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Biomedical subjects

Fernando A Guerra

Publications and source records attributed to Fernando A Guerra.

10 recordsLinked to original sources
PubMed2006

Safety, tolerability and immunogenicity of VAQTA given concomitantly versus nonconcomitantly with other pediatric vaccines in healthy 12-month-old children.

BACKGROUND: The objective of this study is to assess whether hepatitis A vaccine is immunogenic and well tolerated when administered to 12-month-old children alone or concomitantly with other routinely administered pediatric vaccines. METHODS: Six hundred seventeen healthy 12-month-old children were randomized to receive dose 1 of hepatitis A vaccine given alone or concomitantly with measles-mumps-rubella vaccine and varicella vaccine and dose 2 of hepatitis A vaccine given alone or concomitantly with diphtheria-tetanus-acellular pertussis vaccine and optionally with oral or inactivated poliovirus vaccine. Participants were followed for clinical adverse experiences and serologic responses to all vaccine antigens. Antibody responses were compared with historical controls for some indices. RESULTS: The safety profile was generally comparable whether hepatitis A vaccine was administered alone or concomitantly with other vaccines. When administered alone, the hepatitis A seropositivity rate was 98.3% and 100% for dose 1 and dose 2, respectively, and after dose 2 was similar to historical rates and the geometric mean titers were similar between initially seropositive and initially seronegative subjects (6207 and 6810 mIU/mL, respectively). After concomitant administration with hepatitis A vaccine, antibody responses to measles, mumps, rubella, diphtheria, tetanus and filamentous hemagglutinin (98.8%, 99.6%, 100%, 98.6%, 100% and 83.3%, respectively) were similar to historical controls and response to poliovirus was demonstrated, but immune responses to varicella zoster virus (79%) and pertussis toxoid (76%) were inferior to historical controls. CONCLUSIONS: Hepatitis A vaccine is highly immunogenic and generally well tolerated when administered to healthy children as young as 12 months of age regardless of initial hepatitis A serostatus and can be administered concomitantly with measles-mumps-rubella vaccine and oral or inactivated poliovirus vaccine.

Antibodies, Bacterial↗
PubMed2005

Best-practice models that work: the CDC's Racial and Ethnic Adult Disparities Immunization Initiative (READII) Programs.

In this panel discussion, three health leaders provide information on techniques and approaches used to effectively implement the CDC's Racial and Ethnic Adult Disparities Immunization Initiative (READII) Programs. Part 1 offers an overview of READII and information on early results and program accomplishments. In Part 2, the Mississippi READII initiative is explored, with insights on how this program has served 10,000 African Americans in inner-city Jackson, Mississippi as well 23,000 elderly African Americans in 18 rural Delta counties, said to be the poorest counties in the nation. The third segment of this presentation explains challenges and successes found in San Antonio, Texas where READII efforts focused on immunizing the city's elderly Hispanics. Readers will find lessons learned and plans for future expansion to use as models when considering implementation of immunization programs in local communities.

Adult↗
PubMed2004

Overcoming the hurdles to providing urban health care in the 21st century.

The delivery of health care services to urban populations in the United States is a system of rapidly increasing complexity. With the emergence of superspecialized physicians, a scientific approach to disease management has received great emphasis. Those providing health care at the population level may also apply this evidence-based approach. Analysis of the process of health care delivery in its entirety is complicated, confusing, and may be fraught with bias. In this article, a powerful instrument for providing a scientific approach to urban health care health policy development is introduced. This tool allows for analysis and assessment of hurdles to health care delivery to urban populations by dividing the process into elements of "administration," "provision," and "utilization" (APU). This APU triangle model, while intuitive, also allows a more definitive analysis by parts than would be possible to make of the whole. Using this model, the authors explore some of the hurdles faced by each element as well as some potential solutions. Although this model is presented in the context of urban hurdles to health care, it is equally applicable to rural environments or other service-delivery systems. In conclusion, this article discusses the emergence of the role of the public health department as the facilitator and manager between sectors of the community not traditionally connected in a collaborative health care model. Thus, the urban public health department coordinates efforts to surmount the hurdles and provides the venue for analysis, development, and employment of successful strategies.

Cities↗
PubMed2004

Prevention of gonorrhea and Chlamydia through behavioral intervention: results of a two-year controlled randomized trial in minority women.

BACKGROUND: Sexually transmitted disease (STD), including AIDS, disproportionately affects African-American and Hispanic women. GOAL: To evaluate efficacy of standard and enhanced (addition of optional support groups) gender- and culture-specific, small-group behavioral interventions, compared to interactive STD counseling, in high risk minority women for two years. METHODS: Women with a non-viral STD were treated and enrolled in a randomized trial. Follow-up screens and interviews occurred at 6 months, 1 year, 18 months (short interview, optional exam) and 2 years. The primary outcome was subsequent infection with chlamydia and/or gonorrhea. Secondary outcomes included risky sexual behaviors. We employed logistic regression based on intention-to-treat. RESULTS: Data from 775 women were included; the retention rate was 91%. Adjusted infection rates were higher in the controls in Year 1 (26.8%), Year 2 (23.1%), and cumulatively (39.8%) than in the enhanced (15.4%, P = 0.004; 14.8%, P < 0.03; 23.7%, P < 0.001, respectively) and standard (15.7%, P = 0.006; 14.7%, P = 0.03; 26.2%, P < 0.008, respectively) intervention arms at these time points. Enhanced-intervention women who opted to attend support groups (attendees) had the lowest adjusted infection rates in Year 1 (12.0%) and cumulatively (21.8%). Intervention women in general, but particularly attendees, were significantly less likely than controls to have repeat infections. Multiple partners and unprotected sex with an untreated or incompletely treated partner helped explain group differences in infection. CONCLUSIONS: Risk-reduction interventions significantly decreased both single and multiple infective episodes with chlamydia and/or gonorrhea and risky sexual behaviors in the two-year study period. Support-group attendance appeared to contribute additional risk reduction in Year 1.

Adult↗
PubMed2003

Strengthening the supply of routinely recommended vaccines in the United States: recommendations from the National Vaccine Advisory Committee.

Between late 2000 and the spring of 2003, the United States experienced shortages of vaccines against 8 of 11 preventable diseases in children. In response, the Department of Health and Human Services requested that the National Vaccine Advisory Committee (NVAC) make recommendations on strengthening the supply of routinely recommended vaccines. The NVAC appointed a Working Group to identify potential causes of vaccine supply shortages, develop strategies to alleviate or prevent shortages, and enlist stakeholders to consider the applicability and feasibility of these strategies. The NVAC concluded that supply disruptions are likely to continue to occur. Strategies to be implemented in the immediate future include expansion of vaccine stockpiles, increased support for regulatory agencies, maintenance and strengthening of liability protections, improved communication among stakeholders, increased availability of public information, and a campaign to emphasize the benefits of vaccination. Strategies requiring further study include evaluation of appropriate financial incentives to manufacturers and streamlining the regulatory process without compromising safety or efficacy.

Drug Industry↗
PubMed2002

Post-licensure comparative study of unusual high-pitched crying and prolonged crying following COMVAX and placebo versus PedvaxHIB and RECOMBIVAX HB in healthy infants.

BACKGROUND: In a previous clinical trial comparing COMVAX with its monovalent components, PedvaxHIB and RECOMBIVAX HB, one of 92 comparisons of post-vaccination adverse experiences revealed a higher rate of unusual, high-pitched crying following the second, but not the first or third doses of COMVAX compared with two monovalent control vaccines. Rates of prolonged crying were similar between groups at each visit. OBJECTIVES: To compare the frequencies of unusual, high-pitched crying between recipients of COMVAX plus placebo and recipients of PedvaxHIB plus RECOMBIVAX HB following the second vaccine doses (primary) and to summarize the frequency of unusual, high-pitched crying and prolonged crying after each vaccination visit. DESIGN: We enrolled 1215 healthy infants in a randomized, double blind, placebo-controlled study. Participating infants received study vaccines at 2 and 4 months of age and other routine childhood vaccines at 6-7 weeks and 3 months of age. Crying was evaluated via questionnaire at the time of enrollment (baseline) and daily from days 0 to 2 after each injection. RESULTS: Reports of unusual, high-pitched crying and prolonged crying were uncommon (<1%) prior to the first vaccination visit and were comparable in both treatment groups. After each injection, rates of unusual, high-pitched crying (range: 4.26-6.96%) and prolonged crying (range: 0-1.36%) appeared similar between treatment groups and for each vaccination visit. Crying resolved in all infants; no neurological impairment was reported. CONCLUSION: This study found no statistically significant differences in rates of unusual, high-pitched crying and prolonged crying in infants vaccinated with COMVAX plus placebo compared with infants vaccinated with its monovalent components, PedvaxHIB and RECOMBIVAX HB.

Bacterial Outer Membrane Proteins↗
PubMed2002

Immigrant health: legal tools/legal barriers.

The United States is a country of immigrants, our government having been formed by recent arrivals. This trend has continued throughout our history; according to the Center for Immigration Studies, more than 26 million immigrants have settled in the United States since 1970, and approximately one million new immigrants come to the United States each year. The immigrant population faces highly diverse health issues that states, cities, and counties must address, many of which pose significant legal and policy issues. Social, cultural, and linguistic factors complicate those challenges, as does the overlay of federal immigration and health policy. Two federal laws, the Welfare Reform Act of 1996 and Title VI of the federal Civil Rights Act of 1964, have affected immigrants in two very different ways. The former made it difficult for immigrants to qualify for publicly funded benefits. In contrast, Title VI made it easier for immigrants to obtain benefits by requiring federally funded service providers to offer translating services to persons with limited English language skills. Tuberculosis treatment is perhaps the most pressing health need among recent arrivals to the United States. Methods to slow down and hopefully eliminate this disease are underway, but a more comprehensive approach to not only tuberculosis but to immigrant health in general is needed. Indeed, it will benefit those directly affected by tuberculosis and will have serious implications for the entire population for generations to come.

Cultural Characteristics↗