Progress towards the elimination of hepatitis B in children in Colombia: A novel two-phase study approach.

The World Health Organization (WHO) has established a target to eliminate mother-to-child-transmission (EMTCT) of hepatitis B virus (HBV), defined as a prevalence of hepatitis B surface antigen (HBsAg) of ≤0.1% among children, by 2030. Using nationally representative serosurveys to verify achievement of this target requires large sample sizes and significant resources. We assessed the feasibility of a potentially more efficient two-phase method to verify EMTCT of HBV in Colombia. In the first phase, we conducted a risk assessment to identify municipalities at the highest risk of ongoing HBV transmission. We ranked the 1122 municipalities of Colombia based on the reports of HBV infection in pregnant women per 1000 population. Municipalities with ≥0.3 reports per 1000 persons (equating to the top quartile) were further assessed based on health facility birth rates, coverage with three doses of hepatitis B vaccine (HepB3) and seroprevalence data. Hepatitis B risk was considered to be further increased for municipalities with HepB3 coverage or health facility birth rate <90%. In the second phase, we conducted a multistage household serosurvey of children aged 5-10 years in 36 municipalities with the highest assessed HBV risk. HBsAg was not detected in any of 3203 children tested, yielding a 90% upper confidence bound of <0.1% prevalence. Coverage with HepB3 and hepatitis B birth dose was high at 97.5% and 95.6%, respectively. These results support the conclusion that Colombia has likely achieved EMTCT of HBV.

Public health education in Colombia: influence on public policies.

Colombia has a tradition on Public Health education since the mid years of 1950's. The first cohorts of Public Health academics and workers were trained at the National School of Public Health, which was established, with the support of the Rockefeller Foundation, at the Universidad Nacional de Colombia in Bogota, but later moved to the Universidad de Antioquia in Medellin. In the current context, Colombian Public Health academics have rallied against the neoliberal Health Reform implanted in 1993 that has failed to address the country's health priorities. Most of the interactions between Public Health academic leaders with government and other decision makers, revolve around the discussion on whether a new way to conceptualize and operate the national health system should be visualized and implemented. So far, the academic sector have been unable to overthrow the main aspects of the Reform -private insurance companies operating, and profiting, on public money- but they have demonstrated how inequalities in health access have widening under the Health Reform and how it have been unable to improve the health situation of the population.

Effectiveness of a prevention program in the incidence of cardiovascular outcomes in a low-income population from Colombia: a real-world propensity score-matched cohort study.

BACKGROUND: Cardiovascular diseases (CVDs) and diabetes mellitus (DM) are among the leading cause of morbidity and mortality in low-and-middle-income countries (LMICs) but evidence in these contexts regarding the effectiveness of primary prevention interventions taking into account patient adherence is scarce. We aimed to evaluate the effectiveness of a cardiovascular risk management program (De Todo Corazón - DTC program) in the incidence of the first cardiovascular outcome (CVO) in a low-income population from the Caribbean region of Colombia using adherence as the main variable of exposure. METHODS: A retrospective propensity score-matched cohort study was conducted. Adult patients with a diagnosis of hypertension (HTA), diabetes mellitus (DM), chronic kidney disease (CKD), or dyslipidemia affiliated to the DTC program between 2013 and 2018 were considered as the study population. Patients with 30 to 76 years, without a history of CVOs, and with more than 6 months of exposure to the program were included. The main outcome of interest was the reduction in the risk of CVOs (stroke, myocardial infarction, or congestive heart failure) based on the adherence to the intervention (attendance to medical appointments with health care professionals and the control of cardiovascular risk factors). Kaplan Meier curves and propensity score-matched Cox regression models were used to evaluate the association between adherence and the incidence of CVOs. RESULTS: A total of 52,507 patients were included. After propensity score matching, a sample of 35,574 patients was analyzed. Mean (SD) exposure time was 1.97 (0.92) years. Being adherent to the program was associated to a 85.4, 71.9, 32.4 and 78.9% risk reduction of in the low (HR 0.14; 95% CI 0.05-0.37; p < 0.001), medium (HR 0.28; 95% CI 0.21-0.36; p < 0.001), high-risk with DM (HR 0.67; 95% CI 0.43-1.04; p = 0.075) and hig-risk without DM (HR 0.21; 95% CI 0.09-0.48; p < 0.001) categories, respectively. CONCLUSIONS: The DTC program is effective in the reduction of the risk of CVOs. Population-based interventions may be an important strategy for the prevention of CVOs in underserved populations in the context of LMICs. A more exhaustive emphasis on the control of diabetes mellitus should be considered in these strategies.

First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor Colombian population: a cohort study.

BACKGROUND: According to several studies in population of high-income countries (HIC), patients with Type 2 diabetes mellitus (DM) have a considerably higher risk of cardiovascular morbidity and mortality. However, it is not clear if the magnitude of this association can be widespread in other populations. The objective of this study was to determine the independent association between Type 2 DM and first cardiovascular event in Colombian Caribbean poor population with no records of previous cardiovascular events reported. METHODS: We retrospectively reviewed the individual records from the hospitalizations database of 64,668 patients of cardiovascular risk management program from July 2014 to December 2015. We used a propensity score matching cohort analysis for this study. The Kaplan-Meier curves were constructed for the cardiovascular events related endpoints and matched Cox-regression analysis to estimate associations of a history of Type 2 DM with cardiovascular outcomes during 1.5 years of follow-up. A formal sensitivity analysis using The Breslow-Day and Tarone Homogeneity tests was conducted. RESULTS: Out of 56,351 patients with no previous cardiovascular events records, 19,368 (34.4%) patients were found to suffer Type 2 DM. Using propensity scores for Type 2 DM, we gathered a cohort of 18,449 pairs of patients with and without Type 2 DM who were balanced on 22 baseline characteristics. A first cardiovascular event occurred in 650 (3.5%) and 403 (2.1%) matched patients with and without Type 2 DM, respectively, during 1.5 years of follow-up. Type 2 DM was associated with first cardiovascular event (HR 1.69; 95% CI 1.43-2.00; p = 0.000), AMI (HR 1.79; 95% CI 1.45-2.20; p = 0.000) and stroke (HR 1.54; 95% CI 1.18-2.02; p = 0.001). Hazard ratios (95% CIs) for the association of Type 2 DM with all-cause mortality, cardiovascular mortality and all-cause hospitalization were 1.36 (1.21-1.53; p < 0.001), 1.52 (1.12-2.08; p 0.004), and 1.20 (1.21-1.53; p < 0.001), respectively. CONCLUSION: Type 2 DM resulted to be a significant independent risk factor for first cardiovascular event in Colombian Caribbean poor population with no previous records of cardiovascular events.

Features of Dengue and Chikungunya Infections of Colombian Children under 24 Months of Age Admitted to the Emergency Department.

We aimed to assess clinical and laboratory differences between dengue and chikungunya in children <24 months of age in a comparative study. We collected retrospective clinical and laboratory data confirmed by NS1/IgM for dengue for 19 months (1 January 2013 to 17 August 2014). Prospective data for chikungunya confirmed by real-time polymerase chain reaction were collected for 4 months (22 September 2014-14 December 2014). Sensitivity and specificity [with 95% confidence interval (CI)] were reported for each disease diagnosis. A platelet count <150 000 cells/ml at emergency admission best characterized dengue, with a sensitivity of 67% (95% CI, 53-79) and specificity of 95% (95% CI, 82-99). The algorithm developed with classification and regression tree analysis showed a sensitivity of 93% (95% CI, 68-100) and specificity of 38% (95% CI, 9-76) to diagnose dengue. Our study provides potential differential characteristics between chikungunya and dengue in young children, especially low platelet counts.

[Reasons some children under 5 do not get vaccinated in four Colombian citiesMotivos por que não são vacinadas crianças menores de cinco anos em quatro cidades colombianas]. / Motivos de no vacunación en menores de cinco años en cuatro ciudades colombianas.

OBJECTIVE: Identify barriers and reasons why children under 5 do not get vaccinated in some Colombian cities. METHODS: Qualitative design based on interviews and focus groups of health workers and caregivers in four Colombian cities selected according vaccination coverage and population densities. RESULTS: Different factors were identified that may hinder completion of vaccination schedules in the two municipalities with low coverage, such as fear of a post-vaccination reaction, socioeconomic and geographical conditions and population safety, working conditions of the vaccination staff, administrative and economic problems, and precarious information systems. CONCLUSIONS: From a qualitative standpoint, the vaccination teams and caregivers pointed to social and institutional issues that may hinder vaccination coverage in the cities that participated in the study.

OBJETIVO: Conhecer as barreiras e os motivos por que não são vacinadas crianças menores de cinco anos em algumas cidades da Colômbia. MÉTODOS: Estudo de delineamento qualitativo baseado em entrevistas e grupos focais conduzido com profissionais da saúde e cuidadores em quatro cidades colombianas selecionadas segundo a cobertura de vacinação e a densidade populacional. RESULTADOS: Foram identificados diversos fatores para não serem seguidos os esquemas de vacinação nos dois municípios com baixa cobertura: receio de reação pós-vacinal, condições socioeconômicas, geográficas e de segurança da população, condições laborais do pessoal encarregado pela vacinação, problemas administrativos e econô- micos e situação precária dos sistemas de informação. CONCLUSÃO: Do ponto de vista qualitativo, as equipes de vacinação e os cuidadores destacaram aspectos sociais e institucionais que contribuem para, ou limitam, o cumprimento das metas de cobertura de vacinação nas cidades participantes do estudo.

Compliance with birth dose of Hepatitis B vaccine in high endemic and hard to reach areas in the Colombian amazon: results from a vaccination survey.

BACKGROUND: Hepatitis B vaccination was introduced into the Expanded Program of Immunization in Colombia in 1992, in response to WHO recommendations on hepatitis B immunization. Colombia is a low endemic country for Hepatitis B virus infection (HBV) but it has several high endemic areas like the Amazon basin where more than 70 % of adults had been infected. A cross- sectional study was carried out in three rural areas of the Colombian Amazon to evaluate compliance with the recommended schedule for hepatitis B vaccine in Colombian children (one monovalent dose given in the first 24 h after birth + 3 doses of a pentavalent containing Hepatitis B. (DPT + Hib + Hep B). METHODS: A household survey was conducted in order to collect vaccination data from children aged from 6 months to <8 years. Vaccination status was related to sociodemographic data obtained from children caretakers. RESULTS: Among 938 children above 6 months and < 8 years old studied, 79 % received a monovalent dose of hepatitis B vaccine, but only 30.7 % were vaccinated in the first 24 h after birth. This proportion did not increase by age or subsequent birth cohorts. Coverage with three doses of a DTP-Hib-HepB vaccine was 98 %, but most children did not receive them according to the recommended schedule. Being born in a health facility was the strongest predictor of receiving a timely birth dose. CONCLUSIONS: This study suggests that more focused strategies on improving compliance with hepatitis B birth dose should be implemented in rural areas of the Amazon, if elimination of perinatal transmission of HBV is to be achieved. Increasing the proportion of newborns delivered at health facilities should be one of the priorities to reach that goal.

Characterization of rotavirus genotypes before and after the introduction of a monovalent rotavirus vaccine in Colombia.

Strain monitoring for emergence of novel strains after the introduction of rotavirus vaccine is an integral component of routine rotavirus immunization programs. Using a laboratory based strain surveillance system between 2008 and 2012, a wide variation in strain pattern in Colombia was founded both before and after the introduction of a monovalent rotavirus vaccine in 2009. G2P[4], a strain fully heterotypic to the vaccine was predominant before vaccine introduction in 2008 (47%) and after vaccine introduction in 2010 (54%), 2011 (86%), and 2012 (32%). The presence of this strain before the introduction of vaccine and decreasing prevalence during the most recent surveillance year suggests secular variation rather than vaccine pressure as a cause for this fluctuation. While strain monitoring can be valuable after vaccine introduction, these surveillance data alone without information on disease incidence or strain specific vaccine effectiveness can be prone to misinterpretation with regard to the role of vaccine pressure on emergence of new or persistent strains.

How Possible Is the Elimination of Viral Hepatitis? An Analysis Based on the Global Burden of Disease from Hepatitis B and C, 1990-2019.

This study assesses the feasibility of hepatitis B (HBV) and C (HCV) elimination using an analysis of trends of epidemiology data (1990-2019) from the Global Burden of Disease Study. Joinpoint regression analysis was used to identify significantly changing points in the trends of Age-standardized Prevalence Rates (ASPR) and Age-standardized Mortality Rates (ASMR) and to estimate the annual percentage changes (APC) and the average annual percentage changes (AAPC) for the period. The Sociodemographic Index (SDI) was used to analyze trends between countries. The total percentage change of the ASPR (2019/1990) was -31.4% and -12.8% for HBV and HCV worldwide, respectively; the rate ratio (HBV/HCV) was 2.5. Mortality had decreased for HBV but not for HCV. The total percentage change for the ASMR (2019/1990) was -26.7% and 10.0% for HBV and HCV, respectively. While the ASMR of HBV decreased, HCV increased during this period. The percentage change in ASMR of HBV was highest in countries with high-middle SDI and lowest in countries with high SDI. For HCV, the percentage change in ASMR was highest in countries with high SDI (increase), and only in countries with low SDI did it decrease. The global HBV and HCV rates have fallen with different AAPCs associated with the SDI. Despite the advances, there is still a long way to go to achieve the 2030 elimination goals. An important challenge is related to finding a way to speed up the yearly rate at which the decline is happening.

Seroprevalence of Hepatitis E virus in children and adolescents living in urban Bogotá: An explorative cross-sectional study.

The majority of Hepatitis E Virus (HEV)-related studies are carried out in adults whereas information about HEV seroprevalence, clinical disease manifestation, molecular epidemiology, and transmission patterns in children is limited. To estimate HEV seroprevalence among scholar children living in an urban setting and to analyze risk factors for an infection, we invited children aged 5-18 years from Bogotá (Colombia) for a cross-sectional survey. We collected self-reported data on demographics, social, clinical, and exposure variables in a structured interview. Venous blood samples were analyzed with two commercially available ELISAs for HEV-specific IgG antibodies. Among the 263 participants, we found three HEV IgG-reactive samples (1.1%) using both assays. We additionally characterized the samples for HEV IgM using a commercially available IgM ELISA and for HEV RNA. Here, we found one IgM-reactive sample, which was also reactive for IgG. In contrast, none of the IgM- and IgG-reactive sera samples showed detectable RNA levels indicating HEV exposure had not been recently. All participants reported access to drinking water and sanitary systems in their households and frequent hand washing routines (76-88%). Eighty percent of children reported no direct contact with pigs, but occasional pork consumption was common (90%). In contrast to the majority of studies performed in Colombian adults, we found a low unadjusted HEV seroprevalence of 1.1% (95% CI: 0.3-3.6%) for both HEV IgG ELISAs in our study population. While the majority of participants reported pork consumption, we speculate in the absence of viral RNA for genotyping in the affected individuals, that existing access to drinking water and sanitary systems within our study group contribute to the low HEV seroprevalence.

Comparative effectiveness and duration of protection of ChAdOx1, CoronaVac, BNT162b2, mRNA-1273, and Ad26.COV2.S COVID-19 vaccines for symptomatic and hospitalized Mu, Delta, and Omicron: A test-negative case-control study.

OBJECTIVE: We carried out a study to estimate the vaccine effectiveness (VE) of homologous vaccination schedules against COVID-19, using data from mandatory information systems from Bogota, Colombia. METHODS: A test-negative case-control study in adults from Bogota (Colombia), between March 1st of 2021 and February 25th of 2022. We assess VE among symptomatic COVID-19 cases during the Mul, Delta, and Omicron predominance periods in Bogota, with controls matched by sex, age (±5 years), and date of testing (±7 days), using a case:control ratio of 1:1. We selected homologous vaccination schedules with ChAdOx1, CoronaVac, BNT162b2, mRNA-1273, and Ad26.COV2.S. VE was reported as one minus the odds ratio in adjusted conditional logistic regressions, with their 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant. RESULTS: 52,913 cases were matched to controls, 16,722 for Mu, 14,094 for Delta, and 22,097 for Omicron. VE was high against COVID-19 during Mu weeks with full vaccination using the monovalent BNT162b2 (VE: 69; 95% CI, 65 to 72) vaccine and ChAdOx1 (VE: 64; 95% CI, 31 to 81) and significantly lower with CoronaVac (P < 0.001) and Ad26.COV2.S (P = 0.005). During Delta, VE against COVID-19 was higher with BNT162b2 (VE: 55; 95% CI, 51 to 58). The VE for COVID-19 cases during Omicron was higher with a booster dose of monovalent BNT162b2 (VE: 45; 95% CI, 34 to 54). The VE of primary series and booster for ChAdOx1, Ad26.COV2.S, and CoronaVac did not show protection for Omicron. CONCLUSION: Our study provides further evidence on the protective effect of mRNA vaccines for Omicron, and warrant that the duration of protection against symptomatic infection may last for only a few months.

Reductions in Childhood Pneumonia Mortality After Vaccination in the United States.

BACKGROUND: We aim to estimate the magnitude of the reduction in pneumococcal pneumonia and meningitis mortality after the mass introduction of pneumococcal conjugate vaccine (PCV)7 and PCV13 in children in the United States. METHODS: We assessed the trends in mortality rates from pneumococcal pneumonia and meningitis, in the United States between 1994 and 2017. We fitted an interrupted time-series negative binomial regression model (adjusted by trend, seasonality, PCV7/PCV13 coverage, and H. influenzae type b vaccine coverage) to estimate the counterfactual rates without vaccination. We reported a percent reduction in mortality estimates relative to the projected no-vaccination scenario, using the formula 1 minus the incidence risk ratio, with 95% confidence intervals (CIs). RESULTS: Between 1994 and 1999 (the prevaccination period), the all-cause pneumonia mortality rate for 0-1-month-old children was 2.55 per 100,00 pop., whereas for 2-11 months-old children, this rate was 0.82 deaths per 100,000 pop. During the PCV7-period in 0-59-month-old children in the United States, the adjusted reduction of all-cause pneumonia was 13% (95% CI: 4-21) and 19% (95% CI: 0-33) of all-cause meningitis For PCV13, the reductions in this age group were 21% (95% CI: 4-35) for all-cause pneumonia mortality and 22% (95% CI: -19 to 48) for all-cause meningitis mortality. PCV13 had greater reductions of all-cause pneumonia than PCV13 in 6-11-month-old infants. CONCLUSIONS: The universal introduction of PCV7, and later PCV13, for children 0-59 months old in the United States was associated with decreases in mortality due to all-cause pneumonia.

Humoral immune response to SARS-CoV-2 and endemic coronaviruses in urban and indigenous children in Colombia.

BACKGROUND: Although anti-SARS-CoV-2 humoral immune responses and epidemiology have been extensively studied, data gaps remain for certain populations such as indigenous people or children especially in low- and middle-income countries. To address this gap, we evaluated SARS-CoV-2 seroprevalence and humoral immunity towards the parental B.1 strain, local SARS-CoV-2 variants, and endemic coronaviruses in children from Colombia from March to April 2021. METHODS: We performed a cross-sectional seroprevalence study with 80 children from Bogotá and expanded our analysis by comparing results with an independent observational study of 82 children from the Wiwa community living in the north-eastern Colombian territories. Antibody IgG titers towards SARS-CoV-2 and the endemic coronaviruses as well as ACE2 binding inhibition as a proxy for neutralization towards several SARS-CoV-2 variants were analyzed using two multiplex-based immunoassays. RESULTS: While we find seroprevalence estimates of 21.3% in children from Bogotá, seroprevalence is higher with 34.1% in Wiwa children. We observe a robust induction of antibodies towards the surface-exposed spike protein, its S1-, S2- and receptor-binding-subdomains in all SARS-CoV-2 seropositive children. Only nucleocapsid-specific IgG is significantly lower in the indigenous participants. ACE2 binding inhibition is low for all SARS-CoV-2 variants examined. We observe a dominance of NL63 S1 IgG levels in urban and indigenous children which suggests an early exposure to this respiratory virus independent of living conditions and geographic location. SARS-CoV-2 seropositivity does not correlate with antibody levels towards any of the four endemic coronaviruses indicating the absence of cross-protective immunity. CONCLUSIONS: Overall, antibody titers, but in particular ACE2 binding inhibition are low within Colombian samples, requiring further investigation to determine any potential clinical significance.

Our knowledge of SARS-CoV-2, the virus causing COVID-19 remains incomplete for certain populations including indigenous people and younger age groups. Here, we aim to understand the extent to which children from urban and indigenous populations of Colombia were previously infected with SARS-CoV-2 and the related common cold coronaviruses. By measuring antibodies, protective proteins produced by the immune system, we find higher levels of previous SARS-CoV-2 infections in indigenous children of the Wiwa community (34.1%) compared to children from urbanized Bogotá (21.3%). Antibody levels towards the common cold coronaviruses were similar in SARS-CoV-2 infected and uninfected children suggesting immune responses to one coronavirus do not automatically protect against closely-related viruses. Further, we find low levels of protective immunity against SARS-CoV-2 in both populations. This finding warrants further investigation as it relates to reinfection risk and future vaccination strategies in these populations.

Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus.

Prevention of mother-to-child transmission of hepatitis B virus (HBV) infection is a cornerstone of efforts to support progress towards elimination of viral hepatitis. Current guidelines recommend maternal screening, antiviral therapy during the third trimester of high-risk pregnancies, universal and timely HBV birth dose vaccination, and post-exposure prophylaxis with hepatitis B immunoglobulin for selected neonates. However, serological and molecular diagnostic testing, treatment and HBV vaccination are not consistently deployed, particularly in many high endemicity settings, and models predict that global targets for reduction in paediatric incidence will not be met by 2030. In this article, we briefly summarise the evidence for current practice and use this as a basis to discuss areas in which prevention of mother-to-child transmission can potentially be enhanced. By reducing health inequities, enhancing pragmatic use of resources, filling data gaps, developing advocacy and education, and seeking consistent investment from multilateral agencies, significant advances can be made to further reduce vertical transmission events, with wide health, societal and economic benefits.

[Cost-effectiveness of vaccinating pregnant women against pandemic influenza in Colombia]. / Costo-efectividad de la vacunación contra influenza pandémica en mujeres embarazadas en Colombia.

OBJECTIVE: Estimating the cost-effectiveness ratio of vaccinating pregnant women against the 2009 pandemic influenza A (H1N1) in Colombia during the second wave of the pandemic. METHODS: A decision tree was constructed, which simulated the health results (deaths and years of potential life lost [YPLL]) in two cohorts of pregnant women; one vaccinated, the other unvaccinated. The model's parameters were drawn from scientific literature and costs were estimated on the basis of a previous study. Incremental cost-effectiveness ratios (ICER) were calculated. RESULTS: Vaccinating pregnant women against pandemic flu would have prevented between 4 664 and 15 741 outpatient visits and between 119 and 401 hospitalizations. Between US$ 249 530 and US$ 842 163 in costs of care would have been avoided. For the base scenario, vaccinating pregnant women would be cost-effective (ICER/YPLL avoided US$ 7 657). This ICER was responsive to the disease's fatality rate; vaccination would not be cost-effective in Colombia in scenarios with a lower fatality rate. CONCLUSIONS: Vaccinating pregnant women against pandemic influenza is cost-effective in a scenario with a high mortality rate. The existing evidence that pregnant women are at increased risk of complications and that the vaccine is safe would justify its use in pregnant women.

Criteria for New Vaccine Introduction in a National Expanded Program on Immunization: A Survey of Expanded Program on Immunization Managers.

OBJECTIVES: This study aimed to critically review the decision-making (DM) processes for new vaccines introduction in Latin America's Expanded Program on Immunization (EPIs) and role of cost-effectiveness analyses (CEAs). METHODS: An online survey was conducted between August and December 2019 to Latin America and the Caribbean (LAC) EPI managers, participants of the National Immunization Technical Advisory Group (NITAG). Information about criteria to introduce the most recent vaccine was asked. CEA role in that decision and technical knowledge of informants were investigated. Frequencies of categorical data were calculated. Bar plots and stacked bar plots were used to visualize the data. RESULTS: A total of 26 EPI managers and stakeholders participated in the survey from 14 LAC countries. Respondents worked at the Ministry of Health and the Pan American Health Organization. Most recent vaccines included were human papillomavirus (42.3%), injectable polio (26.9%), and varicella (15.4%). High burden of disease and cost-effectiveness/cost-utility were identified as the main a priori criteria used to new vaccine introduction, but not all inputs are available or good quality. Discussion about vaccine introduction was conducted at NITAG meetings, reported as independent by most countries. Nevertheless, NITAG members did not master the essential CEAs concepts. CONCLUSIONS: DM of vaccine introduction in LAC is reported by EPI managers as a process of discussion with participation of several actors where economic rationalities had a high role in the decision. It is necessary to strengthen the technical capacity to understand economical inputs to inform DM and advocate to include other rationalities as important in the discussion.

Impact of mobility restrictions on the dynamics of transmission of COVID-19 in Colombian cities.

BACKGROUND: Our aim was to study the association between case rates and reductions in urban mobility in state capitals of Colombia. METHODS: We designed an ecological time-series study to correlate the Colombian incidence rate with reductions in mobility trends of retail stores. RESULTS: The meta-analysis of ß coefficients describing the association between case rates and reductions in mobility trends of retail stores resulted in a mean estimate of 0.0637 (95% confidence interval 0.027 to 0.101; p<0.001) with nearly 100% heterogeneity. CONCLUSIONS: We recommend continuing to consider mobility restrictions when the number of cases starts to climb in each local jurisdiction.

How Expensive Are Hospitalizations by COVID-19? Evidence From Colombia.

OBJECTIVES: This study aimed to estimate the direct medical costs due to hospitalizations by COVID-19 in Colombia and to identify their cost drivers in Colombia. METHODS: This is a retrospective cost-of-illness study of COVID-19 in Colombia. We estimated direct medical costs using data from patients insured to a Benefit Plan Administrator Company, between March 15, 2020 and May 29, 2020. Absolute and relative frequencies, averages, medians, and interquartile ranges (IQRs) were used to characterize the population and estimate the costs of hospitalized patients with COVID-19. We stratified the cost analysis by sex, age groups, comorbidities, and type of hospitalization (general ward and intensive care unit [ICU]). Cost drivers were calculated from a generalized linear model. RESULTS: We studied 113 confirmed patients, 51.3% men. On average, the hospital length of stay was 7.3 (± 6.2) days. A person hospitalized with COVID-19 reported median costs of $1688 (IQR 788-2523). In women, this cost was $1328 (IQR 463-2098); in men, this was 1.4 times greater. The median cost for ICU was $4118 (IQR 2069-5455), 3 times higher than those hospitalized only in the general ward. Admission to the ICU, having 1 comorbidity, length of stay, high blood pressure, having 5 comorbidities, and being treated in the city of Cartagena were statistically significant with direct medical costs. CONCLUSIONS: Our study provides an idea of the magnitude of costs needed to hospitalize a COVID-19 case in Colombia. Other studies in Colombia have assessed the costs of hospitalization for infectious diseases such as influenza, costs significantly lower than those described here.

Substantial Out-of-Pocket Health Expenditure on Prenatal Check-Ups: Estimates from a Sample of Pregnant Women in Cartagena, Colombia.

OBJECTIVE: We aimed to estimate out-of-pocket (OOP) health expenditures and the indirect costs related to prenatal check-ups in pregnant women seen in a maternity hospital in the Colombian Caribbean region. METHODS: We described the economic costs of pregnant women, with no age limits, who attended prenatal check-ups in a maternity hospital. To estimate OOP and indirect costs owing to prenatal check-ups in pregnant women, a survey was constructed, where the woman was asked about some sociodemographic variables, to characterize those attending the prenatal check-ups. Absolute and relative frequencies, averages and confidence intervals were used to characterize the population and estimate OOP and indirect costs in pregnant women. The latter were estimated from the percentile method. A bootstrapping was performed to reduce the bias within the analysis. RESULTS: In total, 56 pregnant women were surveyed, with an average age of 25.9 years (±6.2). All women surveyed had OOP associated to the prenatal check-up in at least one cost-item, and the OOP ranged between $0.3 and $108.7. Transportation was the item with the highest frequency of expenses, followed by food, other expenses, and drugs. The mean of OOP expenditures was $24.3 (CI 95% $18.1-31.4) for women who attended their prenatal check-up. DISCUSSION: Considering the estimated OOP health expenditures caused by prenatal check-ups by household income, women living with <1 minimum wage spend 7% of their income in a prenatal check-up. In women with 1-2 and >2-3 minimum wages, these proportions were 5%, 3%, respectively. Unfortunately, this makes prenatal care a significant source of economic burden, impacting poor households in Cartagena.