Vigilancia epidemiológica de la Pertussis: la experiencia Argentina y su importancia para el resto de países de la región

Sr. Editor:
Hemos leído con interés el artículo de Romanin y col. titulado: “Situación epidemiológica de coqueluche y estrategias para su control: Argentina, 2002-2011”, 1 donde los autores presentan las estrategias implementadas en los últimos años en Argentina para la vigilancia epidemiológica y control de Bordetella pertussis. De éstas, la más relevante es la cooperación estrecha entre las entidades sanitarias, especialmente el Ministerio de Salud de la Nación (MSN), el Sistema Nacional de Vigilancia de la Salud de Argentina (SNVS) y La Dirección Estadística e Información en Salud (DEIS) del MSN, interacción que no ocurre en todos los países latinoamericanos.
Authors: Bendezú Medina, Sandy; Pavic Espinoza, Ivana; Solari, Lely
Source: Archivos Argentinos de Pediatria (Arch. argent. pediatr.)
URL: http://hdl.handle.net/10757/338891

Aetiology, epidemiology and clinical characteristics of acute moderate-to-severe diarrhoea in children under 5 years of age hospitalized in a referral paediatric hospital in Rabat, Morocco

The objective of the study was to describe the aetiology, epidemiology and clinical characteristics of the principal causes of acute infectious diarrhoea requiring hospitalization among children under 5 years of age in Rabat, Morocco. A prospective study was conducted from March 2011 to March 2012, designed to describe the main pathogens causing diarrhoea in hospitalized children >2 months and less than 5 years of age. Among the 122 children included in the study, enteroaggregative Escherichia coli (EAEC) and rotavirus were the main aetiological causes of diarrhoea detected. Twelve (9.8 %) children were referred to an intensive care unit, while two, presenting infection by EAEC, and EAEC plus Shigella sonnei, developed a haemolytic uraemic syndrome. Additionally, six (4.9 %) deaths occurred, with EAEC being isolated in four of these cases. Diarrhoeagenic E. coli and rotavirus play a significant role as the two main causes of severe diarrhoea, while other pathogens, such as norovirus and parasites, seem to have a minimal contribution. Surveillance and prevention programmes to facilitate early recognition and improved management of potentially life-threatening diarrhoea episodes are needed.
Authors: Benmessaoud, R; Jroundi, I; Nezha, M; Moraleda, C; Tligui, H; Seffar, M; Alvarez Martínez, MJ; Pons, MJ; Chaacho, S;Hayes, EB; Vila, J; Alonso,PL; Bassat, Q; Ruiz, J
Source: Journal of Medical Microbiology (J Med Microbiol.)
URL: http://hdl.handle.net/10757/338011

Factors associated with non-use of condoms in an online community of frequent travellers

Background Millions of travellers around the world have gathered together into online communities. The objective is to analyse the factors associated with risky sexual behaviour among travellers. Methods Cross-sectional study was conducted within an online community of travellers using an online survey; we included travellers who had engaged in sexual activity while on their last trip. Risky sexual behaviour was defined as inconsistent condom use (<100%), and the factors associated were evaluated using the prevalence ratio (PR). Results Of the 468 participants, 245 had sex during their last trip. 59.7% did not consistently use condoms, and one out of every four participants reported never using condoms. Having a travel destination of Latin America or the Caribbean was significantly associated with inconsistent condom use. This association was maintained (PR 1.37, CI 95% 1.06–1.77) after adjusting for gender, age, migration, the presence of travel partners, and the use of drugs and alcohol prior to sexual activity. Conclusion An association was observed between travel destination (specifically Latin America or the Caribbean) and risky sexual behaviour. For this reason, tourists should be educated in STI transmission and regional STI and HIV incidences both before and during their travels; public health systems ought to work together with travel agencies, international airports, etc., in order to distribute this information and ensure a responsible travel experience.
Authors:  Alcedo, Sami; Kossuth-Cabrejos, Stefano; Piscoya, Alejandro; Mayta Tristán, Percy
Source: Travel Medicine and Infectious Disease (Travel Med Infect Dis.)

URL:  http://hdl.handle.net/10757/338010

Usefulness of Neutrophil-to-Lymphocyte Ratio in Risk Stratification of Patients With Advanced Heart Failure

Elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in patients with acute heart failure (HF) and neoplastic diseases. We investigated the association between NLR and mortality or cardiac transplantation in a retrospective cohort of 527 patients presented to the Cleveland Clinic for evaluation of advanced HF therapy options from 2007 to 2010. Patients were divided according to low, intermediate, and high tertiles of NLR and were followed longitudinally for time to all-cause mortality or heart transplantation (primary outcome). The median NLR was 3.9 (interquartile range 2.5 to 6.5). In univariate analysis, intermediate and highest tertiles of NLR had a higher risk than the lowest tertile for the primary outcome and all-causes mortality. Compared with the lowest tertile, there was no difference in the risk of heart transplantation for intermediate and high tertiles. In multivariate analysis, compared with the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with the primary outcome (hazard ratio [HR] [ 1.61, 95% confidence interval [CI] 1.10 to 2.37 and HR [ 1.55, 95% CI 1.02 to 2.36, respectively) and all-cause mortality (HR [ 1.83, 95% CI 1.07 to 3.14 and HR [ 2.16, 95% CI 1.21 to 3.83, respectively). In conclusion, elevated NLR is associated with increased mortality or heart transplantation risk in patients with advanced HF.
Authors: Benites Zapata, Vicente A.; Hernandez, Adrian V.; Nagarajan, Vijaiganesh; Cauthen, Clay A.; Starling, Randall C.; Tang, W.H. Wilson
Source: The American Journal of Cardiology (Am J Cardiol.)

URL:  http://hdl.handle.net/10757/338009

Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children

Introduction: Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 yearsold. Methodology: A cost-effectiveness analysis was developed in three phases: a systematic evidence search for calculating effectiveness; a cost analysis for vaccine strategies and outcome management; and an economic model based on decision tree analysis, including deterministic and probabilistic sensitivity analysis using acceptability curves, tornado diagram, and Monte Carlo simulation. A hypothetic 100 vaccinated children/vaccine cohort was built. An incremental cost-effectiveness ratio (ICER) was calculated. Results: The isolation probability for all serotypes in each vaccine was estimated: 38% for PCV7, 41% PCV10, and 17% PCV13. Avoided hospitalization was found to be the best effectiveness model measure. Estimated costs for PCV7, PCV10, and PCV13 cohorts were USD13,761, 11,895, and 12,499, respectively. Costs per avoided hospitalization were USD718 for PCV7, USD333 for PCV10, andUSD 162 for PCV13. At ICER, PCV7 was dominated by the other PCVs. Eliminating PCV7, PCV13 was more cost effective than PCV10 (confirmed in sensitivity analysis). Conclusions: PCV10 and PCV13 are more cost effective than PCV7 in prevention of pneumonia in children <5 years-old in Peru. PCV13 prevents more hospitalizations and is more cost-effective than PCV10. These results should be considered when making decisions about the Peruvian National Inmunizations Schedule.
Authors: Mezones Holguin, Edward; Bolaños Díaz, Rafael; Fiestas, Víctor; Sanabria, César; Gutiérrez Aguado, Alfonso; Fiestas, Fabián; Suárez, Víctor J.; Rodríguez Morales, Alfonso J.; Hernandez, Adrian V.
Source: The Journal of Infection in Developing Countries

URL:  http://hdl.handle.net/10757/337985