Pertussis infant morbidity and mortality trends after universal maternal immunisation in Mexico: An ecological database study with time-series analysis.

INTRODUCTION: Pertussis is a highly contagious infectious disease caused by Bordetella pertussis and a leading cause of infant mortality in Mexico. The Tetanus-diphtheria-acellular pertussis (Tdap) vaccine was recommended in the Mexican Immunisation Programme for pregnant women in 2013. We describe pertussis morbidity and mortality trends in infants ≤2 and ≤12 months of age), before and after maternal Tdap immunisation implementation in Mexico. METHODS: An ecological retrospective database study was performed in the Mexican National and Workers Social Security Institutes (IMSS; ISSSTE). Data were collected on confirmed pertussis ambulatory cases, hospitalisations, and deaths, plus vaccination coverage (Tdap; Diphtheria-tetanus-acellular pertussis [DTPa]) and population estimates. Descriptive and regression time-trend analyses were performed for pertussis morbidity and mortality in infants between pre- (2010-2012) and post- (2014-2018) maternal Tdap immunisation periods. RESULTS: Around 1 million infants a year are covered in IMSS/ISSSTE databases. Average full primary infant DTPa vaccine coverage was 71.4%-72.7% nationally. Since 2013, annual maternal Tdap vaccine coverage ranged from 70%-93%. Between 2010-2018, 2,024 pertussis cases, 2,518 hospitalisations and 71 deaths were reported in infants. Among infants 0-2 months old (maternal immunisation target group), there was a significant decrease, post-maternal vaccination, in pertussis incidence (49.9%, p < 0.000), hospitalisation (70.0%, p < 0.000) and mortality (82.4%, p = 0.003). In infants 0-12 months old, pertussis hospitalisations (28.9%, p = 0.000) and mortality (36.2%, p = 0.059) decreased, but incidence increased (61.8%, p = 0.000). CONCLUSION: After maternal immunisation was implemented, there was a decreasing trend in incidence, hospitalisation and death due to pertussis in infants 0-2 months old. Increases in incidence reported in 0-12-month-olds are likely due to major changes in diagnosis and reporting introduced during the study period as well as limited vaccination and health coverage in some states. These findings confirm the important contribution of the Tdap maternal immunisation programme in reducing pertussis disease burden, particularly severe disease, among infants in Mexico.

[Rapid immune response against hepatitis B using an accelerated intradermal vaccination schedule]. / Respuesta inmune rápida contra la hepatitis B mediante esquema acelerado de vacunación intradérmica.

OBJECTIVE: To analyze the prescription of antiviral and antibiotic agents in children with upper airway infection (UAI) during Influenza H1N1 epidemic. METHODS: A cross-section study (01/04/2009 to 31/03/2010) was performed. We analyzed the antiviral and antibiotic agents' prescription and its relation with the presence of the triad of symptom of suspicion (migraine, fever and cough) and the cost for attention (medicines and screening test). RESULTS: 838 children were attendance for UAI, 40.3% with the suspicion triad. In 733 patients, the screening test were done with 155 positive results (120 had the triad). All patient with a positive result received oseltamivir. During the first five months of the epidemic, the medical prescriptions were: antibiotics 60-85%, 0-7% anti-viral and 20-30% symptomatic drugs. At the 6th at 8th months (peak of outbreak) antibiotics 35-70%, anti-virals 20-25% and 10-30% symptomatic drugs. At final months (9th to 11th) antimicrobials 65-80%, anti-virals 20-30% and symptomatic 0-10%. The cost for URI attention increased a 27%. CONCLUSIONS: Medical prescription changed during the epidemic, with an increased in the anti-virals, especially for patients with high suspicion for influenza and positive screening test.

[Kawasaki disease: clinical behaviour and cardiovascular complications in children in a tertiary-care level hospital]. / Enfermedad de Kawasaki: comportamiento clínico y complicaciones cardiovasculares en niños atendidos en un hospital de tercer nivel.

OBJECTIVES: To describe the clinical characteristics, outcome, and treatment response in a series of patients with Kawasaki disease (KD). METHODS: Case-series, review of clinical records of children with KD diagnosis cared for from november 1999 to september 2006. RESULTS: 22 patients were included, male:female ratio, 1.4:1, 82% younger than 5 years, 14% with atypical presentation. Of the 22 patients, 10 (45%) received intravenous gammaglobulin (IVGG) in the first 10 days of symptoms onset at the recommended dose; four of them had coronary artery damage but none developed residual aneurysmatic lesions. Eight received IVGG in a different dose or after 10 days, six of them had coronary lesions and in two the damage was permanent. Four patients did not receive IVGG, and two had residual aneurysmatic lesions. None of those who received adequate treatment developed coronary residual damage, in comparison with 33% who received inadequate or no treatment, but difference was not statistically significant (P =.06). CONCLUSIONS: KD is a rare clinical entity in our country; even though most of the cases occurred with classic clinical criteria, late referral and delay of treatment worsen the prognosis.

[Perinatal infection by rubella virus in breast-fed babies with congenital heart disease]. / Infección perinatal por el virus de la rubéola en lactantes con cardiopatía congénita.

BACKGROUND: seroepidemiological surveys suggest that approximately 20 % of women of childbearing age are susceptible to rubella. It is necessary to detect congenital rubella cases. Our objective was to determine the frequency of perinatal infection by rubella virus (RV) in infants with congenital heart disease. METHODS: prospective, cross-sectional study. We studied hospitalized and outpatients from September 2007 to December 2008. Neonates and infants under one year of age with congenital heart disease were included. A blood sample of 3 mL was taken from mother-child binomial and micro-ELISA for IgG and IgM against rubella were performed. RESULTS: 80 patients were studied, 56 % were female, with a median age of 3 months. More frequent congenital heart disease was ventricular septal defect (28.5 %), followed by atrial septal defect (17.5 %). Median maternal age was 28 years old. A history of febrile illness and rash during pregnancy was positive in 1.25 %. 7 cases of perinatal infection by RV were detected, three met the criteria for congenital rubella syndrome, and four had only congenital heart disease. CONCLUSIONS: the search for cases of congenital rubella syndrome in newborns and infants with heart disease could be used as a strategy to detect non-obvious cases.

Introducción: las encuestas seroepidemiológicas sugieren que 20 % de las mujeres en edad fértil es susceptible a la rubéola. El objetivo de esta investigación fue determinar la frecuencia de infección perinatal por el virus de la rubéola en lactantes con cardiopatía congénita. Métodos: estudio prospectivo y transversal de niños menores de un año de edad con diagnóstico de cardiopatía congénita. Se tomaron 3 mL de sangre al binomio madre-hijo y se realizó ELISA de micropartículas para anticuerpos IgG e IgM contra la rubéola. Resultados: se estudiaron 80 pacientes con edad de tres meses; 56 % era del sexo femenino. Las cardiopatías congénitas más frecuentes fueron las comunicaciones interventricular (28.5 %) y la interauricular (17.5 %). La mediana de la edad materna fue de 28 años; 1.25 % de las madres tuvo antecedente de enfermedad febril y exantema durante el embarazo. Se detectaron siete casos (8.75 %) de infección perinatal por el virus de la rubéola, tres cumplieron el criterio de síndrome de rubéola congénita y cuatro de cardiopatía. Conclusiones: se sugiere buscar rubéola congénita en los recién nacidos y lactantes con cardiopatías, como una estrategia para detectar los casos no obvios.

Enfermedad de Kawasaki: comportamiento clínico y complicaciones cardiovasculares en niños atendidos en un hospital de tercer nivel / Kawasaki disease: clinical behaviour and cardiovascular complications in children in a tertiary-care level hospital

OBJECTIVES: To describe the clinical characteristics, outcome, and treatment response in a series of patients with Kawasaki disease (KD). METHODS: Case-series, review of clinical records of children with KD diagnosis cared for from november 1999 to september 2006. RESULTS: 22 patients were included, male:female ratio, 1.4:1, 82% younger than 5 years, 14% with atypical presentation. Of the 22 patients, 10 (45%) received intravenous gammaglobulin (IVGG) in the first 10 days of symptoms onset at the recommended dose; four of them had coronary artery damage but none developed residual aneurysmatic lesions. Eight received IVGG in a different dose or after 10 days, six of them had coronary lesions and in two the damage was permanent. Four patients did not receive IVGG, and two had residual aneurysmatic lesions. None of those who received adequate treatment developed coronary residual damage, in comparison with 33% who received inadequate or no treatment, but difference was not statistically significant (P =.06). CONCLUSIONS: KD is a rare clinical entity in our country; even though most of the cases occurred with classic clinical criteria, late referral and delay of treatment worsen the prognosis.