Infección por SARS-CoV-2 en niños: características clínicas y dinámica de la transmisión de SARS-CoV-2 en un centro de salud privado: Uruguay / SARS-CoV-2 infection in children: clinical characteristics and dynamics of SARS-CoV-2 transmission in a private health center: Uruguay

INTRODUCCIÓN: Hasta la fecha, la prevalencia y gravedad de la enfermedad COVID- 19 en niños es menor que en adultos. Existen controversias en relación a la dinámica de la transmisión y al rol que juegan en la diseminación de la enfermedad. OBJETIVO: Describir las características clínicas y la dinámica de transmisión de los pacientes bajo 15 años de edad notificados por sospecha y/o contacto para COVID-19 en el período 13 marzo - 20 noviembre 2020, en un prestador integral privado de salud (Médica Uruguaya Corporación de Asistencia Médica, MUCAM). METODOLOGÍA: Estudio descriptivo, retrospectivo, en el que se describen manifestaciones clínicas, noción epidemiológica, casos secundarios, gravedad y evolución. Se estimó el riesgo y la tasa de ataque secundaria intradomiciliaria. RESULTADOS: Cumplieron los criterios de inclusión 539 pacientes. El diagnóstico se confirmó en 29 (5,3%): 13 (7,0%) de los 351 niños sintomáticos y 16 (4,5%) de los 188 asintomáticos. Tuvieron noción de contacto el 100% de los casos confirmados y 85% de los no confirmados (p < 0.05). El OR para la infección a partir de un contacto intradomiciliario fue 26,5 (9,8- 71,7) y la tasa de ataque secundaria intradomiciliaria 23% ± 4,1. CONCLUSIONES: En esta serie, en los pacientes bajo 15 años de edad predominaron las formas leves y asintomáticas. Uno de cada cinco expuestos intradomiciliarios contrajo la enfermedad siendo esta noción de contacto decisiva para indicar estudios confirmatorios. La mayoría de los niños no continuó la cadena de transmisión.

BACKGROUND: To date, the prevalence and severity of the COVID-19 disease in children is lower than in adults. There are controversies regarding the dynamics of transmission and the role they play in the spread of the disease. AIM: To describe the clinical characteristics and transmission dynamics of patients under 15 years of age reported for suspicion and/or contact for COVID-19 in the period March 13 - November 20, 2020, in a private comprehensive health provider (Médica Uruguaya Medical Assistance Corporation, MUCAM). METHODS: Descriptive, retrospective study, in which clinical manifestations, epidemiological notion, secondary cases, severity and evolution are described. The risk and rate of secondary intradomiciliary attack were estimated. RESULTS: 539 patients met the inclusion criteria. The diagnosis was confirmed in 29 (5.3%): 13 (7.0%) of the 351 symptomatic children and 16 (4.5%) of the 188 asymptomatic. 100% of the confirmed cases and 85% of the unconfirmed cases had the notion of contact (p < 0.05). The OR for infection from an indoor contact was 26.5 (9.8-71.7) and the rate of secondary indoor attack 23% ± 4.1. CONCLUSIONS: In this series, mild and asymptomatic forms predominated in patients under 15 years of age. One in five exposed indoors contracted the disease, this notion of contact being decisive to indicate confirmatory studies. Most of the children did not continue the chain of transmission.

Epidemiological characteristics of influenza clusters in Hangzhou / 预防医学

Objective@#To analyze the epidemiological characteristics of influenza clusters in Hangzhou from 2018 to 2019, so as to provide references for the prevention and control of influenza. @*Methods@#The data came from the epidemic investigation reports of influenza clusters in Hangzhou from the 27th week of 2018 and the 26th week of 2019. The time distribution, school types, population distribution and etiology of influenza were analyzed. Multivariate logistic regression model was employed to analyze the influencing factors for the attack rate of influenza clusters. @*Results@#During the surveillance season, a total of 231 school influenza clusters involving 4 233 cases were reported. The median of the attack rate was 21.74%. The peak of the clusters was in March 2019, with 89 events and 1 476 cases ( 34.87% ). The clusters occurred mainly in primary schools ( 188 events, 81.39% ) and were mainly caused by Victoria-like strains of influenza B virus ( 84 events, 36.36% ). The multivariate logistic regression analysis indicated that infection of teachers increased the risk of high attack rate ( OR=3.133, 95%CI: 1.180-8.320 ), and kindergartens had higher risk of high attack rate than primary schools ( OR=4.123, 95%CI: 1.579-10.763 ). @*Conclusions@#The influenza clusters in Hangzhou from 2018 to 2019 is mainly caused by Victoria-like strains of influenza B virus. Kindergartens and teachers are the key points for the prevention and control of influenza clusters.

Outbreaks of dengue in Central India in 2016: Clinical, laboratory & epidemiological study

Background & objectives: Dengue virus (DENV) causes outbreaks and sporadic cases in tropical and subtropical countries. Documenting intricacies of DEN outbreaks is important for future interventions. The objective of this study was to report clinical, laboratory and epidemiological features of DEN outbreaks reported in different districts of Central India in 2016. Methods: In 2016, outbreaks (n=4) suspected of DEN were investigated by rapid response team. Door-to-door fever and entomological surveys were conducted. Blood samples were collected and tested using NS1 or IgM ELISA; real-time reverse transcription-polymerase chain reaction was done to identify serotypes of DEN virus (DENV). NS1-positive samples were tested for the presence of IgG by ELISA. Clinical and demographic data were collected and analyzed. Results: Outbreaks occurred in both urban and rural areas in monsoon season and Aedes aegypti was identified as the vector. Fever, chills, headache and myalgia were the major symptoms; no fatality was recorded. Of the 268 DEN suspects, 135 (50.4%) were found serologically positive. DEN positivity was higher (n=75; 55.56%) among males and in the age group of 16-45 yr (n=78; 57.8%). DENV 3 followed by DENV 2 were detected as the major responsible serotypes. High attack rates (up to 38/1000) and low cumulative IgG prevalence (14.9%) were recorded in rural areas. Interpretation & conclusions: Our study showed that DENV 3 was the major serotype responsible for outbreaks that occurred in monsoon. High attack rates and lower number of secondary infections in rural areas indicated that DENV is emerging in rural parts of Central India. Early diagnosis at local level and timely intervention by mosquito control activities are needed to avoid such outbreaks in future.

Attack rate and household secondary attack rate of acute conjunctivitis during an outbreak in South India: A community‑based survey.

Introduction: Knowledge on epidemiology of the disease in the contemporary world will help to develop appropriate strategies to curtail the transmission during an outbreak. This study was carried out during an outbreak of conjunctivitis in selected areas of Puducherry, South India, to assess the attack rate of conjunctivitis, identify factors associated with developing conjunctivitis and calculate household secondary attack rate (HSAR) of conjunctivitis and its correlates. Methodology: During December 2014, a community‑based survey was conducted in a selected urban and rural area in Puducherry, South India. Simple random sampling was used to select primary sampling units and systematic sampling to select households. All individuals in the selected households were studied. A questionnaire was used to obtain data on sociodemographic characteristics, conjunctivitis during September–November, 2014, and number of household contacts who developed conjunctivitis within 7 days of index case. The attack rate and HSAR of conjunctivitis was expressed as percentage. Multivariate logistic regression was used to find factors independently associated with developing conjunctivitis and also 100% HSAR. Results: Of 3193 study participants from 772 households, 509 (15.9%, 95% confidence interval 14.7–17.2%) had an attack of conjunctivitis during the reference period. Of the 772 households, 218 (28.2%) had at least one case of conjunctivitis. Of 218 households, 33 (15.1%) households had 100% HSAR. Lower age, not being unemployed, low socioeconomic status, and residing in rural area were independently associated with developing conjunctivitis. Index case being male and living in a household with ≥5 members were independently associated with 100% HSAR. Conclusion: In the outbreak under study, more than one‑fourth of households had at least one case of conjunctivitis and about one in every six individuals had an attack of conjunctivitis.

Measles outbreak investigation in Dwarahat block of District Almora, Uttarakhand.

Background: We report an assessment of measles outbreak during the months of February 2014 to April 2014 in Dwarahat block of district Almora and the response mounted to it. Materials and Methods: An intensive door‑to‑door search to six measles affected villages in Dwarahat block of district Almora, covering a population of 2,408 was carried out to identify the cases of measles by a rapid response team (RRT). A total of ten blood samples were randomly collected for detecting IgM antibody against measles. For all cases, information on personal details, place of residence, time of onset and status of immunization were obtained. Results: Overall attack rate (AR) was 2.8%. AR among the population of age‑group 0–16 was 7.2%. Statistically significant higher AR (16.26%) was seen for the age‑group of 0–5 years as compare to 6–10 and 11–16 years of age (AR‑8.71, relative risk‑0.53, 95% confidence interval‑0.32–0.88, P value‑0.012 and AR‑0.57%, relative risk‑0.035, 95% confidence interval‑0.00–0.14, P value‑0.000, respectively). Males were affected more often than females 35 [59.2%] vs. 24 [40.8%]. Measles‑related complications were seen in three children. No death was reported. Of the 10 samples, nine were positive for measles IgM antibodies by enzyme‑linked immunosorbent assay (ELISA). Conclusion: The recognition of early warning signals, timely investigation and application of specific control measures can contain the outbreak. The unvaccinated or partially protected human beings serve as the reservoir of measles virus. Hence, there is a need for sero surveillance for measles in Uttarakhand and one catch up measles immunisation campaign to prevent future outbreak.

Measles Outbreak among the Dukpa Tribe of Buxa Hills in West Bengal, India: Epidemiology and Vaccine Efficacy.

Although measles is a vaccine preventable disease, its occurrence and outbreaks are common in India. Four remote and inaccessible hamlets, inhabited by the Dukpa tribe, at Buxa Hills under Kalchini Block of Jalpaiguri District, West Bengal experienced a measles outbreak during the months of April-June, 2011. The authors conducted an investigation to assess vaccine coverage, vaccine effi cacy (VE) and to describe the patterns of measles outbreaks in this community. The over-all attack rate was 14.3%; that among males and females were 12.6% and 16.0% respectively (P = 0.189). Attack rate was highest (40%) in 0 to <5 years followed by that in the 5 to <15 years (36.5%). VE was 66.3% (95% of the confi dence interval 46.9-78.6%). There is an urgent need to increase the vaccination coverage through special tactics for reaching the unreached.

Interpretation of the presence of IgM and IgG antibodies in a rapid test for dengue: analysis of dengue antibody prevalence in Fortaleza City in the 20th year of the epidemic / Interpretação da presença dos anticorpos IgM e IgG nos testes rápidos para dengue: análise da prevalência dos anticorpos da dengue em Fortaleza, no vigésimo ano da epidemia

INTRODUCTION: The diagnosis of dengue and the differentiation between primary and secondary infections are important for monitoring the spread of the epidemic and identifying the risk of severe forms of the disease. The detection of immunoglobulin (Ig)M and IgG antibodies is the main technique for the laboratory diagnosis of dengue. The present study assessed the application of a rapid test for dengue concerning detection of new cases, reinfection recognition, and estimation of the epidemic attack rate. METHODS: This was a retrospective, cross-sectional, descriptive study on dengue using the Fortaleza Health Municipal Department database. The results from 1,530 tested samples, from 2005-2006, were compared with data from epidemiological studies of dengue outbreaks in 1996, 2003, and 2010. RESULTS: The rapid test confirmed 52% recent infections in the tested patients with clinical suspicion of dengue: 40% detected using IgM and 12% of new cases using IgG in the non-reactive IgM results. The positive IgM plus negative IgG (IgM+ plus IgG-) results showed that 38% of those patients had a recent primary dengue infection, while the positive IgG plus either positive or negative IgM (IgG+ plus IgM+/-) results indicated that 62% had dengue for at least a second time (recent secondary infections). This proportion of reinfections permitted us to estimate the attack rate as >62% of the population sample. CONCLUSIONS: The rapid test for dengue has enhanced our ability to detect new infections and to characterize them into primary and secondary infections, permitting the estimation of the minimal attack rate for a population during an outbreak.

INTRODUÇÃO: O diagnóstico de infecções por dengue e sua diferenciação entre infecções primárias e secundárias são importantes para monitorar a disseminação de epidemias e para identificar riscos de formas graves da doença. A detecção de anticorpos IgM e IgG tem sido o principal mecanismo para o diagnóstico laboratorial. Este estudo visa avaliar a capacidade do teste rápido para dengue para: detectar casos novos da doença, diagnosticar reinfecções e estimar taxas de ataque de epidemias. MÉTODOS: Este trabalho consiste de estudo descritivo, transversal retrospectivo, sobre dengue, que utiliza o banco de dados da Secretaria Municipal de Saúde de Fortaleza. Os resultados de 1.530 amostras testadas entre 2005-2006 foram confrontados com dados de estudos epidemiológicos relativos aos surtos de dengue em 1996, 2003 e 2010. RESULTADOS: o teste foi capaz de confirmar 52% de infecções recentes entre pacientes com suspeitas clínicas de dengue: 40% das infecções foram confirmadas pela banda IgM e 12% de casos extras foram detectados pela banda IgG reagente em amostras IgM nãoreagentes. Resultados IgM reagentes e IgG não-reagentes mostraram que 38% das infecções eram primárias, enquanto resultados IgG reagentes, com ou sem IgM reagente, indicaram que 62% das infecções recentes eram reinfecções. Esta proporção de infecções secundárias permitiu estimar a taxa de ataque como maior ou igual a 62% naquela população amostral. CONCLUSÕES: O teste rápido para dengue apresentou capacidade aumentada para diagnosticar infecções recentes e de caracterizá-las entre infecções primárias e secundárias, permitindo estimar a taxa de ataque mínima para a população amostral de um surto.

The attack rates of the pandemic influenza infection, Ulaanbaatar, November 2009 / Монголын Анагаах Ухаан

BACKGROUND: In Ulaanbaatar, the first case of the pandemic influenza infection has been reported on 12 October 2010.By November 9, a total of 929 cases laboratory-confirmed had been reported to National Center for CommunicableDiseases (NCCD). Of these cases reported, 9 people died.METHODS: The objectives of the study were to describe patients who admitted and hospitalized at NCCD and to determineoverall attack rates among health workers, secondary attack rates among students of colleges and universities. Datawas analyzed using Epi-Info2000.RESULTS: Among 929 of laboratory-confirmed cases, 50.3% (95% CI 43.0-57.5) were males aged 23 (±14.9) in averagewith youngest – 7 months, oldest – 76 years old. Data analysis by districts among the hospitalized patients, showed32.8% (139) of total cases in Bayanzurkh district including the first case of the pandemic influenza infection. The majorityof patients who admitted and hospitalized to NCCD mostly experienced fever (288, 68.1%), dry cough (251, 59.3%),headache (203, 48.0%), sore throat (175, 41.6%). With 1020 physicians and health workers in total, 41.4% (422) ofthem work at NCCD, 35.4% (361) – at MCHRC. 11.1% of health workers out of total become ill with pandemic H1N12009 (overall attack rate 11.1%) with the most common symptom, 380C and higher fever (100.0%, 113), sore throat(83.2%, 94), cough (76.1%, 86) and runny nose (59.3%, 67). The higher attack rates of health workers by occupationwere doctor (18.0%) and auxiliary (13%). The secondary attack rates among university students for influenza-likeillness(ILI) were 12.9%. These secondary attack rates were higher among students of art’s college as compared withother universities (52.4%). For students, the main clinical symptoms were fever + sore throat (75.0%, 18), fever+ cough(70.8%, 17).DISCUSSION: In China, as of 27 September, 2009, from reported total 19981 cases infected with pandemic influenza,61.0% were males, mean age was 17, mainly affected with 83% school students that consistent with our study result.The similar results on clinical symptoms were obtained in Russia. Out of 130 patients, 28.6% had 380Ñ and higherfever, for 54.3% the body temperature reached 38.1-390Ñ where as 17.1% - higher 390Ñ and 96% had cough, 89%had muscle ache, 65% had headache, 14% had diarrhea.

A Survey on the Non-communicable Disease Prevalence and its Risk Factors Analysis in Residents in Shanghai / 中国慢性病预防与控制

Objective To evaluate the epidemic status of main non-communicable chronic diseases among the residents of Jingan district in Shanghai.Methods Multistage cluster sampling was adopted.960 residents were investigated with questionnaire and physical examination.Results The prevalence rates of Hypertension,diabetes mellitus,Cerebral vessels and Heart-blood were 25.6%,5.8%,3.1%and 5.7%,respectively.The multivarate logistic regression analysis showed that the related risk factors to four non-communicable chronic diseases included family history,the OR(95%CI)1.6(1.2～2.3),6.9 (3.5～13.6),4.5(2.0～10.0),2.2(1.2～4.0)separately.Conclusion Hypertension,diabetes are the main non-communicable disease hazarding the public health.The government and professional institutes should raise the attention on this serious problem and finance more as well as supplying policy support.

An Epidemiologic Investigation of Shigellosis Outbreak in Gangnung 1998 / 한국역학회지

An epidemiologic investigation was carried out to identify the distribution and the cause of Shigellosis outbreak, which was occurred in Gangnung city from August to November, 1998. This study carried out from September, 14, to November, 20, 1998. The total number of Shigellosis confirmed patient is 87. We surveyed and obtained the stool sample from all suspected patients and their members of household. The major findings of this study are as follows. 1. The first patient appeared in September 11 and the number of patients increased to September 13, that is peak time, and the patient number tailed down apparently from September, 18, 1998. 2. The incidence rate per 1,000 is largest in Wangsan-Myeon Doma-Ri(32.9), and second largest in Wangsan-Myeon Mokgea-Ri(31.6), The total incidence rate in Gangnung-shi is 0.4(0.4 for man and 0.3 for woman). The age group with the largest incidence rate per 1,000 is 5-14 age group whose incidence rate is 1.4. 3. The secondary generation attack rate in confirmed patient family is 20.6%, and the secondary attack is 7.8%. 4. We considered the meal of school, environmental factor, milk, carrier of Shigellosis as the cause of outbreak, but we were not able to identify the bacteria of shigellosis. But we suspected the meal of school that played important role in outbreak, because outbreak occurred explosively after students ate the meal of school. 5. We considered three hypotheses for the cause of the outbreak. First, a propagation from external regions; Second, an outbreak from contaminated foods; Third, a propagation from carriers in Gangnung. In order to obtain the further information for first and third hypothesis, we should perform PFGE(Pulsed-field gelectrophoresis) with the shigella bacteria of each epidemic region.

An Epidemiologic Investigation on the Mode of Transmission of the Lethal Salmonellosis Outbreak in Hamyang County / 한국역학회지

An outbreak of Salmonella enteritidis epidemic involving about 200 inpatients of gastroenteritis and 1 death occurred among about 750 participants from Hamyang County who attended 4 wedding lunch parties at one buffet restaurant on April 25, 1999. There were also many patients including 1 death among about 500 participants outside Hamyang County who attended same parties. Person to person interviews made to 155 inpatients revealed that distribution of incubation periods was between 1 to 34 hours with median time, 13-14 hours. A retrospective cohort study was conducted to investigate the mode of transmission. Telephone interviews were made to party participants (except 61 inpatients who already had been interviewed personally) on symptoms and on which they had eaten among 40 served foods including water at the parties and data among 288 persons were available for the analyses. One hundred and ninety one interviewees had more than two symptoms among symptoms of diarrhea(more than 3 times), abdominal pain, and fever, which gave an attack rate of 66.3%(191/288). The relative short incubation period and high attack rate suggested the presence of higher infecting dose in this epidemic. Logistic regression analysis revealed that the probable infective foods were boiled cockle, gamju, boiled midodok, fried rices, eomook, and boiled pig's trotter. Salmonella enteritidis were identified in the specimens of boiled cockle, cooked beef, and uncooked beef. Only boiled cockle was both an epidemiological and microbiological infective food. There might be cross-contaminations between several served foods, which meant presence of many contaminated foods by Salmonella enteritidis with different stage of their multiplications. Efforts to inspect food service areas and educate foodhandlers in good personal hygiene and proper foodhandling practices should be strengthened to reduce the incidences of salmonellosis in Korea.

Study on Epidemiology of Kawasaki Disease in Jilin Province from 1999 to 2008 / 实用儿科临床杂志

Objective To investigate the epidemiological characteristics and clinical prognosis of Kawasaki disease(KD) in Jilin pro-vince for recent 10 years.Methods The survey forms unified of standard KD epidemiology were used and sent to the province′s 32 hospitals above the county and city level with pediatric in-patients,in order to conduct a survey on the KD children during 10 years period from Jan.1,1999 to Dec.31,2008.SPSS 15.0 software was used to analyze the data.Results There were 93.75% of the survey forms came back.Five hundred and seventy-seven KD cases were reported from the 32 hospitals of 8 districts.The incidence of KD was of an increasing trend.It was 18 cases in 1999,while it was up to 122 cases in 2008.Male patients were 382 cases(66.2%),female patients were 195 cases(33.8%).The ratio of male and female was 1.96 to 1.The age of patients varied from 58 days to 14 years,those under 5 years of age accounted of 88.73%.Fourteen(2.4%) cases were found to have the sequelae of coronary artery disease.The ratio of male and female was 3.671.The younger the age,the higher the incidence of cardiac sequelae.The mainest cardiac sequelae was coronary artery ectasia.The time of visiting was(7.58?4.63) days after the onset.The KD children from 4 minority peoples including 50 cases accounted for 8.7%.The disease occurred all over the year,and had obvious season peak.Coronary artery lesions accounted for 63.26%.There was no death during acute pe-riod.The recurrence rate was 0.5%.Conclusions The incidence of KD in Jilin is in an increasing trend.The age and gender distribution are not exactly the same to pre-vious reports.There are two seasonal peaks including summer and winter,which is different to previous reports of domestic,United State,Japan.