Burden of varicella in Latin America and the Caribbean: findings from a systematic literature review.

BACKGROUND: Varicella is typically mild and self-limiting, but can be associated with complications and even death. The limited data available on varicella in Latin America and the Caribbean (LAC) indicate substantial burden in countries where varicella vaccine is not part of publicly funded childhood national immunization programs. METHODS: A systematic literature review of published studies was complemented by "gray" literature on varicella incidence, complications, mortality, and economic consequences, in the absence and presence of universal varicella vaccination (UVV) in LAC. RESULTS: Seroprevalence data indicate that varicella is usually a disease of childhood in LAC. Varicella incidence rates, while unreliable in the absence of mandatory reporting, show a trend to increased incidence due to greater urbanization and population density. The introduction of UVV in national immunization programs has led to significant reductions in varicella incidence in these areas. CONCLUSIONS: Varicella continues to pose a substantial healthcare burden in LAC. The future introduction of UVV in additional countries is predicted to provide substantial reductions in cases, with important economic benefits. For countries that have already implemented UVV, the challenge is to maintain high rates of coverage and, where relevant, consider inclusion of a second dose to reduce breakthrough cases. Given the significant proportion of the region now implementing UVV, a regional recommendation in order to prevent any potential for age-shifts in varicella infection might be considered.

Efficacy, immunogenicity, and safety of a 9-valent human papillomavirus vaccine in Latin American girls, boys, and young women.

BACKGROUND: A 9-valent human papillomavirus (HPV6/11/16/18/31/33/45/52/58; 9vHPV) vaccine was developed to expand coverage of the previously developed quadrivalent (HPV6/11/16/18; qHPV) vaccine. METHODS: Efficacy, immunogenicity, and safety outcomes were assessed in Latin American participants enrolled in 2 international studies of the 9vHPV vaccine, including a randomized, double-blinded, controlled with qHPV vaccine, efficacy, immunogenicity, and safety study in young women aged 16-26 years, and an immunogenicity and safety study in girls and boys aged 9-15 years. Participants (N=5312) received vaccination at Day 1, Month 2, and Month 6. Gynecological swabs were collected regularly in young women for cytological and HPV DNA testing. Serum was analyzed for HPV antibodies in all participants. Adverse events (AEs) were also monitored in all participants. RESULTS: The 9vHPV vaccine prevented HPV 31-, 33-, 45-, 52-, and 58-related high-grade cervical, vulvar, and vaginal dysplasia with 92.3% efficacy (95% confidence interval 54.4, 99.6). Anti-HPV6, 11, 16, and 18 geometric mean titers at Month 7 were similar in the 9vHPV and qHPV vaccination groups. Anti-HPV antibody responses following vaccination were higher among girls and boys than in young women. Most (>99%) 9vHPV vaccine recipients seroconverted for all 9 HPV types at Month 7. Antibody responses to the 9 HPV types persisted over 5 years. The most common AEs were injection-site related, mostly of mild to moderate intensity. CONCLUSIONS: The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Latin American young women, girls, and boys. These data support 9vHPV vaccination programs in Latin America, a region with substantial cervical cancer burden.

Burden of genital warts in Colombia: an observational study / Carga das verrugas genitais na Colômbia: um estudo observacional

Introduction: Genital warts are benign lesions caused by sexual transmission of human papillomavirus types 6 and 11, with significant impact on healthcare resource use and patients' quality of life. Objective: To describe the epidemiology of genital warts in adults visiting a physician office for any reason, physician practice patterns, and healthcare resource use and costs in Colombia. Methods: Participants were a convenience sample of 53 physicians in 5 specialties: primary care (15), gynecology (24), urology (12), proctology (1), and dermatology (1). Physicians completed a survey and daily log of all patients 18-60 years old seen over 10 days in their practices in 2016-2017. The physician survey recorded genital warts consultation and management patterns. The daily log recorded patient demographic information and genital warts diagnosis. Results: Among 6,393 patients logged by physicians, the genital warts prevalence was 2.03% (95%CI 1.69­2.38) and incidence 1.30% (95%CI 1.02­1.58). Primary care physicians referred most of their genital warts cases for treatment (female: mean 63.3%, SD=44.8; male: mean 58.3%, SD=43.8). Treatment of non-resistant episodes (<6-month duration) lasted an average of 37.4 days (SD=29.4) and required an average of 4.0 (SD=1.9) office visits for females and 3.0 (SD=1.7) for males. The overall mean cost of an episode of care was USD558.13 (SD=507.30). Conclusion: Genital warts cases reported by most participant physicians were mainly direct-consult, but patients were typically treated by specialists. Much of the genital warts health care utilization and costs reported could be prevented by immunization with the quadrivalent or nonavalent HPV vaccine.

Introdução: As verrugas genitais são lesões benignas, de transmissão sexual, causadas pelo papilomavírus humano tipos 6 e 11 e que causam impacto significativo no uso de recursos de saúde e na qualidade de vida dos pacientes. Objetivo: Descrever a epidemiologia das verrugas genitais em adultos que buscaram atendimento médico ambulatorial por qualquer motivo, incluindo padrões de prática médica, uso de recursos de saúde e custos na Colômbia. Métodos: foi utilizada uma amostra de conveniência composta por 53 médicos em 5 especialidades: clínico geral (15), ginecologia (24), urologia (12), proctologia (1) e dermatologia (1). Os médicos completaram um questionário e registros diários de todos os pacientes com idade entre 18 e 60 anos atendidos durante 10 dias em seus consultórios em 2016-2017. O questionário registrou os padrões de prática médica e de tratamento de verrugas genitais. Os registros diários continham informações demográficas do paciente e o diagnóstico de verrugas genitais. Resultados: Entre 6.393 atendimentos médicos, a prevalência das verrugas genitais foi de 2,03% (IC95% 1,69­2,38) e a incidência de 1,30% (IC95% 1,02­1,58). Os clínicos gerais encaminharam a maioria dos pacientes com verrugas genitais para tratamento (mulheres: média de 63,3%, DP=44,8; homens: média de 58,3%, DP=43,8). O tratamento dos casos não-persistentes (<6 meses de duração) durou em média 37,4 dias (DP=29,4) e requereu uma média de 4,0 (DP=1,9) consultas para mulheres e 3,0 (DP=1,7) para homens. O custo médio geral do tratamento foi de US$ 558,13 (SD=507,30). Conclusão: Os casos de verrugas genitais relatados pela maioria dos médicos participantes derivaram-se principalmente de atendimentos primários e os pacientes foram tratados geralmente por especialistas. Grande parte da utilização de recursos e custos relacionados a verrugas genitais poderia ser evitada pela imunização com a vacina papilomavírus humano 4-valente ou 9-valente.

Burden of genital warts in Ecuador: an observational study in the practice of physicians / Carga das verrugas genitais no Equador: estudo observacional sobre a clínica médica

Introduction: Human papillomavirus types 6 and 11 cause 90% of genital warts. Although the epidemiology of cervical cancer and the distribution of human papillomavirus genotypes have been investigated in Ecuador, little is known about the occurrence of genital warts. Objective: To estimate the incidence and prevalence of genital warts among patients routinely presenting at the practice of physicians, describe the demographics of genital warts cases and highlight the physician specialties that treat genital warts, including patterns of consultation and referral in Ecuador. Methods: Participants were a convenience sample of physicians who treat and/or diagnose genital warts in their practices. Physicians completed a daily log, recording the demographics and diagnosis of genital warts in all patients aged 18 to 60 years seen over 10 days in their practices. Physicians then completed a survey recording their practice characteristics and referral patterns of genital warts. Results: A sample of 105 physicians of different specialties participated in the study. Among 12,133 patients, the prevalence of genital warts was 5.5%, and the incidence, 3.7%. Prevalence was 6.9% in men, peaking at 12.6% in those aged from 25 to 29 years old. Prevalence was 5.1% for females, peaking at 6.5% in those aged from 30 to 34 years old. Most women were seen in direct consultations (75%) rather than by referral ones (24%). Most physicians (72%) treated females with genital warts, except for primary care physicians, who referred most cases (88%). Conclusion: Cases of genital warts are frequently encountered by physicians in Ecuador and are typically treated by specialists rather than primary care physicians.

Introdução: Os tipos 6 e 11 do papilomavírus humano causam 90% das verrugas genitais. Embora a epidemiologia do câncer do colo do útero e a distribuição dos genótipos do papilomavírus humano tenham sido investigadas no Equador, pouco se sabe sobre a ocorrência das verrugas genitais. Objetivo: Estimar a incidência e a prevalência das verrugas genitais em pacientes atendidos rotineiramente na clínica médica, descrever os dados demográficos dos casos de verrugas genitais e determinar as especialidades médicas que tratam as verrugas genitais, incluindo os padrões de consulta e encaminhamento no Equador. Métodos: Foi realizada uma amostragem por conveniência com médicos que tratavam e/ou diagnosticam verrugas genitais em sua clínica médica. Os médicos registraram as suas atividades cotidianas em um diário, anotando dados demográficos e diagnóstico de verrugas genitais de todos os pacientes com idade entre 18 e 60 anos atendidos durante 10 dias em suas clínicas. Posteriormente, os médicos responderam a uma pesquisa sobre as características da conduta tomada e os padrões de encaminhamento médico das verrugas genitais. Resultados: Uma amostra de 105 médicos de diferentes especialidades participou do estudo. Entre 12.133 pacientes, a prevalência de verrugas genitais foi de 5,5% e a incidência foi de 3,7%. A prevalência foi de 6,9% no sexo masculino, atingindo o valor máximo de 12,6% na faixa etária de 25 a 29 anos. A prevalência foi de 5,1% para o sexo feminino, alcançando 6,5% entre 30 e 34 anos. Na maior parte dos casos, as mulheres foram tratadas predominantemente pelo médico que realizou o primeiro atendimento (75%) e não por meio de encaminhamento a outra especialidade (24%). A maioria dos médicos (72%) tratou mulheres com verrugas genitais, exceto os médicos de atenção primária, que em geral encaminharam os casos (88%). Conclusão: Casos de verrugas genitais são frequentemente diagnosticados por médicos no Equador e são mais frequentemente tratados por especialistas do que por médicos de atenção primária.

Long-term safety and efficacy results of once-daily emtricitabine-based highly active antiretroviral therapy regimens in human immunodeficiency virus-infected pediatric subjects.

OBJECTIVES: The purpose of this work was to obtain long-term safety and efficacy data for antiretroviral regimens containing emtricitabine in HIV-infected pediatric subjects and confirm that a pediatric dose of 6 mg/kg once daily would provide steady-state emtricitabine concentrations comparable to those observed in adults given 200 mg of emtricitabine once daily. PATIENTS AND METHODS: HIV-infected subjects between 3 months and 16 years of age were enrolled, including 71 antiretroviral-naïve subjects and 45 antiretroviral-experienced subjects. Naive subjects received emtricitabine plus stavudine plus lopinavir or ritonavir. Experienced subjects replaced the lamivudine in their existing regimens with emtricitabine. Tolerance, safety, disease progression, and virologic and immunologic responses were evaluated. RESULTS: The Kaplan-Meier probability of persistent virologic response in the intent-to-treat population through week 164 at < or = 400 copies per mL and < or = 50 copies per mL was 74% and 62%, respectively. Three subjects (3%) discontinued the study for adverse events, 8 (7%) for virologic failure, and 1 died through a median follow-up of 164 weeks. The annualized incidence rate of grade 3 to 4 adverse events and grade 3 to 4 laboratory abnormalities was 6% and 3%, respectively. The annualized incidence rate of serious adverse events was 9%, with 1% attributed as related to emtricitabine. Genotypic analysis showed the emergence of the M184V mutation in 4 of the 15 subjects who experienced virologic failure through week 164. Pharmacokinetic evaluation demonstrated plasma drug exposures in these children comparable to adults receiving the approved dose of 200 mg once daily. CONCLUSIONS: These results demonstrate the safety and efficacy of emtricitabine in pediatric patients. They also support that the safety and efficacy profile of emtricitabine in children is similar to that demonstrated in adults.

Lesiones orales en niños VIH+/SIDA bajo dos diferentes tipos de terapias antirretrovirales / HIV/AIDS-associated oral lesions in children treatment with two anti-retroviral schemes

Introducción. Pacientes adultos VIH+/SIDA bajo terapia antirretroviral altamente activa (TAAA) que incluya inhibidores de proteasa VIH-1, muestran disminución de infecciones oportunistas, desconociéndose si las lesiones orales de niños VIH+/SIDA bajo TAAA muestran esta asociación. Objetivo: determinar si los niños VIH+/SIDA bajo TAAA muestran disminución de lesiones orales.Material y métodos. Veintiocho niños VIH+/SIDA (Clínica de Inmunodeficiencia, Hospital Infantil de México Federico Gómez) fueron incluidos en este estudio; 16 pacientes estuvieron bajo tratamiento con AZT+3TC+ritonavir, y 12 pacientes con tratamiento DDI+D4T. Todos los pacientes fueron oralmente examinados al inicio, 6 y 12 meses de tratamiento, determinándose la prevalencia de lesiones orales. Análisis estadístico: X2, exacta de Fisher, X2 de Mantel-Haenszel para tendencias.Resultados. Grupo AZT+3TC+ritonavir: prevalencia de lesiones orales: inicial=25 por ciento; 6 meses=12.5 por ciento, 12 meses=31.2 por ciento. Grupo DDI+D4T: prevalencia inicial de lesiones orales=41.6 por ciento; 6 meses=50 por ciento: 12 meses=33.3 por ciento. X2 de Mantel-Haenszel=4.3 (P=0.037).Conclusiones. Los niños VIH+/SIDA bajo TAAA aparentemente muestran disminución de lesiones orales.