First Record of Natural Transovarial Transmission of Dengue Virus in Aedes albopictus from Cuba.

Transovarial transmission (TOT) of dengue virus (DENV) in Aedes spp. is an important mechanism for DENV maintenance in nature and may be important in initiating outbreaks. The objective of this study was to explore the occurrence of TOT in wild Aedes albopictus populations in Cuba. Mosquito larvae were collected in Cotorro municipality, Havana, Cuba, and identified to species. Fifteen pools of Ae. albopictus each containing 30 larvae were processed for DENV detection by using conventional reverse transcription polymerase chain reaction (RT-PCR) and nested PCR. Four out of 15 pools processed were positive for DENV-3, but no other DENV serotype was detected. This is the first time TOT of DENV detected in Cuban field populations of Ae. albopictus, and this suggests that this species may be an important vector of DENV in Cuba.

Cuidado de enfermería perdido y factores contribuyentes en un hospital de Tabasco, México / Missed nursing care and contributing factors in a hospital in Tabasco, México

Resumen: Objetivo: Determinar el cuidado de enfermería perdido y factores contribuyentes en un hospital de Tabasco, México. Materiales y métodos: Estudio cuantitativo, descriptivo y correlacional en 50 enfermeras(os) de diferentes turnos de un hospital público de tercer nivel de atención, se utilizó la encuesta MISSCARE, para el análisis de los datos se empleó estadística descriptiva y el coeficiente de correlación de Spearman, se consideró lo estipulado en el Reglamento de la Ley General de Salud en Materia de Investigación para la salud. Resultados: La dimensión que presentó mayor cuidado de enfermería perdido fue la de intervenciones de cuidado básico (M= 22.6, DE= 14.2), seguido de planificación del alta y educación del paciente (M= 21.2, DE= 15.4), las intervenciones de cuidado con evaluaciones continuas resultaron la dimensión con menor cuidado perdido (M= 9.6, DE= 7.9). Los factores de mayor contribución para que se dé el cuidado de enfermería perdido, fueron los del recurso humano (M= 75.8, DE= 18.3), seguido de los factores del recurso material (M= 68.2, DE= 21.1). Éstos últimos mostraron asociación negativa y significativa con las intervenciones con evaluaciones continuas (rs= -0.318, p= 0.025). Conclusiones: La mayor presencia de cuidado de enfermería perdido recae en las intervenciones de cuidado básico, los factores del recurso humano son calificados en primer orden, para que se presente la omisión o retraso de las intervenciones del cuidado; sin embargo, solo los factores del recurso material mostraron relación negativa significativa con las intervenciones de evaluación continua.

Abstract: Objective: To determine the missed nursing care and the contributing factors in a hospital in Tabasco, Mexico. Materials and methods: Quantitative, descriptive and correlational study in 50 nurses from different shifts of a public hospital of the third level of care, the MISSCARE survey was used, descriptive statistics and the Spearman correlation coefficient were used for data analysis. considered what is stipulated in the Regulation of the General Health Law on Research for health. Results: The dimension that presented the most missed nursing care was basic care interventions (M= 22.6, SD= 14.2), followed by discharge planning and patient education (M= 21.2, SD= 15.4), care interventions with continuous evaluations resulted in the dimension with the least care lost (M= 9.6, SD= 7.9). The factors with the greatest contribution to the provision of lost nursing care were human resources (M= 75.8, SD= 18.3), followed by material resource factors (M= 68.2, SD= 21.1). The latter showed a negative and significant association with the interventions with continuous evaluations (rs= -0.318, p= 0.025). Conclusions: The greater presence of missed nursing care falls on basic care interventions, human resource factors are ranked first so that the omission or delay of care interventions occurs; however, only the material resource factors showed a significant negative relationship with the continuous assessment interventions.

Missed Nursing Care in Hospitalized Patients / Omisión en atención de enfermería para pacientes hospitalizados / Omissao no atendimento de enfermagem para pacientes hospitalizados

Objective: Determine missed nursing care in hospitalized patients and the factors related to missed care, according to the perception of the nursing staff and the patient. Method: Correlational descriptive study of a sample of 160 nurses and hospitalized patients, using the MISSCARE Nursing Survey. Results: Nursing personnel indicated there were fewer care omissions in continuous evaluation interventions (M = 94.56; SD = 11.10). The greatest number of omissions pertained to basic care interventions (M = 80.2; SD=19.40). Patients mentioned there were fewer omissions in continuous evaluation interventions (M = 96.32; SD=7.96), while the greatest number of omissions pertained to patient discharge and education (M=45.00; SD=23.22). The factors that contributed to missed nursing care, according to the nursing staff, were related to human resources (M = 80.67; SD=17.06) and material resources (M = 69.72; SD = 23.45); patients mentioned human resources and communication. Conclusions: Nursing care that is not carried out according to the needs of the patient, or is omitted or delayed, was identified. This aspect is relevant, since nursing care is fundamental to the recovery of hospitalized patients.

Objetivo: determinar el cuidado de enfermería no prestado a pacientes hospitalizados y los factores relacionados con la atención no prestada, según la percepción del personal de enfermería y la del paciente. Método: estudio descriptivo correlacional de una muestra de 160 enfermeras y pacientes hospitalizados, utilizando la Encuesta de Enfermería MISSCARE. Resultados: el personal de enfermería indicó que hubo menos omisiones de atención en intervenciones continuas de evaluación (M = 94,56; DE = 11,10). El mayor número de omisiones se refirió a intervenciones de atención básica (M = 80,2; DE = 19,40). Los pacientes mencionaron que hubo menos omisiones en intervenciones continuas de evaluación (M = 96,32; DE = 7,96), mientras que el mayor número de omisiones correspondió a dar de alta al paciente y a la educación (M = 45,00; DT = 23,22). Los factores que contribuyeron a la atención de enfermería no prestada, de acuerdo con el personal de enfermería, estuvieron relacionados con recursos humanos (M= 80,67; DE = 17,06) y recursos materiales (M = 69,72; DE = 23,45); los pacientes mencionaron los recursos humanos y la comunicación como factores determinantes en este sentido. Conclusiones: se identificó el cuidado de enfermería que no se lleva a cabo de acuerdo con las necesidades del paciente, o que se omite o retrasa. Este aspecto es relevante ya que la atención de enfermería es fundamental para la recuperación de los pacientes hospitalizados.

Objetivo: determinar o cuidado de enfermagem nao prestado a pacientes hospitalizados e os fatores relacionados com o atendimento nao prestado, segundo a percepqao da equipe de enfermagem e a do paciente. Método: estudo descritivo correlacional de uma amostra de 160 enfermeiras e pacientes hospitalizados, no qual se utilizou a Pesquisa MISSCARE. Resultados: a equipe de enfermagem indicou que houve menos omissoes de atendimento em intervenqoes continuas de avaliaqao (M = 94,56; DE = 11,10). O maior número de omissoes se referiu a intervenqoes de atendimento básico (M = 80,2; DE = 19,40). Os pacientes mencionaram que houve menos omissoes em intervenqoes continuas de avaliaqao (M = 96,32; DE = 7,96), enquanto o maior número de omissoes correspondeu a dar alta ao paciente e a educaqao (M = 45,00; DT = 23,22). Os fatores que contribuiram para o atendimento de enfermagem nao prestado, de acordo com a equipe de enfermagem, estiveram relacionados com recursos humanos (M= 80,67; DE = 17,06) e recursos materiais (M = 69,72; DE = 23,45); os pacientes mencionaram os recursos humanos e a comunicaqao como fatores determinantes nesse sentido. Conclusoes: identificou-se o cuidado de enfermagem que nao se realiza de acordo com as necessidades do paciente, que se omite ou atrasa. Esse aspecto é relevante já que a atenqao de enfermagem é fundamental para a recuperaqao dos pacientes hospitalizados.

WHO dengue case classification 2009 and its usefulness in practice: an expert consensus in the Americas.

INTRODUCTION: In 2009, the new World Health Organization (WHO) dengue case classification - dengue/severe dengue (D/SD) - was introduced, replacing the 1997 WHO dengue case classification: dengue fever/dengue haemorrhagic fever/dengue shock syndrome (DF/DHF/DSS). METHODS: A 2-day expert consensus meeting in La Habana/Cuba aimed to (1) share the experiences from Pan American Health Organization (PAHO) member states when applying D/SD, (2) present national and local data using D/SD, and (3) agree with the presented evidence on a list of recommendations for or against the use of D/SD for PAHO, and also globally. RESULTS: Eight key questions were discussed, concluding: (1) D/SD is useful describing disease progression because it considers the dynamic nature of the disease, (2) D/SD helps defining dengue cases correctly for clinical studies, because it defines more precisely disease severity and allows evaluating dynamically the progression of cases, (3) D/SD describes correctly all clinical forms of severe dengue. Further standards need to be developed regionally, especially related to severe organ involvement, (4) D/SD allows for pathophysiological research identifying - in a sequential manner - the clinical manifestations of dengue related to pathophysiological events, (5) the warning signs help identifying early cases at risk of shock (children and adults), pathophysiology of the warning signs deserves further studies, (6) D/SD helps treating individual dengue cases and also the reorganization of health-care services for outbreak management, (7) D/SD helps diagnosing dengue, in presumptive diagnosis and follow-up of the disease, because of its high sensitivity and high negative predictive value (NPV), and (8) there is currently no update of the International Disease Classification10 (ICD10) to include the new classification of dengue (D/SD); therefore, there are not enough experiences of epidemiological reporting. Once D/SD has been implemented in epidemiological surveillance, D/SD allows to (1) identify severity of dengue cases in real time, for any decision-making on actions, (2) measure and compare morbidity and mortality in countries, and also globally, and (3) trigger contingency plans early, not only based on the number of reported cases but also on the reported severity of cases. CONCLUSION: The expert panel recommends to (1) update ICD10, (2) include D/SD in country epidemiological reports, and (3) implement studies improving sensitivity/specificity of the dengue case definition.

The protein DIIIC-2, aggregated with a specific oligodeoxynucleotide and adjuvanted in alum, protects mice and monkeys against DENV-2.

Previously, we reported the ability of the chimeric protein DIIIC-2 (domain III of the dengue envelope protein fused to the capsid protein of dengue-2 virus), to induce immunity and protection in mice, when it is highly aggregated with a non-defined oligodeoxynucleotide (ODN) and adjuvanted in alum. In this work, three different defined ODNs were studied as aggregating agents. Our results suggest that the nature of the ODN influences the capacity of protein DIIIC-2 to activate cell-mediated immunity in mice. Consequently, the ODN 39M was selected to perform further experiments in mice and nonhuman primates. Mice receiving the preparation 39M-DIIIC-2 were solidly protected against dengue virus (DENV) challenge. Moreover, monkeys immunized with the same preparation developed neutralizing antibodies, as measured by four different neutralization tests varying the virus strains and the cell lines used. Two of the immunized monkeys were completely protected against challenge, whereas the third animal had a single day of low-titer viremia. This is the first work describing the induction of short-term protection in monkeys by a formulation that is suitable for human use combining a recombinant protein from DENV with alum.

Evaluation in mice of the immunogenicity and protective efficacy of a tetravalent subunit vaccine candidate against dengue virus.

A dengue vaccine must induce protective immunity against the four serotypes of the virus. Our group has developed chimeric proteins consisting of the protein P64k from Neisseria meningitidis and the domain III from the four viral envelope proteins. In this study, the immunogenicity of a tetravalent vaccine formulation using aluminum hydroxide as adjuvant was evaluated in mice. After three doses, neutralizing antibody titers were detected against the four viral serotypes, the lowest seroconversion rate being against dengue virus serotype 4. One month after the last dose, immunized animals were challenged with infective virus, and partial but statistically significant protection was found to have been achieved. Based on these results, further studies in mice and non-human primates using this tetravalent formulation in a prime-boost strategy with attenuated viruses are strongly recommended.

Dengue specific immunoglobulins M, A, and E in primary and secondary dengue 4 infected Salvadorian children.

El Salvador is a Central American country that has been affected by several dengue outbreaks. This study investigated the levels of IgM, IgA, and IgE anti-dengue antibodies in serum samples from children in El Salvador, with a clinical and serological diagnosis of dengue infection during the dengue 4 outbreak in 2002-2003. Seventy one serum samples were tested by ELISA and cases were classified in three groups: 13 primary dengue fever (PDF), 21 secondary dengue fever (SDF), and 37 secondary dengue hemorrhagic fever (SDHF). Also, the specificity of anti-dengue IgM for the different serotypes was tested. No significant differences in the IgM response were found between PDF and SDF, but these were detected between PDF and SDHF (P = 0.0053) and between SDF and SDHF (P = 0.0003). The IgA and IgE values showed a statistically significant difference between primary and secondary groups. The highest positivity percentage of IgA was between 95% (SDF) and 100% (SDHF) towards day 7 of onset of fever. All secondary cases were positive for IgE antibodies. The specificity of IgM was determined for DENV-4 virus in primary and secondary DF groups. This is the first study on dengue cases in Salvadorian children related to the immune response of different immunoglobulins to the type of infection and the clinical picture. Further prospective studies are needed to define if the pattern of immunoglobulins can determine early dengue infection and/or severity.

Molecular characterization of hepatitis E virus in patients with acute hepatitis in Venezuela.

Hepatitis E virus (HEV) causes a common infection in developing countries. HEV infection occurs as outbreaks, as sporadic clinical cases and as large epidemics in endemic areas. The objective of this study was to determine the presence of HEV infection in patients with clinical suspicion of hepatitis A virus (HAV) infection, referred to the Instituto Nacional de Higiene "Rafael Rangel" in Venezuela. Seventy-four sera were tested for anti-HAV and anti-HEV IgM antibodies. HEV-RNA was amplified from anti-HEV IgM positive sera using nested reverse transcription polymerase chain reaction for ORF1 (RNA dependent RNA polymerase region) and the amplicons sequenced for phylogenetic analysis. The frequency of anti-HEV IgM was 22/74 (30%) in the samples tested. Dual infection with HAV and HEV was found in 31% (12/39) of anti-HAV IgM positive patients. Viremia was detected in 3/22 (14%) of sera positive for anti-HEV IgM. Two HEV strains were classified as genotype 1 and one as genotype 3, which were closely related to Yam 67 (north of India) and US1 isolates from the USA, respectively. These findings suggest that HEV is an important cause of acute viral hepatitis in Venezuela as a single infection or co-infection with HAV, with high morbidity in children and young adults suggesting that this infection is endemic in Venezuela.

Satisfacción de las madres con la atención a sus hijos hospitalizados / Maternal Satisfaction with Care Provided to Hospitalized Children / Satisfação das mães com o cuidado à criança hospitalizada

El objetivo del estudio fue determinar los factores que se relacionan con la satisfacción de la madre con la atención que recibe su hijo hospitalizado. La muestra: 127 madres de niños hospitalizados en una institución pública de Monterrey, N.L., México. Estudio descriptivo correlacional. Se utilizó el cuestionario de satisfacción del familiar pediátrico. El manejo del dolor fue un factor importante para la satisfacción de las madres participantes. La satisfacción de la madre con el servicio de hospitalización se asoció con la satisfacción con la atención de enfermería (rs = 0,458; p= 0,0001). La edad del hijo, el número de hospitalizaciones previas y la percepción de su estado de salud no fueron factores significativos para la satisfacción de las madres. Es importante que el servicio de hospitalización y la atención de enfermería respondan a las expectativas de los familiares de estos pacientes.

The study was designed to identify the factors associated with a mother's satisfaction with the care her child receives during hospitalization. The sample included 127 mothers of children who were patients at a public hospital in Monterrey, N.L., México. The study was correlational and descriptive. A family pediatric satisfaction questionnaire was used. Pain management was an important factor in the satisfaction of participating mothers. The mother's satisfaction with inpatient services was associated with nursing care and assistance (rs = 0,458; p= 0,0001). The child's age, the number of prior hospitalizations, and the perception of the child's state of health were not significant factors with respect to maternal satisfaction. It also is important for inpatient services and nursing care to respond to the expectations of the pediatric patient's family.

O objetivo deste estudo foi determinar os fatores relacionados à satisfação materna com os cuidados ao seu filho internado em um hospital. A amostra constou de 127 mães de crianças internadas em uma instituição pública de Monterrey, NL (México), aplicando uma pesquisa descritiva correlacional. Foi utilizado o questionário de satisfação da família do paciente pediátrico. O manejo da dor é um fator importante para a satisfação das mães participantes. A satisfação maternal com o atendimento hospitalar foi associada à satisfação com os cuidados de enfermagem (rs = 0,458; p = 0,0001). A idade da criança, o número de hospitalizações e a percepção do estado de saúde não foram fatores significativos para a satisfação das mães. É importante que o serviço de internamento e os cuidados de enfermagem satisfaçam às expectativas da família do paciente.

Kinetics of dengue virus NS1 protein in dengue 4-confirmed adult patients.

In this work, the presence of NS1 protein as a possible early marker of dengue infection was studied in serum samples from confirmed adult patients with a primary and secondary dengue 4 infection. A total of 209 serum samples collected from day 2 up to day 7 of fever onset from 71 patients were tested by Platelia NS1 antigen capture ELISA kit (BioRad, Marnes-la-Coquette, France), and the results were compared with those obtained by capture antidengue virus IgM (MAC)-ELISA and ELISA inhibition method tests. The 83.3% of primary cases and 96.4% of secondary cases were NS1 positive. The kinetics of NS1 protein showed the highest values in optical density mean ratio or in percentage of positives between days 2 and 4. The results obtained in this study show the utility of the NS1 protein as a virologic early marker of dengue infection. Prospective studies should be carried out to confirm its utility as a prognostic marker of severe illness.

Dengue: where are we today?

Dengue is considered the main arthropod-borne viral disease of humans. In the last few years, an increasing number of reports of mild and severe cases have been reported. The growing dengue incidence observed in recent years has been accompanied by reports of new observations, findings and global initiatives with an improvement in our understanding of this phenomenon. The epidemiology and new clinical classification of dengue, advances in the diagnostic and pathogenesis knowledge, and vaccine development as well as control methods including new global initiatives are summarised here.

First report on fatal myocarditis associated with adenovirus infection in Cuba.

Myocarditis is caused frequently by viral infections of the myocardium. In the past, enteroviruses (EV) were considered the most common cause of myocarditis in all age groups. Other viruses that cause myocarditis are adenovirus and influenza viruses. Parvovirus B19 infection is associated sometimes with myocarditis. Members of the Herpesviridae family, cytomegalovirus (CMV), and human herpesvirus 6 (HHV-6) have been associated occasionally with myocarditis. During an atypical outbreak of acute febrile syndrome, eight children, with ages from 5 months to 15 years, died in cardiogenic shock due to myocarditis in July-August 2005, in the city of Havana, Cuba. Nested polymerase chain reaction (nPCR) and nested reverse transcription-PCR (nRT-PCR) were carried out on fresh heart muscle and lung tissue to analyze the genomic sequences of adenovirus, CMV, HHV-6, herpes simplex virus, Epstein-Barr virus (EBV), varizella zoster virus, influenza virus A, B, C, respiratory syncytial virus (RSV) A and B, parainfluenza viruses, rhinoviruses, coronavirus, flaviruses and enteroviruses. Evidence was for the presence of the adenovirus genome in 6 (75%) of the children. Phylogenetic analyses of a conserved hexon gene fragment in four cases showed serotype 5 as the causal agent. No others viruses were detected. Histological examination was undertaken to detect myocardial inflammation. After exclusion of other possible causes of death, the results indicated that viral myocarditis was the cause of death in patients with adenovirus infection.

Soyabean fortification and enrichment of regular and quality protein maize tortillas affects brain development and maze performance of rats.

The brain development and performance of rats fed throughout two generations with an indigenous maize tortilla-based diet was studied. The experiment compared casein control with five different diets produced from: regular fresh masa; regular, enriched dry masa flour containing thiamin, riboflavin, niacin, folic acid, Fe and Zn (REDMF); dry masa flour fortified with 60 g/kg defatted soyabean meal and enriched (FEDMF); enriched quality protein maize (QPM) flour (EQPM); QPM flour fortified with 30 g/kg defatted soyabean meal and enriched (FEQPM). In both generations, brain and cerebellum weights and myelin concentration were significantly higher (P < 0.05) in rats fed the FEDMF and FEQPM diets. There was no significant difference (P > 0.05) in brain DNA in first-generation rats; however, second-generation rats fed FEDMF, EQPM and FEQPM tortillas had higher cerebral DNA, neuron size and brain activity as estimated by the RNA:DNA ratio. Short-term and long-term memory performance in the Morris maze improved (P < 0.05) among rats fed the FEDMF, FEQPM and EQPM diets. Second-generation rats fed the FEDMF and FEQPM diets had a superior (P < 0.05) working memory and learning performance. The utilisation of regular or QPM tortillas enriched with selected micronutrients and fortified with soyabean is highly recommended to assure adequate brain development. The high lysine-tryptophan QPM made it possible to save half of the soyabean flour without sacrificing the nutritional value of soyabean-fortified tortillas.

West Nile Virus Infection in Humans and Horses, Cuba

West Nile virus was first detected in the Western Hemisphere during an outbreak of encephalitis in New York State in 1999 (1). Genetic analyses showed that the virus responsible for the 1999 outbreak was nearly identical to a WNV strain circulating in Israel in 1998 (2). Recent outbreaks of WNV disease in the United States and Canada have been accompanied by a high proportion of deaths in birds (3,4), substantial illness in equines (4,5), and thousands of cases of severe neurologic disease in humans (6). The range of WNV has rapidly expanded across the continental United States and Canada (7). WNV infection in humans, equines, and birds in Mexico (8), the Caribbean (9), and South and Central America (10,11) shows southward movement of the virus. Because Cuba is close to areas of the United States where WNV is endemic and because of recent evidence that suggests spread of WNV into the Caribbean, surveillance was established to monitor for WNV in Cuba. Beginning in 2002, the Medical Services and Ministry of Agriculture and Veterinarian Services of Cuba established a national surveillance program by using birds, horses, and humans to detect WNV activity. In this report, we summarize the key findings of surveillance activities(AU)

El virus del Nilo Occidental se detectó por primera vez en el Hemisferio Occidental durante un brote de encefalitis en el estado de Nueva York en 1999 (1). Análisis genéticos mostraron que el virus responsable del brote de 1999 fue casi idéntico a una cepa de virus que circulan en Israel en 1998 (2). Los recientes brotes de la enfermedad del VNO en Estados Unidos y Canadá se han visto acompañadas por una elevada proporción de muertes en las aves (3,4), enfermedad importante en equinos (4,5), y miles de casos de enfermedad neurológica en los seres humanos (6 ). La gama de virus se ha expandido rápidamente en todo el territorio continental de Estados Unidos y Canadá (7). La infección por el VNO en los seres humanos, equinos y aves en Mexico (8), el Caribe (9), América del Sur y Centroamérica (10,11) muestra el movimiento hacia el sur del virus. Porque Cuba está cerca de zonas de Estados Unidos, donde el virus es endémico y debido a las pruebas recientes sugieren que la propagación de virus en el Caribe, la vigilancia se estableció para supervisar VNO en Cuba. A partir de 2002, los Servicios Médicos y el Ministerio de Agricultura y Servicios Veterinarios de Cuba estableció un programa nacional de vigilancia mediante el uso de aves, caballos, y los seres humanos para la detección de VNO actividad. En este informe, resumimos las principales conclusiones de las actividades de vigilancia

Aedes aegypti larval indices and risk for dengue epidemics.

We assessed in a case-control study the test-validity of Aedes larval indices for the 2000 Havana outbreak. "Cases" were blocks where a dengue fever patient lived during the outbreak. "Controls" were randomly sampled blocks. Before, during, and after the epidemic, we calculated Breteau index (BI) and house index at the area, neighborhood, and block level. We constructed receiver operating characteristic (ROC) curves to determine their performance as predictors of dengue transmission. We observed a pronounced effect of the level of measurement. The BI(max) (maximum block BI in a radius of 100 m) at 2-month intervals had an area under the ROC curve of 71%. At a cutoff of 4.0, it significantly (odds ratio 6.00, p<0.05) predicted transmission with 78% sensitivity and 63% specificity. Analysis of BI at the local level, with human-defined boundaries, could be introduced in control programs to identify neighborhoods at high risk for dengue transmission.

West Nile Virus infection in humans and horses, Cuba.

A surveillance system to detect West Nile virus (WNV) was established in Cuba in 2002. WNV infection was confirmed by serologic assays in 4 asymptomatic horses and 3 humans with encephalitis in 2003 and 2004. These results are the first reported evidence of WNV activity in Cuba.

Aedes aegypti Larval Indices and Risk for Dengue Epidemics

We assessed in a case-control study the test-validity of Aedes larval indices for the 2000 Havana outbreak. "Cases" were blocks where a dengue fever patient lived during the outbreak. Controls were randomly sampled blocks. Before, during, and after the epidemic, we calculated Breteau index (BI) and house index at the area, neighborhood, and block level. We constructed receiver operating characteristic (ROC) curves to determine their performance as predictors of dengue transmission. We observed a pronounced effect of the level of measurement. The BI(max) (maximum block BI in a radius of 100 m) at 2-month intervals had an area under the ROC curve of 71 percent. At a cutoff of 4.0, it significantly (odds ratio 6.00, p<0.05) predicted transmission with 78 percent sensitivity and 63percent specificity. Analysis of BI at the local level, with human-defined boundaries, could be introduced in control programs to identify neighborhoods at high risk for dengue transmission(AU)

Se evaluaron en un estudio caso-control de la prueba de validez de los índices larvarios de Aedes para el 2000 La Habana brote. Casos se bloquea cuando un paciente vive la fiebre del dengue durante el brote. "Controles" fueron sometidos a un muestreo aleatorio bloques. Antes, durante y después de la epidemia, se calculó el índice de Breteau (BI) y el índice de vivienda en la zona, barrio, manzana y nivel. Construimos características de funcionamiento del receptor (ROC) para determinar las curvas de su rendimiento como predictores de la transmisión del dengue. Hemos observado un marcado efecto del nivel de medición. La BI (max) (máximo del bloque de BI en un radio de 100 m) a los 2 meses tuvo un área bajo la curva ROC del 71 por ciento. En un corte de 4,0, es significativa (odds-ratio 6,00, p <0,05) prevé la transmisión con el 78 por ciento de sensibilidad y especificidad del 63 por ciento. Análisis de BI a nivel local, con límites definidos humanos, se podrían introducir en los programas de control para identificar los barrios en alto riesgo de transmisión del dengue

Amplificación dependiente de anticuerpos del virus dengue en cepas cubanas utilizando anticuerpos monoclonales / Dengue virus antibodies dependent amplification in Cuban strains by using monoclonal antibodies

Se describieron los diferentes comportamientos de anticuerpos monoclonales anti-dengue serotipo 2 (H3/6, 4G3) y anti-proteína recombinante de la envoltura del virus dengue cuando fueron enfrentados a diferentes cepas de los serotipos 2 y 4 de este virus (D2 Nueva Guinea C, A15 cepa cubana y A15 propagada 53 veces en cultivo de riñón de perro Beagly y D4 H-2412 cepa prototipo) en un ensayo de inmunoamplificación dependiente de anticuerpos. Los anticuerpos monoclonales han demostrado ser una herramienta eficaz para explicar que la neutralización y el incremento de la multiplicidad viral pueden realizarse como funciones biológicas separadas. Solamente el AcM H3/6 fue capaz de producir el fenómeno amplificación dependiente de anticuerpos frente a la cepa A15 con un incremento significativo en la multiplicación viral. Los AcMs 4G3 y 4B6 no fueron capaces de inmunoamplificar la multiplicación viral de las cepas estudiadas.

The different behaviors of antidengue monoclonal antibodies serotype 2 (H3/6, 4G3) and antiprotein recombinant from the dengue virus sheath were described when they faced diverse strains from the serotypes 2 and 4 of this virus (D2 New Guinea C, A15 Cuban strain and A15 propagated 53 times in culture of Beagley dog kidney and D4 H-22412 prototype strain) in an immunoamplification assay dependent of antibodies. Themonoclonal antibodies have prove to be an efficient tool to explain that the neutralizatrion and increase of viral multiplicity may be carried out as separate biological functions. Only the H3/6 monoclonal antibdoy was capable of producing the amplification assay dependent phenomenon against the A15 strain with a significant rise in the viral multiplication. The 4G3 and 4B6 monoclonal antibodies were not capable of immunoamplifying the viral multiplication of the studied strains.

Amplificación dependiente de anticuerpos del virus dengue en cepas cubanas utilizando anticuerpos monoclonales / Dengue virus antibodies dependent amplification in Cuban strains by using monoclonal antibodies

Se describieron los diferentes comportamientos de anticuerpos monoclonales anti-dengue serotipo 2 (H3/6, 4G3) y anti-proteína recombinante de la envoltura del virus dengue cuando fueron enfrentados a diferentes cepas de los serotipos 2 y 4 de este virus (D2 Nueva Guinea C, A15 cepa cubana y A15 propagada 53 veces en cultivo de riñón de perro Beagly y D4 H-2412 cepa prototipo) en un ensayo de inmunoamplificación dependiente de anticuerpos. Los anticuerpos monoclonales han demostrado ser una herramienta eficaz para explicar que la neutralización y el incremento de la multiplicidad viral pueden realizarse como funciones biológicas separadas. Solamente el AcM H3/6 fue capaz de producir el fenómeno amplificación dependiente de anticuerpos frente a la cepa A15 con un incremento significativo en la multiplicación viral. Los AcMs 4G3 y 4B6 no fueron capaces de inmunoamplificar la multiplicación viral de las cepas estudiadas(AU)

Role of the virology diagnosis laboratory in the surveillance of rubella virus Cuba 1988/2000.

In Cuba, on the basis of Measles Elimination Program, the incidence of this disease decline, and was necessary to test rubella virus as a possible etiology agent that produce fever and rash illness. To reach this goal, Cuba developed rubella elimination strategies with integrated epidemiologic and laboratory surveillance. In the country, the vaccination program against rubella started in 1982 by vaccinating 12-14 years old females, with a special surveillance program with laboratory study of all suspected cases. Through 1988-2000, the Serology Diagnosis Laboratory in the Virology Branch of Pedro Kouri Institute had the responsibility to do the measles and rubella surveillance and play a key roll in the elimination strategies of these diseases. For confirmation of all suspected cases, 8566 serum samples with the suspected diagnosis of measles or rubella from different provinces in Cuba were studied in the laboratory using different techniques as haemagglutination inhibition test (HIA), ultra micro analytic assay (UMA); and in 1995 by the newly introduced IgM ELISA, which was used taken only one sample in the acute phase of the disease. These techniques allowed knowing that the annual number of reported rubella cases in the country decreased substantially after the implementation, in 1986, of the second vaccine policy, that of vaccinating women of childbearing age. However, in 1989, was detected an outbreak of rubella virus infection that had occurred in young adults male 15-19 age groups in Matanzas' province. The last three indigenous cases of this disease were confirmed by our laboratory in 1995, after national vaccine coverage over 95%.