COVID-19 among Amazonian indigenous in Peru: mortality, incidence, and clinical characteristics.

BACKGROUND: Few studies have described the clinical characteristics of patients with COVID-19 from ethnic minority groups. Our objective was to evaluate the mortality and incidence rates, clinical characteristics and factors associated with mortality in cases with COVID-19 belonging to the Amazonian indigenous ethnic group in Peru. METHODS: We performed a retrospective cohort study including all cases from COVID-19 among Peruvian people identified as Amazonian indigenous from 07 March to 31 October 2020. We calculated the standardized mortality and incidence ratios using the indirect age-adjusted method to determine the differences between Amazonian Indigenous and the general population. In addition, we used multivariable logistic regression to determine the risk factors for death. RESULTS: A total of 19 018 laboratory confirmed COVID-19 cases were analyzed. Indigenous people had 3.18 (95% CI, 3.13-3.23) times the risk of infection and 0.34 (0.31-0.37) times the mortality risk of the general Peruvian population. Males had 1.29 (1.04-1.61) times the odds of death compared with females and for each year of age, the odds of mortality increased 1.03 (1.03-1.04) times. Cases with respiratory distress had 2.47 (1.96-3.10) times more likely to die. Having an immunodeficiency was 18.7 (6.12-57.00) times more likely to die. DISCUSSION: The Amazonian indigenous population in Peru was strongly affected by COVID-19 compared with the general Peruvian population.

Early transmission dynamics of COVID-19 in a southern hemisphere setting: Lima-Peru: February 29th-March 30th, 2020.

The COVID-19 pandemic that emerged in Wuhan China has generated substantial morbidity and mortality impact around the world during the last four months. The daily trend in reported cases has been rapidly rising in Latin America since March 2020 with the great majority of the cases reported in Brazil followed by Peru as of April 15th, 2020. Although Peru implemented a range of social distancing measures soon after the confirmation of its first case on March 6th, 2020, the daily number of new COVID-19 cases continues to accumulate in this country. We assessed the early COVID-19 transmission dynamics and the effect of social distancing interventions in Lima, Peru. We estimated the reproduction number, R, during the early transmission phase in Lima from the daily series of imported and autochthonous cases by the date of symptoms onset as of March 30th, 2020. We also assessed the effect of social distancing interventions in Lima by generating short-term forecasts grounded on the early transmission dynamics before interventions were put in place. Prior to the implementation of the social distancing measures in Lima, the local incidence curve by the date of symptoms onset displays near exponential growth dynamics with the mean scaling of growth parameter, p, estimated at 0.9 (95%CI: 0.9,1.0) and the reproduction number at 2.3 (95% CI: 2.0, 2.5). Our analysis indicates that school closures and other social distancing interventions have helped slow down the spread of the novel coronavirus, with the nearly exponential growth trend shifting to an approximately linear growth trend soon after the broad scale social distancing interventions were put in place by the government. While the interventions appear to have slowed the transmission rate in Lima, the number of new COVID-19 cases continue to accumulate, highlighting the need to strengthen social distancing and active case finding efforts to mitigate disease transmission in the region.

Early transmission dynamics of COVID-19 in a southern hemisphere setting: Lima-Peru: February 29th-March 30th, 2020.

The COVID-19 pandemic that emerged in Wuhan China has generated substantial morbidity and mortality impact around the world during the last four months. The daily trend in reported cases has been rapidly rising in Latin America since March 2020 with the great majority of the cases reported in Brazil followed by Peru as of April 15th, 2020. Although Peru implemented a range of social distancing measures soon after the confirmation of its first case on March 6th, 2020, the daily number of new COVID-19 cases continues to accumulate in this country. We assessed the early COVID-19 transmission dynamics and the effect of social distancing interventions in Lima, Peru. We estimated the reproduction number, R, during the early transmission phase in Lima from the daily series of imported and autochthonous cases by the date of symptoms onset as of March 30th, 2020. We also assessed the effect of social distancing interventions in Lima by generating short-term forecasts grounded on the early transmission dynamics before interventions were put in place. Prior to the implementation of the social distancing measures in Lima, the local incidence curve by the date of symptoms onset displays near exponential growth dynamics with the mean scaling of growth parameter, p, estimated at 0.96 (95% CI: 0.87, 1.0) and the reproduction number at 2.3 (95% CI: 2.0, 2.5). Our analysis indicates that school closures and other social distancing interventions have helped slow down the spread of the novel coronavirus, with the nearly exponential growth trend shifting to an approximately linear growth trend soon after the broad scale social distancing interventions were put in place by the government. While the interventions appear to have slowed the transmission rate in Lima, the number of new COVID-19 cases continue to accumulate, highlighting the need to strengthen social distancing and active case finding efforts to mitigate disease transmission in the region.

[Epidemiology of guillain-barré syndrome in Peru]. / Epidemiología del síndrome de guillain-barré en el Perú.

OBJECTIVE: To describe the epidemiological behavior of Guillain-Barré syndrome (GBS) in Peru. MATERIALS AND METHODS: Descriptive study of secondary data on the Ministry of Health (MINSA) hospital discharges during the period 2012-2017; EsSalud and SuSalud hospital discharges between 2015 and 2017; and national mortality data between 2014-2016. The identification of GBS in the databases was carried out using the International Classification of Diseases, 10th version, by means of code G610. Incidence, fatality rate, and mortality were estimated by age, sex, and department group. RESULTS: A total of 955 cases of GBS were identified in the database of MINSA hospital discharges between 2012 and 2017, with a higher frequency in men, within the 20 to 59-year old population. The national incidence of GBS per 100,000 inhabitants was 0.62 (2015), 0.92 (2016), and 0.91 (2017), being higher in older adults and in men. The overall case fatality rate was 3.5%, and was highest in those over 60. The average length of hospitalization was 16 ± 22 days. In addition, Lima is the department that accounted for more than 40% of all GBS cases; and Cusco, Lima, Callao, Lambayeque, and Arequipa had the highest incidence. CONCLUSIONS: This study provides relevant information to better understand the epidemiological behavior of GBS in Peru, and thus ensure adequate patient care nationally.

Objetivos. Describir el comportamiento epidemiológico del síndrome de Guillain-Barré (SGB) en el Perú. Materiales y métodos. Estudio descriptivo de datos secundarios sobre egresos hospitalarios del Ministerio de Salud (MINSA) durante el periodo 2012 - 2017, egresos hospitalarios de EsSalud y de SuSalud entre 2015 y 2017, y datos nacionales de mortalidad entre 2014-2016. La identificación del SGB en las bases de datos se realizó utilizando la Clasificación Internacional de Enfermedades, 10ª versión, mediante el código G610. Se estimó la incidencia, tasa de letalidad y mortalidad por grupos de edad, sexo y departamento. Resultados. En la base de datos de egresos hospitalarios del MINSA se identificaron un total de 955 casos de SBG entre 2012 y 2017, con una mayor frecuencia en hombres y en la población de 20 a 59 años. La incidencia nacional de SGB por cada 100 mil habitantes fue de 0,62 (2015), 0,92 (2016) y 0,91 (2017), siendo más alta en adultos mayores y en hombres. La tasa de letalidad global fue de 3,5%, y fue más alta en los mayores de 60 años. El promedio del tiempo de hospitalización fue de 16 ± 22 días.. Además, Lima es el departamento que concentró más del 40% de casos de SGB y Cusco, Lima, Callao, Lambayeque y Arequipa tuvieron la mayor incidencia. Conclusiones. Este estudio proporciona información relevante para entender mejor el comportamiento epidemiológico del SGB en el Perú, y así poder garantizar una atención adecuada de los pacientes a nivel nacional.

Epidemiología del síndrome de guillain-barré en el Perú / Epidemiology of guillain-barré syndrome in Peru

RESUMEN Objetivos. Describir el comportamiento epidemiológico del síndrome de Guillain-Barré (SGB) en el Perú. Materiales y métodos. Estudio descriptivo de datos secundarios sobre egresos hospitalarios del Ministerio de Salud (MINSA) durante el periodo 2012 - 2017, egresos hospitalarios de EsSalud y de SuSalud entre 2015 y 2017, y datos nacionales de mortalidad entre 2014-2016. La identificación del SGB en las bases de datos se realizó utilizando la Clasificación Internacional de Enfermedades, 10ª versión, mediante el código G610. Se estimó la incidencia, tasa de letalidad y mortalidad por grupos de edad, sexo y departamento. Resultados. En la base de datos de egresos hospitalarios del MINSA se identificaron un total de 955 casos de SBG entre 2012 y 2017, con una mayor frecuencia en hombres y en la población de 20 a 59 años. La incidencia nacional de SGB por cada 100 mil habitantes fue de 0,62 (2015), 0,92 (2016) y 0,91 (2017), siendo más alta en adultos mayores y en hombres. La tasa de letalidad global fue de 3,5%, y fue más alta en los mayores de 60 años. El promedio del tiempo de hospitalización fue de 16 ± 22 días.. Además, Lima es el departamento que concentró más del 40% de casos de SGB y Cusco, Lima, Callao, Lambayeque y Arequipa tuvieron la mayor incidencia. Conclusiones. Este estudio proporciona información relevante para entender mejor el comportamiento epidemiológico del SGB en el Perú, y así poder garantizar una atención adecuada de los pacientes a nivel nacional.

ABSTRACT Objective. To describe the epidemiological behavior of Guillain-Barré syndrome (GBS) in Peru. Materials and Methods. Descriptive study of secondary data on the Ministry of Health (MINSA) hospital discharges during the period 2012-2017; EsSalud and SuSalud hospital discharges between 2015 and 2017; and national mortality data between 2014-2016. The identification of GBS in the databases was carried out using the International Classification of Diseases, 10th version, by means of code G610. Incidence, fatality rate, and mortality were estimated by age, sex, and department group. Results. A total of 955 cases of GBS were identified in the database of MINSA hospital discharges between 2012 and 2017, with a higher frequency in men, within the 20 to 59-year old population. The national incidence of GBS per 100,000 inhabitants was 0.62 (2015), 0.92 (2016), and 0.91 (2017), being higher in older adults and in men. The overall case fatality rate was 3.5%, and was highest in those over 60. The average length of hospitalization was 16 ± 22 days. In addition, Lima is the department that accounted for more than 40% of all GBS cases; and Cusco, Lima, Callao, Lambayeque, and Arequipa had the highest incidence. Conclusions. This study provides relevant information to better understand the epidemiological behavior of GBS in Peru, and thus ensure adequate patient care nationally.

Opportunistic and other infections in HIV-infected children in Latin America compared to a similar cohort in the United States.

Opportunistic and other infections have declined since the introduction of highly active antiretroviral therapy (HAART) in developed countries but few studies have addressed the impact of HAART in HIV-infected children from developing countries. This study examines the prevalence and incidence of opportunistic and other infections in Latin America during the HAART era. Vertically HIV-infected children enrolled in a cohort study between 2002 and 2007 were followed for the occurrence of 29 targeted infections. Cross-sectional and longitudinal analyses were performed to calculate the prevalence of infections before enrollment and the incidence rates of opportunistic and other infections after enrollment. Comparisons were made with data from a U.S. cohort (PACTG 219C). Of the 731 vertically HIV-infected children 568 (78%) had at least one opportunistic or other infection prior to enrollment. The most prevalent infections were bacterial pneumonia, oral candidiasis, varicella, tuberculosis, herpes zoster, and Pneumocystis jiroveci pneumonia. After enrollment, the overall incidence was 23.5 per 100 person-years; the most common infections (per 100 person-years) were bacterial pneumonia (7.8), varicella (3.0), dermatophyte infections (2.9), herpes simplex (2.5), and herpes zoster (1.8). All of these incidence rates were higher than those reported in PACTG 219C. The types and relative distribution of infections among HIV-infected children in Latin America in this study are similar to those seen in the United States but the incidence rates are higher. Further research is necessary to determine the reasons for these higher rates.