica correspondiente sobre una base demográfica, permitiera estimar la carga de enfermedad, orientara a las autoridades nacionales en la toma de decisiones, ayudara en la determinación de la composición ideal de las vacunas conjugadas que deberían emplearse en la región y facilitara la medición del impacto de las intervenciones vacunales.
- Crear y mantener a largo plazo una relación entre los laboratorios de salud pública de la región en el intercambio de información y transferencia tecnológica.
Crear y mantener al interior de los países una estrecha relación entre departamentos de epidemiología y laboratorio para la vigilancia de enfermedades bacterianas invasoras inmunoprevenibles.
Para alcanzar esos objetivos, en 1993 se inició una red multicéntrica en seis países de la región: Argentina, Brasil, Chile, Colombia, México y Uruguay. Los países fueron seleccionados con base en criterios epidemiológicos, alta prevalencia, distribución geográfica, tamaño de la población y posibilidades operativas. El National Centre for Streptococcus (NCS) en Alberta, Canadá, y el Centers for Disease Control en Ottawa, Canadá, suministraron el apoyo de laboratorio y epidemiológico, respectivamente. Se estableció un protocolo común, el cual fue refinado en los lugares para responder a las situaciones particulares de cada país. La selección de los hospitales se basó en la población pediátrica atendida y el deseo manifiesto de los clínicos y del personal de laboratorio de participar en el proyecto.
Surveillance objectives within SIREVA
Since 1993, the importance of bacterial pneumonia and meningitis prompted the Pan American Health Organization to implement a regional surveillance program based on a network of sentinel hospitals and laboratories, SIREVA (Regional Vaccine System) and then, SIREVA II (Surveillance Network System of Agents Responsible for Bacterial Pneumonia and Meningitis), to provide prospective information on the distribution data of serotypes and susceptibility of S. pneumoniae to antibiotics, as well as epidemiological information for estimating the burden of these diseases and the formulation of increasingly efficient vaccines.
- Generate quality information accepted by the international scientific community.
- Create an intra- and interregional network that would serve as a model platform in accordance with the principles of quality management.
- Create a biological material bank that, associated with the corresponding epidemiological information on a demographic basis, would allow to estimate disease burden, guide national decision-making authorities, assist in determining the ideal composition of conjugated vaccines to be used in the region and facilitate the measurement of the impact of vaccine interventions.
- Create and maintain in the long term a relationship between public health laboratories in the region in the exchange of information and technology transfer.
- Create and maintain within countries a close relationship between epidemiology departments and laboratory for the surveillance of vaccine preventable invasive bacterial diseases.
To achieve these objectives, a multicenter network was initiated in six countries in the region in 1993: Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. Countries were selected based on epidemiological criteria, high prevalence, geographical distribution, population size and operational possibilities. The National Centre for Streptococcus (NCS) in Alberta, Canada, and the Laboratory Center for Disease Control in Ottawa, Canada, provided laboratory and epidemiological support, respectively. A common protocol was established, which was refined in places to respond to the specific situations of each country. The selection of hospitals was based on the pediatric population served and the manifest desire of clinicians and laboratory staff to participate in the project.
“We are aware of no attempts to employ standardized surveillance and laboratory methods in multicountry analyses, with the notable exception of several recent Latin American studies that were part of an effort coordinated by the Pan American Health Organization’s SIREVA project.” Hausdorff W, Bryant J, Paradiso PR, Siber G. Clin Infect Dis. 2000;30:100-21.
“SIREVA has been a phenomenal success; the challenge now is to obtain data on the denominator of the strains in each country to calculate serotype specific rates of disease; then together with stable surveillance and data on vaccine coverage, SIREVA will be able to measure the impact of PCV across the countries of the PAHO region” Doctor Keith P Klugman, William H Foege Professor of Global Health Emory University, Atlanta GA USA Comunicación personal, 2012
“Difference in serotype by region and age. More than 60,000 isolates were identified from 169 studies conducted in 70 countries. There was a substantial number of isolates in the analysis from each region, with the greatest number coming from Latin America and the Caribbean. The serotype distribution was heavily influenced by the serotype distributions of Africa and Asia where pneumococcal disease incidence and mortality is the highest.” The Fourth Regional Pneumococcal Symposium, Johannesburg, South Africa, March 2009.