Efficacy and Safety of Vitamin D Supplementation to Prevent COVID-19 in Frontline Healthcare Workers. A Randomized Clinical Trial.

BACKGROUND: Associations between vitamin D (VD) deficiency and the risk of SARS-CoV-2 infection have been documented in cross-sectional population studies. Intervention studies in patients with moderate to severe COVID-19 have failed to consistently document a beneficial effect. OBJECTIVE: To determine the efficacy and safety of VD-supplementation in the prevention of SARS-CoV-2 infection in highly exposed individuals. METHODS: A double-blind, parallel, randomized trial was conducted. Frontline healthcare workers from four hospitals in Mexico City, who tested negative for SARS-CoV-2 infection, were enrolled between July 15 and December 30, 2020. Participants were randomly assigned to receive 4,000 IU VD (VDG) or placebo (PG) daily for 30 d. RT-PCR tests were taken at baseline and repeated if COVID-19 manifestations appeared during follow-up. Serum 25-hydroxyvitamin D3 and antibody tests were measured at baseline and at day 45. Per-protocol and intention-to-treat analysis were conducted. RESULTS: Of 321 recruited subjects, 94 VDG and 98 PG completed follow-up. SARS-CoV-2 infection rate was lower in VDG than in PG (6.4 vs. 24.5%, p <0.001). The risk of acquiring SARS-CoV-2 infection was lower in the VDG than in the PG (RR: 0.23; 95% CI: 0.09-0.55) and was associated with an increment in serum levels of 25-hydroxyvitamin D3 (RR: 0.87; 95% CI: 0.82-0.93), independently of VD deficiency. No significant adverse events were identified. CONCLUSIONS: Our results suggest that VD-supplementation in highly exposed individuals prevents SARS-CoV-2 infection without serious AEs and regardless of VD status.

Antibacterial effect of acetic acid during an outbreak of carbapenem-resistant Acinetobacter baumannii in an ICU (II).

INTRODUCTION: Acetic acid (AA) has been commonly used in medicine as an antiseptic agent for the past 6000 years. This study evaluated the antibacterial effect of AA during an outbreak in an intensive care unit (ICU) facility in Baja California Sur, México. METHODOLOGY: Thirty-five environmental samples were collected, subsequently, disinfection with AA (4%) was performed, and two days later the same areas were sampled inside the ICU facility. Carbapenem-resistant A. baumannii (CRAB) was detected with loop-mediated isothermal amplification assay (Garciglia-Mercado et al. companion paper), targeting blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, blaOXA-58-like, blaIMP and blaVIM genes. CRAB isolates before and after disinfection were compared by PFGE. RESULTS: Eighteen (54.5%) and five (14.3%) of thirty-five environmental samples were identified as Acinetobacter baumannii before and after disinfection, respectively, showing a significant decrease of 85.7% (p < 0.05) both by Loop-mediated isothermal amplification (LAMP) and polymerase chain reaction (PCR). Furthermore, the presence of blaOXA-23-like and blaOXA-58-like genes significantly decreased (p < 0.05) both by LAMP and PCR methods. PFGE genotype showed high similarity among CRAB isolates before and after disinfection, suggesting wide clonal dissemination in the ICU facility. CONCLUSIONS: This study demonstrated the novel application of AA with the LAMP assays developed for detecting CRAB. AA promises to be a cheap and efficacious disinfectant alternative to both developed and especially developing countries, preventing the spread of this organism in the environment and to other susceptible patients in health care settings.

[Preventable diseases by vaccination. Coverage and impact]. / Enfermedades inmunoprevenibles. Coberturas e impactos de la vacunación.

OBJECTIVE: to evaluate the coverage and impacts of the vaccination component in Integrated Health Programs. MATERIAL AND METHODS: a descriptive study of secondary data analysis was carried out. We analyzed data generated by the Universal Vaccination Program (PROVAC) since 1991, the data compiled in the 2000 National Health Survey (ENSA) and the 2005 National Survey of Coverage of Integrated Health Programs (ENCOPREVENIMSS), as well as the IMSS Annual Epidemiological Gazettes since 1973. RESULTS: the coverage of the basic schemes of the Extended Immunization Program (PAI) in children from one to four years old increased from 46.0% in 1990 to 92.5% in 1992 and 98.2% in 2005. The coverage with booster doses was substantially lower, ranging between 57.0% and 97.3% depending on the type of vaccine and the number of doses. The coverage also varied, although to a lesser extent, among public healthcare institutions. In relation to the impact of the Universal Vaccination Program and the PREVENIMSS strategy among IMSS affiliates, we distinguished at least three situations: (1) illnesses in which a drop in incidence predates the Universal Vaccination Program: tuberculous meningitis, diphtheria, whooping cough, and tetanus; (2) illnesses in which the drop in incidence is clearly related to the program: measles, rubella, mumps, and meningitis due to H. influenzae b. (3) illnesses for which the impact has not yet been assessed: hepatitis B. In addition to a drop in the incidence of immunopreventable diseases, we observed changes in the age distribution of cases. CONCLUSIONS: the PREVENIMSS strategy has not interfered with, and in some case has helped to consolidate the achievements of the Universal Vaccination Program. The results of this investigation point to the need to modernize the current system of evaluating coverage and expanding vaccination schemes with booster doses.