Characterization of Dengue Virus 4 Cases in Paraguay, 2019-2020.

In 2019-2020, dengue virus (DENV) type 4 emerged to cause the largest DENV outbreak in Paraguay's history. This study sought to characterize dengue relative to other acute illness cases and use phylogenetic analysis to understand the outbreak's origin. Individuals with an acute illness (≤7 days) were enrolled and tested for DENV nonstructural protein 1 (NS1) and viral RNA by real-time RT-PCR. Near-complete genome sequences were obtained from 62 DENV-4 positive samples. From January 2019 to March 2020, 799 participants were enrolled: 253 dengue (14 severe dengue, 5.5%) and 546 other acute illness cases. DENV-4 was detected in 238 dengue cases (94.1%). NS1 detection by rapid test was 52.5% sensitive (53/101) and 96.5% specific (387/401) for dengue compared to rRT-PCR. DENV-4 sequences were grouped into two clades within genotype II. No clustering was observed based on dengue severity, location, or date. Sequences obtained here were most closely related to 2018 DENV-4 sequences from Paraguay, followed by a 2013 sequence from southern Brazil. DENV-4 can result in large outbreaks, including severe cases, and is poorly detected with available rapid diagnostics. Outbreak strains seem to have been circulating in Paraguay and Brazil prior to 2018, highlighting the importance of sustained DENV genomic surveillance.

Detection of neutralizing antibodies against flaviviruses in free-ranging birds, Paraguay (2016-2018).

Saint Louis encephalitis virus (SLEV), West Nile virus (WNV) and Ilheus virus (ILHV) are flaviviruses maintained by enzootic transmission networks between mosquitoes and birds. They have been detected in South America, with no records for Paraguay. We detected the presence of neutralizing antibodies for SLEV, WNV and ILHV in free-ranging birds collected in Paraguay (2016-2018). Four positive samples were detected in resident birds: one SLEV (rufous-bellied thrush), one WNV (barred antshrike) and two ILHV (white-tipped dove and shiny cowbird). These results bring new information about enzootic activity of flaviviruses in Paraguay.

Factores de riesgo relacionados al embarazo de adolescentes de 14 a 19 años de la Unidad de Salud San Gerónimo Salado, Limpio Paraguay en el periodo 2020-2021 / Risk factors related to pregnancy in adolescents aged 14 to 19 years of the San Gerónimo Salado Health Unit, Limpio Paraguay in the period 2020-2021

Introducción. El embarazo no planeado durante la adolescencia se configura como un problema de salud pública. Son múltiples los factores de riesgo relacionados con esta situación, estos pueden ser individuales, familiares y sexuales. Objetivo. Describir la distribución de los factores de riesgo relacionados con el embarazo adolescente, a partir de los datos obtenidos en la Unidad de Salud San Gerónimo de Limpio-Paraguay, de enero 2020 a noviembre 2021. Metodología. Estudio descriptivo, cuantitativo, transversal de adolescentes embarazadas con por lo menos dos consultas prenatales. Se obtuvieron datos por fuente primaria mediante una encuesta y por fuente secundaria por revisión de fichas de consultas prenatales. Se aplicaron medidas estadísticas de distribución de frecuencia y porcentaje. Se describieron los factores de riesgo posiblemente relacionados con el embarazo en adolescentes. Resultados.Se incluyeron en el estudio 45 adolescentes embarazadas. Entre los factores individuales, el 69% de las adolescentes encuestadas manifestaron tener un grado de conocimiento básico y deficiente sobre planificación familiar y métodos anticonceptivos. En cuanto al factor familiar, en el 71% se observó la repetición de patrones familiares, como embarazos precoces. Conclusión.El estudio brinda información sobre los factores de riesgo de este grupo vulnerable de mujeres de la Unidad de Salud de la Familia de la localidad, mostrando la necesidad de incrementar acciones de promoción-prevención hacia este grupo de edad, para mejorar su salud sexual y reproductiva.

Introduction.Unplanned pregnancy during adolescence is configured as a public health problem. There are multiple risk factors related to this situation, these can be individual, family and sexual. Objective:To describe the distribution of risk factors related to adolescent pregnancy, based on the data obtained at the San Gerónimo de Limpio-Paraguay Health Unit, from January 2020 to November 2021. Methodology:descriptive, quantitative, cross-sectional study of adolescent pregnant women with at least two prenatal visits. Data were obtained by primary source through a survey and by secondary source by reviewing prenatal consultation records. Statistical measures of frequency and percentage distribution were applied. Risk factors possibly related to pregnancy in adolescents were described. Results:45 pregnant adolescents were included in the study. Among the individual factors, 69% of the adolescents surveyed stated that they had a basic and deficient level of knowledge about family planning and contraceptive methods. Regarding the family factor, in 71% the repetition of family patterns was observed, such as early pregnancies. Conclusion:the study provides information on the risk factors of this vulnerable groupof women from the local Family Health Unit, showing the need to increase promotion-prevention actions towards this age group, to improve their sexual health and reproductive.

Evaluación del sistema de vigilancia epidemiológica universal de las meningoencefalitis en Paraguay, 2016 / Evaluation of the universal epidemiological surveillance system for meningoencephalitis in Paraguay, 2016

Introducción.Las patologías neurológicas bacterianas constituyen un problema de salud mundial. En Paraguay, se emplean dos tipos de vigilancia epidemiológica para las infecciones meningocócicas: universal y centinela. Objetivo. Evaluar el sistema de vigilancia epidemiológica universal de las meningoencefalitis. Metodología.Estudio descriptivo transversal, basado en las directrices del Updated Guidelines for Evaluating Public Health Surveillance Systems-CDC-2001. Se analizó la base de datos del sistema nacional del 2016 seleccionando en forma aleatoria una muestra de 240 casos sospechosos de un total de 640 casos para evaluar los atributos de calidad de datos, aceptabilidad, oportunidad, sensibilidad y valor predictivo positivo (VPP), mediante una escala de calificaciones. Las medidas de frecuencias y tendencia central (media, mediana) fueron calculadas en Excel. Resultado.La evaluación de la calidad de los datos mostró una completitud de 95% e inconsistencia 4,2%. La aceptabilidad de los actores alcanzó 92%. La oportunidad de toma de muestra ≤ 24h (mediana= 1 día; rango= -31-35 días), el de diagnóstico ≤72h (mediana= 0 día; rango= 0-61 días) y la de notificación ha superado las 24h requeridas (mediana= 3 días; rango= 0-41 días). La sensibilidad del sistema fue 90% y elVPP 7,5%. Conclusión. El sistema es sensible en cuanto a la vigilancia clínica con un VPP bajo, la calidad de datos es excelente, aceptable por los actores, oportuna para la toma de muestras y de diagnóstico. Sin embargo, se debe mejorar la oportunidad de notificación.

Introduction. Bacterial neurological diseases are a global health problem. In Paraguay, two types of epidemiological surveillance are used for meningococcal infections: universal and sentinel. Objetive.The objective was to evaluate the universal epidemiological surveillance system for meningoencephalitis. Methodology:Cross-sectional descriptive study, following the guidelines of the Updated Guidelines for Evaluating Public Health Surveillance Systems-CDC-2001. The database of the national system of 2016 was analyzed. To evaluate the attributes: data quality, acceptability, timeliness, sensitivity and positive predictive value (PPV) the sample size of a total population of 640 was calculated using EpiInfo7.2.2.2, confidence level 95%. The minimum size studied was 240 suspected cases. The grading scale was developed. Random samples of records, frequency measurements and central tendency (mean, median) were calculated in Excel. Results:Epidemiological files were evaluated, the quality of the data in terms of completeness was 95% and inconsistency 4.2%. The acceptability of the actors reached 92%. The opportunity to take a sample ≤ 24 hours (Me= 1 day; R= -31-35 days), diagnosis ≤72h (Me= 0 days; R= 0-61 days) and notification has exceeded the required 24h (Me= 3 days; R= 0-41 days). The sensitivity of thesystem was found to be 90% with a PPV of 7.5%. Conclusion.In conclusion, the system is sensitive in terms of clinical surveillance with a low PPV, the data quality is excellent, acceptable by the actors, timely for sampling and diagnosis. However, the timeliness of notification needs to be improved.

Revisiting the dengue epidemic of 2011 in Paraguay: molecular epidemiology of dengue virus in the Asuncion metropolitan area.

BACKGROUND: Dengue is one of the most important re-emerging viral diseases and the most common human arthropod-borne viral infection worldwide. Any of the four Dengue virus serotypes (DENV-1 to 4) can cause asymptomatic infections or clinical manifestations that range in severity from a mild, self-limited illness, to a severe disease characterized by a shock syndrome that can lead to death. Paraguay suffers periodic epidemic outbreaks of dengue since 1988 when the DENV-1 was introduced in the country. Epidemics caused by all four serotypes have been reported and the country. Although dengue is endemic in Paraguay, few studies have described the molecular epidemiology of DENV in the country, which is important to understand the local and global spread, as well as the evolution of this pathogen. METHODS: This was a cross-sectional study of a convenience sample. Suspected dengue patients of any age were recruited from the Emergency Laboratory of the Central Hospital of the Institute of Social Welfare, Asuncion, Paraguay, from February to June of 2011. A DENV antigen test was used to confirm the infection. The protein E gene sequences of isolated viruses were sequenced for phylogenetic analysis. RESULTS: Dengue was confirmed in 55.1% of the participants (n = 98/178). The most frequent clinical findings were fever, headache, and myalgia. Identity analyses of the protein E gene sequence of 56 viruses isolated showed the circulation of DENV-1 (n = 45) and DENV-2 (n = 11) in the Asuncion metropolitan area in 2011. Molecular epidemiology analyses suggest that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. CONCLUSIONS: We have analyzed the molecular epidemiology of DENV-1 and DENV-2 isolated in Paraguay in 2011. We found strong evidence that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. Molecular epidemiology studies are of great interest to analyze the dynamic of DENV spread, which are useful for early implementation of containment measures to reduce the risk of explosive epidemics caused by this virus.

Implementación de un sistema de detección de flavivirus en mosquitos / Implementation of a flavivirus detection system in mosquitoes

Los Flavivirus constituyen virus transmitidos por artrópodos, principalmente mosquitos. Pueden producir enfermedades en humanos y animales, también incluyen virus específicos de insectos que solo infectan y se replican en los insectos, no así en vertebrados. En Paraguay los virus dengue, fiebre amarilla y Zika fueron detectados en infecciones humanas, pero los estudios de flavivirus en mosquitos son aún escasos. Por ello, el objetivo del presente estudio fue implementar un sistema de detección de flavivirus en mosquitos en el IICS-UNA. Primero, se organizaron capacitaciones en colecta, preparación de pools y procesamiento por técnicas de RT-PCRs convencionales realizadas por expertos internacionales a profesionales locales (bioquímicos y biólogos). Además, se implementaron planillas de registro de datos y de control de transporte de muestras de los lugares de colectas hasta el IICS-UNA. Se prepararon en total 201 pools de 1 a 35 mosquitos cada uno agrupados por especie, localidad, entre otros criterios. Para asegurar la integridad del RNA extraído se realizó la detección de un control interno (Actina-1), siendo todos los pools positivos para el mismo, 91/201 pools fueron positivos para flavivirus. Se realizó la secuenciación de 19/91 pools positivos para flavivirus identificándose flavivirus de insectos (detectándose principalmente Culex Flavivirus, cell fusing agents Flavivirus y Kamiti river virus), evidenciando la elevada distribución de estos virus. Estos resultados demuestran que fue factible implementar el sistema de detección de flavivirus en mosquitos, lo cual podría contribuir a fortalecer la vigilancia y control de estas virosis, así como el conocimiento sobre la importancia ecológica de flavivirus de insectos

Flaviviruses are viruses transmitted by arthropods, mainly mosquitoes. They can cause diseases in humans and animals, they also include specific insect viruses that only infect and replicate in insects, not in vertebrates. In Paraguay, dengue, yellow fever, and Zika viruses were detected in human infections, but studies of flaviviruses in mosquitoes are still scarce. Therefore, the objective of the present study was the implementation of a flavivirus detection system in mosquitoes at IICS-UNA. First, trainings on collection, pool preparation and processing by conventional RT-PCR techniques were organized by international experts for local professionals (biochemists and biologists). In addition, data log sheets and sample transport control forms from the collection sites to the IICS were implemented. A total of 201 pools of 1 to 35 mosquitoes were prepared, each grouped by species, locality, among others. To ensure the integrity of the extracted RNA, an internal control (Actin-1) detection was performed, all pools being positive for it; 91/201 pools were positive for flaviviruses. The sequencing of 19/91 pools positive for flavivirus was carried out, identifying flavivirus in all cases of insects (mainly detecting Culex Flavivirus, cell fusing agents Flavivirus and Kamiti river virus), evidencing the high distribution of these viruses. These results demonstrate that it was feasible to implement the flavivirus detection system in mosquitoes, which could contribute to strengthen the detection, surveillance and control of these viruses, as well as, the knowledge about the ecological importance of insect flaviviruses

Comparison of Anti-Dengue and Anti-Zika IgG on a Plasmonic Gold Platform with Neutralization Testing.

Antibody cross-reactivity confounds testing for dengue virus (DENV) and Zika virus (ZIKV). We evaluated anti-DENV and anti-ZIKV IgG detection using a multiplex serological platform (the pGOLD assay, Nirmidas, Palo Alto, CA) in patients from the Asunción metropolitan area in Paraguay, which experiences annual DENV outbreaks but has reported few autochthonous ZIKV infections. Acute-phase sera were tested from 77 patients who presented with a suspected arboviral illness from January to May 2018. Samples were tested for DENV and ZIKV RNA by real-time reverse transcription-PCR, and for DENV nonstructural protein 1 with a lateral-flow immunochromatographic test. Forty-one patients (51.2%) had acute dengue; no acute ZIKV infections were detected. Sixty-five patients (84.4%) had anti-DENV-neutralizing antibodies by focus reduction neutralization testing (FRNT50). Qualitative detection with the pGOLD assay demonstrated good agreement with FRNT50 (kappa = 0.74), and quantitative results were highly correlated between methods (P < 0.001). Only three patients had anti-ZIKV-neutralizing antibodies at titers of 1:55-1:80, and all three had corresponding DENV-neutralizing titers > 1:4,000. Hospitalized dengue cases had significantly higher anti-DENV IgG levels (P < 0.001). Anti-DENV IgG results from the pGOLD assay correlate well with FRNT, and quantitative results may inform patient risk stratification.

Real-time RT-PCR for the detection and quantitation of Oropouche virus.

Oropouche virus (OROV) causes an acute, systemic febrile illness, and in certain regions of South America, this represents the second most common human arboviral infection after dengue virus. A new real-time RT-PCR was developed for OROV and reassortant species. The new OROV rRT-PCR proved linear across 6-7 orders of magnitude with a lower limit of 95% detection of 5.6-10.8 copies/µL. Upon testing dilutions of OROV and Iquitos virus reference genomic RNA, all dilutions with >10 copies/µL were detected in both the OROV rRT-PCR and a comparator molecular assay, but the OROV rRT-PCR detected more samples with ≤10 copies/µL (8/14 vs 0/13, respectively, P = 0.002). In a set of 100 acute-phase clinical samples from Paraguay patients with a suspected arboviral illness, no patients tested positive for OROV RNA using either assay. The OROV rRT-PCR provides a sensitive molecular assay for the study of this important yet neglected tropical arboviral infection.

Characterization of dengue cases among patients with an acute illness, Central Department, Paraguay.

BACKGROUND: In 2018, Paraguay experienced a large dengue virus (DENV) outbreak. The primary objective of this study was to characterize dengue cases in the Central Department, where the majority of cases occur, and identify factors associated with DENV infection. METHODS: Patients were enrolled from January-May 2018 if they presented with a suspected arboviral illness. Acute-phase specimens (≤8 days after symptom onset) were tested using rRT-PCR, a rapid diagnostic test for DENV nonstructural protein 1 (NS1) and anti-DENV IgM and IgG, and ELISA for IgG against NS1 from Zika virus (ZIKV). RESULTS: A total of 231 patients were enrolled (95.2% adults) at two sites: emergency care and an outpatient clinical site. Patients included 119 (51.5%) dengue cases confirmed by rRT-PCR (n = 115, 96.6%) and/or the detection of NS1 and anti-DENV IgM (n = 4, 3.4%). DENV-1 was the predominant serotype (109/115, 94.8%). Epidemiologically, dengue cases and non-dengue cases were similar, though dengue cases were less likely to reside in a house/apartment or report a previous dengue case. Clinical and laboratory findings associated with dengue included red eyes, absence of sore throat, leucopenia and thrombocytopenia. At an emergency care site, 26% of dengue cases (26/100) required hospitalization. In univariate analysis, hospitalization was associated with increased viral load, anti-DENV IgG, and thrombocytopenia. Among dengue cases that tested positive for IgG against ZIKV NS1, the odds of DENV NS1 detection in the acute phase were decreased 10-fold (OR 0.1, 0.0-0.3). CONCLUSIONS: Findings from a predominantly adult population demonstrate clinical and laboratory factors associated with DENV infections and the potential severity of dengue in this group. The combination of viral load and specific IgG antibodies warrant further study as a prognostic to identify patients at risk for severe disease.

Factors associated with high-risk human papillomavirus infection and high-grade cervical neoplasia: A population-based study in Paraguay.

BACKGROUND: Cervical cancer (CC) is one of the leading causes of cancer mortality among women from Paraguay, with high incidence and mortality rates (31.2 and 16 per 100 000 women, respectively). Although the risk factors associated with high-risk human papillomavirus (hrHPV) infection and preneoplastic cervical lesions are widely studied, population-based characteristics of particular settings may influence the feasibility of HPV-based CC screening implementation. This study aimed to explore factors associated with hrHPV infection and high-grade cervical neoplasia in hrHPV-positive (hrHPV+) women from Paraguay. METHODS: A total of 5677 women aged 30-64 years from the Central Department of Paraguay were screened with HPV test (Hybrid Capture 2) and Pap smear. Sociodemographic and risk factor interviews were conducted. hrHPV+ women were referred to colposcopy and women with an abnormal colposcopy had a biopsy taken. The outcomes recorded were the hrHPV status and the presence of high-grade cervical intraepithelial neoplasia or worse (CIN2+) among hrHPV+ women. Associations were investigated using multivariate logistic regressions. RESULTS: hrHPV prevalence was 13.8% (95%CI 13.0-14.8). This value decreased with the age of women (p-trend<0.001) and increased with the lifetime number of sexual partners (p-trend<0.001) and number of previous female partners of their current male partner if women had had one lifetime sexual partner (p-trend<0.001), increasing from 3.06 (95%CI 0.073-20.9) if partners had had one previous female partner to 9.19 (95%CI 2.36-61.1) if they had had eight or more. In hrHPV+ women, CIN2+ prevalence was 10.7% (95%CI 8.58-13.2) and increased with time since the last Pap smear (p-trend<0.001) and with the increasing number of pregnancies (p-trend = 0.05). CONCLUSION: In these settings, the sexual behavior of women and their male partners is associated with hrHPV infection. In hrHPV+ women, underscreening practices and multiple pregnancies are associated with CIN2+. This knowledge can contribute to public health policies for CC prevention and control in Paraguay.

Alphaviruses: Serological Evidence of Human Infection in Paraguay (2012-2013).

INTRODUCTION: Alphaviruses can produce febrile illness and encephalitis in dead-end hosts such as horses and humans. Within this genus, the Venezuelan Equine Encephalitis virus (VEEV) complex includes pathogenic epizootic subtypes and enzootic subtypes that are not pathogenic in horses (except subtype IE, Mexican strains), although they can cause febrile symptoms in humans. The Rio Negro virus (RNV-VEEV subtype VI) circulates in Argentina, where it was associated with undifferentiated febrile illness. Mayaro (MAYV) and Una (UNAV) viruses belong to a different group, the Semliki Forest virus complex, with confirmed circulation. OBJECTIVE: The present study aimed to determine RNV, MAYV, and UNAV seroprevalences by plaque reduction neutralization test in 652 samples of Paraguayan individuals mainly from the Central Department, between years 2012 and 2013. METHODS: Samples with antibodies titer >1:20 against RNV were also tested for Mosso das Pedras-subtype IF, subtype IAB, and Pixuna (PIXV)-subtype IV viruses that belongs to VEEV antigenic complex. RESULTS: The overall seroprevalence of RNV was 3.83%, and for UNAV it was 0.46%, and no neutralizing antibodies were detected against MAYV in the studied population. Two of the twenty-seven heterotypic samples were positive for PIXV. The 50.1% of neutralizing antibody titers against RNV were high (equal to or greater than 1/640), suggesting recent infections. The effect of age on the prevalence of RNV was negligible. CONCLUSIONS: These results bring new information about neglected alphaviruses in South America, and these data will serve as the basis for future studies of seroprevalence of other VEEV, and studies to search potential hosts and vectors of these viruses in the region.

[Monitoring the Paraguayan epidemiological dengue surveillance system (2009-2011) using Benford's law].

INTRODUCTION: Dengue is the most widespread arbovirus worldwide. In Paraguay, it reappeared in 1988-1989, with one of the largest epidemic outbreaks occurring in 2011. OBJECTIVE: To evaluate the performance of the dengue epidemiological surveillance system in Paraguay between 2009 and 2011. MATERIALS AND METHODS: We conducted an ecological study with secondary epidemiological surveillance data. We analyzed notified cases of the disease based on the distribution expected by Benford's law. To this end, we used the first and second digits from the global records stratified by region, season, population density, indicators of housing conditions and heads of cattle. RESULTS: The epidemiological surveillance system performed better during non-epidemic periods and in the states with better housing conditions and fewer heads of cattle. CONCLUSION: Given that a difference in the performance existed, we recommended that the system remains operating at the same high alert level even during periods when fewer cases are expected. The technology used by the method proposed to monitor the notification of cases is easy to transfer to operational staff.

Productividad de la revista memorias del IICS, periodo 2005-2015 / Productivity of the journal memorias del IICS, period 2005-2015

La generación y divulgación de la producción científica nacional constituyen algunas de las herramientas para mejorar la salud de la población. Este trabajo se realizó con el objetivo de describir las características de la producción científica de la revista Memorias del Instituto de Investigaciones en Ciencias de la Salud en un periodo de 10 años. El estudio fue descriptivo y en él se analizaron los artículos publicados desde diciembre del 2005 hasta diciembre de 2015 incluyendo las secciones de artículos originales, reportes de casos, temas de actualidad, artículos de revisión y comunicaciones cortas. Las variables analizadas fueron: año de publicación, tipo de artículo, número de artículos, número de autores, eje temático, institución firmante, procedencia de los primeros autores y número de citaciones de los artículos originales en Google Scholar. En el periodo de estudio se publicaron 208 artículos de 457 autores y 37 instituciones. El promedio del número de artículos fue de 19 por número y la mediana del número de autores por artículo 4,5. Hubo predominio del eje temático de Epidemiología con 28 artículos (13,5%). La mayor contribución fue del Instituto de Investigaciones en Ciencias de la Salud de la Universidad Nacional de Asunción con 111 artículos (52,9%). El máximo de citas para un artículo original, según Google Scholar, fue de 10. La revista cuenta con la colaboración de autores de diversas instituciones pero aún se mantiene la endogamia que dificulta su indexación en bases de datos como Pubmed.

Creation and dissemination of research in Paraguay are some of the tools for theimprovement of population health. This work describes the characteristics of the scientificproduction published in the Journal Memorias del Instituto de Investigaciones en Ciencias dela Salud in the period 2005 to 2015. This was a descriptive study that analyzed all thearticles published from December 2005 to December 2015 including original articles, casereports, current issues, review articles, and short communications. Publication year, articletype, articles number, authors number, thematic area, signatory institution, main authorsorigin and citations amount of the original articles in Google Scholar were analyzed. In thestudy period, 208 articles of 457 authors and 37 institutions were published. The meannumber of articles published per number was 19 and the median of the number of authorsper article was 4.5. There was a predominance of the thematic focus of Epidemiology with28 articles (13.5%). The largest contribution was from the Instituto de Investigaciones enCiencias de la Salud of the Asuncion National University with 111 articles (52.9%). Themaximum citations received by an original article was 10, according to Google Scholar. The journal has the collaborations of authors from various institutions but endogamy stillpersists making difficult the indexation of the journal into data bases like Pubmed.

Monitoring the Paraguayan epidemiological dengue surveillance system (2009-2011) using Benford's law

ABSTRACT Introducción. El dengue es la principal arbovirosis en el mundo. En Paraguay reapareció en 1988-1989, y en el 2011 se produjo uno de los mayores brotes epidémicos. Objetivo. Evaluar el desempeño del sistema de vigilancia epidemiológica del dengue en Paraguay entre 2009 y 2011. Materiales y métodos. Se hizo un estudio ecológico basado en datos secundarios de la vigilancia epidemiológica. Con base en la distribución esperada según la ley de Benford, se analizaron los casos notificados de la enfermedad; para tal fin, se usaron los primeros y segundos dígitos de los registros globales y estratificados por regiones, estaciones, densidad poblacional, indicadores de las condiciones de la vivienda y número de cabezas de ganado bovino. Resultados. El sistema de vigilancia epidemiológica se desempeñó mejor durante los periodos no epidémicos, y en los departamentos donde existen mejores condiciones de vivienda y pocas cabezas de ganado bovino. Conclusión. Dadas las diferencias de desempeño, se recomendó que el sistema mantenga la alerta incluso cuando no se espere un mayor número de casos. El método propuesto para evaluar la notificación de casos es fácil de transferir al personal operativo.

RESUMEN Introduction: Dengue is the most widespread arbovirus worldwide. In Paraguay, it reappeared in 1988-1989, with one of the largest epidemic outbreaks occurring in 2011. Objective: To evaluate the performance of the dengue epidemiological surveillance system in Paraguay between 2009 and 2011. Materials and methods: We conducted an ecological study with secondary epidemiological surveillance data. We analyzed notified cases of the disease based on the distribution expected by Benford's law. To this end, we used the first and second digits from the global records stratified by region, season, population density, indicators of housing conditions and heads of cattle. Results: The epidemiological surveillance system performed better during non-epidemic periods and in the states with better housing conditions and fewer heads of cattle. Conclusion: Given that a difference in the performance existed, we recommended that the system remains operating at the same high alert level even during periods when fewer cases are expected. The technology used by the method proposed to monitor the notification of cases is easy to transfer to operational staff.

Estado nutricional y aspectos alimentarios de mujeres indígenas del departamento de Presidente Hayes, Paraguay / Nutritional state and food aspects of indigenous women from Presidente Hayes department, Paraguay

Introducción: Las comunidades indígenas presentan un mayor riesgo de inseguridad alimentaria y malnutrición, menor disponibilidad de recursos, y una creciente dependencia de alimentos más baratos aunque con un alto grado de procesamiento. Objetivo: Identificar el estado nutricional y aspectos alimentarios en mujeres indígenas de tres comunidades del Departamento de Presidente Hayes, Chaco Paraguayo. Metodología: Estudio observacional de diseño transversal con componente analítico, que incluyó a 81 mujeres de 15 a 44 años de edad, de las etnias Maká y Toba Qom. Previo consentimiento informado, se realizó la valoración nutricional y la entrevista para obtener los datos sociodemográficos y alimentarios. Resultados: Las mujeres indígenas presentaron una frecuencia de sobrepeso de 30,8% y obesidad del 21,0%, mientras que el 1,2 % presentó desnutrición. No encontramos diferencia significativa entre las etnias, en relación al sobrepeso y obesidad, (p>0,05). Observamos que las indígenas tenían una alta ingesta de frutas, azúcares y mieles. El 87 y 88% de las mujeres indígenas de ambas etnias estudiadas refirieron no consumir lácteos y derivados y entre 65 y 69% refirieron no consumir verduras. Conclusiones: Observamos un elevado porcentaje de obesidad y sobrepeso, un bajo consumo de lácteos y verduras y un alto consumo de azúcares, relacionados posiblemente a cambios en los aspectos alimentarios y sus costumbres, influenciados por la cercanía a las zonas urbanas y el acceso a alimentos de menor precio y mayor contenido energético.

Introduction: Indigenous communities present higher risk of food insecurity and malnutrition, lower availability of resources and growing dependence on cheaper food but with high degree of processing. Objective: To identify the nutritional state and food aspects in indigenous women from three communities of Presidente Hayes Department, Paraguayan Chaco. Methodology: Cross-sectional observational study with analytical component including 81 women who were 15 to 44 years old from the Maká and Toba Qom ethnic groups. After giving their informed consent, the nutritional assessment and the interview to collect socio-demographic and food data were carried out. Results: The indigenous women presented an overweight frequency of 30.8 % and obesity of 21.0%, while malnutrition was observed in 1.2%. No significant differences were found between ethnic groups in relation to overweight and obesity (p>0.05). High ingestion of fruits, sugar and honey was observed and 87% and 88% of the indigenous women from both ethnic groups referred that they did not consume dairy products and derivatives and 65% and 69% referred that they did not consume vegetables. Conclusions: High percentages of obesity and overweight were observed. Low consumption of dairy products, its by products and vegetables and a high consumption of sugar were observed, related probably to changes in food aspects and the habits of these groups, influenced by the proximity to urban areas and the access to low prices food with high energetic content.

Distribution of human papillomavirus (HPV) genotypes and bacterial vaginosis presence in cervical samples from Paraguayan indigenous.

OBJECTIVE: To determine the frequency of human papillomavirus (HPV) types and to assess bacterial vaginosis (BV) possible associations with cervical infections in indigenous Paraguayan women of the Department of Presidente Hayes. METHODS: This study included 181 sexually active women without cervical lesions. HPV typing was performed by polymerase chain reaction with primers PGMY 09/11 followed by reverse line hybridization. BV was diagnosed by the Nugent criteria using the results from a Gram stain smear. RESULTS: Sixteen percent of women were positive for at least one high risk HPV type (HR-HPV). The most frequent genotypes were HPV 16 (4.4%), followed by HPV 58 (3.3%), HPV 45 (3.3%), HPV 53 (2.8%) and HPV 11 (2.8%). A significant association between HR-HPV and BV was observed (p=0.01). In addition, women with BV had a higher frequency of Chlamydia trachomatis (p=0.0007), Trichomonas vaginalis (p=0.00009), Mycoplasma hominis (p=0.001). CONCLUSIONS: A large variety of HPV genotypes was detected and showed a slightly different pattern from previous studies on urban women in Paraguay, with the predominance of HR-HPV. Furthermore, the information of co-infections involved in BV could be useful for the improvement of national prevention programs, as well as for laboratory surveillance of these genital infections.

Una propuesta rápida y económica para detectar el virus de papiloma humano por PCR a partir de muestras cervicales con reactivo desnaturalizante / A rapid and economic option for human papillomavirus detection by PCR in cervical samples with denaturing reagent

Trabajos han demostrado la utilidad de la captura híbrida II (CH II®) en la detección del virus de papiloma humano de alto riesgo oncogénico (HR-HPV) como método de tamizaje primario para detección de cáncer de cuello uterino, así como las bondades de la PCR que permite acceder a métodos de tipificación viral. Por ello el objetivo fue detectar el genoma del HPV por PCR a partir de muestras de CH II® cien veces diluidas. Estudio transversal en 141 muestras cervicales de mujeres con citología normal y anormal que concurrieron al IICS, UNA. Las muestras fueron procesadas por CH II® y almacenadas con reactivo desnaturalizante a -80ºC. Luego, las muestras fueron diluidas 100 veces con agua destilada y posteriormente procesadas por PCR. Se detectó HPV en 51% y 43% de las muestras analizadas por CH II® y PCR, respectivamente. Diecisiete de 23 muestras positivas por CH II® con carga viral relativa baja fueron negativas por PCR. Esto podría deberse a la degradación del material. Además, 6 muestras negativas por CH II® fueron positivas por PCR sugiriendo presencia de infección con tipos virales no incluidos en CH II® . Estos resultados sugieren que es posible realizar la detección de HPV por PCR en muestras procesadas por CH II® previa dilución. Esta propuesta rápida, sencilla y económica, minimiza el riesgo de perder el material genético en la extracción y permite acceder a métodos de tipificación viral que podrían contribuir con datos sobre tipos de HPV circulantes para realizar una vigilancia en la era post-vacunal.

Studies havedemonstrated the usefulness of the hybrid capture II (CHII) in thedetection of oncogenic high risk human papillomavirus (HR-HPV) asaprimaryscreeningmethod for detection of cervical cancer, as well as the benefits of PCR that allows accessto viral typing methods. The objective was todetect HPV by PCR from cervical samplesprocessed by CH II.It was a cross-sectional study including141cervicalsamples ofwomenattendingtheIICS,UNA. Thesampleswereprocessed by CH IIand storedwithdenaturing reagent at-80ºC.Then,theywere diluted 100 times with distilled water andsubsequently processed by PCR. HPV was detected in 51% and 43% of the samples analyzed by CH IIand PCR respectively. Seventeen of 23 positive samples by CH IIwith relatively low viral load were negative by PCR. This could be due to degradation ofthe material. In addition,sixnegative samples by CH IIwere positive by PCR suggestingthe presence of infection with HPV types not included in CH II. These results suggestthat it is possible to detect HPV by PCRfrom samples processed by CH IIprior dilution.This is a quick, easy and economic alternative which minimizes the risk of losing thegenetic material in the extraction process,and allows access to viral typing methods thatcouldprovide data aboutcirculating HPVtypesto carry out surveillance in thepost-vaccine era.

Human papillomavirus and other genital infections in indigenous women from Paraguay: a cross-sectional analytical study.

BACKGROUND: The incidence of cervical cancer in Paraguay is among the highest in the world, with the human papillomavirus (HPV) being a necessary factor for cervical cancer. Knowledge about HPV infection among indigenous women is limited. This cross-sectional study analyzed the frequency of HPV and other genital infections in indigenous Paraguayan women of the Department of Presidente Hayes. METHODS: This study included 181 sexually active women without cervical lesions. They belonged to the following ethnicities: Maká (n = 40); Nivaclé (n = 23); Sanapaná (n = 33); Enxet Sur (n = 51) and Toba-Qom (n = 34). The detection of HPV and other gynecological infectious microorganisms was performed by either molecular methods (for Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis), gram staining and/or culture (for Gardnerella vaginalis, Candida sp, Trichomonas vaginalis, Neisseria gonorrhoeae), serological methods (for Treponema pallidum, human immunodeficiency virus [HIV]) or cytology (cervical inflammation). RESULTS: A high prevalence (41.4%) of women positive for at least one sexually transmitted infection (STI) was found (23.2% any-type HPV, 11.6% T pallidum, 10.5% T vaginalis, 9.9% C trachomatis and 0.6% HIV) with 12.2% having more than one STI. HPV infection was the most frequent, with 16.1% of women positive for high-risk HPV types. There was a statistically significant association observed between any-type HPV and C trachomatis (p = 0.004), which indicates that the detection of one of these agents should suggest the presence of the other. There was no association between any-type HPV and other genital infections or cervical inflammation, suggesting that other mechanism could exist to favor infection with the virus. CONCLUSION: This multidisciplinary work suggests that STIs are frequent, making it necessary to implement control measures and improve diagnosis in order to increase the number of cases detected, especially in populations with poor access to health centers.

Prevalencia de anemia en varias comunidades de la etnia Nivaclé del Chaco paraguayo / Prevalence of anemia in several communities of the Nivaclé ethnic group of the Paraguayan Chaco

La anemia es la concentración de la hemoglobina por debajo de los valores límites establecidos. Las comunidades indígenas de la etnia Nivaclé que habitan el Chaco paraguayo viven bajo condiciones de extrema pobreza, careciendo de asistencia sanitaria y de programas de control de enfermedades. Este estudio descriptivo de corte transversal realizado de junio de 2001 a marzo de 2002, tuvo como objetivo establecer la prevalencia y distribución de anemia en hombres y mujeres de 15 a 65 años, de la etnia Nivaclé que habitan en el Chaco paraguayo. Se incluyó a todos los indígenas voluntarios sanos presentes en el momento del estudio que aceptaron participar, previo consentimiento informado. La concentración de hemoglobina se determinó en 379 indígenas Nivaclé. La OMS considera que existe anemia en los adultos (a partir de 15 años), cuando la concentración de hemoglobina es inferior a 130 g/L para el sexo masculino y menor a 120 g/l para el femenino. La prevalencia de anemia en mujeres n= 217 fue de 49,8 % (con media hemoglobina de 117,67 ± 12,16 g/L); y en los hombres n= 162 resultó de 33,3 % (promedio de hemoglobina de 132,62 ± 11,65 g/L). La elevada prevalencia de anemia observada, especialmente en mujeres, se debería a una pobre nutrición, lo que conlleva a una mala salud que justifica la incorporación de estrategias de atención primaria de salud que se adapten a la cultura y a las condiciones de estas comunidades.