Evaluation of Reference Centers for Special Immunobiologicals implementation

Abstract

OBJECTIVE To describe the Reference Centers for Special Immunobiologicals and evaluate their implementation considering formal regulations.METHODS We conducted a program evaluation, of evaluative research type. From August 2011 to January 2012, a questionnaire was applied to the 42 Reference Centers for Special Immunobiologicals existing in the Country, approaching the structure, human resources, and developed activities dimensions. We conducted a descriptive analysis of data and used a clustering for binary data with the squared Euclidean distance, by the farthest neighbor method, to aggregate services with similar features.RESULTS We observed great diversity among the services in the three dimensions. The clustering resulted in five service profiles, named according to their characteristics. 1) Best structure: 12 Reference Centers for Special Immunobiologicals with the highest proportion of services with the minimum of rooms recommended, purpose-built vaccine refrigerators, preventive maintenance of the cold chain, and oxygen source. 2) Immunobiologicals distributor: six Reference Centers for Special Immunobiologicals that distributed more than applied immunogens; no doctor present for more than half of the working hours and no purpose-built vaccine refrigerators . 3) Incipient implementation: five Reference Centers for Special Immunobiologicals with inadequate structure, such as absence of purpose-built vaccine refrigerators, preventive maintenance of the cold chain and oxygen source; none had computer. 4) Vaccination rooms: 13 Reference Centers for Special Immunobiologicals, everyone did routine immunization, most participated in vaccination campaigns. 5) Teaching and research: six services, all inserted into teaching hospitals, developed researches and received trainees; most had doctors in more than half of the working hours.CONCLUSIONS The evaluation of the Reference Centers for Special Immunobiologicals implementation was based on the profiles found and considered the official regulations: services categorized as “better structure” and “teaching and research” were considered implemented; “immunobiologicals distributor” and “vaccination room” services, partially implemented, and the ones with the “incipient implementation” profile, not implemented. The results of this evaluation can contribute to the reformulation of the services, considering the current context.

Multiple Sclerosis Manifested by Paralysis of Cranial VI Pair with Diplopia

“…Although optic neuritis was the most commonly observed alteration, the possibility that other ocular alterations precede or accompany the disease should be highlighted. course of the disease [17,19,[20][21][22]. This perception was fundamental in the patient's condition, since her clinical condition began with diplopia secondary to abducens nerve paralysis and not due to manifestations related to optic neuritis.…”

“…Ocular findings in MS include optic neuritis, retinitis, peripheral vasculitis, ocular motility abnormalities that present with diplopia or nystagmus, and pars planitis [1,12,17,20,21]. All of them must be recognized by the ophthalmologist, although optic neuritis, due to its high frequency and established correlation with MS, is the most important ocular change in the follow-up of these patients [14,19,[20][21][22][23].…”

“…Ocular findings in MS are frequent and are often the first clinical manifestation of the diseas [19,[21][22][23]. Although optic neuritis was the most commonly observed alteration, the possibility that other ocular alterations precede or accompany the disease should be highlighted.…”

Advancing the Science of Vaccine Safety During the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond: Launching an International Network of Special Immunization Services

“…However, clinically significant AEFIs are so rare that it is difficult for healthcare professionals to provide standardized evaluation, diagnosis, and management for an individual patient’s novel AEFI; to recognize new adverse events that are possible AESIs; and for the field of vaccine safety to advance scientifically. In response, tertiary clinical immunization services that bring together subspecialists as needed on challenging AEFI cases were organized in several countries, starting with Italy in 1992 [ 31 ], Brazil in 1993 [ 32 ], the United Kingdom [ 33 ], the civilian Clinical Immunization Safety Assessment (CISA) [ 34 ] and military Vaccine Healthcare Centers Networks in the United States [ 35 ], followed by services in Canada [ 36 ] and Australia [ 37 ].…”