ABSTRACT
OBJETIVOS: Determinar los costos médicos directos relacionados con la atención sanitaria de los casos de enfermedades neumocócicas invasoras (ENI) y neumonías adquiridas en la comunidad confirmadas mediante radiología (NAC-Rx) en niños chilenos. MÉTODO: Estudio de seguimiento prospectivo de las prestaciones de salud entregadas a 594 niños de 0 a 35 meses con ENI y 1489 niños de 1 a 35 meses con NAC-Rx, diagnosticados y tratados en establecimientos de la red pública de salud de la Región Metropolitana de Chile. Las prestaciones se valoraron según las tarifas del Fondo Nacional de Salud (FONASA) y los precios de dos clínicas privadas. Se estimó la incidencia nacional anual de ENI y NAC-Rx para calcular la carga económica total nacional de la población afiliada al seguro de salud estatal. RESULTADOS: Los costos promedio de los casos que requirieron hospitalización fueron US$ 1056,20 para las ENI y US$ 594,80 para las NAC-Rx, mientras que para los casos tratados en forma ambulatoria fueron US$ 77,70 y US$ 65,20, respectivamente. Los precios por los mismos servicios de internación fueron US$ 4484,10 y US$ 2962,70 en una de las clínicas privadas y US$ 9967,50 y US$ 6578,40 en la otra. El costo anual nacional estimado de la atención de los niños menores de 5 años según las tarifas de FONASA fue de US$ 789045 para las ENI y US$ 13823289 para las NAC-Rx. CONCLUSIONES: La alta demanda asistencial y económica por NAC-Rx en niños de 0 a 3 años es una razón de salud pública tremendamente poderosa que apoya el uso sistemático de la vacunación antineumocócica en niños chilenos.
OBJECTIVES: To determine the direct medical costs of health care services for cases of invasive pneumococcal disease (IPD) and pneumonia acquired in the community and confirmed by radiology (NAC-Rx) among Chilean children. METHODS: A prospective follow-up study of the health services delivered to 594 children 0-35 months of age with IPD and 1 489 children 1-35 months with NAC-Rx, diagnosed and treated by organizations within public health network of the Región Metropolitana de Chile. The value of the health services was established according to rates supplied by the Fondo Nacional de Salud (FONASA, the National Health Fund) and prices charged by two private clinics. The national IPD and NAC-Rx rates were estimated to calculate the total national economic burden for the population covered by state health insurance. RESULTS: The mean cost of cases requiring hospitalization was US$ 1056.20 for IPD and US$ 594.80 for NAC-Rx, while that of cases treated by out-patient services was US$ 77.70 and US$ 65.20, respectively. The cost of the same services for in-patient care at the private clinics was US$ 4484.10 and US$ 2962.70 at one clinic and US$ 9967.50 and US$ 6578.40 at the other. The estimated national annual cost of services for children under 5 years of age, according to FONASA rates, was US$ 789045 for IPD and US$ 13823289 for NAC-Rx. CONCLUSION: The high demand for services and financial resources for NAC-Rx in children 0-3 years of age is a tremendously powerful public health reason to support the routine use of pneumococcal vaccination in Chilean children.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Health Care Costs , Pneumonia, Pneumococcal/economics , Pneumonia, Pneumococcal/therapy , Chile , Community-Acquired Infections/etiology , Community-Acquired Infections/therapy , Follow-Up Studies , Pneumonia, Pneumococcal , Prospective StudiesSubject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Immunization Programs/organization & administration , Male , Primary Prevention/organization & administration , Typhoid Fever/prevention & control , Typhoid-Paratyphoid Vaccines/administration & dosage , Vaccination/standards , Global HealthABSTRACT
Background: The efficacy of influenza vaccination programs depends on the antigenic similitude between vaccine and the influenza virus circulating in the community. Therefore the surveillance of clinical activity and antigenic features of influenza virus is of utmost importance. Aim: To perform a systematic surveillance of clinical activity and antigenic characteristics of influenza virus. Material and methods: Since 1996 and during the cold months (may to september), 20 samples of upper respiratory secretions per week, were obtained from children with acute respiratory infections consulting to the emergency room of a public hospital. Using indirect immunofluorescence and cellular cultures, the presence of influenza, syncytial respiratory, parainfluenza and adenovirus was assessed. The weekly number of consultations in the emergency room and the number of hospital discharges due to acute respiratory infections, were registered. Results: Influenza and syncytial respiratory were the predominant virus detected since 1996. In 1996 and 1998, the weekly detection of influenza virus followed a single seasonal curve. The maximal weekly positively results reached 85 and 80 percent of the obtained samples, respectively. During 1997, two curves of influenza virus activity were observed, but none reached more than 50 percent of weekly positive samples. The demand for outpatient care evolved in parallel to the weekly detection of influenza virus. The hospital discharges due to acute respiratory infections paralleled the syncytial respiratory virus detection rates. Conclusions: This surveillance model is effective for the detection of influenza and other virus responsible for acute respiratory infections and their relationship with the demand for health care during the cold months
Subject(s)
Humans , Child , Respiratory Tract Infections/etiology , Epidemiological Monitoring , Orthomyxoviridae/isolation & purification , Orthomyxoviridae/pathogenicity , Outpatients , Respiratory Syncytial Viruses/isolation & purification , Respiratory Syncytial Viruses/pathogenicity , Respiratory Tract Infections/diagnosis , Paramyxoviridae/isolation & purification , Paramyxoviridae/pathogenicity , Adenoviruses, Human/isolation & purification , Adenoviruses, Human/pathogenicity , Nasal Lavage Fluid/virologyABSTRACT
La diarrea aguda es causa frecuente de consulta en niños menores de 2 años; de acuerdo a nuestra experiencia es posible identificar uno omás agentes bacterianos en el 50-70 por ciento de los casos. En estudios epidemiológicos y en determinados pacientes, es importante poder identificar él o los agentes causales y para ello es necesario seguir la metodología más eficiente. El objetivo de este trabajo fue comparar el rendimiento de 2 estrategias: siembra directa de deposición en medios selectivos versus enriquecimiento previo en calcio GN y posterior cultivo en medios selectivos.Como otro objetivo nos planteamos analizar la eficiencia de diferentes medios selectivos para aislamiento de Shigella. Para comparar ambos flujos de trabajos se estudiaron 1.869 muestras de deposiciones provenientes de un estudio etiológico de diarrea aguda. Se realizó siembra directa en agar MC, XLD, SS y HE, versus enriquecimiento en caldo GN, por 18 horas a 37ºC y resiembra posterior en los mismos medios. Para el aislamiento de Shigella se estudiaron 15.950 muestras de deposición, provenientes de un estudio de vigilancia activa de Shigella, que se sembraron en los mismos 4 medios selectivos. Rendimiento de ambos flujos: se aislaron 33 cepas de Shigella sp y 10 cepas de Salmonella sp, de las cuales 32 cepas de Shigella (97 por ciento), se recuperaron de la siembra directa y 13 (39,4 por ciento), mediante enriquecimiento previo en caldo GN, diferencia significativa, p < 0,00001. El rendimiento para Salmonella resultó similar por ambas metodologías. En relación a los medios selectivos para recuperación de Shigella, utilizando más de 1 medio el rendimiento aumenta en forma significativa (de 38,3 por ciento a 61,7 por ciento) p < 0,000001. De los medios analizados, el mejor rendimento se observó con XLD (16 por ciento) y SS (15,5 por ciento). En conclusión, no recomendamos el enriquecimiento previo en caldo GN, tiene menor rendimiento para aislamiento de Salmonella y Shigella, encarece el procedimiento y demora los resultados
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Culture Media , Diarrhea, Infantile/microbiology , Enterobacteriaceae/isolation & purification , Feces/microbiologyABSTRACT
Enterohemorrhagic escherichia coli (EHEC), have been associated with pathogenesis of hemolytic uremic syndrome (HUS) worldwide. Our aim was to determine the association of EHEC ing¿fection and HUS in chilean children. During may 1991 and october 1993, 34 children HUS and 33 age matched controls (children with diarrhea that did not develop HUS) were enrolled in a case/control study. For each child a stool and serum sample were obtained at admission. Stools were processed for common enteropathogen and for EHEC identification. EHEC were identified in stools by gene probes for different virulence factors (EHEC plasmid-associated fimbria, Shiga-like toxin I, Shiga-like toxin II and eae adherence factor) and by detection of free fecal toxin by neutralization assay in Vero cells. Sera were processed for anti-cytotoxin antibodies also by an assay in Vero cells. Enteropathogens were isolated in 20.6 percent and 15.5 percent of HUS and control children respectively (p=NS). 91 percent of the HUS children and 73 percent of the control children were EHEC positive by one or more of the techniques used (p=0.05). Of the 3 detection methods used for EHEC, only free fecal cytotoxin was significantly more common in HUS children than controls (45.5 percent vs 9 percent p=0.007). Genotype patterns of HUS and controls strains were similar except for a trend towards a higher frequency of non-toxigenic strains in the control group. Serogroup 0157 was more common in HUS children than in controls (9 percent vs 0 percent p=0.036). In Chile as in other countries, EHEC infection is common and significantly associated with occurrence of HUS. Infection with EHEC strains 0157 seems to be important risk factor for HUS
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Escherichia coli Infections/microbiology , Hemolytic-Uremic Syndrome/microbiology , Specimen Handling , Case-Control Studies , Risk Factors , Cytotoxins/isolation & purification , Diarrhea, Infantile/microbiology , Escherichia coli Infections/epidemiology , Feces/microbiology , Gastrointestinal Hemorrhage/microbiologySubject(s)
Child , Adolescent , Humans , Male , Female , Typhoid-Paratyphoid Vaccines/analysis , Chile , Follow-Up Studies , Vaccines, AttenuatedABSTRACT
Se ha identificado en gran parte a los agentes etiológicos de la diarrea infantil y se preparan, por métodos modernos de biotecnología, vacunas potenciales contra los más importantes (rotavirus, E. coli enterotoxígena y Shigella). La mayor parte de esas vacunas potenciales se administran por vía oral, que es preferible por estimular una inmunidad localizada en el intestino. Para combatir la diarrea endémica y epidémica y la fiebre entérica, esas vacunas deben distinguirse por su buena tolerancia, elevada eficacia, costo reducido y resultado práctico y ha de haber posibilidades óptimas de administrarlas mediante programas ampliados de inmunización. Ya es posible, e incluso inminente, el logro de vacunas específicas que mitiguen la gravedad de la diarrea infantil y la consiguiente mortalidad. Esas vacunas serán una nueva arma en la batalla contra las infecciones entéricas