[Pneumococcal conjugate vaccines in pediatrics, its impact on Public Health]. / Vacunas conjugadas contra neumococo en pediatría, su impacto en la Salud Pública.

Streptococcus pneumoniae (also known as pneumococcus) is part of the natural bacterial flora of the nasal and pharyngeal mucosa, colonizes mainly the nasopharynx, and causes this carriage to precede pneumococcal disease, thus becoming the main source of propagation among people, especially in children. Since 1983, when the first 23-component anti-pneumococcal vaccine was authorized, different conjugated vaccines have been developed according to the circulating serotypes that cause invasive pneumococcal diseases (IPD), reducing the incidence and mortality of these diseases considerably. In November 2021, a group of experts held a virtual meeting to update and analyze the impact that pneumococcal vaccines have generated on the countries' public health, especially during the COVID-19 pandemic. The recommendations that emerged included the need to look for alternatives in serotype-independent vaccines after the introduction of pneumococcal conjugate vaccines (PCV) in the national immunization schedules, as well as to strengthen the surveillance of serotypes, focusing on those not included in the current vaccines. The objective of this report is to communicate the conclusions of the group of experts that in November 2021 analyzed the impact of pneumococcal vaccines on public health in the countries, in order to generate recommendations applicable in Latin America.

COVID-19 in Latin America: A Snapshot in Time and the Road Ahead.

Since its initial detection in Brazil in February 2020, SARS-CoV-2 and the associated COVID-19 pandemic have continued to devastate Latin America. Specific comorbidities, as well as sociodemographic and lifestyle factors that may be more prevalent in underserved areas, have been identified as risk factors for COVID-19 infection or associated adverse outcomes. Dynamics of infections and deaths in Latin America have varied by country and temporally, as has SARS-CoV-2 variant prevalence; however, more recently, the Delta and subsequent Omicron variants have become ubiquitous. Successful pandemic responses have involved robust infection mitigation measures, testing, and smart deployment of healthcare resourcing. While in some Latin American countries up to 90% of the population is fully vaccinated (i.e., 2 doses) against COVID-19, other countries have failed to reach the World Health Organization's 70% target. Continued focus on comprehensive surveillance, strategies to maximize vaccine availability and uptake, and mitigation of collateral damage on other aspects of public health and social services are critical for managing the COVID-19 pandemic. This review summarizes the COVID-19 experience in Latin America, including epidemiology and vaccination. Key learnings and future considerations for the ongoing pandemic response are also discussed.

Willingness to Get a COVID-19 Vaccine and Its Potential Predictors in Costa Rica: A Cross-Sectional Study.

Since 2020, the COVID-19 pandemic has had a significant impact on morbidity and mortality around the world. As one of the most successful and cost-effective health interventions for preventing infectious diseases, immunization against SARS-CoV-2, is at the moment the most effective strategy for controlling the current pandemic. Despite the high vaccine acceptance rates that countries such as Costa Rica have shown in the past, the public acceptance of the COVID-19 vaccine is still uncertain. The purpose of this study was to examine adults' willingness to get a novel COVID-19 vaccine and its potential predictors in Costa Rica. We conducted a cross-sectional study comprising a sample of 4717 adult participants living in Costa Rica who participated in a voluntary electronic survey regarding their intent to get a future COVID-19 vaccine. Results suggest that a high percentage (86.1%) of Costa Ricans aged 18 or more would be willing to be vaccinated once a safe and effective vaccine is approved and distributed in the country. Some relevant significant predictors of willingness to get a COVID-19 vaccine in Costa Rica were higher income, being male, work in the health care sector, and having a relative or a close acquaintance diagnosed with COVID-19. Our findings suggest that it is essential to concentrate efforts on the immediate development of culturally appropriate communication, dissemination, and implementation strategies to maximize immunization against SARS-CoV-2 in Costa Rica.

BCG Scar Local Skin Inflammation as a Novel Reaction Following mRNA COVID-19 Vaccines in Two International Healthcare Workers.

Bacillus Calmette-Guérin (BCG) local scar inflammatory reactions have been mostly associated with Kawasaki disease in children and less commonly with other viral infections (i.e., measles). BCG scar inflammation associated with or following vaccine administration has only been reported with the influenza vaccine. We describe the first reports in the literature of local BCG inflammation following two different available messenger ribonucleic acid (mRNA) anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) vaccines (mRNA-1273, and BNT162b2) in two young healthy physicians, one from Costa Rica, and another from the United States of America, with normal cell blood counts, flow cytometries, and negative for human immunodeficiency virus (HIV). In both cases, BCG scar inflammation appeared after 24 hours of vaccination of the second dose, without signs of reaction on the injection site, and resolved within four days. Dermoscopic findings in one case showed arborizing and comma-shaped vessels. Pharmacovigilance surveillance of BCG scar reactions following coronavirus disease 2019 (COVID-19) vaccines should be considered particularly in countries where BCG is part of their national immunization programs.

Epidemiological and clinical profile between influenza A and B virus in Costa Rican children.

OBJECTIVE: We aimed to evaluate the clinical and epidemiological behavior of influenza type A versus type B and analyze if there was any correlation or differences between the characteristics of both groups. METHODS: An observational, retrospective, descriptive, and population-based study based of children who were hospitalized at the only national pediatric hospital of Costa Rica from January 1, 2010 to December 31, 2018 and had a confirmed influenza virus infection. RESULTS: 336 patients were analyzed. Mean age was 35,6 ± 36,7 months (3,0 ± 3,1 years). The only significant variables at 25% in relation to influenza type A or B virus were: sex, month of diagnosis, fever, vomiting, cough, use of antibiotics and admission to the PICU. The hospitalization rate at our hospital increased between the months of October to December, with a higher percentage of cases in November and December, which reveals that the "real peak" in our population begins between 3 to 4 months after the end of the vaccination campaign. Patients with influenza A virus had a 2.5 times greater risk of being admitted to the PICU. Mortality rate was 0.6% and 0% among influenza A and B children, respectively. CONCLUSIONS: Variables in which a causality was found with type A or B virus were: admission to the PICU, month of diagnosis, and cough. However, influenza B clinical behavior continues to be unpredictable.

Latin American forum on immunization services during the COVID-19 pandemic.

Introduction: The Latin American Society of Pediatric Infectology (SLIPE for its acronym in Spanish) is working hard to contribute with strategic actions to prevent the recurrence of Vaccine-Preventable Diseases and to prevent the reduction of vaccine coverage in the region of the Americas.Areas covered: On Friday, September 25th, a Latin American forum of experts on immunization services during the COVID-19 pandemic was held through Webex platform. Issues such as: the imminent risk of occurrence and outbreaks of vaccine-preventable diseases, the importance of epidemiological surveillance and the vaccination campaign challenges, in the context of a pandemic were discussed.Expert opinion: Vaccination campaigns should no longer be postponed or delayed; instead, they must be reactivated; governments, scientific societies, and physicians must promote vaccination programs to avoid outbreaks of vaccine-preventable diseases. On the eve of a SARS-CoV-2 vaccine, it is necessary to insist on the availability of sufficient doses to avoid dose shortages in disadvantaged areas of the region.

COVID-19 basic reproduction number and assessment of initial suppression policies in Costa Rica

SARS-COV-2 is the most recent from a series of emerging pathogens stressing national health systems. Initially restricted to Hubei province in China, COVID-19, the disease caused by SARS-COV-2 has become pandemic, reaching almost every nation on our planet. Here, we present an estimate of the Basic Reproduction Number (R0) for this disease based on confirmed cases recorded during the initial 30 days of transmission. Based on local transmission data for the six initial days of transmission, we estimated (mean ± SE) R0 = 2.58 ± 2.43. R0 was reduced by up to 56% to R0 = 1.12 ± 0.02 following suppression measures in place by April 4th, 2020. Independent estimates for the time-varying reproduction number (Rt) based on the serial interval distribution estimated for China showed that after 30 days, Rt decreased reaching a value of 0.914 ± 0.104 on April 4th, 2020. In this study, we also describe the suppression strategies in place in Costa Rica and compare their impacts with those implemented in Panamá and Uruguay, provided these three middle-income countries have similar demographic and economic indicators. However, these three countries have structurally different health systems and have resorted to different suppression measures against COVID-19. We compare the early epidemic growth curves in the three countries using an exponential deceleration model. We found the lowest epidemic growth rate in Costa Rica, followed by Panamá and then Uruguay, while the highest deceleration was observed in Uruguay, followed by Costa Rica and Panamá. We discuss how the unified, universal healthcare system of Costa Rica has been vital to successfully manage the early stage of the COVID-19 epidemic and call for the developments of precision public health tools to further improve epidemic health surveillance in Costa Rica.

Bioethical Implications in Vaccine Development, a COVID-19 Challenge.

Introduction In the last 18 years, on three occasions, coronavirus has represented a challenge for global health. Between 2002 and 2003 with Severe Acute Respiratory Syndrome, in 2012 with Middle East Respiratory Syndrome, and since the end of 2019 with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the coronavirus disease 2019 (COVID-19) pandemic, which has challenged health care models and the way of doing research, placing bioethics at the center of discussion.  Methods On August 19, 2020, a webinar organized by the Research Institute of Medical Science (IICIMED, for its acronym in Spanish), entitled 'Bioethical Implications in Vaccine Development, a COVID-19 Challenge' took place. Three experts spoke about the importance of bioethics in the race to develop a COVID-19 vaccine, the risk involved in shortening the terms of the clinical trial phases, and how the associated risks can be minimized, in order to expedite research results.  Conclusion With the novel SARS-CoV-2 coronavirus, critical challenges have been posed not only for public health but for research and the scientific community. A safe and effective vaccine is urgently needed to prevent COVID-19 transmission, complications, and deaths; the adherence to ethical principles required by clinical research is mandatory and closer supervision is also essential.