•Infants are at particular risk of meningococcal disease caused by Neisseria meningitidis.•MenACWY-TT is a meningococcal vaccine targeting 4 of the 6 most prevalent serogroups.•3+1 (at ages 2, 4, 6, ...15–18 months); 1+1 (6, 15–18 months) or 1-dose (15–18 months) MenACWY-TT schedules were immunogenic.•Co-administration of MenACWY-TT with other pediatric vaccines was well-tolerated.
Invasive meningococcal disease has a high burden in young children, particularly during infancy. We investigated the immunogenicity and safety of a quadrivalent meningococcal conjugated vaccine (MenACWY-TT) co-administered with routine vaccines in healthy infants.
In this phase IIIb study (NCT01340898) conducted in 2 centers in Lebanon and Mexico, 750 infants were randomized (2:1:1) to receive MenACWY-TT according to 3 schedules: 3+1 (at ages 2, 4, 6 and 15–18 months; group ACWY3+1); 1+1 (at 6 and 15–18 months; group ACWY1+1) or single-dose at 15–18 months (group ACWY1). All infants received PHiD-CV and DTPa-IPV/Hib at ages 2, 4, 6, 15–18 months. Immune responses to MenACWY-TT were assessed by rSBA and hSBA at 7 months (groups ACWY3+1, ACWY1+1) and pre- and post-vaccination at 15–18 months of age (all groups). Immune responses to co-administered vaccines, reactogenicity and safety were also evaluated.
Immunogenicity of MenACWY-TT at 1 month post-primary vaccination was demonstrated in group ACWY3+1: the lower limit of the 95% confidence interval for the percentage of infants with rSBA titers ≥8 was >80% for each serogroup. At 7 months of age, ≥93.9% of MenACWY-TT-primed infants had rSBA titers ≥8. Post-MenACWY-TT vaccination at age 15–18 months, ≥96.3% of participants in all groups had rSBA titers ≥8, regardless of the number of doses received previously. The percentage of infants with hSBA titers ≥4 were ≥87.2% and ≥89.7% at post-primary and booster/single-dose vaccination, respectively. Immune responses to PHiD-CV and DTPa-IPV/Hib did not seem impacted by co-administration with MenACWY-TT in infancy. The incidence of all adverse events was similar among groups. Serious adverse events were reported for 63/750 children in all groups; none were considered vaccine-related by investigators.
Primary vaccination with 3 or 1 dose(s) of MenACWY-TT when co-administered with routine pediatric vaccines in infants is immunogenic and well-tolerated.
Introduction
The risk of herpes zoster (HZ) increases with age. In countries with an ageing population such as Mexico, a rise in the risk of HZ and complications is expected. The goal of this study ...was to provide an updated estimate of the potential burden of HZ and associated complications in Mexico.
Methods
A retrospective database study was performed using data from the national surveillance database of the Ministry of Health (Secretaría de Salubridad y Asistencia/Dirección General de Información en Salud). HZ cases and associated complications were identified via the International Classification of Diseases 10th Revision codes. Emergency room (ER) visits, hospitalizations, and deaths were extracted and analyzed by age group and year. The observation period was between 2011 and 2020 for ER visits and hospitalizations and between 2011 and 2019 for deaths. Cumulative incidence per 1000 people and case fatality rate were estimated.
Results
During the observation period, 53,030 ER visits, 4172 hospitalizations, and 263 deaths due to HZ were reported nationwide. The cumulative incidence of HZ based on ER visits was 1.04 per 1000 people aged ≥ 50 years but increased in older age groups (1.47 per 1000 people aged ≥ 65 years). The most common complications were neuralgia (10.9%), ocular disease (7.0%), meningoencephalitis (2.9%), and disseminated disease (3.1%). Patients ≥ 65 years accounted for 37% of hospitalizations and 81% of deaths.
Conclusion
In Mexico, HZ and its complications impose a considerable burden on the population and the healthcare system. Prospective surveillance studies are required to obtain an accurate picture of the current epidemiology of HZ in Mexico and to estimate the benefits of future vaccination strategies against HZ.
Plain Language Summary
Herpes zoster (HZ), also called shingles, is a disease typically characterized by a painful skin rash. It affects mostly older adults and immunocompromised populations. Approximately 30% of patients have complications such as prolonged, severe pain; eye disease; or disease affecting parts of the body other than the skin. In this study, we analyzed national passive surveillance data for HZ disease and related complications in Mexico. Over the last 10 years (2011–2020), more than 50,000 cases and 4000 hospitalizations have been observed. In those, 263 people died, and most of the deaths (81%) occurred in people aged 65 years or older. Since the proportion of older people in the Mexican population will increase over the next decades, herpes zoster will probably become more frequent and complicated. Vaccination against HZ could help protect the older population against this serious disease.
Highlights • Streptococcus pneumoniae serotype 19A is a frequent pathogen in infants aged ≤60 days. • Serotypes 3, 6A, 10A, 12F, and 15A/B increased after the introduction of heptavalent pneumococcal ...conjugate vaccine (PCV7) in infants aged ≤60 days. • Theoretical serotype coverage among children aged ≤60 days during the period 2000–2014 was 63.5% for PCV13.
Abstract
Background
Fungal meningitis can be associated with epidural anesthesia procedures. Fusariosis is a rare infection typically affecting immunocompromised patients and rarely causes ...meningitis. During 2022–2023, public health officials responded to a large outbreak of Fusarium solani meningitis associated with epidural anesthesia in Durango, Mexico.
Methods
The public health response and epidemiological and clinical features of patients affected by this outbreak were described. Coordinated actions were addressed to identify the etiological agent, determine its drug susceptibility, develop diagnostic tests, and implement clinical and epidemiological protocols. Retrospective analyses of clinical variables and outcomes were performed to determine association with better patient survival.
Results
A total of 1801 persons exposed to epidural anesthesia were identified, of whom 80 developed meningitis. Fusarium solani was found in 3 brain biopsies and showed susceptibility to voriconazole and amphotericin B. After F solani polymerase chain reaction (PCR) implementation, 57 patients with meningitis were PCR-screened, and 31 (38.8%) had a positive result. Most patients were female (95%), and cesarean section was the most common surgical procedure (76.3%). The case fatality rate was 51.3% (41 patients) and the median hospitalization duration was 39.5 days (interquartile range, 18–86 days). Seventy-one patients (88.8%) received voriconazole/amphotericin B and 64 subjects (80%) additionally received steroids. Cox regression analysis showed an increased lethality risk in patients who received antifungal treatment after 5 days (hazard ratio, 2.1 95% confidence interval, 1.01–4.48, P < .05).
Conclusions
The F solani meningitis outbreak in Durango was an unprecedented medical challenge. Timely treatment and effective healthcare management were associated with better survival outcomes.
During 2022–2023, an outbreak of Fusarium solani–related meningitis occurred in Durango, Mexico, affecting 80 patients with a mortality of 51.3%. Prompt antifungal treatment and increased health awareness were associated with patient survival.
To describe the antimicrobial use in four tertiary care hospitals in Mexico.
Point prevalence surveys (PPSs) were conducted on medical records of hospitalized patients with prescribed antimicrobials ...(AMs) in four tertiary care hospitals in Mexico in 2019. Prevalence estimates and descriptive statistics were used to present the collected data on antimicrobial prescribing and microbiological studies.
The prevalence of patients with prescribed AMs among the hospitals ranged from 47.1% to 91.3%. Antibiotics for systemic use (J01s) were the most prescribed (84.6%, 95% CI: 81.5-87.3), mainly extended-spectrum J01s: third-generation cephalosporins 19.8% 95% CI: 16.8-23.1, and carbapenems 17.0% 95% CI: 14.2-20.2. Antibiotic treatments were largely empirical, with no planned duration or review dates. The ceftriaxone use was excessive and prolonged. No formal reference guidelines for antimicrobial prescribing were available in the hospitals. Multidrug-resistant
and ESKAPE pathogens were identified in all hospitals.
This study describes the extensive use of antimicrobials and broad-spectrum antibiotics for systemic use in Mexican hospitals, along with the presence of resistant pathogens to the antibiotics frequently used in the hospitals surveyed.
Background and Aims Streptococcus pneumoniae constitutes one of the main causes of sepsis, bacteremia and meningitis (pneumococcal invasive disease – PID), and pneumonia in infants and small ...children. Antipneumococcal vaccination in Mexico is expected to be a useful strategy to reduce morbimortality due to this cause. We undertook this study to determine the prevalence of PID and pneumonia and the PCV vaccination status of affected children as well as serotype distribution and antimicrobial susceptibility of pneumococcal strains responsible for PID in infants and small children in Mexico. Methods From March 2010–June 2011, a prospective multicenter study was carried out in four states in Mexico to determine the prevalence of bacteremia, meningitis, septic arthritis and pneumonia due to S. pneumoniae and other microorganisms in children from 28 days–59 months of age. Isolated pneumococcal strains were serotyped and their antimicrobial resistance determined. Results During the study period, 545 children were diagnosed with bacteremia, meningitis, septic arthritis or pneumonia; 46.7% of these clinical entities occurred among children <12 months of age. Community-acquired pneumonia was the most prevalent disease. It was possible to identify a causal microorganism in 55 cases, from which 80% were S. pneumoniae. Fifteen percent of patients with PID died. The most prevalent pneumococcal serotypes were 19A, 35B, 19F and 6A. 10.2% of nonmeningeal strains were resistant to meropenem and 82% were resistant to TMP/SMX. Conclusions This study shows that pneumococcus was the most common bacteria isolated in the studied population, although epidemiological and laboratory-based surveillance still needs improvement.
Hospital-acquired infections caused by multiresistant gram-negative bacteria are difficult to treat and cause high rates of morbidity and mortality. The analysis of antimicrobial resistance trends of ...gram-negative pathogens isolated from hospital-acquired infections is important for the development of antimicrobial stewardship programs. The information obtained from antimicrobial resistant programs from two hospitals from Mexico will be helpful in the selection of empiric therapy for hospital-acquired gram-negative infections.
Two thousand one hundred thirty two gram-negative bacteria collected between January 2005 and December 2010 from hospital-acquired infections occurring in two teaching hospitals in Mexico were evaluated. Escherichia coli was the most frequently isolated gram-negative bacteria, with >50% of strains resistant to ciprofloxacin and levofloxacin. Klebsiella spp. showed resistance rates similar to Escherichia coli for ceftazidime (33.1% vs 33.2%), but exhibited lower rates for levofloxacin (18.2% vs 56%). Of the samples collected for the third most common gram-negative bacteria, Pseudomonas aeruginosa, >12.8% were resistant to the carbapenems, imipenem and meropenem. The highest overall resistance was found in Acinetobacter spp. Enterobacter spp. showed high susceptibility to carbapenems.
E. coli was the most common nosocomial gram-negative bacilli isolated in this study and was found to have the second-highest resistance to fluoroquinolones (>57.9%, after Acinetobacter spp. 81.2%). This finding represents a disturbing development in a common nosocomial and community pathogen.
Background and Aims Streptococcus pneumoniae is the leading cause of acute otitis media, pneumonia, meningitis, and sepsis. The heptavalent pneumococcal conjugate vaccine (PCV7) was incorporated into ...the national immunization program in Mexico in 2008. The aim of the study was to analyze the frequency of S. pneumoniae serotypes isolated from children ≤5 years of age with invasive diseases before and after the introduction of PCV7. Methods Isolates from sterile fluids, tissues and other body fluids were obtained from 1993 to 2012. Isolates collected in hospitals for the surveillance network were sent to the Instituto Nacional de Salud Publica. Serotyping was done using the Quellung reaction. The pre-vaccination period was considered from 1993–2007. Results A total of 1346 isolates were collected during 1993–2012. In the pre-vaccination era, serotypes included in PCV7 accounted for 59.7% of the strains, whereas in 2012 they represented only 21% of cases. There was a significant decrease in all PCV7-included serotypes. A gradual increase of the 19A serotype was detected during the vaccination period from 7% in 2008 to 39% of the isolates in 2012. In this year, 29% of the serotypes causing invasive disease were not included in any of the pneumococcal conjugate vaccines. Conclusion The emergence of PCV7 non-included serotypes after vaccination demands increased surveillance. Currently in Mexico, the 13-valent conjugate vaccine (PCV13) offers better coverage than the 10-valent pneumococcal conjugate vaccine (PCV10).
Highlights • We describe an annual decrease in the proportion of pneumococcal serotypes included in pneumococcal conjugate vaccines (PCV) causing invasive and non-invasive pneumococcal disease among ...people. • 5 years of age not targeted to receive the vaccine, after introduction of PCV in the universal vaccine program. • The strongest decrease of pneumococcal diseases was observed in the group of adults from 18 to 49 years of age. • A statistically significant increase of serotype 19A in all study groups was observed, except in adults ≥65 years. • A significant increase of non-vaccine pneumococcal serotypes was observed after the introduction of PCV: Serogroup 15 in the age group 50-64 years and serogroup 23 in children and adolescents among 5-17 years old.
PDF
