[Strategies and recommendations to face respiratory syncytial virus disease in 2024]. / Estrategias y recomendaciones para enfrentar la enfermedad por virus respiratorio sincicial el año 2024.

During the winter of 2023, Chile faced a complex situation related to the respiratory syncytial virus (RSV). After experiencing a decline in RSV circulation during the years of the SARS-CoV-2 pandemic, a late outbreak was observed in the spring of 2022 and an early onset of the outbreak in 2023, with a significant increase in the number of serious cases. The ineffectiveness of strategic planning and risk communication contributed to the complexity of the situation. To avoid the above next winter, measures such as active surveillance, unification of definitions for acute respiratory infections, identification of RSV variants, public education about infections and advance preparation regarding hospital beds and health personnel are suggested. The importance of immunization and intersectoral collaboration to acquire new preventive alternatives is highlighted, as well as the need for early communication about the importance of immunization and identification of high-risk groups, improvement in training of medical personnel and strategic planning of the Ministry of Health. seeking a proactive and collaborative approach to address the complex RSV situation in future winters. The Chilean Immunization Advisory Committee has already carried out an analysis and recommendation on a new prevention alternative. This working group will support any decision of the Ministry of Health in public policies that attempt a change in the paradigm of control of this disease for the health of the children of our country.

Oxigenación por membrana extracorpórea (ECMO): una mirada desde la prevención de Infecciones Asociadas a la Atención en Salud (IAAS) / Extracorporeal membrane oxygenation (ECMO): an infection control perspective

Resumen La aparición de la enfermedad por SARS-CoV-2 el año 2020 nos enfrentó a un aumento creciente y exponencial de pacientes con riesgo vital por falla respiratoria catastrófica y multisistémica que deben ser sometidos a ECMO para sobrevivir. Esto ha generado en nuestro país la aparición de Unidades de Tratamiento (ECMO) en hospitales en que antes no se disponía de este recurso o se realizaba como parte de las intervenciones en Unidades de Cuidados Intensivos (UCI), lo que constituye un nuevo desafío a los programas de control y prevención de infecciones de los centros de salud. Dado que al momento de la redacción de este documento no existe normativa nacional específica que se refiera a este tema, se propone un enfoque para prevención, control y vigilancia de infecciones asociadas a atención de salud en pacientes ECMO. Se presenta una revisión de los riesgos específicos a que están expuestos estos pacientes, definiendo qué medidas de prevención se requieren, proponiendo un conjunto de medidas específicas para instalación y mantención, así como orientación respecto de antibioprofilaxis y se sugiere qué eventos infecciosos vigilar.

Abstract The advent of SARS-CoV-2 disease in 2020 confronts us with a growing and exponential increase in patients at life risk due to catastrophic and multisystemic respiratory failure in need of extracorporeal membrane oxygenation (ECMO) to survive. This has generated in our country the establishment of ECMO treatment Units in hospitals where it was not carried out before or was carried out as part the interventions in Intensive Care Units (ICU), becoming a new challenge to the infection control and prevention programs. Given that at the time of writing this document there are no specific national regulations that refer to this issue, an approach is proposed for the prevention control and surveillance of nosocomial acquired infections in ECMO patients. A review of the specific risks to which these patients are exposed is presented, defining which prevention measures are required, proposing a specific bundle for installation and maintenance, as well as guidance regarding antibioprophylaxis and suggesting which infectious events to monitor.

[Extracorporeal membrane oxygenation (ECMO): an infection control perspective]. / Oxigenación por membrana extracorpórea (ECMO): una mirada desde la prevención de Infecciones Asociadas a la Atención en Salud (IAAS).

The advent of SARS-CoV-2 disease in 2020 confronts us with a growing and exponential increase in patients at life risk due to catastrophic and multisystemic respiratory failure in need of extracorporeal membrane oxygenation (ECMO) to survive. This has generated in our country the establishment of ECMO treatment Units in hospitals where it was not carried out before or was carried out as part the interventions in Intensive Care Units (ICU), becoming a new challenge to the infection control and prevention programs. Given that at the time of writing this document there are no specific national regulations that refer to this issue, an approach is proposed for the prevention control and surveillance of nosocomial acquired infections in ECMO patients. A review of the specific risks to which these patients are exposed is presented, defining which prevention measures are required, proposing a specific bundle for installation and maintenance, as well as guidance regarding antibioprophylaxis and suggesting which infectious events to monitor.

[Salmonellosis outbreaks and the size and role of the Chilean State]. / Brotes de salmonelosis y el tamaño y rol del Estado en Chile.

UNLABELLED: During year 2011 two outbreaks of Salmonella infection captured media attention in the Metropolitan Area (MA) in Chile: one of typhoid fever associated to Salmonella serotype Typhi, and the other, of gastroenteritis related to Salmonella serotype Enteritidis, both with decreasing or stable rates in the previous years. The aim of this work is to analyze probable causes of their reemergence. METHODS: Several government websites were searched looking for epidemiological data. RESULTS: Typhoid fever rates have declined to current values of 1 case per 100.000 habitants, a decreased associated to improvements in the human development index. The typhoid outbreak was associated to a predominant clone within the MA. The only risk factor identified was consumption of raw vegetables acquired in open fairs, but without identifying a common source. Despite improvements in disease notification and molecular epidemiology capabilities, this outbreak is coincidental with a reduced number of food inspection visits in the MA, probably explained by the limited personnel available for this task. In the case of Salmonella Enteritidis, rates have increased twice since 1998 (5.3 to 10.7 per 100.000 habitants) with an important increase in the number of outbreaks linked to this agent (7 to 31 annual outbreaks) since year 2005. Persistence of this problem is probably associated to the low surveillance of poultry farms made by the Chilean state, to the absence of a cold chain during collection, distribution and selling of eggs, and to the lack of an educational program directed to the population. The recent regulation that bans home-made mayonnaise in restaurant or fast food stores is an important advance that requires further evaluation. CONCLUSIONS: The persistence and reemergence of different kind of Salmonellosis in Chile suggests chronic problems on the size and role of the Chilean state regarding food safety.

Eficacia y seguridad de la vacuna influenza en niños: detrás de la evidencia / Effectiveness and safety of influenza vaccine in children

La infección por virus Influenza es una enfermedad respiratoria aguda que se asocia a una elevada tasa de morbilidad y mortalidad. Todos los niños son susceptibles de desarrollar la infección, por lo que la mejor estrategia de prevención podría ser la vacunación universal pediátrica. Tradicionalmente,han sido reconocidos ciertos sujetos de mayor riesgo de desarrollar complicaciones. Si bien existe mucha evidencia que demuestra que la vacuna anti-influenza puede prevenir síntomas respiratorios, hospitalizaciones y muertes; recientemente, algunas publicaciones han mostrado resultados conflictivos revelando inconsistencias en las actuales indicaciones en términos de eficacia y efectividad. El presente artículo, revisa la evidencia publicada en torno a esta interesante controversia médica.

Infección intrahospitalaria por virus influenza / Nosocomial influenza by influenza a virus

Influenza es una enfermedad respiratoria aguda estacional, responsable de brotes periódicos intrahospitalarios. Los mecanismos de transmisión son a través de gotitas y contacto directo o indirecto con secreciones respiratorias, siendo la transmisión por aerosoles de menor magnitud. Los pacientes más afectados son los sujetos inmunosuprimidos, quienes pueden complicarse con neumonía, la cual se asocia con una mortalidad elevada. Las principales medidas de prevención son la vacunación del personal de salud y disminuir la exposición de los contactos con pacientes de alto riesgo. El uso de antivirales anti-influenza permite el bloqueo de brotes si es usado en forma precoz, al igual que el tratamiento del caso índice.

[Review and guidelines for treatment of diarrhea caused by Vibrio parahaemolyticus]. / Revisión y recomendaciones para el manejo de diarrea por Vibrio parahaemolyticus.

In Chile Vibrio parahaemolyticus has been detected in 3 gastroenteritis outbreaks since 1998. The most recent outbreak occurred during the summer of 2005, affecting over 10,000 people of whom one died. Affected individuals presented with one or more of the following symptoms: diarrhea, nausea, vomiting, abdominal pain and/or fever. Fecal white blood cells were detected in only 6% of patients. The predominant serotype in the 3 outbreaks was the pandemic O3:K6 strain. Diagnosis was confirmed by isolation and identification of V. parahaemolyticus in stool cultures and/or by establishing an epidemiological link. V. parahaemolyticus isolates were 100% susceptible to tetracycline, ciprofloxacin and chloramphenicol, and universally resistant to ampicillin. Due to the public health impact of the 2005 outbreak, the Ministry of Health called for a National Task Force mandated to review epidemiological, clinical and microbiological features of the outbreak and to propose management guidelines.

[Influenza: the reemergence of an ancient disease and its risk of pandemia]. / Influenza: reemergencia de una antigua enfermedad y el potencial riesgo de una nueva pandemia.

Influenza is a seasonally, acute respiratory disease, highly transmissible. The diversity of the natural reservoirs of influenza A virus and its faculty of reassortment increase the risk of a new pandemia. Prevention strategies during the outbreaks include vaccination indicated to risk population as infants between 6 to 2 years old, persons above 65 years old, pregnant women and patients with underlying diseases. Antiviral prophylaxis is useful to control small outbreaks and to be used in household contacts of risk population who have not been vaccinated. Antiviral drugs as a treatment should be considered in persons with severe disease. During a pandemia these prevention measures must be reinforced and rational use of antiviral drugs and vaccine with the pandemic strain should be emphasized.

Accidentes en la infancia / Accidents in child hood

Se realizó una investigación descriptiva en un material de 1,280 niños accidentados en los meses de agosto y septiembre de 1984 y afiliados al Convenio de Atención Escolar de la Clínica Alemana. El análisis revela que los accidentes son más frecuentes en los varones que en las niñas y que el grupo etario más afectado es el 10 a 14 años. La casa es el lugar más frecuente de ocurrencia de tales accidentes, de los cuales las causas más comúnes son los golpes y las caídas. El deporte y la recreación son las actividades que producen más accidentes. El esguince es la lesión más frecuente. Las extramidades son los anatómicos más comprometidos. El promedio de consultas por accidentes es de 2 y los días de tratamiento de 7,6. El aumento progresivo de los accidentes en el curso de los últimos años hace importante conocer sus características a fin de poder orientar las medidas educativas y preventivas correspondientes

Etiología de la septicemia acíclica en el adulto / Etiology of non cyclic septicemia in adults

Se analizan aspectos clínicos y microbiológicos de 200 pacientes con diagnóstico clínico de septicemia, hospitalizados en el Servicio de Medicina y en la Unidad de Cuidados Intensivos del Hospital San Juan de Dios entre 1975 y 1985. Los hemocultivos fueron positivos en 178 casos (89%), aislándose con mayor frecuencia Escherichia coli (39,3%); Klebsiella sp. (26,4%); Staphylococcus aureus (12,9%); Proteus sp. (5,1%); Pseudomona aeruginosa (3,9%); flora polimicrobiana (4,5%) y otros en menores porcentajes. En 141 (79,2%) de los 178 casos con confirmación bacteriológica, se precisó el foco primario, siendo lo más frecuente el urinario (48,2%); el vascular (14,2%) y el cutáneo (10,6%). La mortalidad global de la casuística estudiada fue de 47,2% y aumentó a 86,4% si se consideran los pacientes con hemocultivos negativos. La menor mortalidad correspondió a las septicemias por Escherichia coli (38,6%)