The Impact of the Coronavirus Pandemic on Vaccination Coverage in Latin America and the Caribbean.

BACKGROUND: Routine vaccination coverage in Latin America and the Caribbean declined prior to and during the coronavirus pandemic. We assessed the pandemic's impact on national coverage levels and analyzed whether financial and inequality indicators, immunization policies, and pandemic policies were associated with changes in national and regional coverage levels. METHODOLOGY: We compared first- and third-dose coverage of diphtheria-pertussis-tetanus-containing vaccine (DTPcv) with predicted coverages using time series forecast modeling for 39 LAC countries and territories. Data were from the PAHO/WHO/UNICEF Joint Reporting Form. A secondary analysis of factors hypothesized to affect coverages during the pandemic was also performed. RESULTS: In total, 31 of 39 countries and territories (79%) had greater-than-predicted declines in DTPcv1 and DTPcv3 coverage during the pandemic, with 9 and 12 of these, respectively, falling outside the 95% confidence interval. Within-country income inequality (i.e., Gini coefficient) was associated with significant declines in DTPcv1 coverage, and cross-country income inequality was associated with declines in DTPcv1 and DTPcv3 coverages. Observed absolute and relative inequality gaps in DTPcv1 and DTPcv3 coverage between extreme country quintiles of income inequality (i.e., Q1 vs. Q5) were accentuated in 2021, as compared with the 2019 observed and 2021 predicted values. We also observed a trend between school closures and greater-than-predicted declines in DTPcv3 coverage that approached statistical significance (p = 0.06). CONCLUSION: The pandemic exposed vaccination inequities in LAC and significantly impacted coverage levels in many countries. New strategies are needed to reattain high coverage levels.

Health workers vaccination: Experience and lessons learned from Costa Rica.

Objective: To describe the decision-making processes, enablers, challenges and lessons learned in Costa Rica for implementing a sustained and multi-pronged approach in health workers vaccination (HW). Methods: A retrospective descriptive analysis was conducted by searching published and grey literature, including scientific publications, legislation, decrees, policies, manuals, technical reports, and platforms used for data register and coverage monitoring. Key informants from the Ministry of Health (MoH), the Costa Rican Social Security Fund (CCSS) were interviewed representing national, subnational and local levels; as well as members of the National Technical Advisory Group (NITAG) and the private sector. Collected data were transcribed and categorized by the following specific topics using a thematic content analysis approach: decision making process, pre-service screening, vaccination for current HWs and engagement with the private sector. Major findings were discussed and organized into enablers, challenges and lessons learned. Results: Decision making processes to establish the vaccination strategies and schedules in Costa Rica were based on the epidemiological trends of vaccine-preventable diseases (VPDs) and cost analysis. Risk assessment and feasibility considerations determined that some vaccines such as hepatitis B, varicella and influenza, were first introduced in HWs and then were expanded to other target populations. These decisions were approved by the NITAG as the advisory technical advisory group of the MoH. Main enablers identified were: high level and sustained political will, decisions based on data analysis and feasibility considerations, HWs knowledge and high vaccine acceptance and demand. Challenges were related to effective coverage monitoring, and private sector engagement. Conclusions: The Costa Rican experience provides lessons learned that can be leveraged by other countries to strengthen HWs vaccination strategies at regional and global levels.

Pollination service provided by honey bees to buzz-pollinated crops in the Neotropics.

Generalist honey bees grant significant pollination services worldwide. Although honey bees can provide compensatory pollination services, their service to buzz-pollinated crops, compared to specialized pollinators, is not clear. In this study, we assessed the contribution of Africanized honey bees (AHB) and native sonicating bees (NBZ) to the pollination of eggplant (Solanum melongena) and annatto (Bixa orellana) in Yucatan, Mexico, one of the largest producers of these crops in the Americas and a region with one of the largest densities of honey bees in the world. We first compared the relative frequency and abundance of both bee types on flowers of both crops. Secondly, we controlled access to flowers to compare the number and weight of fruit and number of seed produced after single visits of AHB and native bees. For a better assessment of pollination services, we evaluated the productivity of individual flowers multiply visited by AHB. The results were compared against treatments using pollinator-excluded flowers and flowers that were supplied with additional pollen, which allowed an overall measure of pollination service provision (PSP). Our results showed that AHB were the predominant flower visitors in both crops and that were poorly efficient on individual visits. Notably, fruit quantity and seed number increased concomitantly with the number of AHB visits per flower on eggplant, but not on annatto. Estimation of PSP revealed no pollination deficit on eggplant but that a deficit existed on the pollination services to annatto. We found that AHB numerical predominance compensates their poor individual performance and can complement the services of native bees on eggplant, but not on annatto. We discuss possible explanations and implications of these results for buzz-pollinated crops in the neotropics an area with little assessment of pollination services and a high density of honey bees.

Health policy impacts on malaria transmission in Costa Rica.

Costa Rica is near malaria elimination. This achievement has followed shifts in malaria health policy. Here, we evaluate the impacts that different health policies have had on malaria transmission in Costa Rica from 1913 to 2018. We identified regime shifts and used regression models to measure the impact of different health policies on malaria transmission in Costa Rica using annual case records. We found that vector control and prophylactic treatments were associated with a 50% malaria case reduction in 1929-1931 compared with 1913-1928. DDT introduction in 1946 was associated with an increase in annual malaria case reduction from 7.6% (1942-1946) to 26.4% (1947-1952). The 2006 introduction of 7-day supervised chloroquine and primaquine treatments was the most effective health policy between 1957 and 2018, reducing annual malaria cases by 98% (2009-2018) when compared with 1957-1968. We also found that effective malaria reduction policies have been sensitive to natural catastrophes and extreme climatic events, both of which have increased malaria transmission in Costa Rica. Currently, outbreaks follow malaria importation into vulnerable areas of Costa Rica. This highlights the need to timely diagnose and treat malaria, while improving living standards, in the affected areas.

Efectividad a 3 y 6 meses de una intervención integral para caries dental en escolares de Tepetitán, San Vicente; San Fernando y Nombre de Jesús, Chalatenango / Effectiveness at 3 and 6 months of a comprehensive intervention for dental caries in schoolchildren from Tepetitán, San Vicente; San Fernando and Name of Jesus, Chalatenango

Objetivo: Determinar la efectividad a 3 y 6 meses de una intervención integral para la prevención y tratamiento de caries en dientes permanentes, en escolares de 9 a 11 años con 11 meses, atendidos en tres Unidades Comunitarias de Salud Familiar (UCSF) el año 2017. MATERIALES Y MÉTODOS: El estudio efectuado es de tipo intervención comunitaria, cuasi experimental, con grupo control pre-post. Se intervinieron 1,664 superficies en un total de 90 individuos escolares, con un abordaje integral para la prevención y limitación de daño por caries dental, en la cual se realizó una fase higiénica; 125 remineralizaciones con flúor barniz, 737 sellantes de fosas y fisuras (SFF) y 196 obturaciones. RESULTADOS: Inicialmente, según el Índice de Higiene Oral Simplificado (ISHO), el 36.67% de los niños se encontró en categoría óptima, reportándose a los 3 meses el 90%, y el 82.67% a los 6 meses. Así mismo, al diagnóstico inicial, los niños presentaron una media de dientes afectados por caries de 4, reduciéndose a 1 a los 3 meses y de 0 a los 6 meses, siendo esta diferencia estadísticamente significativa (p<0.05). Según la prueba estadística, tuvieron una supervivencia para SFF del 95.05% a los 6 meses y de 34.27% a los 3 meses; mientras que para obturaciones, del 100% y 90%, respectivamente. CONCLUSIONES: La intervención fue efectiva para prevenir y limitar la caries dental, por la supervivencia de tratamientos, reducción de placa dentobacteriana y cálculo.

OBJECTIVE: To determine the effectiveness at 3 and 6 months of a comprehensive intervention for the prevention and treatment of dental caries in permanent teeth, in schoolchildren from 9 to 11 years 11 months old, attended in three Family Health Community Units (UCFS) in 2017. MATERIALS AND METHODS: The study conducted is a community intervention type, quasi-experimental with control pre-post group. It involved 1664 surfaces in a total of 90 schoolchildren individuals with a comprehensive approach to the prevention and limitation of damage by caries in which a hygienic phase was performed through 125 remineralizations with varnish fluoride, 737 fissure sealants (SFF) and 196 dental fillings. RESULTS: According to the Simplified Oral Hygiene Index (OHI-S), the 36.67% of the children were found initially in optimal category, reporting at 3 months the 90%, and the 82.67% at 6 months. Likewise, at the initial diagnosis children presented an average of teeth affected by caries of 4, reduced to 1 to 3 months and 0 at 6 months, this difference is statistically significant (p<0.05). According to the statistics test, there was a survival for fissure sealants of 95.05% at 6 months and 34.27% at 3 months; while for fillings it was of 100% and 90%, respectively. CONCLUSIONS: The intervention was effective to prevent and limit dental caries, according to the survival of treatments, reduction of dentobacterial plaque and dental calculus.

Approach to verify the status of measles, rubella, and congenital rubella syndrome elimination in Costa Rica.

Costa Rica introduced the measles-mumps-rubella (MMR) vaccine in 1986. The Ministry of Health adopted the goal of eliminating endemic measles in 1991 by achieving and maintaining high vaccine coverage through routine delivery, mass campaigns and outreach activities, and the strengthening of expanded program on immunization (EPI) surveillance. Measles and rubella immunization strategies shifted susceptibility to older age groups, leading to the introduction of MMR2 in 1992, administered at age 7 years. In 2000, the goal of accelerated rubella control and congenital rubella syndrome prevention was established, and a nationwide vaccination campaign targeting men and women aged 15-39 was implemented to immunize the population of reproductive age. The last endemic case of measles was confirmed in 1999, and at the end of 2001 Costa Rica reported the last endemic cases of rubella and congenital rubella syndrome. Imported cases of measles and rubella were detected in 2003 and 2005, with no secondary cases detected. In 2008, Costa Rica established a National Committee of Experts, supported by technical teams, to collect the evidence required to verify the interruption of endemic transmission of the measles and rubella viruses. The evidence includes information on trends and epidemiologic analysis, molecular epidemiology, population immunity, the quality of surveillance, and the sustainability of the EPI program.

Switching from OPV to IPV: are we behind the schedule in Latin America?

Oral polio vaccine (OPV) has been an effective strategy since it was initiated almost five decades ago. However, concern regarding its collateral effects has been increasing in recent years among the scientific and policymaker community, since it has proved to be of risk for immunocompetent and immunocompromised individuals by causing cases and even outbreaks of poliomyelitis disease in countries where the virus is not circulating. Enhanced-potency inactivated polio vaccine (IPV), a safer, effective and inexpensive vaccine, has been available for the past couple of decades. Different points of view have emerged regarding stopping the use of OPV to start routine general IPV but, despite the evidence of OPVs derived and associated with unnecessary poliomyelitis cases, Central and South America are still lacking a strategy in place to make the switch from OPV to IPV, and there are no leading efforts to start this strategy. This review gives some evidence-based elements to help raise criteria regarding the best vaccine to choose and highlights the current need for strategic planning in Latin America to avoid more vaccine-associated paralytic poliomyelitis cases.

Resolving emotional conflict: a role for the rostral anterior cingulate cortex in modulating activity in the amygdala.

Effective mental functioning requires that cognition be protected from emotional conflict due to interference by task-irrelevant emotionally salient stimuli. The neural mechanisms by which the brain detects and resolves emotional conflict are still largely unknown, however. Drawing on the classic Stroop conflict task, we developed a protocol that allowed us to dissociate the generation and monitoring of emotional conflict from its resolution. Using functional magnetic resonance imaging (fMRI), we find that activity in the amygdala and dorsomedial and dorsolateral prefrontal cortices reflects the amount of emotional conflict. By contrast, the resolution of emotional conflict is associated with activation of the rostral anterior cingulate cortex. Activation of the rostral cingulate is predicted by the amount of previous-trial conflict-related neural activity and is accompanied by a simultaneous and correlated reduction of amygdalar activity. These data suggest that emotional conflict is resolved through top-down inhibition of amygdalar activity by the rostral cingulate cortex.

Facial emotion recognition after curative nondominant temporal lobectomy in patients with mesial temporal sclerosis.

PURPOSE: The right (nondominant) amygdala is crucial for processing facial emotion recognition (FER). Patients with temporal lobe epilepsy (TLE) associated with mesial temporal sclerosis (MTS) often incur right amygdalar damage, resulting in impaired FER if TLE onset occurred before age 6 years. Consequently, early right mesiotemporal insult has been hypothesized to impair plasticity, resulting in FER deficits, whereas damage after age 5 years results in no deficit. The authors performed this study to test this hypothesis in a uniformly seizure-free postsurgical population. METHODS: Controls (n=10), early-onset patients (n=7), and late-onset patients (n=5) were recruited. All patients had nondominant anteromedial temporal lobectomy (AMTL), Wada-confirmed left-hemisphere language dominance and memory support, MTS on both preoperative MRI and biopsy, and were Engel class I 5 years postoperatively. By using a standardized (Ekman and Friesen) human face series, subjects were asked to match the affect of one of two faces to that of a simultaneously presented target face. Target faces expressed fear, anger, or happiness. RESULTS: Statistical analysis revealed that the early-onset group had significantly impaired FER (measured by percentage of faces correct) for fear (p=0.036), whereas the FER of the late-onset group for fear was comparable to that of controls. FER for anger and happiness was comparable across all three groups. CONCLUSIONS: Despite seizure control/freedom after AMTL, early TLE onset continues to impair FER for frightened expressions (but not for angry or happy expression), whereas late TLE onset does not impair FER, with no indication that AMTL resulted in FER impairment. These results indicate that proper development of the right amygdala is necessary for optimal fear recognition, with other neural processes unable to compensate for early amygdalar damage.

Enhanced baroreflex-mediated inhibition of respiration after muscimol dialysis in the rostroventral medulla.

The rostral ventral medulla (RVM) may be important in the control of cardiorespiratory interactions. We hypothesized that inhibition of the RVM would enhance inhibition of breathing associated with transient blood pressure elevations. In 25 piglets 3-16 days of age, we studied the effect of acutely increasing blood pressure, by systemic infusion of phenylephrine, on respiratory activity before and after inhibition of neural activity in the RVM by dialysis of 10 mM muscimol, a GABA(A)-receptor agonist. Muscimol dialysis through probes that were placed along the ventral medullary surface from approximately 1 mm rostral to the facial nucleus to approximately 0.5 mm caudal to the facial nucleus augmented the respiratory inhibition associated with acute increases in blood pressure. No similar enhancement of respiratory inhibition after phenylephrine treatment was seen in six control animals that did not receive muscimol dialysis. We conclude that the piglet RVM participates in cardiorespiratory interactions and that dysfunction of homologous regions in the human infant could lead to cardiorespiratory instability and may be involved in the pathogenesis of sudden infant death syndrome.