Report of the Influenza Vaccination Program in Mexico (2006-2022) and Proposals for Its Improvement

BACKGROUND

Influenza has continued to be an important public health challenge, and the WHO recommends that countries consider vaccination for persons at high risk. Mexico has such a program, and we sought to determine its current situation.

MATERIAL AND METHODS

This study has an ecological, longitudinal, and retrospective design based on secondary information on the acquisition and application of vaccines against influenza from official data from 2006 to 2022.

RESULTS

We found annual variability in the numbers of purchases and application of doses, with coverage of less than 90% of the total population every year; in addition, 17 million vaccines were not used in this period.

DISCUSSION

This study shows the situation of the program at the national level. Two institutions acquired fewer the vaccines, while one purchased more for its target population, but the necessary vaccinations were not acquired. On average, 1.7 million of the vaccines purchased annually were not used, but in some years, more vaccines were applied than were purchased in all of the institutions. We also observed that, between institutions, the vaccine coverage was very different, from 21% to 180%. On average, 6.2 million people were not vaccinated annually, between 16% and 22% of the target population, demonstrating low coverage. When we compared the coverage data that we calculated to the data published by the institutions, a great difference was observed.

CONCLUSIONS

We found inconsistencies in the data, indicating their unreliability and potential disorganization within the program, as the target populations of each institution were not clear. In addition, the application data may have had reporting errors. Adequate coverage was not achieved, and the coverage was different from that reported in the official sources. We propose the implementation of different systems for control, evaluation, and access to the information of the program.

Outpatient treatment of COVID-19: an experience with 552 cases in Mexico

INTRODUCTION

The impact of the coronavirus disease 2019 (COVID-19) pandemic has globally challenged health services, especially because when the pandemic first reached Mexico, in February 2020, there was no known effective and safe treatment. A treatment scheme was offered by the Institute for the Integral Development of Health (IDISA) in Mexico City from March 2020 to August 2021 when there were many patients with COVID-19. This report summarizes the experience managing COVID-19 with this scheme.

MATERIALS AND METHODS

This is a descriptive, retrolective study. The data was obtained from the case files of the patients who attended the IDISA from March 2020 to August 2021 with COVID-19. All the cases were treated with the scheme consisting of nitazoxanide, azithromycin, and prednisone. Various laboratory blood tests and chest computerized tomography scan were done. When indicated, supplementary oxygen, and another specific treatment were used. A standardized clinical recording was conducted for 20 days based on symptoms and systemic symptoms.

RESULTS

Based on the World Health Organization criteria, the patients were classified according to the disease severity: 170 mild, 70 moderate, and 312 severe cases. The outcome was the discharge of 533 patients after their recovery, 16 were excluded from the study, and 6 died.

CONCLUSIONS

The use of nitazoxanide, azithromycin, and prednisone proved to be effective as it resulted in improvement of symptoms and in successful outcomes for the management of COVID-19 outpatients.

Mucormycosis in children: a study of 22 cases in a Mexican hospital

We present a single-centre, retrospective study (1985-2012) of 22 cases of mucormycosis in children. A total of 158 mucormycosis cases were identified, of which 22 (13.96%) were children. The mean age of the children was 10.3 years (range: 6 months-18 years), and 59% of the infections occurred in males. The rhinocerebral form was the main clinical presentation (77.27%), followed by the primary cutaneous and pulmonary patterns. The major underlying predisposing factors were diabetes mellitus in 68.18% of the patients and haematologic diseases in 27.7% of the patients. The cases were diagnosed by mycological tests, with positive cultures in 95.4% of the patients. Rhizopus arrhizus was the foremost aetiologic agent in 13/22 cases (59.1%). In 21 cultures, the aetiologic agents were identified morphologically and by molecular identification. In 10 cultures, the internal transcribed spacer region of the ribosomal DNA was sequenced. Clinical cure and mycological cure were achieved in 27.3% cases, which were managed with amphotericin B deoxycholate and by treatment of the underlying conditions.

Hyperinfection with Strongyloides stercoralis

Strongyloidiasis is caused by Strongyloides stercoralis, which commonly produces gastrointestinal problems. If immune systems are compromised, the nematode larvae may spread and produce Strongyloides hyperinfection. Diagnosis of strongyloidiasis is based on the observation of larvae in coproparasitological studies. We present a case of a 49-year-oldman, VIH, who developed Strongyloides hyperinfection, diagnosed postmortem. Our patient reached the dissemination stage, which resulted in severe damage to the stomach and intestine, perforation of the intestinal wall, as well as sepsis due to the dissemination of bacteria. The diagnosis is difficult because of the low larvae excretion in stools. It is usually performed by the microscopic examination of fresh and fixed enriched stool samples. Serology was reported to be useful for screening and follow-up after treatment. This case reaffirms that HIV immunosuppression favours the dissemination of S stercoralis larvae. Thus, a search for intestinal parasites should be considered in similar cases.

Disseminated sporotrichosis

Sporotrichosis is a subacute or chronic infection caused by Sporothrix schenckii. It is a primary cutaneous infection and it has different clinical forms: disseminated by lymphatic vessels (75%), localised cutaneous form (20%), disseminated cutaneous and extracuteus rarely. The systemic disseminated sporotrichosis is considered a severe opportunistic infection. The best diagnostic test is the culture. The authors report a case of a 36-year-old man, originally from Puebla, Mexico, with a diagnosis of disseminated sporotrichosis. Differential diagnosis with other pathologies includes leishmaniasis, chromoblastomycosis, tuberculosis verrucose and lymphangitis. The development of unusual presentations in immunocompromised patients has been reported.

Seroepidemiología de la fasciolosis en escolares de la Ciudad de México

El objetivo de esta investigación es conocer la prevalencia de infección por Fasciola hepatica, mediante examen serológico, coprológicos y epidemiológico en una muestra de niños aparentemente sanos residentes en la delegación Coyoacán de la Ciudad de México. En la búsqueda de anticuerpos anti-Fasciola hepatica, se analizaron los sueros de 331 niños de 6 a 12 años de edad mediante la prueba de hemoaglutinación indirecta (HAI). Se realizó examen coprológico de sedimentación simple en serie de tres a todos los participantes. El estudio epidemiológico incluyó 6 variables. Resultados. Cinco de los niños fueron seropositivos a F. hepatica con una seroprevalencia de 1.51%. El estudio coprológico no reportó huevos de F. hepatica. El análisis estadístico entre seropositividad y consumo de berros, alfalfa, y lechuga no resultó significativo (χ2 = 0.42, p = 0.84). Sin embargo se encontró una relación estadísticamente significativa entre los parásitos y la edad de los sujetos. Este hallazgo coincide con la edad de los seropositivos. No se encontró asociación entre seropositividad y vivienda, agua potable, drenaje, abastecimiento de agua o consumo de verduras crudas,(χ2=6.00,p = 0.11) la asociación con el origen de la familia también fue negativo (χ2= 1.85, p = 0.17). Conclusiones. Aunque la Ciudad de México no es una zona endémica, y no tiene características adecuadas para la fasciolosis es importante reconocer que la existencia de residentes de origen múltiple presenta riesgos como pudimos demostrar y es precisamente en la edad escolar la que se tiene como factor de riesgo demostrado

[Systemic lupus erythematous and pregnancy]

OBJECTIVE

To determine the obstetrics outcomes of patients with systemic lupus erythematosus and pregnancy.

MATERIALS AND METHODS

A retrospective, analytic, and descriptive case of study is presented about of the obstetrics outcomes of patients with systemic lupus erythematosus and pregnancy attended in Hospital General de Mexico Obstetrics and Gynecology Service from June, 2000 to February, 2003.

RESULTS

Thirty-six records were reviewed. The mean age was 28 years. The most frequent maternal complications were the hypertensive disorders in association with pregnancy (27.5%). One patient had antiphospholipid syndrome, showed HELLP syndrome I and brain hemorrhage, she died in puerperium period. The main resolution of pregnancy was normal delivery. The median gestational age at delivery was 36 weeks (range of 24-40 weeks), and the mean birth weight was 2,389 g, median Apgar scores were 7 and 8 at 1 and 5 minutes of life respectively. There were 19 cases of low weight at birth and 7 preterm deliveries. There were no cases of neonatal lupus.

CONCLUSION

The maternal-fetal morbid-mortality rates decrease when no lupic disease activity is reported. During the pregnancy stage, preterm delivery and intrauterine growth retardation grow in number as observed in all the study subjects. All pregnancies should still be considered high risk and be managed with a multidisciplinary team. Co-existing antiphospholipid syndrome is the poorer prognosis for pregnancy outcome.

[Comparative study for the evaluation of the efficacy and safety of metronidazole and secnidazole in the treatment of vaginal trichomoniasis]

Presently study included 3 groups of 20 women with tricomoniasis demonstrated parasitologicaly for oozing vaginal, the first group received treatment with vaginal ova with metronidazol for 10 days, the second group ova of secnidazol for 3 days and the third group ova of secnidazol for 7 days. The results showed that the clinical manifestations dimanished significantly and the presence of Trichomonas vaginalis disappeared from the vaginal cavity, therefore cure was achieved parasitological in all the cases. We concluded that they are equally useful the metronidazol for 10 days, and the secnidazol for 3 or 7 days, without the presence of adverse effects.

[Frequency of intraepithelial neoplasia of the cervix and risk factors in women in Mexico City]

Cervical intraepithelial neoplasies (CIN), are very frequent in women with active sexual life who present risk factors. In this paper 220 exfoliative cytology reports from the National Cancer Register of the Direction of Epidemiology, Health Secretory, taken to women from eight Political Delegations in Mexico City, were revised. 134 cases presented CIN. 70.2% were grade III, corresponded to the age group between 26 and 35 years old; more than three pregnancies (47.76%) and more than three births (46.80%). Viral genital infections were related with CIN grades II and III. There are another risk factors that have been poorly analyzed in the national existent literature, therefore, it is necessary to effect further studies to determine the development of CIN in women with active sexual life.

[New sites with Triatominae infected by Trypanosoma cruzi in the Mexican Republic]

We report 29 new localities with Triatominae in the Republic of México; these Triatominae belong to 8 different species. Infection by Trypanosoma cruzi in the majority of these localities with high rates of positivity was found. Biological observations concerning the collected Triatominae are given. The necessity of continued work in relation to geographical distribution, ecology, frequency of infection by T. cruzy, and the role played by Triatominae of the Republic of México in the transmission of the infection to the man is stressed.

[Randomized study comparing the safety and efficacy of albendazole and metronidazole in the treatment of giardiasis in children]

An open, randomized study was carried out with 100 children to compare the efficacy and security of albendazole and metronidazole to eradicate Giardia lamblia. We included 100 patients in primary school age with giardiasis confirmed by parasitoscopic test who had not received treatment during the 2 previous months. A complete clinical study was performed. By using an aleatory code, the children were distributed in 2 groups: A and B. The clinical data was corroborated and the following tests were made: cell blood count, blood chemistry, direct and concentrated coproparasitoscopic study. Both groups were given an antiparasite treatment consisting of albendazole for group A or metronidazole for group B. Clinical, parasitological and blood controls were conducted before, during and after the treatment. A therapeutic efficacy of 94% and 98% for group A and B, respectively, was found. We concluded that albendazole and metronidazole are equally effective in a 5 days treatment period, but some undesirable effects may occur with metronidazole.

[Intestinal helminthiasis in the Mexican Republic]

Very few uncertain and not trustworthy reports about the frequency of intestinal helminthiases found in humans have been made in México. However, with the few trustful studies carried out from 1981 to 1992, it is possible in México to verify that ascariasis, trichuriasis, hookworm infection and hymenolepiasis are present with significant percentages of infected people 11.2%, 1.7%, 0.15% and 1.8%, respectively. With the information obtained from the researches analyzed in this article, one can conclude that human infections by intestinal helminths in México, at the present time are almost as frequent as in past decades. Without any doubt, this occurs because still remain the factors that contribute to the persistence and spreading of the intestinal helminths, such as fecalism, poor hygienic and alimentary habits within deficient environmental sanitary conditions.

Successful treatment of severe complicated measles with non-specific transfer factor

Severe complicated measles has a high mortality rate and no specific treatment. Ten patients with complicated measles - 9 infants with respiratory failure and a 15 year old boy with encephalitis - received immunotherapy with Non-specific Transfer Factor (NTF). The patients had variable degrees of undernourishment and were severely ill when immunotherapy was started. 8/9 cases with respiratory failure were cured. One died of bronchoaspiration while recovering from the measles. The case with encephalitis showed no neurological sequelae two weeks after receiving the last dose of NTF. Treatment of complicated measles with NTF in these patients seemed very effective and deserves further trial.

[Clinical aspects of hymenolepiasis in pediatrics]

The present integral clinical and laboratory study was carried out in 325 children infected with Hymenolepis nana. Results showed that H. nana is found among the top five intestinal parasitosis in school children in Mexico City, in the majority of the cases associated with protozoans and other helminths, especially and with Giardia lamblia. Although the amount of parasites found is small, the clinical manifestations vary very little with larger amounts. The most important and more constant clinical manifestations in those solely infected with H. nana and with other combinations are: abdominal pain, hyporexia and irritability. We have seen that in patients infected solely with H. nana, there is weight loss, meteorism and flatulences. In those associated with G. lamblia, diarrhea is one of the most frequent manifestations. Hymenolepiasis is an important disease in our environment due to its high frequency among pre-school and school children and its constant identifiable clinical manifestations.