Short-, mid-, and long-term complications after multisystem inflammatory syndrome in children over a 24-month follow-up period in a hospital in Lima-Peru, 2020-2022.

Objective: To determine the short-, mid-, and long-term complications after multisystem inflammatory syndrome in children (MIS-C) over a 24-month follow-up period in a hospital in Lima, Peru, 2020-2022, and to explore differences according to the immunomodulatory treatment received and type of SARS-CoV-2 virus circulating. Methods: Ambispective 24-month follow-up study in children <14 years of age diagnosed with MIS-C at the Hospital Nacional Edgardo Rebagliati Martins (HNERM). Results: A total of 62 children were admitted with MIS-C. The most common short-term complications and serious events were intensive care unit (ICU) admission, invasive mechanical ventilation (IMV) due to respiratory failure, and shock; predominantly during the second pandemic wave (lambda predominance) and in children that received intravenous immunoglobulin (IVIG) plus a corticosteroid. Two patients died during the first wave due to MIS-C. During prospective follow-up (median of 24 months; IQR: 16.7-24), only 46.7% of patients were followed for >18-24 months. Of the total, seven (11.3%) patients were identified with some sequelae on discharge. Among the 43 remaining children, sequelae persisted in five (11.6%) cases (neurological, hematological, and skin problems). Six patients (13.9%) presented with new onset disease (hematologic, respiratory, neurological, and psychiatric disorders). One patient died due to acute leukemia during the follow-up period. None of them were admitted to the ICU or presented with MIS-C reactivation. Two patients presented persistence of coronary aneurysm until 8- and 24-month post-discharge. Conclusion: In our hospital, children with MIS-C frequently developed short-term complications and serious events during the acute phase, with less frequent complications in the mid- and long-term. More studies are required to confirm these findings.

Vaccine value profile for norovirus.

Norovirus is attributed to nearly 1 out of every 5 episodes of diarrheal disease globally and is estimated to cause approximately 200,000 deaths annually worldwide, with 70,000 or more among children in developing countries. Noroviruses remain a leading cause of sporadic disease and outbreaks of acute gastroenteritis even in industrialized settings, highlighting that improved hygiene and sanitation alone may not be fully effective in controlling norovirus. Strengths in global progress towards a Norovirus vaccine include a diverse though not deep pipeline which includes multiple approaches, including some with proven technology platforms (e.g., VLP-based HPV vaccines). However, several gaps in knowledge persist, including a fulsome mechanistic understanding of how the virus attaches to human host cells, internalizes, and induces disease.

Biomonitoring Human Exposure to Household Air Pollution and Association with Self-reported Health Symptoms - A Stove Intervention Study in Peru.

BACKGROUND: Household air pollution (HAP) from indoor biomass stoves contains harmful pollutants, such as polycyclic aromatic hydrocarbons (PAHs), and is a leading risk factor for global disease burden. We used biomonitoring to assess HAP exposure and association with self-reported symptoms in 334 non-smoking Peruvian women to evaluate the efficacy of a stove intervention program. METHODS: We conducted a cross-sectional study within the framework of a community randomized control trial. Using urinary PAH metabolites (OH-PAHs) as the exposure biomarkers, we investigated whether the intervention group (n=155, with new chimney-equipped stoves) were less exposed to HAP compared to the control group (n=179, with mostly open-fire stoves). We also estimated associations between the exposure biomarkers, risk factors, and self-reported health symptoms, such as recent eye conditions, respiratory conditions, and headache. RESULTS: We observed reduced headache and ocular symptoms in the intervention group than the control group. Urinary 2-naphthol, a suggested biomarker for inhalation PAH exposure, was significantly lower in the intervention group (GM with 95% CI: 13.4 [12.3, 14.6] µg/g creatinine) compared to control group (16.5 [15.0, 18.0] µg/g creatinine). Stove type and/or 2-naphthol was associated with a number of self-reported symptoms, such as red eye (adjusted OR with 95% CI: 3.80 [1.32, 10.9]) in the past 48h. CONCLUSIONS: Even with the improved stoves, the biomarker concentrations in this study far exceeded those of the general populations and were higher than a no-observed-genotoxic-effect-level, indicating high exposure and a potential for increased cancer risk in the population.

Respiratory Viral Detections During Symptomatic and Asymptomatic Periods in Young Andean Children.

BACKGROUND: Viruses are commonly detected in children with acute respiratory illnesses (ARIs) and in asymptomatic children. Longitudinal studies of viral detections during asymptomatic periods surrounding ARI could facilitate interpretation of viral detections but are currently scant. METHODS: We used reverse transcription polymerase chain reaction to analyze respiratory samples from young Andean children for viruses during asymptomatic periods within 8-120 days of index ARI (cough or fever). We compared viral detections over time within children and explored reverse transcription polymerase chain reaction cycle thresholds (CTs) as surrogates for viral loads. RESULTS: At least 1 respiratory virus was detected in 367 (43%) of 859 samples collected during asymptomatic periods, with more frequent detections in periods with rhinorrhea (49%) than those without (34%, P < 0.001). Relative to index ARI with human rhinovirus (HRV), adenovirus (AdV), respiratory syncytial virus (RSV) and parainfluenza virus detected, the same viruses were also detected during 32, 22, 10 and 3% of asymptomatic periods, respectively. RSV was only detected 8-30 days after index RSV ARI, whereas HRV and AdV were detected throughout asymptomatic periods. Human metapneumovirus and influenza were rarely detected during asymptomatic periods (<3%). No significant differences were observed in the CT for HRV or AdV during asymptomatic periods relative to ARI. For RSV, CTs were significantly lower during ARI relative to the asymptomatic period (P = 0.03). CONCLUSIONS: These findings indicate that influenza, human metapneumovirus, parainfluenza virus and RSV detections in children with an ARI usually indicate a causal relationship. When HRV or AdV is detected during ARI, the causal relationship is less certain.

Concordance between RT-PCR-based detection of respiratory viruses from nasal swabs collected for viral testing and nasopharyngeal swabs collected for bacterial testing.

BACKGROUND: Epidemiologic studies of respiratory infections frequently rely on separate sample collections for the detection of bacteria and viruses. The requirement for two specimens presents cost, logistical, and acceptability challenges. OBJECTIVES: To determine the agreement in detection of respiratory viruses using RT-PCR between two different types of samples collected on the same day: nasal swabs preserved in viral transport medium (NS) and nasopharyngeal swabs preserved in skim milk-tryptone-glucose-glycerol [STGG] medium (NP), the current standard for pneumococcal colonization studies. STUDY DESIGN: Paired NS and NP samples were collected between May 2009 and September 2011 as part of the RESPIRA-PERU study, a large prospective cohort of Andean children <3 years of age. NS samples used polyester swabs and viral transport medium whereas NP samples used rayon wire-handled swabs and STGG medium. Samples were tested for influenza, human metapneumovirus (MPV), respiratory syncytial virus (RSV), human rhinovirus (HRV), parainfluenza virus 3 (PIV3) and adenovirus (ADV) using real-time RT-PCR. We calculated the agreement, and compared cycle thresholds (CT) between NP and NS samples. RESULTS: Among 226 paired NP-NS samples, we observed very high agreement with a Kappa statistic ranging from 0.71 for ADV to 0.97 for MPV. CT values were similar for both strategies. CONCLUSIONS: NP samples preserved in STGG provide a simple and reliable strategy for identification of both pneumococcus and respiratory viruses. This single specimen collection strategy could be used for epidemiologic studies, especially in resource-limited settings. Furthermore, archived NP-STGG specimens from previous studies could be reliably tested by RT-PCR for viruses.

The role of influenza and parainfluenza infections in nasopharyngeal pneumococcal acquisition among young children.

BACKGROUND: Animal models suggest that influenza infection favors nasopharyngeal acquisition of pneumococci. We assessed this relationship with influenza and other respiratory viruses in young children. METHODS: A case-control study was nested within a prospective cohort study of acute respiratory illness (ARI) in Andean children <3 years of age (RESPIRA-PERU study). Weekly household visits were made to identify ARI and obtain nasal swabs for viral detection using real-time reverse-transcription polymerase chain reaction. Monthly nasopharyngeal (NP) samples were obtained to assess pneumococcal colonization. We determined whether specific respiratory viral ARI episodes occurring within the interval between NP samples increased the risk of NP acquisition of new pneumococcal serotypes. RESULTS: A total of 729 children contributed 2128 episodes of observation, including 681 pneumococcal acquisition episodes (new serotype, not detected in prior sample), 1029 nonacquisition episodes (no colonization or persistent colonization with the same serotype as the prior sample), and 418 indeterminate episodes. The risk of pneumococcal acquisition increased following influenza-ARI (adjusted odds ratio [AOR], 2.19; 95% confidence interval [CI], 1.02-4.69) and parainfluenza-ARI (AOR, 1.86; 95% CI, 1.15-3.01), when compared with episodes without ARI. Other viral infections (respiratory syncytial virus, human metapneumovirus, human rhinovirus, and adenovirus) were not associated with acquisition. CONCLUSIONS: Influenza and parainfluenza ARIs appeared to facilitate pneumococcal acquisition among young children. As acquisition increases the risk of pneumococcal diseases, these observations are pivotal in our attempts to prevent pneumococcal disease.

A household-based study of acute viral respiratory illnesses in Andean children.

BACKGROUND: Few community studies have measured the incidence, severity and etiology of acute respiratory illness (ARI) among children living at high-altitude in remote rural settings. METHODS: We conducted active, household-based ARI surveillance among children aged <3 years in rural highland communities of San Marcos, Cajamarca, Peru from May 2009 through September 2011 (RESPIRA-PERU study). ARI (defined by fever or cough) were considered lower respiratory tract infections if tachypnea, wheezing, grunting, stridor or retractions were present. Nasal swabs collected during ARI episodes were tested for respiratory viruses by real-time, reverse-transcriptase polymerase chain reaction. ARI incidence was calculated using Poisson regression. RESULTS: During 755.1 child-years of observation among 892 children in 58 communities, 4475 ARI were observed, yielding an adjusted incidence of 6.2 ARI/child-year (95% confidence interval: 5.9-6.5). Families sought medical care for 24% of ARI, 4% were classified as lower respiratory tract infections and 1% led to hospitalization. Of 5 deaths among cohort children, 2 were attributed to ARI. One or more respiratory viruses were detected in 67% of 3957 samples collected. Virus-specific incidence rates per 100 child-years were: rhinovirus, 236; adenovirus, 73; parainfluenza virus, 46; influenza, 37; respiratory syncytial virus, 30 and human metapneumovirus, 17. Respiratory syncytial virus, metapneumovirus and parainfluenza virus 1-3 comprised a disproportionate share of lower respiratory tract infections compared with other etiologies. CONCLUSIONS: In this high-altitude rural setting with low-population density, ARI in young children were common, frequently severe and associated with a number of different respiratory viruses. Effective strategies for prevention and control of these infections are needed.

Physicians’ responsibility for antibiotic use in infants from periurban Lima, Peru / Responsabilidad del médico en el uso de antibióticos en niños menores de 1 año de zonas periurbanas de Lima, Perú

Objetivo. Describir el uso de antibióticos en niños de 2 a 12 meses de edad en entornos donde estos medicamentos se pueden obtener sin prescripción. Métodos. Se analizaron los datos de un estudio de cohorte efectuado entre septiembre del 2006 y diciembre del 2007 en 1 023 niños menores de 2 meses de la zonaperiurbana de Lima, Perú, cuyo seguimiento se realizó hasta el año de edad. Resultados. De los 1 023 niños, 770 (75,3%) tomaron 2 085 tandas de tratamiento antibiótico. Se registraron dos tandas por niño por año (rango 0–12). Las tasas más elevadas de uso de antibióticos se encontraron en los niños de 3 a 6 meses (37,2%). Los niños recibieron antibióticos para 8,2% de los resfriados comunes, 58,6% de las faringitis, 66,0% de las bronquitis, 40,7% de las diarreas, 22,8% de las dermatitis y 12,0% de las obstruccionesbronquiales. La prescripción de un médico fue la razón más frecuente para el uso de antibióticos (90,8%). Se comprobó el uso de medicamentos sin prescripción en 6,9% de los niños, y en 63,9% de ellos este fue precedido por una prescripción médica. Conclusiones. En el entorno estudiado, los niños menores de 1 año a menudo estánexpuestos a los antibióticos. El abuso de los antibióticos es frecuente ante enfermedades como faringitis, bronquitis, obstrucción bronquial y diarrea, pero por lo general es inadecuado (83,1% de las tandas de tratamiento antibiótico) según las etiologías más comunes en este grupo etario. Las intervenciones dirigidas a mejorar el uso de los antibióticos deben concentrarse en los médicos, ya que la prescripción médica fue la razón más común para el uso de antibióticos.

Objective. To describe the use of antibiotics in Peruvian children under 1 year in a setting where they are available without a prescription. Methods. Data were analyzed from a cohort study between September 2006 and December 2007 of 1 023 children < 2 months old in periurban Lima, Peru, followed until they were 1 year old. Results. Seven hundred seventy of 1 023 (75.3%) children took 2 085 courses of antibiotics. There were two courses per child per year (range 0–12). Higher rates of antibiotic usewere found in children 3–6 months old (37.2%). Antibiotics were given to children for 8.2% of common colds, 58.6% of all pharyngitis, 66.0% of bronchitis, 40.7% of diarrheas, 22.8%of dermatitis, and 12.0% of bronchial obstructions. A physician’s prescription was the most common reason for antibiotic use (90.8%). Medication use without a prescription was found in 6.9% of children, and in 63.9% of them it was preceded by a physician’s prescription. Conclusions. Infants are often exposed to antibiotics in this setting. Overuse of antibiotics is common for diagnoses such as pharyngitis, bronchitis, bronchial obstruction, and diarrhea but is typically inappropriate (83.1% of courses) based on the most common etiologies for this age group. Interventions to improve the use of antibiotics should focus on physicians, since a physician’s prescription was the most common reason for antibiotic use.

Toxocariosis atípica: reporte de un caso en la costa norte del Perú / Atypic toxocariasis: a case report from the Peruvian north coast

Se presenta el caso de un varón de cuatro años y medio con toxocariosis atípica, procedente de La Matanza, Morropón,Piura. El paciente presentó síntomas inespecíficos durante nueve días; la sospecha de toxocariosis derivó del hallazgo de eosinofilia periférica marcada (15 por ciento ó 1470 células/uL) en el hemograma. El diagnóstico se confirmó por serología mediante el método de enzimoinmunoanálisis (ELISA) demostrando la presencia de anticuerpos anti-Toxocara de tipo IgG, así como de tipo IgM. El cuadro se autolimitó antes de que el paciente recibiera tratamiento con albendazol 15mg/ kg/día durante cinco días.

We present the case of a 4.5 years old boy with atypic toxocariasis, from La Matanza, Morropon, Piura. The patienthad non-specific symptoms during 9 days. Suspicion of Toxocariasis was supported by marked eosinophilia in the cellblood count (15 per cent or 1470 cells/uL). Diagnosis was confirmed by laboratory with ELISA serology demonstrating the presence of IgG and IgM anti-Toxocara antibodies. Symptoms receded before the patient received a five-day treatment with albendazol 15mg/kg/day.

Gravedad de la gastroenteritis causada por Vibrio parahaemolyticus del grupo pandémico en el Perú / Severity of the gastroenteritis caused by Vibrio parahaemolyticus of the pandemic group in Peru

Objetivos. Determinar las características epidemiológicas y clínicas de la gastroenteritis causada por Vibrio parahaemolyticus del grupo pandémico en el Perú. Materiales y métodos. Se examinó las historias clínicas y registros de laboratorio de cien casos de gastroenteritis en los cuales se aisló V. parahaemolyticus del grupo pandémico y no pandémico. Se recolectó información epidemiológica y clínica y se realizó el análisis estadístico de los datos para evaluar si la gravedad de la enfermedad se asoció con la presencia de las cepas del grupo pandémico. Resultados. Se logró colectar información epidemiológica en 85 por ciento de los casos e información clínica sólo en 37 por ciento de los casos, principalmente de los hospitalizados. Los casos del grupo pandémico tuvieron una mayor probabilidad de tener deposiciones líquidas (96,3 por ciento frente a 62,5 por ciento, p<0,05), presentar deshidratación moderada o grave (100 por ciento frente a 60 por ciento, p<0,05) y requerir atención hospitalaria (98 por ciento frente a 42,9 por ciento, p<0,0001). Fue más probable aislar una cepa pandémica en personas de 30 o más años de edad (63 por ciento frente a 39,5 por ciento, p<0,05). Conclusiones. El Vibrio parahaemolyticus del grupo pandémico causa enfermedad gastrointestinal de mayor gravedad que las cepas no pandémicas, con mayor probabilidad de requerir atención hospitalaria. Basados en este reporte, se recomienda incluir la identificación de V. parahaemolyticus en el diagnóstico etiológico de agentes causantes de gastroenteritis grave en el sistema de salud del Perú.

Objective. To determine the epidemiological and clinic characteristics of gastroenteritis caused by Vibrio parahaemolyticus strains of the pandemic group in Peru. Material and methods. Clinical and laboratory records were searched in 100cases of gastroenteritis caused by V parahaemolyticus, either of the pandemic or non pandemic group. Clinical and epidemiological data were collected and statistical analysis was done to evaluate if the severity of illness was associated with the pandemic group. Results. Epidemiological data were collected in 85 per cent of cases, and clinical data were only available in 37 per cent of cases, mainly on those hospitalized. Cases associated with the pandemic strains had a higher probability of liquid stools (96.3 per cent vs. 62.5 per cent, p<0.05), moderate or severe dehydration (100 per cent vs. 60 per cent, p<0.05), and hospital care (98 per cent vs. 42.9 per cent, p<0.0001). Cases aged thirty or older were associated with the pandemic strains (63 per cent vs. 39.5 per cent, p<0.05). Conclusions. Vibrio parahaemolyticus of the pandemic group causes more severe gastrointestinal disease than none pandemic strains, with higher probability of requiring hospital care. Based on this report, it is advisable to include the identification of V. parahaemolyticus in the etiological diagnosis of agents causing severe gastroenteritis in the Peruvian health system.

Feces, flies, and fetor: findings from a Peruvian shantytown

Sanitary disposal of feces is vital to combat childhood diarrhea, and its promotion is key to improving health in developing countries. Knowledge of prevailing feces disposal practices is a prerequisite to formulation of effective intervention strategies. Two studies were conducted in a shantytown area of Lima, Peru. First, information was gathered through in-depth interviews with mothers and structured observations (4 hours) of young children and their caretakers. Data on beliefs and practices related to feces disposal behaviors were obtained. Excreta were deposited by animals or humans in or near the house in 82% of households observed. Beliefs about feces depended on their source and were reflected in how likely the feces were to be cleared. While 22% of children aged 318 months were observed to use a potty for defecation, 48% defecated on the ground where the stools often remained. Although almost all children were cleaned after defecation, 30% retained some fecal matter on their body or clothes. Handwashing after the child's defecation was extremely rare for both children (5%) and caretakers (20%). The hygienic disposal of feces poses problems in this type of community. Nevertheless existing practices were found that show promise for promotion on a wider scale, including greater use of potties.

La disposición sanitaria de las heces es indispensable para poder combatir la diarrea de la infancia y su promoción es esencial para mejorar la salud en países en desarrollo. Es necesario conocer las prácticas actuales de disposición de excretas a fin de formular estrategias de intervención eficaces. Dos estudios se llevaron a cabo en un barrio pobre de Lima, Perú. En el primero se recolectó información por medio de entrevistas minuciosas a madres y observaciones estructuradas (4 horas) de niños pequeños y sus responsables. Se obtuvieron datos sobre las creencias y prácticas vigentes con respecto a la disposición de excretas. En 82% de los domicilios observados, se encontraron excretas depositadas por animales o seres humanos dentro o en el exterior. Las creencias en torno a las heces dependieron de su origen y se vieron reflejadas en las posibilidades de que las heces fueran recogidas. Aunque se observó que 22% de los niños de 18 meses o más defecaban en un recipiente, 48% defecaban en el suelo, donde las heces a menudo se quedaban. Pese a que a casi todos los niños los limpiaron después de defecar, 30% siguieron teniendo materia fecal en el cuerpo o en la ropa. Los niños (5%) o sus responsables (20%) raras veces se lavaron las manos después de la defecación del niño. En este tipo de comunidad, la disposición sanitaria de las heces plantea un problema. No obstante, se observaron algunas prácticas que apuntan a que en un futuro su promoción, incluido el uso de un recipiente, será más amplia.

Deteccion de portadores de Salmonella Typhi mediante la prueba de hemaglutinacion indirecta con antigeno Vi muy purificado / Screening of Salmonella Typhi carriers by indirect hemagglutination using highly purified Vi antigen

A study was carrried out to determine the predictive value and the cost-effectiveness of the indirect hemagglutination test using highly purified Vi antigen as a means of screening Salmonella Typhi carrriers in a high-risk group living in an área where typhoid fever is emdemic. The group consisted of women over age 30 who were participating in a municipal sanitary control program for food handlers in Lima, Perú. Test yielding an anti-Vi antibody titer= 1:40 were considered positive (79 percent sensitivity, and 99 percent and 100 percent specificity for the local population). On this basis, 29 women (1.5 percent) tested positive out of a total of 1 931. A follow-up bacteriological study demonstrated that 26 of these 29 women were carriers of S. typhi; thus, the test had a predictive value of 15 percent. The prevalence of carriers in this group was estimated at 292 per 100 000 population. The test cost $US 0.30 per person. In comparison, the method that requires a series of three fecal cultures to isolate the causative agent would have cost $US 1.72. It can be concluded that the test studied is suficiently sensitive, that it is highly specific, and that it is cost-effective when used to detect S. typhi carriers in áreas where typhoid fever is endemic