Estructura y funcionamiento de las redes nacionales de laboratorios de tuberculosis en la Región de las Américas / Structure and Functioning of National Tuberculosis Laboratory Networks in the Region of the Americas

El presente estudio pretende identificar necesidades y brechas de acceso al diagnóstico de calidad. Se desarrolló un cuestionario que fue remitido a los laboratorios nacionales de referencia (LNR) de 20 países de la región (Argentina, Belice, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Guyana, Honduras, México, Nicaragua, Panamá, Paraguay, Perú, República Dominicana, Uruguay y Venezuela) durante el año 2017. El análisis de los resultados de este estudio, que describe la estructura y actividades de las 20 redes nacionales de laboratorio de TB (RNLTB) durante 2016, permitió realizar diversas observaciones y recomendaciones, según se citan.

[Monitoring of activity of influenza in Santa Fe, Argentina, 2005-2010]. / Monitoreo de la actividad de influenza en Santa Fe, Argentina, 2005-2010.

BACKGROUND: Influenza viruses have a relevant public health impact. OBJECTIVE: To describe the activity of influenza and assess the morbidity and mortality impact during 2005 to 2010 in Santa Fe, Argentina. METHODS: Epidemiological and virological indicators were calculated based on sentinel surveillance. Mortality data from patients over and under the age of 65 were analyzed using the integrated autoregressive moving average model and an excess of mortality attributable to influenza was determined. RESULTS: The viral circulation effect on morbidity was measured through the evolution in the proportion of influenza-like illness (ILI) patients. Peak incidence was observed between weeks 23 and 33. An excess of deaths was identified in 2007 among patients over 65 and among those under 65 in 2009, which was related with influenza A(H3N2) and A(H1N1)pandemic virus circulation respectively, associated with a higher proportion of virus recovery and a higher ILI percentage. CONCLUSIONS: The sentinel surveillance of influenza is a simple and efficient methodology that identifies influenza trends. Our study showed that the virus has caused a rise of mortality in patients > 65 in epidemic periods associated with the H3N2 subtype and in patients < 65 in the pandemic period with the circulation ofA(HIN1)pandemic virus.

Monitoreo de la actividad de influenza en Santa Fe, Argentina, 2005-2010 / Monitoring of activity of influenza in Santa Fe, Argentina, 2005-2010

Background. Influenza viruses have a relevant public health impact. Objective. To describe the activity of influenza and assess the morbidity and mortality impact during 2005 to 2010 in Santa Fe, Argentina. Methods. Epidemiological and virological indicators were calculated based on sentinel surveillance. Mortality data from patients over and under the age of 65 were analyzed using the integrated autoregressive moving average model and an excess of mortality attributable to influenza was determined. Results. The viral circulation effect on morbidity was measured through the evolution in the proportion of influenza-like illness (ILI) patients. Peak incidence was observed between weeks 23 and 33. An excess of deaths was identified in 2007 among patients over 65 and among those under 65 in 2009, which was related with influenza A(H3N2) and A(H1N1)pandemic virus circulation respectively, associated with a higher proportion of virus recovery and a higher ILI percentage. Conclusions. The sentinel surveillance of influenza is a simple and efficient methodology that identifies influenza trends. Our study showed that the virus has caused a rise of mortality in patients > 65 in epidemic periods associated with the H3N2 subtype and in patients < 65 in the pandemic period with the circulation of A(H1N1) pandemic virus.

Introducción: Los virus influenza son agentes patógenos de gran importancia para la salud pública. Objetivos: Describir la actividad de influenza y evaluar su impacto en la morbilidad y mortalidad durante el período 2005 - 2010 en Santa Fe, Argentina. Métodos: A partir de la vigilancia centinela se han calculado indicadores epidemiológicos y virológicos. Se analizaron datos de mortalidad en mayores y menores de 65 años, utilizando el método auto-regresivo integrado de promedios móviles y se determinó el exceso de mortalidad atribuible a influenza. Resultados: El efecto de la circulación viral sobre la morbilidad se midió a través de la proporción de pacientes con ETI. El pico de incidencia se observó entre la semana 23 y 33. Se identificó exceso de muertes en 2007 en mayores de 65 años y en 2009 en menores de 65 asociado a la circulación de influenza A(H3N2) e influenza A(H1N1)pdm 2009, respectivamente, acompañado de mayor proporción de recuperación del virus y porcentaje de ETI. Conclusión: La vigilancia centinela es sencilla, oportuna e identifica la tendencia de la ocurrencia de influenza en el tiempo. Las estimaciones demuestran que el virus ha ejercido un aumento de la mortalidad en > 65 años en períodos epidémicos asociado al subtipo H3N2 y en < 65 años en período pandémico con la circulación del nuevo virus.

Clinical features of the hospitalized patients with 2009 pandemic influenza A (H1N1) in Santa Fe, Argentina.

BACKGROUND: During 2009 occurred the emergence and global spread of a novel influenza A (H1N1) virus. We describe the clinical and epidemiologic features of hospitalized patients who survived and patients who died because of pandemic 2009 influenza A (H1N1) infection reported in Santa Fe, Argentina, from May to July 2009. METHODS: Using medical charts, we collected data on 242 patients who were hospitalized with confirmed laboratory results (defined as positive by specific PCR for pandemic 2009 influenza A H1N1). RESULTS: During the study period, there were 242 cases of hospitalization or death. Of the 242, 46% were admitted to an intensive care unit (ICU) and 33·5% died. The mean age was 27·8 years for surviving and 39·6 for those who died. Twenty-eight percent of hospitalizations involved persons under the age of 15 years; 33% of the patients were between the age of 15 and 44 years; and only 3·3% were 65 years of age or older. Sixty-seven percent had an underlying medical conditions, including diabetes, obesity, heart and lung diseases, and pregnancy. Of the 242 patients, 68% had findings consistent with pneumonia. Treatment with oseltamivir was administered to 227 (93·8%) patients from which 38 received oseltamivir within 48 hours after the onset of symptoms. CONCLUSIONS: The pandemic strain caused severe illness, including pneumonia and acute respiratory distress syndrome, and resulted in ICU admissions in 46% of patients and death in 33·5%. The mean age of hospitalized infected cases was lower than is common with seasonal influenza. Underlying medical conditions were common in the 67% the evaluated patients. Patients who died had a higher prevalence of comorbidities (86·4%) than those who survived (57%), suggesting that the presence of chronic illness may increase the likelihood of death. However, the severe illness was also identified among young, healthy persons.

HIV infection and geographically bound transmission of drug-resistant tuberculosis, Argentina.

During 2003-2009, the National Tuberculosis (TB) Laboratory Network in Argentina gave 830 patients a new diagnosis of multidrug-resistant (MDR) TB and 53 a diagnosis of extensively drug- resistant (XDR) TB. HIV co-infection was involved in nearly one third of these cases. Strain genotyping showed that 7 major clusters gathered 56% of patients within restricted geographic areas. The 3 largest clusters corresponded to epidemic MDR TB strains that have been undergoing transmission for >10 years. The indigenous M strain accounted for 29% and 40% of MDR and XDR TB cases, respectively. Drug-resistant TB trends in Argentina are driven by spread of a few strains in hotspots where the rate of HIV infection is high. To curb transmission, the national TB program is focusing stringent interventions in these areas by strengthening infection control in large hospitals and prisons, expediting drug resistance detection, and streamlining information-sharing systems between HIV and TB programs.