Seizures following COVID-19 vaccination in Mexico: A nationwide observational study.

The COVID-19 pandemic led to the development and emergency approval of an array of effective vaccines against SARS-CoV-2. Given the relatively small number of patients included in vaccine trials, postapproval epidemiological surveillance is crucial to detect infrequent vaccine-related adverse events. We conducted a nationwide retrospective descriptive study evaluating the incidence of seizures among recipients of SARS-CoV-2 vaccines in Mexico from December 24, 2020 (date of administration of first doses nationwide) to October 29, 2021. Among 81 916 351 doses of any vaccine that were administered, we documented seizures in 53 patients, of which 31 (60%) were new onset seizures. The incidence rate of seizures per million doses was highest for mRNA-1273 (Moderna) with 2.73 per million, followed by BNT162b2 (Pfizer-BioNTech) with 1.02 per million, and Ad5-nCoV (CanSino) with 1.01 per million. Thus, we found that seizures following SARS-CoV-2 vaccination are exceedingly rare events.

Incidence of Guillain-Barré syndrome following SARS-CoV-2 immunization: Analysis of a nationwide registry of recipients of 81 million doses of seven vaccines.

BACKGROUND AND PURPOSE: Information on Guillain-Barré syndrome (GBS) as an adverse event following immunization (AEFI) against SARS-CoV-2 remains scarce. We aimed to report GBS incidence as an AEFI among adult (≥18 years) recipients of 81,842,426 doses of seven anti-SARS-CoV-2 vaccines between December 24, 2020, and October 29, 2021, in Mexico. METHODS: Cases were retrospectively collected through passive epidemiological surveillance. The overall observed incidence was calculated according to the total number of administered doses. Vaccines were analyzed individually and by vector as mRNA-based (mRNA-1273 and BNT162b2), adenovirus-vectored (ChAdOx1 nCov-19, rAd26-rAd5, Ad5-nCoV, and Ad26.COV2-S), and inactivated whole-virion-vectored (CoronaVac) vaccines. RESULTS: We identified 97 patients (52 males [53.6%]; median [interquartile range] age 44 [33-60] years), for an overall observed incidence of 1.19/1,000,000 doses (95% confidence interval [CI] 0.97-1.45), with incidence higher among Ad26.COV2-S (3.86/1,000,000 doses, 95% CI 1.50-9.93) and BNT162b2 recipients (1.92/1,00,000 doses, 95% CI 1.36-2.71). The interval (interquartile range) from vaccination to GBS symptom onset was 10 (3-17) days. Preceding diarrhea was reported in 21 patients (21.6%) and mild COVID-19 in four more (4.1%). Only 18 patients were tested for Campylobacter jejuni (positive in 16 [88.9%]). Electrophysiological examinations were performed in 76 patients (78.4%; axonal in 46 [60.5%] and demyelinating in 25 [32.8%]); variants were similar across the platforms. On admission, 91.8% had a GBS disability score ≥3. Seventy-five patients (77.3%) received intravenous immunoglobulin, received seven plasma exchange (7.2%), and 15 (15.5%) were treated conservatively. Ten patients (10.3%) died, and 79.1% of survivors were unable to walk independently. CONCLUSIONS: Guillain-Barré syndrome was an extremely infrequent AEFI against SARS-CoV-2. The protection provided by these vaccines outweighs the risk of developing GBS.

Neurologic adverse events among 704,003 first-dose recipients of the BNT162b2 mRNA COVID-19 vaccine in Mexico: A nationwide descriptive study.

mRNA vaccines against SARS-CoV-2 are remarkably effective. Limited information exists about the incidence of adverse events following immunization (AEFI) with their use. We conducted a prospective observational study including data from 704,003 first-doses recipients; 6536 AEFI were reported, of whom 65.1% had at least one neurologic AEFI (non-serious 99.6%). Thirty-three serious events were reported; 17 (51.5%) were neurologic (observed frequency, 2.4/100,000 doses). At the time of writing this report, 16/17 cases had been discharged without deaths. Our data suggest that the BNT162b2 mRNA COVID-19 vaccine is safe; its individual and societal benefits outweigh the low percentage of serious neurologic AEFI. This information should help to dissipate hesitancy towards this new vaccine platform.

Full genome sequence of the first SARS-CoV-2 detected in Mexico.

SARS-CoV-2 was first detected in the city of Wuhan, Hubei Province, China. In this report, we describe the complete genome sequence of the first imported SARS-CoV-2, detected in a Mexican patient who had traveled to Bergamo, Italy. Phylogenetic analysis showed that this isolate belongs to subclade A2a (lineage G) and is closely related to isolates from Finland, Germany and Brazil, all of which were from patients with a history of travel to Italy. This is the first report of the complete genome sequence of this virus in Mexico.

Study protocol for the multicentre cohorts of Zika virus infection in pregnant women, infants, and acute clinical cases in Latin America and the Caribbean: the ZIKAlliance consortium.

BACKGROUND: The European Commission (EC) Horizon 2020 (H2020)-funded ZIKAlliance Consortium designed a multicentre study including pregnant women (PW), children (CH) and natural history (NH) cohorts. Clinical sites were selected over a wide geographic range within Latin America and the Caribbean, taking into account the dynamic course of the ZIKV epidemic. METHODS: Recruitment to the PW cohort will take place in antenatal care clinics. PW will be enrolled regardless of symptoms and followed over the course of pregnancy, approximately every 4 weeks. PW will be revisited at delivery (or after miscarriage/abortion) to assess birth outcomes, including microcephaly and other congenital abnormalities according to the evolving definition of congenital Zika syndrome (CZS). After birth, children will be followed for 2 years in the CH cohort. Follow-up visits are scheduled at ages 1-3, 4-6, 12, and 24 months to assess neurocognitive and developmental milestones. In addition, a NH cohort for the characterization of symptomatic rash/fever illness was designed, including follow-up to capture persisting health problems. Blood, urine, and other biological materials will be collected, and tested for ZIKV and other relevant arboviral diseases (dengue, chikungunya, yellow fever) using RT-PCR or serological methods. A virtual, decentralized biobank will be created. Reciprocal clinical monitoring has been established between partner sites. Substudies of ZIKV seroprevalence, transmission clustering, disabilities and health economics, viral kinetics, the potential role of antibody enhancement, and co-infections will be linked to the cohort studies. DISCUSSION: Results of these large cohort studies will provide better risk estimates for birth defects and other developmental abnormalities associated with ZIKV infection including possible co-factors for the variability of risk estimates between other countries and regions. Additional outcomes include incidence and transmission estimates of ZIKV during and after pregnancy, characterization of short and long-term clinical course following infection and viral kinetics of ZIKV. STUDY REGISTRATIONS: clinicaltrials.gov NCT03188731 (PW cohort), June 15, 2017; clinicaltrials.gov NCT03393286 (CH cohort), January 8, 2018; clinicaltrials.gov NCT03204409 (NH cohort), July 2, 2017.

Sífilis congénita en México. Análisis de las normas nacionales e internacionales desde la perspectiva del diagnóstico de laboratorio.

INTRODUCTION: Congenital syphilis continues to be a public health problem in Mexico. OBJECTIVE: To assess the similarities and differences between national standards, guidelines and international documents related to the detection of syphilis in pregnant women and congenital syphilis. METHOD: Two algorithms were developed based on the standard of female care during pregnancy and on the standard for prevention and control of sexually transmitted infections. Based on the Centers for Disease Control (CDC) guidelines, algorithms were developed for syphilis during pregnancy, syphilis in the newborn and sexual contacts. RESULTS: The standard for pregnancy mentions that syphilis testing should be carried out in every pregnant woman on her first contact or at delivery, without diagnostic tests being specified. The Official Mexican Standard (NOM) on sexually transmitted infections mentions the traditional algorithm for syphilis detection, treatment follow-up, coinfection with human immunodeficiency virus and congenital syphilis criteria. The CDC recommend reverse algorithm, antibody titer, treatment and follow-up as part of diagnosis. CONCLUSIONS: The elimination of mother-to-child transmission of syphilis requires NOMs updating and homogenizing, as well as the study of stillbirths and neonates born to mothers with syphilis.

INTRODUCCIÓN: La sífilis congénita continúa siendo un problema de salud pública en México. OBJETIVO: Evaluar las similitudes y diferencias entre normas nacionales, guías y documentos internacionales relacionados con la detección de sífilis en embarazadas y sífilis congénita. MÉTODO: Se elaboraron dos algoritmos basados en las normas sobre atención de la mujer durante el embarazo y sobre prevención y control de infecciones de transmisión sexual. A partir de la guía de Centers for Disease Control and Prevention (CDC) se realizaron algoritmos sobre sífilis durante el embarazo, sífilis en recién nacido y contactos sexuales. RESULTADOS: La norma sobre embarazo menciona que la prueba de sífilis debe efectuarse a toda mujer embarazada en su primer contacto o durante el parto, sin especificar pruebas diagnósticas. La norma oficial mexicana (NOM) sobre infecciones de transmisión sexual menciona el algoritmo tradicional para detección de sífilis, seguimiento al tratamiento, coinfección con virus de inmunodeficiencia humana y criterios de sífilis congénita. CDC recomienda algoritmo reverso, título de anticuerpos, tratamiento y seguimiento como parte del diagnóstico. CONCLUSIONES: La eliminación de la transmisión maternoinfantil de sífilis requiere actualizar y homogeneizar las NOM, así como el estudio de mortinatos y de recién nacidos de madres con sífilis.

Congenital syphilis in Mexico. Analysis of national and international standards from the perspective of laboratory diagnosis.

INTRODUCTION: Congenital syphilis continues to be a public health problem in Mexico. OBJECTIVE: To assess the similarities and differences between national standards, guidelines and international documents related to the detection of syphilis in pregnant women and congenital syphilis. METHOD: Two algorithms were developed based on the standard of female care during pregnancy and on the standard for prevention and control of sexually transmitted infections. Based on the Centers for Disease Control (CDC) guidelines, algorithms were developed for syphilis during pregnancy, syphilis in the newborn and sexual contacts. RESULTS: The standard for pregnancy mentions that syphilis testing should be carried out in every pregnant woman on her first contact or at delivery, without diagnostic tests being specified. The Official Mexican Standard (NOM) on sexually transmitted infections mentions the traditional algorithm for syphilis detection, treatment follow-up, coinfection with human immunodeficiency virus and congenital syphilis criteria. The CDC recommend reverse algorithm, antibody titer, treatment and follow-up as part of diagnosis. CONCLUSIONS: The elimination of mother-to-child transmission of syphilis requires NOMs updating and homogenizing, as well as the study of stillbirths and neonates born to mothers with syphilis.

Zika virus infection estimates, Mexico.

OBJECTIVE: To assess the magnitude of the Mexican epidemic of Zika virus infection and the associated risk of microcephaly. METHODS: From the reported number of laboratory-confirmed symptomatic infections among pregnant women and the relevant birth rate, we estimated the number of symptomatic cases of infection that occurred in Mexico between 25 November 2015, when the first confirmed Mexican case was reported, and 20 August 2016. We used data from the birth certificates to compare mean monthly incidences of congenital microcephaly before (1 January 2010-30 November 2015) and after (1 December 2015-30 September 2017) the introduction of Zika virus, stratifying the data according to whether the mother's place of residence was at an altitude of at least 2200 m above sea level. We used Poisson interrupted time series, statistical modelling and graphical analyses. FINDINGS: Our estimated number of symptomatic cases of infection that may have occurred in the general population of Mexico between 25 November 2015 and 20 August 2016, 60 172, was 7.3-fold higher than the corresponding number of reported cases. The monthly numbers of microcephaly cases per 100 000 live births were significantly higher after the introduction of the virus than before (incidence rate ratio, IRR: 2.9; 95% confidence interval, CI: 2.3 to 3.6), especially among the babies of women living at altitudes below 2200 m (IRR: 3.4; 95% CI: 2.9 to 3.9). CONCLUSION: The Mexican epidemic appears to be much larger than indicated by estimates based solely on counts of laboratory-confirmed cases, and to be associated with significantly increased risk of microcephaly.

The hidden burden of Chikungunya in central Mexico: results of a small-scale serosurvey.

OBJECTIVE: To estimate the seroprevalence of CHKV antibodies and assess correlates of seropositivity at a small geographical scale. MATERIALS AND METHODS: A community-based serosurvey of 387 households in Puente de Ixtla, Morelos (central Mexico). Serum IgG antibodies to CHKV were detected by immunoassay. RESULTS: From 27 April to 29 May 2016, we interviewed and collected blood samples from 387 individuals at the same number of households. A total of 114 (29.5%) participants were seropositive to CHK, 36 (31.6%) of them reported no symptoms of CHKV infection within 12 months before the survey. CONCLUSIONS: The estimated seroprevalence to CHKV antibodies was higher than expected by the small number of confirmed cases of CHKV infection reported in Mexico by the National Surveillance System.

The 2009 pandemic in Mexico: Experience and lessons regarding national preparedness policies for seasonal and epidemic influenza.

Influenza is a viral respiratory disease capable of causing epidemics that represent a threat for global security. Mexico was the first country to notify the WHO of an outbreak of what later became the first influenza pandemic of the 21st Century, caused by the virus A(H1N1)2009. Before this event Mexico had a national pandemic influenza preparedness plan, which included seasonal influenza vaccination, stockpiles of personal protection equipment and strategic drugs, and risk communication strategies. During the epidemic, the national public health laboratory network and case surveillance systems were strengthened together with surge capacities for intensive care and delivery of antiviral drugs. Risk communication was conducted for people to comply with implemented measures regarding social distancing (workplace and school closures, household quarantine). This report describes the Mexican experience during the 2009 influenza pandemic and the lessons that this experience provides to public health preparedness for future pandemics.

Chikugunya and zika virus dissemination in the Americas: different arboviruses reflecting the same spreading routes and poor vector-control policies.

PURPOSE OF REVIEW: This review gathers the most recent investigations about chikungunya and zika viruses in America and would help in creating new research approaches. RECENT FINDINGS: Clinical descriptions of chikungunya fever have been performed in the American outbreak observing that fever, polyarthalgia, myalgia and rash are the most common symptoms in the acute phase, while chronic arthralgia has persisted in 37-90% of small cohorts. The Asian origin of American strains of chikungunya virus (CHIKV) and zika virus (ZIKV) evidences a dissemination route in common and both are being transmitted by Aedes aegypti. Regarding zika fever, the association of congenital malformations with previous ZIKV exposure of pregnant women and potential sexual transmission of ZIKV are the most important discoveries in the New World. SUMMARY: Massive outbreaks of chikungunya fever in 2014 and then followed by zika fever epidemics of lower magnitude in the next year throughout the American continent have their origins in Asia but may have used Pacific Islands as a path of dissemination. Reports of chronic arthralgia have been little described in the continent and more research is needed to measure the economic and health impact in patients who contracted CHIKV before. On the contrary, zika is menacing newborns' health because of its link with congenital microcephaly and sexual health by prolonged presence of viral particles in semen and urine.

Dengue vaccine: local decisions, global consequences.

As new vaccines against diseases that are prevalent in low- and middle-income countries gradually become available, national health authorities are presented with new regulatory and policy challenges. The use of CYD-TDV - a chimeric tetravalent, live-attenuated dengue vaccine - was recently approved in five countries. Although promising for public health, this vaccine has only partial and heterogeneous efficacy and may have substantial adverse effects. In trials, children who were aged 2-5 years when first given CYD-TDV were seven times more likely to be hospitalized for dengue, in the third year post-vaccination, than their counterparts in the control group. As it has not been clarified whether this adverse effect is only a function of age or is determined by dengue serostatus, doubts have been cast over the long-term safety of this vaccine in seronegative individuals of any age. Any deployment of the vaccine, which should be very cautious and only considered after a rigorous evaluation of the vaccine's risk-benefit ratio in explicit national and subnational scenarios, needs to be followed by a long-term assessment of the vaccine's effects. Furthermore, any implementation of dengue vaccines must not weaken the political and financial support of preventive measures that can simultaneously limit the impacts of dengue and several other mosquito-borne pathogens.

À mesure que de nouveaux vaccins contre des maladies très répandues dans les pays à revenu faible et intermédiaire deviennent disponibles, les autorités sanitaires nationales sont confrontées à de nouveaux défis règlementaires et politiques. L'utilisation du CYD-TDV, un vaccin vivant atténué, chimérique et tétravalent contre la dengue, a récemment été approuvée dans cinq pays. Bien qu'il soit prometteur pour la santé publique, ce vaccin n'a qu'une efficacité partielle et hétérogène et pourrait avoir d'importants effets indésirables. Dans les essais, les enfants âgés de 2 à 5 ans lors de la première administration du CYD-TDV avaient sept fois plus de risques d'être hospitalisés pour la dengue au cours de la troisième année après la vaccination que leurs homologues du groupe témoin. Comme il n'a pas été précisé si cet effet indésirable est uniquement lié à l'âge ou s'il est déterminé par le statut sérologique de la dengue, des doutes planent sur l'innocuité à long terme de ce vaccin chez les personnes séronégatives de tout âge. Tout déploiement de ce vaccin, qui devrait se faire de manière très prudente et réfléchie, après une évaluation rigoureuse du rapport bénéfices-risques dans des scénarios nationaux et sous-nationaux explicites, devrait être suivi par une évaluation à long terme de ses effets. En outre, la vaccination contre la dengue ne doit pas fragiliser le soutien politique et financier en faveur de mesures préventives, qui peuvent dans le même temps limiter l'impact de la dengue et de plusieurs autres pathogènes transmis par les moustiques.

A medida que nuevas vacunas contra enfermedades prevalentes en países con ingresos bajos y medios están cada vez más disponibles, las autoridades sanitarias nacionales se enfrentan a nuevos desafíos legislativos y políticos. Recientemente, cinco países han aprobado el uso de la CYD-TDV, una vacuna contra el dengue quimérica tetravalente de virus vivos atenuados. A pesar de ser prometedora para la salud pública, esta vacuna sólo tiene una eficacia parcial y heterogénea, y puede presentar efectos enormemente perjudiciales. En los ensayos, los niños de entre 2 y 5 años tratados con CYD-TDV por primera vez tuvieron una probabilidad de ser hospitalizados por el dengue, durante el tercer año tras la administración de la vacuna, siete veces mayor que sus homólogos del grupo de control. Dado que no se ha aclarado si este efecto perjudicial es únicamente cuestión de edad o si está determinado por el estado serológico del dengue, se ha puesto en duda la seguridad a largo plazo de esta vacuna en individuos seronegativos de cualquier edad. La vacuna, que debería administrarse con precaución y tenerse en consideración únicamente tras una evaluación rigurosa del coeficiente de riesgo y beneficio de la misma en escenarios nacionales y subnacionales concretos, debe ser objeto de seguimiento a largo plazo para evaluar sus efectos. Asimismo, la implementación de las vacunas contra el dengue no debe debilitar el apoyo político y financiero a medidas preventivas que puedan limitar los impactos del dengue y, al mismo tiempo, varios patógenos transmitidos por picaduras de mosquitos.

Risk factors for severe disease and mortality in children with COVID-19.

Background: Pediatric COVID-19 patients have lower rates of hospitalization and fatal outcomes compared to adults with COVID-19; however, children represent a challenge in the detection, diagnosis, and treatment of COVID-19. Our aim was to determine the risk factors for hospital admission, invasive mechanical ventilation, and mortality in pediatric COVID-19 patients in Mexico during the COVID-19 pandemic. Material and methods: A retrospective cohort of pediatric patients with COVID-19 from February 2020 to April 2021 was reported on the National Epidemiological Surveillance System for Viral Respiratory Disease (SISVER) platform. Results: Among the 104,133 patients included in our study, 6214 were hospitalized, and 621 patients underwent invasive mechanical ventilation. A total of 0.65 % died during hospitalization. Children aged <12 months (odds ratio [OR]: 17.1; 95 % confidence interval [CI]: 15.9-19.4, p < 0.001), 1-4 years (OR: 3.69; 95 % CI: 3.2-4.1, p < 0.001), 5-9 years (OR: 1.86; 95 % CI: 1.66-2.08, p < 0.001), and 10-14 years (OR: 1.23; 95 % CI: 1.11-1.37, p < 0.001), and those diagnosed with diabetes (OR: 2.32; 95 % CI 1.68-3.20, p < 0.001) and obesity (OR: 1.24; 95 % CI 1.04-1.48, p = 0.015) were associated with hospital admission. Renal disease (OR: 3.85; 95 % CI: 2.25-6.59, p < 0.001) was associated with invasive mechanical ventilation. Pneumonia (OR: 15.9; 95 % CI: 12.6-20.1, p < 0.001) and renal disease (OR: 3.85; 95 % CI: 2.25-6.59, p value < 0.001) were associated with death. Conclusion: Pneumonia increases the risk of death. The youngest age group has a higher risk of hospital admission. Comorbidities such as renal disease or immunosuppression increase the risk of death in all age groups.

Clinical features and outcomes of mpox in people with and without HIV: a national comparative study.

BACKGROUND: People who live with HIV (PWLH) have been one of the most affected groups during the current mpox outbreak. They are hypothesized to have a more severe clinical course than people without HIV but comparative data is scarce. We aimed to compare clinical features and outcomes of mpox in people with and without HIV in Mexico. SETTING: Country-wide study in Mexico. METHODS: We performed an observational study using nation-wide epidemiological data. We included all people with confirmed mpox diagnosed between May and November 2022 in Mexico. Clinical and sociodemographic characteristics were compared between people with and without HIV. Multivariable logistic regression models were preformed to determine the association between HIV, clinical features, and outcomes and reported with odds ratios (ORs) and 95% confidence intervals (95% CI). ORs for rare outcomes were interpreted as risk ratios. RESULTS: Among 3291 people with mpox, 59% were PWLH. PWLH had an increased risk of severe mpox (OR 2.6, 2.4-2.9) and death (OR 10.8, 9.7-11.9). They also had a higher risk of otalgia, proctitis, and urethritis. Eleven individuals died, of whom ten were PWLH. All deaths were directly attributed to mpox. CONCLUSION: People with HIV have a higher risk of severe mpox and death due to mpox.

Multidrug-resistant tuberculosis among patients in Baja California, Mexico, and Hispanic patients in California.

OBJECTIVES: We sought to compare prevalence and determinants of multidrug-resistant tuberculosis (MDR-TB) between tuberculosis patients in Baja California, Mexico, and Hispanic patients in California. METHODS: Using data from Mexico's National TB Drug Resistance Survey (2008-2009) and California Department of Public Health TB case registry (2004-2009), we assessed differences in MDR-TB prevalence comparing (1) Mexicans in Baja California, (2) Mexico-born Hispanics in California, (3) US-born Hispanics in California, and (4) California Hispanics born elsewhere. RESULTS: MDR-TB prevalence was 2.1% in Baja California patients, 1.6% in Mexico-born California patients, 0.4% in US-born California patients, and 2.7% in Hispanic California patients born elsewhere. In multivariate analysis, previous antituberculosis treatment was associated with MDR-TB (odds ratio [OR] = 6.57; 95% confidence interval [CI] = 3.34, 12.96); Mexico-born TB patients in California (OR = 5.08; 95% CI = 1.19, 21.75) and those born elsewhere (OR = 7.69; 95% CI = 1.71, 34.67) had greater odds of MDR-TB compared with US-born patients (reference category). CONCLUSIONS: Hispanic patients born outside the US or Mexico were more likely to have MDR-TB than were those born within these countries. Possible explanations include different levels of exposure to resistant strains and inadequate treatment.

The impact of altitude on hospitalization and hospital mortality from pandemic 2009 influenza A (H1N1) virus pneumonia in Mexico.

OBJECTIVE: To determine the effect of altitude of residence on influenza A (H1N1). MATERIALS AND METHODS: We analyzed 207 135 officially notified of influenza-like illness (ILI) cases, 23 048 hospitalizations and 573 deaths during the first months of the novel pandemic influenza A H1N1 virus, to examine if residents of high altitude had more frequently these adverse outcomes. RESULTS: Adjusted rates for hospitalization and hospital mortality rates increased with altitude, probably due to hypoxemia.

Epidemiological and clinical characteristics of patients with human monkeypox infection in Mexico: a nationwide observational study.

Background: Human monkeypox, a zoonosis historically endemic to West and South Africa, has led to a worldwide outbreak driven by human-to-human transmission resulting in an international public health emergency. Endemic and outbreak monkeypox cases may differ in their affected populations, clinical features, and outcomes. Thus, profiling cases of the current monkeypox outbreak worldwide is crucial. Methods: We performed a nationwide observational surveillance-based study from May 24 to September 5, 2022. Patients that met the operational clinical definition of monkeypox or symptomatic close contacts of confirmed cases were tested by real-time polymerase chain reaction. Clinical data were collected with a standardized case-report form. We report epidemiologic, sociodemographic, and clinical characteristics of confirmed cases. Findings: Five-hundred and sixty-five human monkeypox confirmed cases were analysed; 97.2% were men, of whom 59.5% identified as men who have sex with men, and 54.5% had human immunodeficiency virus infection. The median age was 34 years. All patients but one had rash (99.8%), 78.9% had fever, and 47.8% reported myalgia. The anogenital area was the most commonly affected one by rash (49.6%), and proctitis occurred in 6.2% of patients. Six patients required hospitalization, of which one died due to causes unrelated to monkeypox. Interpretation: The 2022 monkeypox outbreak in Mexico is mainly driven by middle-aged men who have sex with men, of which a large proportion are persons who live with human immunodeficiency virus infection. Clinical features such as the high proportion of anogenital lesions suggest sexual contact is a pivotal transmission mechanism in this outbreak. Funding: This research was supported by grant A1-S-18342 from Consejo Nacional de Ciencia y Tecnología (CONACyT), Mexico (to S.I.V.-F.).

Protection of hybrid immunity against SARS-CoV-2 reinfection and severe COVID-19 during periods of Omicron variant predominance in Mexico.

Background: With the widespread transmission of the Omicron SARS-CoV-2 variant, reinfections have become increasingly common. Here, we explored the role of immunity, primary infection severity, and variant predominance in the risk of reinfection and severe COVID-19 during Omicron predominance in Mexico. Methods: We analyzed reinfections in Mexico in individuals with a primary infection separated by at least 90 days from reinfection using a national surveillance registry of SARS-CoV-2 cases from March 3rd, 2020, to August 13th, 2022. Immunity-generating events included primary infection, partial or complete vaccination, and booster vaccines. Reinfections were matched by age and sex with controls with primary SARS-CoV-2 infection and negative RT-PCR or antigen test at least 90 days after primary infection to explore reinfection and severe disease risk factors. We also compared the protective efficacy of heterologous and homologous vaccine boosters against reinfection. Results: We detected 231,202 SARS-CoV-2 reinfections in Mexico, most occurring in unvaccinated individuals (41.55%). Over 207,623 reinfections occurred during periods of Omicron (89.8%), BA.1 (36.74%), and BA.5 (33.67%) subvariant predominance and a case-fatality rate of 0.22%. Vaccination protected against reinfection, without significant influence of the order of immunity-generating events and provided >90% protection against severe reinfections. Heterologous booster schedules were associated with ~11% and ~ 54% lower risk for reinfection and reinfection-associated severe COVID-19, respectively, modified by time-elapsed since the last immunity-generating event, when compared against complete primary schedules. Conclusion: SARS-CoV-2 reinfections increased during Omicron predominance. Hybrid immunity provides protection against reinfection and associated severe COVID-19, with potential benefit from heterologous booster schedules.

Effect of Liposuction on Body Weight and Serum Concentrations of Leptin, Lipids, Glucose, and Insulin: A Meta-Analysis.

BACKGROUND: Abdominal obesity has been associated with an increased risk of insulin resistance, metabolic syndrome, and diabetes. Central fat removal procedures such as liposuction, lipectomy, and abdominoplasty are among the most common surgical procedures. The impact of the latter on the former is controversial and understudied. The authors aimed to explore the effect of subcutaneous fat elimination procedures on insulin resistance measures and adipokine levels. METHODS: Relevant studies regarding the effects of surgical subcutaneous fat removal on glucose, insulin, adipokines, and lipid metabolism, as well as blood pressure, were identified by searching PubMed and Ovid-Cochrane without limits in date, type of publication, or language. After the selection process, 24 studies were obtained. The results of the articles were summarized using descriptive statistics. For the final analysis, a randomized effects model was used to evaluate heterogeneity; averages and meta-analytic differences were expressed with a confidence interval of 95%. RESULTS: All studies reported a reduction in weight (-2.64 kg; 95% CI, -4.32 to -0.96; P = 0.002; I 2 = 36%; P of I 2 < 0.001) and body mass index after liposuction. A significant improvement in triglycerides (-10.06 mg/dL; 95% CI, -14.03 to -6.09; P < 0.001; I 2 = 48%; P of I 2 = 0.05), serum glucose concentration (-4.25 mg/dL; 95% CI, -5.93 to -2.56; P < 0.001; I 2 = 68%; P of I 2 < 0.001), serum insulin concentration (-2.86 µIU/mL; 95% CI, -3.75 to -1.97; P < 0.001; I 2 = 59%; P of I 2 = 0.003), and serum leptin concentration (-7.70 ng/mL; 95% CI, -11.49 to -3.92; P = 0.0001; I 2 = 96%; P of I 2 < 0.001) was consistently observed. CONCLUSION: In addition to weight loss, there is a significant decrease in leptin, triglyceride, glucose, and insulin serum concentrations after liposuction, a fact that should be considered in future discussions.

Effectiveness of a nationwide COVID-19 vaccination program in Mexico against symptomatic COVID-19, hospitalizations, and death: a retrospective analysis of national surveillance data.

OBJECTIVES: Vaccination has been effective in ameliorating the impact of COVID-19. Here, we report vaccine effectiveness (VE) of the nationally available COVID-19 vaccines in Mexico. METHODS: Retrospective analysis of a COVID-19 surveillance system to assess the VE of the BNT162b2, messenger RNA (mRNA)-12732, Gam-COVID-Vac, Ad5-nCoV, Ad26.COV2.S, ChAdOx1, and CoronaVac vaccines against SARS-CoV-2 infection, COVID-19 hospitalization, and death in Mexico. The VE was estimated using time-varying Cox proportional hazard models in vaccinated and unvaccinated adults, adjusted for age, sex, and comorbidities. VE was also estimated for adults with diabetes, aged ≥60 years, and comparing the predominance of SARS-CoV-2 variants B.1.1.519 and B.1.617.2. RESULTS: We assessed 793,487 vaccinated and 4,792,338 unvaccinated adults between December 24, 2020 and September 27, 2021. The VE against SARS-CoV-2 infection was the highest for fully vaccinated individuals with mRNA-12732 (91.5%, 95% confidence interval [CI] 90.3-92.4) and Ad26.COV2.S (82.2%, 95% CI 81.4-82.9); for COVID-19 hospitalization, BNT162b2 (84.3%, 95% CI 83.6-84.9) and Gam-COVID-Vac (81.4% 95% CI 79.5-83.1), and for mortality, BNT162b2 (89.8%, 95% CI 89.2-90.2) and mRNA-12732 (93.5%, 95% CI 86.0-97.0). The VE decreased for all vaccines in adults aged ≥60 years, people with diabetes, and periods of Delta variant predominance. CONCLUSION: All the vaccines implemented in Mexico were effective against SARS-CoV-2 infection, COVID-19 hospitalization, and death. Mass vaccination with multiple vaccines is useful to maximize vaccination coverage.