Resumo em Inglês:

This piece summarizes a document entitled "Critical Issues in Health System Performance Assessment," which was prepared for the Regional Consultation of the Americas on Health Systems Performance Assessment, a meeting held in Washington, D.C., 8 to 10 May 2001. That gathering came about in response to the publication, by the World Health Organization (WHO), of its World Health Report 2000. Done by an advisory group, the Report focused on a comparative evaluation of the performance of the health systems of the WHO Member States. The task of preparing the Report was hindered by a series of factors, from the scar-city of basic data in some countries to the lack of reliable indicators--and especially uniform ones--that would make it possible to draw general conclusions. With a view to overcoming these deficiencies, an innovative methodology was conceived for the Report, based on the evaluation of processes and outcomes, which would make it possible to make valid comparative analyses. Unfortunately, the suitability of the methodology that was used in the Report has been criticized internationally and has led the WHO Director-General to take concrete steps for the next Report, which will come out in October 2002, in order to have improved results. This piece describes measures that need to be taken conceptually and methodologically, with an emphasis on changes in the system for evaluating health system performance and on involving every WHO Member State in the analysis of the data.

Resumo em Inglês:

This piece presents the recommendations of the Advisory Committee on Immunization Practices of the United States of America concerning the use of aluminum hydroxide adsorbed cell-free anthrax vaccine (Anthrax Vaccine Adsorbed, or AVA) and the use of chemoprophylaxis against Bacillus anthracis in the United States. The recommended vaccination schedule consists of three subcutaneous injections, at 0, 2, and 4 weeks, and three booster vaccinations, at 6, 12, and 18 months. To maintain immunity, an annual booster injection is recommended. Approximately 95% of vaccinees seroconvert, with a fourfold rise in anti-PA (protective antigen) IgG titers after three doses. Analysis of data from the United States' Vaccine Adverse Event Reporting System has documented no pattern of serious adverse events clearly associated with the vaccine, except injection-site reactions. Vaccination is contraindicated in the case of a previous history of anthrax infection or anaphylactic reaction following a previous dose of AVA or any of the vaccine components. In addition, vaccination should be postponed in the case of moderate or severe acute illness. Pregnant women should be vaccinated against anthrax only if the potential benefits of vaccination outweigh the potential risks to the fetus. Vaccination during breast-feeding is not medically contraindicated. Routine preexposure vaccination with AVA is indicated for persons engaged in: a) work involving production quantities or concentrations of B. anthracis cultures or b) activities with a high potential for aerosol production. For the military and other select populations or for groups for which a calculable risk can be assessed, preexposure vaccination may be indicated. Following confirmed or suspected exposure to B. anthracis, postexposure antibiotic prophylaxis should be administered with ciprofloxacin, ofloxacin, doxycycline, penicillin VK, or amoxicillin. If the vaccine is available, prophylaxis should continue for 4 weeks (until three doses of vaccine have been administered); otherwise, prophylaxis should continue for 30-60 days.