Introduction: The COVID-19 pandemic has caused a global health crisis. Vaccines against this disease have demonstrated variable efficacy and safety, although effectiveness has not been evaluated. In ...February 2021, the Ministry of Health of Peru approved the emergency use of the inactivated SARS-CoV-2 (Vero Cell) vaccine and initiated vaccination with health personnel at the national level. The objective of the study is to determine the effectiveness of this vaccine to reduce infections, hospitalizations, and deaths due to COVID-19. Methodology: We performed a retrospective cohort study in the period from 23 February to 26 June 2021; data were obtained from the Ministry of Health (including demographic, epidemiologic, clinical, hospital, laboratory results, deaths, and both date and quantity of vaccine doses delivered). The exposed cohort were those who received one or two vaccine doses and the non-exposed were unvaccinated. The events studied were infections, hospitalizations and deaths in the cohorts. We consider a case confirmed for COVID-19 if the test result was positive for SARS-CoV-2, via PCR or antigen test. Effectiveness was measured with incidence density ratio and risk. Confounding factors were controlled using a Poisson model with robust variance. Results: We enlisted 520,733 health workers, of whom 415,212 had two vaccine doses and 105,521 were unvaccinated. The median age was 40 years (IQR: 32–50), and 65.6% were female. The effectiveness of two vaccine doses fourteen days after application adjusted by age, sex, hospitalization, and antecedent of having the infection was 90.9% (95% CI: 85.5–94.2%); effectiveness to avoid death from COVID-19; 67.7% (60.1–73.8%) effectiveness to avoid hospitalizations; and 26.3% (23.8–28.6%) effectiveness to reduce the risk of infection by SARS-CoV-2 relative to the unvaccinated cohort. Conclusions: The inactivated SARS-CoV-2 (Vero Cell) vaccine used in two doses has an acceptable effectiveness against death and risk of hospitalization, whereas it has less effectiveness in preventing COVID-19 infection.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
HIV incidence remains high among transgender women in Lima, Peru, most of whom report sex work. On the basis of a stakeholder analysis and health system capacity assessment, we designed a ...mathematical model to guide HIV programmatic planning among transgender women sex workers (TWSW) in Lima.
Using a deterministic compartmental model, we modelled HIV transmission among TWSW, their stable partners, and their clients to estimate the impact and cost-effectiveness of combinations of interventions compared with the standard of care on reducing HIV incidence over a 10-year period. We simulated HIV transmission accounting for differences in sexual positioning in anal intercourse and condom use by partner type and fitted the model to HIV surveillance data using Latin hypercube sampling. The interventions we considered were 15% relative increase in condom use with clients and 10% relative increase with stable partners; increase in antiretroviral treatment (ART) coverage at CD4 count lower than 500 cells per mm3 and greater than or equal to 500 cells per mm3; and 15% pre-exposure prophylaxis (PrEP) coverage using generic and branded formulations. We considered a basic scenario accounting for current limitations in the Peruvian HIV services and an enhanced scenario assuming achievement of the UNAIDS 90-90-90 targets and general improvements in HIV services. The 50 best fits according to log-likelihood were used to give the minimum and maximum values of intervention effect for each combination. We used disability-adjusted life-years (DALYs) to measure the negative health outcomes associated with HIV infection that could be averted through the interventions investigated and calculated incremental cost-effectiveness ratios to compare their cost-effectiveness.
Under the basic scenario, combining the four interventions of increasing condom use with clients and stable partners, extending ART to people with CD4 count greater than or equal to 500 cells per mm3, and 15% PrEP coverage with generic drugs would avert 47% (range 27–51) of new infections in TWSW, their clients, and their stable partners over 10 years, with an incremental cost-effectiveness ratio of US$509 per DALY averted. Under the enhanced scenario, this strategy would avert 61% (44–64) of new infections among this population with an incremental cost-effectiveness ratio of $1003 per DALY averted. Under both scenarios, implementation of this strategy approaches or surpasses the 50% incidence reduction goal and would represent a cost-effective use of country resources if generic PrEP drugs are used. The total cost of implementing this strategy under the enhanced scenario would be approximately $1·2 million per year over 10 years, corresponding to 10% of the current Global Fund's yearly contribution in Peru.
Investments in HIV services among TWSW in Lima would be cost-effective, even under stringent cost-effectiveness criteria when accounting for setting-specific resource constraints. Notable improvements in HIV testing rates, innovative interventions to increase condom use, and reduced PrEP costs will be key to achieving the 50% incidence reduction goal. Modelling studies incorporating stakeholders' perspectives and health system assessments can bring added value to HIV policy making.
National Institutes of Health.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
To estimate the incidence of influenza-virus-associated severe pneumonia among Salvadorian children aged < 5 years.
Data on children aged < 5 years admitted with severe pneumonia to a sentinel ...hospital in the western region were collected weekly. Nasal and oropharyngeal swab specimens were collected from a convenience sample of case patients for respiratory virus testing. A health-care utilization survey was conducted in the hospital catchment area to determine the proportion of residents who sought care at the hospital. The incidence of influenza-virus-associated severe pneumonia among all Salvadorian children aged < 5 years was estimated from surveillance and census data, with adjustment for health-care utilization. Influenza virus strains were characterized by the United States Centers for Disease Control and Prevention to determine their correspondence with northern and southern hemisphere influenza vaccine formulations.
Physicians identified 2554 cases of severe pneumonia. Samples from 608 cases were tested for respiratory viruses and 37 (6%) were positive for influenza virus. The estimated incidence of influenza-virus-associated severe pneumonia was 3.2 cases per 1000 person-years (95% confidence interval, CI: 2.8-3.7) overall, 1.5 cases per 1000 person-years (95% CI: 1.0-2.0) during 2008, 7.6 cases per 1000 person-years (95% CI: 6.5-8.9) during 2009 and 0.6 cases per 1000 person-years (95% CI: 0.3-1.0) during 2010. Northern and southern hemisphere vaccine formulations matched influenza virus strains isolated during 2008 and 2010.
Influenza-virus-associated severe pneumonia occurred frequently among young Salvadorian children during 2008-2010. Antigens in northern and southern hemisphere influenza vaccine formulations corresponded to circulating strains.
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CEKLJ, DOBA, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Data needed to guide influenza vaccine policies are lacking in tropical countries. We multiplied the number of severe acute respiratory infections by the proportion testing positive for influenza. ...There were ≈6,699 influenza hospitalizations and 803 deaths in Costa Rica during 2009-2012, supporting continuation of a national influenza vaccine program.
The demographic characteristics of pandemic influenza decedents among middle and low-income tropical countries are poorly understood. We explored the demographics of persons who died with influenza A ...(H1N1)pdm09 infection during 2009-2010, in seven countries in the American tropics.
We used hospital-based surveillance to identify laboratory-confirmed influenza deaths in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and Dominican Republic. An influenza death was defined as a person who died within two weeks of a severe acute respiratory infection (SARI) defined as sudden onset of fever >38 °C, cough or sore-throat, and shortness of breath, or difficulty breathing requiring hospitalization, and who tested positive for influenza A (H1N1)pdm09 virus by real time polymerase chain reaction. We abstracted the demographic and clinical characteristics of the deceased from their medical records.
During May 2009-June 2010, we identified 183 influenza deaths. Their median age was 32 years (IQR 18-46 years). One-hundred and one (55 %) were female of which 20 (20 %) were pregnant and 7 (7 %) were in postpartum. One-hundred and twelve decedents (61 %) had pre-existing medical conditions, (15 % had obesity, 13 % diabetes, 11 % asthma, 8 % metabolic disorders, 5 % chronic obstructive pulmonary disease, and 10 % neurological disorders). 65 % received oseltamivir but only 5 % received it within 48 h of symptoms onset.
The pandemic killed young adults, pregnant women and those with pre-existing medical conditions. Most sought care too late to fully benefit from oseltamivir. We recommend countries review antiviral treatment policies for people at high risk of developing complications.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objetivo. Evaluar los factores de riesgo para parto pretérmino (PP) idiopático según prematuridad. Materiales y métodos. Estudio observacional de corte longitudinal, realizado en el Instituto ...Nacional Materno Perinatal durante el periodo 2017. A todas las pacientes se realizó medición de la longitud cervical. Las variables estudiadas fueron factores sociodemográficos, obstétricos y perinatales. Se usó el método de regresión logística multivariado y análisis de curvas ROC. Resultados. Se enrolaron 306 casos de los cuales cumplieron los criterios de inclusión 218 participantes.La medición cervical promedio en el grupo pretérmino y el grupo a término fue respectivamente 21.1 ± 9.2 versus 29.2 ± 8.2; p=<0.01. Los factores de riesgo de PP idiopático identificados fueron cérvix corto (ORa=5.9), obesidad materna (ORa=5.7), antecedente de parto pretérmino (ORa=5.5), edad materna avanzada (ORa=2,5), antecedente de cesárea previa (ORa=2.0), periodo intergenésico corto (ORa=1,7), periodo intergenésico largo (ORa=1,4) y primiparidad (ORa=1.0). Conclusiones. Los factores de riesgo asociados para parto pretérmino idiopático son longitud cervical corta, obesidad materna, antecedente de parto pretérmino, edad materna avanzada, antecedente de cesárea previa, periodo intergenésico corto, periodo intergenésico largo y primiparidad.
Objetivo. Describir el perfil sociodemográfico de gestantes en el Perú según regiones naturales. Métodos. Estudio realizado a partir de la fuente de datos de ENDES 2014-2018, se incluyeron 5464 ...gestantes que cumplieron criterios de selección. Se aplicó estadística descriptiva y estadística inferencial. Resultados. Embarazo adolescente en la Costa fue de 13%, embarazo en añosas 15.3%; en la región de la Sierra el embarazo adolescente 14.7% y el embarazo en añosas 16.9%; en la región de la Selva el embarazo adolescente fue del 17.1% y el embarazo en añosas del 13.4%. Las mujeres gestantes que refirieron que no tenían la preferencia de quedar embarazadas en ese momento actual, fue en la Costa 62.4%, Sierra 62.1% y en la Selva 59.4%. Las gestantes que proceden de la Costa con mayor frecuencia tienen estudios de secundaria y pertenecer a un quintil intermedio de riqueza. Las gestantes que procedían de la Selva o la Sierra presentaron con mayor frecuencia estudios de solo primaria y pertenecer al quintil inferior de riqueza. Conclusiones. Existen diferencias en el perfil sociodemográfico de mujeres gestantes según regiones naturales en nuestro país, donde la edad, el nivel educativo, quintil de riqueza, deseos de quedar embarazada representan un papel importante que contribuyen a conocer la evolución y las tendencias en el perfil de las gestantes.
Objetivo: Evaluar la situación y determinantes sociales de la anemia en gestantes de centros poblados y comunidades rurales del Perú durante el año 2017. Materiales y Métodos: Estudio Transversal ...utilizando la base de datos de la Encuesta Demográfica y de Salud Familiar (ENDES) 2017. Se analizaron los registros de 8 533 mujeres gestantes pertenecientes a centros poblados y comunidades rurales incluyendo gestantes que residen en la capital y capitales departamentales. Se analizó la estadística descriptiva y regresión logística. Resultados: El 28% de las pacientes presentaron anemia en la gestación. Aquellas pacientes que pertenecen a centros poblados y comunidades rurales del Perú tienen un OR 2,0 IC95% (1,4-2,9) p <0,001 en comparación con las gestantes que residen en las capitales departamentales y la capital nacional. Conclusiones: Existe asociación entre el lugar de residencia geográfica de las gestantes en centros poblados y comunidades rurales con la presencia de anemia en el embarazo en la población peruana.
In view of ongoing pandemic threats such as the recent human cases of novel avian influenza A(H7N9) in China, it is important that all countries continue their preparedness efforts. Since 2006, ...Central American countries have received donor funding and technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) to build and improve their capacity for influenza surveillance and pandemic preparedness. Our objective was to measure changes in pandemic preparedness in this region, and explore factors associated with these changes, using evaluations conducted between 2008 and 2012.
Eight Central American countries scored their pandemic preparedness across 12 capabilities in 2008, 2010 and 2012, using a standardized tool developed by CDC. Scores were calculated by country and capability and compared between evaluation years using the Student's t-test and Wilcoxon Rank Sum test, respectively. Virological data reported to WHO were used to assess changes in testing capacity between evaluation years. Linear regression was used to examine associations between scores, donor funding, technical assistance and WHO reporting.
All countries improved their pandemic preparedness between 2008 and 2012 and seven made statistically significant gains (p < 0.05). Increases in median scores were observed for all 12 capabilities over the same period and were statistically significant for eight of these (p < 0.05): country planning, communications, routine influenza surveillance, national respiratory disease surveillance, outbreak response, resources for containment, community interventions and health sector response. We found a positive association between preparedness scores and cumulative funding between 2006 and 2011 (R2 = 0.5, p < 0.01). The number of specimens reported to WHO from participating countries increased significantly from 5,551 (2008) to 18,172 (2012) (p < 0.01).
Central America has made significant improvements in influenza pandemic preparedness between 2008 and 2012. U.S. donor funding and technical assistance provided to the region is likely to have contributed to the improvements we observed, although information on other sources of funding and support was unavailable to study. Gains are also likely the result of countries' response to the 2009 influenza pandemic. Further research is required to determine the degree to which pandemic improvements are sustainable.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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