In the Dawn of an Early Invasion: No Genetic Diversity of Angiostrongylus cantonensis in Ecuador?

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.

Safety and efficacy of the two doses conjugated protein-based SOBERANA-02 COVID-19 vaccine and of a heterologous three-dose combination with SOBERANA-Plus: a double-blind, randomised, placebo-controlled phase 3 clinical trial.

Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: 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.

Conocimientos, percepciones y prácticas de médicos de atención primaria en Ecuador sobre la infección por Angiostrongylus cantonensis / Knowledge, perceptions and practice of primary healthcare doctors in Ecuador on Angiostrongylus cantonensis infection

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.

Introduction: Human angiostrongyliasis presents a broad clinical spectrum, which ranges from asymptomatic infection to eosinophilic meningitis, eosinophilic meningoencephalitis, and ocular angiostrongyliasis. Objective: To determine the knowledge, perceptions, and practice of primary healthcare doctors in the Republic of Ecuador regarding Angiostrongylus cantonensis infection. Methods: It was conducted a descriptive observational study. A survey on knowledge, perceptions, and practice was designed, validated, and applied to 163 primary healthcare doctors from Napo and Guayas provinces between November and December 2017. The information obtained was stored in a Microsoft Access 2016 database, and a frequency analysis was performed to the answers provided to every question. Results: Insufficient knowledge, inadequate perceptions, and incorrect practice regarding angiostrongyliasis were found. Conclusions: The results evidenced the need to implement an educational intervention program to primary healthcare doctors aimed at reducing the deficiencies found to have a positive impact on the communities where the intermediate and definitive hosts and a potential infection risk exist.

Progresión de la COVID-19 en trabajadores de una institución de salud cubana, vacunados con el esquema heterólogo de SOBERANA / Progression of COVID-19 in workers of a cuban health institution, vaccinated with the heterologous scheme of SOBERANA

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 por ciento 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(AU)

Severe acute respiratory syndrome coronavirus 2 is the causative agent of COVID-19. In the week of March 21 to 27, 2021 an increase of 8 percent in cases was confirmed in Cuba. The Cuban Ministry of Public Health decided to approve the health intervention with the SOBERANA vaccine candidates to be administered to the staff working in health institutions. The objectives were to describe the vaccination coverage achieved with the SOBERANA heterologous scheme and the progression of the disease in the vaccinated subjects. This is a descriptive, prospective study. We perceived 884 subjects that fulfilled the criteria to be included. The subjects were followed up by the researchers of the sentinel site during the application of the scheme and 5 months after its conclusion. Adequate vaccination coverage was achieved for the heterologous scheme of three doses of SOBERANA. The most frequent comorbidities inside the group of workers who fell ill of COVID-19, 14 days after of completing the heterologous scheme were: high blood pressure, asthma, type 2 diabetes mellitus and ischemic heart disease. The bigger proportion of sick persons corresponded to those who worked in the high-risk red zone, followed by those who worked in the green zone and in the professional group, and lastly non-professional non-technical workers. Disease progression to severe and critical forms was not described in vaccinated workers. Symptoms and more frequent signs in the sick persons were fever, cough, asthenia and anorexia. Adequate vaccination coverage was achieved; the progression of the disease to severe or critical forms was aborted despite the high occupational exposure of the staff and chronic comorbidities(AU)

The direct effect of pneumococcal conjugate vaccines on invasive pneumococcal disease in children in the Latin American and Caribbean region (SIREVA 2006-17): a multicentre, retrospective observational study.

BACKGROUND: 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. METHODS: 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. FINDINGS: 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. INTERPRETATION: 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. FUNDING: None. TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

Encefalitis por amebas de vida libre: herramientas actuales para el diagnóstico y tratamiento tempranos / Free-living amoeba encephalitis: current tools for early diagnosis and treatment

Introducción: Naegleria fowleri, Acanthamoeba spp. y Balamuthia mandrillaris son amebas de vida libre que producen daños sustanciales del sistema nervioso central y cuyo diagnóstico premortem es poco frecuente. Objetivo: Proveer una visión general de los aspectos clínico-epidemiológicos y las posibilidades diagnósticas más eficaces en la meningoencefalitis amebiana primaria y la encefalitis granulomatosa amebiana, así como las experiencias de tratamiento expuestas en la literatura reciente. Métodos: Se realizó una revisión bibliográfica sobre las amebas de vida libre. Se analizó la información obtenida de artículos científicos en la base de datos Google Scholar®, PubMed y las citas relacionadas por el programa en PubMed Central. Análisis y síntesis de la información: En primer término del análisis de la meningoencefalitis amebiana primaria y la encefalitis granulomatosa amebiana, resalta la diferenciación de sus características clínicas y epidemiológicas, también que el líquido cefalorraquídeo presenta gran relevancia para el diagnóstico de la meningoencefalitis amebiana primaria. Sin embargo, para los casos presuntivos de la encefalitis granulomatosa amebiana el examen del líquido cefalorraquídeo depende de la valoración riesgo-beneficio y se ha obtenido mayor positividad con el diagnóstico histopatológico de biopsias premortem. En general, se acrecienta la implementación de la investigación del ADN por diferentes métodos que brindan certeza de cada una de las especies de AVL causantes de enfermedad neurológica. El aislamiento en cultivo confirmatorio de N. fowleri, Acanthamoeba spp. y B. mandrillaris presenta diferencias en la factibilidad de crecimiento en diversos medios de acuerdo con la especie y limitaciones adicionales. Conclusiones: La mortalidad asociada con las infecciones del sistema nervioso central por amebas de vida libre permanece alta, aunque varios estudios brindan experiencias útiles a partir de los casos de pacientes que han sobrevivido. Resulta importante tener en cuenta que el diagnóstico rápido de la infección es clave para un tratamiento exitoso(AU)

Introduction: Naegleria fowleri, Acanthamoeba spp. and Balamuthia mandrillaris are free-living amoebae of infrequent premortem diagnosis which cause substantial damage to the central nervous system. Objective: To provide an overview of the clinical-epidemiological aspects and the most effective diagnostic possibilities in primary amebic meningoencephalitis and granulomatous amebic encephalitis, as well as their treatment experiences in recent publications.. Methods: A bibliographic review was conducted about free-living amoebae. An analysis was performed of data obtained from scientific papers published in the databases Google Scholar and PubMed, and the citations listed by the PubMed Central program. Data analysis and synthesis: As principal term of the analysis of primary amebic meningoencephalitis and amebic granulomatous encephalitis, the differentiation of their clinical and epidemiological characteristics stands out, also that cerebrospinal fluid is highly relevant for the diagnosis of primary amebic meningoencephalitis. However, for presumptive cases of amoebic granulomatous encephalitis, the examination of cerebrospinal fluid depends on the risk-benefit assessment and greater positivity has been obtained with the histopathological diagnosis of premortem biopsies. In general, the implementation of DNA research by different methods provided accurate information about each one of the free-living amoeba species that cause neurological disease. Confirmatory culture isolation of N. fowleri, Acanthamoeba spp. and B. mandrillaris revealed growth feasibility differences between diverse media depending on the species and additional limitations. Conclusions: Mortality associated to central nervous system infections caused by free-living amoebae remains high. Studies describing cases of patients who have survived constitute useful material. It is important to bear in mind that fast diagnosis of the disease is crucial to treatment success(AU)

Factores asociados con la mortalidad por meningitis neumocócica en hospitales de La Habana / Factors associated with mortality due to pneumococcal meningitis in Havana hospitals

Introducción: la meningitis neumocócica constituye un serio problema de salud por su alta morbilidad, letalidad y graves secuelas. Objetivos: identificar algunos factores de riesgo asociados con la mortalidad por meningitis neumocócica. Métodos: se realizó un estudio de caso-control en 7 hospitales de La Habana (enero de 2002-diciembre de 2011) de 45 pacientes (0-86 años de edad), con meningitis neumocócica confirmada: 15 fallecidos (casos) y 30 sobrevivientes (controles), a partir de la vigilancia nacional de síndromes neurológicos bacterianos, historias clínicas, movimientos hospitalarios, tarjetas de enfermedades de declaración obligatoria y registros de laboratorio. Se midió la asociación (análisis bivariado y multivariado) de algunos factores con la muerte a través de la oportunidad relativa y su intervalo de confianza a 95 por ciento, considerando asociación cuando fue mayor o igual que 2. Resultados: la letalidad general resultó de 33,3 por ciento. La media entre el inicio de los síntomas y la consulta médica fue de 2,4 días; entre la consulta y el ingreso 0,5 días; entre el ingreso y el diagnóstico 0,4 días, y entre el diagnóstico y el tratamiento 0,2 días. La estadía hospitalaria media fue de 12,2 días. El análisis bivariado y multivariado mostró asociación significativa de la inconsciencia al ingreso, con la muerte. Otras variables se asociaron con el desenlace fatal pero no fueron significativas. Conclusiones: estar inconsciente al momento del ingreso es un factor de riesgo para la muerte por meningitis neumocócica, en los pacientes con esta enfermedad de los hospitales investigados en La Habana

Introduction: pneumococcal meningitis is a critical public health problem with a high rate of morbidity and mortality and serious sequelae. Objectives: identify some risk factors associated with mortality due to pneumococcal meningitis. Methods: a case-control study was conducted of 45 patients aged 0-86 with confirmed pneumococcal meningitis cared for in seven Havana hospitals from January 2002 to December 2011. Of the 45 patients studied, 15 had died (cases) and 30 had survived (controls). The study was based on national bacterial neurological syndrome surveillance data, medical records, hospital movements, notifiable disease cards and laboratory records. Association (bivariate and multivariate analysis) of some factors with death was measured through odds ratio with a confidence interval of 95 percent, considering it an association if greater than or equal to 2. Results: overall case-fatality rate was 33.3 percent. Mean time between the onset of symptoms and medical consultation was 2.4 days; between consultation and admission 0.5 day; between admission and diagnosis 0.4 day; and between diagnosis and treatment 0.2 day. Mean hospital stay was 12.2 days. Bivariate and multivariate analysis revealed a significant association between unconsciousness at admission and death. Other variables were associated with death as well, but they were not significant. Conclusions: being unconscious at admission is a risk factor for death due to pneumococcal meningitis in patients with this disease in the Havana hospitals studied

Meningitis por estreptococo ß-hemolítico del grupo B en lactantes / Meningitis in breast-fed infants caused by Group B ß-hemolytic streptococcus

Introducción: el estreptococo ß-hemolítico del grupo B es causa frecuente de sepsis y muerte neonatal. Objetivo: caracterizar el comportamiento de la meningitis por estreptococo ß-hemolítico del grupo B en Cuba. Métodos: se realizó un estudio observacional (descriptivo y analítico) de 57 casos de meningitis por ß-hemolítico del grupo B, con inicio de los síntomas entre el 1ro de enero de 1998 y 31 de diciembre de 2010. Se estimó el riesgo según el año de ocurrencia, la edad, el sexo, la provincia y el municipio, así como la letalidad y la asociación de la demora en la consulta médica y el ingreso hospitalario, con la muerte. Resultados: la incidencia de todo el período fue 0,03/1 000 nacidos vivos y la letalidad alcanzó 31,58 %. La proporción de casos en el sexo masculino (50,9 %) fue muy similar al femenino (49,1 %). Los menores de 2 meses fueron más afectados por la enfermedad (38 casos) y aportaron el 100 % de los fallecidos (18). Las provincias con mayor riesgo fueron Pinar del Río (0,09/1 000 nacidos vivos) y Santiago de Cuba (0,08/1 000 nacidos vivos). El municipio con mayor riesgo fue San Luis, en Santiago de Cuba (0,31/1 000 nacidos vivos). La media de tiempo para la consulta médica fue alrededor de 17 horas, y para el ingreso fue aproximadamente 5 horas. No hubo asociación de la demora para la consulta (RR= 0,66) y el ingreso (RR= 1,22) con la muerte. Conclusiones: la meningitis por estreptococo ß-hemolítico del grupo B constituye una causa importante y prevenible de meningitis y muerte neonatal en Cuba.

Introduction: group B ß-hemolytic streptococcus is a common cause of sepsis and neonatal death, Objective: to characterize the behavior of the Group B ß-hemolytic streptococcus meningitis in Cuba. Methods: an observational, descriptive and analytical study was performed on 57 patients suffering meningitis caused by Group B ß-hemolytic streptococcus, with the onset of symptoms ranging from January 1st 1998 to December 2010. The risk was estimated according to the year of occurrence, the age, the province and the municipality as well as the fatality rate and the association of delay in medical diagnosis and in admission to the hospital and death. Results: the incidence rate of the whole period was 0.03 per 1 000 livebirths and the fatality rate amounted to 31.58 %. The propo9rtion of cases between males and females was very similar (50.9 % and 49.1 % respectively). The infants aged younger than 3 months were more affected by the disease (38 cases) and they accounted for 100 % of those children who died (18 cases). The most risky provinces were Pinar del Rio (9.09 per 1 000 livebirths) and Santiago de Cuba (0.08 per 1 000 livebirths). The municipality with the highest risk index was San Luis in Santiago de Cuba (0.31 per 1 000 livebirhts). The average length of time for medical diagnosis was 17 hours and for admission to the hospital was 5 hours. No association was found between delay in medical diagnosis (RR= 0.66) and in admission to the hospital (RR= 1.22) and death occurrence. Conclusions: Group B ß-hemolytic streptococcus is a significant preventable cause of meningitis and neonatal death.

Efectividad de la vacuna antimeningocócica VA-MENGOC-BC® en el primer año de vida, Cuba, 1997-2008 / Effectiveness of the anti-meningococcal vaccine VA-MENGO-BC® in the first year of life of Cuban children, 1997-2008

Introducción: la enfermedad meningocócica constituye un importante problema de salud mundial. Desde 1991 la vacuna VA-MENGOC-BC® se aplica en Cuba a los niños menores de 1 año. Objetivo: evaluar la efectividad de la vacuna VA-MENGOC-BC®. Métodos: para la evaluación poslicenciamiento de VA-MENGOC-BC® se estudiaron los lactantes con enfermedad meningocócica notificados entre 1997 y 2008. Resultados: ocurrieron 114 casos para una incidencia media anual de 7,1/100 000 lactantes. La estimación de la efectividad vacunal media resultó de 84,0 por ciento, oscilando entre 68 y 104 por ciento. La ocurrencia de enfermedad meningocócica en los no vacunados fue de 20,2 por ciento (23/114); 79,8 por ciento (91/114) en lactantes con edad de vacunación y en 75,8 por ciento (69/91) se precisó la fecha de inmunización. Tenían una sola dosis de vacuna aplicada 26,4 por ciento (24/91) y 73,6 por ciento (67/91) recibió el esquema completo (2 dosis). La enfermedad meningocócica predominó en los primeros 6 meses de edad, declinó a partir de este momento y comenzó de nuevo su ascenso a los 10 y 11 meses. Predominó la forma meníngea (89,5 por ciento); la letalidad general fue de 7 por ciento (8/114), con 4,4 por ciento para la meningococemia y 2,6 por ciento para la meningitis. Conclusiones: la efectividad de VA-MENGOC-BC® fue satisfactoria. Se sugiere realizar un análisis por un grupo de expertos sobre la necesidad de aplicar una tercera dosis.

Introduction: 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. Objective: 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. Results: 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 percent, ranging from 68 percent to 104 percent. The frequency of disease in unvaccinated children was 20.2 percent (23/114); 79.8 percent (91/114) within the vaccination age, but only 75.8 percent (69/91) of them had confirmed the immunization date. Only 26.4 percent (24/91) had one single dose applied whereas 73.6 percent (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 percent); case-fatality rate was 7.0 percent (8/114), being 4,4 percent for meningococcemia and 2,6 percent for meningitis. Conclusions: 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.

[Effectiveness of the anti-meningococcal vaccine VA-MENGO-BC in the first year of life of Cuban children, 1997-2008]. / Efectividad de la vacuna antimeningocócica VA-MENGOC-BC en el primer año de vida, Cuba, 1997-2008.

INTRODUCTION: 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. OBJECTIVE: 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. RESULTS: 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. CONCLUSIONS: 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.