Measles Serostatus in Mothers and Their Newborns in Antioquia, Colombia: Implications for Measles Elimination.

To describe the serostatus of measles IgG antibodies in pregnant women and newborns, placental transfer, and factors that determine being below the threshold of 150 mIU/mL, a cross-sectional study was conducted. Blood samples of 790 pregnant women at the time of delivery and 734 umbilical cord samples were analyzed from eight hospitals in the Aburrá Valley of Antioquia, Colombia. Measles IgG antibody measurement was performed with ELISA. The proportion of individuals with antibodies < 150 mIU/mL was 13.9% (95% CI: 12.2-15.8) in pregnant women and 11.1% (95% CI: 9.2-13.4) in newborns. The geometric mean of the antibody level of the pregnant women was 552 mIU/mL (95% CI: 504-605) and in the umbilical cord 662 mIU/mL (95% CI: 604-727). A positive correlation between pregnant woman and umbilical cord antibodies was found. The median ratio of measles IgG antibodies in umbilical cord/pregnant woman was 1.22 for all participants. A seroprevalence below the threshold of 150 mIU/mL was found in newborns whose mothers were born between 1983 and 1994, compared with those born before that period, when exposure to the wildtype virus was common (adjusted prevalence ratio: 3.6, 95% CI: 1.3-9.6). These findings suggest that there are gaps in measles immunity among women of childbearing age, before pregnancy. To close this immune gap and support efforts to maintain measles control, serological screening for measles antibodies should be routinely included in reproductive health and antenatal care programs to identify women without immunity who should be vaccinated before pregnancy or after delivery.

Seroprevalence against Diphtheria in Pregnant Women and Newborns in Colombia: New Arguments to Promote Maternal Immunization.

The tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine is recommended during pregnancy for neonatal protection against pertussis, although little is known of the protection it provides against diphtheria. The work used a cross-sectional design to estimate seroprevalence against diphtheria in 805 pregnant women with ≥37 gestation weeks and their newborns whose deliveries were attended in eight hospitals randomly chosen from a subregion of Antioquia, Colombia and to explore factors related with maternal protection. Levels of IgG antibodies were determined by using a commercial enzyme-linked immunosorbent assay test. Placental transfer of antibodies and crude and adjusted prevalence ratio (aPR) were analyzed to describe factors related with maternal protection against diphtheria. Protection against diphtheria was observed in 91.7% (95% CI 90.3-93.0) of the pregnant women and 93.1% (95% CI 91.7-94.4) of newborns, whose antibody levels were positively correlated (Spearman's r = 0.769; p = 0.000). Maternal protection could be influenced by having been vaccinated during the current pregnancy (aPR 0.85, 95% CI: 0.82-0.93). The protective effect of vaccination during pregnancy and the efficiency of maternal antibody transfers were detected. Public health efforts should focus on increasing Tdap vaccination during each pregnancy to protect mothers and newborns against diphtheria.

Seroprevalence of Varicella in Pregnant Women and Newborns in a Region of Colombia.

We estimate the seroprevalence of IgG antibodies to varicella zoster virus (VZV) based on the first serological study in a cohort of pregnant women and newborns from the Aburrá Valley (Antioquia-Colombia) who attended delivery in eight randomly chosen hospitals. An indirect enzyme immunoassay was used to determine anti-VZV IgG antibodies. Generalized linear models were constructed to identify variables that modify seropositivity. In pregnant women, seropositivity was 85.8% (95% CI: 83.4-85.9), seronegativity was 12.6% (95% CI: 10.8-14.6), and concordance with umbilical cord titers was 90.0% (95% CI: 89-91). The seropositivity of pregnant women was lower in those who lived in rural areas (IRR: 0.4, 95% CI: 0.2-0.7), belonged to the high socioeconomic status (IRR: 0.4, 95% CI: 0.2-0.7), and had studied 11 years or more (IRR: 0.6, 95% CI: 0.4-0.8). Among newborns, seropositivity was lower in those who weighed less than 3000 g (IRR: 0.8, 95% CI: 0.6-1.0). The high seropositivity and seronegativity pattern indicates the urgent need to design preconception consultation and vaccination reinforcement for women of childbearing age according to their sociodemographic conditions, to prevent infection and complications in the mother and newborn.

Seroprevalence of hepatitis B and factors potentially associated in a population-based study in Medellin, Colombia.

The seroprevalence of hepatitis B (HB) and of potentially associated factors in Medellin, Colombia, were investigated 17years after the start of universal vaccination. Biological and sociodemographic data from a population survey with a multistage random sampling were analyzed in 6-64year old individuals. HB surface antigen, total HB core antibodies and HB surface antibodies, and in some cases IgM antibodies to HB core antigen, were tested in 2077 samples. Factors potentially associated with and natural, and vaccine immunity relative to susceptibility (absence of any marker) were analyzed using a multinomial logistic regression. The prevalence of serological patterns was: chronic infection 0.20% (95% CI 0.11-0.71), vaccine immunity 25.10% (95% CI 21.72-28.83) and natural immunity 2.60% (95% CI 1.80-3.74). No markers were detected in 71.30% (95% CI 67.70-74.83) of the individuals and evidence of recent infection was not detected. Relative to the absence of markers, natural immunity was potentially associated with age (6-17years and 41-64years) and sleeping less than 6 hours, while vaccine immunity was associated with age (6-17years), reporting vaccination against HB, belonging to high socioeconomic strata, home ownership and being obese, after adjusting for other variables. These results may be a population effect of mass vaccination. It is recommended to complete the vaccination schedule and to study in detail, persistence of antibodies and the role of obesity and socioeconomic strata in the vaccine immunity.

Analysis of hepatitis B virus genotypes by restriction fragment length polymorphism / Análisis de genotipos del virus de la hepatitis B mediante el análisis de polimorfismos de longitud de fragmentos de restricción

Introduction: Ten viral genotypes (A-J) distributed in all continents have been described for hepatitis B virus (HBV). One of the methodologies for determining the viral genotype is the restriction fragment length polymorphism (RFLP) technique, a simple and relatively inexpensive method, albeit with some limitations. Objective: The initial objective of the project was to identify the HBV genotypes by RFLP in serum samples obtained from patients and blood donors. However, due to the discrepancies of RFLP patterns it was also necessary to perform phylogenetic genotyping and in silico analysis of HBV sequences. Materials and methods: We obtained 56 serum samples. DNA extraction was followed by PCR amplification of a fragment of HBV ORF S. We analyzed PCR products by RFLP with Alw I, Bsr I, Cfr I, Hpa II and Sty I, and we sequenced some. We compared the patterns obtained with those in previous reports. We also performed RFLP analysis in silico since we found differences between the patterns expected and those obtained. Results: We identified genotypes A and F, subgenotype F3, in the samples. This result is in agreement with those of previous studies carried out in Colombia; indeed, subgenotype F3 is the most frequent in the Andean region of the country, while genotype A is the most frequent HBV genotype in the western region (department of Chocó). Based on the in silico analysis of 229 HBV sequences from GenBank and 11 sequences of this study, we identified the RLFP pattern for genotype F, subgenotype F3, and we described some modifications of genotype A RFLP patterns. Conclusions: We identified the single nucleotide polymorphism pattern for genotype F, subgenotype F3, by in silico analysis and sequencing. Further robust in silico analyses are necessary to validate the RFLP patterns of HBV genotype and subgenotypes.

Introducción. Se han descrito diez genotipos (A-J) del virus de la hepatitis B (HBV) que están distribuidos en todos los continentes. Una de las técnicas utilizadas para determinar el genotipo viral es el análisis del polimorfismo de longitud de los fragmentos de restricción, un método simple y económico, pero con algunas limitaciones. Objetivo. El objetivo inicial del estudio fue identificar el genotipo del HBV mediante RFLP en muestras de suero obtenidas de pacientes y donantes de sangre. Sin embargo, por las discrepancias observadas en los patrones de RFLP fue necesario realizar análisis filogenéticos y un análisis in silico de secuencias del HBV. Materiales y métodos. Se obtuvieron 56 muestras de suero. Tras la extracción de ADN, se amplificó un fragmento del ORF S del HBV mediante reacción en cadena de la polimerasa, cuyos productos se analizaron por RFLP con las enzimas Alw I, Bsr I, Cfr I, Hpa II y Sty I, y algunos se secuenciaron. Los patrones obtenidos se compararon con los reportados previamente. Se efectuó un análisis in silico de RFLP en consideración de las diferencias entre los patrones esperados y los observados. Resultados. Se identificaron los genotipos A y F, subgenotipo F3, en las muestras. Este resultado coincide con lo descrito en estudios previos en los que se ha demostrado que el genotipo F, subgenotipo F3, es prevalente en la población de la región andina del país, en tanto que el genotipo A predomina en el occidente (departamento del Chocó). Con base en el análisis in silico de 229 secuencias virales obtenidas del GenBank y las 11 secuencias de este estudio, se caracterizó un nuevo patrón de RFLP específico para el genotipo F, subgenotipo F3, y se describieron algunas modificaciones en el patrón de RFLP del genotipo A, subgenotipo A1. Conclusiones. Se caracterizó el patrón de genotipificación del genotipo F, subgenotipo F3, del HBV mediante RFLP, análisis in silico y secuenciación. Se requieren nuevos análisis in silico con un número mayor de secuencias para validar los patrones de RFLP de los genotipos y subgenotipos del VHB.

Seroprevalence of mumps in an epidemic period in Medellín, Colombia.

OBJECTIVE: We related seroprevalence and outbreaks data in order to identify factors that could explain the occurrence of outbreaks despite high vaccination coverage in Medellín Colombia. METHODS: Samples from a population seroprevalence data obtained in 2009 in a random survey were analyzed. IgG levels were determined for mumps using 2 commercial tests of 2119 individuals aged 6-64 years. A comparative analysis was undertaken using age-specific mumps seroprevalence data and information of 98 epidemiological investigations of mumps outbreaks reported in 2009. RESULTS: Overall, seroprevalence was 91.6% (95% CI=89.3-93.5%). The age-specific seronegativity was 20.3% and 20.6% in age groups 11-15 years and 16-20 years respectively. Individuals aged 6-20 years were the most affected during outbreaks. In individuals born in 2003, a year after the change in the booster schedule from 10 to 5 years, the proportion of unvaccinated individuals (14%) and those who received only one dose of MMR (45%) increased substantially. On average, 23.5 days elapsed between the onset of symptoms in secondary cases and the outbreak investigation. CONCLUSION: Potential contributing factors for the occurrence of outbreaks of mumps were the relatively high prevalence of seronegativity among individuals aged 11-20 years, delays in investigation and control of outbreaks, and incomplete vaccination schedules.

Analysis of hepatitis B virus genotypes by restriction fragment length polymorphism.

INTRODUCTION: Ten viral genotypes (A-J) distributed in all continents have been described for hepatitis B virus (HBV). One of the methodologies for determining the viral genotype is the restriction fragment length polymorphism (RFLP) technique, a simple and relatively inexpensive method, albeit with some limitations. OBJECTIVE: The initial objective of the project was to identify the HBV genotypes by RFLP in serum samples obtained from patients and blood donors. However, due to the discrepancies of RFLP patterns it was also necessary to perform phylogenetic genotyping and in silico analysis of HBV sequences. MATERIALS AND METHODS: We obtained 56 serum samples. DNA extraction was followed by PCR amplification of a fragment of HBV ORF S. We analyzed PCR products by RFLP with AlwI, BsrI, CfrI, HpaII and StyI, and we sequenced some. We compared the patterns obtained with those in previous reports. We also performed RFLP analysis in silico since we found differences between the patterns expected and those obtainedResults: We identified genotypes A and F, subgenotype F3, in the samples. This result is in agreement with those of previous studies carried out in Colombia; indeed, subgenotype F3 is the most frequent in the Andean region of the country, while genotype A is the most frequent HBV genotype in the western region (department of Chocó). Based on the in silico analysis of 229 HBV sequences from GenBank and 11 sequences of this study, we identified the RLFP pattern for genotype F, subgenotype F3, and we described some modifications of genotype A RFLP patterns. CONCLUSIONS: We identified the single nucleotide polymorphism pattern for genotype F, subgenotype F3, by in silico analysis and sequencing. Further robust in silico analyses are necessary to validate the RFLP patterns of HBV genotype and subgenotypes.

[Herd immunity against rubella according to a survey of the population in Medellin, Colombia]. / Inmunidad colectiva contra la rubéola según una encuesta poblacional en Medellín, Colombia.

OBJECTIVE: Calculate the critical proportion (Pc) for achieving herd immunity based on a 2009 population study conducted in Medellin, Colombia, by age, globally and disaggregated by sex, location, and socioeconomic stratum. METHODS: A survey of seroprevalence in the population was conducted by means of a random sample of 2 124 individuals aged 6 to 64 that was representative of age, sex, and location. The basic reproduction number was estimated using a quadratic regression of the average IgG titers for rubella by age in unvaccinated individuals with titers greater than or equal to 15 IU/ml. The effective reproduction number (Re) was calculated with the data on the weighted proportion of protection by age, sex, location, and socioeconomic stratum. RESULTS: Overall, the Pc was 90.0% (95% CI, 88.6-95.2%) and the Re was 0.95 (95% CI, 0.8-1.8), for a weighted proportion of protection of 89.4% (95% CI, 86.8- 91.6%). Protection was lower than the expected Pc in both sexes, in high and low socioeconomic strata, and in the rural area. In the urban area, protection was greater than the Pc (89.4%, with a 95% CI, 86.6-91.7%, compared to 87.4% and a 95% CI, 85.2-87.8%). CONCLUSIONS: The urban area has made progress toward herd immunity, but the overall proportion of protection in women, the rural area, and the high socioeconomic strata must be increased. The effective number may be greater than one, indicating the potential for the spread of the disease.

Inmunidad colectiva contra la rubéola según una encuesta poblacional en Medellín, Colombia / Herd immunity against rubella according to a survey of the population in Medellin, Colombia

Objetivo. Calcular la proporción crítica (Pc) para el logro de la inmunidad colectiva a partir de un estudio poblacional realizado en el 2009 en Medellín, Colombia, por edad, en forma global y desagregada por sexo, zona de procedencia y estrato socioeconómico. Métodos. Se realizó una encuesta de seroprevalencia poblacional, con una muestra aleatoria de 2 124 individuos de 6 a 64 años, representativa por edad, sexo y zona. Se estimó el número básico de reproducción utilizando una regresión cuadrática de los títulos promedio de IgG contra la rubéola por edad en los individuos no vacunados con títulos mayores o iguales a 15 UI/ml. Se calculó el número efectivo de reproducción (Re ) con los datos de la proporción ponderada de protección por edad, sexo, zona y estrato socioeconómico. Resultados. En forma global, la Pc fue de 90,0% (IC95% 88,6­95,2) y el Re de 0,95 (IC95% 0,8­1,8), para una proporción ponderada de protección de 89,4% (IC95% 86,8­91,6). La protección fue menor que la Pc esperada en ambos sexos, en los estratos socioeconómicos alto y bajo, y en la zona rural. En la zona urbana la protección fue mayor que la Pc (89,4%, IC95% 86,6­91,7 en comparación con 87,4%, IC95% 85,2­87,8). Conclusiones. En la zona urbana se ha avanzado hacia la inmunidad colectiva, pero se requiere aumentar la proporción de protección en forma global, en las mujeres, en la zona rural y en los individuos de estrato socioeconómico alto. El número efectivo puede tener un valor mayor de uno, lo que indica el potencial de propagación de la enfermedad.

Objective. Calculate the critical proportion (Pc ) for achieving herd immunity based on a 2009 population study conducted in Medellin, Colombia, by age, globally and disaggregated by sex, location, and socioeconomic stratum. Methods. A survey of seroprevalence in the population was conducted by means of a random sample of 2 124 individuals aged 6 to 64 that was representative of age, sex, and location. The basic reproduction number was estimated using a quadratic regression of the average IgG titers for rubella by age in unvaccinated individuals with titers greater than or equal to 15 IU/ml. The effective reproduction number (Re) was calculated with the data on the weighted proportion of protection by age, sex, location, and socioeconomic stratum. Results. Overall, the Pc was 90.0% (95% CI, 88.6­95.2%) and the Re was 0.95 (95% CI, 0.8­1.8), for a weighted proportion of protection of 89.4% (95% CI, 86.8­ 91.6%). Protection was lower than the expected Pc in both sexes, in high and low socioeconomic strata, and in the rural area. In the urban area, protection was greater than the Pc (89.4%, with a 95% CI, 86.6­91.7%, compared to 87.4% and a 95% CI, 85.2­87.8%). Conclusions. The urban area has made progress toward herd immunity, but the overall proportion of protection in women, the rural area, and the high socioeconomic strata must be increased. The effective number may be greater than one, indicating the potential for the spread of the disease.

Prolonged co-circulation of two distinct Dengue virus Type 3 lineages in the hyperendemic area of Medellin, Colombia.

During the past two decades, Dengue virus-3 (DENV-3) has re-emerged in the Western Hemisphere causing significant epidemics of dengue fever (DF) and dengue hemorrhagic fever (DHF). In an effort to understand the molecular evolution of DENV-3 and their relationships to other DENV-3 circulating in the western hemisphere, we conducted a phylogenetic study on DENV-3 isolates made between 2002 and 2007 in the metropolitan area of Medellín, Colombia. An unexpected co-circulation of two different variants of DENV-3 subtype III during at least 5 years in Medellín was found. In addition, a more complete analysis of DENV-3 viruses isolated in other South American regions revealed the existence of three different subtype III lineages, all derived from independent introductions. This study documents significant genetic diversity of circulating viruses within the same subtype and an unusual capacity of the population of this city to support continuous circulation of multiple variants of dengue virus.