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The Zika virus (ZIKV) epidemic had a sanitary, psychosocial, and economic impact on individuals of reproductive age. The primary concern revolved around infection during pregnancy due to possible vertical transmission and its association with adverse fetal and infant outcomes, known as Congenital Zika Syndrome (CZS). This qualitative study employs phenomenology and grounded theory. This study includes interviews with 98 women, some pregnant during the ZIKV epidemic in Brazil, Colombia, and Puerto Rico, who had children with CZS or without diagnosed neurological impairment. Additionally, the study included a group of women who were pregnant during the COVID-19 pandemic in these same countries. In both groups, interviewees had varying levels of knowledge about ZIKV. The study found that messages conveyed through the media tended to be alarmist, in contrast to the information provided by healthcare professionals, which was considered more trustworthy. Pregnant women during the ZIKV epidemic reported receiving their ZIKV and CSZ infection diagnoses late, either during or after childbirth. The study underscores the needs of pregnant women in high-risk scenarios, the importance of health education processes, and the necessity to reinforce communication and continuing education.
A epidemia do vírus Zika (ZIKV) teve impacto sanitário, psicossocial e econômico sobre pessoas em idade reprodutiva. A principal preocupação foi a infecção durante a gravidez devido a possível transmissão vertical e sua associação com resultados fetais e infantis adversos, conhecida como síndrome congênita associada à infecção pelo Vírus Zika (SCZ). Este estudo qualitativo utiliza a fenomenologia e a teoria fundamentada. O estudo inclui entrevistas com 98 mulheres, parte grávida durante a epidemia de ZIKV no Brasil, Colômbia e Porto Rico e que tiveram filhos com SCZ ou sem comprometimento neurológico diagnosticado. Além disso, o estudo inclui um grupo de mulheres grávidas durante a pandemia de COVID-19 nos mesmos países. Em ambos os grupos, as entrevistadas tinham diferentes níveis de conhecimento sobre ZIKV. O estudo constatou que as mensagens veiculadas por meio da mídia eram alarmistas; em contraste com as informações fornecidas por profissionais de saúde, consideradas mais confiáveis. Mulheres gestantes durante a epidemia do ZIKV relataram ter recebido seu diagnóstico de infecção por ZIKV e SCZ tardiamente ou após o parto. O estudo destaca as necessidades das mulheres grávidas em cenários de alto risco, a importância de processos de educação em saúde e a necessidade de reforçar a comunicação e a educação continuada.
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Zika virus (ZIKV) infection in pregnancy is associated with severe abnormalities of the brain and eye and other adverse outcomes. Zika en Embarazadas y Niños was a prospective cohort study conducted in multiple Colombian cities that enrolled pregnant women in their first trimester. Specimens collected from pregnant women (n = 1,519) during February 2017-September 2018 and their infants (n = 1,080) during June 2017-March 2019 were tested for prenatal ZIKV infection by nucleic acid amplification tests or IgM antibody testing. Zika virus infection in pregnancy was present in 3.2% of pregnant women (incidence rate [IR] per 1,000 person-months = 5.9, 95% CI: 4.3-7.8). Presumptive ZIKV infection was present in 0.8% of infants (IR = 1.6, 95% CI: 0.7-2.9). Five percent of infants with prenatal ZIKV exposure or infection presented with Zika-associated abnormalities; 4.7% were small for gestational age. Understanding the risk of ZIKV infection during pregnancy and associated adverse outcomes can help inform counseling efforts.
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Providing accurate, evidence-based information to women with Zika infection during pregnancy was problematic because of the high degree of uncertainty in the diagnosis of the infection and the associated risk. The 2015-17 Zika virus epidemic overwhelmingly affected women in countries with limited access to safe abortion. Understanding women's perspectives on risk communication during pregnancy in the context of an emerging pathogen can help inform risk communication in response to future outbreaks that affect fetal or child development. We conducted a cross-sectional qualitative interview study with 73 women from 7 locations in Brazil, Colombia, and Puerto Rico to understand women's experiences of Zika virus (ZIKV) test and outcome-related communication during the ZIKV pandemic. We used thematic analysis to analyze the in-depth interviews. Participants in Brazil and Colombia reported that the healthcare system's lack of preparation and organization in communicating ZIKV test results and associated adverse outcomes led to their feeling abandoned and alone in confronting the challenges of a ZIKV-affected pregnancy. In contrast, participants in Puerto Rico reported that the regular testing schedules and clear, well-planned communication between the care team and between providers and pregnant women helped them to feel they could prepare for a ZIKV-affected pregnancy. Communication of the risk associated with an emerging pathogen suspected to affect pregnancy and developmental outcomes is a fraught issue. Public health authorities and healthcare providers should work together in the interpandemic period to understand families' preferences for risk communication during pregnancy in the presence of uncertainty and develop a community-informed plan for risk communication.
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Background: Prenatally transmitted viruses can cause severe damage to the developing brain. There is unexplained variability in prenatal brain injury and postnatal neurodevelopmental outcomes, suggesting disease modifiers. Discordant outcomes among dizygotic twins could be explained by genetic susceptibly or protection. Among several well-recognized threats to the developing brain, Zika is a mosquito-borne, positive-stranded RNA virus that was originally isolated in Uganda and spread to cause epidemics in Africa, Asia, and the Americas. In the Americas, the virus caused congenital Zika syndrome and a multitude of neurodevelopmental disorders. As of now, there is no preventative treatment or cure for the adverse outcomes caused by prenatal Zika infection. The Prenatal Infection and Neurodevelopmental Genetics (PING) Consortium was initiated in 2016 to identify factors modulating prenatal brain injury and postnatal neurodevelopmental outcomes for Zika and other prenatal viral infections. Methods: The Consortium has pooled information from eight multi-site studies conducted at 23 research centers in six countries to build a growing clinical and genomic data repository. This repository is being mined to search for modifiers of virally induced brain injury and developmental outcomes. Multilateral partnerships include commitments with Children's National Hospital (USA), Instituto Nacional de Salud (Colombia), the Natural History of Zika Virus Infection in Gestation program (Brazil), and Zika Instituto Fernandes Figueira (Brazil), in addition to the Centers for Disease Control and Prevention and the National Institutes of Health. Discussion: Our goal in bringing together these sets of patient data was to test the hypothesis that personal and populational genetic differences affect the severity of brain injury after a prenatal viral infection and modify neurodevelopmental outcomes. We have enrolled 4,102 mothers and 3,877 infants with 3,063 biological samples and clinical data covering over 80 phenotypic fields and 5,000 variables. There were several notable challenges in bringing together cohorts enrolled in different studies, including variability in the timepoints evaluated and the collected clinical data and biospecimens. Thus far, we have performed whole exome sequencing on 1,226 participants. Here, we present the Consortium's formation and the overarching study design. We began our investigation with prenatal Zika infection with the goal of applying this knowledge to other prenatal infections and exposures that can affect brain development.
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Resumo A epidemia do vírus Zika (ZIKV) teve impacto sanitário, psicossocial e econômico sobre pessoas em idade reprodutiva. A principal preocupação foi a infecção durante a gravidez devido a possível transmissão vertical e sua associação com resultados fetais e infantis adversos, conhecida como síndrome congênita associada à infecção pelo Vírus Zika (SCZ). Este estudo qualitativo utiliza a fenomenologia e a teoria fundamentada. O estudo inclui entrevistas com 98 mulheres, parte grávida durante a epidemia de ZIKV no Brasil, Colômbia e Porto Rico e que tiveram filhos com SCZ ou sem comprometimento neurológico diagnosticado. Além disso, o estudo inclui um grupo de mulheres grávidas durante a pandemia de COVID-19 nos mesmos países. Em ambos os grupos, as entrevistadas tinham diferentes níveis de conhecimento sobre ZIKV. O estudo constatou que as mensagens veiculadas por meio da mídia eram alarmistas; em contraste com as informações fornecidas por profissionais de saúde, consideradas mais confiáveis. Mulheres gestantes durante a epidemia do ZIKV relataram ter recebido seu diagnóstico de infecção por ZIKV e SCZ tardiamente ou após o parto. O estudo destaca as necessidades das mulheres grávidas em cenários de alto risco, a importância de processos de educação em saúde e a necessidade de reforçar a comunicação e a educação continuada.
Abstract The Zika virus (ZIKV) epidemic had a sanitary, psychosocial, and economic impact on individuals of reproductive age. The primary concern revolved around infection during pregnancy due to possible vertical transmission and its association with adverse fetal and infant outcomes, known as Congenital Zika Syndrome (CZS). This qualitative study employs phenomenology and grounded theory. This study includes interviews with 98 women, some pregnant during the ZIKV epidemic in Brazil, Colombia, and Puerto Rico, who had children with CZS or without diagnosed neurological impairment. Additionally, the study included a group of women who were pregnant during the Covid-19 pandemic in these same countries. In both groups, interviewees had varying levels of knowledge about ZIKV. The study found that messages conveyed through the media tended to be alarmist, in contrast to the information provided by healthcare professionals, which was considered more trustworthy. Pregnant women during the ZIKV epidemic reported receiving their ZIKV and CSZ infection diagnoses late, either during or after childbirth. The study underscores the needs of pregnant women in high-risk scenarios, the importance of health education processes, and the necessity to reinforce communication and continuing education.
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OBJECTIVE: To describe the clinical and epidemiological characteristics of newborn infants with SARS-CoV-2 infection notified in the Colombian Public Health Surveillance System. DESIGN: This epidemiological descriptive analysis was conducted using the data of all cases of newborn infants with confirmed SARS-CoV-2 infection notified in the surveillance system. Absolute frequencies and central tendency measures were calculated and a bivariate analysis comparing variables of interest with symptomatic and asymptomatic disease was performed. SETTING: Population-based descriptive analysis. PATIENTS: Laboratory-confirmed COVID-19 cases in newborn infants (aged ≤28 days of life) reported to the surveillance system from 1 March 2020 to 28 February 2021. RESULTS: 879 newborns were identified, corresponding to 0.04% of all reported cases in the country. The mean age at diagnosis was 13 days (range 0-28 days), 55.1% were male and most (57.6%) were classified as symptomatic. Preterm birth and low birth weight were identified in 24.0% and 24.4% of the cases, respectively. Common symptoms were fever (58.3%), cough (48.3%) and respiratory distress (34.9%). A higher prevalence of symptomatic newborns was seen in individuals with low birth weight for gestational age (prevalence ratio (PR): 1.51, 95% CI: 1.44 to 1.59) and newborns with underlying conditions (PR: 1.33, 95% CI: 1.13 to 1.55). CONCLUSIONS: There were a low proportion of confirmed COVID-19 cases in the newborn population. A substantial number of newborns were classified as symptomatic, having low birth weight and being preterm. Clinicians caring for COVID-19-infected newborns should be aware of population characteristics that potentially contribute to disease manifestations and severity.
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COVID-19 , Nacimiento Prematuro , Recién Nacido , Humanos , Lactante , Masculino , Femenino , COVID-19/epidemiología , Colombia/epidemiología , Pandemias , SARS-CoV-2RESUMEN
BACKGROUND: Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection during pregnancy is related with adverse maternal, fetal, and neonatal outcomes. Placental SARS-CoV-2 involvement may include various degrees of inflammation and malperfusion leading to diverse pregnancy complications. METHODS: Placental, fetal and umbilical cord samples of three fetal demise cases that occurred in the context of maternal SARS-CoV-2 infections were analyzed. Cases were notified to the Colombian SARS-CoV-2 National Surveillance System. RT-PCR and immunohistochemistry (IHC) analysis were employed to identify potential tissue viral involvement. RESULTS: RT-PCR and IHC confirmed the presence of viral genomes and antigens in placental and umbilical cord tissues. Histopathological analysis revealed findings consistent with placental malperfusion and inflammation. CONCLUSIONS: SARS-CoV-2 infection during pregnancy can lead to placental dysfunction and damage compromising fetal survival. Many questions regarding SARS-CoV-2 dynamics during pregnancy including placental physiopathology and in utero transmission are still pending definitive answers.
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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.
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Infecciones por Arbovirus , Fiebre Chikungunya , Virus Chikungunya , Humanos , Niño , Persona de Mediana Edad , Fiebre Chikungunya/epidemiología , Vigilancia en Salud Pública , BiomarcadoresRESUMEN
Zika virus (ZIKV) is a mosquito-borne pathogen that caused a major epidemic in the Americas in 2015-2017. Although the majority of ZIKV infections are asymptomatic, the virus has been associated with congenital birth defects and neurological complications (NC) in adults. We combined multiple data sources to improve estimates of ZIKV infection attack rates (IARs), reporting rates of Zika virus disease (ZVD) and the risk of ZIKV-associated NC for 28 capital cities in Colombia. ZVD surveillance data were combined with post-epidemic seroprevalence data and a dataset on ZIKV-associated NC in a Bayesian hierarchical model. We found substantial heterogeneity in ZIKV IARs across cities. The overall estimated ZIKV IAR across the 28 cities was 0.38 (95% CrI: 0.17-0.92). The estimated ZVD reporting rate was 0.013 (95% CrI: 0.004-0.024), and 0.51 (95% CrI: 0.17-0.92) cases of ZIKV-associated NC were estimated to be reported per 10 000 ZIKV infections. When we assumed the same ZIKV IAR across sex or age group, we found important spatial heterogeneities in ZVD reporting rates and the risk of being reported as a ZVD case with NC. Our results highlight how additional data sources can be used to overcome biases in surveillance data and estimate key epidemiological parameters.
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The COVID-19 pandemic caused by the SARS-CoV-2 virus has generated globally more than 110.7 million infections and 2.4 million deaths. The severity of this infection can range from asymptomatic, mild to severe. To know the possible associations between the presence of the virus and histopathological alterations found in tissues of fatal cases of COVID-19, the presence of the virus in the lung tissue of a patient with a clinical history of SARS-CoV-2 infection was evaluated. Lung tissue was histologically processed for immunohistochemical detection of SARSCoV-2. In the histopathological study, morphological changes associated with pneumonitis of viral origin were observed. Likewise, the location of the SARS-CoV-2 virus was observed mainly in the cytoplasm of the cells of the inflammatory infiltrate.
La pandemia de COVID-19 causada por el virus SARS-CoV-2 ha generado más de 110,7 millones de infecciones y 2,4 millones de muertes a nivel mundial. Esta infección puede ser asintomática y sus manifestaciones clínicas pueden variar entre leves y graves. Para conocer las posibles asociaciones entre la presencia del virus y las alteraciones histopatológicas encontradas en los tejidos de casos fatales de COVID-19, se evaluó la presencia del virus en el tejido pulmonar de un paciente con antecedentes clínicos de infección por SARS-CoV-2. La muestra se procesó para la detección inmunohistoquímica del virus. En el estudio histopatológico, se observaron cambios morfológicos asociados con neumonitis de origen viral. Asimismo, el virus se localizó principalmente en el citoplasma de las células del infiltrado inflamatorio.
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COVID-19 , Pandemias , Humanos , SARS-CoV-2 , PulmónRESUMEN
The COVID-19 pandemic caused by the SARS-CoV-2 virus has generated globally more than 110.7 million infections and 2.4 million deaths. The severity of this infection can range from asymptomatic, mild to severe. To know the possible associations between the presence of the virus and histopathological alterations found in tissues of fatal cases of COVID-19, the presence of the virus in the lung tissue of a patient with a clinical history of SARS-CoV-2 infection was evaluated. Lung tissue was histologically processed for immunohistochemical detection of SARS- CoV-2. In the histopathological study, morphological changes associated with pneumonitis of viral origin were observed. Likewise, the location of the SARS-CoV-2 virus was observed mainly in the cytoplasm of the cells of the inflammatory infiltrate.
La pandemia de COVID-19 causada por el virus SARS-CoV-2 ha generado más de 110,7 millones de infecciones y 2,4 millones de muertes a nivel mundial. Esta infección puede ser asintomática y sus manifestaciones clínicas pueden variar entre leves y graves. Para conocer las posibles asociaciones entre la presencia del virus y las alteraciones histopatológicas encontradas en los tejidos de casos fatales de COVID-19, se evaluó la presencia del virus en el tejido pulmonar de un paciente con antecedentes clínicos de infección por SARS-CoV-2. La muestra se procesó para la detección inmunohistoquímica del virus. En el estudio histopatológico, se observaron cambios morfológicos asociados con neumonitis de origen viral. Asimismo, el virus se localizó principalmente en el citoplasma de las células del infiltrado inflamatorio.
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COVID-19 , Pulmón , Inmunohistoquímica , Antígenos ViralesRESUMEN
Objective: Determine the temporal and spatial structure of the severe acute respiratory syndrome virus (SARS-CoV-2) that causes coronavirus disease (COVID-19), in the cities of Cartagena and Barranquilla, Colombia, in order to take necessary actions to support contact tracing. Methods: Cross-sectional ecological study with spatial analysis based on kernel densities of variables, including cases, mobile application alerts, population vulnerability, multidimensional poverty index; inverse distance weighted spatial interpolation of active cases; and, finally, the spatial superposition technique as a final result. The database of the National Institute of Health of the cities of Cartagena and Barranquilla and the Department of National Statistics was used. Results: The analysis identified an upward epidemiological trend in cases in the two cities, and determined the spatial direction of disease spread in neighborhoods, through spatial interpolation. Intervention areas were detected in 15 neighborhoods in Cartagena and 13 in Barranquilla, 50 meters around active cases with fewer than 21 days of evolution and by geographical risk layers, as a mechanism to stop the spread of COVID-19. Conclusions: Spatial analysis proved to be a useful complementary methodology for contact tracing, by determining temporal and spatial structure and providing necessary scientific evidence for the application of direct intervention measures, where necessary, to reduce the spread of SARS-CoV-2.
Objetivo: Determinar a estrutura temporal e espacial do vírus da síndrome respiratória aguda grave (SARS-CoV-2, na sigla em inglês), causador da doença pelo coronavírus de 2019 (COVID-19, na sigla em inglês), nas cidades de Cartagena e Barranquilla, visando a tomar ações necessárias que apoiem o rastreamento de contatos. Métodos: Estudo ecológico transversal que inclui análise espacial baseada em densidade de Kernel de variáveis como casos, alertas de um aplicativo móvel, vulnerabilidade populacional, índice de pobreza multidimensional, aplicação de interpolação espacial (IDW, na sigla em inglês) de casos ativos e, por último, aplicação da técnica de sobreposição espacial como resultado final. Foram utilizadas as bases de dados do Instituto Nacional de Saúde para as cidades de Cartagena e Barranquilla e do Departamento Nacional de Estatística. Resultados: A análise determinou o comportamento epidemiológico ascendente dos casos nas duas cidades e identificou a direção espacial de propagação da doença nos bairros, por meio de interpolação espacial. Foram detectadas áreas para intervenção em 15 bairros de Cartagena e 13 de Barranquilla, em 50 metros ao redor dos casos ativos com menos de 21 dias de evolução e de acordo com as camadas de risco geográfico, como mecanismo para impedir a propagação da COVID-19. Conclusões: A análise espacial permitiu determinar a estrutura temporal e espacial como uma metodologia complementar útil para o rastreamento de contatos, e forneceu a evidência científica necessária para a aplicação de medidas de intervenção direta, quando necessário, visando a reduzir o contágio pelo SARS-CoV-2.
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[RESUMEN]. Objetivo. Determinar la estructura temporal y espacial del virus del síndrome respiratorio agudo grave (SARSCoV- 2, por su sigla en inglés), causante de la enfermedad por coronavirus (COVID-19, por su sigla en inglés) en las ciudades de Cartagena y Barranquilla para tomar acciones necesarias que apoyen el rastreo de contactos. Métodos. Estudio ecológico transversal que incluye análisis espacial basado en densidades Kernel de variables como casos, alertas desde una aplicación móvil, vulnerabilidad poblacional, índice de pobreza multidimensional, aplicación de interpolación espacial (IDW, por su sigla en inglés) de los casos activos y, por último, la aplicación de la técnica de superposición espacial como resultado final. Se utilizó la base de datos del Instituto Nacional de Salud de las ciudades de Cartagena y Barranquilla y el Departamento de Estadística Nacional. Resultados. El análisis determinó el comportamiento epidemiológico ascendente de los casos en las dos ciudades e identificó la dirección espacial de propagación de la enfermedad en los barrios, a través de la interpolación espacial. Se detectaron las zonas en las cuales intervenir en 15 barrios de Cartagena y 13 de Barranquilla, en 50 metros alrededor de los casos activos con menos de 21 días de evolución y según las capas de riesgo geográfico, como mecanismo para frenar la propagación de la COVID-19. Conclusiones. El análisis espacial permitió determinar la estructura temporal y espacial como metodología complementaria útil para el rastreo de contactos, y aportó la evidencia científica necesaria para la aplicación de medidas de intervención directa donde fuera necesario, dirigidas a reducir el contagio del SARS-CoV-2.
[ABSTRACT]. Objective. Determine the temporal and spatial structure of the severe acute respiratory syndrome virus (SARSCoV- 2) that causes coronavirus disease (COVID-19), in the cities of Cartagena and Barranquilla, Colombia, in order to take necessary actions to support contact tracing. Methods. Cross-sectional ecological study with spatial analysis based on kernel densities of variables, including cases, mobile application alerts, population vulnerability, multidimensional poverty index; inverse distance weighted spatial interpolation of active cases; and, finally, the spatial superposition technique as a final result. The database of the National Institute of Health of the cities of Cartagena and Barranquilla and the Department of National Statistics was used. Results. The analysis identified an upward epidemiological trend in cases in the two cities, and determined the spatial direction of disease spread in neighborhoods, through spatial interpolation. Intervention areas were detected in 15 neighborhoods in Cartagena and 13 in Barranquilla, 50 meters around active cases with fewer than 21 days of evolution and by geographical risk layers, as a mechanism to stop the spread of COVID-19. Conclusions. Spatial analysis proved to be a useful complementary methodology for contact tracing, by determining temporal and spatial structure and providing necessary scientific evidence for the application of direct intervention measures, where necessary, to reduce the spread of SARS-CoV-2.
[RESUMO]. Objetivo. Determinar a estrutura temporal e espacial do vírus da síndrome respiratória aguda grave (SARSCoV- 2, na sigla em inglês), causador da doença pelo coronavírus de 2019 (COVID-19, na sigla em inglês), nas cidades de Cartagena e Barranquilla, visando a tomar ações necessárias que apoiem o rastreamento de contatos. Métodos. Estudo ecológico transversal que inclui análise espacial baseada em densidade de Kernel de variáveis como casos, alertas de um aplicativo móvel, vulnerabilidade populacional, índice de pobreza multidimensional, aplicação de interpolação espacial (IDW, na sigla em inglês) de casos ativos e, por último, aplicação da técnica de sobreposição espacial como resultado final. Foram utilizadas as bases de dados do Instituto Nacional de Saúde para as cidades de Cartagena e Barranquilla e do Departamento Nacional de Estatística. Resultados. A análise determinou o comportamento epidemiológico ascendente dos casos nas duas cidades e identificou a direção espacial de propagação da doença nos bairros, por meio de interpolação espacial. Foram detectadas áreas para intervenção em 15 bairros de Cartagena e 13 de Barranquilla, em 50 metros ao redor dos casos ativos com menos de 21 dias de evolução e de acordo com as camadas de risco geográfico, como mecanismo para impedir a propagação da COVID-19. Conclusões. A análise espacial permitiu determinar a estrutura temporal e espacial como uma metodologia complementar útil para o rastreamento de contatos, e forneceu a evidência científica necessária para a aplicação de medidas de intervenção direta, quando necessário, visando a reduzir o contágio pelo SARS-CoV-2.
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Sistemas de Información Geográfica , Infecciones por Coronavirus , Vigilancia en Salud Pública , Mapa de Riesgo , Colombia , Sistemas de Información Geográfica , Infecciones por Coronavirus , Vigilancia en Salud Pública , Mapa de Riesgo , Sistemas de Información Geográfica , Infecciones por Coronavirus , Vigilancia en Salud Pública , Mapa de Riesgo , Colombia , COVID-19RESUMEN
Coronavirus disease 2019 (COVID-19) is transmitted person-to-person mainly by close contact or droplets from respiratory tract. However, the actual time of viral shedding is still uncertain as well as the different routes of transmission. We aimed to characterize RNA shedding from nasopharyngeal and rectal samples in prolonged cases of mild COVID-19 in young male soldiers. Seventy patients from three different military locations were monitored after recommending to follow more strict isolation measures to prevent the spread of the virus. Then, nasopharyngeal, rectal, and blood samples were taken. SARS-CoV-2 RNA was detected by RT-PCR and specific antibodies by chemiluminescent immunoassays. The median nucleic acid conversion time (NACT) was 60 days (IQR: 7-85 days). Rectal swabs were taken in 60â% of patients. Seven patients (10â%) were positive in nasopharyngeal and rectal swabs, and five (7.14â%) remained positive in rectal swabs, but negative in nasopharyngeal samples. Four patients (5.71â%) that had been discharged, were positive again after 15 days. No significant difference was found in nucleic acid conversion time between age groups nor clinical classification. Maintaining distancing among different positive patients is essential as a possible re-exposure to the virus could cause a longer nucleic acid conversion time in SARS-COV-2 infections.
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Anticuerpos Antivirales/sangre , COVID-19 , Inmunoglobulina G/sangre , ARN Viral/análisis , COVID-19/diagnóstico , COVID-19/prevención & control , Brotes de Enfermedades , Humanos , Masculino , Personal Militar , SARS-CoV-2 , Esparcimiento de VirusRESUMEN
RESUMEN Objetivo. Determinar la estructura temporal y espacial del virus del síndrome respiratorio agudo grave (SARS-CoV-2, por su sigla en inglés), causante de la enfermedad por coronavirus (COVID-19, por su sigla en inglés) en las ciudades de Cartagena y Barranquilla para tomar acciones necesarias que apoyen el rastreo de contactos. Métodos. Estudio ecológico transversal que incluye análisis espacial basado en densidades Kernel de variables como casos, alertas desde una aplicación móvil, vulnerabilidad poblacional, índice de pobreza multidimensional, aplicación de interpolación espacial (IDW, por su sigla en inglés) de los casos activos y, por último, la aplicación de la técnica de superposición espacial como resultado final. Se utilizó la base de datos del Instituto Nacional de Salud de las ciudades de Cartagena y Barranquilla y el Departamento de Estadística Nacional. Resultados. El análisis determinó el comportamiento epidemiológico ascendente de los casos en las dos ciudades e identificó la dirección espacial de propagación de la enfermedad en los barrios, a través de la interpolación espacial. Se detectaron las zonas en las cuales intervenir en 15 barrios de Cartagena y 13 de Barranquilla, en 50 metros alrededor de los casos activos con menos de 21 días de evolución y según las capas de riesgo geográfico, como mecanismo para frenar la propagación de la COVID-19. Conclusiones. El análisis espacial permitió determinar la estructura temporal y espacial como metodología complementaria útil para el rastreo de contactos, y aportó la evidencia científica necesaria para la aplicación de medidas de intervención directa donde fuera necesario, dirigidas a reducir el contagio del SARS-CoV-2.
ABSTRACT Objective. Determine the temporal and spatial structure of the severe acute respiratory syndrome virus (SARS-CoV-2) that causes coronavirus disease (COVID-19), in the cities of Cartagena and Barranquilla, Colombia, in order to take necessary actions to support contact tracing. Methods. Cross-sectional ecological study with spatial analysis based on kernel densities of variables, including cases, mobile application alerts, population vulnerability, multidimensional poverty index; inverse distance weighted spatial interpolation of active cases; and, finally, the spatial superposition technique as a final result. The database of the National Institute of Health of the cities of Cartagena and Barranquilla and the Department of National Statistics was used. Results. The analysis identified an upward epidemiological trend in cases in the two cities, and determined the spatial direction of disease spread in neighborhoods, through spatial interpolation. Intervention areas were detected in 15 neighborhoods in Cartagena and 13 in Barranquilla, 50 meters around active cases with fewer than 21 days of evolution and by geographical risk layers, as a mechanism to stop the spread of COVID-19. Conclusions. Spatial analysis proved to be a useful complementary methodology for contact tracing, by determining temporal and spatial structure and providing necessary scientific evidence for the application of direct intervention measures, where necessary, to reduce the spread of SARS-CoV-2.
RESUMO Objetivo. Determinar a estrutura temporal e espacial do vírus da síndrome respiratória aguda grave (SARS-CoV-2, na sigla em inglês), causador da doença pelo coronavírus de 2019 (COVID-19, na sigla em inglês), nas cidades de Cartagena e Barranquilla, visando a tomar ações necessárias que apoiem o rastreamento de contatos. Métodos. Estudo ecológico transversal que inclui análise espacial baseada em densidade de Kernel de variáveis como casos, alertas de um aplicativo móvel, vulnerabilidade populacional, índice de pobreza multidimensional, aplicação de interpolação espacial (IDW, na sigla em inglês) de casos ativos e, por último, aplicação da técnica de sobreposição espacial como resultado final. Foram utilizadas as bases de dados do Instituto Nacional de Saúde para as cidades de Cartagena e Barranquilla e do Departamento Nacional de Estatística. Resultados. A análise determinou o comportamento epidemiológico ascendente dos casos nas duas cidades e identificou a direção espacial de propagação da doença nos bairros, por meio de interpolação espacial. Foram detectadas áreas para intervenção em 15 bairros de Cartagena e 13 de Barranquilla, em 50 metros ao redor dos casos ativos com menos de 21 dias de evolução e de acordo com as camadas de risco geográfico, como mecanismo para impedir a propagação da COVID-19. Conclusões. A análise espacial permitiu determinar a estrutura temporal e espacial como uma metodologia complementar útil para o rastreamento de contatos, e forneceu a evidência científica necessária para a aplicação de medidas de intervenção direta, quando necessário, visando a reduzir o contágio pelo SARS-CoV-2.
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BACKGROUND: Our aim was to describe the neuroimaging and clinical evaluations of children with antenatal Zika-virus (ZIKV) exposure. METHODS: The Colombian National Institute of Health performed serial clinical evaluations of children with probable antenatal ZIKV exposure (i.e., born to ZIKV symptomatic mothers or born with birth defects compatible with ZIKV infection, regardless of laboratory results) over 2 years that included head circumference (HC), eye examination, and neurodevelopmental assessments. Clinical neuroimaging studies (head computed tomography and/or brain magnetic resonance imaging) were analyzed for abnormalities, two-dimensional measurements were made of the right and left frontal and occipital cortical thickness. Two abnormal patterns were defined: Pattern 1 (sum of four areas of cortex <6 cm) and Pattern 2 (sum of four areas of cortex ≥6 cm and < 10 cm). RESULTS: Thirty-one children had a neuroimaging study; in 24, cortical thickness was measured. The median age at the first visit was 8 (range: 6-9) months and 22 (range: 19-42) months at the last evaluation. In the 24 cases with cortical measurements, three were normal, 12 were in Pattern 1, and nine were in Pattern 2. Children within Pattern 1 had lower mean HC at birth and in follow-up (both p < .05) and a higher frequency of structural eye abnormalities (p < .01). A trend towards poorer neuromotor development was seen in Pattern 1, although not statistically significant (p = .06). CONCLUSION: Brain imaging classification based on cortical measurements correlate with ophthalmologic abnormalities and HC. Cortical thickness may be a marker for clinical outcomes in children with congenital ZIKV infection.
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Microcefalia , Complicaciones Infecciosas del Embarazo , Infección por el Virus Zika , Virus Zika , Encéfalo/diagnóstico por imagen , Niño , Colombia , Femenino , Humanos , Recién Nacido , Neuroimagen , EmbarazoRESUMEN
Abstract Objective: To determine the mortality and survival of COVID-19 cases in Colombia between March and July 2020. Materials and methods: A retrospective cohort study in the Colombian population between March 6 to July 8, 2020, with the data reported to the National Institute of Health. Survival analysis was performed considering the real-time PCR results, died or recovered, the onset of symptoms until the date of death, or the final time of the cohort. The actuarial variation and Long-Rank test were applied for survival. Risk factors were determined by Cox regression. Results: The overall survival rate was 100%, 98%, 97%, and 95% for day 1, 10, 20 and 30, respectively. Differences were found in survival in age, sex, region, and hospitaliza tion time spending (p <0.01), the 30-day survival rate was 96% and 95% for females and males, respectively. The region with the highest survival was Antioquia with 99% and the lower Barranquilla with 93%. The age group with the lowest survival was ≥80 years of age with 60%, and being hospitalized represented a survival rate of 68%. Conclusions: This study is one of the first to estimate survival in the Colombian population diagnosed with COVID-19.
Resumen Objetivo: determinar la mortalidad y supervivencia de casos de COVID-19 en Colombia entre marzo y julio de 2020. Materiales y métodos: Estudio de cohorte retrospectivo en población colombiana entre el 6 de marzo al 8 de julio de 2020, con los datos reportados al Instituto Nacional de Salud. El análisis de supervivencia se realizó considerando los resultados de la PCR en tiempo real, fallecido o recuperado, el inicio de los síntomas hasta la fecha del fallecimiento o el momento final de la cohorte. Para la supervivencia se aplicó la variación actuarial y la prueba de rango largo. Los factores de riesgo se determinaron mediante regresión de Cox. Resultados: La tasa de supervivencia general fue del 100%, 98%, 97% y 95% para los días 1, 10, 20 y 30, respectivamente. Se encontraron diferencias en la su pervivencia en cuanto a edad, sexo, región y tiempo de hospitalización (p <0,01), la tasa de supervivencia a 30 días fue del 96% y 95% para mujeres y hombres, respectivamente. La región con mayor supervivencia fue Antioquia con 99% y la Baja Barranquilla con 93%. El grupo de edad con menor supervivencia fue el ≥80 años con 60%, y la hospitalización representó una tasa de supervivencia del 68%. Conclusiones: Este estudio es uno de los primeros en estimar la supervivencia en la población colombiana diagnosticada con COVID-19.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Análisis de Supervivencia , COVID-19 , Tasa de Supervivencia , Factores de Riesgo , Estudios de Cohortes , Mortalidad , Colombia , Supervivencia , MétodosAsunto(s)
Academias e Institutos , Prueba de Ácido Nucleico para COVID-19/métodos , Liderazgo , COVID-19/epidemiología , COVID-19/transmisión , Prueba Serológica para COVID-19 , Colombia/epidemiología , Genoma Viral , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Difusión de la Información , Modelos Teóricos , SARS-CoV-2/genética , SARS-CoV-2/inmunología , Estudios Seroepidemiológicos , Manejo de Especímenes/métodos , Capacidad de ReacciónRESUMEN
Zika virus (ZIKV) and chikungunya virus (CHIKV) were recently introduced into the Americas resulting in significant disease burdens. Understanding their spatial and temporal dynamics at the subnational level is key to informing surveillance and preparedness for future epidemics. We analyzed anonymized line list data on approximately 105,000 Zika virus disease and 412,000 chikungunya fever suspected and laboratory-confirmed cases during the 2014-2017 epidemics. We first determined the week of invasion in each city. Out of 1,122, 288 cities met criteria for epidemic invasion by ZIKV and 338 cities by CHIKV. We analyzed risk factors for invasion using linear and logistic regression models. We also estimated that the geographic origin of both epidemics was located in Barranquilla, north Colombia. We assessed the spatial and temporal invasion dynamics of both viruses to analyze transmission between cities using a suite of (i) gravity models, (ii) Stouffer's rank models, and (iii) radiation models with two types of distance metrics, geographic distance and travel time between cities. Invasion risk was best captured by a gravity model when accounting for geographic distance and intermediate levels of density dependence; Stouffer's rank model with geographic distance performed similarly well. Although a few long-distance invasion events occurred at the beginning of the epidemics, an estimated distance power of 1.7 (95% CrI: 1.5-2.0) from the gravity models suggests that spatial spread was primarily driven by short-distance transmission. Similarities between the epidemics were highlighted by jointly fitted models, which were preferred over individual models when the transmission intensity was allowed to vary across arboviruses. However, ZIKV spread considerably faster than CHIKV.
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Fiebre Chikungunya , Epidemias/estadística & datos numéricos , Infección por el Virus Zika , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/transmisión , Virus Chikungunya , Colombia/epidemiología , Humanos , Análisis Espacio-Temporal , Virus Zika , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/transmisiónRESUMEN
Zika virus (ZIKV) is a mosquito-borne pathogen that recently caused a major epidemic in the Americas. Although the majority of ZIKV infections are asymptomatic, the virus has been associated with birth defects in fetuses and newborns of infected mothers as well as neurological complications in adults. We performed a descriptive analysis on approximately 106,000 suspected and laboratory-confirmed cases of Zika virus disease (ZVD) that were reported during the 2015-2017 epidemic in Colombia. We also analyzed a dataset containing patients with neurological complications and recent febrile illness compatible with ZVD. Females had higher cumulative incidence of ZVD than males. Compared to the general population, cases were more likely to be reported in young adults (20 to 39 years of age). We estimated the cumulative incidence of ZVD in pregnant females at 3,120 reported cases per 100,000 population (95% CI: 3,077-3,164), which was considerably higher than the incidence in both males and non-pregnant females. ZVD cases were reported in all 32 departments. Four-hundred and eighteen patients suffered from ZIKV-associated neurological complications, of which 85% were diagnosed with Guillain-Barré syndrome. The median age of ZIKV cases with neurological complications was 12 years older than that of ZVD cases. ZIKV-associated neurological complications increased with age, and the highest incidence was reported among individuals aged 75 and older. Even though neurological complications and deaths due to ZIKV were rare in this epidemic, better risk communication is needed for people living in or traveling to ZIKV-affected areas.