Risk Factors for Mortality Among Children Younger Than Age 5 Years With Severe Diarrhea in Low- and Middle-income Countries: Findings From the World Health Organization-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks.

BACKGROUND: Diarrhea is the second leading cause of death in children younger than 5 years of age globally. The burden of diarrheal mortality is concentrated in low-resource settings. Little is known about the risk factors for childhood death from diarrheal disease in low- and middle-income countries. METHODS: Data from the World Health Organization (WHO)-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks, which are composed of active, sentinel, hospital-based surveillance sites, were analyzed to assess mortality in children <5 years of age who were hospitalized with diarrhea between 2008 and 2018. Case fatality risks were calculated, and multivariable logistic regression was performed to identify risk factors for mortality. RESULTS: This analysis comprises 234 781 cases, including 1219 deaths, across 57 countries. The overall case fatality risk was found to be 0.5%. Risk factors for death in the multivariable analysis included younger age (for <6 months compared with older ages, odds ratio [OR] = 3.54; 95% confidence interval [CI], 2.81-4.50), female sex (OR = 1.18; 95% CI, 1.06-1.81), presenting with persistent diarrhea (OR = 1.91; 95% CI, 1.01-3.25), no vomiting (OR = 1.13; 95% CI, .98-1.30), severe dehydration (OR = 3.79; 95% CI, 3.01-4.83), and being negative for rotavirus on an enzyme-linked immunosorbent assay test (OR = 2.29; 95% CI, 1.92-2.74). Cases from the African Region had the highest odds of death compared with other WHO regions (OR = 130.62 comparing the African Region with the European Region; 95% CI, 55.72-422.73), whereas cases from the European Region had the lowest odds of death. CONCLUSIONS: Our findings support known risk factors for childhood diarrheal mortality and highlight the need for interventions to address dehydration and rotavirus-negative diarrheal infections.

Update on Immunodeficiency-Associated Vaccine-Derived Polioviruses - Worldwide, July 2018-December 2019.

Since establishment of the Global Polio Eradication Initiative* in 1988, polio cases have declined >99.9% worldwide; extensive use of live, attenuated oral poliovirus vaccine (OPV) in routine childhood immunization programs and mass campaigns has led to eradication of two of the three wild poliovirus (WPV) serotypes (types 2 and 3) (1). Despite its safety record, OPV can lead to rare emergence of vaccine-derived polioviruses (VDPVs) when there is prolonged circulation or replication of the vaccine virus. In areas with inadequate OPV coverage, circulating VDPVs (cVDPVs) that have reverted to neurovirulence can cause outbreaks of paralytic polio (2). Immunodeficiency-associated VDPVs (iVDPVs) are isolated from persons with primary immunodeficiency (PID). Infection with iVDPV can progress to paralysis or death of patients with PID, and excretion risks seeding cVDPV outbreaks; both risks might be reduced through antiviral treatment, which is currently under development. This report updates previous reports and includes details of iVDPV cases detected during July 2018-December 2019 (3). During this time, 16 new iVDPV cases were reported from five countries (Argentina, Egypt, Iran, Philippines, and Tunisia). Alongside acute flaccid paralysis (AFP) surveillance (4), surveillance for poliovirus infections among patients with PID has identified an increased number of persons excreting iVDPVs (5). Expansion of PID surveillance will facilitate early detection and follow-up of iVDPV excretion among patients with PID to mitigate the risk for iVDPV spread. This will be critical to help identify all poliovirus excretors and thus achieve and maintain eradication of all polioviruses.

Etiology of Severe Acute Watery Diarrhea in Children in the Global Rotavirus Surveillance Network Using Quantitative Polymerase Chain Reaction.

Background: The etiology of acute watery diarrhea remains poorly characterized, particularly after rotavirus vaccine introduction. Methods: We performed quantitative polymerase chain reaction for multiple enteropathogens on 878 acute watery diarrheal stools sampled from 14643 episodes captured by surveillance of children <5 years of age during 2013-2014 from 16 countries. We used previously developed models of the association between pathogen quantity and diarrhea to calculate pathogen-specific weighted attributable fractions (AFs). Results: Rotavirus remained the leading etiology (overall weighted AF, 40.3% [95% confidence interval {CI}, 37.6%-44.3%]), though the AF was substantially lower in the Americas (AF, 12.2 [95% CI, 8.9-15.6]), based on samples from a country with universal rotavirus vaccination. Norovirus GII (AF, 6.2 [95% CI, 2.8-9.2]), Cryptosporidium (AF, 5.8 [95% CI, 4.0-7.6]), Shigella (AF, 4.7 [95% CI, 2.8-6.9]), heat-stable enterotoxin-producing Escherichia coli (ST-ETEC) (AF, 4.2 [95% CI, 2.0-6.1]), and adenovirus 40/41 (AF, 4.2 [95% CI, 2.9-5.5]) were also important. In the Africa Region, the rotavirus AF declined from 54.8% (95% CI, 48.3%-61.5%) in rotavirus vaccine age-ineligible children to 20.0% (95% CI, 12.4%-30.4%) in age-eligible children. Conclusions: Rotavirus remained the leading etiology of acute watery diarrhea despite a clear impact of rotavirus vaccine introduction. Norovirus GII, Cryptosporidium, Shigella, ST-ETEC, and adenovirus 40/41 were also important. Prospective surveillance can help identify priorities for further reducing the burden of diarrhea.

Global Measles and Rubella Laboratory Network Support for Elimination Goals, 2010-2015.

In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP)* with the objective to eliminate measles and rubella in five World Health Organization (WHO) regions by 2020. In September 2013, countries in all six WHO regions had established measles elimination goals, and additional goals for elimination of rubella and congenital rubella syndrome were established in three regions (1). Capacity for surveillance, including laboratory confirmation, is fundamental to monitoring and verifying elimination. The 2012-2020 Global Measles and Rubella Strategic Plan of the Measles and Rubella Initiative(†) calls for effective case-based surveillance with laboratory testing for case confirmation (2). In 2000, the WHO Global Measles and Rubella Laboratory Network (GMRLN) was established to provide high quality laboratory support for surveillance (3). The GMRLN is the largest globally coordinated laboratory network, with 703 laboratories supporting surveillance in 191 countries. During 2010-2015, 742,187 serum specimens were tested, and 27,832 viral sequences were reported globally. Expansion of the capacity of the GMRLN will support measles and rubella elimination efforts as well as surveillance for other vaccine-preventable diseases (VPDs), including rotavirus, and for emerging pathogens of public health concern.

Maternal mortality due to pandemic influenza A H1N1 2009 virus in Colombia.

AIMS: The 2009 H1N1 pandemic illustrated the higher morbidity and mortality from viral infections in peripartum women. We describe clinical features of women who recently died of H1N1 in Colombia. METHODS: This is a case series study that was gathered through a retrospective record review of all maternal H1N1 deaths in the country. The national mortality database of confirmed mortality from H1N1 in pregnancy and up to 42 days after delivery was reviewed during the H1N1 season in 2009. Women with H1N1 infections were confirmed by the laboratory of virology. Demographic, clinical, and laboratory data were reviewed. Statistical analyses were performed and median values of non-parametric data were reported with inter-quartile range (IQR). RESULTS: A total of 23 H1N1 maternal deaths were identified. Eighty-three percent occurred in the third trimester. None of the mothers who died had received influenza vaccination. The median time from symptom onset to the initiation of antiviral treatment was 8.8 days (IQR 5.8-9.8). Five fatalities did not receive any anti-viral therapy. Median PaO2/FiO2 on day 1 was 80 (IQR, 60-98.5). All patients required inotropic support and mechanical ventilation with barotrauma-related complications of mechanical ventilation occurring in 35% of patients. CONCLUSION: In Colombia, none of the women suffering H1N1-related maternal deaths had received vaccination against the disease and most had delayed or had no anti-viral therapy. Given the lack of evidence-based clinical predictors to identify women who are prone to die from H1N1 in pregnancy, following international guidelines for vaccination and initiation of antiviral therapy in suspected cases would likely improve outcomes in developing countries.

Phylogenetic reconstruction of dengue virus type 2 in Colombia.

BACKGROUND: Dengue fever is perhaps the most important viral re-emergent disease especially in tropical and sub-tropical countries, affecting about 50 million people around the world yearly. In Colombia, dengue virus was first detected in 1971 and still remains as a major public health issue. Although four viral serotypes have been recurrently identified, dengue virus type 2 (DENV-2) has been involved in the most important outbreaks during the last 20 years, including 2010 when the fatality rate highly increased. As there are no major studies reviewing virus origin and genotype distribution in this country, the present study attempts to reconstruct the phylogenetic history of DENV-2 using a sequence analysis from a 224 bp PCR-amplified product corresponding to the carboxyl terminus of the envelope (E) gene from 48 Colombian isolates. RESULTS: As expected, the oldest isolates belonged to the American genotype (subtype V), but the strains collected since 1990 represent the American/Asian genotype (subtype IIIb) as previously reported in different American countries. Interestingly, the introduction of this genotype coincides with the first report of dengue hemorrhagic fever in Colombia at the end of 1989 and the increase of cases during the next years. CONCLUSION: After replacement of the American genotype, several lineages of American/Asian subtype have rapidly spread all over the country evolving in new clades. Nevertheless, the direct association of these new variants in the raise of lethality rate observed during the last outbreak has to be demonstrated.

Phylogenetic history demonstrates two different lineages of dengue type 1 virus in Colombia.

BACKGROUND: Dengue Fever is one of the most important viral re-emergent diseases affecting about 50 million people around the world especially in tropical and sub-tropical countries. In Colombia, the virus was first detected in the earliest 70's when the disease became a major public health concern. Since then, all four serotypes of the virus have been reported. Although most of the huge outbreaks reported in this country have involved dengue virus serotype 1 (DENV-1), there are not studies about its origin, genetic diversity and distribution. RESULTS: We used 224 bp corresponding to the carboxyl terminus of envelope (E) gene from 74 Colombian isolates in order to reconstruct phylogenetic relationships and to estimate time divergences. Analyzed DENV-1 Colombian isolates belonged to the formerly defined genotype V. Only one virus isolate was clasified in the genotype I, likely representing a sole introduction that did not spread. The oldest strains were closely related to those detected for the first time in America in 1977 from the Caribbean and were detected for two years until their disappearance about six years later. Around 1987, a split up generated 2 lineages that have been evolving separately, although not major amino acid changes in the analyzed region were found. CONCLUSION: DENV-1 has been circulating since 1978 in Colombia. Yet, the phylogenetic relationships between strains isolated along the covered period of time suggests that viral strains detected in some years, although belonging to the same genotype V, have different recent origins corresponding to multiple re-introduction events of viral strains that were circulating in neighbor countries. Viral strains used in the present study did not form a monophyletic group, which is evidence of a polyphyletic origin. We report the rapid spread patterns and high evolution rate of the different DENV-1 lineages.

[Tuberculosis-related hospitalization in Spain: a cost analysis]. / Hospitalizaciones por tuberculosis en España: análisis de sus costes.

OBJECTIVE: To evaluate the number and cost of hospitalizations due to tuberculosis occurring in the Spanish National Health System (NHS) during 1999 to 2006. METHODS: The specific diagnosis-related groups (DRG) for tuberculosis (DRGs 705, 709, 711 and 798-802) were analyzed. RESULTS: We observed a striking decrease in hospitalizations (-25%), concomitant tuberculosis-HIV infection (-8.7%), and tuberculosis-related deaths (-0.5%, NS). In addition, there was a drop in the absolute number of hospital admissions and overall cost (from 31.3 to 30.8 and from 40.6 to 40.1 million euro), and a significant decrease in the relative hospitalizations and cost with respect to the overall number and hospital budget (from 0.21% to 0.10% and from 0.15% to 0.07%). CONCLUSIONS: There is a marked decrease in tuberculosis-related hospitalizations and mortality, but the disease remains a considerable health burden.

[Seroprevalence of hepatitis B virus and human immunodeficiency virus infection in a population of multiply-transfused patients in Colombia]. / Seroprevalencia de infección por virus de la hepatitis B y por virus de la inmunodeficiencia humana en una población de pacientes con múltiples transfusiones en cuatro hospitales, Colombia, Sur América.

INTRODUCTION: Although the transfusion of blood products is a common therapy, it carries risk of transmission of infections, especially hepatitus B virus (HBV) and human immunodeficiency virus (HIV). OBJECTIVE: As part of the blood safety initiative, the Pan American Health Organization supported studies to estimate the prevalence of human immunodeficiency virus and hepatitis B virus infection in Colombia. MATERIALS AND METHODS: Between February and September 2003, a cross sectional study examined 500 multiply-transfused patients at four hospital centers in the cities of Bogota and Medellin. The serum samples were analyzed by enzyme immunoassay (EIA) using commercial kits. RESULTS: The seroprevalence of HIV infection was 1.8% (CI 95% 0.5-3.1). The seroprevalence of HBV infection was 18.6% (CI 95% 15.1-22.1). Six risk factors were associated with HIV and HBV infection: (1) receiving more than 48 units of blood or blood components, (2) diagnosis of hemophilia, (3) receiving transfusions for more than one year, (4) receiving whole blood, (5) coinfection with hepatitis C virus and (6) receiving transfusions before 1993. CONCLUSIONS: This is the first epidemiological study with a significant sample size performed in multiply-transfused patients in Colombia. The principal finding was the high prevalence of HBV and HIV infection in patients with diagnosis of hemophilia compared with the other five groups of multiply-transfused patients.

Whole-gene analysis of inter-genogroup reassortant rotaviruses from the Dominican Republic: Emergence of equine-like G3 strains and evidence of their reassortment with locally-circulating strains.

Inter-genogroup reassortant group A rotavirus (RVA) strains possessing a G3 VP7 gene of putative equine origin (EQL-G3) have been detected in humans since 2013. Here we report detection of EQL-G3P[8] RVA strains from the Dominican Republic collected in 2014-16. Whole-gene analysis of RVA in stool specimens revealed 16 EQL-G3P[8] strains, 3 of which appear to have acquired an N1 NSP1 gene from locally-circulating G9P[8] strains and a novel G2P[8] reassortant possessing 7 EQL-G3-associated genes and 3 genes from a locally-circulating G2P[4] strain. Phylogenetic/genetic analyses of VP7 gene sequences revealed nine G3 lineages (I-IX) with newly-assigned lineage IX encompassing all reported human EQL-G3 strains along with the ancestral equine strain. VP1 and NSP2 gene phylogenies suggest that EQL-G3P[8] strains were introduced into the Dominican Republic from Thailand. The emergence of EQL-G3P[8] strains in the Dominican Republic and their reassortment with locally-circulating RVA could have implications for current vaccination strategies.

Simultaneous circulation of genotypes I and III of dengue virus 3 in Colombia.

BACKGROUND: Dengue is a major health problem in tropical and subtropical regions. In Colombia, dengue viruses (DENV) cause about 50,000 cases annually, 10% of which involve Dengue Haemorrhagic Fever/Dengue Shock Syndrome. The picture is similar in other surrounding countries in the Americas, with recent outbreaks of severe disease, mostly associated with DENV serotype 3, strains of the Indian genotype, introduced into the Americas in 1994. RESULTS: The analysis of the 3'end (224 bp) of the envelope gene from 32 DENV-3 strains recently recovered in Colombia confirms the circulation of the Indian genotype, and surprisingly the co-circulation of an Asian-Pacific genotype only recently described in the Americas. CONCLUSION: These results have important implications for epidemiology and surveillance of DENV infection in Central and South America. Molecular surveillance of the DENV genotypes infecting humans could be a very valuable tool for controlling/mitigating the impact of the DENV infection.

Molecular epidemiology of rabies in Colombia 1994-2005 based on partial nucleoprotein gene sequences.

One hundred and twenty-four rabies viruses (RABV) were isolated from humans and eight species of mammals in Colombia during 1994-2005. To determine the genetic and reservoir-associated diversity cDNA fragments encoding 88 amino acids at the carboxyl terminus of the nucleoprotein were sequenced and used in phylogenetic analyses. Eight genetic lineages (GL) were characterized. GL1, GL2 and GL3 consisted of dog-associated antigenic variant (AV) 1 RABV, isolated in the centre-east, north and southwest of Colombia, respectively. GL1 is apparently extinct in Colombia. The GL4 were AV3, AV8 and non-determined (ND) AV viruses associated with hematophagous bats. The GL5 and GL6 consisted of AV4 viruses. GL6 isolate was found associated with Tadarida brasiliensis bats. GL5 segregated independently. The GL7 and GL8 segregated independently within clades associated with colonial insectivorous and solitary bats, respectively. Both of these were represented by NDAV viruses. Viruses isolated from humans grouped within GL2, GL3 and GL4, which in turn corresponded to AV1, 3, 8 and ND. Dogs and D. rotundus are the two major rabies reservoirs and vectors in Colombia. Insectivorous bats may also be important rabies reservoirs but spillovers to other species are rare. Our data were consistent with previous studies in which partial Psi, G and L gene sequences were analyzed. Our results confirmed the existence of RABV of unclassified AV in Colombia.

[Detection of yellow fever virus by reverse transcriptase polymerase chain reaction in wild monkeys: a sensitive tool for epidemiologic surveillance]. / Detección por reacción en cadena de la polimerasa de transcriptasa inversa del virus de la fiebre amarilla en monos silvestres: una herramienta sensible para la vigilancia epidemiológica.

INTRODUCTION: Yellow fever is a zoonotic infection maintained in nature by non-human primates. Appropriate surveillance with sensitive laboratory techniques is necessary to evidence viral activity in the tropical forest habitats of these primates. OBJECTIVE: Yellow fever virus was detected in hepatic tissue samples from non-human primates by reverse transcriptase polymerase chain reaction (RT-PCR) technique using specific primers for diagnosis. MATERIALS AND METHODS: Hepatic tissue samples were processed from five monkeys belonging genus Alouatta spp found dead in sylvatic areas of Cesar and Magdalena Provinces, Colombia, between December 2003 and June 2004. Samples were treated with lysis buffer prior to the isolation of viral RNA, which was then subjected to reverse transcriptase polymerase chain reaction (RT-PCR) using yellow fever-specific primers. Simultaneously, viral proteins were identified by immunohistochemistry on parafin-embedded hepatic tissue. RESULTS: The PCR method amplified fragments of the expected size (424 bp) in four of the tested samples. In addition, these samples showed a positive reaction by immunohistochemistry, supporting the evidence that the virus was present. CONCLUSION: The detection of yellow fever virus in wild monkeys was clear evidence of enzootic activity in northern Colombia. Increased probability of yellow fever transmission among human populations is indicated due to urbanization processes as a consequence of forced migration and displacement of the human populations. Molecular tests for rapid and specific detection of yellow fever in tissue samples of non-human primates is an important tool for epidemiologic surveillance. Rapid virus identification will permit the timely activation of control systems for prevention of further cases and epidemic situations.

Hepatitis C virus seroprevalence in multi-transfused patients in Colombia.

BACKGROUND: Hepatitis C Virus (HCV) infection is a public health problem worldwide, with particular relevance in multi-transfused patients given that HCV is principally transmitted by exposure to infected blood. STUDY DESIGN: Between February and September 2003 a cross-sectional study was carried out in four hospital centres in Bogotá and Medellin, Colombia, to determine the risk factors for HCV infection in 500 multi-transfused patients. RESULTS: The study population was distributed in five groups: haemophilia, haemodyalsis, acute bleeding, ontological illnesses and sickle cell disease or thalassemia. Serum samples from patients were tested for HCV antibodies (Asxym, Abbott). An overall prevalence (9.0%; 95% confidence interval (CI): 6.4-11.6) (45/500) of HCV infection was found. Anti-HCV antibodies were detected in 32.2% of patients with haemophilia, 6.1% of patients undergoing haemodialysis, 7.1% of patients with sickle cell disease or thalassemia, 2.6% of patients with acute bleeding and 3.4% of patients with ontological or hematological diseases. The main risk factors associated with infection by HCV were: to be hemophilic (odds ratio, OR = 18.03; 95% Cl: 3.96-114.17), having received transfusions before 1995 (OR = 12.27; 95% Cl: 5.57-27.69), and having received more than 48 units of blood components (OR = 6.08; 95% CI: 3.06-12.1). In the multivariate analysis, only the year of transfusions (before 1995) remained significantly associated with risk of infection by HCV. CONCLUSIONS: The data show a 3-fold reduction in the infection risk between 1993 and 1995, when the serological screening for HCV in blood donors was being introduced. A reduction greater than 90% was achieved by 1995 when the screening coverage reached 99%.

[Permeability to phi chi 174 bacteriophages in polyolephin membrane condoms]. / Determinación de la permeabilidad viral de los condones de membrana de poliolefina al bacteriófago phi chi 174.

Membranes used for the manufacture of condoms eventually can develop tiny pores, thereby decreasing dramatically their effectiveness as a physical barrier against the transmission of infectious agents. A technique was designed that was based on the ability of bacteriophage viruses to trespass membranes and to infect certain bacteria species, and then developing lysis plaques in the colonies of the host bacteria. The effectiveness of 60 polyolefin condoms in preventing the diffusion of the bacteriophage phi chi 174(ATCC13706-B1), 27 nm diameter, was compared to 20 latex condoms. Physiological conditions such as pressure, pH, superficial tension, length, time of exposure and viral titre were simulated. A pressurization system was designed, in which compressed air was injected simultaneously to ten condoms. Four of the 60 polyolefin condoms and one of the 20 latex condoms were permeable to the virus. Therefore, at least 93% of the condoms evaluated were able to contain the virus. The difference in permeability between the two types of membranes was not statistically significant (P = 0.79).

[Reduction of HIV mother-to-child transmission in Colombia, two years of experience, 2003-2005]. / Reducción de la transmisión madre hijo del VIH en Colombia: dos años de experiencia nacional, 2003-2005.

INTRODUCTION: A national initiative on reduction of HIV mother-to-child-transmission is being implemented since 2003 in Colombia, including HIV counseled and voluntary testing as part of the routine antenatal care, comprehensive care with ARV treatment to HIV-positive pregnant women and their infected children, caesarian delivery, and replacement of breast milk. OBJECTIVE: To describe the achievements in the implementation of the prevention strategy of mother-to-child HIV transmission, 2003-2005. MATERIALS AND METHODS: The implementation procedures of the Project are described, as well as the coverage percentages achieved, the prevention of vertical transmission and its associated factors, and the six-month prevalence by geographical departments. The probability of transmission adjusted to the ARV treatment offered and the differences by regions are also analyzed. RESULTS: The Project was implemented in 757 municipalities (68%); diagnostic tests were performed to 200,853 pregnant women, 377 of whom were diagnosed as HIV positive (0.19%), with higher prevalences in the Caribbean region, and in the Departments of Quindio and Santander. Complete six-month follow-up after delivery was provided to 285 women and their neonates (12 of whom were HIV-positive). The probability of transmission with the use of ARV schemes during pregnancy (n=170) was 1.78% (IC 95%: 0.37-5.13%). Factors related to probability of transmission were: initial viral load > 10,000/mm3, absence of antenatal care, and late recruitment of pregnant women. No statistical differences were found between the ARV schemes used. In the Caribbean region, antenatal care was lower, and late recruitment of pregnant women was higher. CONCLUSIONS: Reduction of HIV mother-to-child-transmission is an effective preventive intervention, which also strengthens the quality of antenatal care services. Sustainability of this initiative, with nationwide coverage, must be a target for national and regional public health authorities, and for health care providers.

Adherencia y potenciales eventos adversos prevenidos durante la administración de medicamentos endovenosos empleando bombas de infusión inteligentes en cuatro unidades de cuidados intensivos en Colombia / Adherence and potential adverse events prevented during the administration of intravenous medications using Smart infusion pump in four intensive care units in Colombia

Resumen Introducción: Las bombas de infusión inteligentes, constituyen una herramienta útil para la administración segura de medicamentos endovenosos dado que permiten prevenir potenciales eventos adversos. Objetivo: Evaluar la adherencia y los potenciales eventos adversos prevenidos, durante la administración de medicamentos endovenosos empleando bombas de infusión inteligentes. Metodología: Estudio observacional, realizado en cuatro unidades de cuidados intensivos usando datos del software Hospira MedNetTM. Un análisis descriptivo fue llevado a cabo junto con un análisis bivariado empleando una prueba U de Mann-Whitney, una prueba de Kruskal-Wallis y un test de Bonferroni para evaluar la adherencia y los potenciales eventos adversos prevenidos por año y servicio. Resultados: La adherencia fue del 74,0%, se presentaron 78.299 alertas de seguridad y se previnieron 4,54% (n=16.288) potenciales eventos adversos. Se encontraron diferencias entre el primer y segundo año en la adherencia [Mediana: 69,15 (Q1:64,2-Q3:75,5) Vs Mediana: 84,2(Q1:72,15-Q3:89,05), p<0.001], adherencia a la seguridad [Mediana: 87,1% (Q1:83,05-Q3:91,2) Vs Mediana: 94,05 (Q1:89,95-Q3:96,2), p<0.001] y las ediciones de alertas de limite relativo [Mediana:17,0 (Q1:8,5-Q3:24,5) Vs Mediana: 12,0 (Q1:7,0-Q3:17,5), p=0.013]. La solución salina, la norepinefrina, el lactato de ringer, la piperacilina-tazobactam, la nitroglicerina y la heparina presentaron el mayor número de alertas de seguridad. Conclusión: Se encontró una buena adherencia (uso de la farmacoteca) y adherencia a la seguridad (indicador de uso de la bomba), con una reducción de los potenciales eventos adversos; así el uso de bombas inteligentes podría contribuir en la prevención de potenciales errores durante la administración de medicamentos endovenosos en la unidad de cuidados intensivos.

Abstract Introduction: Smart infusion pumps have become a useful tool for the safe administration of intravenous medications, since they allow the prevention of potential adverse events. Objetive: To assess adherence and potential adverse events prevented during intravenous medication administration using smart infusion pumps. Methods: Observational study, conducted in four intensive care units using data from Hospira MedNetTM software. A descriptive analysis was carried out together with a bivariate analysis using a Mann-Whitney U test, a KruskalWallis test and a Bonferroni test to assess adherence and potential adverse events prevented by year and service. Results: Adherence was 74.0%, 78,299 safety alerts were presented and 4.54% (n = 16,288) potential adverse events were prevented. Differences were found between the first and second year in adherence [Median: 69.15 (Q1: 64.2-Q3:75.5) versus Median: 84.2 (Q1: 72.15-Q3: 89.05), p<0.001]. Likewise safety adherence [Median: 87.1% (Q1: 83.05-Q3: 91.2) versus Median: 94.05 (Q1: 89.95-Q3: 96.2), p<0.001] and the relative limit alert editions [Median: 17.0 (Q1: 8.5-Q3: 24.5) versus Median: 12.0 (Q1: 7.0-Q3: 17.5), p=0.013]. The saline solution, norepinephrine, ringer's lactate, piperacillin-tazobactam, nitroglycerin and heparin presented the highest number of safety alerts. Conclusions: Adequate adherence (use of the drug library) and safety adherence (indicator of pump use) were found, with a reduction in potential adverse events; thus, the use of smart pumps could contribute to the prevention of potential errors during the administration of intravenous medications in the intensive care unit.

Development of a reverse transcription polymerase chain reaction method for yellow fever virus detection.

INTRODUCTION: Yellow fever is considered a re-emerging disease and is endemic in tropical regions of Africa and South America. At present, there are no standardized or commercialized kits available for yellow fever virus detection. Therefore, diagnosis must be made by time-consuming routine techniques, and sometimes, the virus or its proteins are not detected. Furthermore, co-circulation with other flaviviruses, including dengue virus, increases the difficulty of diagnosis. OBJECTIVE: To develop a specific reverse transcriptase-polymerase chain reaction (RT-PCR) and nested PCR-based assay to improve the detection and diagnosis of yellow fever virus using both serum and fresh tissue samples. MATERIALS AND METHODS: RT-PCR primers were designed to amplify a short fragment of all yellow fever virus genotypes reported. A second set of primers was used in a nested PCR to increase sensitivity. Thirty-three clinical samples were tested with the standardized reaction. RESULTS: The expected amplicon was obtained in 25 out of 33 samples analyzed using this approach, and 2 more samples tested positive after a subsequent nested PCR approach. CONCLUSION: This improved technique not only ensures the specific detection of a wide range of yellow fever virus genotypes but also may increase the sensitivity of detection by introducing a second round of amplification, allowing a rapid differential diagnosis between dengue and yellow fever infection, which is required for effective surveillance and opportune epidemiologic measures.

Seroprevalence of measles and rubella antibodies in pregnant women Haiti, 2012.

BACKGROUND: Haiti had set a national goal to eliminate measles and rubella, as well as congenital rubella syndrome (CRS) by 2010. A 2007-2008 nationwide measles and rubella vaccination campaign targeting 1-19 years, however, reached only 79% of the target population. To assess whether population immunity was adequate to support elimination, we conducted a national serosurvey. METHODS: We systematically selected 740 serum specimens collected from pregnant women in a 2012 national antenatal HIV sentinel serosurvey across four age strata: 15-19, 20-24, 25-29 and 30-39 years. Sera were tested for measles and rubella specific immunoglobulin G antibodies (IgG) using commercial immunoassays. We classified sera as seropositive, seronegative or indeterminate per manufacturer's instructions, and analyzed seroprevalence according to age strata, and rural or urban residence. We assessed immunity by estimating antibody concentrations in international units per milliliter (IU/mL) for seropositive and indeterminate sera. Measles IgG concentrations >0.12 IU/mL and rubella IgG concentrations >10 IU/mL were considered clinically protective. RESULTS: Of 740 sera, 696 (94.1%) were seropositive and 20 (2.7%) were indeterminate for measles IgG; overall 716 (96.8%) sera had IgG concentrations >0.12 IU/mL. For rubella IgG, 691 (93.4%) sera were seropositive and 1 (0.1%) was indeterminate; a total of 687 (92.8%) had IgG concentrations >10 IU/mL. Measles seropositivity varied across age strata (p=0.003); seropositivity increased from 88.6% among 15-19 year olds to 98.4% among 30-39 year olds (Cochran-Armitage trend tes t ≤ 0.0001). Rubella seropositivity did not differ across age strata. There were no statistically significant differences in measles or rubella seropositivity by urban versus rural residence. CONCLUSION: Despite previous low vaccination coverage for measles, results from this serosurvey indicate high levels of measles and rubella seropositivity in pregnant women, and contribute to the evidence for measles, rubella and CRS elimination from Haiti by the target date.

[Serological, molecular and virological analyses associated with yellow fever surveillance in Colombia]. / Importancia de los análisis serológicos, moleculares y virológicos en la vigilancia de la fiebre amarilla en Colombia, 2006-2008.

INTRODUCTION: Yellow fever is an immunopreventable viral hemorrhagic fever that causes high morbidity and mortality in tropical and sub-tropical regions. In Colombia, approximately 5 million persons are at risk of becoming infected with yellow fever virus. OBJECTIVE: The serological, molecular and virological analyses on the yellow fever surveillance samples were summarized in order to indicate the importance of appropriate and timely sampling in the process of case confirmation. MATERIALS AND METHODS: The survey was based on samples received at the Arbovirus Laboratory, Virology Group, Instituto Nacional de Salud, Bogotá, during years 2006 to 2008. A total of 2,096 serum and tissue samples were tested for IgM antibodies against yellow fever by capture enzyme-linked immunosorbent assay, viral isolation-indirect fluorescence antibody technique, and reverse transcriptase-polymerase chain reaction. Positive samples were correlated with the clinical and epidemiological findings for their interpretation and confirmation. RESULTS: Of the 15 yellow fever cases confirmed in Colombia during 2006-2008 by histopathological techniques, 82% were confirmed at the Arbovirus Laboratory using serologic and molecular techniques. The positive cases were distributed in the rainforest region and in the foothills of the eastern chain of the Andes mountains. CONCLUSION: The case distribution and prognosis illustrated the necessity of maintaining and strengthening the surveillance processes in those regions where the yellow fever virus is circulating. The cases must be recruited and diagnosed sufficiently early in order to use the above techniques in samples from live patients, in contrast to the histopathological procedures that require samples from fatal cases.