The impact of COVID-19 and catch-up strategies on routine childhood vaccine coverage trends in Latin America: A systematic literature review and database analysis.

Globally, an estimated 23 million children missed vaccination in 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. We analyzed vaccination coverage trends and catch-up strategies/recommendations implemented in Latin America during the pandemic. We performed a national administrative database analysis and a systematic literature review to evaluate vaccination coverage data and identify catch-up strategies for missed vaccinations in selected countries in Latin America (Argentina, Brazil, Chile, Colombia, Mexico and Peru). Data were extracted from national health ministry vaccination coverage and supranational databases to identify coverage of rotavirus (RV), pentavalent/hexavalent, measles, Bacillus Calmette-Guérin (BCG) and pneumococcal conjugate vaccines (PCV) at country level before and during the COVID-19 pandemic. A systematic literature review of published papers was conducted to identify vaccination catch-up strategies published in January 2020-June 2021. National administrative database-reported data showed that vaccination coverage trends were declining prior to 2020. The change in vaccination coverage before and during the COVID-19 pandemic ranged from 2.5% to -11.5% (RV), -3.0% to -11.0% (measles), 1.5% to -7.5% (PCV), 9.0% to -14.0% (pentavalent/hexavalent), and 3.0% to -18.5% (BCG). Among 696 identified studies, 14 studies were included in this review. Catch-up vaccination strategies included prioritizing routine vaccinations as per the national immunization schedule. Overall vaccination coverage declined by varying degrees among the countries investigated. This trend was observed prior to 2020, suggesting multifactorial reasons for declining vaccination rates in Latin America.

What is the context? The coronavirus disease 2019 (COVID-19) led to health immunization disruptions in at least 68 countries, affecting around 80 million children.Routine childhood vaccination coverage was already suffering a decline in Latin America in the past decade, this situation could deteriorate further due to COVID-19.Consensus is lacking on the use of current guidelines and recommendations for catch-up vaccinations, as these are difficult to implement.What is new? We analyzed national health ministry databases to evaluate vaccination coverage trends in Latin America before and during the COVID-19 pandemic.We also conducted a systematic literature review to describe catch-up strategies for missed vaccinations during the pandemic.Vaccination coverage declined for the rotavirus, measles and pneumococcal conjugate vaccines at country level from 2017-2020.Pentavalent/hexavalent and Bacillus Calmette-Guerin vaccine coverage varied among countries for the same period.Catch-up vaccination strategies included prioritizing routine vaccinations as per the national immunization schedule.What is the impact? Continued efforts from healthcare officials and providers could prevent unvaccinated children from severe disease through catch-up vaccinations.

Serum saturated fatty acid decreases plasma adiponectin and increases leptin throughout pregnancy independently of BMI.

OBJECTIVE: The aim of this study was to investigate whether serum concentrations of total saturated fatty acids (SFAs), polyunsaturated fatty acids (PUFAs), and their fractions are associated with plasma adiponectin and leptin concentrations throughout pregnancy. METHODS: A prospective cohort of 201 pregnant women was followed from gestational weeks 5 to 13, 20 to 26, and 30 to 36. Blood samples were collected at the three visits after 12 h of fasting. Fatty acid concentrations were determined using fast gas-liquid chromatography. Plasma adiponectin (µg/mL) and leptin (ng/dL) concentrations were evaluated using enzyme-linked immunosorbent assay kits. Statistical analyses included median adipokine concentrations according to the tertiles of fatty acid distribution and multiple linear mixed-effect models adjusted for body mass index, gestational age, total energy intake, alcohol consumption, and smoking. RESULTS: Women classified in the third SFA concentration tertile had lower median values of adiponectin compared with those in the first tertile ([first trimester: first tertile = 5.36; third tertile = 5.00]; [second trimester: first tertile = 6.39; third tertile = 4.47]; [third trimester: first tertile = 6.46; third tertile = 4.60]). Similar trends were observed for the 14:0, 16:0 and 18:0 fractions. In the multiple longitudinal models, total SFA (ß = -41.039; P = 0.008) and 16:0 were negatively associated with plasma adiponectin (16:0, ß = -0.511; P = 0.001). Total PUFA ω-6 (ß = 28.961; P = 0.002) and 18:2 ω-6 (ß = 0.259, P = 0.006) were positively associated with the adiponectin. Total SFA (ß = 0.110, P = 0.007), 14:0 (ß = 0.072, P = 0.011), and 20:3 ω-6 (ß = 0.039; P = 0.035) were positively associated with plasma leptin. CONCLUSIONS: Total serum SFA and the 16:0 fraction were negatively associated with plasma adiponectin and positively associated with leptin concentrations. Total ω-6 PUFA was positively associated only with plasma adiponectin concentrations throughout pregnancy.

Factors associated with prospective leptin concentrations throughout pregnancy in pregestational normal weight, overweight and obese women.

BACKGROUND: Leptin concentrations increase throughout pregnancy but little is known about factors that influence this physiological change and whether they differ according to pregestational body mass index (BMI). OBJECTIVE: To assess whether longitudinal trends of leptin in pregnancy are influenced by biochemical, anthropometric and lifestyle factors in women with normal weight (NW), overweight (OW) or obese (OB) pregestational BMI. DESIGN AND METHODS: Prospective cohort of 232 pregnant women followed at 5-13th, 20-26th and 30-36th gestational weeks. The effect of selected variables on longitudinal behaviour of plasma leptin concentrations, stratifying for NW (18·5-24·9 kg/m(2) ), OW (25-29·9 kg/m(2) ) and OB (≥30·0 kg/m(2) ) pregestational BMI was assessed through longitudinal linear mixed-effects models. RESULTS: The multiple regression model for women with NW revealed associations of maternal body weight (ß = 0·714, CI = 0·491 to 0·937), serum HDL-cholesterol (ß = 0·239, CI =0·089 to 0·388) and C-reactive protein (CRP) (ß = -0·138, CI = -0·272 to -0·004) with plasma leptin concentrations. Maternal body weight (ß = -0·871, CI = 0·475 to 1·267) and serum HDL-cholesterol concentrations (ß = 0·315, CI = -0·022 to 0·651) were also associated with leptin in OW women. In OB women, serum HDL-cholesterol (ß = 0·722, CI = 0·219 to 1·226), maternal body weight (ß = 0·666, CI = 0·187 to 1·145), triglycerides concentrations (ß = -0·130, CI = -0·241 to -0·020) and dietary carbohydrate (ß = 0·075, CI = 0·023 to 0·126) were significantly associated with plasma leptin. CONCLUSION: Maternal body weight and serum concentrations of HDL-cholesterol were associated with leptin changes independent of pregestational BMI. Serum CRP concentrations were associated with leptin only in NW women and serum triglycerides concentrations and dietary carbohydrate only in OB. These results indicate that factors that influence leptin concentrations differ according to pregestational BMI.

Plasma adiponectin is inversely associated with antenatal anxiety: Results from a Brazilian cohort.

Antenatal anxiety may increase the risk of undesirable birth outcomes. Studies have demonstrated an association between adiponectin and anxiety, but this issue has not been investigated during pregnancy. This study aimed to evaluate the association between plasma adiponectin, measured throughout gestation, and the occurrence of anxiety at late pregnancy (30-36th weeks). A prospective cohort was investigated in Rio de Janeiro, Brazil. Healthy pregnant women, aged 20-40 years, were evaluated between gestational weeks 5-13, 22-26 and 30-36. State anxiety was measured using a validated version of the State-Trait Anxiety Inventory, and women were categorized as high (score≥50, n=30) or low anxiety (score<50, n=129). Plasma samples for all trimesters were analyzed using commercial ELISA kits to determine adiponectin concentrations (U/mL). Statistical analysis involved student's t-tests, chi-square, Pearson correlation, multiple logistic regression and linear mixed effects (LME) regression to model longitudinal trends of adiponectin, stratified for anxiety categories. Women with higher anxiety scores had lower mean concentrations of 3rd trimester adiponectin compared with those with lower scores (7.9; 95% CI: 7.0-8.9 vs. 9.9; 95% CI: 9.1-10.7). Women with 3rd trimester adiponectin values within the third tertile (10.47-26.57U/mL) were less likely to have high antenatal anxiety (adjusted OR=0.30; 95% CI: 0.09-0.98) compared with those within the first tertile (2.25-7.08U/mL). Unlike women with low levels of anxiety, those with high levels had a significant decrease of plasma adiponectin throughout pregnancy (ß=-0.07; 95% CI: -0.13-[-0.01] vs. ß=-0.01; 95% CI: -0.05 to 0.03). Multiple LME model indicated higher adiponectin throughout pregnancy for women with low anxiety (ß=-1.57; 95% CI: -2.78-[-0.37]). In conclusion, plasma adiponectin throughout pregnancy was inversely associated with antenatal anxiety.