Description of maternal and neonatal adverse events in pregnant people immunised with COVID-19 vaccines during pregnancy in the CLAP NETWORK of sentinel sites. Nested case-control analysis of the immunization-associated risk: A study protocol.

INTRODUCTION: COVID-19 is associated with higher morbimortality in pregnant people compared with non-pregnant people. At present, the benefits of maternal immunisation are considered to outweigh the risks, and therefore, vaccination is recommended during pregnancy. However, additional information is needed on the safety of the vaccines in this population. METHODS AND ANALYSIS: This a retrospective cohort nested case-control study in pregnant people who attended maternity hospitals from eight Latin American and Caribbean countries. A perinatal electronic clinical history database with neonatal and obstetric information will be used. The proportion of pregnant people immunised with COVID-19 vaccines of the following maternal and neonatal events will be described: preterm infant, small for gestational age, low birth weight, stillbirth, neonatal death, congenital malformations, maternal near miss and maternal death. Moreover, the risk of prematurity, small for gestational age and low birth weight associated with exposure to COVID-19 vaccines will be estimated. Each case will be matched with two groups of three randomly selected controls. Controls will be matched by hospital and mother's age (±3 years) with an additional matching by delivery date and conception time in the first and second control groups, respectively. The estimated required sample size for the main analysis (exposure to any vaccine) concerning 'non-use' is at least 1009 cases (3027 controls) to detect an increased probability of vaccine-associated event risk of 30% and at least 650 cases (1950 controls) to detect 30% protection. Sensitivity and secondary analyses considering country, type of vaccine, exposure windows and completeness of immunisation will be reported. ETHICS: The study protocol was reviewed by the Ethical Review Committee on Research of the Pan American Health Organization. Patient informed consent was waived due to the retrospective design and the utilisation of anonymised data (Ref. No: PAHOERC.0546.01). Results will be disseminated in open access journals.

Zika Virus Transmission - Region of the Americas, May 15, 2015-December 15, 2016.

Zika virus, a mosquito-borne flavivirus that can cause rash with fever, emerged in the Region of the Americas on Easter Island, Chile, in 2014 and in northeast Brazil in 2015 (1). In response, in May 2015, the Pan American Health Organization (PAHO), which serves as the Regional Office of the Americas for the World Health Organization (WHO), issued recommendations to enhance surveillance for Zika virus. Subsequently, Brazilian investigators reported Guillain-Barré syndrome (GBS), which had been previously recognized among some patients with Zika virus disease, and identified an association between Zika virus infection during pregnancy and congenital microcephaly (2). On February 1, 2016, WHO declared Zika virus-related microcephaly clusters and other neurologic disorders a Public Health Emergency of International Concern.* In March 2016, PAHO developed case definitions and surveillance guidance for Zika virus disease and associated complications (3). Analysis of reports submitted to PAHO by countries in the region or published in national epidemiologic bulletins revealed that Zika virus transmission had extended to 48 countries and territories in the Region of the Americas by late 2016. Reported Zika virus disease cases peaked at different times in different areas during 2016. Because of ongoing transmission and the risk for recurrence of large outbreaks, response efforts, including surveillance for Zika virus disease and its complications, and vector control and other prevention activities, need to be maintained.

The influence of climatic conditions on the transmission dynamics of the 2009 A/H1N1 influenza pandemic in Chile.

BACKGROUND: The role of demographic factors, climatic conditions, school cycles, and connectivity patterns in shaping the spatio-temporal dynamics of pandemic influenza is not clearly understood. Here we analyzed the spatial, age and temporal evolution of the 2009 A/H1N1 influenza pandemic in Chile, a southern hemisphere country covering a long and narrow strip comprising latitudes 17°S to 56°S. METHODS: We analyzed the dissemination patterns of the 2009 A/H1N1 pandemic across 15 regions of Chile based on daily hospitalizations for severe acute respiratory disease and laboratory confirmed A/H1N1 influenza infection from 01-May to 31-December, 2009. We explored the association between timing of pandemic onset and peak pandemic activity and several geographical and demographic indicators, school vacations, climatic factors, and international passengers. We also estimated the reproduction number (R) based on the growth rate of the exponential pandemic phase by date of symptoms onset, estimated using maximum likelihood methods. RESULTS: While earlier pandemic onset was associated with larger population size, there was no association with connectivity, demographic, school or climatic factors. In contrast, there was a latitudinal gradient in peak pandemic timing, representing a 16-39-day lag in disease activity from the southern regions relative to the northernmost region (P < 0.001). Geographical differences in latitude of Chilean regions, maximum temperature and specific humidity explained 68.5% of the variability in peak timing (P = 0.01). In addition, there was a decreasing gradient in reproduction number from south to north Chile (P < 0.0001). The regional mean R estimates were 1.6-2.0, 1.3-1.5, and 1.2-1.3 for southern, central and northern regions, respectively, which were not affected by the winter vacation period. CONCLUSIONS: There was a lag in the period of most intense 2009 pandemic influenza activity following a South to North traveling pattern across regions of Chile, significantly associated with geographical differences in minimum temperature and specific humidity. The latitudinal gradient in timing of pandemic activity was accompanied by a gradient in reproduction number (P < 0.0001). Intensified surveillance strategies in colder and drier southern regions could lead to earlier detection of pandemic influenza viruses and improved control outcomes.

Centro nacional de enlace en Chile, enfrentando la pandemia: del papel a la práctica / National focal point in Chile, facing the pandemic: from paper to practice

Uno de los ejes centrales que se estableció por parte de la Organización Mundial de la Salud (OMS), en el marco del Reglamento Sanitario Internacional 2005 (RSI), fue la creación del Centro Nacional de Enlace (CNE), que Chile inauguró y puso en marcha el 2008. Dicha instancia debe contar con las capacidades para detectar, evaluar, verificar, analizar, notificar y difundir información relevante para la toma de decisiones. Este artículo describe cómo el CNE respondió a la pandemia de la influenza A (H1N1) en Chile, durante la cual todo el sistema de salud fue puesto a prueba, e ilustra las diferentes etapas vividas. Se describe el proceso práctico para formar, dotar de personal a la nueva instancia, coordinar los diferentes departamentos, generar reportes y enfrentar la situación de crisis. Se analiza el proceso enfrentado para lograr criterios comunes y obtener datos de calidad que permitan adoptar las decisiones adecuadas.

One of the main orientations established by the World Health Organization (WHO) under the International HealthRegulations 2005 (IHR) was to create National Links Centers (NLC) which Chile set up and made operationalin march 2008. This instance must have the capacity to detect, assess, verify, analyze, report and disseminateinformation relevant to decision-making. This article describes how the NLC responded to the pandemic in Chile,during which the entire health system was tested, and illustrates the various stages experienced. It describes thepractical process of forming, staffing the new instance, coordinating the different departments, generating reportsand confronting the crisis. The process carried out to achieve common standards and obtain quality data to enable appropriate decisions is analyzed.

Encuesta mundial de tabaquismo en jóvenes 2003 (GYTS 2003) / Global survey of youth smoking 2003 (GYTS 2003)

El consumo de tabaco es reconocido actualmente como uno de los factores de riesgo prevenible, responsable de la mayor frecuencia de enfermedades y muertes, tanto en países desarrollados como en desarrollo. Los daños más graves a la salud, causados por fumar o estar expuestos al humo del tabaco de otros fumadores, aparecen generalmente a largo plazo, pasada la mitad de la cuarta década de la vida. Las primeras experiencias con los productos de tabaco ocurren, en más del 70 por ciento de los casos, durante la adolescencia e incluso a finales de la niñez, continuando con el hábito durante 20 o más años. La encuesta se aplicó en los 100 establecimientos seleccionados (25 en cada región), con un total de 271 cursos entre 7º básico y 1º medio. No hubo rechazo a participar en el estudio por parte de los establecimientos ni de los alumnos. Se encuestó a 8.460 de 9.238 alumnos matriculados en los cursos seleccionados (91.6 por ciento de participación). La diferencia entre el número de alumnos matriculados y los que contestaron la encuesta se debe, principalmente, al ausentismo escolar habitual. El 66 por ciento de los alumnos de la Región Metropolitana y el 62 por ciento de la VIII región, reconoce haber fumado cigarrillos alguna vez en la vida (prevalencia de vida), ambas prevalencias significativamente superiores a las observadas en la I Región (52 por ciento); la V Región se encuentra en una posición intermedia. No se aprecian diferencias significativas por sexo.