Genomic Surveillance of SARS-CoV-2 Variants in the Dominican Republic and Emergence of a Local Lineage.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus that evolves over time, leading to new variants. In the current study, we assessed the genomic epidemiology of SARS-CoV-2 in the Dominican Republic. A total of 1149 SARS-CoV-2 complete genome nucleotide sequences from samples collected between March 2020 and mid-February 2022 in the Dominican Republic were obtained from the Global Initiative on Sharing All Influenza Data (GISAID) database. Phylogenetic relationships and evolution rates were analyzed using the maximum likelihood method and the Bayesian Markov chain Monte Carlo (MCMC) approach. The genotyping details (lineages) were obtained using the Pangolin web application. In addition, the web tools Coronapp, and Genome Detective Viral Tools, among others, were used to monitor epidemiological characteristics. Our results show that the most frequent non-synonymous mutation over the study period was D614G. Of the 1149 samples, 870 (75.74%) were classified into 8 relevant variants according to Pangolin/Scorpio. The first Variants Being Monitored (VBM) were detected in December 2020. Meanwhile, in 2021, the variants of concern Delta and Omicron were identified. The mean mutation rate was estimated to be 1.5523 × 10-3 (95% HPD: 1.2358 × 10-3, 1.8635 × 10-3) nucleotide substitutions per site. We also report the emergence of an autochthonous SARS-CoV-2 lineage, B.1.575.2, that circulated from October 2021 to January 2022, in co-circulation with the variants of concern Delta and Omicron. The impact of B.1.575.2 in the Dominican Republic was minimal, but it then expanded rapidly in Spain. A better understanding of viral evolution and genomic surveillance data will help to inform strategies to mitigate the impact on public health.

Population-Level Effectiveness of an Inactivated Whole-Virion COVID-19 Vaccine: A Test Negative Case-Control Study in the Dominican Republic.

Background: A continuing nationwide vaccination campaign began in the Dominican Republic on February 16, 2021 to prevent severe consequences of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Estimates of vaccine effectiveness under real-world conditions are needed to support policy decision making and inform further vaccine selection. Methods: We conducted a test-negative case-control study to assess the real-world effectiveness of nationwide coronavirus disease 2019 (COVID-19) vaccination program using an inactivated vaccine (CoronaVac) on preventing symptomatic SARS-CoV-2 infections and hospitalizations from August to November 2021 in the Dominican Republic. Participants were recruited from 10 hospitals in 5 provinces to estimate the effectiveness of full immunization (≥14 days after receipt of the second dose) and partial immunization (otherwise with at least 1 dose ≥14 days after receipt of the first dose). Results: Of 1078 adult participants seeking medical care for COVID-19-related symptoms, 395 (36.6%) had positive polymerase chain reaction (PCR) tests for SARS-CoV-2; 142 (13.2%) were hospitalized during 15 days of follow up, including 91 (23%) among 395 PCR-positive and 51 (7.5%) among 683 PCR-negative participants. Full vaccination was associated with 31% lower odds of symptomatic infection (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.52-0.93) and partial vaccination was associated with 49% lower odds (OR, 0.51; CI, 0.30-0.86). Among 395 PCR-positive participants, full vaccination reduced the odds of COVID-19-related hospitalization by 85% (OR, 0.15; 95% CI, 0.08-0.25) and partial vaccination reduced it by 75% (OR, 0.25; 95% CI, 0.08-0.80); full vaccination was associated with reduced use of assisted ventilation by 73% (OR, 0.27; 95% CI, 0.15-0.49). Conclusions: Given the ancestral and delta viral variants circulating during this study period, our results suggest that the inactivated COVID-19 vaccine offered moderate protection against symptomatic SARS-CoV-2 infections and high protection against COVID-19-related hospitalizations and assisted ventilation. This is reassuring given that, as of August 2022, an estimated 2.6 billion inactivated CoronaVac vaccine doses had been administered worldwide. This vaccine will become a basis for developing multivalent vaccine against the currently circulating omicron variant.

Monitoring Temporal Changes in SARS-CoV-2 Spike Antibody Levels and Variant-Specific Risk for Infection, Dominican Republic, March 2021-August 2022.

To assess changes in SARS-CoV-2 spike binding antibody prevalence in the Dominican Republic and implications for immunologic protection against variants of concern, we prospectively enrolled 2,300 patients with undifferentiated febrile illnesses in a study during March 2021-August 2022. We tested serum samples for spike antibodies and tested nasopharyngeal samples for acute SARS-CoV-2 infection using a reverse transcription PCR nucleic acid amplification test. Geometric mean spike antibody titers increased from 6.6 (95% CI 5.1-8.7) binding antibody units (BAU)/mL during March-June 2021 to 1,332 (95% CI 1,055-1,682) BAU/mL during May-August 2022. Multivariable binomial odds ratios for acute infection were 0.55 (95% CI 0.40-0.74), 0.38 (95% CI 0.27-0.55), and 0.27 (95% CI 0.18-0.40) for the second, third, and fourth versus the first anti-spike quartile; findings were similar by viral strain. Combining serologic and virologic screening might enable monitoring of discrete population immunologic markers and their implications for emergent variant transmission.

Evaluation of sample pooling for the detection of SARS-CoV-2 in a resource-limited setting, Dominican Republic / Evaluación del análisis de muestras agrupadas para la detección de SARS-CoV-2 en entornos con recursos limitados, República Dominicana

Introduction: COVID-19 is a worldwide public health threat. Diagnosis by RT-PCR has been employed as the standard method to confirm viral infection. Sample pooling testing can optimize the resources by reducing the workload and reagents shortage, and be useful in laboratories and countries with limited resources. This study aims to evaluate SARS-CoV-2 detection by sample pooling testing in comparison with individual sample testing. Materials and methods: We created 210 pools out of 245 samples, varying from 4 to 10 samples per pool, each containing a positive sample. We conducted detection of SARS-CoV-2-specific RdRp/E target sites. Results: Pooling of three samples for SARS-CoV-2 detection might be an efficient strategy to perform without losing RT-PCR sensitivity. Conclusions: Considering the positivity rate in Dominican Republic and that larger sample pools have higher probabilities of obtaining false negative results, the optimal sample size to perform a pooling strategy shall be three samples.(AU)

Introducción: La COVID-19 es una amenaza de salud pública mundial. La RT-PCR es el método estándar para confirmar la infección. La estrategia de pruebas de muestras agrupadas puede reducir la carga de trabajo y la escasez de reactivos, y ser útil en países con escasos recursos. Evaluamos la detección del SARS-CoV-2 mediante esta estrategia en comparación con pruebas individuales. Materiales y métodos: Creamos 210 grupos de 245 muestras, de 4 a 10 muestras por grupo, cada uno con una muestra positiva. Realizamos extracción de ARN y qRT-PCR para detectar la presencia de la diana RdRp/E. Resultados: La combinación de hasta 3 muestras para la detección del SARS-CoV-2 podría ser una estrategia eficaz sin perder la sensibilidad. Conclusiones: Considerando la tasa de positividad en República Dominicana y que los grupos con más muestras tienen mayor probabilidad de obtener resultados falsos negativos, el tamaño óptimo para realizar esta estrategia es de 3 muestras.(AU)

Evaluation of sample pooling for the detection of SARS-CoV-2 in a resource-limited setting, Dominican Republic.

INTRODUCTION: COVID-19 is a worldwide public health threat. Diagnosis by RT-PCR has been employed as the standard method to confirm viral infection. Sample pooling testing can optimize the resources by reducing the workload and reagents shortage, and be useful in laboratories and countries with limited resources. This study aims to evaluate SARS-CoV-2 detection by sample pooling testing in comparison with individual sample testing. MATERIALS AND METHODS: We created 210 pools out of 245 samples, varying from 4 to 10 samples per pool, each containing a positive sample. We conducted detection of SARS-CoV-2-specific RdRp/E target sites. RESULTS: Pooling of three samples for SARS-CoV-2 detection might be an efficient strategy to perform without losing RT-PCR sensitivity. CONCLUSIONS: Considering the positivity rate in Dominican Republic and that larger sample pools have higher probabilities of obtaining false negative results, the optimal sample size to perform a pooling strategy shall be three samples.

Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic: a qualitative study.

BACKGROUND: Good governance and regulatory supervision are required to conduct research in an international public health emergency context and to ensure compliance with ethical standards. The "Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic" study is a regional effort in which research ethics stakeholders participated in addressing research ethics governance and preparedness response challenges to the COVID-19 pandemic in Central America and the Dominican Republic. METHODS: A qualitative action research study was conducted following a participatory approach. Research ethics stakeholders in Central America and the Dominican Republic were mapped; a regional webinar and three virtual workshops were conducted discussing research ethics governance, ethics review and collaborative research practice during the pandemic. A roundtable session presented results and obtained feedback on a draft of a policy to strengthen regional research ethics governance. RESULTS: Countries across Central America and the Dominican Republic are at different stages in their development of research ethics systems. Countries with more established systems before COVID-19 were better organized and prepared to respond. This finding argues against improvisation and supports further work on strengthening governance of research ethics systems. Community engagement in research ethics public policy-making is practically absent in the region. Research and research ethics collaboration schemes are lacking amongst the countries; however, there are incipient initiatives in the region, such as the Central America and Caribbean Network of Research Ethics Committees. A policy brief with recommendations on how to advance towards strengthening the governance of research ethics systems was prepared and submitted to the Central American Integration System for analysis and possible approval. CONCLUSION: National research ethics systems in Central America and the Dominican Republic were unprepared to respond to the COVID-19 pandemic with respect to research oversight and effective collaboration. In most cases, national research ethics systems were found to be weak, and regional research collaboration was practically absent. To promote collaboration, a joint strategy needs to be developed with a regional vision towards sharing knowledge and best practices.

Antimicrobial resistance in Escherichia coli and Pseudomonas aeruginosa before and after the coronavirus disease 2019 (COVID-19) pandemic in the Dominican Republic.

Objective: To describe antimicrobial resistance before and after the COVID-19 pandemic in the Dominican Republic. Design: Retrospective study. Setting: The study included 49 outpatient laboratory sites located in 13 cities nationwide. Participants: Patients seeking ambulatory microbiology testing for urine and bodily fluids. Methods: We reviewed antimicrobial susceptibility reports for Escherichia coli isolates from urine and Pseudomonas aeruginosa (PSAR) from bodily fluids between January 1, 2018, to December 31, 2021, from deidentified susceptibility data extracted from final culture results. Results: In total, 27,718 urine cultures with E. coli and 2,111 bodily fluid cultures with PSAR were included in the analysis. On average, resistance to ceftriaxone was present in 25.19% of E. coli isolated from urine each year. The carbapenem resistance rates were 0.15% for E. coli and 3.08% for PSAR annually. The average rates of E. coli with phenotypic resistance consistent with possible extended-spectrum ß-lactamase (ESBL) in urine were 25.63% and 24.75%, respectively, before and after the COVID-19 pandemic. The carbapenem resistance rates in urine were 0.11% and 0.20%, respectively, a 200% increase. The average rates of PSAR with carbapenem resistance in bodily fluid were 2.33% and 3.84% before and after the COVID-19 pandemic, respectively, a 130% percent increase. Conclusions: Resistance to carbapenems in PSAR and E. coli after the COVID-19 pandemic is rising. These resistance patterns suggest that ESBL is common in the Dominican Republic. Carbapenem resistance was uncommon but increased after the COVID-19 pandemic.

The Impact of COVID-19 on the Monitoring of Pregnancy and Delivery of Pregnant Women in the Dominican Republic.

Pregnancy monitoring is vital to guaranteeing that both the foetus and the mother are in optimal health conditions. WHO protocols recommend at least eight medical examinations during the pregnancy period. While the cancellation or reduction of appointments during pregnancy due to the pandemic may help reduce the risk of infection, it could also negatively influence perinatal outcomes and the birthing process. The aim of this research was to analyse the differences in perinatal outcomes and birth characteristics in two groups of pregnant women: women who gave birth before and during the pandemic, and whether these differences are due to changes in pregnancy monitoring because of the COVID-19 situation. A retrospective study was carried out from July 2018 to December 2021, at the Santo Domingo Hospital (Dominican Republic). A total of 1109 primiparous pregnant women were recruited for this study during the birthing process and perinatal visits. The results describe how women who gave birth before the pandemic had greater control and monitoring of their pregnancy, more doctor visits (p = 0.001), fewer caesarean sections (p = 0.006), and more skin-to-skin contact after birth (p = 0.02). During the COVID-19 pandemic, pregnant women's attendance at routine pregnancy monitoring, both doctor visits and ultrasound scans, has decreased, leading to an increase in the number of caesarean and instrumental deliveries. At the perinatal level, processes such as skin-to-skin contact after birth between mother and newborn or the introduction of early breastfeeding in the delivery room have also been reduced.

SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection - A multistage national household survey and modelling study, Dominican Republic, June-October 2021.

Background: Population-level SARS-CoV-2 immunological protection is poorly understood but can guide vaccination and non-pharmaceutical intervention priorities. Our objective was to characterise cumulative infections and immunological protection in the Dominican Republic. Methods: Household members ≥5 years were enrolled in a three-stage national household cluster serosurvey in the Dominican Republic. We measured pan-immunoglobulin antibodies against the SARS-CoV-2 spike (anti-S) and nucleocapsid glycoproteins, and pseudovirus neutralising activity against the ancestral and B.1.617.2 (Delta) strains. Seroprevalence and cumulative prior infections were weighted and adjusted for assay performance and seroreversion. Binary classification machine learning methods and pseudovirus neutralising correlates of protection were used to estimate 50% and 80% protection against symptomatic infection. Findings: Between 30 Jun and 12 Oct 2021 we enrolled 6683 individuals from 3832 households. We estimate that 85.0% (CI 82.1-88.0) of the ≥5 years population had been immunologically exposed and 77.5% (CI 71.3-83) had been previously infected. Protective immunity sufficient to provide at least 50% protection against symptomatic SARS-CoV-2 infection was estimated in 78.1% (CI 74.3-82) and 66.3% (CI 62.8-70) of the population for the ancestral and Delta strains respectively. Younger (5-14 years, OR 0.47 [CI 0.36-0.61]) and older (≥75-years, 0.40 [CI 0.28-0.56]) age, working outdoors (0.53 [0.39-0.73]), smoking (0.66 [0.52-0.84]), urban setting (1.30 [1.14-1.49]), and three vs no vaccine doses (18.41 [10.69-35.04]) were associated with 50% protection against the ancestral strain. Interpretation: Cumulative infections substantially exceeded prior estimates and overall immunological exposure was high. After controlling for confounders, markedly lower immunological protection was observed to the ancestral and Delta strains across certain subgroups, findings that can guide public health interventions and may be generalisable to other settings and viral strains. Funding: This study was funded by the US CDC.

Genome Sequence of a Recombinant SARS-CoV-2 Lineage XAM (BA.1.1/BA.2.9) Strain from a Clinical Sample in Santo Domingo, Dominican Republic.

Here, we report a recombinant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage XAM (Omicron BA.1.1/BA.2.9) strain that was collected in Santo Domingo, Dominican Republic. This demonstrates how SARS-CoV-2 variants can vary greatly between regions and thus underlines the great importance of regional genomic surveillance efforts.

Informe anual 2021. República Dominicana: Respuesta a la COVID-19 y preparación para el futuro

En el 2022 se celebra el 120.º aniversario de la Organización Panamericana de la Salud (OPS). En calidad de organismo independiente especializado en salud del sistema interamericano, la OPS brinda cooperación técnica a sus Estados Miembros para abordar las enfermedades transmisibles y no transmisibles y sus causas, fortalecer los sistemas de salud y responder a situaciones de emergencia y desastres en toda la Región de las Américas. Asimismo, como Oficina Regional de la Organización Mundial de la Salud para la Región de las Américas, participa en los equipos de las Naciones Unidas en los países, colaborando con otros organismos, fondos y programas del sistema de las Naciones Unidas para contribuir al logro de los Objetivos de Desarrollo Sostenible a nivel de país. A nivel subregional, la OPS trabaja con los mecanismos de integración para que la salud y sus determinantes tengan un lugar en la agenda política. En el informe anual correspondiente al 2021 se presenta la cooperación técnica de la OPS en los países y territorios en este período, con la aplicación de las estrategias de cooperación en los países, la respuesta a sus necesidades y prioridades, y el desarrollo de las actividades en el marco de los mandatos regionales y mundiales de la OPS y los Objetivos de Desarrollo Sostenible. En consonancia con el tema general de "responder a la COVID-19 y prepararse para el futuro", se ponen de relieve las medidas que ha adoptado la OPS con respecto a la pandemia de COVID-19 y sus esfuerzos continuos en áreas prioritarias como las emergencias de salud, los sistemas y servicios de salud, las enfermedades transmisibles, las enfermedades no transmisibles y la salud mental, la salud a lo largo del curso de vida y la equidad en la salud. También se presenta un resumen financiero del bienio 2020-2021.

Assessment of a Comparative Bayesian-Enhanced Population-Based Decision Model for COVID-19 Critical Care Prediction in the Dominican Republic Social Security Affiliates.

INTRODUCTION: The novel coronavirus disease 2019 (COVID-19) has been a major health concern worldwide. This study aims to develop a Bayesian model to predict critical outcomes in patients with COVID-19. METHODS: Sensitivity and specificity were obtained from previous meta-analysis studies. The complex vulnerability index (IVC-COV2 index for its abbreviation in Spanish) was used to set the pretest probability. Likelihood ratios were integrated into a Fagan nomogram for posttest probabilities, and IVC-COV2 + National Early Warning Score (NEWS) values and CURB-65 scores were generated. Absolute and relative diagnostic gains (RDGs) were calculated based on pretest and posttest differences. RESULTS: The IVC-COV2 index was derived from a population of 1,055,746 individuals and was based on mortality in high-risk (71.97%), intermediate-risk (26.11%), and low-risk (1.91%) groups. The integration of models in which IVC-COV2 intermediate + NEWS ≥ 5 and CURB-65 > 2 led to a "number needed to (NNT) diagnose" that was slightly improved in the CURB-65 model (2 vs. 3). A comparison of diagnostic gains revealed that neither the positive likelihood ratio (P = 0.62) nor the negative likelihood ratio (P = 0.95) differed significantly between the IVC-COV2 NEWS model and the CURB-65 model. CONCLUSION: According to the proposed mathematical model, the combination of the IVC-COV2 intermediate score and NEWS or CURB-65 score yields superior results and a greater predictive value for the severity of illness. To the best of our knowledge, this is the first population-based/mathematical model developed for use in COVID-19 critical care decision-making.

Travel Medicine in the Dominican Republic / La Medicina del Viajero en República Dominicana

Introduction: Travel Medicine specialty has existed for more than 40 years. However, this is practically unknown by Dominicans despite the large number of people who travel to and from our country. Methods: With the objective of determining the knowledge of Dominicans about the existence of Travel Medicine specialty and their attitudes in relation to it, we conducted a virtual survey of 8 questions, in which 2,584 Dominicans participated. Results: Despite the fact that more than 80 % of those surveyed knew that to travel to certain countries they had to take certain vaccines, less than 25 % had heard of the specialty of Traveler's Medicine. After knowing the definition and objectives of the specialty, more than 90 % of the participants considered it important to consult a specialist prior to the trip. Conclusion: The lack of knowledge of the specialty and the absence of this service in the public health system are the main barriers to the access of Dominicans to the Travel Medicine consultation. It is necessary to publicize the specialty, using scientific evidence and taking as an example the worldwide dissemination of COVID-19 through travelers, to make the population aware of the importance of pre and post-trip consultation, as well as the creation of this service in public hospitals

Introducción: la especialidad Medicina del Viajero existe hace más de 40 años. Sin embargo, esta es prácticamente desconocida por los dominicanos a pesar de la gran cantidad de personas que viajan desde y hacia nuestro país. Material y métodos: Con el objetivo de determinar el conocimiento de los dominicanos sobre la existencia de la Medicina del Viajero y sus actitudes en relación a esta, realizamos una encuesta virtual de 8 preguntas, de la cual participaron 2,584 dominicanos. Resultados: a pesar de que más del 80 % de los encuestados sabían que para viajar a determinados países debían tomar ciertas vacunas, menos del 25 % había escuchado hablar de la especialidad Medicina del Viajero. Tras conocer la definición y objetivos de la especialidad más del 90 % de los participantes consideró importante realizar una consulta previa al viaje con un especialista. Conclusión: el desconocimiento de la especialidad y la ausencia de este servicio en el sistema público de salud son las principales barreras para el acceso de los dominicanos a la consulta de Medicina del Viajero. Es necesario dar a conocer la especialidad, utilizando evidencia científica y tomando como ejemplo la difusión mundial de la COVID-19 a través de los viajeros, concienciar a la población de la importancia de la consulta pre y post viaje, así como la creación de este servicio en hospitales públicos

Returning to normal? 'Building back better' in the Dominican education system after Tropical Storm Erika and Hurricane Maria.

Child-centred disaster risk reduction aims to reduce child vulnerability and increase resilience to disasters. The 2015 Comprehensive School Safety Framework (CSSF) sought to decrease hazard risks to education. Between 2015 and 2017, Dominica was struck by Tropical Storm Erika and Hurricane Maria, which significantly affected the education system at the local and national scales. Since Maria, a couple of national initiatives (Safer Schools and Smart Schools) have been introduced to increase resilience and meet the CSSF's objectives. This paper assesses progress made through a qualitative analysis of interviews with 29 school leaders, government officials, and disaster risk reduction stakeholders. Implementation of the climate resilience programme in 2018 resulted in nationwide teacher training and production of school disaster plans. Limited successes have improved social resilience, but short-term implementation due to COVID-19 and a lack of a teacher knowledge base have presented challenges to the scheme's long-term sustainability and the implementation of the CSSF's goals.

Structural and Psychosocial Impacts of the COVID-19 Pandemic on HIV Care and Treatment Outcomes Among Female Sex Workers in the Dominican Republic.

BACKGROUND: The COVID-19 pandemic and its associated socioeconomic disruptions have disproportionally affected marginalized populations, including people living with HIV. Little is known about how the pandemic has affected populations experiencing multiple forms of stigma, discrimination, and violence, such as female sex workers (FSW) living with HIV. METHODS: We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use, and partner abuse on engagement in HIV care and antiretroviral therapy adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes. RESULTS: Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one-third of the participants (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (adjusted odds ratio [aOR] = 1.14, 95% CI: 1.02 to 1.27), mental health challenges (aOR = 1.38, 95% CI: 1.06 to 1.79), and partner emotional abuse (aOR = 2.62, 95% CI: 1.01 to 6.79) were associated with higher odds of negatively affected HIV care, respectively. The relationship between increased emotional partner abuse and negatively affected HIV care was mediated by greater COVID-19-related mental health challenges. CONCLUSIONS: FSW living with HIV in the Dominican Republic have been significantly affected by the COVID-19 pandemic. Targeted interventions that address structural (financial security and partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being.

Psychological helpline in response to the COVID-19 pandemic in the Dominican Republic.

The global health emergency due to COVID-19 is a disruptive event that has had various effects on mental health. Given this emergency, the Dominican Republic intervened to mitigate the negative impact of the pandemic, considering the physical isolation decreed in the country. In this context, the Autonomous University of Santo Domingo and the School of Psychology designed the UASD COVID-19 Psychological Helpline. The objective of this article is to describe the development, implementation and evaluation of a programme of psychological first aid. The programme aimed to attenuate the impact of morbidity and mortality due to mental health issues associated with the COVID-19 pandemic through mobile technology. There were 62 psychologists involved and trained to provide care, and a protocol was developed, implemented, monitored and evaluated. Over the course of four months, the programme assisted 497 people. The average age of the participants was 32 years, and 73% were women. The reasons for contacting the helpline included anxiety, stress, depression, domestic violence, suicidal behaviours and other behavioural problems. Following the intervention, most users reported feeling satisfied and having improved emotions. The first psychological aid in the country developed through telephone and chat messaging was an optimal resource since face-to-face interaction was not possible. It also reached more people and reduced the attention gap.

Tracking the impact of the COVID-19 pandemic on routine infant vaccinations in the Dominican Republic.

As the COVID-19 pandemic progresses, millions of infants are unprotected against immune-preventable diseases due to interruptions in vaccination services. The direct effects of the pandemic, as well as the non-pharmacological interventions for its containment, mitigation and suppression adopted by many countries, have affected their vaccination programs. We conducted an ecological study analyzing the performance of the vaccination program in the Dominican Republic before (2019) and during the COVID-19 pandemic (2020). We compared annual public coverage data, analyzed trends and changes in coverage, dropout rate, and number of partially and unvaccinated infants by geographic area and COVID-19 incidence rate. Compared to baseline, coverage for all vaccines decreased by 10.4 (SD, 3.6) percent; among these, coverage for the third dose of the pentavalent vaccine decreased from 90.1% in 2019 to 81.1% in 2020. The number of partially vaccinated (n = 34,185) and unvaccinated (n = 5,593) infants increased 66% and 376%, respectively. The slight increase in the annual dropout rate (1.1%) was directly proportional to the number of COVID-19 cases per month. We found a significant association between the annual absolute change of Penta3 and the subnational Human Development Index. The pandemic significantly weakened the performance of the routine vaccination program. Interventions are needed to recover and maintain lost vaccination coverage, reducing the risk of outbreaks of preventable diseases, especially in those provinces with less human development.

Impacto del aislamiento social por el COVID-19 en la calidad del sueño en adultos de 18 a 60 años en la República Dominicana: estudio observacional / Impact of social isolation due to COVID-19 on sleep quality in adults aged 18 to 60 years in the Dominican Republic: An observational study

Introducción: durante la actual situación de confinamiento surgida por el COVID-19, la población ha estado expuesta a estados emocionales donde su calidad de sueño se ha visto afectada. Por esta razón, esta investigación se ha propuesto determinar el impacto del aislamiento social por el COVID-19 en la calidad del sueño en adultos de 18 a 60 años en la República Dominicana. Materiales y métodos: este estudio observacional de corte transversal fue realizado en la República Dominicana en el 2020, específicamente en adultos de 18 a 60 años. La encuesta fue esparcida virtualmente vía Google Forms. Las variables utilizadas fueron categóricas (sexo, estado civil, zona de residencia, nivel académico, consumo de sustancias) y continuas (edad, calidad de sueño, nivel de estrés). De igual forma, se utilizaron encuestas aprobadas internacionalmente, como el Índice de Calidad de Sueño de Pittsburgh. Resultados: la población del estudio consistió en 821 participantes (edad media 30.94 años, 74.3 % mujeres). La prevalencia de una mala calidad del sueño fue de 80.7 %. La puntuación media del PSQI fue de 8.56 ± 4.20. Por otro lado, se destacó la relación del estrés con una mala calidad de sueño, obteniendo una p=0.00. Los factores independientes relacionados con la mala calidad del sueño incluyeron la edad y el sexo femenino. Conclusiones: el presente estudio muestra una visión general de las diferentes causas relacionadas a alteraciones en la calidad de sueño. Cabe destacar, la exposición a altos niveles de estrés durante el aislamiento social fruto de la pandemia causada por el COVID-19, asociado con una pobre calidad de sueño. Además, el sexo femenino mostró mayor tendencia a presentar trastornos de sueño, por igual los consumidores de alcohol.

Barreras para la inmunización en República Dominicana y COVID-19 / Barriers to immunization in the Dominican Republic and COVID-19

En los últimos años la República Dominicana ha experimentado una importante reducción en las coberturas de vacunación, producto de esta situación son los casos de tétanos y difteria que han surgido recientemente. Con el objetivo de identificar las barreras para la inmunización y determinar el impacto de la COVID-19 en la adherencia a la vacunación, 2.584 dominicanos completaron una encuesta en línea sobre el historial de vacunación personal y las razones para no vacunarse. Además, respondieron preguntas sobre la aceptación de la vacuna contra la COVID-19 y la influencia de la pandemia en su percepción/adherencia a la vacunación. La mayoría de los encuestados no se vacunó durante la pandemia, el principal motivo fue: no tenía ninguna vacuna programada para este año. Lo que indica que a pesar de que la pandemia dificultó el acceso a los servicios de vacunación, esta no fue la principal barrera para la inmunización en República Dominicana en el 2020. A pesar de que la mayoría de los participantes están a favor de la vacunación, de las vacunas incluidas en nuestro estudio, la vacuna contra sarampión, rubéola y parotiditis (en niños) fue la única que alcanzó el objetivo del Plan de Acción Mundial sobre Vacunas, de lograr una cobertura de vacunación del 90 por ciento para el 2020. La principal barrera para la inmunización es el olvido de vacunarse. Es necesario adoptar un sistema de recordatorio eficaz para aumentar la adherencia y mejorar las tasas de inmunización(AU)

In recent years, the Dominican Republic has experienced a significant reduction in vaccination coverage; cases of tetanus and diphtheria that have recently emerged are a result of this situation. In order to identify barriers to immunization and determine the impact of COVID-19 on vaccination adherence, 2,584 Dominicans completed an online survey on personal vaccination history and reasons for not getting vaccinated. In addition, they answered questions about the acceptance of the COVID-19 vaccine and the influence of the pandemic on their perception/adherence to vaccination. Most of those surveyed were not vaccinated during the pandemic, the main reason being: I had no vaccination scheduled for this year. This indicates that even though the pandemic made it difficult to access vaccination services, this was not the main barrier to immunization in the Dominican Republic in 2020. Despite the fact that most of the participants are in favor of vaccination, of the vaccines included in our study, the only one that reached the goal of the Global Vaccine Action Plan of achieving 90 por ciento vaccination coverage by 2020 was measles, mumps and rubella in children. The main barrier to immunization is forgetting to get vaccinated. It is necessary to adopt an effective reminder system to increase adherence and improve immunization rates(AU)

Whole-Genome Sequences of SARS-CoV-2 Isolates from the Dominican Republic.

Here, we report the genome sequences of five severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains that were obtained from symptomatic individuals with travel histories during community surveillance in the Dominican Republic in 2020. These sequences provide a starting point for further genomic studies of gene flow and molecular diversity in the Caribbean nation. Phylogenetic analysis suggests that all genomes correspond to the B.1 variant.