"Super-Spreaders" and Person-to-Person Transmission of Andes Virus in Argentina.

BACKGROUND: From November 2018 through February 2019, person-to-person transmission of Andes virus (ANDV) hantavirus pulmonary syndrome occurred in Chubut Province, Argentina, and resulted in 34 confirmed infections and 11 deaths. Understanding the genomic, epidemiologic, and clinical characteristics of person-to-person transmission of ANDV is crucial to designing effective interventions. METHODS: Clinical and epidemiologic information was obtained by means of patient report and from public health centers. Serologic testing, contact-tracing, and next-generation sequencing were used to identify ANDV infection as the cause of this outbreak of hantavirus pulmonary syndrome and to reconstruct person-to-person transmission events. RESULTS: After a single introduction of ANDV from a rodent reservoir into the human population, transmission was driven by 3 symptomatic persons who attended crowded social events. After 18 cases were confirmed, public health officials enforced isolation of persons with confirmed cases and self-quarantine of possible contacts; these measures most likely curtailed further spread. The median reproductive number (the number of secondary cases caused by an infected person during the infectious period) was 2.12 before the control measures were enforced and decreased to 0.96 after the measures were implemented. Full genome sequencing of the ANDV strain involved in this outbreak was performed with specimens from 27 patients and showed that the strain that was present (Epuyén/18-19) was similar to the causative strain (Epilink/96) in the first known person-to-person transmission of hantavirus pulmonary syndrome caused by ANDV, which occurred in El Bolsón, Argentina, in 1996. Clinical investigations involving patients with ANDV hantavirus pulmonary syndrome in this outbreak revealed that patients with a high viral load and liver injury were more likely than other patients to spread infection. Disease severity, genomic diversity, age, and time spent in the hospital had no clear association with secondary transmission. CONCLUSIONS: Among patients with ANDV hantavirus pulmonary syndrome, high viral titers in combination with attendance at massive social gatherings or extensive contact among persons were associated with a higher likelihood of transmission. (Funded by the Ministerio de Salud y Desarrollo Social de la Nación Argentina and others.).

Epidemiological description, case-fatality rate, and trends of Hantavirus Pulmonary Syndrome: 9 years of surveillance in Argentina.

Hantavirus pulmonary syndrome (HPS) is an endemic disease in Argentina, one of the most affected countries in the Americas. Andes virus (ANDV) is the main Orthohantavirus species causing HPS in Argentina. In this study, the geographical distribution, clinical presentation, and epidemiological features of HPS from all endemic regions of Argentina were analyzed. We focused on the clinical and epidemiological data from 533 HPS cases confirmed during the period 2009 to 2017 by the National Reference Laboratory for Hantavirus. A case-fatality rate of 21.4% was registered, and most of the cases presented a severe clinical picture requiring intensive care treatment (84%). Since HPS first detection in 1995 the case-fatality rate showed a general trend towards a decrease. After more than 22 years of experience in HPS diagnosis and surveillance, we discuss some possible factors implicated in this tendency. This clinical and epidemiological analysis gives a global perspective, being useful to detect trends and patterns, to update preventive actions at a national level, and evaluate their impact on public health.

[Validation of a questionnaire to assess the quality of health information in Argentinian newspapers]. / Información de salud en la prensa diaria argentina: adaptación al español y validación del cuestionario index of Scientific Quality para medir su calidad.

INTRODUCTION: The daily press is an important source of health information and may influence health care utilization. However, medical reports published in newspapers from developed countries have shown a poor quality. OBJECTIVES: The reliability of the questionnaire Index of Scientific Quality was evaluated by using it to measure the scientific quality of health information published by Argentinian newspapers between 2000 and 2002. It assessed the readability of the texts in grade levels and explored the relationship between quality and other factors. MATERIALS AND METHODS: The Spanish adaptation of the instrument consisted in translation, back-traslation and pilot study. The reliability was assessed by applying the instrument to newspaper articles with more than 300 words that discussed therapy, diagnosis, prevention, lifestyle effects, and hazardous exposure. Two physicians independently graded 129 articles. Inter-observer and intra-observer concordance was quantified for each item with the intra-class correlation coefficient (CI95%). To measure scientific quality, a randomized sample of 210 articles was assessed. Each received a mark that ranged from 0 to 100. Readability was determined by the FRY graph method. The relationship between quality and other variables was explored with multiple linear regression analysis. RESULTS: The inter-rater concordance varied between 0.48 (0.34-0.61) and 0.67 (0.56-0.75). Intra-rater concordance varied from 0.51 (0.37-0.63) to 0.95 (0.93-0.96). The internal consistency (Cronbach's alpha) was 0.88. The quality-of-health-information was rated at 25 points (16.7, 33.3) [median (intercuartil range)]. The reading level was assessed to be at the 10.4 grade (10.2-10.6) [mean (CI 95%)]. CONCLUSIONS: Quality of the health information was greatly deficient; however, no specific factors were related with quality. Readability was probably a key barrier for access to the health information.

Información de salud en la prensa diaria argentina: adaptación al español y validación del cuestionario Index of Scientific Quality para medir su calidad / Validation of a questionnaire to assess the quality of health information in Argentinian newspapers

Introducción. La prensa diaria constituye una fuente de acceso a la información de salud y puede influenciar sobre la utilización de servicios sanitarios. La calidad de las noticias publicadas en periódicos de países desarrollados es subóptima. Objetivo. Adaptar al castellano y evaluar la confiabilidad del cuestionario Index of Scientific Quality; medir la calidad de la información de salud publicada en la prensa diaria argentina durante los años 2000 a 2002; determinar el nivel de lectura requerido (en grados de escolarización) para comprender los textos; analizar los factores asociados a la calidad. Materiales y métodos. La adaptación consistió en la traducción del Index of Scientific Quality, retrotraducción y prueba piloto. Para la confiabilidad, se seleccionaron artículos con más de 300 palabras referidos a tratamiento, prevención, diagnóstico, efectos del estilo de vida y exposiciones peligrosas sobre la salud. Dos médicos calificaron independientemente 129 artículos. Se cuantificó la concordancia interobservador e intraobservador para cada ítem mediante el coeficiente de correlación intraclase (IC95 por ciento). La calidad se evaluó en 210 artículos seleccionados al azar. Se asignaron valores entre 0-100 puntos. El nivel de lectura se evaluó mediante el método gráfico de FRY. Se exploró la relación entre calidad y otras variables mediante un modelo de regresión lineal múltiple. Resultados. La concordancia interobservador osciló entre 0,48 (0,34-0,61) y 0,67 (0,56-0,75); la concordancia intraobservador entre 0,51 (0,37-0,63) y 0,95 (0,93-0,96); la consistencia interna (alfa de Cronbach), 0,88; la calidad mediana(rango intercuartílica)=25 puntos (16,7 y 33,3), y el nivel de lectura [promedio (IC95 por ciento)]=10,4 grados (10,2 y 10,6). Conclusiones. La calidad de la información fue deficitaria. No se encontraron factores que expliquen la baja calidad. El nivel de lectura resultó una barrera de acceso a la información