Population-Level Effectiveness of an Inactivated Whole-Virion COVID-19 Vaccine: A Test Negative Case-Control Study in the Dominican Republic.

Background: A continuing nationwide vaccination campaign began in the Dominican Republic on February 16, 2021 to prevent severe consequences of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Estimates of vaccine effectiveness under real-world conditions are needed to support policy decision making and inform further vaccine selection. Methods: We conducted a test-negative case-control study to assess the real-world effectiveness of nationwide coronavirus disease 2019 (COVID-19) vaccination program using an inactivated vaccine (CoronaVac) on preventing symptomatic SARS-CoV-2 infections and hospitalizations from August to November 2021 in the Dominican Republic. Participants were recruited from 10 hospitals in 5 provinces to estimate the effectiveness of full immunization (≥14 days after receipt of the second dose) and partial immunization (otherwise with at least 1 dose ≥14 days after receipt of the first dose). Results: Of 1078 adult participants seeking medical care for COVID-19-related symptoms, 395 (36.6%) had positive polymerase chain reaction (PCR) tests for SARS-CoV-2; 142 (13.2%) were hospitalized during 15 days of follow up, including 91 (23%) among 395 PCR-positive and 51 (7.5%) among 683 PCR-negative participants. Full vaccination was associated with 31% lower odds of symptomatic infection (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.52-0.93) and partial vaccination was associated with 49% lower odds (OR, 0.51; CI, 0.30-0.86). Among 395 PCR-positive participants, full vaccination reduced the odds of COVID-19-related hospitalization by 85% (OR, 0.15; 95% CI, 0.08-0.25) and partial vaccination reduced it by 75% (OR, 0.25; 95% CI, 0.08-0.80); full vaccination was associated with reduced use of assisted ventilation by 73% (OR, 0.27; 95% CI, 0.15-0.49). Conclusions: Given the ancestral and delta viral variants circulating during this study period, our results suggest that the inactivated COVID-19 vaccine offered moderate protection against symptomatic SARS-CoV-2 infections and high protection against COVID-19-related hospitalizations and assisted ventilation. This is reassuring given that, as of August 2022, an estimated 2.6 billion inactivated CoronaVac vaccine doses had been administered worldwide. This vaccine will become a basis for developing multivalent vaccine against the currently circulating omicron variant.

Efectividad de la reacción en cadena de la polimerasa en tiempo real (PCR-RT) e Inmunodot en el diagnóstico temprano de leptospirosis: análisis comparativo con la prueba de Microaglutinación (MAT) / Effectiveness of the real-time polymerase chain reaction (RT-PCR) and Immunodot in the early diagnosis of Leptospirosis: comparative analysis with the Microagglutination test (MAT)

Introducción: la leptospirosis es una enfermedad infecciosa producida por espiroquetas del género Leptospira. Se disemina a través de la orina de animales domésticos, con mayor frecuencia por roedores. En República Dominicana se necesitan pruebas confiables para el diagnóstico en etapas tempranas de la enfermedad. En el presente trabajo se aborda la validez diagnóstica del PCR en Tiempo Real y del IGM (INMUNODOT) en comparación con la prueba de Microaglutinación (MAT). Materiales y métodos: se realizó un estudio observacional, descriptivo, de corte transversal con 69 pacientes admitidos en el Hospital Regional "José María Cabral y Báez" con diagnóstico presuntivo de leptospirosis desde el 2010 hasta el 2012. Resultados: del total de los casos (69), la mayoría fueron del sexo masculino (94.2 %), menores de 49 años (79.4 %) y provenían de la provincia de Santiago (58 %). La mortalidad fue de 52.1 % de los cuales 52.3 % fueron reportados positivos para Leptospira y 47.6 % resultaron negativos según el MAT. Al comparar los resultados de PCR en relación al MAT se obtuvo una sensibilidad de 27.3 % y una especificidad de 80 %. Los resultados del PCR y del Immunodot fueron equivalentes. Conclusión: en el presente trabajo la realización del PCR en sangre, después del 5to día de inicio de la enfermedad, no demostró ser mejor que la Inmunodot para la detección temprana de la enfermedad, al contrastarlos con el resultado del MAT. En República Dominicana, los casos hospitalizados con diagnóstico presuntivo de leptospirosis permanecen con muy alta mortalidad. Por tanto, es prioritario optimizar el diagnóstico y el tratamiento de estos casos. En este estudio, los casos confirmados con Leptospirosis que fallecieron indican que debe actualizarse el protocolo de tratamiento y asegurarse que pueda implementarse. Por otra parte, los casos no confirmados fallecidos exigen investigar otras causas de enfermedad como la Infección por Hanta Virus.

Introduction: Leptospirosis is an infectious disease caused by spirochaetes of the genus Leptospira. It spread through the urine of domestic animals most frequently in rodents. Need reliable tests to diagnose in early stages of the disease and it has been proposed the use of the PCR in real-time as an option. The present work deals with the diagnostic real-time PCR and IGM (INMUNODOT) in comparison with the Microagglutination (MAT) test. Materials and methods: An observational, descriptive, cross-sectional study with 69 patients admitted as possible Leptospirosis in the Hospital "Jose Maria Cabral y Báez" of Santiago from 2010 to 2012. Results: Of the total cases (69), most were male (94.2%), under 49 years of age (79.4%) coming from the province of Santiago (58%). Mortality was 52.1% of which 52.3% were reported positive for leptospirosis and 47.6% were negative according to the MAT. To compare the results of PCR in relation to the MAT was obtained a sensitivity of 27.3% and a specificity of 80%. The results of the PCR and immunodot were equivalent. Conclusion: In this study, the realization of the PCR in blood after the 5th day of the disease not proved to be better than the Inmunodot for the early detection of the disease. Is necessary to evaluate cases less than 5th day. In the Dominican Republic, hospitalized with a presumptive diagnosis of Leptospirosis cases remain with very high mortality. Therefore, it is important to optimize the diagnosis and treatment of these cases. In this study, confirmed cases with Leptospirosis who died, indicate that you must upgrade the treatment protocol and ensure that it can be implemented. On the other hand, the deceased not confirmed cases require to investigate other causes of disease as the Hanta Virus infection.

Progress towards elimination of HIV mother-to-child transmission in the Dominican Republic from 1999 to 2011.

In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999-2008 and 12/302 (4.0%) in 2009-2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003-2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.