Local and regional dynamics of chikungunya virus transmission in Colombia: the role of mismatched spatial heterogeneity.

BACKGROUND: Mathematical models of transmission dynamics are routinely fitted to epidemiological time series, which must inevitably be aggregated at some spatial scale. Weekly case reports of chikungunya have been made available nationally for numerous countries in the Western Hemisphere since late 2013, and numerous models have made use of this data set for forecasting and inferential purposes. Motivated by an abundance of literature suggesting that the transmission of this mosquito-borne pathogen is localized at scales much finer than nationally, we fitted models at three different spatial scales to weekly case reports from Colombia to explore limitations of analyses of nationally aggregated time series data. METHODS: We adapted the recently developed Disease Transmission Kernel (DTK)-Dengue model for modeling chikungunya virus (CHIKV) transmission, given the numerous similarities of these viruses vectored by a common mosquito vector. We fitted versions of this model specified at different spatial scales to weekly case reports aggregated at different spatial scales: (1) single-patch national model fitted to national data; (2) single-patch departmental models fitted to departmental data; and (3) multi-patch departmental models fitted to departmental data, where the multiple patches refer to municipalities within a department. We compared the consistency of simulations from fitted models with empirical data. RESULTS: We found that model consistency with epidemic dynamics improved with increasing spatial granularity of the model. Specifically, the sum of single-patch departmental model fits better captured national-level temporal patterns than did a single-patch national model. Likewise, multi-patch departmental model fits better captured department-level temporal patterns than did single-patch departmental model fits. Furthermore, inferences about municipal-level incidence based on multi-patch departmental models fitted to department-level data were positively correlated with municipal-level data that were withheld from model fitting. CONCLUSIONS: Our model performed better when posed at finer spatial scales, due to better matching between human populations with locally relevant risk. Confronting spatially aggregated models with spatially aggregated data imposes a serious structural constraint on model behavior by averaging over epidemiologically meaningful spatial variation in drivers of transmission, impairing the ability of models to reproduce empirical patterns.

Clinical and histopathological features of fatal cases with dengue and chikungunya virus co-infection in Colombia, 2014 to 2015.

We report clinical features and histopathological findings in fatal cases with dengue (DENV) and chikungunya (CHIKV) co-infection identified at the Colombian National Institute of Health between September 2014 and October 2015. Seven such cases were documented. Dengue serotype 2 virus was identified in six cases. All patients were adults and comorbidities were present in four. Fever, arthralgia or myalgia was present in all cases. The frequency of rash, haemorrhage, oedema, and gastrointestinal symptoms was variable. Laboratory findings such as thrombocytopenia, renal failure, and leukocyte count were also inconsistent between cases. Post-mortem tissue examination documented focal hepatocellular coagulative necrosis in three cases, incipient acute pericarditis in one and tubulointerstitial nephritis in one. This study provides evidence of mortality in patients with DENV and CHIKV co-infection. Fatal cases were characterised by variable clinical and laboratory features. Evaluation of histopathology of autopsy tissues provided evidence of the pathological consequences of the disease.

Differences in COVID-19 Vaccination and Experiences among Patients with Hypertension in Colombia and Jamaica during the COVID-19 Pandemic.

Background: COVID-19 vaccination and shielding targeted hypertensive patients in low and middle income countries. We describe the COVID-19 experiences of hypertensive patients in Colombia and Jamaica and discuss factors associated with vaccine acceptance. Methods: A cross-sectional study was conducted between December 2021 and February 2022 in 4 randomly selected primary care clinics in Colombia and 10 primary care clinics in Jamaica. Participants in Colombia were randomly selected from an electronic medical record. In Jamaica consecutive participants were selected on clinic days for non-communicable diseases. Interviewer-administered questionnaires were conducted by telephone. Results: 576 participants were recruited (50% Jamaica; 68.5% female). Jamaica's participants were younger (36% vs 23% <60 years) and had a lower proportion of persons with "more than high school" education (17.2% vs 30.3%, p=0.011). Colombia's participants more commonly tested positive for COVID-19 (24.2% vs 6.3%, p<0.001), had a family member or close friend test positive for COVID-19 (54.5% vs, 21.6%; p<0.001), experienced loss of a family member or friend due to COVID-19 (21.5% vs 7.8%, p<0.001) and had vaccination against COVID-19 (90.6% vs 46.7%, p<0.001). Fear of COVID-19 (AOR 2.71, 95% CI 1.20-6.13) and residence in Colombia (AOR 5.88 (95% CI 2.38-14.56) were associated with COVID-19 vaccination. Disruption in health services affecting prescription of medication or access to doctors was low (<10%) for both countries. Conclusion: Health services disruption was low but COVID-19 experiences such as fear of COVID-19 and vaccine acceptance differed significantly between Colombia and Jamaica. Addressing reasons for these differences are important for future pandemic responses.

High levels of cardiovascular biomarkers in fatal Chikungunya virus infection.

Chikungunya virus (CHIKV) infection is an emerging arboviral disease that has spread geographically to many previously unaffected areas. Although severe cases of acute CHIKV infection have been documented, little is known about its pathogenesis. We aimed to determine the levels of cardiovascular biomarkers in fatal and non-fatal patients with acute CHIKV infection. This study included fatal and non-fatal patients with CHIKV reported to National System for Public Health Surveillance and laboratory-confirmed by the Colombian National Institute of Health. Each fatal patient was matched to 2 non-fatal patients for age (± 10 years). Blood samples were processed for cardiovascular biomarkers by multiplex immunoassays. Twenty-five cases of fatal CHIKV infection and 50 patients of non-fatal CHIKV infection were included. Nearly 20% of the population were under 10 years old and 52% were over 60. The median serum levels of endocan-1 (p = 0.000), creatine kinase MB isoenzyme (p = 0.000), oncostatin (p = 0.000), fatty-acid-binding protein 3 (p = 0.000) and fatty-acid-binding protein 4 (p = 0.000) were significantly higher in fatal CHIKV infection cases than in non-fatal patients. Troponin I tended to be higher in fatal CHIKV infection cases than in non-fatal CHIKV infection patients (p = 0.063). Among fatal patients, no significant differences were found in serum levels of cardiovascular biomarkers among younger (< 50 years-old) and older (≥ 50 years-old) patients. We found high serum levels of cardiovascular biomarkers in fatal CHIKV infection. These results promote the fact that endothelial and cardiac damage can occurs and may be significant factors related organ failure and death in these patients.

Evaluación del Sistema de Vigilancia de VIH - SIDA y Mortalidad por SIDA en Caquetá, Colombia durante el período 2014-2018 / Evaluation of the HIV - AIDS and the AIDS Mortality Surveillance System in Caquetá, Colombia, between 2014 and 2018

Resumen Introducción: La pandemia por el Virus de Inmunodeficiencia Humana (VIH) y el Síndrome de Inmunodeficiencia Adquirida (SIDA) han generado numerosas pérdidas humanas, deterioro de la calidad de vida y consecuencias económicas negativas. Se han implementado programas de prevención para fortalecer el diagnóstico temprano y frenar la transición del VIH al SIDA. Objetivo: Hacer seguimiento de la notificación de VIH-SIDA para evaluar los atributos cualitativos y cuantitativos, de acuerdo con los procesos establecidos para la notificación al SIVIGILA, en Caquetá, Colombia. Métodos: Fue utilizada metodología de evaluación de sistemas de vigilancia de los CDC. Para evaluar los atributos cualitativos se realizaron encuestas virtuales a 47 responsables del sistema en diferentes entes territoriales. Para evaluar los atributos se revisaron documentos y bases de datos. Se realizó análisis cualitativos mediante triangulación en Epi-info y análisis cuantitativos usando medidas de frecuencia. Resultados: a)Simplicidad: es fácil el diligenciamiento de registros; b)Flexibilidad: el subsistema ha tenido diferentes cambios en definición de caso e inclusión de variables; c)Aceptabilidad: se reconoce la importancia de la vigilancia de VIH - SIDA y Mortalidad por SIDA; d) Oportunidad: No es oportuno, no se tiene una periodicidad establecida para el análisis de la información; e)Representatividad: no representan el total de los casos del territorio; f)Utilidad: el subsistema permite formulación de políticas públicas; g) Calidad: hubo 20 casos repetidos; h) Sensibilidad: no capta todas las mortalidades.

Abstract Introduction: HIV/AIDS is a global pandemic that has generated numerous human losses, life's quality deterioration, and unfavorable economic consequences. Several prevention programs have been implemented to strengthen early diagnosis and stop the transition from HIV to AIDS. Objective: To evaluate and follow-up on the qualitative and quantitative attributes of the HIV-AIDS notification process according to the established procedure of notification to the SIVIGILA in Caqueta, Colombia. Methods: Centers for Disease Control and Prevention's methodology was used for evaluating the subsystem. Virtual surveys were carried out in 47 people in charge of the system in different territorial entities, and documents and databases were reviewed to examine qualitative attributes. In terms of analysis, triangulation in Epi-info was made in qualitative aspects, and frequency measurements were used in quantitative aspects. Results: The results are divided into eight categories. a)Simplicity: it is easy to complete the records. b)Flexibility: the subsystem has had different changes in terms of case definition and the inclusion of variables. c)Acceptability: it is recognized the importance of monitoring HIV - AIDS and AIDS Mortality. d)Opportunity: It is not opportune; there is no periodicity for the information analysis. e)Representativeness: the total number of cases in the territory is not represented. f)Utility: the subsystem allows the formulation of public policies. g)Quality: there were 20 repeated cases. h)Sensibility: all mortalities are not taken into account.

Clinical and immunological features of post-chikungunya virus chronic arthritis and its effect on functional ability and quality of life in a cohort of Colombian patients / Caracterización clínica e inmunológica de la artropatía crónica por virus chikungunya y su relación con discapacidad funcional y afectación de la calidad de vida en una cohorte de pacientes colombianos

ABSTRACT Introduction: Post-chikungunya virus (CHIKV) chronic arthritis is a common complication of the acute infection caused by this virus, with high risk of progression to functional and quality of life sequelae. Objective: To identify the clinical and immunological characteristics, functional disabilities, and quality of life decline in a sample of Colombian patients with chronic arthropathy associated with chikungunya virus (CHIKV). Methods: A group of 94 patients was evaluated in a City in Colombia during the CHIKV epidemics from 2014 to 2015. Results: The mean age of the 94 patients was 57 years; 76% were women, and 100% came from low socioeconomic groups. Typically, the joint disease was symmetrical, with joint swelling present in 30% of the cases, mostly involving the small and large joints of the upper limbs. Rheumatoid factor was positive in 1.06% and anti-citrulline antibodies in 0%. There were detectable levels of IL6 in 64.9%, and IL 17 in 7.45% of the patients. The severity of disease activity was determined using the DAS28 score, identifying 55.3% with moderate activity, 40.4% with mild activity, and 4.2% with high activity. The HAQ-DI identified a moderate functional limitation in 45.7% of the cases, with a mean score of 1.02. The quality of life measured with the SF-36 scale showed that all of the domains evaluated were affected but pain and the physical and emotional domains were significantly more affected. Conclusions: Patients with post-chikungunya chronic arthritis, presented in most cases arthralgia, arthritis, functional impairment, and poor quality of life. It is then necessary to adopt comprehensive therapeutic measures for a sound intervention of this pathology.

RESUMEN Introducción: La artropatía por virus de chikungunya (CHIKV) es una complicación frecuente secundaria a la infección inicial por este virus con un alto riesgo de progresión a secuelas funcionales y de calidad de vida. Objetivo: Identificar las características clínicas, inmunológicas, de discapacidad funcional y de deterioro de la calidad de vida en una muestra de pacientes colombianos con artropatía crónica por CHIKV. Métodos: Se evaluó un grupo de 94 pacientes en una ciudad colombiana durante la epidemia por CHIKV en el periodo 2014-2015. Resultados: En los 94 pacientes la edad media fue de 57 años, siendo el 76% mujeres y el 100% de la población afectada perteneció a estratos socioeconómicos bajos. El cuadro articular característicamente fue simétrico con inflamación articular en el 30%, mayor compromiso de articulaciones grandes y pequeñas de miembros superiores. Se identificó positividad para factor reumatoide en el 1,06%, anticuerpos anticitrulina en el 0%, niveles detectables de IL-6 en el 64,9% y de IL-17 en el 7,45% de los pacientes. La severidad de la actividad articular se exploró con la escala DAS28, identificando un 55,3% con actividad moderada, un 40,4% actividad leve y un 4,2% con actividad alta. El HAQ-DI identificó un compromiso funcional moderado en el 45,7%, con puntaje medio de 1,02. La calidad de vida medida con la escala SF-36 mostró que todos los dominios evaluados fueron afectados con mayor compromiso de los dominios dolor, rol físico y rol emocional. Conclusiones: En los pacientes afectados por artropatía crónica por CHIKV se observó artralgias, artritis, deterioro funcional y de la calidad de vida en la mayoría de la población estudiada, por lo que es necesario adoptar medidas terapéuticas en todos estos niveles para una intervención adecuada en esta patología.