To study the epidemiology of invasive pneumococcal infections in infants and young children in Santiago, Chile, as a representative pediatric population in a newly industrializing country where ...pneumococcal conjugate vaccines may be used in the future.
A 5-year retrospective laboratory-based review (1989 to 1993) was followed by a 3-year prospective laboratory and hospital surveillance study in two of the six health administrative areas of Santiago to detect all hospitalized cases of invasive pneumococcal disease (defined as Streptococcus pneumoniae isolated from blood, cerebrospinal fluid or another normally sterile site) among infants and children (0 to 23 months of age in the retrospective and 0 to 59 months of age in the prospective study).
During the 5-year retrospective survey the incidence of invasive pneumococcal disease was 90.6 cases per 10(5) infants 0 to 11 months old and 18.5 cases per 10(5) toddlers 12 to 23 months old. Similar rates (60.2 per 10(5) infants and 18.1 per 10(5) toddlers) were recorded during the 3 years of prospective surveillance. Among the 110 cases in children 0 to 59 months of age detected during the 3-year prospective surveillance, 2 clinical forms, pneumonia and meningitis, accounted for 87.2% of all cases; 13 of the 49 pneumonia patients (26%) had empyema as a complication. Notably 40 of the 110 cases (36.4%) occurred before 6 months of age (63.4% of the 63 infant cases). Serotypes 1, 14, 5 and 6B were the most prevalent. Overall 76 and 69%, respectively, of S. pneumoniae isolates were antigenic types that would be covered by the 11- or 9-valent conjugate vaccines under development.
Invasive pneumococcal infections in Santiago, Chile, exhibit an epidemiologic pattern intermediate between that of developing and industrialized countries. The high burden of disease in early infancy dictates that an accelerated immunization schedule (beginning in the perinatal period) or maternal immunization with pneumococcal vaccines should be explored.
As expert consensus has been arisen about universal antiparasitic treatment for all patients infected with Trypanosoma cruzi, most important drugs licensed for Chagas disease treatment are reviewed: ...nifurtimox and benznidazol, their mechanisms of action, doses, treatment schedules, adverse effects and contraindications. Two other drugs used for Chagas disease treatment, for which a Chilean experience may be exhibited, are allopurinol and itraconazole. Indications for treatment of Chagas disease in immunocompetent patients and immunocompromised hosts are detailed. This chapter refers besides to the evaluation and monitoring of antiparasitic therapy in immunocompromised patients, the availability of drugs and includes various forms facsimiles suggested to perform clinical and laboratory follow up of patients that undergo treatment, indicating the prescribed drug, adverse effects and time of follow up.
The primary intention of this work is to provide a starting point for a realisation of an electronic antenatal health record in Norway. Furthermore, the ambition was to conduction an evaluation into ...the potential for using archetypes for representation of structured clinical information in antenatal health care in Norway. Focus of work has been to investigate former projects in electronic solutions for antenatal health records, to gain knowledge of earlier practical experiences regarding development of archetypes and finally how lessons learnt in both can be applicable and utilised in the development of an electronic antenatal health care record in Norway. To answer these questions a qualitative case study has been performed including a literature review and interviews with informants acting within antenatal health care. As a proof-of-concept for direct reuse of formerly developed archetypes, candidate archetypes have been translated and a template has been designed. In addition all candidate archetypes have been evaluated as to clinical content coverage as regards Norwegian requirements, as well as thoroughly assessed utilising published Archetype Quality Requirements. Through this qualitative case study I have learnt the importance of involving all stakeholders as early as possible in development projects in general as in archetype development specifically. It is also important to sustain stakeholder involvement throughout the development cycle to ensure that the interests of all stakeholders are met. The in-depth validation of clinical content in candidate archetypes shows that Norwegian requirements for clinical content in antenatal health care records are met. Furthermore, the in depth validation of the quality of archetypes has resulted in significant findings for Norwegian stakeholders in antenatal health care; a thorough investigation and clarification process regarding intended use of an electronic antenatal health care record has to be initiated and concluded before development activities can commence. The need for stakeholder inclusion in a development project is also identified for antenatal health records. The identification of clinical content provided by the present project can be seen as a first step in the development of a Norwegian antenatal health record. There has also been identified significant findings regarding how translation of archetypes can be facilitated; by establishing a demonstration archetype including most commonly utilised terms in archetypes, in order to secure consistent translations with good quality in all archetypes. Finally, the in-depth evaluation regarding the metadata quality in archetypes has provided significant results with proposals for additions, specifications and needed alterations of the Archetype Quality Requirements that are published by Kalra et al (2012). To my knowledge, no other project has utilised and thoroughly evaluated these quality requirements.
A contar del año 1998 se han presentado en Chile tres brotes epidémicos por Vibrio parahaemolyticus, el último de ellos durante el verano del 2005, que afectó a más de 10.000 personas. Los afectados ...presentaron un cuadro clínico caracterizado por diarrea, náuseas, vómitos, dolor abdominal y fiebre; 6% de los casos tuvo leucocitos fecales positivos y un paciente falleció. La cepa predominante en los tres brotes ha sido la pandémica O3: K6. El diagnóstico de V. parahaemolyticus se realizó con la confirmación microbiológica de las cepas y tipificación o por asociación epidemiológica. Las cepas fueron susceptibles in vitro a tetraciclina, cefalosporinas de tercera generación, quinolonas y cloranfenicol no observándose susceptibilidad a ampicilina. Todos los casos se asociaron al consumo de mariscos crudos o insuficientemente cocidos. Por la repercusión de este brote, el Ministerio de Salud impulsó la formación de una comisión multidisciplinaria para actualizar los aspectos epidemiológicos, clínicos y microbiológicos, y elaborar una guía de recomendaciones en el manejo de esta infección.
Los autores, en referencia a un artículo anterior en esta revista, hacen un resumen de su propia perspectiva histórica acerca del manejo de la salud pública en Chile en relación a enfermedades ...transmisibles, que no coincide con los planteamientos básicamente críticos efectuados por el autor de dicho artículo. Se reconoce que existe mucho camino por andar en esta materia, pero que los esfuerzos realizados en Chile son muy significativos y no pueden desconocerse, incluso muchos resultan pioneros o líderes en América Latina, lo cual ha sido reconocido reiteradamente por los organismos internacionales del sector. La relación entre el Laboratorio Nacional y de Referencia (Instituto de Salud Pública de Chile), el Ministerio de Salud (Epidemiología y Disam) y la red de laboratorios, ha contribuido fuertemente a lo largo de muchos años, a la concreción de logros sanitarios que nos enorgullecen en el ámbito de las infecciosas transmisibles
The authors present an abridged history from their personal point of view of public health dealing with communicable diseases in Chile, in reference to an article previously published in Revista ...Chilena de Infectología. They do not agree with the mainly critical view of the author. They recognize that although there is a lot to be done on this matter, Chile has been a pioneer in Latin America in many policies relating to the control of these infections, having been recognized by international organisms. The relationship between the National Institute of Public Health, the Ministry of Health and the Laboratory Network, has strongly contributed along the years to concrete sanitary achievements in the field of transmissible diseases which are a pride for our country.
Nine- and 11-valent pneumococcal conjugate vaccines under development may control pediatric pneumococcal disease in nonindustrialized countries. Because these vaccines are expensive, population-based ...surveillance of pneumococcal disease in children <36 months of age was undertaken in Santiago, Chile to provide health authorities with reliable data on the burden of invasive pneumococcal disease and causative serotypes, including those in outpatients with high fever.
Automated blood culture machines were introduced into 9 hospitals that admit 85% of all hospitalized children in Santiago. Acutely ill pediatric febrile ambulatory patients are attended at 8 emergency rooms (ERs) and 36 urgent primary care services. After a 12-month pilot study in 3 ERs, health authorities collected blood cultures from children <36 months of age with high fever seen in the ER as standard practice. isolates were serotyped.
Blood cultures of 18 (1.2%) of 1,503 outpatients 6 to 35 months of age with high fever in the pilot study yielded S. In the ensuing 24 months 236 children <36 months old were hospitalized with invasive pneumococcal disease (incidence, 33.9 cases/10(5) children), and 188 bacteremias were detected among ambulatory ER patients with high fever (incidence, 27.0 cases/10(5) children). Although serotypes were similar among hospitalized and ambulatory cases (except 18C, which was more common in the latter), case fatality was 9.5% in hospitalized (21 of 236) 0% in ambulatory cases (0 of 188) (P = <0.0001). High level resistance to penicillin (25.8% vs 10.1%) and cefotaxime (19.5% vs 6.2%) was observed more often among pneumococcal isolates from hospitalized than among ambulatory cases (P < 0.001).
ER surveillance detected approximately one case of pneumococcal bacteremia among febrile ambulatory patients for each hospitalized invasive case. Because 71% of cases were caused by vaccine serotypes (and 87% by vaccine serogroups), 9- and 11-valent pneumococcal conjugate vaccines could prevent most invasive pediatric pneumococcal disease in Chile.
Evolutionary theory may contribute to practical solutions for control
of disease by identifying interventions that may cause pathogens to
evolve to reduced virulence. Theory predicts, for example, ...that
pathogens transmitted by water or arthropod vectors should evolve to
relatively high levels of virulence because such pathogens can gain the
evolutionary benefits of relatively high levels of host exploitation
while paying little price from host illness. The entrance of Vibrio
cholerae into South America in 1991 has generated a natural experiment
that allows testing of this idea by determining whether geographic and
temporal variations in toxigenicity correspond to variation in the
potential for waterborne transmission. Preliminary studies show such
correspondences: toxigenicity is negatively associated with access to
uncontaminated water in Brazil; and in Chile, where the potential for
waterborne transmission is particularly low, toxigenicity of strains
declined between 1991 and 1998. In theory vector-proofing of houses
should be similarly associated with benignity of vectorborne pathogens,
such as the agents of dengue, malaria, and Chagas' disease. These
preliminary studies draw attention to the need for definitive
prospective experiments to determine whether interventions such as
provisioning of uncontaminated water and vector-proofing of houses
cause evolutionary reductions in virulence.
Four hundred ninety-nine methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered from 1996 to 1998 from 22 hospitals in five countries of Latin America-Argentina, Brazil, Chile, Uruguay ...and Mexico-were examined for antimicrobial susceptibility and clonal type in order to define the endemic clones in those hospitals. The hybridization of ClaI restriction digests with the mecA- and Tn554-specific DNA probes combined with pulsed-field gel electrophoresis of chromosomal SmaI digests (ClaI-mecA::ClaI-Tn554::PFGE clonal types) documented not only the predominance and persistence of the Brazilian clone (XI::B::B) in Brazil (97%) and Argentina (86%) but also its massive dissemination to Uruguay (100%). Moreover, a close relative of the Brazilian clone (XI::kappa::B) was highly represented in Chile (53%) together with a novel clone (47%) (II::E'::F) resistant to pencillin, oxacillin, ciprofloxacin, chloramphenicol, clindamycin, erythromycin, and gentamicin. A unique clonal type (I::NH::M) was detected in Mexico among pediatric isolates and was resistant to penicillin, oxacillin, and gentamicin only. This study clearly documented the very large capacity for geographic expansion and the persistence of the Brazilian clone, contributing not only to the increasing uniformity of the MRSA in South America but worldwide as well.
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