Pan American Health Organization Research Articles

Concerns, attitudes, and intended practices of Caribbean healthcare workers concerning COVID-19 vaccination: A cross-sectional study

SummaryBackgroundThe Caribbean has a long history of being a global leader in immunization, and one factor contributing to this success has been the commitment of healthcare workers in promoting the benefits of vaccines. Healthcare workers play a critical role in building trust between the public and the immunization program and are generally cited as the most trusted source of information on vaccination. Healthcare workers themselves, therefore, must be confident in vaccination as a public health good and able to transmit this confidence to those who trust them. However, just as with the general public, healthcare workers develop confidence at different rates and may be susceptible to misinformation about vaccines.MethodsDuring April and May 2021, the Pan American Health Organization (PAHO) conducted a mixed-methods survey to assess vaccination attitudes, opinions, and reasoning of 1197 healthcare workers across 14 Caribbean countries.FindingsSeventy-seven percent of respondents expressed clear intention to be vaccinated for COVID-19 as soon as possible. Intention to be vaccinated as soon as possible was expressed by lower proportions of nurses (66%) and allied health professionals (62%) than physicians (85%) and by younger respondents than older ones (64% vs. 85%, respectively; p < 0.001 for all these comparisons). Across 32 questions about attitudes and opinions, vaccine hesitancy was consistently expressed by higher proportions of nurses and allied health professionals than physicians and by younger respondents than older ones.InterpretationInsights from the survey are helping PAHO address healthcare worker concerns with informative messages and supporting countries in policy development to increase vaccine confidence and coverage among Caribbean healthcare workers.FundingThis work has been sponsored by the World Health Organization/Pan American Health Organization, the Government of Germany and The Gavi Alliance.

Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.

Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.

Estimation of Intake of Critical Nutrients Associated with Noncommunicable Diseases According to the PAHO/WHO Criteria in the Diet of School-Age Children in Montevideo, Uruguay.

Purpose: To estimate the effect of the consumption of products with an excessive amount of critical nutrients associated with NCDs, according to the PAHO Nutrient Profile Model on the quality of the diet of Uruguayan school-age children (4 to 12 years). Methods: A 24 h recall of food intake was conducted in a representative sample of 332 participants in the evaluation of the School Feeding Program in 2018 in public schools in Montevideo, Uruguay. Food and preparations were categorized according to the NOVA food classification, according to the nature, extent, and purposes of the industrial processes they undergo. Later, they were analyzed according to the Pan American Health Organization Nutrient Profile Model (PAHO NPM) to identify processed and ultra-processed products with an excessive content of critical nutrients. Results: Only 0.52% of children consumed exclusively natural foods, or culinary ingredients. Twenty-five per cent of children consumed ≥4 products categorized with an excessive content of free sugars, total fat, or saturated fat according to the PAHO NPM; in the case of excessive sodium, this was 40%. In general, children who included products with excessive free sugars, sodium, or saturated fat in their diet exceeded the limits established by the World Health Organization, and, as a result, their diet is of poorer nutritional quality compared to children who did not consume such products. Conclusion: Diets free of ultra-processed and processed products with excess free sugars, total fats, saturated fats, and sodium increased the chances of school-age children in Montevideo of meeting WHO nutrient intake recommendations. Meanwhile, intake of each additional gram of products with excessive critical nutrients according to PAHO NPM, significantly worsens diets, preventing children from meeting WHO recommendations.

Trend and dynamics of the COVID-19 pandemic in Latin America during the first wave

Objective: The present study aimed to evaluate the trend and dynamics of COVID-19 in LA. Methods: This cross-sectional study was based on data published on the Pan American Health Organization and the World Health Organization websites. Information was collected in three periods: 05/10/2020 (Period A), 06/19/2020 (Period B), and 07/20/2020 (Period C). Descriptive analysis was performed. Results: In Period A, the number of confirmed cases of COVID-19 in LA had reached 284,521. In the second period, the number of cumulated cases was 1,958,180. In Period C, a total of 4,046,179 cases of COVID-19 had been notified. The highest prevalence and detection rates of COVID-19 in LA was reported in Chile, Panama, Peru, and Brazil. The mortality rate regarding new deaths in Period A was less than 60 deaths/106 habitants in all countries. However, in the second period, Ecuador (232 deaths/106 hab) presented the highest mortality rate. In Period C, the greatest rates were reported in Peru (297 deaths/106 hab) and Chile (248 deaths/106 hab). Brazil being accountable for the highest number of deaths in LA due to COVID-19. Conclusion: The trend and dynamics of COVID-19 spread in LA reveals the heterogeneous distribution and uncontrollability of the epidemic in several countries.

Evaluating intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model.

To investigate intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model. Dietary intakes of 12,153 participants from the Australian Health Survey (2011-12) aged 2 + years were evaluated. Food items reported during a 24h recall were classified using the NOVA system. The Pan-American Health Organization Nutrient Profile Model (PAHO NPM) was applied to identify processed and ultra-processed products with excessive content of critical nutrients. Differences in mean intakes and prevalence of excessive intakes of critical nutrients for groups of the population whose diets were made up of products with and without excessive content in critical nutrients were examined. The majority of Australians consumed daily at least three processed and ultra-processed products identified as excessive in critical nutrients according to the PAHO NPM. Individuals consuming these products had higher intakes of free sugars (β = 8.9), total fats (β = 11.0), saturated fats (β = 4.6), transfats (β = 0.2), and sodium (β = 1788 for adolescents and adults; β = 1769 for children 5-10 years; β = 1319 for children aged < 5 years) (p ≤ 0.001 for all nutrients) than individuals not consuming these foods. The prevalence of excessive intake of all critical nutrients also followed the same trend. The PAHO NPM has shown to be a relevant tool to predict intake levels of nutrients linked to non-communicable diseases in Australia and, therefore, could be used to inform policy actions aimed at increasing the healthiness of food environments.

Development, verification, and validation of an RT-qPCR-based protocol for Yellow Fever diagnosis

IntroductionYellow fever (YF) is a public health threat with frequent outbreaks in tropical and subtropical areas, despite the existence of a safe and effective vaccine. The diagnosis of acute infection of the etiologic agent relies mainly on real-time reverse transcription-polymerase chain reaction (RT-qPCR)-based assays. ObjectivesThe aim of this study was to evaluate and compare this novel protocol for yellow fever virus (YFV) diagnosis against assays developed in-house by reference laboratories for arboviruses. MethodsWe developed a novel molecular protocol for the detection of YFV that includes an Internal Control to validate the reaction and an External Control to monitor the RNA extraction efficiency. Results and DiscussionOur assay detects one viral genome per reaction and displays no cross-reactions with dengue (1-4), Zika, or Chikungunya viruses. This novel assay yielded 95% of agreement with the reference method recommended by the Pan American Health Organization when analyzing 204 clinical samples and cultured viruses, these samples were analyzed in 3 different diagnosis centers for arboviruses in Brazil. The data suggest the use of the proposed multiplex assay protocol to do routine tests in a clinical laboratory. This product adds higher specificity and sensitivity in addition to reduced cost per test due to hands-on time and reagent spending.

Efeitos da pandemia do Coronavírus (COVID-19) no setor turístico da região nordeste do Brasil

The aim of this study is to discuss the effects of the coronavirus pandemic (Covid -19) on the tourism sector in the Northeast of Brazil. It was collated from reliable national/international news reports and data taken from the online portals of the Brazilian Institute of Geography and Statistics, the Ministry of Tourism and the Ministry of Health, the World Health Organization and the Pan American Health Organization, together with references to the impact of the pandemic on the tourism economy, both from a quantitative and qualitative perspective. The research typology is descriptive and exploratory, endorsed by the information gathered and the use of specialized literature supporting the theoretical discussion and analysis of results. Among the main effects of the pandemic in the tourism sector, the study highlights: cancellation of major events; the shutdown and/ or closing of hotels, high number of layoffs in the region’s tourism sector, among others. It also shows some actions, measures and policies to readjust the activities in an attempt to contain the economic crisis within the tourism sector.

The fight against sexually transmitted infections cannot stop in the COVID-19 era: a brazilian experience in online training for sexually transmitted infections guidelines

Introduction: The Brazilian Ministry of Health had planned face-to-face workshops for professional training about the Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections for the year 2020. Due to the COVID-19 pandemic, the workshops were cancelled, and a new strategy was adopted: virtual meetings, called Webinars — Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections 2020. Objective: To report the experience at the Ministry of Health in online training about the clinical protocol and therapeutic guidelines for comprehensive care for people sexually transmitted infections for health professionals in 2020. Methods: The webinars were held in partnership with the Brazilian Society of Sexually Transmitted Diseases and the Pan American Health Organization. Each chapter of the Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections — 2020 was converted into a webinar, with the participation of at least three experts, two speakers, and a moderator. Results: In total, 16 webinars were presented, covering topics such as sexually transmitted infections surveillance, prevention, diagnosis, treatment, public policies, and sexual violence. The initiative had more than 77,000 hits, with an average of 4,900 hits per webinar and the topic “syphilis” being the most accessed. The event reached all 27 federative units of Brazil, as well as 27 other countries. About 500 questions were received from the audience and answered during the sessions and/or through a document published later on by the Ministry of Health. Conclusion: Given the high number of hits and inquiries received, we can conclude that health professionals remained engaged in the topic of sexually transmitted infections during the pandemic. This experience shows the great potential of innovative methods for distance learning to promote continuing education, including a series of webinars aimed at strengthening the fight against sexually transmitted infections.Keywords: Sexually transmitted infections. Education, continuing. Professional training. Clinical protocols. Education, distance.

A “Política da Boa Vizinhança para a febre amarela”: Guerra Fria, o Programa de Erradicação do Aedes aegypti dos Estados Unidos e a cooperação internacional em saúde nas Américas

Abstract This article analyzes the implementation and development of the United States Aedes aegypti Eradication Program from the mid-1950s, an event that marked the country's adhesion to the Continental Campaign for the Eradication of Aedes aegypti, launched by the Pan American Health Organization (PAHO) in 1947. This paper considers that the history of the Continental Campaign is a privileged moment for the understanding of U.S. foreign policy towards Latin America in the context of the Cold War.

Substance Use in Healthcare Professionals During the COVID-19 Pandemic in Latin America: A Systematic Review and a Call for Reports.

Background:The COVID-19 pandemic has generated a remarkable change in the behaviour of Healthcare workers (HCWs) around the world. However, there is a lack of evidence on substance use among HCWs in Latin America. Therefore, this study aimed to determine the current frequency of substance use among Latin American among HCWs.Methods:We searched 8 databases (PubMed, Scopus, ScientDirect, Web of Science, Cochrane, Scielo, LILACS and Latindex), 4 public prepublication servers (SocArXiv, medRxiv, bioRxiv and Preprints) and Google scholar from 1/9/2019 to 11/1/2021. We determined the frequency of each study based on original studies, scientific letters, and clinical trials in English, Spanish and Portuguese.Results:A total of 17 175 study articles were identified from electronic databases and preprints, and 2 cross-sectional studies conducted in 2020 were included in the qualitative analysis. Both studies included HCWs but did not perform a differential analysis. The first was developed by the Pan-American Health Organization and included interviewees from 35 countries, while the second was conducted with 1145 Brazilian participants. Both studies showed increases in substance use during the pandemic, with alcohol being the most commonly used substance (30%), but PAHO’s study reported a 13.8% increase in self-reported heavy-episodic drinking, with differences among genders (males, 15.4%), age groups (highest increase in the 40-49 age group, 16.5%) and area of residence (urban with 14%). The second study showed that 21 32% of participants reported initiating psychoactive substance use, 29.3% added some substance to their initial use and 4% of them had to replace the substance, mainly due to difficulty of access. Other substances of abuse that showed significant increases were tobacco (0.5%) and marijuana (0.3%).Conclusion:Overall, despite the analysis of the 2 studies, the results provided are not a conclusive description of the frequency of substance use by HCWs in Latin America during the COVID-19 pandemic. Further research is required to understand the impact of the pandemic on drug abuse in the region.Protocol Registration:The protocol has been registered on 30 November 2021 on the International Prospective Register of Systematic Reviews (PROSPERO) with ID: CRD420212919700.

Environmental education and healthy housing as strategies for the prevention of COVID-19 at the household level.

Context: The COVID-19 is the most recent global health concern that affects human health mainly the respiratory system with more than 170 million people affected by the virus worldwide. Also, Latin America has been emerging as an epicenter of contagion, and transmission is gradually increasing among the communities in each of the countries analyzed. The infection of more than 30 million people in Latin America supposes the construction of new models and habits of public health that promote attitudes to reduce the number of cases and mortality. Method: A proposal was defined based on three frameworks and models—the principle of healthy housing promoted by the Panamerican Health Organization, the four types of knowledge transfer without memorization proposed by the OECD, and the theory of social constructivism (in which knowledge is built from a present reality). This proposal is aims to help a community to understand the health risks present at home so that they can prevent the spread of the virus COVID-19 through the use of good practices. Results: The proposal shows categorized risk factors at home that increase the possibility of contagion of COVID- 19 and getting infected; also, it presents possible solutions to these factores, which focus on good practices of healthy housing to improve habitability and prevent diseases that also allow the virus to spread. Conclusions: It is necessary to implement strategies that humanize public health problems and that in turn include the knowledge that the field of engineering can contribute to solve these problems. In addition, these strategies must emerge from practical work focused on the community. An example of this is the proposal for good practices for healthy housing to prevent the spread of the COVID-19 virus.

Epidemiology of cholangiocarcinoma

Aim: We aimed to analyze temporal trends in mortality from intrahepatic (ICC) and extrahepatic (ECC) cholangiocarcinoma in selected countries worldwide. Methods: Official death certification data for ICC and ECC and populations estimates for 29 countries worldwide (17 from Europe, 8 from the Americas, and 4 from Australasia) and for Hong Kong Special Administrative Region of the People’s Republic of China (SAR), from 1995 to 2018, were extracted from the World Health Organization and the Pan American Health Organization databases. Age-standardized mortality rates were computed. A joinpoint regression analysis was performed. Results: In both sexes, ICC mortality rates increased in most countries considered, including the USA, the UK, and Australia; in some countries, including Italy and France, the increasing trends leveled off over the most recent years. In men, around 2016, the highest rates (1.7-2.3/100,000) were observed in Hong Kong SAR, Portugal, France, Spain, Australia, Austria, the UK, and Canada; Latin American countries and some eastern European countries had the lowest rates (0.2-0.8/100,000). A similar pattern was observed in women, but with lower rates (from 1.7/100,000 in Hong Kong SAR to 0.14/100,000 in Argentina). ECC mortality declined in most European and Australasian countries, but it tended to increase in Americas. In both sexes, rates were below 1/100,000 around 2016, with the only exceptions being Japan (2.6/100,000 men and 1.2/100,000 women) and Hungary (1.5/100,000 men and 1.1/100,000 women). Conclusion: ICC mortality increased in most areas of the world, likely due to increased prevalence of risk factors and improved cancer recognition and classification. ECC mortality fell in most countries, largely due to the widespread use of cholecystectomy.

Implementation of advanced practice nursing in Brazilian Primary Health Care: methodological path.

to describe the operationalization of the steps of a model proposed by the Pan American Health Organization for implementing advanced practice nursing in Primary Health Care services. a methodological study, with a qualitative approach, carried out in a local health system located in southern São Paulo. The first six steps of the model were followed: 1) improve health outcomes; 2) identify stakeholders; 3) determine unmet health needs; 4) identify priorities and goals to introduce advanced nursing practices in primary health care; 5) define advanced practice nursing in primary health care; 6) plan implementation strategies. in each step, the objectives, methodological strategies and operationalization were described. the model proved to be effective to support the process of development and implementation of advanced practice nursing in the local system studied.

Consumo de alimentos processados e ultraprocessados em adultos e sua relação com qualidade de vida e qualidade do sono

ABSTRACT Objective: To evaluate the consumption of processed and ultra-processed foods in Paraguayan adults and its relationship with quality of life and sleep quality. Methods: A cross-sectional descriptive observational study was carried out on Paraguayan adults in May 2022. An online survey was applied in which sociodemographic data, frequency of food consumption using the NOVA classification and Pan American Health Organization criteria, quality of life evaluated by the European Quality of Life-5 Dimensions and report of hours of sleep were collected. Results: A total of 273 Paraguayan adults were included in the study, of which 71.1% were female, 51.6% lived in the capital, 53.1% were single, 66% had a university educational level and the average age was 36.48±13.2. Regarding the consumption of processed and ultra-processed foods, the critical nutrients most consumed daily were free sugars by 34.0%, and fats by 23.4% of the population. The global quality of life index was low (0,58±0,05) and 69.0% reported insufficient hours of sleep. Statistically significant relationships were found between the consumption of processed and ultra-processed foods with quality of life and quality of sleep (p&lt;0.05 for both). Conclusion: The most consumed critical nutrients in the Paraguayan adult population are free sugars and fats, finding a significant relationship between the consumption of processed and ultra-processed foods with quality of life and quality of sleep.

Improving cardiovascular health with the patient-centered, integrated primary care HEARTS model in Trinidad and Tobago.

ABSTRACTThis article describes the introduction of the Pan American Health Organization’s HEARTS in the Americas program in Trinidad and Tobago and the successful experiences and challenges encountered in introducing and scaling it up as a strategy for strengthening the health system’s response to cardiovascular diseases. Evidence about implementation of the HEARTS program in the World Health Organization’s Region of the Americas was reviewed to identify the progress made, barriers, success factors and lessons learned. In 2019, the Ministry of Health commenced implementation of the program in 5 (4.9%) of the 102 primary health care centers, and by the end of 2021, it had been scaled up to 46 (45.0%) centers. The HEARTS program ensures that patients’ cardiovascular health is managed in a comprehensive way through providing counseling about a healthy lifestyle, using evidence-based treatment protocols, ensuring access to essential medicines and technologies, and using a risk-based team approach, a monitoring and evaluation system and also a team-based approach to care delivery. The barriers encountered during implementation included the fragmentation of the existing health care system, the paternalistic role assumed by health care professionals, the resistance of some health care workers to change and a lack of team-based approaches to providing care. Successful implementation of the program was enabled through ensuring high-level political commitment, establishing the national HEARTS Oversight Committee, ensuring stakeholder involvement throughout all phases and implementing standardized approaches to care. When implemented in the context of existing primary health care settings, the HEARTS program provides an exceptionally well integrated and comprehensive model of care that embodies the principles of universal health care while ensuring the health of both populations and individuals. Thus, it enables and promotes a strengthened primary health care system and services that are responsive and resilient.

Disminución del riesgo cardiovascular en pacientes obesos que participaron en un programa de medicina de estilo de vida

Lifestyle Medicine in the management of chronic diseases such as obesity is essential to reduce cardiovascular risk and to reverse the disease process (1). Objective: To determine if a Lifestyle Medicine program can reduce cardiovascular risk in obese adults in Colombia. Material and methods: Descriptive observational study cases series type followed for 6 months in a Lifestyle Medicine Clinic. 9 patients were included taking into account 2 measures of cardiovascular risk as a parameter to complete the program. The following measurements were taken: cardiovascular risk using the Pan American Health Organization (PAHO) calculator, Body Mass Index (BMI), lipid profile, history of smoking, history of diabetes, and systolic blood pressure. Results: Of the 9 obese patients, 22% had an intermediate cardiovascular risk and 78% had a low risk at the beginning of the study. After 6 months, it was achieved that 100% of the participants had a low cardiovascular risk; Furthermore, 11% of the patients managed to normalize their blood pressure values ​​and 20% showed a decrease in high blood pressure values. In addition, 22% went from type 3 obesity to type 2 obesity. Finally, through psychological consultation, it was possible to reduce anxiety levels from high to intermediate in at least 44% of the participants. Conclusions: The Lifestyle Medicine program, in a group of obese patients, managed to achieve a low cardiovascular risk, the decrease and normalization of blood pressure figures and reduction in BMI in participants who completed the study.

Cost-effectiveness of HPV vaccination in 195 countries: A meta-regression analysis

Cost-effectiveness analysis (CEA) is a well-known, but resource intensive, method for comparing the costs and health outcomes of health interventions. To build on available evidence, researchers are developing methods to transfer CEA across settings; previous methods do not use all available results nor quantify differences across settings. We conducted a meta-regression analysis of published CEAs of human papillomavirus (HPV) vaccination to quantify the effects of factors at the country, intervention, and method-level, and predict incremental cost-effectiveness ratios (ICERs) for HPV vaccination in 195 countries. We used 613 ICERs reported in 75 studies from the Tufts University's Cost-Effectiveness Analysis (CEA) Registry and the Global Health CEA Registry, and extracted an additional 1,215 one-way sensitivity analyses. A five-stage, mixed-effects meta-regression framework was used to predict country-specific ICERs. The probability that HPV vaccination is cost-saving in each country was predicted using a logistic regression model. Covariates for both models included methods and intervention characteristics, and each country's cervical cancer burden and gross domestic product per capita. ICERs are positively related to vaccine cost, and negatively related to cervical cancer burden. The mean predicted ICER for HPV vaccination is 2017 US$4,217 per DALY averted (95% uncertainty interval (UI): US$773-13,448) globally, and below US$800 per DALY averted in 64 countries. Predicted ICERs are lowest in Sub-Saharan Africa and South Asia, with a population-weighted mean ICER across 46 countries of US$706 per DALY averted (95% UI: $130-2,245), and across five countries of US$489 per DALY averted (95% UI: $90-1,557), respectively. Meta-regression analyses can be conducted on CEA, where one-way sensitivity analyses are used to quantify the effects of factors at the intervention and method-level. Building on all published results, our predictions support introducing and expanding HPV vaccination, especially in countries that are eligible for subsidized vaccines from GAVI, the Vaccine Alliance, and Pan American Health Organization.

Nutrient profile of food products exempted from the application of front-ofpackage warnings during the first stage of the Healthy Eating Law in Peru: case studyPerfil nutricional de produtos alimentícios isentos da aplicação de advertências na parte frontal da embalagem durante a primeira etapa da Lei de Alimentação Saudável no Peru: estudo de caso

RESUMENObjetivo.Identificar el perfil nutricional de productos alimentarios eximidos de presentar uno o más sellos de advertencia nutricional en el frente del envase durante la primera etapa de vigencia de la Ley 30021 de Promoción de la Alimentación Saludable para Niños, Niñas y Adolescentes de Perú.Métodos.Se recolectaron datos de 188 productos desde puntos de venta de la ciudad de Lima. La muestra por conveniencia incluyó productos que hasta el 17 de septiembre de 2021 estaban eximidos por la legislación de presentar alguna de las advertencias para el azúcar, el sodio o las grasas saturadas. Se evaluó la proporción de productos que estarían obligados a aplicar uno o más sellos de advertencia a partir de la entrada en vigencia de la segunda etapa de la legislación. Se verificó cuántos productos eximidos de la aplicación de advertencias por la legislación contienen exceso de azúcar, sodio o grasas saturadas según los criterios de la Organización Panamericana de la Salud (OPS).Resultados.El 76,1% de los productos superaba al menos uno de los umbrales para el azúcar, el sodio o las grasas saturadas vigentes a partir de septiembre de 2021. La proporción de productos eximidos de presentar advertencias por la legislación y que contienen exceso de azúcar, sodio o grasas saturadas según la OPS será 4,2, 3,4 y 2,3 veces menor, respectivamente, a partir de la segunda etapa.Conclusión.Durante la primera etapa de vigencia de la ley, 58%, 42% y 28,2% de los productos eximidos de la presentación de advertencias contenían exceso de azúcar, grasas saturadas o sodio, respectivamente, según la OPS.

Indirect Governance of Transnational Crises

Abstract Intergovernmental, regional, and international organizations play an active role in the governance of transnational crises. In the context of the COVID-19 pandemic in Latin America, the World Health Organization and the Pan-American Health Organization have been linked with multiple actors and levels of decision-making, putting into practice what the literature on global governance refers to as indirect governance by orchestration. This article shows that, in practice, the mechanisms of orchestration have established heterogeneous models of coordination and action that, in situations of transnational crisis, allow these organizations to bring together resources, capacities, and authority.

Booster doses for inactivated COVID-19 vaccines: if, when, and for whom

Booster doses for inactivated COVID-19 vaccines: if, when, and for whom