Characterization of Dengue Virus 4 Cases in Paraguay, 2019-2020.

In 2019-2020, dengue virus (DENV) type 4 emerged to cause the largest DENV outbreak in Paraguay's history. This study sought to characterize dengue relative to other acute illness cases and use phylogenetic analysis to understand the outbreak's origin. Individuals with an acute illness (≤7 days) were enrolled and tested for DENV nonstructural protein 1 (NS1) and viral RNA by real-time RT-PCR. Near-complete genome sequences were obtained from 62 DENV-4 positive samples. From January 2019 to March 2020, 799 participants were enrolled: 253 dengue (14 severe dengue, 5.5%) and 546 other acute illness cases. DENV-4 was detected in 238 dengue cases (94.1%). NS1 detection by rapid test was 52.5% sensitive (53/101) and 96.5% specific (387/401) for dengue compared to rRT-PCR. DENV-4 sequences were grouped into two clades within genotype II. No clustering was observed based on dengue severity, location, or date. Sequences obtained here were most closely related to 2018 DENV-4 sequences from Paraguay, followed by a 2013 sequence from southern Brazil. DENV-4 can result in large outbreaks, including severe cases, and is poorly detected with available rapid diagnostics. Outbreak strains seem to have been circulating in Paraguay and Brazil prior to 2018, highlighting the importance of sustained DENV genomic surveillance.

Human Papillomavirus (HPV) Infection and Risk Behavior in Vaccinated and Non-Vaccinated Paraguayan Young Women.

Cervical cancer is a global health concern and ranks fourth among the most prevalent cancers in women worldwide. Human papillomavirus (HPV) infection is a known precursor of cervical cancer and preventive measures include prophylactic vaccines. This study focused on sexually active Paraguayan women aged 18-25 years, exploring the intersection of HPV vaccination and sexual behavior. Among 254 participants, 40.9% received the Gardasil-4 vaccine, with no significant differences in sexual behavior between the vaccinated and unvaccinated sexually active groups. However, a notable decrease in the prevalence of HPV among the vaccinated women highlights the efficacy of this vaccine in reducing infections. The prevalence of any HPV type was 37.5% in vaccinated participants compared to 56.7% in unvaccinated participants (p = 0.0026). High-risk HPV types showed a significant difference, with a prevalence of 26.0% in vaccinated women compared with 52.7% in unvaccinated women (p < 0.001). Although a potential decline in genital warts was observed among the vaccinated individuals, statistical significance (p = 0.0564) was not reached. Despite the challenges in achieving high vaccination coverage, the observed reduction in HPV prevalence underscores the importance of ongoing monitoring, healthcare professional recommendations, and comprehensive risk management. These findings contribute to dispelling concerns about HPV vaccination influencing sexual behavior, advocating further large-scale research to explore the impact of vaccines on various HPV types and potential cross-protection.

Carga de influenza en la comunidad de Barrio Obrero. Paraguay / Burden of Influenza in the community of Barrio Obrero. Paraguay

La influenza (FLU) causa morbilidad grave y mortalidad. El objetivo del estudio fue evaluar la incidencia, la etiología y el uso de recursos para la gripe en un barrio de bajos ingresos de Asunción, Paraguay mediante un estudio de cohorte prospectiva de base poblacional con muestreo aleatorio estratificado de viviendas de julio a Octubre de 2013. El monitoreo de los hogares para la identificación de los casos de enfermedad tipo influenza (ETI) fue telefónico. En aquellos pacientes con ETI, se tomaron hisopados nasofaríngeos para RT-PCR e IFI. Se establecieron los factores de riesgo para ETI por la prueba de chi cuadrado considerándose significativa p<0,05; además se calculó RR con IC95%. De 8.279 viviendas, 401 familias (2.065 personas) fueron monitoreadas; se identificaron 141 casos de ETI que representa una incidencia de 6,8% (IC95%: 5,5-7,6%); el 56% de los casos buscaron atención médica, en su mayoría (80%) en servicios públicos. Se testaron 84% de los hisopados nasofaríngeos, siendo positivo en el 22% para virus respiratorios; 86% FLU (63% FLU A, 37% FLU B). Se encontró asociación (p< 0,001) entre enfermar de ETI y tener edad menor de 5 años (RR: 2,43 (1,68-3,49). Este es el primer estudio que da información sobre la carga de Influenza en Paraguay. El monitoreo telefónico resultó ser una buena estrategia para monitoreo de los hogares para la identificación de los casos de ETI. El virus de la Influenza fue el patógeno más común identificado, con una alta demanda de asistencia médica, lo que resulta una carga sustancial para los servicios de salud.

Influenza (FLU) causes severe morbidity and mortality. This study aimed to evaluate the incidence, etiology and use of resources for influenza in a low-income neighborhood in Asunción, Paraguay through a prospective population base cohort with stratified random sampling of houses from July to October 2013. Monitoring of cases of influenza-like illness (ILI) was by telephone. In ETI cases, nasopharyngeal swabs were collected for RT-PCR and IFI. Risk factors for ETI were established using chi square test at p≤0.05; RR with CI 95% was also calculated. Of 8,279 homes, 401 families (2,065 people) were monitored; 141 ILI cases were identified, yielding an incidence of 6.8% (95% CI 5.5-7.6), 56% of cases sought medical attention, mostly (80%) in public health services. Among the ILIs, 84% of nasopharyngeal swabs were tested, 22% positive for respiratory viruses; 86% FLU (63% FLU A, 37% FLU B). An association (p<0.001) between ILI disease and aged less than 5 years (RR: 2.43 (1.68-3.49) was found. This is the first study that gives information on Influenza burden in Paraguay. Telephone monitoring was a good strategy for house monitoring in order to identify cases of ILI. Influenza virus was the most common pathogen identified, with a high demand for medical assistance, which results in a substantial burden for health services.

Pandemia por influenza A H1N1 2009: características clínicas y epidemiológicas de los casos pediátricos en Paraguay / The 2009 H1N1 influenza A pandemic: clinical and epidemiological characteristics of pediatric cases in Paraguay

Objetivo: Describir las características clínicas y epidemiológicas de los casos pediátricos (0 a 18 años) reportados a la Dirección General de Vigilancia de la Salud (DGVS) durante la pandemia del 2009. Metodología: El estudio es observacional, descriptivo con componentes analíticos, incluyéndose todos los casos sospechosos de infección por Influenza A (H1N1) menores de 19 años que fueron notificados a la DGVS a partir del 28 de abril de 2009 hasta el 30 de enero del 2010.Los centros notificadores fueron públicos y privados. Para la recolección de los datos se utilizó una ficha clínico- epidemiológica que incluía: edad, sexo, procedencia, signos y síntomas, co-morbilidades, antecedentes de vacunación, resultado laboratorial para influenza A (H1N1) y evolución clínica. Resultados: Fueron notificados a la DGVS, 3233 casos sospechosos de Influenza A (H1N1), de los cuales el 50,6% era del sexo masculino. El grupo etareo predominante fue de 15 a 18 años (43,9%), seguido del grupo de 1 a 4 años (31,7%). La mayoría de los casos provenía del Departamento Central 38,4%, seguido de Asunción 23%, y Alto Paraná 10,2%. El 90% de los casos se reportó entre junio y agosto. Entre los signos y síntomas más frecuentemente hallados se encuentran la tos (90%), fiebre (77%) y dolor de garganta (61%). El 4,7% de los casos tenía por lo menos un factor de riesgo de complicaciones, citándose entre las más frecuentes el asma (n=91), embarazo (n=26), enfermedad cardiovascular (n=19). El 6,6% de los que presentaron algún factor de riesgo de co-morbilidad, falleció. La tasa de mortalidad fue de 1,6% y fue significativamente mayor en los menores de 1 año (5,6%, p<0,001). En 476 casos (14,7%), se confirmó la infección por Influenza A (H1N1). Conclusión: Las características clínicas observadas fueron similares a las reportadas a nivel internacional. La necesidad de hospitalización y la mortalidad fueron significativamente mayores en los menores de 1 año.

Introduction: In April 2009 the first cases were reported of a new influenza subtype, H1N1 Influenza A, which showed different clinical behavior in different age groups. Objective: To describe the clinical and epidemiological characteristics of pediatric cases (ages 0 to 18 years) reported to the general directorate for health surveillance (DGVS) during the pandemic of 2009.Methodology: The study was observational and descriptive with analytical components, and included all suspected cases of infection by H1N1 influenza A in patients under age 19 reported to the DGVS between April 28, 2009 and January 30, 2010. Reporting centers included both public and private facilities. To collect data we used a clinical-epidemiological form that included: age, sex, place of origin, signs and symptoms, comorbidities, vaccination history, laboratory results for influenza A H1N1, and clinical outcome. Results: The DGVS received 3233 reports of suspected cases of influenza A H1N1, of which 50.6% were in male patients. Incidence was highest in the age 15 to 18 group (43.9%), followed by the age 1 to 4 group (31.7%). Most cases came from the Central Department (38.4%), followed by Asuncion(23%) and Alto Parana 10.2%). Fully 90% of cases were reported between June and August. Signs and symptoms most frequently found were cough (90%), fever (77%) and sore throat (61%). At least one risk factor for complications was present in 4.7% of cases, with the most common being asthma (n=91), pregnancy (n=26), and cardiovascular disease (n=19). Of those that presented any comorbidity risk factor, 6.6% died. The mortality rate was 1.6% and was significantly higher in children under age 1 year (5.6%, p<0.001). In 476 cases (14.7%) infection by H1N1 influenza A was confirmed. Conclusion: The clinical features observed were similar to those reported internationally. The need for hospitalization and mortality were significantly higher in children under age 1 year.