Streptococcus pneumoniae isolated from patients with invasive pneumococcal disease has been subjected to laboratory-based surveillance in Latin American and Caribbean countries since 1993. Invasive ...pneumococcal diseases remain a major cause of death and disability worldwide, particularly in children. We therefore aimed to assess the direct effect of pneumococcal conjugate vaccines (PCVs) on the distribution of pneumococcal serotypes causing invasive pneumococcal disease in children younger than 5 years before and after PCV introduction.
We did a multicentre, retrospective observational study in eight countries that had introduced PCV (ie, PCV countries) in the Latin American and Caribbean region: Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Paraguay, and Uruguay. Cuba and Venezuela were also included as non-PCV countries. Isolate data for Streptococcus pneumoniae were obtained between 2006 and 2017 from children younger than 5 years with an invasive pneumococcal disease from local laboratories or hospitals. Species' confirmation and capsular serotyping were done by the respective national reference laboratories. Databases from the Sistema Regional de Vacunas (SIREVA) participating countries were managed and cleaned in a unified database using Microsoft Excel 2016 and the program R (version 3.6.1). Analysis involved percentage change in vaccine serotypes between pre-PCV and post-PCV periods and the annual reporting rate of invasive pneumococcal diseases per 100 000 children younger than 5 years, which was used as a population reference to calculate percentage vaccine type reduction.
Between 2006 and 2017, 12 269 isolates of invasive pneumococcal disease were collected from children younger than 5 years in the ten Latin American and Caribbean countries. The ten serotypes included in ten-valent pneumococcal conjugate vaccine (PCV10) decreased significantly (p<0·0001) after any PCV introduction, except for the Dominican Republic. The percentage change for the ten vaccine serotypes in PCV10 countries was −91·6% in Brazil (530 72·9% of 727 before, 27 6·1% of 441 after); −85·0% in Chile (613 72·6% of 844 before, 44 10·9% of 404 after); −84·7% in Colombia (231 63·1% of 366 before, 34 9·7% of 352 after); and −73·8% in Paraguay (127 77·0% of 165 before, 22 20·2% of 109 after). In the 13-valent pneumococcal conjugate vaccine (PCV13) countries, the percentage change for the 13 vaccine serotypes was −59·6% in Argentina (853 85·0% of 1003 before, 149 34·3% of 434 after); −16·5% in the Dominican Republic (95 80·5% of 118 before, 39 67·2% of 58 after); −43·7% in Mexico (202 73·2% of 276 before, 63 41·2% of 153 after); and −45·9% in Uruguay (138 80·7% of 171 before, 38 43·7% of 87 after). Annual reporting rates showed a reduction from −82·5% (6·21 before vs 1·09 after per 100 000, 95% CI −61·6 to −92·0) to −94·7% (1·15 vs 0·06 per 100 000, −89·7 to −97·3) for PCV10 countries, and −58·8% (2·98 vs 1·23 per 100 000, −21·4 to −78·4) to −82·9% (7·80 vs 1·33 per 100 000, −76·9 to −87·4) for PCV13 countries. An increase in the amount of non-vaccine types was observed in the eight countries after PCV introduction together with an increase in their percentage in relation to total invasive strains in the post-PCV period.
SIREVA laboratory surveillance was able to confirm the effect of PCV vaccine on serotypes causing invasive pneumococcal disease in the eight PCV countries. Improved monitoring of the effect and trends in vaccine type as well as in non-vaccine type isolates is needed, as this information will be relevant for future decisions associated with new PCVs.
None.
For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
The nematode
has been reported worldwide. However, some basic questions remain unanswered about
.
in Ecuador: (1) Was the invasion of
.
in Ecuador unique, or did it occur in different waves? (2) Was ...this invasion as recent as historical records suggest? (3) Did this invasion come from other regions of South America or elsewhere? To address these issues, we assessed the genetic diversity of MT-CO1 gene sequences from isolates obtained in 11 of Ecuador's 24 provinces. Our Bayesian inference phylogenetic tree recovered
.
as a well-supported monophyletic group. All 11 sequences from Ecuador were identical and identified as AC17a. The haplotype AC17a, found in Ecuador and the USA, formed a cluster with AC17b (USA), AC13 (Thailand), and AC12a-b (Cambodia). Notably, all the samples obtained in Ecuadorian provinces' different geographic and climatic regions had no genetic difference. Despite the lack of genetic information on
.
in Latin America, except in Brazil, our finding differs from previous studies by its absence of gene diversity in Ecuador. We concluded that the invasion of
.
in Ecuador may have occurred: (1) as a one-time event, (2) recently, and (3) from Asia via the USA. Further research should include samples from countries neighboring Ecuador to delve deeper into this.
RESUMEN Introducción: La angiostrongiliasis humana presenta un amplio espectro clínico: desde una infección asintomática a meningitis eosinofílica, meningoencefalitis eosinofílica y ...angiostrongiliasis ocular. Objetivo: Determinar los conocimientos, percepciones y prácticas en relación con la infección por Angiostrongylus cantonensis que poseen médicos de atención primaria de la República del Ecuador. Métodos: Se realizó un estudio observacional descriptivo. Se diseñó, validó y aplicó una encuesta sobre conocimientos, percepciones y prácticas a 163 médicos de atención primaria de las provincias Napo y Guayas, entre los meses de noviembre y diciembre de 2017. La información obtenida se almacenó en una base de datos Microsoft Access y se realizó un análisis de frecuencias a las respuestas dadas a cada una de las preguntas. Resultados: Se encontraron conocimientos insuficientes, percepciones inadecuadas y prácticas incorrectas en relación con la angiostrongiliasis. Conclusiones: Estos resultados orientan hacia la implementación de un programa de intervención educativa en médicos de atención primaria con el fin de atenuar las deficiencias encontradas, para incidir de forma positiva en comunidades donde existe la presencia de hospederos intermediarios y definitivos infectados y un riesgo potencial de infección.
El coronavirus de tipo 2 del síndrome respiratorio agudo severo es el agente causal de la COVID-19. En la semana del 21 al 27 de marzo de 2021 se confirmó en Cuba un incremento del 8% de los casos. ...El Ministerio de Salud Pública de Cuba decidió aprobar la intervención sanitaria con los candidatos vacunales SOBERANA para ser administrados al personal que laboraba en instituciones de salud. Los objetivos del presente trabajo son describir las coberturas de vacunación alcanzadas con el esquema heterólogo de SOBERANA y la progresión de la enfermedad en los sujetos vacunados con el mismo. Se trata de un estudio descriptivo, prospectivo. Se captaron 884 sujetos que cumplieron los criterios para ser incluidos. Los sujetos fueron seguidos por los investigadores del sitio centinela durante la aplicación del esquema y 5 meses después de concluido. Se lograron adecuadas coberturas de vacunación para el esquema heterólogo de tres dosis de SOBERANA. Las comorbilidades más frecuentes en el grupo de trabajadores que enfermó de COVID-19 después de 14 días de culminado el esquema heterólogo fueron: hipertensión arterial, asma, diabetes mellitus tipo 2 y cardiopatía isquémica. La mayor proporción de enfermos correspondió a los que trabajaron durante la pandemia en zona roja con alto riesgo, seguido de los que trabajaron en zona verde y en el grupo de los profesionales y, por último, los trabajadores no profesionales no técnicos. No se describió progresión de la enfermedad hacia las formas graves y críticas en los trabajadores vacunados. Los síntomas y signos más frecuentes en el grupo de enfermos fueron fiebre, tos, astenia y anorexia. Se lograron adecuadas coberturas vacunales, llegando a ser abortada la progresión de la enfermedad a formas graves o críticas a pesar de la alta exposición laboral del personal y la existencia de comorbilidades crónicas.
meningococcal disease is an important health problem worldwide. Since 1991 the vaccine VA-MENGOC-BC has been used in Cuban under one-year old infants.
to evaluate the effectiveness of the vaccine ...VA-MENGO-BC METHODS: for the evaluation after licensing this vaccine, all the infants affected by meningococcal disease between 1997 and 2008 were studied.
a total number of 114 cases were recorded. The annual average incidence was 7.1 per 100 000 infants. The mean vaccinal effectiveness for the period was 84.0 %, ranging from 68 % to 104 %. The frequency of disease in unvaccinated children was 20.2 % (23/114); 79.8 % (91/114) within the vaccination age, but only 75.8 % (69/91) of them had confirmed the immunization date. Only 26.4 % (24/91) had one single dose applied whereas 73.6 % (67/91) had completed their vaccination schedule (2 doses). The meningococcal disease prevailed in the first six months of life, declined afterwards and then started to rise again at 10 and 11 months of age. The meningeal form of clinical presentation predominated (89.5 %); case-fatality rate was 7.0 % (8/114), being 4.4 % for meningococcemia and 2,6 % for meningitis.
the vaccine VA-MENGOC-BC effectiveness in infants was satisfactory. It is suggested that further analysis be made by a group of experts on the use of a booster dose.
SOBERANA-02 is a COVID-19 conjugate vaccine (recombinant RBD conjugated to tetanus toxoid). Phases 1/2 clinical trials demonstrated high immunogenicity, promoting neutralising IgG and specific T-cell ...response. A third heterologous dose of SOBERANA-Plus (RBD-dimer) further increased neutralising antibodies. The aim of this study is to evaluate the safety and efficacy of two immunisation regimes: two doses of SOBERANA-02 and a heterologous three-dose combination with SOBERANA-Plus added to it.
From March 8th to June 24th, 2021 we conducted in Havana, Cuba a multicentre randomised, double-blind, placebo-controlled, phase-3 trial evaluating a two doses SOBERANA-02 scheme and a heterologous scheme with one dose SOBERANA-Plus added to it (RPCEC00000354). Participants 19–80 years were randomly assigned to receiving 28 days apart either the two or three dose scheme or placebo. The main endpoint was vaccine efficacy in preventing the occurrence of RT-PCR confirmed symptomatic COVID-19 at least 14 days after the second or third dose in the per-protocol population. We also assessed efficacy against severe disease and, in all participants receiving at least one vaccine/placebo dose, safety for 28 days after each dose.
We included 44,031 participants (52.0% female, 48.0% male; median age 50 years, range 19–80 years; 7.0% black, 24.0% mixed-race, 59.0% white) in a context of initial Beta VOC predominance, with this variant being partially replaced by Delta near the trial's end. Vaccine efficacy in the heterologous combination was 92.0% (95%CI 80.4–96.7) against symptomatic disease. There were no severe COVID-19 cases in the vaccine group against 6 in the placebo group. Two doses of SOBERANA-02 was 69.7% (95%CI 56.5–78.9) and 74.9% (95%CI 33.7–90.5) efficacious against symptomatic and severe COVID-19, respectively. The occurrence of serious and severe adverse events (AE) was very rare and equally distributed between placebo and vaccine groups. Solicited AEs were slightly more frequent in the vaccine group but predominantly local and mostly mild and transient.
Our results indicate that the straightforward to manufacture SOBERANA vaccines are efficacious in a context of Beta and Delta VOC circulation, have a favourable safety profile, and may represent an attractive option for use in COVID-19 vaccination programmes.
This study received funds from the National Fund for Science and Technology (FONCI-CITMA-Cuba, contract 2020–20) of the Ministry of Science, Technology and Environment of Cuba.
The nematode Angiostrongylus cantonensis has been reported worldwide. However, some basic questions remain unanswered about A. cantonensis in Ecuador: (1) Was the invasion of A. cantonensis in ...Ecuador unique, or did it occur in different waves? (2) Was this invasion as recent as historical records suggest? (3) Did this invasion come from other regions of South America or elsewhere? To address these issues, we assessed the genetic diversity of MT-CO1 gene sequences from isolates obtained in 11 of Ecuador’s 24 provinces. Our Bayesian inference phylogenetic tree recovered A. cantonensis as a well-supported monophyletic group. All 11 sequences from Ecuador were identical and identified as AC17a. The haplotype AC17a, found in Ecuador and the USA, formed a cluster with AC17b (USA), AC13 (Thailand), and AC12a-b (Cambodia). Notably, all the samples obtained in Ecuadorian provinces’ different geographic and climatic regions had no genetic difference. Despite the lack of genetic information on A. cantonensis in Latin America, except in Brazil, our finding differs from previous studies by its absence of gene diversity in Ecuador. We concluded that the invasion of A. cantonensis in Ecuador may have occurred: (1) as a one-time event, (2) recently, and (3) from Asia via the USA. Further research should include samples from countries neighboring Ecuador to delve deeper into this.
•Introducing a domestic pneumococcal conjugate vaccine is likely to be cost-effective in Cuba.•In a ‘worst case’ scenario, cost per DALY averted was still less than 0.4 GDP per capita.•The impact of ...the vaccine would need to be monitored following its introduction.
To evaluate the cost-effectiveness of introducing a domestic pneumococcal conjugate vaccine (PCV7-TT) into the Cuban National Immunization Program (NIP).
We compared PCV7-TT given at two, four and six months of age to a scenario without PCV7-TT, over a ten-year period (2020–2029). We calculated the cost (Cuban pesos – CUP) per Disability Adjusted Life Year (DALY) averted from a Government perspective. We compared results from a static cohort model and a parsimonious prediction model informed by the serotype distribution among pneumococcal carriers and cases. We ran probabilistic and deterministic uncertainty analyses.
PCV7-TT could prevent 6897 (95% uncertainty interval, 4344–8750) hospitalizations and 189 (115–253) deaths in children <5 years of age, over the period 2020–2029. This could cost around 25 million (20–31) discounted CUP but would be offset by treatment cost savings of around 23 million (14–31). A parsimonious model predicted less favourable impact and cost-effectiveness but the cost per DALY averted was still less than 0.4 times the current GDP per capita.
PCV7-TT is likely to be cost-effective in Cuba. The impact of the vaccine would need to be carefully monitored following its introduction into the NIP.
PDF
