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1.
Health Promot Chronic Dis Prev Can ; 40(11-12): 336-341, 2020 12 09.
Artículo en Inglés, Francés | MEDLINE | ID: covidwho-1029022

RESUMEN

INTRODUCTION: Research has shown that during the 2003 SARS pandemic, emergency department (ED) visits among the pediatric population decreased. We set out to investigate if this was also true for injury-related ED visits during the COVID-19 pandemic. METHODS: Using data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), we looked at 28 years of injury-related ED visits at the Montreal Children's Hospital, a provincially designated Pediatric Trauma Centre. We compared data from a two-month period during the COVID-19 lockdown (16 March to 15 May) to the same period in previous years (1993-2019) to determine whether the 2020 decrease in ED visit numbers was unprecedented (i.e. a similar decrease had never occurred) for different age groups, nature of injuries, mechanisms and severity. RESULTS: The 2020 decrease was unprecedented across all age groups between 1993 and 2019. When compared with the 2015 to 2019 average, the decrease was smallest in children aged 2 to 5 years (a 35% decrease), and greatest in the group aged 12 to 17 years (83%). Motor vehicle collisions and sports-related injuries practically vanished during the COVID-19 lockdown. Surprisingly, more children aged 6 to 17 years presented with less urgent injuries during the COVID-19 lockdown than in previous years. CONCLUSION: As was the case with SARS in 2003, COVID-19 acted as a deterrent for pediatric ED visits. The lockdown in particular had a profound impact on injury-related visits. The de-confinement period will be monitored to determine the impact in both the short and the long term.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Traumatismos en Atletas/epidemiología , Niño , Preescolar , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Factores Protectores , Quebec/epidemiología , Heridas y Traumatismos/etiología
2.
Genet Med ; 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: covidwho-1028696

RESUMEN

PURPOSE: A COVID-19 pandemic business continuity plan (BCP) was rapidly developed to protect the Victorian newborn screening (NBS) program. Here, we present the outcomes of our COVID-19 BCP and its impact on the Victorian NBS laboratory service. METHODS: Change management principles were used to develop a BCP that included mapping of NBS processes against staff resources, triaging priorities, technology solutions, supply chain continuity, gap analysis, and supporting maternity service providers. The effect was assessed quantitatively by review of key performance indicator data and qualitatively from staff feedback. RESULTS: A four-stage BCP was implemented. Stage 1 split teams into two, which rotated weekly, onsite (laboratory) and offsite (home). At 20 weeks post-implementation the BCP only progressed to stage 1 and the overall turnaround time was maintained. Staff experience indicated benefits from the review of workflow but noted some social impact associated with the change. CONCLUSION: The preparedness and agility of implementation was based on our focus on the newborn babies and their families, our production system, and a continuous improvement mindset. Both our people and technology infrastructure processes are crucial to this success as we continue to adapt to new challenges.

3.
Seminars in Perinatology ; 44:7, 2020.
Artículo | WHO COVID | ID: covidwho-1029947

RESUMEN

During the early months of the COVID-19 pandemic, infection prevention and control (IP&C) for women in labor and mothers and newborns during delivery and receiving post-partum care was quite challenging for staff, patients, and support persons due to a relative lack of evidence-based practices, high rates of community transmission, and shortages of personal protective equipment (PPE) We present our IP&C policies and procedures for the obstetrical population developed from mid-March to mid-May 2020 when New York City served as the epicenter of the pandemic in the U S For patients, we describe screening for COVID-19, testing for SARS-CoV-2, and clearing patients from COVID-19 precautions For staff, we address self-monitoring for symptoms, PPE in different clinical scenarios, and reducing staff exposures to SARS-CoV-2 For visitors/support persons, we address limiting them in labor and delivery, the postpartum units, and the NICU to promote staff and patient safety We describe management of SARS-CoV-2-positive mothers and their newborns in both the well-baby nursery and in the neonatal ICU Notably, in the well-baby nursery we do not separate SARS-CoV-2-positive mothers from their newborns, but emphasize maternal mask use and social distancing by placing newborns in isolates and asking mothers to remain 6 feet away unless feeding or changing their newborn We also encourage direct breastfeeding and do not advocate early bathing Newborns of SARS-CoV-2-positive mothers are considered persons under investigation (PUIs) until 14 days of life, the duration of the incubation period for SARS-CoV-2 We share two models of community-based care for PUI neonates Finally, we provide our strategies for enhancing communication and education during the early months of the pandemic

4.
Seminars in Perinatology ; 44(7), 2020.
Artículo | WHO COVID | ID: covidwho-1029142

RESUMEN

As the COVID-19 pandemic continues to spread worldwide, it is crucial that we determine populations that are at-risk and develop appropriate clinical care policies to protect them While several respiratory illnesses are known to seriously impact pregnant women and newborns, preliminary data on the novel SARS-CoV-2 Coronavirus suggest that these groups are no more at-risk than the general population Here, we review the available literature on newborns born to infected mothers and show that newborns of mothers with positive/suspected SARS-CoV-2 infection rarely acquire the disease or show adverse clinical outcomes With this evidence in mind, it appears that strict postnatal care policies, including separating mothers and newborns, discouraging breastfeeding, and performing early bathing, may be more likely to adversely impact newborns than they are to reduce the low risk of maternal transmission of SARS-CoV-2 or the even lower risk of severe COVID-19 disease in otherwise healthy newborns

5.
Seminars in Perinatology ; 44(7), 2020.
Artículo | WHO COVID | ID: covidwho-1029108

RESUMEN

As we confront COVID-19, the global public health emergency of our times, new knowledge is emerging that, combined with information from prior epidemics, can provide insights on how to manage this threat in specific patient populations Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), both caused by coronaviruses, caused serious respiratory illness in pregnant women that resulted in adverse perinatal outcomes Thus far, COVID-19 appears to follow a mild course in the vast majority of pregnant women A significant proportion of pregnant women appear to be asymptomatic carriers of SARS-CoV-2 However, there is limited information on how COVID-19 impacts the fetus and whether vertical transmission occurs While these knowledge gaps are addressed, it is important to recognize the highly efficient transmission characteristics of SARS-C0V-2 and its potential for causing serious disease in vulnerable individuals, including health care workers This review provides perspectives from a single center in New York City, the epicenter of the pandemic within the United States It offers an overview of the preparations required for deliveries of newborns of mothers with COVID-19 and the management of neonates with particular emphasis on those born with complex issues

6.
Preprint | medRxiv | ID: ppmedrxiv-21249598

RESUMEN

ObjectivesThe primary objective was to evaluate the preliminary impact of Essential Coaching for Every Mother on self-efficacy, social support, postpartum anxiety and postpartum depression. The second objective was to explore the acceptability of the Essential Coaching for Every Mother program provided during the COVID-19 pandemic. MethodsA prospective pre-post study was conducted with first time mothers in Nova Scotia, Canada between July 15th and September 19th, 2020. Participants completed a self-report survey at enrolment (after birth) and six-weeks postpartum. Variety of standardized measures were used and qualitative feedback on the program was also collected. Paired t-tests were carried out to determine changes from baseline to follow-up on psychosocial outcomes and qualitative feedback was analysed through thematic analysis. ResultsA total of 88 women enrolled. Self-efficacy increased between baseline (B) and follow-up (F) (B:33.33; F:37.11, p=0.000) while anxiety (STAI) declined (B:38.49; F:34.79; p=0.004). No other significant changes were found. In terms of acceptability, 89% of participants felt that the number of messages were just right, 84.5% felt the messages contained all the information they needed relative to caring for a newborn and 98.8% indicated they would recommend this program to other new mothers. ConclusionEssential Coaching for Every Mother may play a role increasing maternal self-efficacy and decreasing anxiety, although future work with a control group is important to delineate the true effects of the program. Overall, mothers were satisfied with the Essential Coaching for Every Mother program and would recommend it for other mothers, during COVID-19 and beyond.

8.
MMWR Morb Mortal Wkly Rep ; 69(49): 1868-1872, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1024819

RESUMEN

The Head Start program, including Head Start for children aged 3-5 years and Early Head Start for infants, toddlers, and pregnant women, promotes early learning and healthy development among children aged 0-5 years whose families meet the annually adjusted Federal Poverty Guidelines* throughout the United States.† These programs are funded by grants administered by the U.S. Department of Health and Human Services' Administration for Children and Families (ACF). In March 2020, Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act,§ which appropriated $750 million for Head Start, equating to approximately $875 in CARES Act funds per enrolled child. In response to the coronavirus disease 2019 (COVID-19) pandemic, most states required all schools (K-12) to close or transition to virtual learning. The Office of Head Start gave its local programs that remained open the flexibility to use CARES Act funds to implement CDC-recommended guidance (1) and other ancillary measures to provide in-person services in the early phases of community transmission of SARS-CoV-2, the virus that causes COVID-19, in April and May 2020, when many similar programs remained closed. Guidance included information on masks, other personal protective equipment, physical setup, supplies necessary for maintaining healthy environments and operations, and the need for additional staff members to ensure small class sizes. Head Start programs successfully implemented CDC-recommended mitigation strategies and supported other practices that helped to prevent SARS-CoV-2 transmission among children and staff members. CDC conducted a mixed-methods analysis to document these approaches and inform implementation of mitigation strategies in other child care settings. Implementing and monitoring adherence to recommended mitigation strategies reduces risk for COVID-19 transmission in child care settings. These approaches could be applied to other early care and education settings that remain open for in-person learning and potentially reduce SARS-CoV-2 transmission.


Asunto(s)
/prevención & control , Jardines Infantiles/organización & administración , Escuelas de Párvulos/organización & administración , /epidemiología , Centers for Disease Control and Prevention, U.S. , Preescolar , Guías como Asunto , Humanos , Lactante , Recién Nacido , Estados Unidos/epidemiología
9.
J Perinatol ; 40(Suppl 1): 36-46, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-1023856

RESUMEN

OBJECTIVES: To determine the relationship between the emergence of COVID-19 and neonatal intensive care unit (NICU) family presence as well as how NICU design affects these changes. STUDY DESIGN: A cross-sectional survey from April 21 to 30, 2020. We queried sites regarding NICU demographics, NICU restrictions on parental presence, and changes in ancillary staff availability. RESULTS: Globally, 277 facilities responded to the survey. NICU policies preserving 24/7 parental presence decreased (83-53%, p < 0.001) and of preserving full parental participation in rounds fell (71-32%, p < 0.001). Single-family room design NICUs best preserved 24/7 parental presence after the emergence of COVID-19 (single-family room 65%, hybrid-design 57%, open bay design 45%, p = 0.018). In all, 120 (43%) NICUs reported reductions in therapy services, lactation medicine, and/or social work support. CONCLUSIONS: Hospital restrictions have significantly limited parental presence for NICU admitted infants, although single-family room design may attenuate this effect.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Administración Hospitalaria , Unidades de Cuidado Intensivo Neonatal/organización & administración , Pandemias , Padres , Neumonía Viral , Visitas a Pacientes/estadística & datos numéricos , Estudios Transversales , Arquitectura y Construcción de Hospitales , Humanos , Recién Nacido , Política Organizacional , Habitaciones de Pacientes , Estados Unidos
10.
J Perinatol ; 40(5): 820-826, 2020 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1023850

RESUMEN

BACKGROUND: Little is known about the perinatal aspects of COVID-19. OBJECTIVE: To summarize available evidence and provide perinatologists/neonatologists with tools for managing their patients. METHODS: Analysis of available literature on COVID-19 using Medline and Google scholar. RESULTS: From scant data: vertical transmission from maternal infection during the third trimester probably does not occur or likely it occurs very rarely. Consequences of COVID-19 infection among women during early pregnancy remain unknown. We cannot conclude if pregnancy is a risk factor for more severe disease in women with COVID-19. Little is known about disease severity in neonates, and from very few samples, the presence of SARS-CoV-2 has not been documented in human milk. Links to websites of organizations with updated COVID-19 information are provided. Infographics summarize an approach to the pregnant woman or neonate with suspected or confirmed COVID-19. CONCLUSIONS: As the pandemic continues, more data will be available that could lead to changes in current knowledge and recommendations.


Asunto(s)
Infecciones por Coronavirus , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo/virología , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Recién Nacido , Masculino , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Embarazo , Factores de Riesgo
12.
Arch Med Res ; 51(7): 603-607, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-1023465

RESUMEN

Coronavirus disease 2019 (COVID-19), a new type and rapidly spread viral pneumonia, is now producing an outbreak of pandemic proportions. The clinical features and laboratory results of different age groups are different due to the general susceptibility of the disease. The laboratory findings of COVID-19 in pregnant women are also conflicting. Para-clinical investigations including laboratory tests and radiologic findings play an important role in early diagnosis and treatment monitoring of COVID-19. The majority of previous reports on the COVID-19 laboratory results were based on data from the general population and limited information is available based on age difference and pregnancy status. This review aimed to describe the COVID-19 laboratory findings in neonates, children, adults, elderly and pregnant women altogether for the first time. The most attracting and reliable markers of COVID-19 in patients were: normal C-reactive protein (CRP) and very different and conflicting laboratory results regardless of clinical symptoms in neonates, normal or temporary elevated CRP, conflicting WBC count results and procalcitonin elevation in children, lymphopenia and elevated lactate dehydrogenase (LDH) in adult patients, lymphopenia and elevated CRP and LDH in the elderly people, leukocytosis and elevated neutrophil ratio in pregnant women.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Adolescente , Adulto , Anciano , Biomarcadores/sangre , /diagnóstico , /normas , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/sangre , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto Joven
14.
Journal of the College of Physicians and Surgeons Pakistan ; 30(10):S136, 2021.
Artículo | WHO COVID | ID: covidwho-1024874
15.
Scientific Chronicles ; 25(2):238-256, 2020.
Artículo | WHO COVID | ID: covidwho-1023112

RESUMEN

"Coronavirus of Wuhan" or "new Coronavirus" or SARS - CoV - 2 (Severe Acute Respiratory Syndrome Coronavirus - 2) causes an infection known as COVID - 19 Infection is transmitted mainly by inhalation or contact of infected droplets after coughing and sneezing by symptomatic or asymptomatic patients The main characteristic clinical feature of COVID - 19 is fever accompanied by cough and/or shortness of breath To confirm the diagnosis, molecular testing is required for sputum smears or secretions, preferably from the lower respiratory tract, and for computed tomography of the lungs There is no specific treatment Adherence to the basic principles of prenatal pregnancy management, during labour and postnatal pregnancy the should be of paramount importance and necessity, in order to ensure better health for both the mother and the fetus and newborn This article examines COVID - 19 infections in pregnancy, mainly in the diagnosis and basic principles of women's management during pregnancy, childbirth and lactation, the proper application of which is estimated to ensure that the transmission of the virus is avoided both in the mother and in the newborn

16.
No convencional | Literatura gris | ID: grc-743726

RESUMEN

This is an information note designed to provide information on issues relating to breastfeeding when COVID-19 is suspected, probable, or confirmed It includes information on the following: protective effect of breastfeeding;standard infant feeding guidelines;support for breastfeeding mothers;feeding of newborn infants;mothers who are symptomatic or severely ill;no promotion of breastmilk substitutes

17.
Rev. peru. ginecol. obstet. (En línea) ; 66(2): 00008, abr-jun 2020. tab, graf
Artículo en Español | LILACS (Américas) | ID: covidwho-1022717

RESUMEN

Resumen Se presenta un caso de atención de parto eutócico sin complicaciones en una paciente COVID-19 positivo. La mujer de 33 años, tercigesta de 39 semanas, controlada en una clínica privada, acudió en trabajo de parto presentando tos no asociada a otra sintomatología. Fue diagnosticada con COVID-19 por prueba rápida IgM (+) IgG (-). Se realizó el aislamiento y se proveyó de equipo de protección personal según protocolo de la clínica. El trabajo de parto fue manejado según condiciones obstétricas, con analgesia epidural en fase activa, y teniendo como resultado un recién nacido sin complicaciones. No se realizó contacto piel a piel ni clampaje tardío. Ambos fueron dados de alta sin complicaciones previo período de aislamiento del recién nacido con estudios negativos para COVID-19. Se les realizó seguimiento telefónico en casa. En el caso presentado, se cumplió con el protocolo recomendado para la atención del parto durante la pandemia de COVID-19.


Abstract We present the case of a eutocic, uncomplicated delivery in a patient positive for COVID-19. The patient, a 33-year-old woman, 39 weeks pregnant, who had received prenatal care in a private clinic, presented in labor, coughing, without any other symptoms. She was diagnosed with COVID-19 by rapid test, IgM (+) and IgG (-). We isolated the patient and provided personal protective equipment following our clinic's protocol. Delivery was managed according to obstetric conditions, applying epidural anesthesia in the active phase; the baby was born without complications. Nor skin-to-skin contact nor delayed umbilical cord clamping were performed. Mother and child were discharged without complications after the newborn completed the required isolation period, testing negative for COVID-19. Telephone follow-up was performed. The healthcare team followed the recommended protocol to manage delivery during the COVID-19 pandemic.

18.
CMAJ ; 193(1): E1-E9, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: covidwho-1021694

RESUMEN

BACKGROUND: Research involving children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has primarily focused on those presenting to emergency departments. We aimed to determine the symptoms most commonly associated with a positive result for a SARS-CoV-2 swab among community-based children. METHODS: We conducted an observational study among children tested and followed for SARS-CoV-2 infection using nasal, nasopharyngeal, throat or other (e.g., nasopharyngeal aspirate or tracheal secretions, or unknown) swabs between Apr. 13 and Sept. 30, 2020, in Alberta. We calculated positive likelihood ratios (LRs) for self-reported symptoms and a positive SARS-CoV-2 swab result in the entire cohort and in 3 sensitivity analyses: all children with at least 1 symptom, all children tested because of contact tracing whether they were symptomatic or not and all children 5 years of age or older. RESULTS: We analyzed results for 2463 children who underwent testing for SARS-CoV-2 infection; 1987 children had a positive result and 476 had a negative result. Of children with a positive test result for SARS-CoV-2, 714 (35.9%) reported being asymptomatic. Although cough (24.5%) and rhinorrhea (19.3%) were 2 of the most common symptoms among children with SARS-CoV-2 infection, they were also common among those with negative test results and were not predictive of a positive test (positive LR 0.96, 95% confidence interval [CI] 0.81-1.14, and 0.87, 95% CI 0.72-1.06, respectively). Anosmia/ageusia (positive LR 7.33, 95% CI 3.03-17.76), nausea/vomiting (positive LR 5.51, 95% CI 1.74-17.43), headache (positive LR 2.49, 95% CI 1.74- 3.57) and fever (positive LR 1.68, 95% CI 1.34-2.11) were the symptoms most predictive of a positive result for a SARS-CoV-2 swab. The positive LR for the combination of anosmia/ageusia, nausea/vomiting and headache was 65.92 (95% CI 49.48-91.92). INTERPRETATION: About two-thirds of the children who tested positive for SARS-CoV-2 infection reported symptoms. The symptoms most strongly associated with a positive SARS-CoV-2 swab result were anosmia/ageusia, nausea/vomiting, headache and fever.


Asunto(s)
/diagnóstico , Técnicas de Laboratorio Clínico/métodos , Pandemias , Manejo de Especímenes/métodos , Adolescente , Alberta/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino
19.
Pediatr Infect Dis J ; 40(1): e7-e11, 2021 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1020315

RESUMEN

OBJECTIVE: The COVID pandemic has affected Colombia with a high number of cases and deceases; however, no studies have been published regarding pediatric population. An epidemiologic analysis of the nationwide COVID register, therefore, is necessary to outline and describe the impact in such population. METHODS: A retrospective analysis was made of the characteristics of a cohort of 5062 patients <18 years of age, until June 16, 2020, reported at the National Institute of Health-INS (https://www.ins.gov.co/News./Pages/Coronavirus.aspx), through the national public access database, with all subjects confirmed with COVID-19 or severe acute respiratory syndrome-CoV-2. RESULTS: Reviewed on June 16, 2020, a total of 54,971 confirmed cases were reported nationwide for COVID-19, of which 5062 (9.2%) are cases in patients under 18 years of age. There was a statistically significant difference between groups; age was statistically significantly higher in the asymptomatic, compared with: deceased, severe and moderate cases; moreover, age was statistically significantly higher in the mild, compared with: deceased, severe and moderate. Statistically significant difference determined with one-way ANOVA was found between groups (F = 16.08, P < 0.001). Post hoc analysis reveals significant differences between groups, the age of patients at home (9.39 years) and those recovered (9.3 years) being significantly higher than those in intensive care unit (4.9 years), in hospital (6.1 years), or than the deceased (2.9 years). CONCLUSION: The results of this study show that, at the nationwide level, patients in more severe states (deceased, severe and moderate), are significantly younger than those in the milder state (asymptomatic and mild).


Asunto(s)
/epidemiología , /patología , Adolescente , Factores de Edad , Infecciones Asintomáticas , Niño , Preescolar , Colombia/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
20.
Dermatol Online J ; 26(12)2020 Dec 15.
Artículo en Inglés | MEDLINE | ID: covidwho-1017482

RESUMEN

Distinctive patterns in the cutaneous manifestations of COVID-19 have been recently reported. We conducted a systematic review to identify case reports and case series characterizing cutaneous manifestations of confirmed COVID-19. Key demographic and clinical data from each case were extracted and analyzed. The primary outcome measure was risk factor analysis of skin related outcomes for severe COVID-19 disease. Seventy-one case reports and series comprising 144 cases of cutaneous involvement in COVID-19 were included. The most frequently occurring morphologies were: morbilliform (30.6%), varicelliform (18.8%), urticarial (13.2%), chilblains-like (12.5%), and acro-ischemic (9%). The median age of patients was 51 years (mean: 45.9, range: 0 to 91). Patients with chilblains-like eruptions had lower frequencies of extracutaneous COVID-19 symptoms (5/18, 27.8%, P<0.05) and were less likely to have severe COVID-19 disease (2/18, 11%, 95% CI 1.4% to 34.7%, P=0.02). Patients with livedoid and acro-ischemic morphologies had severe COVID-19 more frequently than those with other morphologies (17/21, 81%, 95% CI 58.0% to 94.5%, P<0.0001). The most frequently observed cutaneous manifestations of COVID-19 (morbilliform, varicelliform, and urticarial) are well-described patterns of viral exanthems. However, chilblains-like, livedoid, and acro-ischemic morphologies are not traditionally associated with viral infections and were significantly associated with severity of COVID-19 disease.


Asunto(s)
/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Factores de Riesgo , Enfermedades Cutáneas Virales/epidemiología , Enfermedades Cutáneas Virales/etiología , Adulto Joven
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