ABSTRACT
Peru was one of the most affected countries during the COVID-19 pandemic. Moreover, multiple other viral diseases (enteric, respiratory, bloodborne, and vector-borne) are endemic and rising. According to Peru's Ministry of Health, various health facilities in the country were reallocated for the COVID-19 pandemic, thereby leading to reduced action to curb other diseases. Many viral diseases in the area are under-reported and not recognized. The One Health approach, in addition to clinical testing, incorporates environmental surveillance for detection of infectious disease outbreaks. The purpose of this work is to use a screening tool that is based on molecular methods, high throughput sequencing and bioinformatics analysis of wastewater samples to identify virus-related diseases circulating in Trujillo-Peru. To demonstrate the effectiveness of the tool, we collected nine untreated wastewater samples from the Covicorti wastewater utility in Trujillo-Peru on October 22, 2022. High throughput metagenomic sequencing followed by bioinformatic analysis was used to assess the viral diversity of the samples. Our results revealed the presence of sequences associated with multiple human and zoonotic viruses including Orthopoxvirus, Hepatovirus, Rhadinovirus, Parechovirus, Mamastrovirus, Enterovirus, Varicellovirus, Norovirus, Kobuvirus, Bocaparvovirus, Simplexvirus, Spumavirus, Orthohepevirus, Cardiovirus, Molliscipoxvirus, Salivirus, Parapoxvirus, Gammaretrovirus, Alphavirus, Lymphocryptovirus, Erythroparvovirus, Sapovirus, Cosavirus, Deltaretrovirus, Roseolovirus, Flavivirus, Betacoronavirus, Rubivirus, Lentivirus, Betapolyomavirus, Rotavirus, Hepacivirus, Alphacoronavirus, Mastadenovirus, Cytomegalovirus and Alphapapillomavirus. For confirmation purposes, we tested the samples for the presence of selective viruses belonging to the genera detected above. PCR based molecular methods confirmed the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), monkeypox virus (MPXV), noroviruses GI and GII (NoVGI and NoVGII), and rotavirus A (RoA) in our samples. Furthermore, publicly available clinical data for selected viruses confirm our findings. Wastewater or other environmental media surveillance, combined with bioinformatics methods, has the potential to serve as a systematic screening tool for the identification of human or zoonotic viruses that may cause disease. The results of this method can guide further clinical surveillance efforts and allocation of resources. Incorporation of this bioinformatic-based screening tool by public health officials in Peru and other Latin American countries will help manage endemic and emerging diseases that could save human lives and resources.
ABSTRACT
Introduction The Broselow tape (BT) is a useful pediatric tool for weight estimation and dosing reference during emergency care. Many accuracy studies have been performed for various countries and regions of the world but there is very little information for Latin American countries. The primary objective of the study was to assess the accuracy of the BT in a Peruvian pediatric population. Methods This was a retrospective cross-sectional study of 1,160 children aged two to 19 years from three outpatient clinics in La Libertad, Lima, and Iquitos, Peru. Patient height and weight were measured and compared with the weight and color zone generated by the 2017 edition of the BT. Accuracy was estimated by statistical comparison of mean absolute percent differences, error within 10% (EW10), and color zone agreement. Results Comparison of mean differences between measured weight (MW) and estimated BT weight shows that the BT underestimates actual weight for all color zones in this population. Likewise, the Bland-Altman plot of agreement between estimated and measured weights shows an overall underestimation, or bias, equal to 1.60 kg. The overall percent difference was -7.84% with differences gradually increasing for weights over 10 kg. In terms of accuracy, the overall error within 10% was 62.8%. Conclusion The BT underestimates the actual weight of Peruvian pediatric patients in all color categories, particularly in children with higher body mass indexes. Underestimation of weight may lead to the use of non-therapeutic medication doses or incorrect equipment sizes and, subsequently, ineffective resuscitation.
