RESUMEN Objetivo: establecer los aspectos sociales que afectaron la aceptación de la vacuna del virus del papi- loma humano (VPH) en la población colombiana antes y después del evento mal definido e inusitado de etiología desconocida sucedido en 2014. Materiales y métodos: se realizó una búsqueda sistemática de literatura en las bases de datos: Scopus, Web of Science, Medline vía PubMed, Embase, Biblioteca Virtual en Salud y Ovid; además, en Google Académico y en repositorios de universidades y en instituciones de salud en Colombia, con los términos: “Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11, 16, 18”, “Colombia”, “Papiloma” y sus correspondientes términos en inglés, para identificar principalmente revisiones sistemáticas, estudios cuantitativos y cualitativos, y revisiones narrativas que se enfocaran en aspectos sociales como: educación, acceso, relación con el personal de salud, papel de los medios de comunicación, que pudieran haber actuado como barreras o facilitadores para la aceptación de vacunación para VPH en Colombia en el periodo 2006-2018. Se hace una síntesis narrativa de la información. Resultados: se incluyeron 24 documentos. Se identificó la importancia, para los padres, adolescentes, proveedores y los medios, de tener un mejor conocimiento del VPH y su relación con el cáncer de cuello uterino (CCU). Se reconoce la relevancia de una buena comunicación entre las profesiones de la salud y la comunidad para informar adecuadamente tanto los beneficios como los riesgos de la vacuna. La inclusión en los planes de aseguramiento facilitó el acceso a esta por parte de la población. Los medios de comunicación deben ser considerados para que actúen como facilitadores de los programas de vacunación. Conclusión: educar en el conocimiento del VPH, una atención en salud centrada en el paciente y una adecuada cobertura de los medios de comunicación influencian la aceptación del programa de vacuna- ción contra VPH en la población colombiana. Se requiere seguir haciendo seguimiento estricto de los efectos adversos asociados a la vacuna.

ABSTRACT Objective: To identify social factors influencing the acceptance of human papilloma virus (HPV) vaccination in the Colombian population before and after the unexpected and poorly defined event of unknown etiology which occurred in 2014. Materials and methods: A systematic review of the literature was conducted in the following databases: Scopus, Web of Science, Medline via PubMed, Embase, Online Health Library (Biblioteca Virtual en Salud) and Ovid, and also in Google Scholar, academic repositories and in Colombian health institutions, using the terms “recombinant tetravalent vaccine against Human Papilloma Virus types 6, 11, 16, 18”, “Colombia”, “Papilloma” in order to primarily identify systematic reviews, quantitative and qualitative studies, narrative reviews, focusing on social aspects such as education, access, relationship with healthcare staff and role of the media which may have acted as barriers or facilitators for the acceptance of HPV vaccination in Colombia between 2006-2018. A narrative synthesis of the data was made. Results: Twenty-four documents were included. The importance attached by parents, adolescents, providers and the media to having greater knowledge about HPV and its association with cervical cancer was identified. The relevance of good communication among healthcare professions and the community to enable adequate sharing of information regarding the risks and benefits of the vaccines was recognized. The inclusion of the vaccine in health insurance plans made access easier. The media must be involved as facilitators in vaccination programs. Conclusion: Education regarding HPV, patient-centered healthcare and adequate media coverage influence the acceptance of HPV vaccination in the Colombian population. Close follow-up of any vaccine-related adverse events is required.

RESUMO Introdução: As hemoglobinopatias são doenças genéticas comuns em todo o mundo e representam um problema de saúde pública. Na Colômbia, embora existam áreas geográficas com maior risco de apresentá-las, não há programas de triagem nem estudos para estabelecer sua prevalência na população. Objetivo: Estabelecer a prevalência de variantes de hemoglobina (Hb) na população pertencente ao programa de triagem neonatal da Clínica Colsanitas S.A. entre junho de 2000 e dezembro de 2014, em oito cidades do país. Métodos: Estudo transversal retrospectivo. Os registros do programa de triagem neonatal das hemoglobinopatias foram revistos para a informação dos resultados de eletroforese de hemoglobina em pH alcalino, praticada no sangue dos recém-nascidos com idades compreendidas entre 5-15 dias. Resultados: A prevalência geral de Hb anormal foi de 1,3%. Dentro dos grupos de recém-nascidos afetados com qualquer hemoglobinopatia (n = 400), as hemoglobinas anormais estruturais mais frequentes foram hemoglobina S (HbS) (43%), hemoglobina C (HbC) (9%) e Hb rápida (8%). Para as Hb quantitativas, o aumento da hemoglobina A2 (HbA2) foi de 3,7%, e a hemoglobina A (HbA) aumentada permaneceu ligeiramente elevada em 14,7% casos. A frequência de homozigotos para HbS foi de 0,01%. Barranquilla, Cartagena e Cali foram as cidades com maior frequência de hemoglobinopatias. Não houve associação entre sexo e presença de algum tipo de Hb. Discussão e conclusão: A prevalência global de hemoglobinopatias em nosso estudo foi alta (> 1%) de acordo com os critérios da Organização Mundial de Saúde (OMS). Portanto, há a necessidade de implementação de programas de triagem neonatal com maior cobertura nacional para as hemoglobinopatias.

ABSTRACT Introduction: Hemoglobinopathies are among the most common genetic disorders of hemoglobin worldwide and a public health problem. In Colombia, even though geographical areas with high incidence of this disorder have been reported, the absence of a national screening program does not permit us to determine its prevalence. Objective: Establish the prevalence of hemoglobin variants in a population covered by the neonatal screening program of Clínica Colsanitas S.A., between June 2000 and December 2014, including eight capital cities in Colombia. Methods: A retrospective cross-sectional study was conducted. We collected data from reports of the neonatal hemoglobinopathy-screening program for full-term newborn babies between 5 and 15 days old. Qualitative hemoglobin analysis was performed using gel electrophoresis of blood samples taken from the babies' heels. Results: The overall prevalence of abnormal Hb was 1.3%. Within the groups of newborns affected with any hemoglobinopathy (n = 400), the most frequent abnormal structural hemoglobins found were HbS (43%), HbC (9%), fast Hb (8%). For quantitative hemoglobins, HbA2 was 3.7% and HbA kept slightly elevated in 14.7% of cases. Frequency of homozygosis for HbS was 0.01%. Barranquilla, Cartagena and Cali were the cities with the greatest frequency of hemoglobinopathies. No correlation between sex and abnormal hemoglobin was found. Discussion and conclusion: Taking in consideration data from the World Health Organization (WHO) on hemoglobinopathies, our prevalence of > 1% is considered high. Therefore, a more extended coverage and the need for a national screening program are priorities.

Introducción: El alto polimorfismo del sistema HLA, hace que su tipificación sea una herramienta de gran valor al establecer asociación con diferentes enfermedades, patrones inmunológicos, antropogenéticos, así como para establecer probabilidades de encontrar donantes compatibles con receptores de diferentes tipos de trasplante de órganos. Objetivo: Establecer las frecuencias alélicas, genotípicas y haplotípicas en pacientes atendidos en la Clínica Colsanitas SA. Metodología: Se incluyeron un total de 561 pacientes atendidos en el Laboratorio Clínico de La Clínica Colsanitas SA, en 8 sedes en diferentes ciudades del Colombia, durante el período comprendido entre enero de 2004 a agosto de 2008. Se realizó tipificación de HLA -A,-B,-DRB1 por PCR SSP. Las frecuencias alélicas, genotípicas y haplotípicas fueron estimadas mediante el paquete estadístico Stata y el paquete de análisis genético Genepop. Resultados: Fue posible la identificación de 19, 28 y 15 alelos de los loci HLA A-B-DRB1 respectivamente, de los cuales los más frecuentes fueron A*24 (26.2%), A*02 (26%), B*35 (22.7%), DRB1*04 (24%). Los genotipos más frecuentes encontrados fueron A*02,24 (14.2%), B*07,35 (5.5%), DRB1*01,04 y DRB1*04,04 (6.9%). Los haplotipos más frecuentes fueron: HLA A*24, B*35 (9.2%), A*24, DRB1*04 (8.1%); B* 35, DRB1*04 (7.8%), A*2 DRB1*04 (7.4%). Conclusión: Los resultados obtenidos permiten tener referencia para aplicaciones en la población estudiada, así como para establecer probabilidades de compatibilidad en la creciente área de trasplante de órganos.

Introduction: The high polymorphism of the HLA system allows its typification to be used as valuable tool in establishing association to various illnesses, immune and genetic profiles; it also provides a guide to identifying compatibility among donors and receptors of organs transplants. Objective: To establish HLA-A, HLA-B, and HLA.DRB1 allele, genotype and haplotype frequencies among patients treated at Clinica Colsanitas SA. Methods: 561 patients coming from different regions in Colombia, who were attended in 8 centers of the clinical laboratory of the Clinica Colsanitas in different cities of the country from January 2004 to August 2008, were included in this study. All were HLA-A,-B, and -DRB1 typified via SSP PCR. Allele, genotype and haplotype frequencies were estimated with STATA Software Version 9.0 and the GENEPOP genetic analysis package. Results: 19, 28, and 15 different alleles were identified for loci HLA-A,-B and -DRB1, respectively. Alleles found most frequently were A*24 (26.2%), A*02 (26%), B*35(22.7%), and DRB1*04 (24%). The most frequent genotypes were A*02,24 (14.2%), B*07,35 (5.5%), DRB1*01,04, and DRB1*04,04 (6.9%); while most the frequent haplotypes were HLA A*24, B*35 (9.2%), A*24, DRB1*04 (8.1%); B*35, DRB1*04 (7.8%), A*2 DRB1*04 (7.4%). Conclusion: The results obtained provide a useful reference framework for the population studied, allowing compatibility probability calculations to be performed for organ transplants.