Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920070003&lang=en vol. 21 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<B>Dengue y dengue hemorrágico en las Américas</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300001&lng=en&nrm=iso&tlng=en <![CDATA[<B>Economic and health burden of rotavirus gastroenteritis for the 2003 birth cohort in eight Latin American and Caribbean countries</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300002&lng=en&nrm=iso&tlng=en OBJECTIVE: To estimate the health and economic burden of rotavirus gastroenteritis in hospital and outpatient settings in eight Latin American and Caribbean countries (Argentina, Brazil, Chile, Dominican Republic, Honduras, Mexico, Panama, and Venezuela). METHODS: An economic model was constructed using epidemiological data from published articles, national health administration studies, and country-specific cost estimates. For each of the eight countries, the model estimated the rotavirus outcomes for the 2003 birth cohort during the first five years of life. The main outcome measures included health care costs, transportation costs, lost wages, and disease burden expressed in disability-adjusted life years. Estimates were expressed in 2003 US dollars. All future costs and disability-adjusted life year estimates were discounted at a rate of 3%. Sensitivity analyses evaluated the impact of specific variables on the medical cost of treating rotavirus. RESULTS: For every 1 000 children born during 2003 in the eight Latin American and Caribbean countries studied here, we estimated that rotavirus gastroenteritis would result in an average of 246 outpatient visits, 24 hospitalizations, 0.6 deaths, and US$ 7 971 in direct medical costs during their first five years of life. The incidence of rotavirus-associated outpatient visits and the cost of outpatient visits were predicted to have the largest impact on the total medical cost per child. CONCLUSIONS: Rotavirus gastroenteritis is likely to result in substantial disease and economic burden to health systems in Latin American and Caribbean countries, and the foreseeable burden should be an important consideration in evaluating the cost-effectiveness of vaccination.<hr/>OBJETIVO: Estimar la carga económica y de morbilidad de la gastroenteritis por rotavirus en hospitales y servicios ambulatorios de ocho países de América Latina y el Caribe (Argentina, Brasil, Chile, Honduras, México, Panamá, República Dominicana y Venezuela). MÉTODOS: Se elaboró un modelo económico a partir de datos epidemiológicos de artículos publicados, estudios de autoridades sanitarias nacionales y los estimados de costos específicos de cada país. El modelo calculó las consecuencias de la infección por rotavirus en los primeros cinco años de vida de la cohorte de nacidos en 2003 en cada uno de los ocho países estudiados. Las principales medidas de valoración fueron los costos de la atención sanitaria, los costos de transportación, los salarios perdidos y la carga de morbilidad expresada en años de vida ajustados por discapacidad. Los estimados se expresaron en dólares estadounidenses del año 2003. Se empleó una tasa de descuento de 3% para los cálculos de costos y años de vida ajustados por discapacidad de los años siguientes. El impacto de las variables específicas sobre los costos clínicos del tratamiento de la infección por rotavirus se realizó mediante análisis de sensibilidad. RESULTADOS: Se estimó que durante los primeros cinco años de vida, la gastroenteritis por rotavirus provoca en promedio 246 consultas externas, 24 hospitalizaciones, 0,6 muertes y gastos médicos directos por US$ 7 971,00 por cada 1 000 niños nacidos en 2003 en los ocho países estudiados de América Latina y el Caribe. Se prevé que la frecuencia de visitas médicas asociadas con la infección por rotavirus y los costos por consultas externas tengan el mayor impacto en los costos clínicos totales por niño. CONCLUSIONES: La gastroenteritis por rotavirus puede representar una considerable carga económica y de morbilidad para los sistemas sanitarios de los países de América Latina y el Caribe. Se debe prestar una especial atención a la carga previsible al evaluar la efectividad en función del costo de la vacunación contra rotavirus. <![CDATA[<B>Potential cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300003&lng=en&nrm=iso&tlng=en OBJECTIVES: To estimate the costs, benefits and cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries: Argentina, Brazil, Chile, the Dominican Republic, Honduras, Mexico, Panama, and Venezuela. METHODS: An economic model was constructed to estimate the cost-effectiveness of vaccination from the health care system perspective, using national administrative and published epidemiological evidence, country-specific cost estimates, and vaccine efficacy data. The model was applied to the first five years of life for the 2003 birth cohort in each country. The main health outcome was the disability-adjusted life year (DALY), and the main summary measure was the incremental cost per DALY averted. A 3% discount rate was used for all predicted costs and benefits. Sensitivity analyses evaluated the impact of uncertainty regarding key variables on cost-effectiveness estimates. RESULTS: According to the estimates obtained with the economic model, vaccination would prevent more than 65% of the medical visits, deaths, and treatment costs associated with rotavirus gastroenteritis in the eight countries analyzed here. At a cost of US$ 24 per course (for a two-dose vaccine), the incremental cost-effectiveness ratio ranged from US$ 269/DALY in Honduras to US$ 10 656/DALY in Chile. Cost-effectiveness ratios were sensitive to assumptions about vaccine price, mortality, and vaccine efficacy. CONCLUSIONS: Vaccination would effectively reduce the disease burden and health care costs of rotavirus gastroenteritis in the Latin American and Caribbean countries analyzed here. From the health care system perspective, universal vaccination of infants is predicted to be cost-effective, based on current standards.<hr/>OBJETIVOS: Estimar los costos, los beneficios y la efectividad en función del costo de la vacunación contra la gastroenteritis por rotavirus en ocho países de América Latina y el Caribe: Argentina, Brasil, Chile, Honduras, México, Panamá, República Dominicana y Venezuela. MÉTODOS: Se elaboró un modelo económico para estimar la efectividad en función del costo de la vacunación, desde la perspectiva del sistema de salud, a partir de las constancias epidemiológicas nacionales oficiales y publicadas, los estimados de costos específicos de cada país y los datos de eficacia de la vacuna. El modelo se aplicó a los primeros cinco años de vida de la cohorte de nacidos en 2003 en cada uno de esos países. La principal medida de salud fueron los años de vida ajustados por discapacidad (AVAD) y la principal medida sintética fue el costo incremental por AVAD evitado. Se empleó una tasa de descuento de 3% para el pronóstico de los costos y beneficios. El impacto de la incertidumbre relacionada con las variables clave sobre la efectividad en función del costo se realizó mediante el análisis de sensibilidad. RESULTADOS: Según los estimados obtenidos mediante el modelo económico, la vacunación podría evitar más de 65% de las consultas médicas, de las muertes y del costo de tratamiento asociados con la gastroenteritis por rotavirus en los ocho países analizados. Con un costo total de US$ 24,00 (por las dos dosis de la vacuna), la razón incremental de la efectividad en función del costo varió entre US$ 269/AVAD en Honduras y US$ 10 656/AVAD en Chile. Las razones de la efectividad en función del costo fueron sensibles a las diversas hipótesis sobre el precio de la vacuna, la mortalidad y la eficacia de la vacuna. CONCLUSIONES: La vacunación permitiría reducir eficazmente la carga de morbilidad y los costos de la atención sanitaria de la gastroenteritis por rotavirus en los países analizados de América Latina y el Caribe. Desde la perspectiva de los sistemas de salud, se prevé que la vacunación universal de todos los niños será efectiva en función del costo, según los estándares vigentes en la actualidad. <![CDATA[<B>Stress</B>: <B>diagnosis of military police personnel in a Brazilian city</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300004&lng=en&nrm=iso&tlng=en OBJETIVOS: Diagnosticar a ocorrência e a fase de estresse em policiais militares da Cidade de Natal, Brasil, além de determinar a prevalência de sintomatologia física e mental. MÉTODO: Estudo descritivo, com corte transversal. Foi investigada uma amostra de 264 indivíduos extraída de uma população de 3 193 militares do Comando de Policiamento da Capital. Os dados foram coletados entre junho de 2004 e janeiro de 2005 utilizando-se o Inventário de Sintomas de Stress para Adultos de Lipp. Foi determinada a presença de estresse, a fase de estresse (alerta, resistência, quase-exaustão, exaustão), a prevalência de sintomas físicos e mentais e a relação entre estresse e unidade policial, posto policial, sexo, hábito de beber, fumo, escolaridade, estado civil, idade, tempo de serviço e faixa salarial. RESULTADOS: A proporção de policiais sem sintomas de estresse foi de 52,6%, enquanto que 47,4% apresentaram sintomatologia. Dos 47,4% com estresse, 3,4% encontravam-se na fase de alerta, 39,8% na fase de resistência, 3,8% na fase de quase-exaustão e 0,4% na fase de exaustão. Sintomas psicológicos foram registrados em 76,0% dos policiais com estresse, e sintomas físicos, em 24,0%. Das variáveis investigadas, a única que apresentou relação com estresse foi o sexo (P = 0,0337), sendo as mulheres as mais afetadas. CONCLUSÃO: Os níveis de estresse e de sintomas não indicaram um quadro de fadiga crítico. É recomendável uma ação preventiva por parte da organização policial, que poderia incluir a aplicação de um programa de diagnóstico, orientação e controle do estresse.<hr/>OBJECTIVES: To diagnose the occurrence and stage of stress among military police enlisted personnel and officers in the city of Natal (the capital of the state of Rio Grande do Norte, Brazil), and to determine the prevalence of physical and mental symptoms. METHOD: This cross-sectional descriptive study investigated a sample of 264 individuals from a population of 3 193 military personnel from the Natal police command. The data were collected between June 2004 and January 2005 using Lipp's Adult Stress Symptoms Inventory (Inventário de Sintomas de Stress para Adultos de Lipp). The research assessed: (1) presence of stress, (2) the stage of stress (alert, resistance, near-burnout, and burnout), (3) the prevalence of physical and mental symptoms, and (4) the relationship between stress and police unit, rank, gender, drinking, smoking, educational level, marital status, age, years of police service, and salary. RESULTS: No stress symptoms were found in 52.6% of the sample; 47.4% had symptoms. Of the 47.4% of the police personnel with stress symptoms, they were distributed as: 3.4% in the alert stage, 39.8% in the resistance stage, 3.8% in the near-burnout stage, and 0.4% in the burnout stage. Psychological symptoms were recorded in 76.0% of the police personnel with stress, and physical symptoms in 24.0% of them. Of the variables investigated, only gender was related to stress (P = 0.0337), with the female police personnel being more likely to suffer from stress. CONCLUSIONS: The levels of stress and symptoms do not indicate a critical situation of fatigue. However, it is recommended that the police take preventive actions, including implementing an effective program for the diagnosis of, training on, and control of stress. <![CDATA[<B>The relationship between socioeconomic factors and maternal and infant health programs in 13 Argentine provinces</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300005&lng=en&nrm=iso&tlng=en OBJETIVOS: Analizar la relación entre la salud maternoinfantil y los factores determinantes socioeconómicos, culturales y sanitarios y evaluar el efecto de la calidad de los programas de salud sobre los principales indicadores de salud maternoinfantil. MÉTODOS: Estudio analítico de corte transversal con múltiples variables. Se estudiaron seis indicadores maternoinfantiles: las tasas de mortalidad materna, infantil, neonatal y posneonatal y los porcentajes de bajo peso al nacer y de prematuros. El estudio se realizó en 79 unidades administrativas de 13 provincias argentinas distribuidas en las cuatro principales regiones del país: Norte (Salta, Jujuy y Misiones), Centro (Córdoba, Santa Fe y Buenos Aires), Litoral (Entre Ríos), Cuyo (San Luis, San Juan y Mendoza) y Sur (Neuquén, Río Negro y Chubut). Como variable explicativa se utilizó la calidad de los programas de salud, controlada por los factores determinantes socioeconómicos, culturales y sanitarios (período 1999-2000). La calidad de los programas (mala, regular, buena y muy buena) se basó en el análisis cuantitativo y cualitativo de variables seleccionadas de políticas, organización y procesos, según el juicio consensuado de los investigadores. La información documental se obtuvo de fuentes oficiales secundarias y las características e indicadores de los programas de salud se derivaron de las entrevistas a 117 referentes clave. RESULTADOS: Se encontraron marcadas diferencias geográficas en el nivel de salud maternoinfantil, la atención médica y los factores condicionantes de la salud. Solo 10,0% de los programas de salud fueron calificados como muy buenos, 35,4% como buenos, 31,6% como regulares y 23,0% como malos. Se encontró una correlación significativa (P < 0,05) entre las tasas de mortalidad infantil y posneonatal y la condición socioeconómica desfavorable y entre las tasas de mortalidad infantil y neonatal y el porcentaje de bajo peso al nacer, por un lado, y la calidad de los programas por el otro. CONCLUSIONES: En Argentina, el nivel de salud maternoinfantil muestra marcadas diferencias entre las unidades administrativas. La tasa de mortalidad infantil estuvo asociada con las variaciones de los factores determinantes socioeconómicos, culturales y sanitarios y con la calidad de los programas de salud. Estos últimos mejoraron los niveles de salud infantil cuando se implementaron adecuadamente, incluso en condiciones socioeconómicas y sanitarias desfavorables.<hr/>OBJECTIVES: To analyze the relationship between maternal and infant health and socioeconomic, cultural, and sanitation factors in Argentina; to evaluate how health program quality affects the primary health indicators for mothers and infants. METHODS: This is a cross-sectional study with multiple variables. The authors studied six indicators for maternal and infant health: rates for maternal, infant, neonatal, and postneonatal mortality; the percentage of newborns with low birthweight; and the percentage of premature newborns. The study was conducted in 79 administrative units in 13 provinces that represent different geographic regions of Argentina. They included (1) the provinces of Salta and Jujuy in northwest Argentina; (2) the provinces of Córdoba, Santa Fe, and Buenos Aires in central Argentina; (3) the provinces of Entre Ríos and Misiones in the Mesopotamia or northeast region; (4) the provinces of San Luis, San Juan, and Mendoza in the Cuyo or northwest, Andean region; and (5) the provinces of Neuquén, Río Negro, and Chubut in the south. The explanatory variable in the study was the quality of health programs, controlled by socioeconomic, cultural, and sanitation factors in 1999 and 2000. The definition of program quality ("poor," "average," "good," and "very good") was based on quantitative and qualitative analysis of selected variables such as policies, organization, and procedures as determined by the investigators. Documentation was obtained from secondary official sources. The investigators interviewed 117 health system managers (including supervisors of provincial and local health programs, administrators of maternal and child health programs, and hospital directors), who provided information on characteristics and indicators of the health programs. RESULTS: There were marked geographic differences in the levels of maternal and infant health, medical care, and socioeconomic, cultural, and sanitation factors. Only 10.0% of health programs were classified as "very good," 35.4% as "good," 31.6% as "average," and 23.0% as "poor." There was a significant correlation (P < 0.05) between rates of infant and postneonatal mortality and adverse socioeconomic circumstances. There was also a significant correlation between the percentage of low birthweight infants and the quality of health programs. CONCLUSIONS: There are clear disparities in the level of maternal and infant health care in different administrative units in Argentina. The infant mortality rate was associated with variations in socioeconomic, cultural, and sanitation factors and with the quality of health programs. Health programs improved infant health when appropriately implemented, even in adverse socioeconomic and sanitation conditions. <![CDATA[<B>Prevalence of postural changes in high school students in a city in southern Brazil</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300006&lng=en&nrm=iso&tlng=en OBJETIVOS: Estimar a prevalência de alterações posturais laterais e ântero-posteriores em adolescentes do sexo feminino e verificar se determinados fatores socioeconômicos, demográficos, antropométricos e comportamentais estão associados a essas alterações posturais. MÉTODOS: Inquérito epidemiológico com amostra representativa de 495 estudantes do ensino médio regular diurno, com idade de 14 a 18 anos na Cidade de São Leopoldo, Brasil. As estudantes foram avaliadas nos meses de outubro e novembro de 2004. As alterações posturais foram definidas como alterações nas curvas fisiológicas da coluna vertebral, identificadas através de avaliação postural não-invasiva. RESULTADOS: Observou-se uma prevalência de 66% (IC95%: 61,5 a 70,0) para as alterações laterais e de 70% (IC95%: 65,2 a 73,5) para as alterações ântero-posteriores. As alterações laterais foram mais prevalentes nas alunas com índice de massa corporal normal (razão de prevalência, ou RP = 1,32; IC95%: 1,09 a 1,59) e nas que assistiam à televisão por mais de 10 horas semanais (RP = 1,16; IC95%: 1,02 a 1,32). A prevalência de alterações ântero-posteriores foi maior nas alunas cujos responsáveis estudaram até o nível fundamental (responsáveis femininos, RP = 1,30; IC95%: 1,09 a 1,55; e responsáveis masculinos, RP = 1,20; IC95%: 1,02 a 1,40) e nas alunas com sobrepeso ou obesidade (RP = 1,33; IC95%: 1,19 a 1,48). CONCLUSÕES: Preocupa a alta prevalência de alterações na postura das adolescentes, uma vez que essas alterações podem gerar problemas na coluna vertebral a médio e longo prazo. É importante que profissionais da área da saúde, inclusive professores de educação física, estejam aptos a realizar avaliações posturais, e que esse procedimento seja realizado rotineiramente nas escolas.<hr/>OBJECTIVE: To estimate the prevalence of lateral and anteroposterior postural changes in female adolescents and to investigate whether these changes are associated with certain socioeconomic, demographic, anthropometric, or behavioral variables. METHODS: This epidemiologic survey included a representative sample of 495 high school students from regular day school programs in the city of São Leopoldo, Rio Grande do Sul, Brazil, which is in the South region of Brazil. The students, who were 14 to 18 years old, were assessed in October and November of 2004. Postural changes were defined as skews in the spinal curvature, identified through noninvasive postural assessment. RESULTS: The prevalence of lateral changes was 66% (95% confidence interval (CI): 61.5% to 70.0%) vs. 70% for anteroposterior changes (95% CI: 65.2% to 73.5%). Lateral changes were more prevalent in students with a normal body mass index (prevalence ratio (PR) = 1.32; 95% CI: 1.09 to 1.59) and in those who watched television for more than 10 hours weekly (PR = 1.16; 95% CI: 1.02 to 1.32). The prevalence of anteroposterior changes was higher in students whose parents/guardians had no schooling or only had elementary schooling (female guardians: PR = 1.30, 95% CI of 1.09 to 1.55; male guardians: PR = 1.20, 95% CI of 1.02 to 1.40) and in students who were overweight or obese (PR = 1.33; 95% CI of 1.19 to 1.48). CONCLUSIONS: The high prevalence of postural changes observed is reason for concern since these changes can translate into spinal problems in the medium to long term. Health professionals, including physical education teachers, should be trained to perform postural assessments, which should be routinely done in schools. <![CDATA[<B>Health in Cuba and the Millennium Development Goals</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300007&lng=en&nrm=iso&tlng=en The first assessments of the Millennium Development Goals of the United Nations have been completed, and deliberations about world health are increasing. Now is an appropriate time to consider the case of Cuba, which has functioned under difficult conditions for many years, and followed its own path. Cuba's health indicators are much better than might be expected considering its level of income; in many cases the indicators compare to those of industrialized countries. These results should be viewed as the product of a well-defined strategy and the use of essential public health principles rather than as the accumulation of better numbers. The Cuban experience demonstrates that a population's health can improve in even the most adverse economic conditions. This is attainable when sound public health practices are implemented under the principle that health is a basic right and therefore a national priority. An understanding of the Cuban public health system can help other low-income countries adapt these practices to their own conditions and meet the Millennium Development Goals. If this were to occur, there would be substantial improvement in the world's health. <![CDATA[<B>Tasas de cesáreas</B>: <B>análisis de los estimados regionales y nacionales</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300008&lng=en&nrm=iso&tlng=en The first assessments of the Millennium Development Goals of the United Nations have been completed, and deliberations about world health are increasing. Now is an appropriate time to consider the case of Cuba, which has functioned under difficult conditions for many years, and followed its own path. Cuba's health indicators are much better than might be expected considering its level of income; in many cases the indicators compare to those of industrialized countries. These results should be viewed as the product of a well-defined strategy and the use of essential public health principles rather than as the accumulation of better numbers. The Cuban experience demonstrates that a population's health can improve in even the most adverse economic conditions. This is attainable when sound public health practices are implemented under the principle that health is a basic right and therefore a national priority. An understanding of the Cuban public health system can help other low-income countries adapt these practices to their own conditions and meet the Millennium Development Goals. If this were to occur, there would be substantial improvement in the world's health. <![CDATA[<B>Beneficios de la práctica de ejercicios en mujeres tratadas por cáncer de mama</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300009&lng=en&nrm=iso&tlng=en The first assessments of the Millennium Development Goals of the United Nations have been completed, and deliberations about world health are increasing. Now is an appropriate time to consider the case of Cuba, which has functioned under difficult conditions for many years, and followed its own path. Cuba's health indicators are much better than might be expected considering its level of income; in many cases the indicators compare to those of industrialized countries. These results should be viewed as the product of a well-defined strategy and the use of essential public health principles rather than as the accumulation of better numbers. The Cuban experience demonstrates that a population's health can improve in even the most adverse economic conditions. This is attainable when sound public health practices are implemented under the principle that health is a basic right and therefore a national priority. An understanding of the Cuban public health system can help other low-income countries adapt these practices to their own conditions and meet the Millennium Development Goals. If this were to occur, there would be substantial improvement in the world's health. <![CDATA[<B>Reducción de la mortalidad infantil en Chile</B>: <B>un éxito en dos etapas</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300010&lng=en&nrm=iso&tlng=en The first assessments of the Millennium Development Goals of the United Nations have been completed, and deliberations about world health are increasing. Now is an appropriate time to consider the case of Cuba, which has functioned under difficult conditions for many years, and followed its own path. Cuba's health indicators are much better than might be expected considering its level of income; in many cases the indicators compare to those of industrialized countries. These results should be viewed as the product of a well-defined strategy and the use of essential public health principles rather than as the accumulation of better numbers. The Cuban experience demonstrates that a population's health can improve in even the most adverse economic conditions. This is attainable when sound public health practices are implemented under the principle that health is a basic right and therefore a national priority. An understanding of the Cuban public health system can help other low-income countries adapt these practices to their own conditions and meet the Millennium Development Goals. If this were to occur, there would be substantial improvement in the world's health. <![CDATA[<B>Vaccines against dengue</B>: <B>a review of current candidate vaccines at advanced development stages</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892007000300011&lng=en&nrm=iso&tlng=en Los esfuerzos sistemáticos para desarrollar una vacuna contra el dengue comenzaron durante la Segunda Guerra Mundial, inspirados en el desarrollo exitoso de una vacuna contra la fiebre amarilla. Sin embargo, la falta de modelos adecuados de la enfermedad, la información incompleta acerca de los mecanismos patogénicos y los insuficientes incentivos económicos han dificultado los avances. Debido al impacto actual del dengue en todo el mundo y su explosiva diseminación, ha aumentado el interés en el desarrollo de vacunas contra el dengue y se ha avanzado considerablemente en el camino hacia la evaluación clínica de vacunas candidatas. La Iniciativa para la Investigación en Vacunas, de la Organización Mundial de la Salud, está facilitando el desarrollo de y los ensayos con las vacunas candidatas. Las vacunas contra el dengue que se encuentran actualmente en etapas avanzadas de desarrollo son de tres tipos fundamentales: 1) vivas atenuadas; 2) vivas recombinantes; y 3) de subunidades e inactivadas. La mayoría de las vacunas en cartera son vivas atenuadas, siguiendo el camino exitoso de otras vacunas vivas contra flavivirus, especialmente de la desarrollada contra la fiebre amarilla. En general, las vacunas contra el dengue que se encuentran actualmente en desarrollo están bastante avanzadas y son muy diversas. Muy pronto comenzará la evaluación de estas vacuna candidatas en ensayos de eficacia basados en poblaciones expuestas, lo que requerirá resolver varios problemas técnicos, operacionales y regulatorios.