Vaccination against pertussis in Latin American preterm and low-birth weight infants: experts opinion position for a neglected childhood age group.

BACKGROUND: Pertussis remains as one of the oldest leading vaccine-preventable diseases of childhood, despite many decades of primary vaccine doses' and boosters' implementation. Although the epidemiology is well understood in infants and children, premature babies and low-birth weight infants remain a special group where the disease incidence is unknown, severity of the disease is considerable, and specific vaccination recommendations are scarce. RESEARCH DESIGN AND METHODS: A retrospective review of the available evidence of pertussis vaccination in premature and low birth weight infants was analyzed from January 2000 to December 2022 in six selected countries: Argentina, Mexico, Colombia, Panamá, Costa Rica, and Chile. RESULTS: Chile had reports of adverse effects associated with vaccination of premature infants with the pentavalent vaccine, and their rationale to switching to the hexavalent vaccine. Colombia had reports of the justification for the use of hexavalent vaccine in prematures in the Neonatal Units and Kangaroo Mother Programs throughout the country. Mexico had selected publications of the vaccination status in prematures and low-birth weight infants. CONCLUSION: Despite its importance, increased morbidity, and highest risk of complications in premature babies, there is a paucity of information of vaccine recommendations and coverage rates among selected Latin American infants.

Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries.

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed.

Changes in the incidence of acute bacterial meningitis caused by Streptococcus pneumoniae and the implications of serotype replacement in children in Colombia after mass vaccination with PCV10.

Introduction: Acute bacterial meningitis (ABM) is a public health problem. The disease has reemerged after the introduction of pneumococcal conjugate vaccines (PCVs) due to an increase in serotypes that are not covered. The objective was to determine the changes in the disease incidence before and after the introduction of the 10-valent vaccine (PCV10) in Colombia. Methods: This multicenter study was conducted in 17 hospitals in Colombia. Data were collected from January 2008 to December 2019 in 10 hospitals in Bogotá and from January 2017 to December 2019 in seven hospitals in Cali, Medellín and Cartagena. The data were grouped into three periods: 2008-2011, 2012-2015, and 2016-2019. Results: Of the 706 cases of invasive pneumococcal disease, 81 (11.4%) corresponded to meningitis. The relative incidence in Bogotá in the first period was 0.6 per 100,000 patients ≤ 5 years, decreased to 0.4 per 100,000 patients ≤ 5 years in the second period and increased in the third period to 0.7 per 100,000 patients ≤ 5 years. Serotypes covered by PCV10 decreased from 75 to 9.1%, with Spn19A (31.8%) and Spn34 (13.6%) emerging in the third period. Increased resistance to penicillin (13 to 37%) and to ceftriaxone (5.9 to 16%) was due to the emergence of multidrug-resistant Spn19A. The total mortality rate was 23.5% and increased from 12 to 33%. Conclusions: ABM due to pneumococcus has high morbidity and mortality rates. Reemergence of the disease has been observed due to the inclusion of polymerase chain reaction (PCR) for diagnosis and replacement of circulating serotypes after the introduction of PCV10, with an increase in Spn19A, which causes death and exhibits antimicrobial resistance. Continued surveillance is needed.

Factors Associated With Hospitalization or Intensive Care Admission in Children With COVID-19 in Latin America.

Background: Limited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19. Objective: To describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America. Method: Multicenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children <18 years of age with COVID-19 confirmed by polymerase chain reaction or antigen detection from the nasopharynx were included. Children with multisystem inflammatory syndrome in children (MIS-C) were excluded. Associations were assessed using univariate and multivariable logistic regression models. Results: A total of 1063 children with COVID-19 were included; 500 (47%) hospitalized, with 419 (84%) to the pediatric wards and 81 (16%) to the ICU. In multivariable analyses, age <1 year (Odds Ratio [OR] 1.78; 95% CI 1.08-2.94), native race (OR 5.40; 95% CI 2.13-13.69) and having a co-morbid condition (OR 5.3; 95% CI 3.10-9.15), were associated with hospitalization. Children with metabolic or endocrine disorders (OR 4.22; 95% CI 1.76-10.11), immune deficiency (1.91; 95% CI 1.05-3.49), preterm birth (OR 2.52; 95% CI 1.41-4.49), anemia at presentation (OR 2.34; 95% CI 1.28-4.27), radiological peribronchial wall thickening (OR 2.59; 95% CI 1.15-5.84) and hypoxia, altered mental status, seizures, or shock were more likely to require PICU admission. The presence of pharyngitis (OR 0.34; 95% CI 0.25-0.48); myalgia (OR 0.47; 95% CI 0.28-0.79) or diarrhea (OR 0.38; 95% CI 0.21-0.67) were inversely associated with hospital admission. Conclusions: In this data analysis reported to the SLIPE research network in Latin America, infants, social inequalities, comorbidities, anemia, bronchial wall thickening and specific clinical findings on presentation were associated with higher rates of hospitalization or PICU admission. This evidence provides data for prioritization prevention and treatment strategies for children suffering from COVID-19.

Manejo de los episodios de neutropenia febril en niños con cáncer: consenso de la Sociedad Latinoamericana de Infectología Pediátrica 2021 / Management of episodes of febrile neutropenia in children with cancer: consensus of the Latin American Society of Pediatric Infectious Diseases 2021

Resumen El Comité de Infecciones en el Niño Inmunocomprometido de la Sociedad Latinoamericana de Infectología Pediátrica, entrega este documento de Consenso, llamado "Manejo de los episodios de neutropenia febril en niños con cáncer. Consenso de la Sociedad Latinoamericana de Infectología Pediátrica 2021". El documento contiene recomendaciones sobre aspectos de prevención, predicción, diagnóstico, tratamiento y pronóstico de los episodios de fiebre y neutropenia, incluyendo recomendaciones específicas sobre: Análisis de ingreso; evaluación, ajustes y duración de terapias antimicrobianas; diagnóstico y manejo de infección fúngica invasora; análisis de los principales focos clínicos de infección; condiciones ambientales necesarias para hospitales que atienden niños con cáncer y quimioprofilaxis. Se ha puesto especial énfasis en entregar las mejores recomendaciones para optimizar el manejo de los episodios de fiebre y neutropenia en niños con cáncer, buscando la equidad y la excelencia a través de todos los centros que atienden estos pacientes en América Latina.

Abstract The Committee for Infections in Immunocompromised Children of Sociedad Latinoamericana de Infectología Pediátrica, presents this Consensus document, titled "Management of episodes of febrile neutropenia in children with cancer. Consensus of the Sociedad Latinoamericana de Infectología Pediátrica 2021". The document includes recommendations on prevention, prediction, diagnosis, treatment and prognosis of episodes of fever and neutropenia, including specific recommendations on: Analysis at admission; evaluation, adjustments and duration of antimicrobial therapies; diagnosis and management of invasive fungal infection; analysis of the main clinical source of infections; environmental conditions necessary for hospitals caring for children with cancer and chemoprophylaxis. Special emphasis has been placed on providing the best recommendations to optimize the management of episodes of fever and neutropenia in children with cancer, with equity and excellence through all the centers that treat these patients in Latin America.

[Management of episodes of febrile neutropenia in children with cancer. Consensus of the Latin American Society of Pediatric Infectious Diseases 2021]. / Manejo de los episodios de neutropenia febril en niños con cáncer. Consenso de la Sociedad Latinoamericana de Infectología Pediátrica 2021.

The Committee for Infections in Immunocompromised Children of Sociedad Latinoamericana de Infectología Pediátrica, presents this Consensus document, titled "Management of episodes of febrile neutropenia in children with cancer. Consensus of the Sociedad Latinoamericana de Infectología Pediátrica 2021". The document includes recommendations on prevention, prediction, diagnosis, treatment and prognosis of episodes of fever and neutropenia, including specific recommendations on: Analysis at admission; evaluation, adjustments and duration of antimicrobial therapies; diagnosis and management of invasive fungal infection; analysis of the main clinical source of infections; environmental conditions necessary for hospitals caring for children with cancer and chemoprophylaxis. Special emphasis has been placed on providing the best recommendations to optimize the management of episodes of fever and neutropenia in children with cancer, with equity and excellence through all the centers that treat these patients in Latin America.

Emergence of Streptococcus pneumoniae serotype 19A (Spn19A) in the pediatric population in Bogotá, Colombia as the main cause of invasive pneumococcal disease after the introduction of PCV10.

Introduction: With the use of pneumococcal conjugate vaccines(PCV), the behavior of invasive pneumococcal disease(IPD) has changed relative to serotype distribution. The introduction of these vaccines in national immunization programs has reduced the incidence of IPD, with a marked decrease in the circulation of the serotypes included in the vaccine used in each country. However, the subsequent emergence of other serotypes not included in the vaccine, such 19A in case of PCV7 and PCV10, has been documented. Materials and methods: This was case series study (2008-2017) in pediatric patients admitted to 10 hospitals in Bogota who were diagnosed with IPD. It was conducted during the transitional period of implementing the PCV10 vaccine in Colombia in 2012. Cases of bacteremic pneumococcal pneumonia, meningitis, primary bacteremia and osteoarticular infection were included. A descriptive analysis of the demographic, clinical and laboratory variables of patients with IPD by Spn19A, its trend over time, profiles of antimicrobial susceptibility and clinical outcomes was performed. Results: There were 463 cases of IPD, 315(68%) with known serotypes. The prevalence of IPD by Spn19A was 17.7%(56 cases), tending to increase over time. During 2008-2011, the prevalence was 4.4%, and during 2014-2017, it was 32.4%, The most frequent diagnosis was pneumonia(80.4%). In nonmeningeal isolates, 39.6% were not susceptible to penicillin. An increase in the resistance was observed over time. Conclusion: Spn19A is a prevalent cause of IPD in the pediatric population of the analyzed cohort, with an increasing trend of this serotype during the surveillance period after the introduction of PCV10, being the most common serotype identified in recent years.

Pertussis in Latin America: Recent epidemiological data presented at the 2017 Global Pertussis Initiative meeting.

The Global Pertussis Initiative (GPI) is an expert scientific forum that publishes consensus recommendations for pertussis monitoring, prevention, and treatment across many regions of the world. Here, we report on the regional 2017 GPI meeting on the Americas, focusing on Latin America. Information on current pertussis epidemiology, surveillance, vaccine strategies, diagnostic capabilities, disease awareness, and major local obstacles was presented by researchers from Argentina, Brazil, Colombia, Costa Rica, El Salvador, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela. Pertussis outbreaks have occurred during the last decade in the majority of participant countries and have been followed by improvements in surveillance. In the countries that introduced maternal immunization during pregnancy, a reduction in the infant case fatality rate has been detected. All countries need to maintain and improve pertussis surveillance to reach primary vaccination coverage >90%. Moreover, countries without maternal immunization programs should strongly consider them.

Caracterización de pacientes fallecidos por enfermedad neumocóccica invasiva en la poblacion infantil de Bogotá, Colombia / Characterization of patients who died of invasive pneumococcal disease in the child population of Bogota, Colombia

Introducción: El Streptococcus pneumoniae (S. pneumoniae), también denominado neumococo, es una de las principales bacterias asociadas a mortalidad en menores de 2 años, con una incidencia de morbimortalidad variable de acuerdo a la demografía y exposición a factores protectores o de riesgo. Objetivo: Caracterizar los pacientes fallecidos por enfermedad neumocóccica invasiva (ENI) entre el 2008-2014 en la población infantil de 8 instituciones de salud en Bogotá, Colombia. Pacientes y método: Estudio observacional descriptivo tipo serie de casos, en pacientes fallecidos por ENI, mayores de 28 días hasta los 18 años, en 8 instituciones de tercer nivel de atención en Bogotá, Colombia. Periodo del estudio del 1 de enero de 2008 al 15 de enero de 2014. Tamaño de la muestra: 239 pacientes. Resultados: Se revisaron 239 casos registrados de ENI, presentando una mortalidad del 7,5% (n = 18). La edad promedio de los pacientes que fallecieron fue de 43,7 meses, con un rango de edad entre 2 y 176 meses (14 años); el 66% de los casos era de sexo masculino. Se identificaron serotipos en 8 pacientes, encontrando: 6A, 6B, 10A, 14, 18C, 23B, 23F, 35B. La presentación clínica más frecuente de los casos de mortalidad fue meningitis con el 33% (6 casos), seguida por bacteriemia sin foco en el 28% (5 casos) y neumonía con el 27% (5 casos). Se presentaron situaciones clínicas combinadas como neumonía y meningitis en el 11% (2 casos). Dos de los pacientes tenían factores de riesgo para ENI claramente documentados (asplenia y enfermedad respiratoria crónica). Conclusiones: La mortalidad por ENI es especialmente alta en los menores de 2 años y en pacientes de sexo masculino, especialmente cuando presenta foco meníngeo (44%). La serotipificación no fue posible en todos los pacientes fallecidos, ya que no se envió la cepa aislada al Instituto Nacional de Salud. Se requiere una vigilancia continua y sistemática para evaluar el impacto de la vacunación y las posibles modificaciones en el patrón de presentación de la enfermedad.

Introduction: Streptococcus pneumoniae (S. pneumoniae), also known as pneumococcus, is one of the main bacteria associated with mortality in children under 2 years of age, with a morbidity and mortality incidence that varies according to demographics and exposure to risk, or protective factors. Objective: To describe the child mortality due to invasive pneumococcal disease (IPD) between 2008 -2014 (6 years), in 8 Medical Centres in Bogotá, Colombia. Patients and method: Descriptive observational case series of patients who died of IPD, aged 28 days to 18 years, in 8 tertiary care institutions in Bogota, Colombia. The study period was from 1 January 2008 to 15 January 2014. Sample size: 239 patients. Results: A total of 239 registered cases of IPD were reviewed, showing a mortality of 8% (n 18). The mean age of patients that died was 43.7 months, with an age range from 2 to 176 months (14 years), with 66% of the cases being male. Serotypes were identified in 8 patients, finding: 6A, 6B, 10A, 14, 18C, 23B, 23F, and 35B. The most common clinical presentation of the cases was meningitis with mortality of 33% (6 cases), followed by bacteraemia without focus in 28% (5 cases), and pneumonia with 27% (5 cases). Combined clinical situations were presented, such as pneumonia and meningitis in 11% (2 cases). Two of the patients had clearly documented risk factors for IPD (asplenia and chronic respiratory disease). Conclusions: IPD mortality is particularly high in children under 2 years in male patients, especially when presented with a meningeal focus (44%). Serotyping was not possible in all patients who died, since no strain isolated was sent to the National Institute of Health. Continuous and systematic vigilance is required to evaluate the impact of vaccination and possible changes in the pattern of presentation of disease.

[Characterization of patients who died of invasive pneumococcal disease in the child population of Bogota, Colombia]. / Caracterización de pacientes fallecidos por enfermedad neumocóccica invasiva en la poblacion infantil de Bogotá, Colombia.

INTRODUCTION: Streptococcus pneumoniae (S. pneumoniae), also known as pneumococcus, is one of the main bacteria associated with mortality in children under 2 years of age, with a morbidity and mortality incidence that varies according to demographics and exposure to risk, or protective factors. OBJECTIVE: To describe the child mortality due to invasive pneumococcal disease (IPD) between 2008 -2014 (6 years), in 8 Medical Centres in Bogotá, Colombia. PATIENTS AND METHOD: Descriptive observational case series of patients who died of IPD, aged 28 days to 18 years, in 8 tertiary care institutions in Bogota, Colombia. The study period was from 1 January 2008 to 15 January 2014. SAMPLE SIZE: 239 patients. RESULTS: A total of 239 registered cases of IPD were reviewed, showing a mortality of 8% (n 18). The mean age of patients that died was 43.7 months, with an age range from 2 to 176 months (14 years), with 66% of the cases being male. Serotypes were identified in 8 patients, finding: 6A, 6B, 10A, 14, 18C, 23B, 23F, and 35B. The most common clinical presentation of the cases was meningitis with mortality of 33% (6 cases), followed by bacteraemia without focus in 28% (5 cases), and pneumonia with 27% (5 cases). Combined clinical situations were presented, such as pneumonia and meningitis in 11% (2 cases). Two of the patients had clearly documented risk factors for IPD (asplenia and chronic respiratory disease). CONCLUSIONS: IPD mortality is particularly high in children under 2 years in male patients, especially when presented with a meningeal focus (44%). Serotyping was not possible in all patients who died, since no strain isolated was sent to the National Institute of Health. Continuous and systematic vigilance is required to evaluate the impact of vaccination and possible changes in the pattern of presentation of disease.

Epidemiological burden of invasive pneumococcal disease in children and adolescents with predisposing risk factors.

OBJECTIVE: Some medical conditions constitute important risk factors for the development of invasive pneumococcal diseases in children and adolescents aged from 5 to 19 years. Conjugate vaccines have potential efficacy in this scenario, but are not available in many Latin American public healthcare systems for this age group. This study aimed to estimate the preventable fraction of invasive pneumococcal diseases among individuals aged from 5 to 19 years with associated risk factors for its development. METHODS: Data regarding the Latin America population, risk factors prevalence and conjugate vaccines efficacy were obtained from the literature. RESULTS: Total population at risk ranged from 17.3 to 64.6 million of individuals and asthma was the most impacting risk factor. According to SIREVA, PCV13 provided a 62.9% serotypes coverage in individuals from 5 to 29 years in 2012, potentially increasing the covered population from [8,338,457-31,057,620] with PCV10 to [10,906,356-40,622,078] with PCV13. To date, according to available efficacy data, the hypothetically immunized population ranged from 11.4 to 42.4 million, representing 7.0% to 26.0% of the total population in this age group. CONCLUSIONS: Vaccination in risk groups should be encouraged, as it potentially contributes to the reduction in the number of cases of invasive pneumococcal disease.

The challenge of changing the inactivated poliomyelitis vaccine in Latin America: declaration of the Latin American Society of Pediatric Infectious Diseases (SLIPE).

Even though we have already covered 99% of the path to eradicate poliomyelitis from the world, this disease is still causing paralysis in children. Its eradication means not only the end of wild poliovirus circulation, but vaccine-derived poliovirus circulation as well. Taking into account different factors such as: current epidemiological data, adverse events of the attenuated oral poliomyelitis vaccine (OPV), the availability of an injectable inactivated vaccine (IPV) without the potential of causing the severe adverse events of the oral vaccine (OPV), the efficacy and effectiveness of the IPV in several countries of the world where it has been used for several years, the rationale of changing the vaccination schedule in different Latin American countries; the Latin American Society of Pediatric Infectious Diseases (SLIPE) announces its recommendation of switching to IPV in Latin America, by this Declaration, with an Action Plan for 2014-2015 period as regards vaccination against polio policies in Latin America. 1. The optimal proposed schedule consists of four IPV doses (three doses in the primary schedule plus a booster dose), whether IPV is combined or not with other indicated vaccines in the immunization program of the country. During the OPV to IPV transition phase, an alternative schedule is acceptable; 2. Countries should set optimal strategies in order to maintain and improve vaccination coverage, and implement a nominal immunization registry; 3. Improving the Epidemiological Surveillance of Acute Flaccid Paralysis (AFP) and setting up an environmental surveillance program; 4. Setting up strategies for introducing IPV in National Immunization Programs, such as communicating properly with the population, among others; 5. Bringing scientific societies closer to decision makers; 6. Ensuring optimal supply and prices for IPV introduction; 7. Training vaccination teams; 8. Enhancing the distribution and storing logistics of vaccines. In addition to the scientific evidence, the countries that have not yet decided to switch to IPV should consider the implications of equity and social justice.

[Assessing the force of hepatitis A virus infection in Colombia by applying catalytic models]. / Estimación de la fuerza de infección de Hepatitis A en Colombia, aplicando modelos catalíticos.

AIMS: Estimating the force of hepatitis A virus (HAV) infection concerning a 1- to 15-year-old child population being attended at six healthcare centres in Colombia by applying catalytic models. METHODS: Anti-HAV seroprevalence was estimated in 2,152 patients attending six health centres in 5 Colombian cities; based on such estimation, the force of infection and average age of infection were obtained for each region. RESULTS: The 1- to 4-year-old age group's force of infection was 0.15 in Barranquilla; for the other cities the force of infection was 0.02 in Bogotá for the 5- to 15-year-old age group and 0.06 in Medellin for the 1- to 9-year-old age group. Average infection age in Bogotá, Bucaramanga, Cali and Medellin was 10.68 to 11.97 years-old. CONCLUSION: There was high anti-HAV prevalence in the young-adult population, average infection age being 10.69 to 11.97 years-old, thereby presenting a similar pattern to that of developing regions having intermediate level of endemicity.

Estimación de la fuerza de infección de Hepatitis A en Colombia, aplicando modelos catalíticos / Assessing the force of hepatitis A virus infection in Colombia by applying catalytic models

Objetivo Estimar la fuerza de infección de hepatitis A en la población de niños entre 1 a 15 años de edad que asistieron a seis centros de salud en Colombia entre el año 2007 y 2008, aplicando modelos catalíticos. Métodos En 2 152 pacientes de seis centros de salud en cinco ciudades de Colombia se estimó la seroprevalencia de anticuerpos contra el virus de la Hepatitis A (anti-VHA) por grupos de edad. Con base en esta estimación, se obtuvo la fuerza de infección y la edad promedio de infección para cada región ajustando modelos catalíticos. Resultados La fuerza de infección fue de 0,15 en el grupo de 1 a 4 años en Barranquilla. En el resto de ciudades la fuerza de infección tomó valores entre 0,02 para Bogotá en el grupo de 5 a 15 años, y 0,06 para Medellín en el grupo de 1 a 9 años. La edad promedio de infección en Bogotá, Bucaramanga, Cali y Medellín estuvo entre 10,7 y 12,0 años. Conclusión En Bogotá, Bucaramanga, Cali y Medellín se estimaron seroprevalencia de anti-VHA entre 26,3 % y 40,4 % en el grupo de 10 a 15 años, con una edad promedio de infección entre 10,7 y 12,0 años; comportamiento semejante a la de regiones en desarrollo con endemicidad intermedia.

Aims Estimating the force of hepatitis A virus (HAV) infection concerning a 1- to 15-year-old child population being attended at six healthcare centres in Colombia by applying catalytic models. Methods Anti-HAV seroprevalence was estimated in 2,152 patients attending six health centres in 5 Colombian cities; based on such estimation, the force of infection and average age of infection were obtained for each region. Results The 1- to 4-year-old age group’s force of infection was 0.15 in Barranquilla; for the other cities the force of infection was 0.02 in Bogotá for the 5- to 15-year-old age group and 0.06 in Medellin for the 1- to 9-year-old age group. Average infection age in Bogotá, Bucaramanga, Cali and Medellin was 10.68 to 11.97 years-old. Conclusion There was high anti-HAV prevalence in the young-adult population, average infection age being 10.69 to 11.97 years-old, thereby presenting a similar pattern to that of developing regions having intermediate level of endemicity.

Virus Respiratorios en Menores de Diez Años con Infección Respiratoria en el Hospital Militar Central de Bogotá 2000-2001 / Respiratory virus in children aged less than 10 years old suffering from respiratory infection in the Hospital Militar Central in Bogota from 2000-2001

Objetivo: Se llevo a cabo un estudio en niños que consultaban por infección respiratoria aguda al Hospital Militar (Hosmil) de Bogota, Colombia, con el objetivo de estimar la frecuencia de enfermedad respiratoria aguda en esa institución producida por algunos virus respiratorios. Métodos: Durante 18 meses, de Marzo de 2000 a Septiembre de 2001, se seleccionaron semanalmente tres a cinco niños con infección respiratoria de aquellos que consultaban al servicio de emergencia o de consulta ambulatoria del Hospital. De cada uno de ellos se obtuvo muestras nasofaringeas que fueron examinadas por inmunofluorescencia para virus sincitial respiratorio (VSR), influenza, adenovirus y parainfluenza. Resultados: Se estudiaron 139 niños de los cuales el 40 por ciento fue positivo para alguno de los virus estudiados. El agente viral mas frecuentemente encontrado fue el VSR (27 por ciento), seguido por el virus de la influenza (5 por ciento) y adenovirus (3 por ciento). La circulación de VSR coincidía con los picos de hospitalizaciones por IRA y por neumonía y del hospital, era mas frecuente en los niños menores de 3 años y se encontraba presente durante todo el año. Conclusiones: Los virus respiratorios causan gran parte de la enfermedad respiratoria moderada o severa en el Hosmil y el VSR es el agente más importante entre ellos.

Objective: A study was carried out on children seeking medical care at the Hospital Militar (Hosmil) in Bogota due to acute respiratory infection; it was aimed at estimating the frequency of respiratory virus-associated acute respiratory disease (ARD) in children aged under 10. Methods: Three to five children aged less than 10 years old were selected every week from the hospital's emergency ward or ambulatory services over an 18-month period from March 2000 to September 2001. Nasopharyngeal samples were obtained from them and processed using indirect immunofluorescence. The relative frequency of respiratory syncytial virus (RSV), influenza, adenovirus and parainfluenza were calculated. Results: Around 40 percent of the 139 children examined proved positive for at least one respiratory virus. RSV was the most frequently found virus (27 percent positivity: 38 patients) followed by influenza (5 percent: 7 patients) and adenovirus (3 percent: 4 patients). RSV circulation peaks coincided with peaks related to ARD and pneumonia in the hospital: it was found most frequently in children aged less than 3 and was present throughout the year. Conclusion: Respiratory viruses were an important cause of moderate to severe respiratory illness in children seeking health care at Hosmil; RSV was the leading agent amongst such viruses.

[Adenovirus in children under five years of age. Circulation patterns and clinical and epidemiological characteristics in Colombia, 1997-2003]. / Adenovirus en Niños Menores de Cinco Años. Patrones de Circulación, Características Clínicas y Epidemiológicas en Colombia, 1997-2003.

OBJECTIVE: The Colombian National Institute of Health has been studying the epidemiology of several respiratory viruses since 1997 to identify their circulation patterns and the role they play as pathogenic agents of acute and/or moderate respiratory infection (RI) in children aged less than 5. METHODS: The study used sentinel surveillance methods in sentinel hospitals in Bogotá and Manizales. Four to eight nasopharyngeal samples were collected every week in the sentinel hospitals from children aged less than five consulting for low or high RI. Nasopharyngeal samples were processed by indirect immunofluorescence. RESULTS: 1,743 children were examined from January 1997 to December 2003; 35 % were found to be positive for respiratory viruses. Respiratory syncytial virus was found more frequently while adenovirus was found in 47 patients (2,6 % of the sample; 1,4-2,5 % 95 %CI). Adenovirus was detected throughout the year (excepting January) but peaks occurred in March, July, October and December. Most patients were hospitalised (50-87%) and were in need of oxygen support. Fatality:case ratio was 7%; B7, 2, C1, and B3 serotypes were identified. CONCLUSION: The data suggested that respiratory infection due to adenovirus was a low frequency event amongst the children seeking medical care at the sentinel hospitals. However, when respiratory disease was caused by adenovirus, it was severe.

Adenovirus en Niños Menores de Cinco Años: patrones de Circulación, Características Clínicas y Epidemiológicas en Colombia, 1997-2003 / Adenovirus in children under five years of age: circulation patterns and clinical and epidemiological characteristics in Colombia, 1997-2003

Objetivo: Desde 1997 el Instituto Nacional de Salud vigila la ocurrencia de algunos virus respiratorios con el fin de identificar sus patrones de circulación y el papel que tienen en la ocurrencia de enfermedad respiratoria moderada o severa, en niños menores de 5 años. Métodos: La vigilancia está basada en hospitales centinela de Bogotá y Manizales en los que todas las semanas se recolectan 4 a 8 muestras nasofaríngeas, de niños menores de cinco años que consultan por enfermedad respiratoria alta o baja. Las muestras son procesadas por inmunofluorescencia indirecta. Resultados: De Enero de 1997 a Diciembre de 2003 se examinaron 1 743 pacientes y se encontraron virus respiratorios en 35 por ciento de las muestras procesadas. El adenovirus se encontró en 47 casos (2,6 por ciento, IC95 por ciento 1,4-3,5 por ciento) y fue detectado durante todos los meses, excepto enero, con picos en marzo, julio, octubre y diciembre. La mayoría de los pacientes requirieron hospitalización (50 a 87 por ciento) y soporte con oxigeno y la razón muerte/caso fue de 7 por ciento. Los serotipos de adenovirus encontrados fueron B7, 2, C1 y B3. Conclusiones: Los datos del presente estudio datos sugieren que en nuestro medio los adenovirus no son los agentes mas frecuentes de enfermedad respiratoria pero, cuando están presentes, producen enfermedad severa.

Objective: The Colombian National Institute of Health has been studying the epidemiology of several respiratory viruses since 1997 to identify their circulation patterns and the role they play as pathogenic agents of acute and/or moderate respiratory infection (RI) in children aged less than 5. Methods: The study used sentinel surveillance methods in sentinel hospitals in Bogotá and Manizales. Four to eight nasopharyngeal samples were collected every week in the sentinel hospitals from children aged less than five consulting for low or high RI. Nasopharyngeal samples were processed by indirect immunofluorescence. Results: 1 743 children were examined from January 1997 to December 2003; 35 percent were found to be positive for respiratory viruses. Respiratory syncytial virus was found more frequently while adenovirus was found in 47 patients (2,6 percent of the sample; 1,4-2,5 percent 95 percentCI). Adenovirus was detected throughout the year (excepting January) but peaks occurred in March, July, October and December. Most patients were hospitalised (50-87 percent) and were in need of oxygen support. Fatality:case ratio was 7 percent; B7, 2, C1, and B3 serotypes were identified. Conclusion: The data suggested that respiratory infection due to adenovirus was a low frequency event amongst the children seeking medical care at the sentinel hospitals. However, when respiratory disease was caused by adenovirus, it was severe.

[Respiratory virus in children aged less than 10 years old suffering from respiratory infection in the Hospital Militar Central in Bogota from 2000-2001]. / Virus Respiratorios en Menores de Diez Años con Infección Respiratoria en el Hospital Militar Central de Bogotá 2000-2001.

OBJECTIVE: A study was carried out on children seeking medical care at the Hospital Militar (Hosmil) in Bogota due to acute respiratory infection; it was aimed at estimating the frequency of respiratory virus-associated acute respiratory disease (ARD) in children aged under 10. METHODS: Three to five children aged less than 10 years old were selected every week from the hospital's emergency ward or ambulatory services over an 18-month period from March 2000 to September 2001. Nasopharyngeal samples were obtained from them and processed using indirect immunofluorescence. The relative frequency of respiratory syncytial virus (RSV), influenza, adenovirus and parainfluenza were calculated. RESULTS: Around 40% of the 139 children examined proved positive for at least one respiratory virus. RSV was the most frequently found virus (27% positivity: 38 patients) followed by influenza (5%: 7 patients) and adenovirus (3%: 4 patients). RSV circulation peaks coincided with peaks related to ARD and pneumonia in the hospital: it was found most frequently in children aged less than 3 and was present throughout the year. CONCLUSION: Respiratory viruses were an important cause of moderate to severe respiratory illness in children seeking health care at Hosmil; RSV was the leading agent amongst such viruses.

Structural aspects of the Mucor bacilliformis proteinase, a new member of the aspartyl-proteinase family.

Bovine chymosin is considered the best milk-clotting enzyme for cheese manufacture; however, the thermophilic Mucor pusillus proteinase is also used nowadays. We herein report structural aspects of the aspartyl proteinase from the local mesophilic Mucor bacilliformis strain. Sequence data indicate a high similarity degree to those of other family members. The protein is monomeric, not glycosylated, has two disulfide bridges, and mainly includes beta structure. A molecular model was built by using the Rhizopus chinensis proteinase structure as the template. Sequence analysis and comparison of our model with bovine chymosin and M. pusillus proteinase structures, indicate that the M. bacilliformis proteinase is at a similar evolutionary distance on a sequence level; as regards tertiary structure, the M. bacilliformis proteinase superimposes on the bovine chymosin structure in a fashion similar to that of the M. pusillus proteinase. Overall results suggest that this novel proteinase can be utilized as a good milk-clotting enzyme in the dairy industry.

Bioactive eremophilanolides from Senecio poepigii.

A new bioactive eremophilanolide, 1alpha-tigloyloxy-8betaH,10betaH-eremophil-7(11)-en-8alpha,12-olide, was isolated from Senecio poepigii and its structure was elucidated by spectral analysis. 1alpha-Angeloyloxy-8beta-methoxy-10betaH-eremophil-7(11)-en-8alpha,12-olide was also isolated. Antifungal and insect antifeedant properties were evaluated.