A simplified alternative diagnostic algorithm for SARS-CoV-2 suspected symptomatic patients and confirmed close contacts (asymptomatic): A consensus of Latin American experts.

INTRODUCTION: Latin America accounts for one-quarter of global COVID-19 cases and one-third of deaths. Inequalities in the region lead to barriers to the best use of diagnostic tests during the pandemic. There is a need for simplified guidelines that consider the region's limited health resources, international guidelines, medical literature, and local expertise. METHODS: Using a modified Delphi method, 9 experts from Latin American countries developed a simplified algorithm for COVID-19 diagnosis on the basis of their answers to 24 questions related to diagnostic settings, and discussion of the literature and their experiences. RESULTS: The algorithm considers 3 timeframes (≤7 days, 8-13 days, and ≥14 days) and presents diagnostic options for each. SARS-CoV-2 real- time reverse transcription-polymerase chain reaction is the test of choice from day 1 to 14 after symptom onset or close contact, although antigen testing may be used in specific circumstances, from day 5 to 7. Antibody assays may be used for confirmation, usually after day 14; however, if clinical suspicion is very high, but other tests are negative, these assays may be used as an adjunct to decision-making from day 8 to 13. CONCLUSION: The proposed algorithm aims to support COVID-19 diagnosis decision-making in Latin America.

Algorithms for testing COVID-19 focused on use of RT-PCR and high-affinity serological testing: A consensus statement from a panel of Latin American experts.

The COVID-19 pandemic has caused an unprecedented public health, social, and economic crisis. Improving understanding on available tests for detecting COVID-19 is critical for effective management of the pandemic. We proposed that a multidisciplinary expert panel can establish recommendations on ideal use of diagnostic tools, with a focus on RT-PCR and serological high-affinity antibodies (both IgM and IgG) tests for the Latin America region. STUDY DESIGN: A collaborative multidisciplinary panel of 5 recognized experts in Latin America (an infectious disease specialist, three pathologists, and an immunologist) was convened and supported by Roche Diagnostics to develop standard guidelines and an evidence-based document of best practices on the use of diagnostic tools for COVID-19. RESULTS: The authors reached consensus on the applicability of diagnostic tools to provide testing algorithms for the use of RT-PCR and serological high-affinity antibodies (both IgM and IgG) tests in three settings: 1) For asymptomatic subjects exposed to a SARS-CoV-2 infected person; 2) For epidemiological purposes and; 3) For symptomatic subjects. CONCLUSION: The serological high-affinity SARS-CoV-2 antibodies (both IgM and IgG) tests play a key role in COVID-19 diagnosis. These tests can be applied for suspected false-negative RT-PCR results and for individual determination of response. The use of these tests can also contribute greatly to public health strategies, such as population screening and supporting vaccination planning. Serological status for high-affinity antibodies (both IgM and IgG) should be performed ideally 21 days after potential infectious contact, given that the majority of exposed individuals will have seroconverted.

A global agenda for older adult immunization in the COVID-19 era: A roadmap for action.

Given our global interconnectedness, the COVID-19 pandemic highlights the urgency of building a global system that can support both routine and pandemic/epidemic adult immunization. As such, a framework to recommend vaccines and build robust platforms to deliver them to protect the rapidly expanding demographic of older adults is needed. Adult immunization as a strategy has the broad potential to preserve and improve medical, social, and economic outcomes, including maintaining functional ability that benefits older adults, their families, communities, and countries. While we will soon have multiple vaccines against COVID-19, we must recognize that we already have a variety of vaccines against other pathogens that can keep adults healthier. They can prevent simultaneous co-infection with COVID-19, and may favorably impact- the outcome of a COVID-19 illness. Further, administering a vaccine against COVID-19 requires planning now to determine delivery strategies impacting how older adults will be immunized in a timely manner. A group of international experts with various backgrounds from health and aging disciplines met to discuss the evidence case for adult immunization and crucial knowledge gaps that must be filled in order to implement effective policies and programs for older adult immunization. This group, coming together as the International Council on Adult Immunization (ICAI), outlined a high-level roadmap to catalyze action, provide policy guidance, and envision a global adult immunization platform that can be adapted by countries to fit their local contexts. Further meetings centered around the value of adult immunization, particularly in the context of COVID-19. There was agreement that programs to deliver existing influenza, pneumococcal, herpes zoster vaccines, and future COVID-19 vaccines to over a billion older adults who are at substantially higher risk of death and disability due to vaccine-preventable diseases are more urgent than ever before. Here we present a proposed framework for delivering routine and pandemic vaccines. We call upon the global community and governments to prioritize action for integrating robust adult immunization programs into the public health agenda.

Vaccines in adults.

The proportion of adult population has increased globally and the current projections indicate that, by 2050, the group of 60 years and older will represent 21.1%. There are now vaccines exclusively designed for adults and others that are applied in early life but need to be updated later in life. Vaccines for adults are not only based on their respective age group but are also linked to risk factors like occupation, life style, health situation, among others. At the same time, longevity brings with it a weakening of the immune response to vaccines, a process known as immunosenescence representing an increasing challenge to adequately protect this age group. For some time, WHO has been promoting the term "Vaccination through the life course" allowing for an extension of the vaccination vision and taking adults as an integral part into the national vaccination programs and calendars. There are several vaccine preventable diseases affecting adults, but those associated with influenza virus and pneumococcus are the ones that affect the largest age group. Several recommendations include, additionally, others to prevent diphtheria, tetanus, whooping cough, hepatitis A and B, meningococcus, chickenpox, measles, rubella, mumps, herpes zoster, human papilloma virus and others. There are still many challenges to overcome in order to fully include adults, particularly health personnel, and to make vaccines extensively valued as a prevention tool in order to achieve a healthy life.

La proporción de población de adultos se ha incrementado globalmente y las proyecciones muestran que para el año 2050 los mayores de 60 años representarán el 21.1%. Actualmente se dispone de vacunas dirigidas exclusivamente a adultos y otras que se aplican en niños pero que se deben actualizar a lo largo de la vida. Las vacunas en adultos se administran, no solo por el grupo de edad al que pertenecen, sino también por factores como ocupación, estilos de vida o estado de salud. Al mismo tiempo, la longevidad disminuye la respuesta inmune a las vacunas por el fenómeno de inmunosenescencia, lo cual representa un desafío para proteger adecuadamente a este grupo. Desde hace varios años la OMS, ha propiciado la utilización del término "Vacunación en el curso de la vida" lo cual permite extender la visión de la vacunación y considerar al adulto como una parte integral de los planes y calendarios de inmunización. Existen varias enfermedades prevenibles por vacunas en adultos, pero aquellas asociadas al virus de influenza y al neumococo, son las que comprenden el grupo más extenso. Diversas recomendaciones incluyen, además de estas vacunas, otras dirigidas a prevenir difteria, tétanos, tos convulsa, hepatitis A y B, meningococo, varicela, sarampión, rubéola, parotiditis, herpes zóster, virus del papiloma humano y otras enfermedades. Se reconocen muchos desafíos a superar para poder incorporar plenamente al adulto, incluyendo al personal de salud, y lograr que la vacunación sea una herramienta de prevención valorada ampliamente para el desarrollo de una vida saludable.

Transmission and Control of Respiratory Viral Infections in the Healthcare Setting.

PURPOSE OF THE REVIEW: Viral respiratory infections have been recognized as a cause of severe illness in immunocompromised and non-immunocompromised hosts. This acknowledgement is a consequence of improvement in diagnosis and better understanding of transmission. Available vaccines and antiviral drugs for prophylaxis and treatment have been developed accordingly. Viral respiratory pathogens are increasingly recognized as nosocomial pathogens as well. The purpose of this review is to describe the most frequent and relevant nosocomial viral respiratory infections, their mechanisms of transmission and the infection control measures to prevent their spread in the healthcare setting. RECENT FINDINGS: Although most mechanisms of transmission and control measures of nosocomial viral infections are already known, improved diagnostic tools allow better characterization of these infections and also lead to the discovery of new viruses such as the coronavirus, which is the cause of the Middle East Respiratory Syndrome, or the human bocavirus. Also, the ability to understand better the impact, dissemination and prevention of these viruses, allows us to improve the measures to prevent these infections. SUMMARY: Healthcare viral respiratory infections increase patient morbidity. Each virus has a different mechanism of transmission; therefore, early detection and prompt implementation of infection control measures are very important in order to avoid their transmission in the hospital setting.

Influenza among the elderly in the Americas: a consensus statement.

Influenza exacts a heavy burden on the elderly, a segment of the population that is estimated to experience rapid growth in the near future. In the past decade most developed and several developing countries have recommended influenza vaccination for those > 65 years of age. The World Health Organization (WHO) set a goal of 75% influenza vaccination coverage among the elderly by 2010, but it was not achieved. In 2011, the Technical Advisory Group at the Pan American Health Organization, Regional Office of WHO for the Americas, reiterated the influenza vaccine recommendation for older adults. Relatively little information has been compiled on the immunological aspect of aging or on reducing its impact, information particularly relevant for clinicians and gerontologist with firsthand experience confronting its effects. To fill this data gap, in 2012 the Americas Health Foundation (Washington, D.C., United States) and the nonprofit, Fighting Infectious Diseases in Emerging Countries (Miami, Florida, United States), convened a panel of Latin American clinicians and gerontologists with expertise in influenza to discuss key issues and develop a consensus statement. The major recommendations were to improve influenza surveillance throughout Latin America so that its impact can be quantified; and to conduct laboratory confirmation of influenza for all patients who have flu-like symptoms and are frail, immunosuppressed, have comorbidities, are respiratory compromised, or have been admitted to a hospital. The panel also noted that: since evidence for antivirals in the elderly is unclear, their use should be handled on a case-by-case basis; despite decreased immunological response, influenza vaccination in older adults is still crucial; indirect immunization strategies should be encouraged; and traditional infection control measures are essential in long-term care facilities.

Influenza among the elderly in the Americas: a consensus statement / La gripe en los ancianos de la Región de las Américas: una declaración de consenso

Influenza exacts a heavy burden on the elderly, a segment of the population that is estimated to experience rapid growth in the near future. In the past decade most developed and several developing countries have recommended influenza vaccination for those > 65 years of age. The World Health Organization (WHO) set a goal of 75% influenza vaccination coverage among the elderly by 2010, but it was not achieved. In 2011, the Technical Advisory Group at the Pan American Health Organization, Regional Office of WHO for the Americas, reiterated the influenza vaccine recommendation for older adults. Relatively little information has been compiled on the immunological aspect of aging or on reducing its impact, information particularly relevant for clinicians and gerontologist with firsthand experience confronting its effects. To fill this data gap, in 2012 the Americas Health Foundation (Washington, D.C., United States) and the nonprofit, Fighting Infectious Diseases in Emerging Countries (Miami, Florida, United States), convened a panel of Latin American clinicians and gerontologists with expertise in influenza to discuss key issues and develop a consensus statement. The major recommendations were to improve influenza surveillance throughout Latin America so that its impact can be quantified; and to conduct laboratory confirmation of influenza for all patients who have flu-like symptoms and are frail, immunosuppressed, have comorbidities, are respiratory compromised, or have been admitted to a hospital. The panel also noted that: since evidence for antivirals in the elderly is unclear, their use should be handled on a case-by-case basis; despite decreased immunological response, influenza vaccination in older adults is still crucial; indirect immunization strategies should be encouraged; and traditional infection control measures are essential in long-term care facilities.

La gripe representa una fuerte carga para los ancianos, un segmento de la población que, según los cálculos, experimentará un rápido crecimiento en un futuro próximo. En el último decenio, la mayor parte de los países desarrollados y varios países en desarrollo han recomendado la vacunación antigripal de las personas mayores de 65 años de edad. La Organización Mundial de la Salud (OMS) estableció la meta de una cobertura de vacunación antigripal de 75% de los ancianos para el año 2010, pero no se alcanzó. En el 2011, el Grupo Consultivo Técnico de la Organización Panamericana de la Salud, Oficina Regional de la OMS para la Región de las Américas, reiteró la recomendación de la vacunación antigripal de los adultos mayores. Se ha recabado relativamente poca información sobre los aspectos inmunológicos del envejecimiento o sobre cómo reducir su repercusión, información particularmente pertinente para médicos clínicos y gerontólogos que deben afrontar de primera mano sus efectos. Para salvar esta brecha en materia de datos, en el 2012, la Americas Health Foundation (Washington, D.C., Estados Unidos) y la Fighting Infectious Diseases in Emerging Countries (fundación sin ánimo de lucro para la lucha contra las enfermedades infecciosas en los países emergentes, con sede en Miami, Florida, Estados Unidos) convocaron un grupo de expertos, médicos clínicos y gerontólogos latinoamericanos con pericia en el tema de la gripe, con objeto de debatir aspectos clave y elaborar una declaración de consenso. Las principales recomendaciones fueron mejorar la vigilancia de la gripe en toda América Latina para que pudiera cuantificarse su repercusión; y llevar a cabo la confirmación de laboratorio en todos los pacientes con síntomas similares a los de la gripe debilitados, inmunodeprimidos, con comorbilidades, con compromiso respiratorio o que hubieran sido ingresados en un hospital. El grupo de expertos también señaló que, dado que no existen datos probatorios claros en relación con los antivíricos en los ancianos, su uso debe manejarse caso por caso; que, a pesar de la reducción de la respuesta inmunitaria, la vacunación antigripal en adultos mayores sigue siendo crucial; que se deben promover las estrategias de vacunación indirecta; y que, en los establecimientos de asistencia a largo plazo, las medidas tradicionales de control de las infecciones son esenciales.

Influenza among adults in Latin America, current status, and future directions: a consensus statement.

In Latin America, adult influenza is a serious disease that exacts a heavy burden in terms of morbidity, mortality, and cost. Although much has been written about the disease itself, relatively little information has been compiled on what could be done to reduce its impact across the region, particularly from the perspective of clinicians with first-hand experience in confronting its effects. To fill this data gap, in 2011, the Pan American Health and Education Foundation (PAHEF) and the U.S.-based nonprofit Fighting Infectious Diseases in Emerging Countries (FIDEC) organized a conference and convened a panel of Latin American scientist-clinicians with experience and expertise in adult influenza in the region tol) discuss the major issues related to the disease and 2) develop and produce a consensus statement summarizing its impact as well as current efforts to diagnose, prevent, and treat it. The consensus panel concluded a more concerted and better-coordinated effort was needed to reduce the adverse impact of seasonal influenza and future pandemics, including more surveillance, more active involvement by both governmental and nongovernmental organizations, and a much greater effort to vaccinate more adults, especially those at high risk of contracting the disease. In addition, a new approach for diagnosing influenza was recommended.

Influenza among adults in Latin America, current status, and future directions: a consensus statement / La gripe en adultos en América Latina, situación actual y tendencias futuras: una declaración de consenso

In Latin America, adult influenza is a serious disease that exacts a heavy burden in terms of morbidity, mortality, and cost. Although much has been written about the disease itself, relatively little information has been compiled on what could be done to reduce its impact across the region, particularly from the perspective of clinicians with firsthand experience in confronting its effects. To fill this data gap, in 2011, the Pan American Health and Education Foundation (PAHEF) and the U.S.-based nonprofit Fighting Infectious Diseases in Emerging Countries (FIDEC) organized a conference and convened a panel of Latin American scientistclinicians with experience and expertise in adult influenza in the region tol) discuss the major issues related to the disease and 2) develop and produce a consensus statement summarizing its impact as well as current efforts to diagnose, prevent, and treat it. The consensus panel concluded a more concerted and better-coordinated effort was needed to reduce the adverse impact of seasonal influenza and future pandemics, including more surveillance, more active involvement by both governmental and nongovernmental organizations, and a much greater effort to vaccinate more adults, especially those at high risk of contracting the disease. In addition, a new approach for diagnosing influenza was recommended.

En América Latina, la gripe en adultos es una enfermedad grave que impone una carga importante en cuanto a la morbilidad, la mortalidad y el costo. Aunque se ha escrito mucho acerca de la enfermedad en sí, se ha recopilado relativamente escasa información sobre lo que podría hacerse para reducir su repercusión en la región, en particular desde la perspectiva de los médicos con experiencia directa en afrontar sus efectos. Para compensar esta falta de información, en 2011 la Fundación Panamericana de la Salud y Educación (PAHEF) y la organización sin fines de lucro establecida en los Estados Unidos Fighting Infectious Diseases in Emerging Countries (FIDEC) organizaron una conferencia y convocaron a un panel de científicos y médicos latinoamericanos con experiencia y conocimientos especializados en la gripe en adultos en la región a fin de 1) analizar los temas principales relacionados con la enfermedad y 2) elaborar y emitir una declaración de consenso que resuma la repercusión, así como los logros actuales en el diagnóstico, la prevención y el tratamiento de la enfermedad. El panel de consenso llegó a la conclusión que se requieren esfuerzos más concertados y mejor coordinados para reducir la repercusión adversa de la gripe estacional y las pandemias futuras, que comprenden una mayor vigilancia, una participación más activa de las organizaciones gubernamentales y no gubernamentales y un esfuerzo mucho mayor para vacunar a más adultos, en especial a las personas que presentan un riesgo elevado de contraer la enfermedad. Además, se recomendó un nuevo enfoque para diagnosticar la gripe.

Pandemic influenza A/H1N1 virus infection in solid organ transplant recipients: a multicenter study.

BACKGROUND: The 2009 novel influenza A/H1N1 virus pandemic did not spare solid organ transplant (SOT) recipients. We aimed to describe the behavior of pandemic influenza infection in a group of SOT recipients in Argentina. METHODS: Data from 10 transplant (Tx) centers were retrospectively collected for SOT that presented with a respiratory illness compatible with pandemic influenza A infection, between May and September 2009. Cases were defined as suspected, probable, or confirmed according to diagnostic method. RESULTS: Seventy-seven cases were included. No significant differences in presenting symptoms, pulmonary infiltrates, and graft involvement were found among 35 suspected, 19 probable, and 23 confirmed cases. The 33 ambulatory cases had significantly more sore throat and headache when compared with 34 cases admitted to medical ward (MW) and 10 admitted to intensive care unit (ICU), 9 of whom required ventilatory support. MW and ICU cases had significantly more dyspnea, hypoxemia, pulmonary infiltrates, and graft dysfunction. Time from onset of symptoms to first visit and to treatment was significantly longer in MW and ICU cases (P=0.008). Coinfections were found in six cases. Most cases received oseltamivir for 5 to 10 days. Six patients (7.8%) died from viral infection at a median of 15 days from admission. No differences in outcome were seen related to the transplanted organ, the immunosuppressive regimen, time from Tx, or confirmation of diagnosis. CONCLUSIONS: Mortality is higher in Tx recipients than in the general population. Poor outcome seems to be related to a delay in the beginning of treatment.