Invasion and Metastasis Suppression by Anti-Neonatal Nav1.5 Antibodies in Breast Cancer.

BACKGROUND: Detectable neonatal Nav1.5 (nNav1.5) expression in tumour breast tissue positive for lymph node metastasis and triple-negative subtype serves as a valid tumour-associated antigen to target and prevent breast cancer invasion and metastasis. Therapeutic antibodies against tumour antigens have become the predominant class of new drugs in cancer therapy because of their fewer adverse effects and high specificity. OBJECTIVE: This study was designed to investigate the therapeutic and anti-metastatic potential of the two newly obtained anti-nNav1.5 antibodies, polyclonal anti-nNav1.5 (pAb-nNav1.5) and monoclonal anti-nNav1.5 (mAb-nNav1.5), on breast cancer invasion and metastasis. METHODS: MDA-MB-231 and 4T1 cells were used as in vitro models to study the effect of pAb-nNav1.5 (59.2 µg/ml) and mAb-nNav1.5 (10 µg/ml) (24 hours treatment) on cell invasion. 4T1-induced mammary tumours in BALB/c female mice were used as an in vivo model to study the effect of a single dose of intravenous pAb-nNav1.5 (1 mg/ml) and mAb-nNav1.5 (1 mg/ml) on the occurrence of metastasis. Real-time PCR and immunofluorescence staining were conducted to assess the effect of antibody treatment on nNav1.5 mRNA and protein expression, respectively. The animals' body weight, organs, lesions, and tumour mass were also measured and compared. RESULTS: pAb-nNav1.5 and mAb-nNav1.5 treatments effectively suppressed the invasion of MDA-MB-231 and 4T1 cells in the 3D spheroid invasion assay. Both antibodies significantly reduced nNav1.5 gene and protein expression in these cell lines. Treatment with pAb-nNav1.5 and mAb-nNav1.5 successfully reduced mammary tumour tissue size and mass and prevented lesions in vital organs of the mammary tumour animal model whilst maintaining the animal's healthy weight. mRNA expression of nNav1.5 in mammary tumour tissues was only reduced by mAb-nNav1.5. CONCLUSION: Overall, this work verifies the uniqueness of targeting nNav1.5 in breast cancer invasion and metastasis prevention, but more importantly, humanised versions of mAb-nNav1.5 may be valuable passive immunotherapeutic agents to target nNav1.5 in breast cancer.

[Nursing Care of the First Neonatal Patient with Veno-arterial ECMO plus venting in Peru]. / Cuidado de Enfermería del Primer Paciente Neonato con ECMO Central Veno-arterial más Venting en Perú.

We report the nursing care of the first newborn patient in Peru who used central veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) - plus left atrial decompression cannula (VENT). We standardized specialized nursing care by identifying 15 diagnoses according to taxonomy II nursing diagnoses (NANDA) and 3 that could be incorporated into it for newborn care in ECMO.

Vaccines for TB: Lessons from the Past Translating into Future Potentials.

Development of vaccines for infectious diseases has come a long way with recent advancements in adjuvant developments and discovery of new antigens that are capable of eliciting strong immunological responses for sterile eradication of disease. Tuberculosis (TB) that kills nearly 2 million of the population every year is also one of the highlights of the recent developments. The availability or not of diagnostic methods for infection has implications for the control of the disease by the health systems but is not related to the immune surveillance, a phenomenon derived from the interaction between the bacteria and their host. Here, we will review the immunology of TB and current vaccine candidates for TB. Current strategies of developing new vaccines against TB will also be reviewed in order to further discuss new insights into immunotherapeutic approaches involving adjuvant and antigens combinations that might be of potential for the control of TB.

Protective capacity of proteoliposomes from Mycobacterium bovis BCG in a mouse model of tuberculosis.

Tuberculosis (TB) is one of the most important causes of mortality and morbidity due to infectious diseases. BCG, the vaccine in use, is not fully protective against TB. In a previous study, we have shown that proteoliposomes (outer membrane extracts), obtained from BCG (PLBCG) were able to induce humoral immune responses against Mycobacterium tuberculosis (Mtb) antigens. With the objective to evaluate the protective capability of PLBCG alone or as a booster with BCG, a murine model of progressive pulmonary TB was used. Animals immunized with PLBCG adjuvanted with alum (PLBCG-Al) showed similar protection to that conferred by BCG. The group immunized with PLBCG-Al as a booster to BCG gave superior protection than BCG as evidenced by a reduction of bacterial load in lungs 2 months after infection with Mtb. Animals immunized with BCG, PLBCG-Al and this formulation as a booster of BCG, showed a significant decrease of tissue damage (percentage of pneumonic area/lung) compared with non-immunized animals. These results demonstrate that immunization with PLBCG-Al alone or as a booster to BCG induce appropriate protection against challenge with Mtb in mice and support the future evaluation of PLBCG as a promising vaccine candidate against Mtb.

Protective effect of a lipid-based preparation from Mycobacterium smegmatis in a murine model of progressive pulmonary tuberculosis.

A more effective vaccine against tuberculosis (TB) is urgently needed. Based on its high genetic homology with Mycobacterium tuberculosis (Mtb), the nonpathogenic mycobacteria, Mycobacterium smegmatis (Ms), could be an attractive source of potential antigens to be included in such a vaccine. We evaluated the capability of lipid-based preparations obtained from Ms to provide a protective response in Balb/c mice after challenge with Mtb H37Rv strain. The intratracheal model of progressive pulmonary TB was used to assess the level of protection in terms of bacterial load as well as the pathological changes in the lungs of immunized Balb/c mice following challenge with Mtb. Mice immunized with the lipid-based preparation from Ms either adjuvanted with Alum (LMs-AL) or nonadjuvanted (LMs) showed significant reductions in bacterial load (P < 0.01) compared to the negative control group (animals immunized with phosphate buffered saline (PBS)). Both lipid formulations showed the same level of protection as Bacille Calmette and Guerin (BCG). Regarding the pathologic changes in the lungs, mice immunized with both lipid formulations showed less pneumonic area when compared with the PBS group (P < 0.01) and showed similar results compared with the BCG group. These findings suggest the potential of LMs as a promising vaccine candidate against TB.

Histopathological Study of the Lungs of Mice Receiving Human Secretory IgA and Challenged with Mycobacterium tuberculosis.

BACKGROUND: Humoral and cellular immune responses are associated with protection against extracellular and intracellular pathogens, respectively. In the present study, we evaluated the effect of receiving human secretory immunoglobulin A (hsIgA) on the histopathology of the lungs of mice challenged with virulent Mycobacterium tuberculosis. METHODS: The hsIgA was purified from human colostrum and administered to Balb/c mice by the intranasal route prior to infection with M. tuberculosis or in a pre-incubated formulation with mycobacteria, with the principal aim to study its effect on qualitative pulmonary histopathology. RESULTS: The intranasal administration of hsIgA and the pre-incubation of mycobacteria with this preparation was associated with the presence of organised granulomas with signs of immune activation and histological features related to efficient disease control. This effect was highly evident during the late stage of infection (60 days), as demonstrated by numerous organised granulomas with numerous activated macrophages in the lungs of treated mice. CONCLUSION: The administration of hsIgA to mice before intratracheal infection with M. tuberculosis or the pre-incubation of the bacteria with the antibody formulation induced the formation of well-organised granulomas and inflammatory lesions in lungs compared with non-treated animals which correlates with the protective effect already demonstrated by these antibody formulations.

Immunoinformatics study on highly expressed Mycobacterium tuberculosis genes during infection.

The most important targets for vaccine development are the proteins that are highly expressed by the microorganisms during infection in-vivo. A number of Mycobacterium tuberculosis (Mtb) proteins are also reported to be expressed in-vivo at different phases of infection. In the present study, we analyzed multiple published databases of gene expression profiles of Mtb in-vivo at different phases of infection in animals and humans and selected 38 proteins that are highly expressed in the active, latent and reactivation phases. We predicted T- and B-cell epitopes from the selected proteins using HLAPred for T-cell epitope prediction and BCEPred combined with ABCPred for B-cell epitope prediction. For each selected proteins, regions containing both T- and B-cell epitopes were identified which might be considered as important candidates for vaccine design against tuberculosis.

Bacterial outer membrane vesicles and vaccine applications.

Vaccines based on outer membrane vesicles (OMV) were developed more than 20 years ago against Neisseria meningitidis serogroup B. These nano-sized structures exhibit remarkable potential for immunomodulation of immune responses and delivery of meningococcal antigens or unrelated antigens incorporated into the vesicle structure. This paper reviews different applications in OMV Research and Development (R&D) and provides examples of OMV developed and evaluated at the Finlay Institute in Cuba. A Good Manufacturing Practice (GMP) process was developed at the Finlay Institute to produce OMV from N. meningitidis serogroup B (dOMVB) using detergent extraction. Subsequently, OMV from N. meningitidis, serogroup A (dOMVA), serogroup W (dOMVW), and serogroup X (dOMVX) were obtained using this process. More recently, the extraction process has also been applied effectively for obtaining OMV on a research scale from Vibrio cholerae (dOMVC), Bordetella pertussis (dOMVBP), Mycobacterium smegmatis (dOMVSM), and BCG (dOMVBCG). The immunogenicity of the OMV has been evaluated for specific antibody induction, and together with functional bactericidal and challenge assays in mice has shown their protective potential. dOMVB has been evaluated with non-neisserial antigens, including with a herpes virus type 2 glycoprotein, ovalbumin, and allergens. In conclusion, OMV are proving to be more versatile than first conceived and remain an important technology for development of vaccine candidates.

Purification of an IgA Monoclonal Antibody Specific for the Acr Protein of Mycobacterium tuberculosis by Immunoaffinity Chromatography.

BACKGROUND: A monoclonal antibody (mAb) of the IgA isotype, designated TBA61, is specific for the Acr protein of Mycobacterium tuberculosis (MTB). TBA61 has been used in studies exploring protection against tuberculosis (TB), and its efficacy has been proven using different challenge models. To purify the mouse IgA isotype, a combination of methods, such as globulin precipitation, ion exchange, and gel filtration, is usually required to achieve a satisfactory degree of purity. METHODS: To minimise the number of chromatographic steps, we proposed to employ immunoaffinity chromatography using the Acr protein of MTB as a specific ligand for this mAb. For this purpose, the HspX gene was cloned and expressed in Escherichia coli, and recombinant Acr (rAcr) was coupled to a cyanogen bromide-activated Sepharose 4B matrix, which was used to purify TBA61 mAb from ascites produced in mice in a single step. RESULTS: The recovery from the purification procedure was 1.46 mg per mL of ascites. Analysis by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and western blot showed a high purity. The purified mAb retained its reactivity against the Acr protein based on enzyme-linked immunosorbent assay (ELISA) and western blot. CONCLUSION: The purification method used is rapid, simple, and specific and can be easily scaled up.

Proteoliposomes from Mycobacterium smegmatis induce immune cross-reactivity against Mycobacterium tuberculosis antigens in mice.

Proteoliposomes (PL) obtained from Mycobacterium smegmatis (Ms) were evaluated for their capacity to elicit cross-reactive responses against Mycobacterium tuberculosis (Mtb) antigens in BALB/c mice. Animals immunized with PL adjuvanted with alum (PL-AL) or Freund's Incomplete Adjuvant (PL-IFA) showed significant IgG responses against the PL as well as total Ms lipids. Both groups of animals also showed significant IgG responses against BCG, but only animals immunized with PL-AL produced significant IgG responses against soluble cell wall proteins (SCWP) or whole cell lysate (WCL) of Mtb. Significant DTH responses against WCL were observed in both groups of animals after 24 h, but only PL-AL-immunized mice showed significant DTH responses after 48 h and 72 h. PL-Ms are capable of eliciting cross-reactive humoral and cellular responses against Mtb antigens and thus may be a potential vaccine strategy against tuberculosis.

Mycobacterium tuberculosis: factores de virulencia / Mycobacterium tuberculosis: virulence factors

Mycobacterium tuberculosis es el agente causal de la tuberculosis, una de las enfermedades infecciosas más letales en el mundo. La única vacuna disponible para su control es el BCG, sin embargo, falla en la protección contra la tuberculosis pulmonar, siendo esta la forma más frecuente y responsable de la diseminación. La identificación de factores de virulencia del microorganismo causal pudiera ayudar en el desarrollo de un nuevo candidato vacunal que sea capaz de neutralizar la acción de esos determinantes patogénicos. El empleo de diferentes modelos animales ha permitido reproducir las etapas de la enfermedad, así como medir o cuantificar la virulencia de las distintas cepas circulantes de Mycobacterium tuberculosis. Las mutaciones génicas y otras técnicas de biología molecular han posibilitado dilucidar los genes específicos involucrados en la virulencia de este microorganismo que codifican para múltiples y complejos factores de diferente naturaleza(AU)

Mycobacterium tuberculosis is the causative agent of tuberculosis, one of the most lethal diseases worldwide. BCG is the only available vaccine for tuberculosis control, but at the same time it fails in the protection from pulmonary tuberculosis, which is the most common and responsible form of dissemination. The identification of virulence factors of the causative organism could help in developing a new vaccine candidate capable of neutralizing the action of these pathogenic determinants. The use of different animal models has allowed to reproduce the stages of the disease and to measure or to quantify the virulence of different circulating strains of M tuberculosis. Gene mutations and other molecular biology techniques have made possible to elucidate the specific genes involved in virulence of this organism, that encodes many complex and different factors(AU)

Evaluación del potencial de Mycobacterium smegmatis como candidato vacunal contra la tuberculosis mediante estudios in sílico e in vivo / Evaluation of the potential of Mycobacterium smegmatis as vaccine Candidate against tuberculosis by in silico and in vivo studies

In this study, we scanned multiple published databases of gene expression in vivo of M tuberculosis at different phases of infection in animals and humans, to select 38 proteins that are highly expressed in the active, latent and reactivation phases. The selected proteins were predicted for T and B epitopes. For each proteins, the regions containing T and B epitopes were selected at the same time to look for identical epitopes on M smegmatis based on sequence alignments. Preliminary studies of humoral immunogenicity and cross-reactivity with M tuberculosis in mice using two M smegmatis-derived experimental vaccines were carried out, demonstrating the immunogenicity of M smegmatis proteoliposomes and the recognition of M tuberculosis proteins by the sera of animals immunized with this vaccine candidate. The conjunction of in silico and in vivo studies suggested the potential for future evaluation of M smegmatis as vaccine candidate against tuberculosis using different strategies.(AU)

En este estudio se revisaron múltiples bases de datos publicadas, relacionadas con experimentos de expresión de genes de M tuberculosis in vivo en diferentes estadios de la infeccción en humanos y animales. Se identificaron 38 proteínas con elevada expresión en las fases activa, latente y de reactivación de la infección. Se llevó a cabo la predicción de epítopes T y B en dichas proteínas. Las regiones de cada proteína que contenían simultàneamente epítopes T y B se seleccionaron y utilizaron para identificar regiones idénticas en M smegmatis mediante el alineamiento de secuencias. Se llevaron a cabo estudios de inmunogenicidad humoral y reactividad cruzada con M tuberculosis en ratones inmunizados con dos vacunas experimentales obtenidas a partir de M smegmatis, demostràndose la immunogenicidad de los proteoliposomas y el reconocimiento de proteínas de M tuberculosis por el suero de ratones vacunados con este candidato vacunal. Los resultados obtenidos con los estudios in sílico e in vivo sugieren la potencialidad para evaluación futura de candidatos vacunales obtenidos a partir de M smegmatis para la prevención de la tuberculosis(AU)

Mecanismos de evasión y persistencia de Mycobacterium tuberculosis durante el estado de latencia y posibles estrategias para el control de la infección latente / Mechanisms of evasion and persistence of Mycobacterium tuberculosis during the latencystate and potential strategies to control latent infection

Mycobacterium tuberculosis, el agente causal de la tuberculosis, infecta aproximadamente alrededor de 54 millones de personas en todo el mundo cada año y constituye una de las principales causas de muerte entre las enfermedades infecciosas. La mayoría de los individuos infectados con M tuberculosis desarrollan una infección latente, etapa en la que este microorganismo sobrevive dentro del hospedero, evadiendo los mecanismos de defensa del sistema inmune del portador. La terapia actual de la tuberculosis comprende la administración de cuatro antimicrobianos durante seis meses. No obstante, M tuberculosis es capaz de sobrevivir después de varios meses de tratamiento con esa terapéutica antimicrobiana combinada. Existen evidencias de que el bacilo tuberculoso, durante la fase estacionaria de crecimiento, incrementa su tolerancia a los ambientes de estrés. El costo de los fßrmacos empleados para el tratamiento y el incremento de cepas de M tuberculosis multidrogorresistentes constituyen uno de los motivos principales para desarrollar una nueva vacuna contra la tuberculosis. Sin embargo, su erradicación està afectada por la capacidad que posee el bacilo tuberculoso de sobrevivir en estado de latencia durante décadas, en las condiciones de hipoxia y causar infecciones recurrentes(AU)

Mycobacterium tuberculosis, the causative agent of tuberculosis, infects approximately 54 million people around the world each year and is a leading cause of death among infectious diseases. Most individuals infected with M tuberculosis develop a latent infection stage at which this organism survives within the host, evading the defense mechanisms of the host immune system. Current TB therapy involves administration of four antibiotics for six months. However, M tuberculosis is able to survive after several months of treatment with this antimicrobial combination therapy. There is evidence that the TB bacilli during the stationary phase of growth, increases tolerance to stress environments. The cost of drugs used for treatment and the increase of M tuberculosis multidrug resistant strains, is one of the main reasons for developing a new vaccine against tuberculosis. However, the elimination of the disease has been prevented by the ability of the bacillus to both survive in latency for decades, under conditions of hypoxia and to cause recurrent infections(AU)

Malaria control in the municipality of San Esteban, Honduras.

OBJECTIVES: To assess the burden of malaria in San Esteban, Department of Olancho, Honduras, and provide recommendations for control. METHODS: Malaria causes appreciable morbidity in San Esteban. In 2006, health workers reported an increase in malaria cases and requested recommendations for control. In 2005, 385 cases (Plasmodium vivax, 316; P. falciparum, 69) were detected from 4 007 blood smears in the San Esteban laboratory (slide positivity rate = 9.6%). During May-July 2006, we assessed the burden of malaria and made recommendations. We reviewed epidemiologic data from slide-confirmed malaria cases in 2005 and 2006 and conducted a knowledge, attitudes, and practices survey in households to assess malaria diagnostic, treatment, and prevention practices. RESULTS: During May-July 2006, 143 laboratory-confirmed malaria cases were detected (P. vivax, 134; P. falciparum, 9) in San Esteban, compared with 104 (P. vivax, 79; P. falciparum, 25) in May-July 2005. From January 2005 to July 2006, 538 cases were detected in San Esteban, with increased frequency in May-October and the highest incidence in children 0-14 years old. We administered 112 surveys in 19 communities. Seventy percent of respondents reported a history of malaria in a household member, with the highest frequency reported in mothers (45%) and children under 14 years old (37%). Most households did not have mosquito protection such as bed nets, screens, or indoor residual insecticide. CONCLUSIONS: Malaria is ongoing in San Esteban, with increased incidence in children. We recommend increased availability and promotion of insecticide-treated bed nets, improved timing and coverage of indoor residual spraying, and improved community malaria practices through education sessions.

La inmunidad antituberculosa y su aplicación en el desarrollo de candidatos vacunales / The anti-tuberculosis immunity and their implications in the vaccine candidates development

La incidencia de la tuberculosis ha alcanzado proporciones alarmantes. BCG, única vacuna disponible para su prevención en humanos, ha sido ineficiente, comprobado en varias pruebas de campo. Por ello es imperiosa la necesidad de lograr nuevas vacunas contra la tuberculosis. Una mejor comprensión de la respuesta inmune inducida durante la infección por Mycobacyterium tuberculosis pudiera ayudar a obtener en relativo corto tiempo la vacuna deseada contra este microorganismo. El objetivo de la presente revisión es mostrar una panorámica general acerca del ciclo de infección de Mycobacterium tuberculosis, las principales células efectoras que participan en la inmunidad antituberculosa y las estrategias fundamentales para el desarrollo de vacunas contra esta enfermedad(AU)

The incidence of tuberculosis has reached alarming rates nowadays. BCG vaccine, the only anti-tuberculosis vaccine available has been inefficient in several field trials around the world. It is currently imperative to obtain new vaccines against tuberculosis. A better understanding of the immune response induced by M. tuberculosis during infection could help to obtain the desired vaccine in a relative short time. The aim of the present review is to show a general panoramic of M. tuberculosis infection cycle , the main effectors cells in the anti- tuberculosis immunity and the fundamental strategies in the rational vaccine development against this disease(AU)

Obtención y caracterización parcial de un extracto lipídico de la membrana externa de Mycobacterium smegmatis / Obtainment and partial characterization of a lipidic fragment of the outer membrane of Mycobacterium smegmatis

En la actualidad, los antígenos lipídicos de las micobacterias constituyen blancos atractivos para el desarrollo de nuevas formulaciones vacunales contra la tuberculosis. En nuestro trabajo se realizó la caracterización parcial de un extracto lipídico de pared celular de Mycobacterium smegmatis mediante cromatografía de capa delgada y Dot blot frente a gammaglobulina humana. Se identificó, fundamentalmente, la presencia de fosfolípidos y ßcidos micólicos en el extracto lipídico y se observó un elevado reconocimiento de los mismos por la gammaglobulina humana, lo cual indica la importancia de continuar los estudios de inmunoprotección empleando antígenos lipídicos de micobacterias(AU)

Currently, lipid antigens of mycobacteria are attractive targets for the development of new tuberculosis vaccinal formulations. A lipid extract of Mycobacterium smegmatis cell wall was characterized using a Thin Layer Chromatography and Dot blot with human gammaglobulin. Mainly we identified the presence of phospholipids and micolic acids in the lipid extract showing a high recognition by human gammaglobulin. These results indicate the relevance of continuing immunoprotection studies with mycobacterial lipid antigens(AU)

Malaria control in the municipality of San Esteban, Honduras / Control de la malaria en el municipio de San Esteban, Honduras

OBJECTIVES: To assess the burden of malaria in San Esteban, Department of Olancho, Honduras, and provide recommendations for control. METHODS: Malaria causes appreciable morbidity in San Esteban. In 2006, health workers reported an increase in malaria cases and requested recommendations for control. In 2005, 385 cases (Plasmodium vivax, 316; P. falciparum, 69) were detected from 4 007 blood smears in the San Esteban laboratory (slide positivity rate = 9.6 percent). During May-July 2006, we assessed the burden of malaria and made recommendations. We reviewed epidemiologic data from slide-confirmed malaria cases in 2005 and 2006 and conducted a knowledge, attitudes, and practices survey in households to assess malaria diagnostic, treatment, and prevention practices. RESULTS: During May-July 2006, 143 laboratory-confirmed malaria cases were detected (P. vivax, 134; P. falciparum, 9) in San Esteban, compared with 104 (P. vivax, 79; P. falciparum, 25) in May-July 2005. From January 2005 to July 2006, 538 cases were detected in San Esteban, with increased frequency in May-October and the highest incidence in children 0-14 years old. We administered 112 surveys in 19 communities. Seventy percent of respondents reported a history of malaria in a household member, with the highest frequency reported in mothers (45 percent) and children under 14 years old (37 percent). Most households did not have mosquito protection such as bed nets, screens, or indoor residual insecticide. CONCLUSIONS: Malaria is ongoing in San Esteban, with increased incidence in children. We recommend increased availability and promotion of insecticide-treated bed nets, improved timing and coverage of indoor residual spraying, and improved community malaria practices through education sessions.

OBJETIVOS: Evaluar la carga de malaria en San Esteban, departamento de Olancho, Honduras, y ofrecer recomendaciones para su control. MÉTODOS: La malaria es causa de una considerable morbilidad en San Esteban. En 2006, los trabajadores sanitarios informaron un aumento de casos de malaria y solicitaron recomendaciones para su control. En 2005, en el laboratorio de San Esteban se detectaron 385 casos (316 por Plasmodium vivax y 69 por P. falciparum) en 4 007 frotis sanguíneos (tasa de positividad: 9,6 por ciento). Entre mayo y julio de 2006 se evaluó la carga de malaria y se hicieron las recomendaciones. Se revisaron los datos epidemiológicos de los casos confirmados de 2005 y 2006 y se aplicó una encuesta sobre conocimientos, actitudes y hábitos en los hogares para evaluar las prácticas relacionadas con el diagnóstico, el tratamiento y la prevención de la malaria. RESULTADOS: Entre mayo y julio de 2006 en San Esteban se detectaron 143 casos de malaria confirmados por el laboratorio (134 por P. vivax y 9 por P. falciparum), en comparación con 104 (79 por P. vivax y 25 por P. falciparum) entre mayo y julio de 2005. Entre enero de 2005 y julio de 2006 se detectaron 538 casos en San Esteban, con un aumento en la frecuencia entre mayo y octubre y la mayor incidencia en niños de 0 a 14 años. Se aplicaron 112 encuestas en 19 comunidades. De los que respondieron, 70 por ciento había tenido algún miembro del hogar con malaria, con una mayor frecuencia en las madres (45 por ciento) y los menores de 14 años (37 por ciento). La mayoría de los hogares carecían de protección contra los mosquitos, como mosquiteros para las camas y ventanas o fumigación de interiores. CONCLUSIONES: La malaria se mantiene en aumento en San Esteban, con una mayor incidencia en los niños. Se recomienda incrementar la disponibilidad y la promoción de mosquiteros tratados con insecticidas, mejorar la periodicidad y la cobertura de la fumigación de interiores y mejorar los hábitos...