[Evidence synthesis: evidence-based clinical practice guidelines for monitoring at-risk newbornsSíntese de evidência: diretrizes de prática clínica baseada em evidência para o acompanhamento de recém-nascidos em risco]

Integrated vector management program in the framework of the COVID-19 pandemic in Medellin, Colombia

Introduction: The COVID-19 pandemic pressured health care systems to remain alert and active in their vector-borne disease control and prevention programs, leading to changes in vector control strategies in urban areas affected by dengue, Zika and chikungunya. Objective: To describe the adaptations made to the vector control and surveillance program in Medellín during the COVID-19 health emergency. Materials and methods: Once the health emergency started, biosecurity protocols were developed. Entomological surveillance was strengthened from the institutional environment instead of homes. Data was collected in Medellín from 2018 to 2021 during the vector control and surveillance program activities, which included epidemiological and entomovirological surveillance, entomological index survey, ovitrap monitoring, community mobilization, search and elimination of mosquito breading sites, and chemical control. These actions were adapted and/or increased to promote self-care among communities in total and partial confinement, and to develop prevention and control measures. Results: Mosquito monitoring was increased by 40% using ovitraps, entomological virological surveillance showed an increase in 2020 of 34,4% compared to 2019 and virtual media was used to keep and improve contact with the community. Conclusion: The COVID-19 pandemic had a significant impact on arbovirus prevention and control programs. The city of Medellín quickly adapted its entomo-virological surveillance activities, control measures, and the contact with the community during the pandemic, which allow the Integrated Vector Management program to remain active in the city.

[Ranking of immunization programs in Latin America, 2019Ranking dos programas de imunização na América Latina, 2019]

OBJECTIVE

To establish a ranking of national immunization programs in Latin America that compares the various realities, identifies challenges and unachieved goals, and encourages countries to search for strategies to overcome the obstacles they face.

METHODS

Ten countries with the most innovative national vaccination schedules (NVCs) were selected. Information published on official websites of ministries of health, the World Health Organization (WHO), the Pan American Health Organization (PAHO), and the United Nations Children's Fund (UNICEF) were used, as well as interviews with experts from each country. A ranking was constructed, based on domains linked to the 2019 NVC (vaccinations given at different life stages, influenza vaccination, and vaccination in special situations); vaccination coverage in 2018; and programmatic aspects.

RESULTS

The general ranking is led by Chile and Panama, due to vaccination in the first and second year of life. They are followed by Argentina, Uruguay, and Costa Rica, which stand out for vaccination of other groups, influenza vaccination, and programmatic aspects. Brazil, Colombia, and Mexico have more delays in their NVCs, as well as programmatic gaps and lower vaccination coverages. Finally, Paraguay and Peru have similar deficiencies and bigger information gaps. However, when the domains are analyzed individually, the ranking changes and the same pattern is not repeated.

CONCLUSIONS

This is the first ranking of national immunization programs in Latin America that highlights strengths and weaknesses in each country. The periodicity of this exercise will be key when comparing the evolution and positioning of these programs over time.

Emergence and evolution of SARS-CoV-2 genetic variants during the Cuban epidemic

The SARS CoV-2 D614G variant circulated in Cuba in 2020. New viral variants were detected after the opening of the border in November 2020. We show the results of the genomic surveillance in Cuba from December 28, 2020, to September 28, 2021 and their relationship to the epidemiological situation in the country. A total of 1,406 nasopharyngeal exudates from COVID-19 patients were processed for RNA extraction and the 1836 bp fragment of the spike gene was amplified and sequenced. The mutations present were determined using the GISAID database. Prevalence ratios were estimated by fitting Poisson univariate and multivariate regression models to investigate associations between SARS-CoV-2 variant group (VOC, non-VOC) and disease outcome. Seventeen genetic variants were detected including VOC Alpha, Beta, Gamma and Delta, one variant of interest (VOI) (Lambda) and two previous VOI (A.2.5.1 and Zeta/P.2). Beta (34.77%), Delta (24.89%) and D614G (19%) variants were the most frequently detected. By June, Delta increased in frequency, displacing Beta. Disease severity increased significantly with age and VOC (PR =1.98, IC 95%: 1.33-3.05, p <0.05). Genomic surveillance allowed us to identify the upsurge of novel variants. Coinciding with the higher epidemic period, multiple variants were co-circulating. Although we cannot rule out that failure in the transmission containment measures occurred, the increase in the number of cases associated with the circulation of several variants, particularly the Beta and Delta variants is highly suggestive. A greater association of Beta variant with clinical severity and Delta variant with a greater transmissibility was observed.

El valor relegado de la atención primaria durante la pandemia COVID-19: una de enfermería

El 11 de marzo del 2020 la Organización Mundial de la Salud caracteriza a una nueva enfermedad denominada COVID-19 como una Pandemia, en respuesta a ello proporciona una serie de lineamientos, en el último de estos se visualiza la Atención Primaria de la Salud como protagonista, sin embargo, es una gran tarea con pocos recursos disponibles, más aún cuando nos encontramos con un nivel de atención historicamente desatendido, en dicho contexto se gesta el presente artículo que responde al objetivo de relevar la importancia de la Atención Primaria de la Salud de América Latina en respuesta al Plan estratégico desarrollado recientemente por la Organización Mundial de la Salud. La necesidad de su fortalecimiento es referida por múltiples realidades como Chile, Perú, Brasil, México, Cuba, Colombia, Costa Rica, El Salvador, Paraguay o Bolivia, se ha descrito que la enfermería presenta un rol preponderante ante la problemática, pues son estos profesionales los que prestan hasta el 90% de los servicios de salud, con resultados en los pacientes comparables o mejores que las contrapartes médicas, no obstante su capacidad está limitada por las leyes estatales y federales. Se describen 4 obstáculos que restringen el poderoso aporte de la Atención Primaria de la Salud.

Bioética social, deberes del Estado derecho y deberes civiles en la vacunación COVID-19

La industria biotecnológica ha desarrollado en tiempo récord varias vacunas que están a disposición de los Gobiernos para ser adquiridas, distribuidas y aplicadas a la sociedad civil para frenar la pandemia delCOVID-19. La población debe confiar en las vacunas como medio para adquirir la inmunidad de rebaño, de lo contrario tendremos que adquirir la inmunidad por contagio. La bioética centrada en la ética clínica amplía su visión a una bioética social que reconoce los derechos fundamentales a la salud, la vida y los deberes del Estado a la adquisición, distribución, acceso, aplicación y vigilancia de la vacunación durante la pandemia del COVID-19. Se reconocen el derecho a la autonomía y a las libertades individuales y los deberes civiles de responsabilidad, compromiso y solidaridad ante las políticas de salud pública. La bioética social es un actor dentro de la pandemia que se relaciona con las personas, las comunidades, el Estado y la salud pública y que se argumenta a través de la ética personal y de responsabilidad. El objetivo de este artículo es dar a conocer la importancia de la bioética social, integrada a los deberes del Estado, los derechos y deberes civiles en la vacunación contra la enfermedad COVID-19.

Evaluation of the SMARTCHEK Genesystem RT-qPCR assay for the detection of SARS-CoV-2 in clinical samples

BACKGROUND

The COVID-19 pandemic remains the main public health problem, due to the quick and easy dissemination of the causal agent, SARS-CoV-2 virus, around the world. Since the beginning of the pandemic, an opportune laboratory diagnosis has been critical to respond this emergency, and RT-qPCR has been used as reference molecular tests for detection of SARS-CoV-2.

METHODS

In this study, we performed the evaluation of a RT-qPCR SMARTCHEK platform (SMARTCHEK, Genesystem) for SARS-CoV-2 detection based on the amplification of RdRp and N gene markers. The platform was evaluated with nasopharyngeal swab samples corresponding to 360 suspected cases of COVID-19 which were remitted to Instituto Nacional de Salud in Peru. This quick method was compared with conventional RT-qPCR as gold standard.

RESULTS

The RT-qPCR SMARTCHEK showed a 98.1% sensitivity (CI: 93.3-99.8%), a 98.8% specificity (CI: 96.6-99.8%), a 97.2% positive predictive value (CI: 92-99.4%) and a 99.2% negative predictive value (CI: 97.2-99.9%). The assay demonstrated a strong agreement between the RT-qPCR SMARTCHEK and conventional RT-qPCR (kappa value ≥ 0.966).

CONCLUSION

The RT-qPCR SMARTCHEK is a platform that gives reliable and fast results, with high sensitivity and specificity for the detection of SARS-CoV-2, and it will be considered a suitable alternative to COVID-19 diagnosis in low-resource settings.