Epidemiological Characteristics of Deaths from COVID-19 in Peru during the Initial Pandemic Response.

BACKGROUND AND AIM: Peru is the country with the highest mortality rate from COVID-19 globally, so the analysis of the characteristics of deaths is of national and international interest. The aim was to determine the epidemiological characteristics of deaths from COVID-19 in Peru from 28 March to 21 May 2020. METHODS: Deaths from various sources were investigated, including the COVID-19 Epidemiological Surveillance and the National System of Deaths (SINADEF). In all, 3851 deaths that met the definition of a confirmed case and had a positive result of RT-PCR or rapid test IgM/IgG, were considered for the analysis. We obtained the epidemiological variables and carried out an analysis of time defined as the pre-hospital time from the onset of symptoms to hospitalization, and hospital time from the date of hospitalization to death. RESULTS: Deaths were more frequent in males (72.0%), seniors (68.8%) and residents of the region of Lima (42.7%). In 17.8% of cases, the death occurred out-of-hospital, and 31.4% had some comorbidity. The median of pre-hospital time was 7 days (IQR: 4.0-9.0) and for the hospital time was 5 days (IQR: 3.0-9.0). The multivariable analysis with Poisson regression with robust variance found that the age group, comorbidity diagnosis and the region of origin significantly influenced pre-hospital time; while sex, comorbidity diagnosis, healthcare provider and the region of origin significantly influenced hospital time. CONCLUSION: Deaths occurred mainly in males, seniors and on the coast, with considerable out-of-hospital deaths. Pre-hospital time was affected by age group, the diagnosis of comorbidities and the region of origin; while, hospital time was influenced by gender, the diagnosis of comorbidities, healthcare provider and the region of origin.

Effectiveness of the Inactivated SARS-CoV-2 (Vero Cell) Vaccine in Peruvian Health Workers.

INTRODUCTION: The COVID-19 pandemic has caused a global health crisis. Vaccines against this disease have demonstrated variable efficacy and safety, although effectiveness has not been evaluated. In February 2021, the Ministry of Health of Peru approved the emergency use of the inactivated SARS-CoV-2 (Vero Cell) vaccine and initiated vaccination with health personnel at the national level. The objective of the study is to determine the effectiveness of this vaccine to reduce infections, hospitalizations, and deaths due to COVID-19. METHODOLOGY: We performed a retrospective cohort study in the period from 23 February to 26 June 2021; data were obtained from the Ministry of Health (including demographic, epidemiologic, clinical, hospital, laboratory results, deaths, and both date and quantity of vaccine doses delivered). The exposed cohort were those who received one or two vaccine doses and the non-exposed were unvaccinated. The events studied were infections, hospitalizations and deaths in the cohorts. We consider a case confirmed for COVID-19 if the test result was positive for SARS-CoV-2, via PCR or antigen test. Effectiveness was measured with incidence density ratio and risk. Confounding factors were controlled using a Poisson model with robust variance. RESULTS: We enlisted 520,733 health workers, of whom 415,212 had two vaccine doses and 105,521 were unvaccinated. The median age was 40 years (IQR: 32-50), and 65.6% were female. The effectiveness of two vaccine doses fourteen days after application adjusted by age, sex, hospitalization, and antecedent of having the infection was 90.9% (95% CI: 85.5-94.2%); effectiveness to avoid death from COVID-19; 67.7% (60.1-73.8%) effectiveness to avoid hospitalizations; and 26.3% (23.8-28.6%) effectiveness to reduce the risk of infection by SARS-CoV-2 relative to the unvaccinated cohort. CONCLUSIONS: The inactivated SARS-CoV-2 (Vero Cell) vaccine used in two doses has an acceptable effectiveness against death and risk of hospitalization, whereas it has less effectiveness in preventing COVID-19 infection.

Brote de malaria en relación con un conglomerado de casos importados en una zona fronteriza, Perú

Introducción: La malaria es transmitida por la picadura de los mosquitos del género Anopheles. La región Tumbes ubicada en la frontera norte del Perú, pese a la presencia permanente del vector estuvo libre de malaria presentando solo casos importados esporádicos. Material y Métodos: Se realizó un estudio de serie de casos de un brote de malaria por P. vivax asociado a un conglomerado de casos importados en el contexto de masiva migración venezolana al Perú. Resultados: Se describen las actividades de control implementadas a través de metodología de cerco epidemiológico modificado para el control de la reintroducción de la enfermedad; se detectó la transmisión del brote relacionada con migrantes venezolanos en tránsito. Conclusiones: la reintroducción de la malaria en la región Tumbes se relaciona a casos importados por migración venezolana. Los cercos epidemiológicos modificados permitieron mejorar la captación de casos in situ.

Background: Malaria is transmitted by the bite of mosquitoes which belong to the genus Anopheles. The Tumbes region, located in the northern border of Peru, despite the permanent presence of the vector, was free from malaria transmission, and there are only sporadic imported cases. Material and Methods: A case series study of an outbreak of malaria caused by P. vivax associated with a conglomerate of imported cases was carried out in the context of massive Venezuelan migration to Peru. Results: The control activities implemented through the modified epidemiological fence methodology to control the reintroduction of the disease are described; transmission of the outbreak related to Venezuelan migrants in transit was detected. Conclusions: the reintroduction of malaria in the Tumbes region was related to cases imported from Venezuela. The modified epidemiological fences made it possible to improve the collection of cases in situ.

Platelet-Based Biomarkers for Diagnosis and Prognosis in COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) caused millions of deaths worldwide. COVID-19's clinical manifestations range from no symptoms to a severe acute respiratory syndrome, which can result in multiple organ failure, sepsis, and death. Severe COVID-19 patients develop pulmonary and extrapulmonary infections, with a hypercoagulable state. Several inflammatory or coagulatory biomarkers are currently used with predictive values for COVID-19 severity and prognosis. In this manuscript, we investigate if a combination of coagulatory and inflammatory biomarkers could provide a better biomarker with predictive value for COVID-19 patients, being able to distinguish between patients that would develop a moderate or severe COVID-19 and predict the disease outcome. We investigated 306 patients with COVID-19, confirmed by severe acute respiratory syndrome coronavirus 2 RNA detected in the nasopharyngeal swab, and retrospectively analyzed the laboratory data from the first day of hospitalization. In our cohort, biomarkers such as neutrophil count and neutrophil-to-lymphocyte ratio from the day of hospitalization could predict if the patient would need to be transferred to the intensive care unit but failed to identify the patients´ outcomes. The ratio between platelets and inflammatory markers such as creatinine, C-reactive protein, and urea levels is associated with patient outcomes. Finally, the platelet/neutrophil-to-lymphocyte ratio on the first day of hospitalization can be used with predictive value as a novel severity and lethality biomarker in COVID-19. These new biomarkers with predictive value could be used routinely to stratify the risk in COVID-19 patients since the first day of hospitalization.

Lethal encephalitis due to free-living amoebae in three members of a family, in Tumbes, Peru. / Encefalitis letal por amebas de vida libre en tres miembros de una familia, Tumbes, Perú.

Free-living amoebas (FLA) are protozoan parasites that occasionally cause disease in humans after contact with contaminated water or soil. We describe a series of three cases of encephalitis in a family group with a fatal outcome that occurred in the Tumbes region between December 2019 and February 2020. Acanthamoeba sp. was identified in the cerebrospinal fluid sample from case 1. All three cases had a history of entering a swimming pool months before the disease. In the Tumbes region there is no previous record of encephalitis due to FLA and its occurrence in a family cluster has never been reported before.

Las amebas de vida libre (AVL) son parásitos protozoarios que ocasionalmente causan enfermedad en humanos luego del contacto con alguna fuente de aguas o suelo contaminado. Se describe una serie de tres casos de encefalitis con desenlace fatal en un grupo familiar, que tuvo lugar en el departamento de Tumbes entre diciembre de 2019 y febrero de 2020. En la muestra de líquido cefalorraquídeo del primer caso se identificó Acanthamoeba sp. Los tres casos presentaron como antecedente haber entrado a una piscina meses antes de la enfermedad. En Tumbes no hay registro previo de casos de encefalitis por AVL y no se han reportado a nivel mundial su ocurrencia en un conglomerado familiar.

Coronavirus disease-2019 and the intestinal tract: An overview.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can progress to a severe respiratory and systemic disease named coronavirus disease-2019 (COVID-19). The most common symptoms are fever and respiratory discomfort. Nevertheless, gastrointestinal infections have been reported, with symptoms such as diarrhea, nausea, vomiting, abdominal pain, and lack of appetite. Importantly, SARS-CoV-2 can remain positive in fecal samples after nasopharyngeal clearance. After gastrointestinal SARS-CoV-2 infection and other viral gastrointestinal infections, some patients may develop alterations in the gastrointestinal microbiota. In addition, some COVID-19 patients may receive antibiotics, which may also disturb gastrointestinal homeostasis. In summary, the gastrointestinal system, gut microbiome, and gut-lung axis may represent an important role in the development, severity, and treatment of COVID-19. Therefore, in this review, we explore the current pieces of evidence of COVID-19 gastrointestinal manifestations, possible implications, and interventions.

Encefalitis letal por amebas de vida libre en tres miembros de una familia, Tumbes, Perú

Las amebas de vida libre (AVL) son parásitos protozoarios que ocasionalmente causan enfermedad en humanos luego del contacto con alguna fuente de aguas o suelo contaminado. Se describe una serie de tres casos de encefalitis con desenlace fatal en un grupo familiar, que tuvo lugar en el departamento de Tumbes entre diciembre de 2019 y febrero de 2020. En la muestra de líquido cefalorraquídeo del primer caso se identificó Acanthamoeba sp. Los tres casos presentaron como antecedente haber entrado a una piscina meses antes de la enfermedad. En Tumbes no hay registro previo de casos de encefalitis por AVL y no se han reportado a nivel mundial su ocurrencia en un conglomerado familiar.

Free-living amoebas (FLA) are protozoan parasites that occasionally cause disease in humans after contact with contaminated water or soil. We describe a series of three cases of encephalitis in a family group with a fatal outcome that occurred in the Tumbes region between December 2019 and February 2020. Acanthamoeba sp. was identified in the cerebrospinal fluid sample from case 1. All three cases had a history of entering a swimming pool months before the disease. In the Tumbes region there is no previous record of encephalitis due to FLA and its occurrence in a family cluster has never been reported before.