National vaccine coverage trends and funding in Latin America and the Caribbean

BACKGROUND

From 2006 to 2011 nearly 174,000 deaths were prevented in Latin America and the Caribbean through vaccination of children under five, which is widely attributed to the Expanded Program on Immunization (EPI). Despite near global adoption of EPI recommendations, vaccination coverage shows substantial variation across world regions. Causes for low immunizations within regions are multifaceted and include vaccination program costs. To date, publications regarding vaccine coverage across Latin America and the Caribbean are not readily available. This study aimed to: (1) compare vaccine coverage trends across nations within the region; and (2) assess whether national immunization program expenditures are correlated with vaccine coverage.

METHODS

Coverage for nine vaccines were collected by nation using publicly available data from WHO. National immunization program expenditures for each country were collected from the World Bank Index. The proportion of countries achieving 90% coverage in the years 2013 and 2017 for each vaccine were compared. Pearson correlation coefficients were calculated to measure the relationship between financing variables and DTP3 coverage for 2017.

RESULTS

In 2017, fewer Latin American and Caribbean nations were able to achieve 90% vaccine coverage for five vaccines compared to 2013. Mostly weak to moderate positive relationships were found between national immunization program expenditures and DTP3 coverage for 2017. Excluding Haiti, a weak negative relationship was found between total government expenditure on vaccines per infant and DTP3 coverage for 2017. Countries across Latin America and the Caribbean were largely self-reliant in funding vaccine expenditures.

CONCLUSIONS

Fewer countries across Latin America and the Caribbean are currently achieving optimum national vaccine coverage and weak to moderate relationships between routine immunization and vaccine expenditures and coverage were observed. Additional factors contributing to national vaccine coverage should be concomitantly examined to implement strategies which optimize delivery of childhood immunizations.

The Impact of Red Light Cameras on Crashes Within Miami-Dade County, Florida

OBJECTIVE

To determine the safety effect of red light camera (RLC) programs, this study attempted to estimate its impact on collisions within Miami-Dade County, Florida Methods: A before-after evaluation using a comparison group along with traffic control correction was employed. Twenty signalized intersections with RLCs that began enforcement on January 1, 2011, were matched to 2 comparison sites located at least 2 miles from camera sites to minimize spillover effect. An empirical Bayes analysis was used to account for potential regression to the mean effects. An index of effectiveness along with 95% confidence intervals were calculated based on the comparison between the estimated and actual number of crashes in the after period.

RESULTS

During the first year, RLC sites experienced a marginal decrease in right angle/turn collisions (-3%), a significant increase in rear-end collisions (+40%), and significant decreases in all injury (-19%) and RLR-related injury collisions (-24%). An increase in right angle/turning (+14%) and rear-end (+51%) collisions at the RLC sites was observed after 2 years despite camera enforcement. A significant reduction in RLR-related injury crashes (-17%), however, was still observed after 2 years. A nonsignificant decline in all injury collisions (-12%) was also noted.

CONCLUSIONS

RLCs showed a benefit in reducing RLR-related injury collisions at camera sites after enforcement commenced, yet its tradeoff was a large increase in rear-end collisions. There was inconclusive evidence whether RLCs affected right angle/turning and all injury collisions. Statutory changes in crash reporting during the second year of camera enforcement affected the incidence of right angle and rear-end collisions; nevertheless, a "novelty effect" could not be ruled out. Future research should consider events such as low frequencies of severe injury/fatal collisions and changes in crash reporting requirements when conducting RLC analyses.

The effectiveness of red light cameras in the United States-a literature review

OBJECTIVE

To examine the available scientific evidence based on peer-reviewed publications concerning the effectiveness of red light cameras (RLCs) within the U.S. traffic system.

METHODS

Relevant literature published prior to December 2012 was retrieved from the PubMed, Medline, and Engineering Index databases using free-text term queries. Jurisdictions with either a fixed number of RLCs studied or area wide programs within the United States were included. RLC studies with additional interventions were excluded. Nine RLC studies were extracted and grouped into 3 categories based on outcome measures: violations, crashes, and injuries/fatalities.

RESULTS

All 9 studies reviewed showed significant reductions in the frequency/rate of violations, crashes, and injuries at intersections after RLC implementation. RLC interventions appear to decrease violations, crashes, and injuries at intersections.

CONCLUSIONS

Despite limited peer-reviewed publications available in the literature, it appears that RLCs decrease violations, crashes, and injuries at intersections. Some studies, however, contained methodological shortcomings. Therefore, the apparent effectiveness should be confirmed with stronger methodological approaches. Although spillover effects appeared to be evident, many of the jurisdictions examined were small in area. Thus, it is unknown whether spillover resulting from RLCs would have similar effects in large metropolitan areas. To determine the full public health impact of RLC programs, crashes, injuries, and fatalities should be considered as primary outcomes of interest. To accomplish this requires a clear definition of which types of crashes will be included for RLC studies. Lastly, it is unknown whether RLCs would be effective in reducing crashes resulting from distracted or alcohol-impaired drivers. Future studies should examine the effects of RLCs by exclusively analyzing these crash types.