COVID-19 vaccine effectiveness against hospitalizations in Paraguay, May 2021-April 2022: A test-negative design.

BACKGROUND: Vaccine effectiveness (VE) estimates vary by population characteristics and circulating variants. North America and Europe have generated many COVID-19 VE estimates but relied heavily on mRNA vaccines. Fewer estimates are available for non-mRNA vaccines and from Latin America. We aimed to estimate the effectiveness of several COVID-19 vaccines in preventing SARS-CoV-2-associated severe acute respiratory infection (SARI) in Paraguay from May 2021 to April 2022. METHODS: Using sentinel surveillance data from four hospitals in Paraguay, we conducted a test-negative case-control study to estimate COVID-19 vaccine effectiveness against SARI by vaccine type/brand and period of SARS-CoV-2 variant predominance (Gamma, Delta, Omicron). We used multivariable logistic regression adjusting for month of symptom onset, age group, and presence of ≥1 comorbidity to estimate the odds of COVID-19 vaccination in SARS-CoV-2 test-positive SARI case-patients compared to SARS-CoV-2 test-negative SARI control-patients. RESULTS: Of 4,229 SARI patients, 2,381 (56%) were SARS-CoV-2-positive case-patients and 1,848 (44%) were SARS-CoV-2-negative control-patients. A greater proportion of case-patients (73%; 95% CI: 71-75) than of control-patients (40%; 95% CI: 38-42) were unvaccinated. During the Gamma variant-predominant period, VE estimates for partial vaccination with mRNA vaccines and Oxford/AstraZeneca Vaxzevria were 90.4% (95% CI: 66.4-97.6) and 52.2% (95% CI: 25.0-69.0), respectively. During the Delta variant-predominant period, VE estimates for complete vaccination with mRNA vaccines, Oxford/AstraZeneca Vaxzevria, or Gamaleya Sputnik V were 90.4% (95% CI: 74.3-97.3), 83.2% (95% CI: 67.8-91.9), and 82.9% (95% CI: 53.0-95.2), respectively. The effectiveness of all vaccines declined substantially during the Omicron variant-predominant period. CONCLUSIONS: This study contributes to our understanding of COVID-19 VE in Latin America and to global understanding of vaccines that have not been widely used in North America and Europe. VE estimates from Paraguay can parameterize models to estimate the impact of the national COVID-19 vaccination campaign in Paraguay and similar settings.

Rapid Epidemic Expansion of Chikungunya Virus East/Central/South African Lineage, Paraguay.

The spread of Chikungunya virus is a major public health concern in the Americas. There were >120,000 cases and 51 deaths in 2023, of which 46 occurred in Paraguay. Using a suite of genomic, phylodynamic, and epidemiologic techniques, we characterized the ongoing large chikungunya epidemic in Paraguay.

Retrospective Spatio-Temporal Dynamics of Dengue Virus 1, 2 and 4 in Paraguay.

Dengue virus (DENV) has been a major public health concern in Paraguay, with frequent outbreaks occurring since early 1988. Although control measures have been implemented, dengue remains a significant health threat in the country, and continued efforts are required for prevention and control. In response to that, in collaboration with the Central Public Health Laboratory in Asunción, we conducted a portable whole-genome sequencing and phylodynamic analysis to investigate DENV viral strains circulating in Paraguay over the past epidemics. Our genomic surveillance activities revealed the co-circulation of multiple DENV serotypes: DENV-1 genotype V, the emerging DENV-2 genotype III, BR4-L2 clade, and DENV-4 genotype II. Results additionally highlight the possible role of Brazil as a source for the international dispersion of different viral strains to other countries in the Americas emphasizing the need for increased surveillance across the borders, for the early detection and response to outbreaks. This, in turn, emphasizes the critical role of genomic surveillance in monitoring and understanding arbovirus transmission and persistence locally and over long distances.

Rapid epidemic expansion of chikungunya virus-ECSA lineage in Paraguay.

The spread of vector-borne viruses, such as CHIKV, is a significant public health concern in the Americas, with over 120,000 cases and 51 deaths in 2023, of which 46 occurred in Paraguay. Using a suite of genomic, phylodynamic, and epidemiological techniques, we characterized the ongoing large CHIKV epidemic in Paraguay. Article Summary Line: Genomic and epidemiological characterization of the ongoing Chikungunya virus epidemic in Paraguay.

Costing Dengue Fever Cases and Outbreaks: Recommendations from a Costing Dengue Working Group in the Americas.

OBJECTIVES: The overall aim of this article was to present a step-by-step guideline for determining the costs associated with dengue in dengue-endemic countries of the Latin American and the Caribbean region and to illustrate how each of these steps can be applied in dengue costing studies. METHODS: An expert panel was convened to develop standards for costing dengue so that over the next decade, decision makers will have access to improved information on the true cost of dengue in endemic countries of the Latin American and the Caribbean region. We described the outcome of the expert panel meeting, which resulted in the provision of a step-by-step dengue costing guideline that aims to provide direction to planners and program managers on how to estimate dengue economic burden studies, and provide a discussion forum of the methods used to cost dengue fever cases and outbreaks in a manner that should be accessible to persons with some familiarity with a cost study. RESULTS: The guideline includes nine sequential steps: 1) definition of the scope of the study; 2) identification of the target population; 3) description of the study perspective; 4) definition of the time horizon; 5) calculation of the sample size; 6) definition of the unit of analysis; 7) identification of the cost items; 8) measurement and valuation of the cost items; and 9) handling of uncertainty. The trade-off between accurate, patient-level cost estimates and data availability constraints is discussed. CONCLUSIONS: The current guideline is the result of constructive collaboration among a multidisciplinary research team to better ascertain the true economic burden of dengue across countries of the region.

The history of dengue outbreaks in the Americas.

Dengue is a viral disease usually transmitted by Aedes aegypti mosquitoes. Dengue outbreaks in the Americas reported in medical literature and to the Pan American Health Organization are described. The outbreak history from 1600 to 2010 was categorized into four phases: Introduction of dengue in the Americas (1600-1946); Continental plan for the eradication of the Ae. aegypti (1947-1970) marked by a successful eradication of the mosquito in 18 continental countries by 1962; Ae. aegypti reinfestation (1971-1999) caused by the failure of the mosquito eradication program; Increased dispersion of Ae. aegypti and dengue virus circulation (2000-2010) characterized by a marked increase in the number of outbreaks. During 2010 > 1.7 million dengue cases were reported, with 50,235 severe cases and 1,185 deaths. A dramatic increase in the number of outbreaks has been reported in recent years. Urgent global action is needed to avoid further disease spread.

Evaluación de la resistencia a insecticidas de una cepa de Aedes aegypti de El Salvador / Assessing the insecticide resistance of an Aedes aegypti strain in El Salvador

OBJETIVOS: Evaluar el nivel de susceptibilidad a insecticidas de una cepa de Aedes aegypti procedente de El Salvador y describir los posibles mecanismos de resistencia al temefós. MÉTODOS: Se evaluó una cepa de A. aegypti procedente del municipio de Soyapango, departamento de San Salvador, El Salvador. Mediante bioensayos se determinó la susceptibilidad de las larvas al insecticida organofosforado temefós y a tres piretroides (deltametrina, lambdacialotrina y cipermetrina) y de los adultos a un insecticida organofosforado (clorpirifós). Se determinó el factor de resistencia (FR50) con respecto a una cepa sensible de referencia (Rockefeller). Se estableció el mecanismo de resistencia al temefós mediante el empleo de sustancias sinergistas, ensayos bioquímicos de actividad enzimática y zimogramas en gel de poliacrilamida. RESULTADOS: Las larvas de la cepa estudiada mostraron una alta resistencia al temefós (FR50 = 24,16). De las enzimas analizadas, se encontró que solo la esterasa A4 estaba vinculada al mecanismo de resistencia al temefós. Los mosquitos adultos resultaron susceptibles a la lambdacialotrina y al clorpirifós y su resistencia a la deltametrina y la cipermetrina quedó en la categoría de verificación. CONCLUSIONES: La resistencia al temefós podría reducir la eficacia del control químico del mosquito A. aegypti en la zona estudiada de El Salvador. Los insecticidas clorpirifós, lambdacialotrina y cipermetrina son buenos candidatos alternativos a utilizar en las nuevas intervenciones de control de este vector.

OBJECTIVES: To assess the level of insecticide susceptibility of a certain Aedes aegypti strain found in El Salvador and to explain the mechanisms for its resistance to temephos. METHODS: An A. aegypti strain from the municipality of Soyapango, Department of San Salvador, El Salvador, was studied. Bioassays were used to determine the susceptibility of the larvae to the organophosphate insecticide temephos and to three pyrethroids (deltamethrin, lambda-cyhalothrin, and cypermethrin); and of adults to an organophosphate insecticide (chlorpyrifos). The resistance factor (RF50) with determined with respect to a reference susceptible strain (Rockefeller). The mechanism of temephos resistance was determined through the use of synergistic substances, biochemical assays for enzymatic activity, and polyacrylamide gel zymograms. RESULTS: The larvae of the strain studied proved highly resistant to temephos (RF50 = 24.16). Of the enzyme samples analyzed, only the esterase A4 was linked to the mechanism of temephos resistance. The adult mosquitoes were susceptible to lambda-cyhalothrin and chlorpyrifos; and resistance to deltamethrin and cypermethrin fell into the category needing further verification. CONCLUSIONS: Temephos resistance could reduce the efficiency of chemical control of the A. aegypti mosquito in El Salvador study area. Chlorpyrifos, lambda-cyhalothrin, and cypermethrin are good alternative insecticides for use in new efforts to control this vector.

Cost of dengue cases in eight countries in the Americas and Asia: a prospective study.

Despite the growing worldwide burden of dengue fever, the global economic impact of dengue illness is poorly documented. Using a common protocol, we present the first multicountry estimates of the direct and indirect costs of dengue cases in eight American and Asian countries. We conducted prospective studies of the cost of dengue in five countries in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and three countries in Asia (Cambodia, Malaysia, and Thailand). All studies followed the same core protocol with interviews and medical record reviews. The study populations were patients treated in ambulatory and hospital settings with a clinical diagnosis of dengue. Most studies were performed in 2005. Costs are in 2005 international dollars (I$). We studied 1,695 patients (48% pediatric and 52% adult); none died. The average illness lasted 11.9 days for ambulatory patients and 11.0 days for hospitalized patients. Among hospitalized patients, students lost 5.6 days of school, whereas those working lost 9.9 work days per average dengue episode. Overall mean costs were I$514 and I$1,394 for an ambulatory and hospitalized case, respectively. With an annual average of 574,000 cases reported, the aggregate annual economic cost of dengue for the eight study countries is at least I$587 million. Preliminary adjustment for under-reporting could raise this total to $1.8 billion, and incorporating costs of dengue surveillance and vector control would raise the amount further. Dengue imposes substantial costs on both the health sector and the overall economy.

[Assessing the insecticide resistance of an Aedes aegypti strain in El Salvador]. / Evaluación de la resistencia a insecticidas de una cepa de Aedes aegypti de El Salvador.

OBJECTIVES: To assess the level of insecticide susceptibility of a certain Aedes aegypti strain found in El Salvador and to explain the mechanisms for its resistance to temephos. METHODS: An A. aegypti strain from the municipality of Soyapango, Department of San Salvador, El Salvador, was studied. Bioassays were used to determine the susceptibility of the larvae to the organophosphate insecticide temephos and to three pyrethroids (deltamethrin, lambda-cyhalothrin, and cypermethrin); and of adults to an organophosphate insecticide (chlorpyrifos). The resistance factor (RF50) with determined with respect to a reference susceptible strain (Rockefeller). The mechanism of temephos resistance was determined through the use of synergistic substances, biochemical assays for enzymatic activity, and polyacrylamide gel zymograms. RESULTS: The larvae of the strain studied proved highly resistant to temephos (RF50 = 24.16). Of the enzyme samples analyzed, only the esterase A4 was linked to the mechanism of temephos resistance. The adult mosquitoes were susceptible to lambda-cyhalothrin and chlorpyrifos; and resistance to deltamethrin and cypermethrin fell into the category needing further verification. CONCLUSIONS: Temephos resistance could reduce the efficiency of chemical control of the A. aegypti mosquito in El Salvador study area. Chlorpyrifos, lambda-cyhalothrin, and cypermethrin are good alternative insecticides for use in new efforts to control this vector.