No. 39, 2015, 90, 505-516 http://www.who.int/wer
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", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 0, + "coordinates": [ + { + "x0": 363.33, + "y0": 216.14, + "x1": 552.32, + "y1": 357.95 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "81ae9de5608a663257695b7b01a6dd93", + "text": "The position papers are designed to be used mainly by national public health offi- cials and managers of immunization programmes. They may also be of interest to international funding agencies, vaccine advisory groups, vaccine manufacturers, the medical community, the scientific media, and the public. They are reviewed by external experts and WHO staff, and reviewed and endorsed by the WHO Stra- tegic Advisory Group of Experts on Immu- nization (SAGE) § (http://www.who.int/ immunization/sage/en). A description of the process followed for the preparation of vaccine position papers is available at: http://www.who.int/immunization/posi- tion_papers/position_paper_process.pdf", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "7962038578eb252646065567ef41f0ba", + "text_as_html": "The position papers are designed to be used mainly by national public health offi- cials and managers of immunization programmes. They may also be of interest to international funding agencies, vaccine advisory groups, vaccine manufacturers, the medical community, the scientific media, and the public. They are reviewed by external experts and WHO staff, and reviewed and endorsed by the WHO Stra- tegic Advisory Group of Experts on Immu- nization (SAGE) § (http://www.who.int/ immunization/sage/en). A description of the process followed for the preparation of vaccine position papers is available at: http://www.who.int/immunization/posi- tion_papers/position_paper_process.pdf
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 0, + "coordinates": [ + { + "x0": 169.34, + "y0": 364.63, + "x1": 342.88, + "y1": 515.71 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "2b16aab33342d7d2f536318904fbd217", + "text": "Ces notes s’adressent avant tout aux fonction- naires responsables de la santé publique et aux administrateurs des programmes de vaccina- tion nationaux, mais elles peuvent aussi inté- resser des organismes internationaux de financement, les fabricants de vaccins, le corps médical, les médias scientifiques et le grand public. Elles sont examinées par des experts extérieurs et par des membres du personnel de POMS et font également l’objet d’un examen et dune approbation par le Groupe straté- gique consultatif d’experts (SAGE) de OMS sur la vaccination (http://www.who.int/immu- nization/sage/en). Une description du proces- sus suivi pour l’élaboration des notes de synthése sur les vaccins est consultable a Padresse: _http://www.who.int/immunization/ position_papers/position_paper_process.pdf", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "7962038578eb252646065567ef41f0ba", + "text_as_html": "Ces notes s’adressent avant tout aux fonction- naires responsables de la santé publique et aux administrateurs des programmes de vaccina- tion nationaux, mais elles peuvent aussi inté- resser des organismes internationaux de financement, les fabricants de vaccins, le corps médical, les médias scientifiques et le grand public. Elles sont examinées par des experts extérieurs et par des membres du personnel de POMS et font également l’objet d’un examen et dune approbation par le Groupe straté- gique consultatif d’experts (SAGE) de OMS sur la vaccination (http://www.who.int/immu- nization/sage/en). Une description du proces- sus suivi pour l’élaboration des notes de synthése sur les vaccins est consultable a Padresse: _http://www.who.int/immunization/ position_papers/position_paper_process.pdf
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", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 0, + "coordinates": [ + { + "x0": 36.9, + "y0": 590.77, + "x1": 146.24, + "y1": 604.93 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "970088ab14f64fb6082f076c90b7e0be", + "text": "09.2015 ISSN 0049-8114 Printed in Switzerland", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "f8c456168dc2ca5ccc02850a3b39db07", + "text_as_html": "09.2015 ISSN 0049-8114 Printed in Switzerland
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 0, + "coordinates": [ + { + "x0": 63.9, + "y0": 610.36, + "x1": 118.16, + "y1": 631.57 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "4e6a41d7bbabc111745ce5cfba7f806c", + "text": "‘Meeting of the Strategic Advisory Group of Experts on Immuni- zation, April 2015: conclusions and recommendations [2015 May 29]. Available from: http://www.who.int/immunization/ sage/meetings/2015/april/1_SAGE_latest_pain_guidelines_ March_24_Final.pdf?ua=1WHO http://www.who.int/wer/2015/ wer9022.pdf?ua=1; accessed August 2015.", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "f8c456168dc2ca5ccc02850a3b39db07", + "text_as_html": "55 interventions (including for injections unrelated to vaccination) applicable to infants, children, adoles- cents, and adults was used as the basis of the review by SAGE.” Interventions were selected for potential global implementation, taking into consideration the following criteria: benefits and harms; patients’ values and preferences; resource utilization; cost of interventions; impact on equity; acceptability; and feasibility from a global perspective. Assessment of the global feasibility of interventions requires consid- eration of their relevance and cultural acceptability within different geographic regions and cultural settings, in particular in low and middle income countries. Recommendations on reducing pain and anxiety at the time of vaccination were discussed by SAGE in April 2015; evidence presented at the meet- ing can be accessed at: http://www.who.int/immuniza- tion/sage/previous/en/index.html.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 1, + "coordinates": [ + { + "x0": 44.99, + "y0": 57.11, + "x1": 274.27, + "y1": 253.42 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-9", + "text": "\n\n\nBackground\nVaccine injections can be a source of iatrogenic pain. Concern about pain is common among caregivers, vaccine recipients including children, adolescents and adults as well as health-care personnel carrying out the vaccination. Studies from the USA and Canada indicate that 24%-40% of parents are concerned about vaccina- tion-associated pain in children; 85% believe health- care providers have a responsibility to make vaccina- tions less painful, and 95% wish to learn how to reduce pain during vaccination of their children.**° A recent study in South Africa found multiple vaccinations in one visit to be acceptable by parents and health-care workers, but called for strategies to mitigate pain at vaccination, as pain is one of the primary sources of anxiety for caregivers of children receiving multiple injections in one visit. Injectable vaccines, adminis- tered with the proper technique and appropriate needle length and gauge, vary in degree of painfulness at the time of vaccination depending on the composition of the vaccine. When multiple vaccines are co-adminis- tered, the order of the injections affects the degree of discomfort caused: administration of the vaccines with the most painful given first and the least painful last increases the cumulative pain.\nNot addressing pain at the time of vaccination may be one of many factors which have a negative impact on\nTaddio A, McMurtry M, Shah \\V, et al. Reducing pain during vaccine injections: clini- cal practice guideline. CMAJ 2015; Aug 24 [Epub ahead of print]. DOI:10.1503/ cmaj.150391\nReport to SAGE on reducing pain and distress at the time of vaccination [Internet]. Geneva: SAGE Technical Consultation Group on Reducing Pain and Distress at the Time of Vaccination; 2015 [updated 2015 Mar 31; cited 2015 May 19]. Available from: http://(www.who.intimmunization/sage/meetings/201 5/april/1_SAGE_latest_ pain_guidelines_March_24_Final.pdf?ua=1; accessed August 2015.\nTaddio A, et al. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine. 2012 Jul 6;30(32):4807C12.\nKennedy A, et al. Vaccine Attitudes, Concerns, and Information Sources Reported by Parents of Young Children: Results From the 2009 Health Styles Survey. Pediatrics. 2011;127:S92C9.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "d7c8f4235b2dd3af1f337fdc73a79092", + "text": "Background", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "", + "text_as_html": "Vaccine injections can be a source of iatrogenic pain. Concern about pain is common among caregivers, vaccine recipients including children, adolescents and adults as well as health-care personnel carrying out the vaccination. Studies from the USA and Canada indicate that 24%-40% of parents are concerned about vaccina- tion-associated pain in children; 85% believe health- care providers have a responsibility to make vaccina- tions less painful, and 95% wish to learn how to reduce pain during vaccination of their children.**° A recent study in South Africa found multiple vaccinations in one visit to be acceptable by parents and health-care workers, but called for strategies to mitigate pain at vaccination, as pain is one of the primary sources of anxiety for caregivers of children receiving multiple injections in one visit. Injectable vaccines, adminis- tered with the proper technique and appropriate needle length and gauge, vary in degree of painfulness at the time of vaccination depending on the composition of the vaccine. When multiple vaccines are co-adminis- tered, the order of the injections affects the degree of discomfort caused: administration of the vaccines with the most painful given first and the least painful last increases the cumulative pain.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 1, + "coordinates": [ + { + "x0": 45.09, + "y0": 290.9, + "x1": 274.01, + "y1": 550.18 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "2a2dea28b5676f05c4757c83e6db3109", + "text": "Not addressing pain at the time of vaccination may be one of many factors which have a negative impact on", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "d7c8f4235b2dd3af1f337fdc73a79092", + "text_as_html": "Not addressing pain at the time of vaccination may be one of many factors which have a negative impact on
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 1, + "coordinates": [ + { + "x0": 44.06, + "y0": 602.89, + "x1": 272.12, + "y1": 623.14 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "412d85d778f8c67acc4dd958264752cd", + "text": "Taddio A, McMurtry M, Shah \\V, et al. Reducing pain during vaccine injections: clini- cal practice guideline. CMAJ 2015; Aug 24 [Epub ahead of print]. DOI:10.1503/ cmaj.150391", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "d7c8f4235b2dd3af1f337fdc73a79092", + "text_as_html": "systématique, ayant examiné 55 interventions (y compris pour des injections sans lien avec la vaccination) réalisées chez des nourrissons, des enfants, des adolescents et des adultes, a servi de base a l’examen du SAGE. Les interventions ont été sélection- nées en vue d’une mise en ceuvre éventuelle a l’échelle mondiale en tenant compte des critéres suivants: effets bénéfiques et préju- diciables; valeurs et préférences des patients; utilisation des ressources, cotits de intervention; incidence en termes d’équité; acceptabilité et faisabilité dans la perspective d’une mise en ceuvre mondiale. L’évaluation de la faisabilité a l’échelle mondiale des interventions suppose la prise en considération de leur perti- nence et de leur acceptabilité culturelle dans les différentes régions géographiques et les divers contextes culturels, et en particulier dans les pays a revenu faible ou intermédiaire. Le SAGE a discuté en avril 2015 de recommandations concernant la réduction de la douleur et de l’anxiété lors de la vaccination; les éléments présentés lors de cette réunion sont consultables a Padresse: _ http://www.who.int/immunization/sage/previous/en/ index.html.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 1, + "coordinates": [ + { + "x0": 294.29, + "y0": 56.9, + "x1": 553.38, + "y1": 263.45 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-11", + "text": "\n\n\nConsidérations générales\nLes injections de vaccins peuvent étre sources de douleurs iatrogénes. Ces douleurs sont souvent une source de préoccu- pations pour les personnes qui s’occupent des enfants, pour les bénéficiaires de la vaccination, y compris les enfants, les adoles- cents et les adultes, ainsi que pour le personnel soignant qui effectue injection. Des études menées aux Etats-Unis d’Amé- rique et au Canada indiquent que 24% a 40% des parents s’in- quiétent de la douleur associée aux vaccinations de l’enfant; 85% pensent quil est de la responsabilité des prestataires de soins de rendre les vaccinations moins douloureuses, et 95% d’entre eux souhaitent apprendre comment diminuer la douleur ressentie par leurs enfants lors d’une vaccination.>**> Une étude récemment réalisée en Afrique du Sud a constaté que l’admi- nistration de plusieurs vaccinations lors d’une méme visite était acceptable par les parents et par les soignants, mais incitait a trouver des stratégies pour atténuer les douleurs lors de leur réalisation, car ces douleurs figurent parmi les principales causes d’inquiétude pour les personnes ayant en charge des enfants qui regoivent plusieurs injections en une seule séance.’ Méme lorsquvils sont administrés avec une technique correcte et une aiguille de longueur et de calibre appropriés, les vaccins injectables sont a l’origine, au moment de la vaccination, d’une douleur de degré variable en fonction de la composition du vaccin. En cas de co-administration de plusieurs vaccins, l’ordre injection influe sur le niveau d’inconfort causé par la vacci- nation, sachant que l’administration en premier du plus doulou- reux et en dernier du moins douloureux augmente la douleur cumulée ressentie.\nNe pas se préoccuper des douleurs vécues lors des vaccinations peut avoir une incidence négative sur les attitudes et les\nTaddio A, McMurtry M, Shah \\, et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015; Aug 24 [Publication électronique en avance d'impression]. DOI:10.1503/ cmaj.150391.\nReport to SAGE on reducing pain and distress at the time of vaccination [Internet]. Geneva: SAGE Technical Consultation Group on Reducing Pain and Distress at the Time of Vaccina- tion; 2015 [mis a jour le 31 mars 2015; cité le 19 mai 2015]. Disponible a I’adresse: http:// www.who.int/immunization/sage/meetings/201 5/april/1_SAGE_latest_pain_guidelines_ March_24_Final.pdf?ua=1; consulté en aodt 2015.\nTaddio A, et al. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine. 2012 Jul 6;30(32):4807C12.\nKennedy A, et al. Vaccine Attitudes, Concerns, and Information Sources Reported by Parents of Young Children: Results From the 2009 Health Styles Survey. Pediatrics. 2011;127:592C9.\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 39, 25 SEPTEMBER 2015\nhealth attitudes and behaviours and may lead to delay or avoidance of future vaccinations. Hesitancy towards vaccination can result in lower vaccination coverage rates, putting the individual and the public at risk of vaccine-preventable diseases. A recent report high- lighted pain mitigation at the time of vaccination as an important strategy to counter vaccine hesitancy.‘ Recommendations for pain mitigation at the time of vaccination now exist in some countries (e.g. Canada, USA, UK), however most countries do not have explicit guidance on this subject.’", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "944315791bafa4b792df7e8c48c8d637", + "text": "Considérations générales", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "", + "text_as_html": "Les injections de vaccins peuvent étre sources de douleurs iatrogénes. Ces douleurs sont souvent une source de préoccu- pations pour les personnes qui s’occupent des enfants, pour les bénéficiaires de la vaccination, y compris les enfants, les adoles- cents et les adultes, ainsi que pour le personnel soignant qui effectue injection. Des études menées aux Etats-Unis d’Amé- rique et au Canada indiquent que 24% a 40% des parents s’in- quiétent de la douleur associée aux vaccinations de l’enfant; 85% pensent quil est de la responsabilité des prestataires de soins de rendre les vaccinations moins douloureuses, et 95% d’entre eux souhaitent apprendre comment diminuer la douleur ressentie par leurs enfants lors d’une vaccination.>**> Une étude récemment réalisée en Afrique du Sud a constaté que l’admi- nistration de plusieurs vaccinations lors d’une méme visite était acceptable par les parents et par les soignants, mais incitait a trouver des stratégies pour atténuer les douleurs lors de leur réalisation, car ces douleurs figurent parmi les principales causes d’inquiétude pour les personnes ayant en charge des enfants qui regoivent plusieurs injections en une seule séance.’ Méme lorsquvils sont administrés avec une technique correcte et une aiguille de longueur et de calibre appropriés, les vaccins injectables sont a l’origine, au moment de la vaccination, d’une douleur de degré variable en fonction de la composition du vaccin. En cas de co-administration de plusieurs vaccins, l’ordre injection influe sur le niveau d’inconfort causé par la vacci- nation, sachant que l’administration en premier du plus doulou- reux et en dernier du moins douloureux augmente la douleur cumulée ressentie.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 1, + "coordinates": [ + { + "x0": 294.83, + "y0": 291.75, + "x1": 553.55, + "y1": 595.88 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "822417b1adb2f94137963e9f2929f5cd", + "text": "Ne pas se préoccuper des douleurs vécues lors des vaccinations peut avoir une incidence négative sur les attitudes et les", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "944315791bafa4b792df7e8c48c8d637", + "text_as_html": "Ne pas se préoccuper des douleurs vécues lors des vaccinations peut avoir une incidence négative sur les attitudes et les
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 1, + "coordinates": [ + { + "x0": 295.13, + "y0": 601.79, + "x1": 549.85, + "y1": 623.5 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "87c10bf852de7bb2be009726f1804777", + "text": "Taddio A, McMurtry M, Shah \\, et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015; Aug 24 [Publication électronique en avance d'impression]. DOI:10.1503/ cmaj.150391.", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "944315791bafa4b792df7e8c48c8d637", + "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 39, 25 SEPTEMBER 2015
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 1, + "coordinates": [ + { + "x0": 377.61, + "y0": 777.59, + "x1": 550.38, + "y1": 786.61 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "de95c754f5314b953c2c03a6584bc092", + "text": "health attitudes and behaviours and may lead to delay or avoidance of future vaccinations. Hesitancy towards vaccination can result in lower vaccination coverage rates, putting the individual and the public at risk of vaccine-preventable diseases. A recent report high- lighted pain mitigation at the time of vaccination as an important strategy to counter vaccine hesitancy.‘ Recommendations for pain mitigation at the time of vaccination now exist in some countries (e.g. Canada, USA, UK), however most countries do not have explicit guidance on this subject.’", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "944315791bafa4b792df7e8c48c8d637", + "text_as_html": "health attitudes and behaviours and may lead to delay or avoidance of future vaccinations. Hesitancy towards vaccination can result in lower vaccination coverage rates, putting the individual and the public at risk of vaccine-preventable diseases. A recent report high- lighted pain mitigation at the time of vaccination as an important strategy to counter vaccine hesitancy.‘ Recommendations for pain mitigation at the time of vaccination now exist in some countries (e.g. Canada, USA, UK), however most countries do not have explicit guidance on this subject.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 2, + "coordinates": [ + { + "x0": 44.66, + "y0": 56.25, + "x1": 273.05, + "y1": 175.61 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-12", + "text": "\n\n\nWHO position\nPain during vaccination sessions is manageable and managing pain does not decrease the efficacy of the vaccine. There are effective, feasible, non-costly, cultur- ally acceptable, and age-specific evidence-based strate- gies to mitigate pain at the time of vaccination. Recom- mendations for measures that can be taken to reduce pain and anxiety during vaccination, and which can be applied in high, middle and low income countries worldwide, are presented below. Measures which are not recommended are also noted.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "ce2c4a83f27ed9b13fc053d2071448b9", + "text": "WHO position", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "", + "text_as_html": "Pain during vaccination sessions is manageable and managing pain does not decrease the efficacy of the vaccine. There are effective, feasible, non-costly, cultur- ally acceptable, and age-specific evidence-based strate- gies to mitigate pain at the time of vaccination. Recom- mendations for measures that can be taken to reduce pain and anxiety during vaccination, and which can be applied in high, middle and low income countries worldwide, are presented below. Measures which are not recommended are also noted.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 2, + "coordinates": [ + { + "x0": 45.21, + "y0": 222.71, + "x1": 273.31, + "y1": 331.24 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-13", + "text": "\n\n\n1. General measures\nThe following general measures are recommended for implementation by national immunization programmes in all countries across all age groups.\n(i) Health-care personnel carrying out vaccination should be calm, collaborative and well informed; they should use neutral words (e.g. “here I go” rather than “here comes the sting”) and avoid language that increases anxiety, promotes distrust and/or is falsely reassuring or dishonest (e.g. phrases such as “it will only hurt for a second”).\n(ii) Proper positioning of the vaccine recipient should be ensured, according to age.* Holding by the care- giver is recommended for infants and young chil- dren, and sitting upright for older populations. Lying down may be preferred for those with a history of fainting.\n(iii) No aspiration should be done during intramuscu- lar injections, as this may increase pain due to longer contact time and lateral movement of the needle.\nReport of the SAGE Working Group on Vaccine Hesitancy [Internet]. Geneva: SAGE Working Group on Vaccine Hesitancy; 2014 [updated 2014 Oct 1; cited 2015 May 19]. Available from: http://www.who.int/immunization/ sage/meetings/2014/october/1_Report_WORKING_GROUP_vaccine_hesi- tancy_final.pdf; accessed August 2015.\n7 Turner N. Introduction and Session Overview [Internet]. Geneva: SAGE Technical Consultation Group on Reducing Pain and Distress at the Time of Vaccination; 2015. Presentation at SAGE Meeting, 2015 Apr 14-16. Cited 2015 May 21]. Available from: http://www.who.int/immunization/sage/meetings/201 5/april/presentations_ background_docs/en/index1.html; accessed August 2015.\n® Immunization in Practice - A practical guide for health staff. Geneva: World Health Organization; 2015. Module 5, Managing an immunization session. Available from: http:/Awww.who.int/immunization/documents/training/en/; accessed August 2015.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 39, 25 SEPTEMBER 2015\ncomportements a l’égard de la santé et peut conduire a différer ou a éviter les vaccinations futures. Les hésitations devant la vaccination peuvent conduire a un affaiblissement des taux de couverture vaccinale, qui lui-méme devrait entrainer un risque de maladie évitable par la vaccination, tant pour les individus que pour la population générale. Un rapport récent a attiré Pattention sur Patténuation de la douleur au moment de la vaccination en tant que stratégie importante pour répondre aux hésitations face a la vaccination. Des recommandations concer- nant l’atténuation de cette douleur existent actuellement dans certains pays (Canada, Etats-Unis d’Amérique, Royaume-Uni, par exemple), mais la plupart des Etats ne disposent pas de conseils aussi explicites sur ce sujet.”", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "476bd64252d7064935d9c0008e105ab0", + "text": "1. General measures", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "", + "text_as_html": "The following general measures are recommended for implementation by national immunization programmes in all countries across all age groups.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 2, + "coordinates": [ + { + "x0": 42.84, + "y0": 356.12, + "x1": 273.3, + "y1": 388.22 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "436402d8401b45032bdf149c7d9b02d9", + "text": "(i) Health-care personnel carrying out vaccination should be calm, collaborative and well informed; they should use neutral words (e.g. “here I go” rather than “here comes the sting”) and avoid language that increases anxiety, promotes distrust and/or is falsely reassuring or dishonest (e.g. phrases such as “it will only hurt for a second”).", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "476bd64252d7064935d9c0008e105ab0", + "text_as_html": "comportements a l’égard de la santé et peut conduire a différer ou a éviter les vaccinations futures. Les hésitations devant la vaccination peuvent conduire a un affaiblissement des taux de couverture vaccinale, qui lui-méme devrait entrainer un risque de maladie évitable par la vaccination, tant pour les individus que pour la population générale. Un rapport récent a attiré Pattention sur Patténuation de la douleur au moment de la vaccination en tant que stratégie importante pour répondre aux hésitations face a la vaccination. Des recommandations concer- nant l’atténuation de cette douleur existent actuellement dans certains pays (Canada, Etats-Unis d’Amérique, Royaume-Uni, par exemple), mais la plupart des Etats ne disposent pas de conseils aussi explicites sur ce sujet.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 2, + "coordinates": [ + { + "x0": 294.08, + "y0": 56.11, + "x1": 552.94, + "y1": 197.99 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-14", + "text": "\n\n\nPosition de I'OMS\nLes douleurs ressenties lors des séances de vaccination sont gérables et une telle gestion ne diminue en rien l’efficacité des vaccins. II existe des stratégies efficaces, faisables, non onéreuses, culturellement acceptables et reposant sur des données spéci- fiques a l’Age, pour atténuer la douleur au moment de la vacci- nation. On trouvera ci-aprés une liste de mesures recomman- dées pour atténuer la douleur et l’anxiété lors des vaccinations et pouvant étre appliquées dans le monde, dans des pays a revenu élevé, intermédiaire ou faible. Les mesures non recom- mandées sont aussi indiquées.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "b57ca3c4c45a9e899d90f2b9108c17c9", + "text": "Position de I'OMS", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "", + "text_as_html": "Les douleurs ressenties lors des séances de vaccination sont gérables et une telle gestion ne diminue en rien l’efficacité des vaccins. II existe des stratégies efficaces, faisables, non onéreuses, culturellement acceptables et reposant sur des données spéci- fiques a l’Age, pour atténuer la douleur au moment de la vacci- nation. On trouvera ci-aprés une liste de mesures recomman- dées pour atténuer la douleur et l’anxiété lors des vaccinations et pouvant étre appliquées dans le monde, dans des pays a revenu élevé, intermédiaire ou faible. Les mesures non recom- mandées sont aussi indiquées.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 2, + "coordinates": [ + { + "x0": 293.55, + "y0": 222.1, + "x1": 553.4, + "y1": 331.55 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-15", + "text": "\n\n\n1. Mesures générales\nIl est recommandé a l’ensemble des programmes nationaux de vaccination d’appliquer les mesures générales suivantes dans tous les pays et dans l’ensemble des tranches d’age.\ni) Le personnel soignant effectuant la vaccination devra se montrer calme, coopératif et bien informé; il devra utiliser des termes neutres («maintenant, j’y vais» au lieu de «je vais piquer») et éviter un langage susceptible d’aggraver l’inquié- tude, de susciter des soupcons et/ou faussement rassurant ou malhonnéte (des phrases comme «vous n’aurez mal que pendant une seconde»).\nii) Il convient de s’assurer du positionnement correct du béné- ficiaire de la vaccination en fonction de son 4ge.* Il est recommandé que celui-ci soit tenu par la personne qui soccupe de lui s'il s’agit d'un nourrisson ou d’un jeune enfant, et quil se tienne assis le dos bien droit s’il est plus agé. Le décubitus dorsal peut étre préférable pour les indi- vidus ayant des antécédents de malaise.\niii) Aucune aspiration ne doit étre pratiquée pendant les injec- tions intramusculaires car un tel geste peut accroitre la douleur en raison du temps de contact plus long et du mouvement latéral de l’aiguille.\n® Report of the SAGE Working Group on Vaccine Hesitancy [Internet]. Geneva: SAGE Working Group on Vaccine Hesitancy; 2014 [mis a jour le 1° octobre 2014; cité le 19 mai 2015]. Disponible a l'adresse: http:/Awww.who.int/immunization/sage/meetings/2014/october/1_Report_WORKING_ GROUP_vaccine_hesitancy_final.pdf; consulté en aofit 2015.\nTurner N. Introduction and Session Overview [Internet]. Genéve: SAGE Technical Consulta- tion Group on Reducing Pain and Distress at the Time of Vaccination; 2015. Présentation a la reunion du SAGE du 14 au 16 avril, 2015. Cité le 21 mai 2015]. Disponible a l’adresse: http://www.who.int/immunization/sage/meetings/2015/april/presentations_background_ docs/en/index1 html; consulté en aotit 2015.\nImmunization in Practice — A practical guide for health staff. Geneva: World Health Organiza- tion; 2015. Module 5, Managing an immunization session. Disponible a l’adresse: http://www. who.int/immunization/documents/training/en/; consulté en aotit 2015.\n507\n(iv) When multiple vaccines are injected sequentially in the same session they should be administered in order of increasing painfulness.” °\nThere is little evidence on the impact of the setting in which vaccinations are carried out. However, based upon observations and principles, ensuring privacy may, in part, reduce vaccination-associated anxiety and related events (e.g. fainting, mass psychogenic illness) that can occur in large, open immunization clinics, school-based programmes, and mass campaigns.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "858c5a6fd14f8427ee09afade743adf8", + "text": "1. Mesures générales", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "", + "text_as_html": "Il est recommandé a l’ensemble des programmes nationaux de vaccination d’appliquer les mesures générales suivantes dans tous les pays et dans l’ensemble des tranches d’age.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 2, + "coordinates": [ + { + "x0": 293.06, + "y0": 355.37, + "x1": 551.99, + "y1": 388.35 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "716a35055743426b0ad9e1b2199db02a", + "text": "i) Le personnel soignant effectuant la vaccination devra se montrer calme, coopératif et bien informé; il devra utiliser des termes neutres («maintenant, j’y vais» au lieu de «je vais piquer») et éviter un langage susceptible d’aggraver l’inquié- tude, de susciter des soupcons et/ou faussement rassurant ou malhonnéte (des phrases comme «vous n’aurez mal que pendant une seconde»).", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "858c5a6fd14f8427ee09afade743adf8", + "text_as_html": "507
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 2, + "coordinates": [ + { + "x0": 539.14, + "y0": 779.62, + "x1": 549.57, + "y1": 784.66 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "f14f2df4ce2c8a2efccf12cc839a4b3e", + "text": "(iv) When multiple vaccines are injected sequentially in the same session they should be administered in order of increasing painfulness.” °", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "858c5a6fd14f8427ee09afade743adf8", + "text_as_html": "There is little evidence on the impact of the setting in which vaccinations are carried out. However, based upon observations and principles, ensuring privacy may, in part, reduce vaccination-associated anxiety and related events (e.g. fainting, mass psychogenic illness) that can occur in large, open immunization clinics, school-based programmes, and mass campaigns.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 3, + "coordinates": [ + { + "x0": 45.13, + "y0": 94.54, + "x1": 273.98, + "y1": 170.42 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-16", + "text": "\n\n\n2. Specific additional measures\nIn addition to the general measures, the following are further age-specific recommendations.\nFor infants and young children:\n(i) The caregiver should be present throughout and after the vaccination procedure.\n(ii) Infants and children aged <3 years should be held by caregivers throughout the procedure, and those aged 23 years should be seated to alleviate fear and distress, preferably on the caregiver’s lap.\n(iii) If culturally acceptable, breastfeeding of infants should be done during or shortly before the vacci- nation session.’ Where oral vaccines are being co-administered with injectable vaccines, it would be best to proceed with the administration of oral rotavirus vaccine, then oral polio vaccine (if OPV is used), then breastfeeding with simultaneous administration of the injectable vaccines.\n(iv) For children <6 years of age, distractions to divert attention away from pain to something more pleas- ant (e.g. with toys, video, music, or conversation with an adult) are recommended.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "322d0816de43c4b537c6c2675cdaa28d", + "text": "2. Specific additional measures", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "", + "text_as_html": "In addition to the general measures, the following are further age-specific recommendations.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 3, + "coordinates": [ + { + "x0": 43.29, + "y0": 217.23, + "x1": 273.08, + "y1": 238.06 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "f5ca6af179a0ec3d5de520cf7ff982c6", + "text": "For infants and young children:", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "322d0816de43c4b537c6c2675cdaa28d", + "text_as_html": "For infants and young children:
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 3, + "coordinates": [ + { + "x0": 44.37, + "y0": 250.16, + "x1": 157.82, + "y1": 260.23 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "22cba3cdcdcb502dc448793934d6c0d3", + "text": "(i) The caregiver should be present throughout and after the vaccination procedure.", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "322d0816de43c4b537c6c2675cdaa28d", + "text_as_html": "Distractions using breathing interventions (slight coughing that does not lead to moving of the fixed arm or breath-holding) are recommended for adults.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 3, + "coordinates": [ + { + "x0": 43.47, + "y0": 495.21, + "x1": 273.93, + "y1": 527.65 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-18", + "text": "\n\n\nFor adolescents:\nDistraction is not effective, and there are no additional evidence-based, age-specific recommendations available for this group beyond the general measures for all age groups.\nWhen rotavirus vaccination is part of the schedule, the vaccine may be given first as the formulation of the currently licensed liquid rotavirus vaccine has shown to have a pain mitigating effect through its sucrose content, followed by oral polio vaccine. Injectable vaccines should be administered after oral vaccination. In the absence of specified grading of painfulness, health-care professionals are encouraged to use their practical experience on the painfulness of specific vaccines to determine accor- dingly the best sequencing of the injections.\nTaddio A, llersich AL, Ipp M, et al. Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations: Systematic re- view of randomized controlled trials and quasi-randomized controlled trials. Clin Ther. 2009;31 Suppl 2:548-76.\nThere are no reports of adverse effects of breastfeeding during vaccination, inclu- ding aspiration, cyanosis, respiratory changes, or vomiting of the infant.\niv) Lorsque plusieurs vaccins sont injectés séquentiellement pendant une méme séance, ils devront étre administrés par ordre de dolorosité grandissante.® ”\nIl existe peu de preuves de influence du contexte dans lequel les vaccinations sont effectuées. Néanmoins, d’aprés les obser- vations et des principes simples, garantir une certaine intimité peut en partie réduire l’anxiété et les manifestations indési- rables (malaise, maladie psychogéne de masse, par exemple) susceptibles d’apparaitre lorsque lintervention est pratiquée dans des centres de vaccination ouverts et de grandes dimen- sions ou dans le cadre de programmes en milieu scolaire et de campagnes de vaccination de masse.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "f9f9a2d869198e8ae1b01d16574e5d6d", + "text": "For adolescents:", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "", + "text_as_html": "Distraction is not effective, and there are no additional evidence-based, age-specific recommendations available for this group beyond the general measures for all age groups.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 3, + "coordinates": [ + { + "x0": 44.05, + "y0": 552.53, + "x1": 273.49, + "y1": 594.87 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "b332bdd79539c0017111401cc8f065a3", + "text": "When rotavirus vaccination is part of the schedule, the vaccine may be given first as the formulation of the currently licensed liquid rotavirus vaccine has shown to have a pain mitigating effect through its sucrose content, followed by oral polio vaccine. Injectable vaccines should be administered after oral vaccination. In the absence of specified grading of painfulness, health-care professionals are encouraged to use their practical experience on the painfulness of specific vaccines to determine accor- dingly the best sequencing of the injections.", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "f9f9a2d869198e8ae1b01d16574e5d6d", + "text_as_html": "Il existe peu de preuves de influence du contexte dans lequel les vaccinations sont effectuées. Néanmoins, d’aprés les obser- vations et des principes simples, garantir une certaine intimité peut en partie réduire l’anxiété et les manifestations indési- rables (malaise, maladie psychogéne de masse, par exemple) susceptibles d’apparaitre lorsque lintervention est pratiquée dans des centres de vaccination ouverts et de grandes dimen- sions ou dans le cadre de programmes en milieu scolaire et de campagnes de vaccination de masse.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 3, + "coordinates": [ + { + "x0": 294.92, + "y0": 93.34, + "x1": 551.46, + "y1": 192.38 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-19", + "text": "\n\n\n2. Mesures supplémentaires spécifiques\nEn plus des mesures générales, d’autres mesures spécifiques sont recommandées en fonction de l’age.\nPour les nourrissons et les jeunes enfants:\ni) La personne qui s’occupe de lenfant devra étre présente pendant tout le processus de vaccination et aprés celui-ci.\nii) Les nourrissons et les enfants <3 ans devront étre tenus par la personne qui s’occupe d’eux pendant toute la durée de Pintervention et ceux 23 ans devront étre assis pour atté- nuer leurs craintes et leur inconfort, de préférence sur les genoux de la personne qui s’occupe d’eux.\niii) Si cela est culturellement acceptable, les nourrissons devront étre allaités pendant ou avant la séance de vaccination.\" Lorsque des vaccins oraux sont co administrés avec des vaccins injectables, la meilleure solution consiste 4 admi- nistrer d’abord le vaccin antirotavirus oral, puis le vaccin antipoliomyélitique oral (si Pon utilise un VPO) et enfin a allaiter ?enfant en lui administrant en méme temps les vaccins injectables.\niv) Pour les enfants <6 ans, il est recommandé de distraire le patient de la douleur en lui présentant quelque chose de plaisant (jouet, vidéo, musique ou conversation avec un adulte, par exemple).", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "df0fd02c85d4afef71d45ef8364d01cb", + "text": "2. Mesures supplémentaires spécifiques", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "", + "text_as_html": "En plus des mesures générales, d’autres mesures spécifiques sont recommandées en fonction de l’age.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 3, + "coordinates": [ + { + "x0": 293.35, + "y0": 216.44, + "x1": 549.8, + "y1": 238.45 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "2be90beada57f3c7cfe3af7fc3f9345b", + "text": "Pour les nourrissons et les jeunes enfants:", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "df0fd02c85d4afef71d45ef8364d01cb", + "text_as_html": "Pour les nourrissons et les jeunes enfants:
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 3, + "coordinates": [ + { + "x0": 293.27, + "y0": 250.26, + "x1": 445.29, + "y1": 260.35 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "f88900d50a3aea6114587c8be7fed331", + "text": "i) La personne qui s’occupe de lenfant devra étre présente pendant tout le processus de vaccination et aprés celui-ci.", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "df0fd02c85d4afef71d45ef8364d01cb", + "text_as_html": "Dans le cas des adultes, des distractions jouant sur la respira- tion (légére toux n’entrainant pas de déplacement du bras immobilisé ou rétention de la respiration) sont recommandées.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 3, + "coordinates": [ + { + "x0": 292.36, + "y0": 495.05, + "x1": 551.68, + "y1": 527.86 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-21", + "text": "\n\n\nPour les adolescents:\nLa distraction n’est pas efficace et il n’existe pas de recomman- dations reposant sur des éléments factuels supplémentaires a Dintention de cette tranche d’age spécifique, au-dela des mesures générales s’appliquant a tous.\n* Lorsque la vaccination contre les rotavirus fait partie du calendrier de vaccination, le vaccin correspondant peut étre administré en premier car il a été montré que la formulation liquide actuellement homologuée pour cet usage avait un effet d’atténuation de la douleur par le biais de sa teneur en sucrose lorsqu’il était suivi du vaccin antipoliomyélitique. Les vaccins injectables devront étre administrés aprés les vaccinations orales. En I’absence de gradation spécifiée de la dolorosité des vaccins, les professionnels de santé sont encouragés a faire appel a leur expé- rience pratique concernant leurs effets douloureux spécifiques pour déterminer en conséquence l‘ordre des injections a privilégier.\nTaddio A, Ilersich AL, Ipp M, et al. Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations: Systematic review of randomized controlled trials and quasi-randomized controlled trials. Clin Ther. 2009;31 Suppl 2:548-76.\nAucun effet indésirable de |’allaitement pendant la vaccination n‘a pas été rapporté, notam- ment en termes d'inhalation, de cyanose, de changements respiratoires ou de vomissements du nourrisson.\n3. Measures not recommended\nTopical anaesthetics, although effective, are not recom- mended for systematic use by national programmes globally because of high costs, lack of availability, and the additional time required for their application. Data, available for only a limited number of products, demon- strate that topical anaesthetics have no effect on immune responses to vaccines.’\nSeveral of the interventions that were considered are not currently recommended due to lack of evidence of pain-mitigation effectiveness and/or the potential for altering vaccine effectiveness. These include:\n(i) warming the vaccine (e.g. by rubbing it between the hands);\n(ii) manual stimulation of the injection site (e.g. by rubbing or pinching);\n(iii) administration of oral analgesics (e.g. acetamino- phen, ibuprofen”) before or at the time of vaccina- tion.\nIf pain occurs later, during the days after vaccination, oral analgesics can then be given to mitigate pain and/ or fever linked to delayed reactogenicity.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "880fee6eca7f0ac735903df8750266ac", + "text": "Pour les adolescents:", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "", + "text_as_html": "La distraction n’est pas efficace et il n’existe pas de recomman- dations reposant sur des éléments factuels supplémentaires a Dintention de cette tranche d’age spécifique, au-dela des mesures générales s’appliquant a tous.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 3, + "coordinates": [ + { + "x0": 293.3, + "y0": 551.9, + "x1": 550.44, + "y1": 595.44 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "b3e7033c3bc759a3b79d5017722f31a4", + "text": "* Lorsque la vaccination contre les rotavirus fait partie du calendrier de vaccination, le vaccin correspondant peut étre administré en premier car il a été montré que la formulation liquide actuellement homologuée pour cet usage avait un effet d’atténuation de la douleur par le biais de sa teneur en sucrose lorsqu’il était suivi du vaccin antipoliomyélitique. Les vaccins injectables devront étre administrés aprés les vaccinations orales. En I’absence de gradation spécifiée de la dolorosité des vaccins, les professionnels de santé sont encouragés a faire appel a leur expé- rience pratique concernant leurs effets douloureux spécifiques pour déterminer en conséquence l‘ordre des injections a privilégier.", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "880fee6eca7f0ac735903df8750266ac", + "text_as_html": "3. Measures not recommended
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 44.9, + "y0": 55.67, + "x1": 175.57, + "y1": 66.0 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "1a42e53b748b5f8150569ef3b1fccf1d", + "text": "Topical anaesthetics, although effective, are not recom- mended for systematic use by national programmes globally because of high costs, lack of availability, and the additional time required for their application. Data, available for only a limited number of products, demon- strate that topical anaesthetics have no effect on immune responses to vaccines.’", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "880fee6eca7f0ac735903df8750266ac", + "text_as_html": "Topical anaesthetics, although effective, are not recom- mended for systematic use by national programmes globally because of high costs, lack of availability, and the additional time required for their application. Data, available for only a limited number of products, demon- strate that topical anaesthetics have no effect on immune responses to vaccines.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 45.3, + "y0": 68.17, + "x1": 274.06, + "y1": 144.18 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "10175d6d8cce8c0f5fc29293cfe1c78b", + "text": "Several of the interventions that were considered are not currently recommended due to lack of evidence of pain-mitigation effectiveness and/or the potential for altering vaccine effectiveness. These include:", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "880fee6eca7f0ac735903df8750266ac", + "text_as_html": "Several of the interventions that were considered are not currently recommended due to lack of evidence of pain-mitigation effectiveness and/or the potential for altering vaccine effectiveness. These include:
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 43.96, + "y0": 161.43, + "x1": 274.25, + "y1": 204.89 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "a44dd5c5fb3f54e18dc722cb094e7838", + "text": "(i) warming the vaccine (e.g. by rubbing it between the hands);", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "880fee6eca7f0ac735903df8750266ac", + "text_as_html": "If pain occurs later, during the days after vaccination, oral analgesics can then be given to mitigate pain and/ or fever linked to delayed reactogenicity.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 44.0, + "y0": 293.93, + "x1": 273.79, + "y1": 326.34 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-22", + "text": "\n\n\n4. Advice for national programmes\nMany immunization programmes have sustained high vaccine coverage levels without addressing pain during the vaccination procedure; however, mitigating pain at vaccination should be considered as part of good immunization practice globally.\nNational programmes should ensure that the recom- mendations listed above are implemented. At health system level, related health policy should be strength- ened by provision of training on the recommended policies and practices. Programmes should recommend the preferred order of injection for country-specific vaccination schedules where possible.\nEducation of health-care workers on pain mitigation strategies, e.g. by inclusion in training curricula, needs to be ensured in order to facilitate their implementa- tion. Additionally, it should be ensured that caregivers and, if appropriate, vaccine recipients, are educated on vaccination pain mitigation strategies. Information could be provided during prenatal visits, breastfeeding education, or at time of vaccination. Context-specific educational methods to be utilized should include teaching of individuals or groups, or provision of writ- ten information.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "5a953d6251e25967b7337a86535ec076", + "text": "4. Advice for national programmes", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "", + "text_as_html": "Many immunization programmes have sustained high vaccine coverage levels without addressing pain during the vaccination procedure; however, mitigating pain at vaccination should be considered as part of good immunization practice globally.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 46.5, + "y0": 362.18, + "x1": 273.18, + "y1": 416.31 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "253df19046abd7a8128e2d81983e69bb", + "text": "National programmes should ensure that the recom- mendations listed above are implemented. At health system level, related health policy should be strength- ened by provision of training on the recommended policies and practices. Programmes should recommend the preferred order of injection for country-specific vaccination schedules where possible.", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "5a953d6251e25967b7337a86535ec076", + "text_as_html": "National programmes should ensure that the recom- mendations listed above are implemented. At health system level, related health policy should be strength- ened by provision of training on the recommended policies and practices. Programmes should recommend the preferred order of injection for country-specific vaccination schedules where possible.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 45.27, + "y0": 433.42, + "x1": 273.15, + "y1": 509.44 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "1dbe1ee246a261538e920d7d417a9760", + "text": "Education of health-care workers on pain mitigation strategies, e.g. by inclusion in training curricula, needs to be ensured in order to facilitate their implementa- tion. Additionally, it should be ensured that caregivers and, if appropriate, vaccine recipients, are educated on vaccination pain mitigation strategies. Information could be provided during prenatal visits, breastfeeding education, or at time of vaccination. Context-specific educational methods to be utilized should include teaching of individuals or groups, or provision of writ- ten information.", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "5a953d6251e25967b7337a86535ec076", + "text_as_html": "Education of health-care workers on pain mitigation strategies, e.g. by inclusion in training curricula, needs to be ensured in order to facilitate their implementa- tion. Additionally, it should be ensured that caregivers and, if appropriate, vaccine recipients, are educated on vaccination pain mitigation strategies. Information could be provided during prenatal visits, breastfeeding education, or at time of vaccination. Context-specific educational methods to be utilized should include teaching of individuals or groups, or provision of writ- ten information.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 44.38, + "y0": 527.6, + "x1": 272.7, + "y1": 647.31 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-23", + "text": "\n\n\n5. Research needs\nPriority research areas include studies on: (i) the extent of concerns about pain at vaccination and its impact on vaccine hesitancy and acceptance in low and middle\n\" Data indicate reduced immunogenicity of some vaccines by use of prophylactic acetaminophen but no interaction has been documented with ibuprofen.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "70a0bf3e936d0420848bb0e7efd7d96c", + "text": "5. Research needs", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "", + "text_as_html": "Priority research areas include studies on: (i) the extent of concerns about pain at vaccination and its impact on vaccine hesitancy and acceptance in low and middle
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 43.49, + "y0": 695.03, + "x1": 271.79, + "y1": 725.67 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "40ee02ec7827e4a34cf439197dcb2b10", + "text": "\" Data indicate reduced immunogenicity of some vaccines by use of prophylactic acetaminophen but no interaction has been documented with ibuprofen.", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "70a0bf3e936d0420848bb0e7efd7d96c", + "text_as_html": "Bien quwefficaces, les anesthésiques locaux ne sont pas recom- mandés pour un usage systématique par les programmes natio- naux a l’échelle mondiale, en raison de leur cott élevé, de leur disponibilité insuffisante et du temps supplémentaire nécessaire pour les appliquer. Les données disponibles, qui ne concernent quun nombre limité de produits, démontrent que les anesthé- siques locaux r’ont pas d’effet sur les réponses immunitaires aux vaccins.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 294.65, + "y0": 68.04, + "x1": 552.04, + "y1": 155.29 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "f61bf0577c06ff7ed0f47723ab6d5ac4", + "text": "Plusieurs des interventions envisagées ne sont actuellement pas recommandées en raison du manque de données sur leur effi- cacité dans l’atténuation de la douleur et/ou de la possibilité quwelles diminuent l’efficacité des vaccins. Il s’agit notamment:", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "849fb8ac6633a184ce52df648a9d1708", + "text_as_html": "Plusieurs des interventions envisagées ne sont actuellement pas recommandées en raison du manque de données sur leur effi- cacité dans l’atténuation de la douleur et/ou de la possibilité quwelles diminuent l’efficacité des vaccins. Il s’agit notamment:
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 293.54, + "y0": 161.53, + "x1": 551.21, + "y1": 205.12 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "46ee191632af4622ae31d67de6925914", + "text": "i) du réchauffement du vaccin (en frottant le contenant entre les mains, par exemple);", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "849fb8ac6633a184ce52df648a9d1708", + "text_as_html": "Si une douleur apparait dans les jours qui suivent la vaccina- tion, il est possible de donner des analgésiques oraux en vue @atténuer la douleur et/ou la fiévre liées a la réactogénicité différée.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 292.51, + "y0": 293.53, + "x1": 551.36, + "y1": 337.76 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-25", + "text": "\n\n\n4. Conseil a l'intention des programmes nationaux\nDe nombreux programmes de vaccination maintiennent dura- blement des taux élevés de couverture vaccinale sans chercher a atténuer la douleur pendant la procédure de vaccination; néanmoins, il faudra considérer cette atténuation comme faisant partie des bonnes pratiques de vaccination pour l’ensemble du monde.\nLes programmes nationaux devront s’assurer que les recom- mandations énumérées plus haut sont bien mises en ceuvre. Au niveau des systémes de santé, il conviendra de renforcer la poli- tique sanitaire associée en délivrant des formations sur les stra- tégies et les pratiques préconisées. Dans la mesure du possible, les programmes devront recommander lordre dinjection a privilégier pour les calendriers de vaccination spécifiques au pays.\nPour faciliter la mise en ceuvre des stratégies d’atténuation de la douleur, il faudra s’assurer de la formation du personnel soignant a ces pratiques, par exemple en incluant leur appren- tissage dans les programmes de formation. De plus, il convient aussi de s’assurer que les personnes qui s’occupent des enfants et, le cas échéant, les bénéficiaires de la vaccination, sont éduquées aux stratégies d’atténuation de la douleur pendant la vaccination. Des informations pourraient leur étre fournies pendant les visites prénatales, la formation a l’allaitement et au moment des vaccinations. Parmi les méthodes d’éducation spécifiques au contexte a appliquer devront figurer l’enseigne- ment individualisé ou par groupe ou l’apport d’informations écrites.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "a7dc92ac344948d72a15e589a67ce35d", + "text": "4. Conseil a l'intention des programmes nationaux", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "", + "text_as_html": "De nombreux programmes de vaccination maintiennent dura- blement des taux élevés de couverture vaccinale sans chercher a atténuer la douleur pendant la procédure de vaccination; néanmoins, il faudra considérer cette atténuation comme faisant partie des bonnes pratiques de vaccination pour l’ensemble du monde.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 294.84, + "y0": 362.21, + "x1": 552.38, + "y1": 427.23 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ab925796017ae5fcb38078da580cc07f", + "text": "Les programmes nationaux devront s’assurer que les recom- mandations énumérées plus haut sont bien mises en ceuvre. Au niveau des systémes de santé, il conviendra de renforcer la poli- tique sanitaire associée en délivrant des formations sur les stra- tégies et les pratiques préconisées. Dans la mesure du possible, les programmes devront recommander lordre dinjection a privilégier pour les calendriers de vaccination spécifiques au pays.", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "a7dc92ac344948d72a15e589a67ce35d", + "text_as_html": "Les programmes nationaux devront s’assurer que les recom- mandations énumérées plus haut sont bien mises en ceuvre. Au niveau des systémes de santé, il conviendra de renforcer la poli- tique sanitaire associée en délivrant des formations sur les stra- tégies et les pratiques préconisées. Dans la mesure du possible, les programmes devront recommander lordre dinjection a privilégier pour les calendriers de vaccination spécifiques au pays.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 293.86, + "y0": 433.19, + "x1": 552.03, + "y1": 520.58 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "6a618083951519c0df61df71a35c63a3", + "text": "Pour faciliter la mise en ceuvre des stratégies d’atténuation de la douleur, il faudra s’assurer de la formation du personnel soignant a ces pratiques, par exemple en incluant leur appren- tissage dans les programmes de formation. De plus, il convient aussi de s’assurer que les personnes qui s’occupent des enfants et, le cas échéant, les bénéficiaires de la vaccination, sont éduquées aux stratégies d’atténuation de la douleur pendant la vaccination. Des informations pourraient leur étre fournies pendant les visites prénatales, la formation a l’allaitement et au moment des vaccinations. Parmi les méthodes d’éducation spécifiques au contexte a appliquer devront figurer l’enseigne- ment individualisé ou par groupe ou l’apport d’informations écrites.", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "a7dc92ac344948d72a15e589a67ce35d", + "text_as_html": "Pour faciliter la mise en ceuvre des stratégies d’atténuation de la douleur, il faudra s’assurer de la formation du personnel soignant a ces pratiques, par exemple en incluant leur appren- tissage dans les programmes de formation. De plus, il convient aussi de s’assurer que les personnes qui s’occupent des enfants et, le cas échéant, les bénéficiaires de la vaccination, sont éduquées aux stratégies d’atténuation de la douleur pendant la vaccination. Des informations pourraient leur étre fournies pendant les visites prénatales, la formation a l’allaitement et au moment des vaccinations. Parmi les méthodes d’éducation spécifiques au contexte a appliquer devront figurer l’enseigne- ment individualisé ou par groupe ou l’apport d’informations écrites.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 293.73, + "y0": 527.47, + "x1": 552.79, + "y1": 669.2 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-26", + "text": "\n\n\n5. Besoins en matiére de recherche\nParmi les domaines a étudier en priorité, figurent: i) ’ampleur des craintes a propos de la douleur et son incidence sur les hésitations devant la vaccination et sur l’acceptation de celle-ci\n” Certaines données indiquent une diminution de la réactogénicité de certains vaccins avec ‘administration prophylactique d'acétaminophéne, mais aucun probléme d’interaction n'a été enregistré avec l'ibuproféne.\n509\nincome countries; (ii) other effective pain mitigation interventions, particularly for adolescents and adults; (iii) pain mitigation interventions that are effective in mass campaigns and school-based programme settings; and (iv) further assessment of which specific vaccine injections are more painful and less painful.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "ce05be7b43f2f151fc1be6921cd543ca", + "text": "5. Besoins en matiére de recherche", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "", + "text_as_html": "Parmi les domaines a étudier en priorité, figurent: i) ’ampleur des craintes a propos de la douleur et son incidence sur les hésitations devant la vaccination et sur l’acceptation de celle-ci
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 293.51, + "y0": 693.81, + "x1": 550.88, + "y1": 726.04 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "5b65c51948185f17b12d56ed061176de", + "text": "” Certaines données indiquent une diminution de la réactogénicité de certains vaccins avec ‘administration prophylactique d'acétaminophéne, mais aucun probléme d’interaction n'a été enregistré avec l'ibuproféne.", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "ce05be7b43f2f151fc1be6921cd543ca", + "text_as_html": "509
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 4, + "coordinates": [ + { + "x0": 539.14, + "y0": 779.62, + "x1": 549.57, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "a5022961883a0147023714a6aff73c81", + "text": "income countries; (ii) other effective pain mitigation interventions, particularly for adolescents and adults; (iii) pain mitigation interventions that are effective in mass campaigns and school-based programme settings; and (iv) further assessment of which specific vaccine injections are more painful and less painful.", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "ce05be7b43f2f151fc1be6921cd543ca", + "text_as_html": "income countries; (ii) other effective pain mitigation interventions, particularly for adolescents and adults; (iii) pain mitigation interventions that are effective in mass campaigns and school-based programme settings; and (iv) further assessment of which specific vaccine injections are more painful and less painful.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 44.74, + "y0": 9.91, + "x1": 272.95, + "y1": 21.42 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-27", + "text": "\n\n\nRubella and congenital rubella syndrome control and elimination — global progress, 2000-2014\nGavin B. Grant,' Susan E. Reef,’ Alya Dabbagh,? Marta Gacic-Dobo,” Peter M.Strebel.?\nRubella virus usually causes a mild fever and rash in children and adults; however, infection during preg- nancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS).\nIn 2011, an updated WHO position paper was published with guidance on the preferred strategy for introduc- tion of rubella-containing vaccine (RCV) into national routine immunization schedules, including an initial vaccination campaign usually targeting children aged 9 months-15 years.’ The Global Vaccine Action Plan (GVAP) was endorsed by the World Health Assembly in 2012 and the Global Measles and Rubella Strategic Plan (2012-2020) published by Measles and Rubella Initiative (MRI) partners in 2012 both include milestones to elim- inate rubella and CRS in at least 2 WHO regions by 2015, and at least 5 WHO regions by 2020.** This report updates a previous report’ and summarizes global prog- ress towards rubella and CRS control and elimination during 2000-2014.\nAs of December 2014, RCV has been introduced in 140 (72%) WHO member states, an increase from 99 (51%) member states in 2000. Reported rubella cases declined by 95%, from 670 894 cases reported to WHO in 2000 from 102 member states to 33 068 cases reported in 2014 from 162 member states. Rubella and CRS elimination goals have been established in the Region of the Americas (target date 2010), European Region (target date 2015), and the Western Pacific Region (target date to be determined). To achieve the 2020 GVAP rubella and CRS elimination goals, RCV\nWorld Health Organization, Global Vaccine Action Plan, Geneva, Switzerland: World Health Organization; 2012. Available at —http://www.who.int/iris/bitstre am/10665/78141/1/9789241504980_eng.pdf?ua=1\nGlobal measles and rubella strategic plan: 2012-2020. Geneva: World Health Orga- nization; 2012. Available at http://reliefweb.int/sites/reliefweb.int/files/resources/ Measles_Rubella_StrategicPlan_2012_2020.pdf; accessed August 2015.\nSee No. 49, 2013, pp. 521-528.", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "d85edac95590dfcab1161b69ebf6b6e4", + "text": "Rubella and congenital rubella syndrome control and elimination — global progress, 2000-2014", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "", + "text_as_html": "Gavin B. Grant,' Susan E. Reef,’ Alya Dabbagh,? Marta Gacic-Dobo,” Peter M.Strebel.?
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 46.13, + "y0": 40.85, + "x1": 269.14, + "y1": 44.49 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "35a3d03d8d6eb24a35c06ba56d6bb020", + "text": "Rubella virus usually causes a mild fever and rash in children and adults; however, infection during preg- nancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS).", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "d85edac95590dfcab1161b69ebf6b6e4", + "text_as_html": "Rubella virus usually causes a mild fever and rash in children and adults; however, infection during preg- nancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 44.97, + "y0": 45.78, + "x1": 273.04, + "y1": 57.72 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "70095f3b3e332189ce3d66d7de8d3aac", + "text": "In 2011, an updated WHO position paper was published with guidance on the preferred strategy for introduc- tion of rubella-containing vaccine (RCV) into national routine immunization schedules, including an initial vaccination campaign usually targeting children aged 9 months-15 years.’ The Global Vaccine Action Plan (GVAP) was endorsed by the World Health Assembly in 2012 and the Global Measles and Rubella Strategic Plan (2012-2020) published by Measles and Rubella Initiative (MRI) partners in 2012 both include milestones to elim- inate rubella and CRS in at least 2 WHO regions by 2015, and at least 5 WHO regions by 2020.** This report updates a previous report’ and summarizes global prog- ress towards rubella and CRS control and elimination during 2000-2014.", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "d85edac95590dfcab1161b69ebf6b6e4", + "text_as_html": "In 2011, an updated WHO position paper was published with guidance on the preferred strategy for introduc- tion of rubella-containing vaccine (RCV) into national routine immunization schedules, including an initial vaccination campaign usually targeting children aged 9 months-15 years.’ The Global Vaccine Action Plan (GVAP) was endorsed by the World Health Assembly in 2012 and the Global Measles and Rubella Strategic Plan (2012-2020) published by Measles and Rubella Initiative (MRI) partners in 2012 both include milestones to elim- inate rubella and CRS in at least 2 WHO regions by 2015, and at least 5 WHO regions by 2020.** This report updates a previous report’ and summarizes global prog- ress towards rubella and CRS control and elimination during 2000-2014.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 43.89, + "y0": 63.29, + "x1": 272.88, + "y1": 93.36 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "579518d03a263d06ad92d53935fa19b1", + "text": "As of December 2014, RCV has been introduced in 140 (72%) WHO member states, an increase from 99 (51%) member states in 2000. Reported rubella cases declined by 95%, from 670 894 cases reported to WHO in 2000 from 102 member states to 33 068 cases reported in 2014 from 162 member states. Rubella and CRS elimination goals have been established in the Region of the Americas (target date 2010), European Region (target date 2015), and the Western Pacific Region (target date to be determined). To achieve the 2020 GVAP rubella and CRS elimination goals, RCV", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "d85edac95590dfcab1161b69ebf6b6e4", + "text_as_html": "As of December 2014, RCV has been introduced in 140 (72%) WHO member states, an increase from 99 (51%) member states in 2000. Reported rubella cases declined by 95%, from 670 894 cases reported to WHO in 2000 from 102 member states to 33 068 cases reported in 2014 from 162 member states. Rubella and CRS elimination goals have been established in the Region of the Americas (target date 2010), European Region (target date 2015), and the Western Pacific Region (target date to be determined). To achieve the 2020 GVAP rubella and CRS elimination goals, RCV
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 45.72, + "y0": 98.92, + "x1": 272.68, + "y1": 120.88 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "9a0757ad3d12936b8c6ff30874d3ae4f", + "text": "World Health Organization, Global Vaccine Action Plan, Geneva, Switzerland: World Health Organization; 2012. Available at —http://www.who.int/iris/bitstre am/10665/78141/1/9789241504980_eng.pdf?ua=1", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "", + "text_as_html": "dans les pays a revenu faible ou intermédiaire; ii) d’autres inter- ventions efficaces dans l’atténuation de la douleur, en particu- lier chez les adolescents et les adultes; iii) les interventions visant a atténuer la douleur efficaces dans le cadre de campagnes de vaccination de masse et en milieu scolaire; et iv) l’évaluation plus poussée de la dolorisité spécifique des différentes injec- tions vaccinales. Ml
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 294.69, + "y0": 9.85, + "x1": 551.17, + "y1": 23.34 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "b0353c315a20f0a4be052b4466728cd8", + "text": "Activités de lutte et d’élimination de la rubéole et du syndrome de rubéole congénitale — Progrés réalisés a I'échelle mondiale, 2000-2014", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "9931680a70011df819b9bc68385f8b99", + "text_as_html": "Activités de lutte et d’élimination de la rubéole et du syndrome de rubéole congénitale — Progrés réalisés a I'échelle mondiale, 2000-2014
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 293.93, + "y0": 29.98, + "x1": 543.5, + "y1": 39.8 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d0cb23dda152779442616c9f2bc8451c", + "text": "Gavin B. Grant,’ Susan E. Reef,’ Alya Dabbagh,? Marta Gacis-Dobo,” Peter M.Strebel.”", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "9931680a70011df819b9bc68385f8b99", + "text_as_html": "Gavin B. Grant,’ Susan E. Reef,’ Alya Dabbagh,? Marta Gacis-Dobo,” Peter M.Strebel.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 312.18, + "y0": 40.69, + "x1": 531.36, + "y1": 44.56 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d8497fa1ee6919ba9f1b4279067e2cf3", + "text": "Linfection par le virus de la rubéole provoque généralement des symptémes bénins de fiévre et d’éruption cutanée chez les enfants et les adultes. Cependant, si elle survient durant la gros- sesse, en particulier au cours du premier trimestre, elle peut entrainer un avortement spontané, la mort foetale, une morti- naissance ou la naissance d’un enfant atteint d’une affection caractérisée par des malformations congénitales, appelée syndrome de rubéole congénitale (SRC).", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "9931680a70011df819b9bc68385f8b99", + "text_as_html": "Linfection par le virus de la rubéole provoque généralement des symptémes bénins de fiévre et d’éruption cutanée chez les enfants et les adultes. Cependant, si elle survient durant la gros- sesse, en particulier au cours du premier trimestre, elle peut entrainer un avortement spontané, la mort foetale, une morti- naissance ou la naissance d’un enfant atteint d’une affection caractérisée par des malformations congénitales, appelée syndrome de rubéole congénitale (SRC).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 294.66, + "y0": 45.7, + "x1": 551.49, + "y1": 61.82 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "337280317596f1c6bd87011600790721", + "text": "En 2011, POMS a publié une note de synthése actualisée dans laquelle elle fournit des orientations sur la stratégie 4 adopter pour introduire le vaccin a valence rubéole dans les calendriers nationaux de vaccination systématique, reposant notamment sur lorganisation dune campagne initiale de vaccination, géné- ralement destinée aux enfants de 9 mois a 15 ans.’ Le Plan d’action mondial pour les vaccins (GVAP), adopté par lAssem- blée mondiale de la Santé en 2012, et le Plan stratégique mondial de lutte contre la rougeole et la rubéole (2012-2020), publié en 2012 par les partenaires de |’'Initiative contre la rougeole et la rubéole, définissent tous deux certaines étapes 4 franchir en vue d’éliminer la rubéole et le syndrome de rubéole congénitale dans au moins 2 Régions de POMS d’ici 2015, et au moins 5 Régions de OMS d’ici 2020.** Le présent rapport actualise les informations présentées dans le rapport précédent' et réca- pitule les progrés accomplis dans la période 2000-2014 pour endiguer et éliminer la rubéole et le SRC a I’échelle mondiale.", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "9931680a70011df819b9bc68385f8b99", + "text_as_html": "En 2011, POMS a publié une note de synthése actualisée dans laquelle elle fournit des orientations sur la stratégie 4 adopter pour introduire le vaccin a valence rubéole dans les calendriers nationaux de vaccination systématique, reposant notamment sur lorganisation dune campagne initiale de vaccination, géné- ralement destinée aux enfants de 9 mois a 15 ans.’ Le Plan d’action mondial pour les vaccins (GVAP), adopté par lAssem- blée mondiale de la Santé en 2012, et le Plan stratégique mondial de lutte contre la rougeole et la rubéole (2012-2020), publié en 2012 par les partenaires de |’'Initiative contre la rougeole et la rubéole, définissent tous deux certaines étapes 4 franchir en vue d’éliminer la rubéole et le syndrome de rubéole congénitale dans au moins 2 Régions de POMS d’ici 2015, et au moins 5 Régions de OMS d’ici 2020.** Le présent rapport actualise les informations présentées dans le rapport précédent' et réca- pitule les progrés accomplis dans la période 2000-2014 pour endiguer et éliminer la rubéole et le SRC a I’échelle mondiale.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 294.48, + "y0": 62.99, + "x1": 553.6, + "y1": 97.47 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "6f9797be7eca52769466ede0fdec6317", + "text": "En décembre 2014, 140 Etats Membres de l’OMS (72%) avaient introduit le vaccin 4 valence rubéole, ce qui représente une hausse de 51% par rapport aux 99 Etats Membres qui l’avaient fait en 2000. Le nombre de cas de rubéole notifiés a POMS a chuté de 95%, passant de 670 894 cas dans 102 Etats Membres en 2000 a 33 068 cas dans 162 Etats Membres en 2014. Des objectifs d’élimination de la rubéole et du SRC ont été fixés pour la Région des Amériques (date cible 2010), la Région euro- péenne (date cible 2015) et la Région du Pacifique occidental (date cible 4 déterminer). Pour franchir les étapes définies par le GVAP en vue d’éliminer la rubéole et le SRC d’ici a 2020,", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "9931680a70011df819b9bc68385f8b99", + "text_as_html": "En décembre 2014, 140 Etats Membres de l’OMS (72%) avaient introduit le vaccin 4 valence rubéole, ce qui représente une hausse de 51% par rapport aux 99 Etats Membres qui l’avaient fait en 2000. Le nombre de cas de rubéole notifiés a POMS a chuté de 95%, passant de 670 894 cas dans 102 Etats Membres en 2000 a 33 068 cas dans 162 Etats Membres en 2014. Des objectifs d’élimination de la rubéole et du SRC ont été fixés pour la Région des Amériques (date cible 2010), la Région euro- péenne (date cible 2015) et la Région du Pacifique occidental (date cible 4 déterminer). Pour franchir les étapes définies par le GVAP en vue d’éliminer la rubéole et le SRC d’ici a 2020,
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER9039_505-510.PDF", + "page": 5, + "coordinates": [ + { + "x0": 294.61, + "y0": 98.75, + "x1": 551.36, + "y1": 120.86 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-29", + "text": "\n\n\nVoir N° 29, 2011, pp. 301-316.\n? Organisation mondiale de la Santé, Plan d’action mondial pour les vaccins, Genéve, Suisse: Organisation mondiale de la Santé; 2012. Disponible a |'adresse: http://apps.who.int/iris/bitstr eam/10665/79315/1/9789242504989_fre.pdf.\n3 Global measles and rubella strategic plan: 2012-2020. Geneva: World Health Organization; 2012. Disponible a |'adresse: http://reliefweb.int/sites/reliefweb.int/files/resources/Measles_ Rubella_StrategicPlan_2012_2020.pdf; consulté en aodt 2015.\nVoir N° 49, 2013, pp. 521-528.\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 39, 25 SEPTEMBER 2015", + "filename": "WER9039_505-510.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "0d46bc34602cd08fe8e61742db76cabd", + "text": "Voir N° 29, 2011, pp. 301-316.", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "", + "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 39, 25 SEPTEMBER 2015
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