Humoral immunity against SARS-CoV-2 evoked by heterologous vaccination groups using the CoronaVac (Sinovac) and BNT162b2 (Pfizer/BioNTech) vaccines in Chile.

Introduction: Severe acute respiratory syndrome virus 2 (SARS-CoV-2) has caused over million deaths worldwide, with more than 61,000 deaths in Chile. The Chilean government has implemented a vaccination program against SARS-CoV-2, with over 17.7 million people receiving a complete vaccination scheme. The final target is 18 million individuals. The most common vaccines used in Chile are CoronaVac (Sinovac) and BNT162b2 (Pfizer-Biotech). Given the global need for vaccine boosters to combat the impact of emerging virus variants, studying the immune response to SARS-CoV-2 is crucial. In this study, we characterize the humoral immune response in inoculated volunteers from Chile who received vaccination schemes consisting of two doses of CoronaVac [CoronaVac (2x)], two doses of CoronaVac plus one dose of BNT162b2 [CoronaVac (2x) + BNT162b2 (1x)], and three doses of BNT162b2 [BNT162b2 (3x)]. Methods: We recruited 469 participants from Clínica Dávila in Santiago and the Health Center Víctor Manuel Fernández in the city of Concepción, Chile. Additionally, we included participants who had recovered from COVID-19 but were not vaccinated (RCN). We analyzed antibodies, including anti-N, anti-S1-RBD, and neutralizing antibodies against SARS-CoV-2. Results: We found that antibodies against the SARS-CoV-2 nucleoprotein were significantly higher in the CoronaVac (2x) and RCN groups compared to the CoronaVac (2x) + BNT162b2 (1x) or BNT162b2 (3x) groups. However, the CoronaVac (2x) + BNT162b2 (1x) and BNT162b2 (3x) groups exhibited a higher concentration of S1-RBD antibodies than the CoronaVac (2x) group and RCN group. There were no significant differences in S1-RBD antibody titers between the CoronaVac (2x) + BNT162b2 (1x) and BNT162b2 (3x) groups. Finally, the group immunized with BNT162b2 (3x) had higher levels of neutralizing antibodies compared to the RCN group, as well as the CoronaVac (2x) and CoronaVac (2x) + BNT162b2 (1x) groups. Discussion: These findings suggest that vaccination induces the secretion of antibodies against SARS-CoV-2, and a booster dose of BNT162b2 is necessary to generate a protective immune response. In the current state of the pandemic, these data support the Ministry of Health of the Government of Chile's decision to promote heterologous vaccination as they indicate that a significant portion of the Chilean population has neutralizing antibodies against SARS-CoV-2.

Perception of discrimination against immigrants compared to Chilean-born and its relationship with access to services and health outcomes.

OBJECTIVES: Compare self-perceived discrimination between immigrants and locals in Chile and analyze the relationship between immigration and perceived discrimination and immigration, discrimination and health outcomes, adjusting for sociodemographic characteristics and social capital. METHODS: Cross-sectional study, using population-based survey (CASEN2017). We selected 2,409 immigrants (representative of N = 291,270) and 67,857 locals (representative of N = 5,438,036) over 18 years of age surveyed. We estimated logistic regression models, considering the complex sample, with discrimination, self-rated health, medical treatment, healthcare system membership, complementary health insurance, medical consultation and problems when consulting as dependent variables, immigration and discrimination as main exposure variables, and social capital and sociodemographic variables as covariates of the models. RESULTS: Immigrants were more likely to perceive discrimination in general compared to locals (OR = 2.31; 95%CI: 1.9-2.9). However, this does not occur for all specific reasons for discrimination; skin color and physical appearance were the most frequent causes of discrimination in immigrants. The interaction between immigration and discrimination was significantly related to worse self-rated health outcomes and treatment for pathologies, disfavoring discrimination against immigrants. In both locals and immigrants, discrimination was not associated with health care access outcomes, except for problems during consultation in locals (OR = 1.61; 95%CI 1.4-1.8). CONCLUSIONS: In Chile, experiences of discrimination are intertwined with other forms of rejection and social exclusion, so it is urgent to raise awareness among the population to prevent these discriminatory practices, especially in health care and daily use places. It is essential to address discrimination in order to have an impact on intermediate variables and health outcomes. The extension of the results to the entire immigrant population could be very useful to deepen the problem and improve the estimates made.

Reduced neutralization against Delta, Gamma, Mu, and Omicron BA.1 variants of SARS-CoV-2 from previous non-Omicron infection.

The understanding of the host immune response to SARS-CoV-2 variants of concern is critical for improving diagnostics, therapy development, and vaccines. Here, we analyzed the level of neutralizing antibodies against SARS-CoV-2 D614G, Delta, Gamma, Mu, and Omicron variants in D614G infected healthcare workers during a follow-up up to 6 months after recovery. We followed up 76 patients: 60.5% were women and 39.5% men. The 96.1% and 3.9% were symptomatic and asymptomatic, respectively. The most frequent symptoms were headache, myalgia, and cough. The 65.8%, 65.8%, and 92.1% of the infected individuals were positive for neutralizing antibodies against D614G variant at 2, 4, and 6 months of follow-up, respectively. The 26.3%, 48.7% and 65.8% of patients neutralized Delta variant, 19.7%, 32.9% and 52.6% of patients neutralized Gamma, 7.9%, 19.7% and 44.7% of patients neutralized Mu, and 4.0%, 9.2% and 15.8% of patients neutralized Omicron. Low neutralization against Gamma and Mu variants was observed during the follow-up, and very low against the Omicron variant was detected during the same period. The median of neutralizing antibody titers against D614G and Delta variants increased significantly during the follow-up. An association was observed between the levels of neutralizing antibodies against D614G and Delta variants and the severity of the disease. Our results suggest an immune escape from neutralizing antibodies with the Omicron variant because of the many mutations localized in the S protein.

Eficiencia del entrenamiento simulado del parto vaginal en estudiantes de enfermería/obstetricia / The efficiency of simulated vaginal birth training in nursing/midwifery students

Introducción: la competencia "asistencia del parto vaginal" se adquiere, parcialmente, mediante simulación en estudiantes de enfermería/obstetricia. Sin embargo, no se ha reportado cuantos partos simulados son necesarios para que estos estudiantes adquieran la mínima competencia. Métodos: estudio cuasi experimental que incluyó a todos los alumnos del internado hospitalario en salud de la mujer, en el segundo semestre del año 2020, excluyendo aquellos que hubieran tenido exposición a la simulación o atención clínica de partos vagina-les. Se evaluó una intervención de práctica simulada en la atención del parto normal en tres etapas: 1) texto, 2) video y 3) simulación. Los estudiantes efectúan tres atenciones simuladas, un evaluador ciego evaluó su rendimiento con una pauta de cotejo (máximo 37 puntos) y se midió la satisfacción con una pauta de evaluación validada. Resultados: el rendimiento de los alumnos mejora significativamente (p < 0.001) con la repetición de la simulación (28,3; 34,3 y 36,7 puntos en 1°, 2° y 3° intento). El porcentaje de estudiantes que logra el umbral de mínima competencia es de 6%, 67% y 100 %, en cada repetición (p < 0.001) Conclusiones: en este grupo de estudiantes, tres repeti-ciones de la simulación/debriefing son suficientes para superar el umbral de mínima competencia. Esta información es útil para definir los recursos necesarios en simulación en atención del parto vaginal en estudiantes de enfermería/obstetricia.

Introduction: Vaginal delivery assistance competence is acquired partially by simulation in nursing/midwifery students. However, it has yet to be reported how many simulated deliveries are necessary for these students to develop the minimum competence. Methods: Quasi-experimental study, all the hospital internship in women>s health students were included in the second semester of 2020, excluding those exposed to the simulation or clinical care of vaginal births. A simulated practice intervention in vaginal delivery care in three stages: 1) text, 2) video, and 3) simulation, was evaluated. The students performed three simulations, a blind observer evaluated their performance with a comparison guideline (maximum 37 points), and their satisfaction was measured with a validated evaluation guideline. Results: The performance of the students improve significantly (p <0.001) with the repetition of the simulation (28.3, 34.3, and 36.7 points in the first, second and third attempts). The percentage of students who achieve the minimum proficiency threshold is 6%, 67%, and 100% in each repetition (p <0.001). Conclusions: In this group of students, three repetitions of the simulation/debriefing are sufficient to exceed the threshold of minimum competence. This information is helpful in defining the necessary resources in simulation in vaginal delivery care in nursing/midwifery students.

[Effectiveness of a multidimensional therapeutic program for aged people attending senior centers]. / Efectividad a mediano plazo de un programa multidimensional en personas mayores en centros diurnos en Chile.

BACKGROUND: It is imperative to have effective programs to improve or maintain the health of aged people. AIM: To evaluate the effectiveness of an intervention based on a multidimensional program in Senior centers in Chile five months after its implementation, in the domains of physical and mental health, functionality and quality of life in aged people. MATERIAL AND METHODS: Sixty participants older than 60 years completed a multidimensional program for one month that included interventions of guided physical exercises, in addition to educational and social activities. They were evaluated at baseline and one and five months after the intervention. RESULTS: After the first and fifth months, significant improvements were observed in the five times sit to stand test (5TSTS) and gait speed (WST), in addition, significant improvements were observed in literacy measured by the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). At the fifth month, slight improvements were observed in the Yesavage and short Falls efficacy scales, Barthel index, Unipodal Station and EuroQol five-dimensional quality of life tests. CONCLUSIONS: A multidimensional program for aged people lasting one month, improved the physical health dimension and literacy by the fifth month of evaluation.

Efectividad a mediano plazo de un programa multidimensional en personas mayores en centros diurnos en Chile / Effectiveness of a multidimensional therapeutic program for aged people attending senior centers

BACKGROUND: It is imperative to have effective programs to improve or maintain the health of aged people. AIM: To evaluate the effectiveness of an intervention based on a multidimensional program in Senior centers in Chile five months after its implementation, in the domains of physical and mental health, functionality and quality of life in aged people. MATERIAL AND METHODS: Sixty participants older than 60 years completed a multidimensional program for one month that included interventions of guided physical exercises, in addition to educational and social activities. They were evaluated at baseline and one and five months after the intervention. RESULTS: After the first and fifth months, significant improvements were observed in the five times sit to stand test (5TSTS) and gait speed (WST), in addition, significant improvements were observed in literacy measured by the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). At the fifth month, slight improvements were observed in the Yesavage and short Falls efficacy scales, Barthel index, Unipodal Station and EuroQol five-dimensional quality of life tests. CONCLUSIONS: A multidimensional program for aged people lasting one month, improved the physical health dimension and literacy by the fifth month of evaluation.

Perception of discrimination against immigrants compared to Chilean-born and its relationship with access to services and health outcomes / Percepción de discriminación en inmigrantes comparados a nacidos en Chile y su relación con acceso a servicios y resultados de salud

ABSTRACT OBJECTIVES Compare self-perceived discrimination between immigrants and locals in Chile and analyze the relationship between immigration and perceived discrimination and immigration, discrimination and health outcomes, adjusting for sociodemographic characteristics and social capital. METHODS Cross-sectional study, using population-based survey (CASEN2017). We selected 2,409 immigrants (representative of N = 291,270) and 67,857 locals (representative of N = 5,438,036) over 18 years of age surveyed. We estimated logistic regression models, considering the complex sample, with discrimination, self-rated health, medical treatment, healthcare system membership, complementary health insurance, medical consultation and problems when consulting as dependent variables, immigration and discrimination as main exposure variables, and social capital and sociodemographic variables as covariates of the models. RESULTS Immigrants were more likely to perceive discrimination in general compared to locals (OR = 2.31; 95%CI: 1.9-2.9). However, this does not occur for all specific reasons for discrimination; skin color and physical appearance were the most frequent causes of discrimination in immigrants. The interaction between immigration and discrimination was significantly related to worse self-rated health outcomes and treatment for pathologies, disfavoring discrimination against immigrants. In both locals and immigrants, discrimination was not associated with health care access outcomes, except for problems during consultation in locals (OR = 1.61; 95%CI 1.4-1.8). CONCLUSIONS In Chile, experiences of discrimination are intertwined with other forms of rejection and social exclusion, so it is urgent to raise awareness among the population to prevent these discriminatory practices, especially in health care and daily use places. It is essential to address discrimination in order to have an impact on intermediate variables and health outcomes. The extension of the results to the entire immigrant population could be very useful to deepen the problem and improve the estimates made.

RESUMEN OBJETIVOS Comparar la autopercepción de discriminación entre inmigrantes y locales en Chile y analizar la relación entre inmigración y discriminación percibida e inmigración, discriminación y resultados de salud, ajustando por características sociodemográficas y capital social. MÉTODOS Estudio transversal, utilizando encuesta poblacional (CASEN2017). Se seleccionaron 2.409 inmigrantes (representativos de N = 291.270) y 67.857 locales (representativos de N = 5.438.036) mayores de 18 años encuestados. Se estimaron modelos de regresión logística, considerando la muestra compleja, con discriminación, salud autoevaluada, tratamiento médico, pertenencia al sistema de salud, seguros complementarios de salud, consulta médica y problemas al consultar como variables dependientes, inmigración y discriminación como variables de exposición principal, y capital social y variables sociodemográficas como covariables de los modelos. RESULTADOS Inmigrantes tuvieron mayor posibilidad de percibir discriminación en general comparado con locales (OR = 2,31; IC95% 1,9-2,9). Sin embargo, esto no ocurre para todos los motivos específicos de discriminación; color de piel y apariencia física fueron las causas de discriminación más frecuentes en inmigrantes. La interacción entre inmigración y discriminación se relacionó significativamente con peores resultados de salud autoevaluada y tratamiento por patologías, en desfavor de los inmigrantes discriminados. Tanto en locales como en inmigrantes la discriminación no se asoció con resultados de acceso a atención en salud, excepto problemas durante la consulta en locales (OR = 1,61; IC95% 1,4-1,8). CONCLUSIONES En Chile, las experiencias de discriminación se entrelazan con otras formas de rechazo y exclusión social, por lo cual es urgente concientizar a la población para prevenir estas prácticas discriminatorias, sobre todo en la atención en salud y lugares de uso cotidiano. Abordar la discriminación es indispensable para lograr impactar en variables intermedias y resultados de salud. La extensión de los resultados a toda la población inmigrante podría ser de amplia utilidad para profundizar la problemática y mejorar las estimaciones realizadas.

Necesidades, Creencias y Prácticas en Salud Oral de Padres y Cuidadores de Preescolares: Un Enfoque Cualitativo

RESUMEN: A casi diez años de la implementación del exitoso programa público de promoción de la salud bucal para preescolares en Chile, se presenta el estudio previo que recogió la visión y significados para los padres acerca de temas de salud oral de sus hijos preescolares en un Chile urbano y rural de siete comunas distintas. Bien sabemos que la alta prevalenci a de la caries dental en Chile y sus consecuencias a lo largo del ciclo vital, ha relevado la Promoción de Salud como una estrategia necesaria para la situación sanitaria de hace una década y para la actual a través de la implementación de programas con enfoque preventivo, como lo es el programa Sembrando Sonrisas, cuyo componente educativo se centra en los/as cuidadores de preescolares. En esta línea, cabe destacar que el Modelo de Creencias en Salud (MCS) actúa como un predictor para las prácticas en salud que desarrollan los/as cuidadores respecto a sus hijos, las cuales pueden ser activadas y/o modificadas por estrategias educativas o consejería otorgada por profesionales de la salud. Este estudio buscó explorar, mediante metodología cualitativa, los sistemas de creencias en torno a las necesidades en salud oral percibidas por padres y cuidadores/as de niños/ as preescolares que participaron del pilotaje del Programa preventivo de salud bucal en población preescolar el año 2007. Los resultados obtenidos evidencian elementos que pudieron condicionar la conducta en torno a los cuidados de la salud oral de las/ os cuidadores hacia los preescolares. Entre los hallazgos, se encuentra que los padres y apoderados atribuían los cuidados en salud oral a terceras personas (odontólogos y educadoras de párvulos), al tiempo que relatan una falta de información en términos comprensibles para que ellos puedan replicar prácticas adecuadas en sus hijos. Por otro lado, la postergación de la visita al odontólogo se explica debido a malas experiencias previas y falta de acceso a servicios de atención odontológica. Sin embargo, la salud dental es relevada desde un punto de vista estético y como un elemento importante en la superación de estigmas sociales.

ABSTRACT: Almost ten years after the implementation of the successful public oral health promotion program for preschoolers in Chile, we present the previous study that collected the vision and meanings for parents about oral health issues of their preschool children in urban and rural Chile in seven different communities. The high prevalence of dental caries and their consequences throughout the lifetime in Chile has made health promotion a relevant strategy that allows facing the current health situation by implementing prevention-oriented programs focused on the pre-school level population, like the "Sembrando Sonrisas" program whose educational component focuses on parents and caregivers. In this line, it is worth mentioning the Health Beliefs Model (HBM), which acts as a predictor for the health practices that parents develop concerning their children, which can be activated and or modified by educational strategies or counseling provided by health professionals. This study seeks to explore, through qualitative methodology, the belief system around the oral health needs perceived by parents and caregivers of pre-school children who participated in the testing of the Preventive Oral Health Program in pre-school level population in 7 counties of the country during 2007. The results obtained showcase that parents and guardians assign oral health care to third parties (dentists, pre-school educators) while reporting a lack of understandable information so that they can replicate practices in their children. On the other hand, postponing the visit to the dentist is justified due to previous bad experiences and lack of access to dental care services. However, dental health is relevant from an aesthetic point of view and as an element to overcome social prejudice.

Intervención multidimensional preventiva de dependencia de personas mayores del centro integral para el envejecimiento feliz / Preventive multidimensional intervention of dependency of the elderly people of the integral center for happy aging

La Universidad de los Andes, ha constituido un centro interdisciplinario pionero en Chile y América Latina, denominado Centro Integral para el Envejecimiento Feliz, especializado en investigación de intervenciones que contribuyan al bienestar integral de Personas Mayores (PM) en situación vulnerable. Se presenta el diseño de una intervención multidimensional, que incorpora evaluaciones, intervenciones integrales e interdisciplinarias mediante prácticas colaborativas entre docentes y estudiantes de distintas carreras de la Universidad, aplicadas en PM asistentes a los Centros Diurnos para Adultos Mayores de la Municipalidad de Puente Alto, Región Metropolitana; y la evidencia en la que se fundamentan sus componentes estratégicos de intervención

The Universidad de los Andes has established a pioneering interdisciplinary center in Chile and Latin America, called the Integral Center for Happy Aging, specialized in research on interventions that contribute to the integral well-being of Older People (PM) in vulnerable situations. The design of a multidimensional intervention is presented, which incorporates evaluations, comprehensive and interdisciplinary interventions through collaborative practices between teachers and students of different careers of the University, applied in PM attending the Day Centers for Older Adults of the Municipality of Puente Alto, region Metropolitan; and the evidence on which its strategic components of intervention are based.

Serotype Distribution of Remaining Pneumococcal Meningitis in the Mature PCV10/13 Period: Findings from the PSERENADE Project.

Pneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5-7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites (N = 8; cases = 1141), PCV10 types caused 5% of cases <5 years of age and 15% among ≥5 years; the top serotypes were 19A, 6C, and 3, together causing 42% of cases <5 years and 37% ≥5 years. In PCV13-using sites (N = 32; cases = 4503), PCV13 types caused 14% in <5 and 26% in ≥5 years; 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed.

Health-related quality of life in older people with functional independence or mild dependence.

BACKGROUND: The concept of Health-Related Quality of Life (HRQOL) has grown in importance in the elderly population (PM), which is due to the increase in life expectancy of contemporary societies and the desire of people to live the most advanced years in good condition. OBJECTIVE: To know the effect of the epidemiological dimensions, functional capacity, social and psychological well-being on the HRQL of a group of senior people from the Borough of Puente Alto intervened by the multidimensional model of the Integral Center for Happy Aging, CIEF, Universidad de los Andes. RESULTS: Correlation was observed between the dimensions mentioned above, as well as the improvement in the predictive models of HRQL in the extent to which social and psychological variables are incorporated into the morbidity and functional capacity dimension, the latter strongly related to HRQL according to the scientific literature. CONCLUSION: The study shows the relevance of incorporating measures of social and psychological well-being in the evaluation of HRQL, especially with a view to the design of multidimensional interventions that encompass individual content and the environment in which seniors develop.

Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Prevalence in Blood in a Large School Community Subject to a Coronavirus Disease 2019 Outbreak: A Cross-sectional Study.

BACKGROUND: A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak affecting 52 people from a large school community in Santiago, Chile, was identified (12 March) 9 days after the first case in the country. We assessed the magnitude of the outbreak and the role students and staff played using self-administered antibody detection tests and a self-administered survey. METHODS: The school was closed on 13 March, and the entire community was placed under quarantine. We implemented a home-delivery, self-administered, immunoglobin (Ig) G/IgM antibody test and survey to a classroom-stratified sample of students and all staff from 4-19 May. We aimed to determine the overall seroprevalence rates by age group, reported symptoms, and contact exposure, and to explore the dynamics of transmission. RESULTS: The antibody positivity rates were 9.9% (95% confidence interval [CI], 8.2-11.8) for 1009 students and 16.6% (95% CI, 12.1-21.9) for 235 staff. Among students, positivity was associated with a younger age (P = .01), a lower grade level (P = .05), prior real-time polymerase chain reaction (RT-PCR) positivity (P = .03), and a history of contact with a confirmed case (P < .001). Among staff, positivity was higher in teachers (P = .01) and in those previously RT-PCR positive (P < .001). Excluding RT-PCR-positive individuals, antibody positivity was associated with fever in adults and children (P = .02 and P = .002, respectively), abdominal pain in children (P = .001), and chest pain in adults (P = .02). Within antibody-positive individuals, 40% of students and 18% of staff reported no symptoms (P = .01). CONCLUSIONS: Teachers were more affected during the outbreak and younger children were at a higher risk for infection, likely because index case(s) were teachers and/or parents from the preschool. Self-administered antibody testing, supervised remotely, proved to be a suitable and rapid tool. Our study provides useful information for school reopenings.

Molecular and epidemiological characterization of imported malaria cases in Chile.

BACKGROUND: Chile is one of the South American countries certified as malaria-free since 1945. However, the recent increase of imported malaria cases and the presence of the vector Anopheles pseudopunctipennis in previously endemic areas in Chile require an active malaria surveillance programme. METHODS: Specimens from 268 suspected malaria cases-all imported-collected between 2015 and 2018 at the Public Health Institute of Chile (ISP), were diagnosed by microscopy and positive cases were included for epidemiological analysis. A photo-induced electron transfer fluorogenic primer real-time PCR (PET-PCR) was used to confirm the presence of malaria parasites in available blood samples. Sanger sequencing of drug resistance molecular markers (pfk13, pfcrt and pfmdr1) and microsatellite (MS) analysis were performed in confirmed Plasmodium falciparum samples and results were related to origin of infection. RESULTS: Out of the 268 suspected cases, 65 were Plasmodium spp. positive by microscopy. A total of 63% of the malaria patients were male and 37% were female; 43/65 of the patients acquired infections in South American endemic countries. Species confirmation of available blood samples by PET-PCR revealed that 15 samples were positive for P. falciparum, 27 for Plasmodium vivax and 4 were mixed infections. The P. falciparum samples sequenced contained four mutant pfcrt genotypes (CVMNT, CVMET, CVIET and SVMNT) and three mutant pfmdr1 genotypes (Y184F/S1034C/N1042D/D1246Y, Y184F/N1042D/D1246Y and Y184F). MS analysis confirmed that all P. falciparum samples presented different haplotypes according to the suspected country of origin. Four patients with P. vivax infection returned to the health facilities due to relapses. CONCLUSION: The timely detection of polymorphisms associated with drug resistance will contribute to understanding if current drug policies in the country are appropriate for treatment of imported malaria cases and provide information about the most frequent resistant genotypes entering Chile.

Riesgo de infección en pacientes con enfermedades inmunológicas y oncológicas tratados con biológicos: revisión panorámica

Biological medications are effective for the treatment of cancer and inflammatory diseases. The aim of this review is to summarize the available evidence in systematic reviews or meta-analyses about the risk of infection in patients with cancer, arthritis, psoriasis and inflammatory bowel disease who use biological medications. We included systematic reviews or meta-analyses of controlled clinical trials and case/control studies that analyze infections during and after treatment with FDA-approved biological medications for the treatment of cancer, arthritis, inflammatory bowel disease and psoriasis, both in adults and children. The following databases were consulted: PubMed, Epistemonikos, Crochrane reviews, JIB, and Prospero. A quality guideline (AMSTAR) was applied to the selected studies. We included 26 studies. The risk of infections in patients with solid organ cancer is consistent in the literature. In psoriasis there is a risk of non-serious infections. In arthritis and other inflammatory diseases there is a risk of serious infections. In inflammatory bowel disease there is a risk for opportunistic infections. In conclusion, in patients with cancer and inflammatory diseases use biological medications entails a risk of infection. The evidence is different depending on the underlying disease of each patient.

Importancia de las vacunas en salud pública: hitos y nuevos desafíos / The importance of vaccines in public health: milestones and new challenges

La creación del Programa de Inmunizaciones en el mundo ha sido una de las estrategias de salud pública más valorada y que contribuye a la equidad. Este programa fue lanzado por la Organización Mundial de la Salud en 1974, posteriormente en el año 1977 fue implementado por la Organización Panamericana de la Salud para los países de la región de América y en Chile fue a partir de 1979, poniendo a disposición un esquema contra 6 enfermedades inmunoprevenibles. Es un programa de Bien Público de cobertura nacional, gratuito para toda la población objeto para cada una de las vacunas, que cuenta con respaldo político, independiente de los cambios de gobierno y con financiamiento nacional en un 100%. Uno de los pilares de éxito de los programas es lograr altas coberturas de vacunación. En el caso de sarampión, dado la alta tasa de reproducción del agente y su condición de enfermedad en fase de eliminación, se requieren coberturas superiores a 95%. Aunque el principal indicador indirecto de desarrollo del programa es la tercera dosis de vacuna contra DFT (Difteria, Pertussis acelular, Tétanos). Aunque han transcurrido 45 años de existencia de los Programas de Inmunización, cinco de las Enfermedades Inmunoprevenibles forman parte de las 10 principales amenazas para la salud mundial. El presente artículo desarrolla parte de la historia del Programa Ampliado de Inmunizaciones de América y de Chile desde su génesis, destacando la importancia de los 12 componentes mínimos que forman parte de las actividades del programa y los hitos que han demostrado el valor, los beneficios de la vacunación, relatando ejemplos como viruela, poliomielitis, sarampión. Por último, se señalan las amenazas y posibles estrategias de superación.

The creation of the Immunization Program in the world has been one of the most valued public health strategies and one that contributes to equity. This Program was launched by the World Health Organization in 1974, later in 1977 it was implemented by the Panamerican Health Organization for the countries of the Americas region and in Chile since 1979, making available a scheme against 6 immunopreventable diseases. It is a program of Public Good of national coverage, free for all the target population for each of the vaccines, which has political support, independent of changes in government and 100% national financing. One of the corner stone of success of the programs is to achieve high vaccination coverage. In the case of measles, given the high rate of reproduction of the agent and its disease condition in the phase of elimination, coverage of more than 95% its needed. Although the main indirect indicator of program development is the third dose of DPT (Difteria, Acellular Pertussis, Tetanus) vaccine. Although 45 years of the existence of Immunization Programs have passed, five of the Immunopreventable Diseases are part of the 10 main risks to world health. This article develops part of the history of the Expanded Program of Immunizations of America and Chile since its genesis, highlighting the importance of the 12 limited components that are part of the activities of the program and the milestones that have experienced the value, benefits of vaccination, such as smallpox, polio, measles. Finally, the threats and possible strategies for overcoming them are pointed out.

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[Risk of infections associated with the use of biological medications; a review]. / Riesgo de infección en pacientes con enfermedades inmunológicas y oncológicas tratados con biológicos: revisión panorámica.

Biological medications are effective for the treatment of cancer and inflammatory diseases. The aim of this review is to summarize the available evidence in systematic reviews or meta-analyses about the risk of infection in patients with cancer, arthritis, psoriasis and inflammatory bowel disease who use biological medications. We included systematic reviews or meta-analyses of controlled clinical trials and case/control studies that analyze infections during and after treatment with FDA-approved biological medications for the treatment of cancer, arthritis, inflammatory bowel disease and psoriasis, both in adults and children. The following databases were consulted: PubMed, Epistemonikos, Crochrane reviews, JIB, and Prospero. A quality guideline (AMSTAR) was applied to the selected studies. We included 26 studies. The risk of infections in patients with solid organ cancer is consistent in the literature. In psoriasis there is a risk of non-serious infections. In arthritis and other inflammatory diseases there is a risk of serious infections. In inflammatory bowel disease there is a risk for opportunistic infections. In conclusion, in patients with cancer and inflammatory diseases use biological medications entails a risk of infection. The evidence is different depending on the underlying disease of each patient.

[Impact of the ERA and GES health programs on mortality from community-acquired pneumonia in persons aged ≥65 years in ChileImpacto do programa de saúde ERA e do GES na mortalidade por pneumonia adquirida na comunidade em indivíduos com idade acima de 65 anos no Chile]. / Impacto de los programas de salud ERA y GES en la mortalidad por neumonía adquirida en la comunidad en personas de 65 años o más en Chile.

OBJECTIVE: Evaluate the impact of the Adult Respiratory Diseases (ERA) Program and the General System of Explicit Health Guarantees (GES) on mortality from community-acquired pneumonia (CAP) in persons aged ≥65 years in Chile. METHODS: In this ecological study, annual and quarterly mortality rates from CAP were calculated in persons aged 65 to 79 years and ≥80 years from 1990 to 2014. Information was gathered from the databases of Chile's Department of Health Statistics and Information and its National Statistics Institute. The ERA Program (implemented in 2001) and the inclusion of CAP in the GES (starting in 2005) were evaluated as interventions. Data were analyzed using the interrupted time-series method, following the Prais-Winsten model, with a 5% significance level. RESULTS: The analysis showed that after the ERA Program began, significant reductions in CAP mortality were observed in the two age groups studied, whereas after CAP was added to the GES program, no statistically significant changes were found in those rates. CONCLUSIONS: Implementation of the ERA Program helped to reduce CAP mortality in persons aged ≥65 years in Chile, whereas inclusion of CAP in the GES program did not.

OBJETIVO: Avaliar o efeito do Programa Enfermidades Respiratorias del Adulto (doenças respiratórias do adulto, ERA) e do Régimen General de Garantías Explícitas en Salud (regime geral de garantias explícitas em Saúde, GES) na mortalidade por pneumonia adquirida na comunidade (PAC) em indivíduos acima de 65 anos no Chile. MÉTODOS: Estudo ecológico em que foram calculadas as taxas anuais e trimestrais de mortalidade por PAC em indivíduos de 65 a 79 anos e acima de 80 anos no período entre 1990 e 2014. Os dados foram obtidos dos bancos de dados do Departamento de Estatística e Informação em Saúde e do Instituto Nacional de Estatística do Chile. As intervenções avaliadas foram o Programa ERA (implantado em 2001) e a inclusão da PAC no GES (a partir de 2005). Os dados foram analisados com o método de séries temporais interrompidas segundo o modelo de Prais-Winsten. O nível de significância foi de 5%. RESULTADOS: A análise demonstrou que, após a implantação do Programa ERA, houve uma redução significativa na taxa de mortalidade por PAC nas duas faixas etárias consideradas. Por outro lado, a inclusão da PAC no GES não teve efeito estatisticamente significativo na taxa de mortalidade. CONCLUSÕES: A implantação do Programa ERA contribuiu para reduzir a taxa de mortalidade por PAC em indivíduos acima de 65 anos no Chile, porém o mesmo não ocorreu com a inclusão da PAC no GES.