Hospital-based surveillance study of rotavirus gastroenteritis in children under 5 years of age in Lebanon

AbstractBackgroundRotavirus (RV) is a major cause of gastroenteritis (GE) in infants and young children globally, with rotavirus gastroenteritis (RVGE) causing dehydration due to diarrhea and frequently leading to hospitalization. Epidemiological data on RVGE in Lebanon are lacking, therefore this study aims to collect such baseline data.MethodsWe conducted multicenter, hospital-based surveillance across Lebanon to estimate the proportion of diarrheal hospitalizations attributable to RV in children under 5 years of age. Medical history, GE symptoms, treatment prior to hospitalization and demographics were obtained from medical records and parent/guardian interviews. The severity of GE episodes was determined using the 20-point Vesikari scale (score ⩾11 was considered severe). Stool samples were analyzed for RV using an enzyme immunoassay and for strain prevalence using reverse transcriptase polymerase chain reaction.ResultsBetween April 2007 and September 2008, a total of 534 subjects were enrolled, of whom 491 were included in the final analysis. GE attributable to RV was 27.7% and nearly 75% of the RVGE cases occurred in children under 2 years of age. No differences were observed between the severity of signs and symptoms in RV positive and negative subjects. Hospitalization occurred mainly between December–March and lasted for a median of 3 days. Treatment primarily consisted of intravenous rehydration and almost all subjects (96.1%) had recovered by the time of discharge. Prevalent circulating G and P types were G4 (36.9%), G1WT (29.2%), P[8]WT (77.7%) and P[4] (17.7%); the most common circulating RV strain was G4P[8]WT (36.9%).ConclusionRVGE hospitalizations are prevalent in children under 5 years of age in Lebanon. This baseline data might be useful for decision makers when initiating measures, such as vaccination, to prevent the disease

Non-typeable Haemophilus influenzae and Streptococcus pneumoniae as primary causes of acute otitis media in colombian children: a prospective study

<p>Abstract</p> <p>Background</p> <p>Acute otitis media (AOM) is one of the most frequently encountered bacterial infections in children aged < 5 years; <it>Streptococcus pneumoniae </it>(<it>S. pneumoniae</it>) and non-typeable <it>Haemophilus influenzae </it>(NTHi) are historically identified as primary AOM causes. Nevertheless, recent data on bacterial pathogens causing AOM in Latin America are limited. This prospective study aimed to identify and characterize bacterial etiology and serotypes of AOM cases including antimicrobial susceptibility in < 5 year old Colombian children.</p> <p>Methods</p> <p>From February 2008 to January 2009, children ≥3 months and < 5 years of age presenting with AOM and for whom a middle ear fluid (MEF) sample was available were enrolled in two medical centers in Cali, Colombia. MEF samples were collected either by tympanocentesis procedure or spontaneous otorrhea swab sampling. Bacteria were identified using standard laboratory methods, and antimicrobial resistance testing was performed based on the 2009 Clinical and Laboratory Standards Institute (CLSI) criteria. Most of the cases included in the study were sporadic in nature.</p> <p>Results</p> <p>Of the 106 enrolled children, 99 were included in the analysis. Bacteria were cultured from 62/99 (63%) of samples with <it>S. pneumoniae, H. influenzae, or S. pyogenes</it>. The most commonly isolated bacteria were <it>H. influenzae </it>in 31/99 (31%) and <it>S. pneumoniae </it>in 30/99 (30%) of samples. The majority of <it>H. influenzae </it>episodes were NTHi (27/31; 87%). 19F was the most frequently isolated pneumococcal serotype (10/30; 33%). Of the 30 <it>S. pneumoniae </it>positive samples, 8/30 (27%) were resistant to tetracycline, 5/30 (17%) to erythromycin and 8/30 (27%) had intermediate resistance to penicillin. All <it>H. influenzae </it>isolates tested were negative to beta-lactamase.</p> <p>Conclusions</p> <p>NTHi and <it>S. pneumoniae </it>are the leading causes of AOM in Colombian children. A pneumococcal conjugate vaccine that prevents both pathogens could be useful in maximizing protection against AOM.</p

Non-capsulated and capsulated Haemophilus influenzae in children with acute otitis media in Venezuela: a prospective epidemiological study

<p>Abstract</p> <p>Background</p> <p>Non-typeable <it>Haemophilus influenzae </it>(NTHi) and <it>Streptococcus pneumoniae </it>are major causes of bacterial acute otitis media (AOM). Data regarding AOM are limited in Latin America. This is the first active surveillance in a private setting in Venezuela to characterize the bacterial etiology of AOM in children < 5 years of age.</p> <p>Methods</p> <p>Between December 2008 and December 2009, 91 AOM episodes (including sporadic, recurrent and treatment failures) were studied in 87 children enrolled into a medical center in Caracas, Venezuela. Middle ear fluid samples were collected either by tympanocentesis or spontaneous otorrhea swab sampling method. Standard laboratory and microbiological techniques were used to identify bacteria and test for antimicrobial resistance. The results were interpreted according to Clinical Laboratory Standards Institute (CLSI) 2009 for non-meningitis isolates. All statistical analyses were performed using SAS 9.1 and Microsoft Excel (for graphical purposes).</p> <p>Results</p> <p>Overall, bacteria were cultured from 69.2% (63 of the 91 episodes); at least one pathogen (<it>S. pneumoniae, H. influenzae, S. pyogenes </it>or <it>M. catarrhalis</it>) was cultured from 65.9% (60/91) of episodes. <it>H. influenzae </it>(55.5%; 35/63 episodes) and <it>S. pneumoniae </it>(34.9%; 22/63 episodes) were the most frequently reported bacteria. Among <it>H. influenzae </it>isolates, 62.9% (22/35 episodes) were non-capsulated (NTHi) and 31.4% (11/35 episodes) were capsulated including types d, a, c and f, across all age groups. Low antibiotic resistance for <it>H. influenzae </it>was observed to amoxicillin/ampicillin (5.7%; 2/35 samples). NTHi was isolated in four of the six <it>H. influenzae </it>positive samples (66.7%) from recurrent episodes.</p> <p>Conclusions</p> <p>We found <it>H. influenzae </it>and <it>S. pneumoniae </it>to be the main pathogens causing AOM in Venezuela. Pneumococcal conjugate vaccines with efficacy against these bacterial pathogens may have the potential to maximize protection against AOM.</p

Economic analysis of peritoneal dialysis compared with hemodialysis in patients with chronic, diabetic or hypertensive kidney disease

ResumenObjetivo: Comparamos, mediante un análisis económico de costo-utilidad, dos componentes fundamentales de la terapia de reemplazo renal (TRR): la hemodiálisis (HD) y la diálisis peritoneal (DP). MetodologÍa: Empleamos un modelo teórico de árbol de decisión para comparar HD y DP (incluyendo en esta última tanto la diálisis peritoneal ambulatoria continua [DPAC] como la diálisis peritoneal automatizada [DPA]). La perspectiva fue la de un terceropagador (un asegurador, por ejemplo), y se calculó un horizonte temporal de un año. El modelo incorpora veinte variables, incluyendo costos locales y frecuencias relacionadas con la enfermedad (algunas locales, otras extraÍdas de la literatura y discutidas con un grupo de expertos). Ejemplos: dÍas de hospitalización por año, mortalidad de cada terapia y años de vida ajustados por calidad (AVAC) para cada condición. Resultados: La DP tiene uncomportamiento dominante en comparación con la HD, ya que, en promedio, cuesta 3 millones de pesos anuales menos, y adicionalmente ofrece al paciente, en promedio, 0,04 AVAC por año de tratamiento. Conclusión En pacientes seleccionados en terapia crónica de reemplazo renal, la DP puede ayudar a reducir costos al tiempo que ofrece una mejor calidad de vida.[ Rosselli D, DeAntonio R, Calderón C. Análisis económico de diálisis peritoneal comparada con hemodiálisis en pacientes con enfermedad renal crónica, diabética o hipertensiva. MedUNAB 2008; 11: 201-205]Palabras clave: Análisis económico, Costo-efectividad, Diálisis peritoneal, Hemodiálisis.We compared, through an economic cost-utility analysis, two fundamental components of renal replacement therapy (RRT): hemodialysis (HD) and peritoneal dialysis (PD). Methodology: We used a theoretical decision tree model to compare HD and PD (including in the latter both continuous ambulatory peritoneal dialysis [CAPD] and automated peritoneal dialysis [APD]). The perspective was that of a third party payer (an insurer, for example), and a time horizon of one year was calculated. The model incorporates twenty variables, including local costs and frequencies related to the disease (some local, others extracted from the literature and discussed with a group of experts). Examples: days of hospitalization per year, mortality for each therapy, and quality-adjusted life years (QALY) for each condition. Results: PD has a dominant behavior compared to HD, since, on average, it costs 3 million pesos less per year, and additionally offers the patient, on average, 0.04 QALYs per year of treatment. Conclusion In selected patients on chronic renal replacement therapy, PD can help reduce costs while offering a better quality of life. [Rosselli D, DeAntonio R, Calderón C. Economic analysis of peritoneal dialysis compared with hemodialysis in patients with disease chronic kidney, diabetic or hypertensive. MedUNAB 2008; 11: 201-205

Análisis económico de diálisis peritoneal comparada con hemodiálisis en pacientes con enfermedad renal crónica, diabética o hipertensiva

ResumenObjetivo: Comparamos, mediante un an&aacute;lisis econ&oacute;mico de costo-utilidad, dos componentes fundamentales de la terapia de reemplazo renal (TRR): la hemodi&aacute;lisis (HD) y la di&aacute;lisis peritoneal (DP). Metodolog&iacute;a: Empleamos un modelo te&oacute;rico de &aacute;rbol de decisi&oacute;n para comparar HD y DP (incluyendo en esta &uacute;ltima tanto la di&aacute;lisis peritoneal ambulatoria continua [DPAC] como la di&aacute;lisis peritoneal automatizada [DPA]). La perspectiva fue la de un terceropagador (un asegurador, por ejemplo), y se calcul&oacute; un horizonte temporal de un a&ntilde;o. El modelo incorpora veinte variables, incluyendo costos locales y frecuencias relacionadas con la enfermedad (algunas locales, otras extra&iacute;das de la literatura y discutidas con un grupo de expertos). Ejemplos: d&iacute;as de hospitalizaci&oacute;n por a&ntilde;o, mortalidad de cada terapia y a&ntilde;os de vida ajustados por calidad (AVAC) para cada condici&oacute;n. Resultados: La DP tiene uncomportamiento dominante en comparaci&oacute;n con la HD, ya que, en promedio, cuesta 3 millones de pesos anuales menos, y adicionalmente ofrece al paciente, en promedio, 0,04 AVAC por a&ntilde;o de tratamiento. Conclusi&oacute;n En pacientes seleccionados en terapia cr&oacute;nica de reemplazo renal, la DP puede ayudar a reducir costos al tiempo que ofrece una mejor calidad de vida.[ Rosselli D, DeAntonio R, Calder&oacute;n C. An&aacute;lisis econ&oacute;mico de di&aacute;lisis peritoneal comparada con hemodi&aacute;lisis en pacientes con enfermedad renal cr&oacute;nica, diab&eacute;tica o hipertensiva. MedUNAB 2008; 11: 201-205]Palabras clave: An&aacute;lisis econ&oacute;mico, Costo-efectividad, Di&aacute;lisis peritoneal, Hemodi&aacute;lisis

La enfermedad diarreica aguda: un reto para la salud pública en Colombia Acute diarrheal disease: a public health challenge in Colombia

OBJETIVOS: Establecer la relación entre la infección por rotavirus y la deshidratación por diarrea en niños colombianos menores de 5 años y determinar los factores de riesgo de la diarrea con deshidratación. MÉTODOS: Se realizó un estudio de casos y testigos en un hospital urbano de Bogotá, Colombia, entre abril de 2000 y febrero de 2001. Se seleccionaron 290 niños menores de 5 años de edad de uno u otro sexo; de ellos 145 estaban hospitalizados por enfermedad diarreica aguda (EDA) con deshidratación (casos) y 145 tenían diagnóstico de EDA sin signos de deshidratación (testigos). A todos los niños se les realizó un examen físico completo. Las madres respondieron un cuestionario con variables demográficas; socioeconómicas; de conocimientos, actitudes y hábitos higiénicos; y de acceso a los servicios de salud. Se determinó la presencia de rotavirus en muestras de heces fecales tomadas durante las primeras 48 horas del ingreso al estudio. RESULTADOS: Se encontró una asociación estadística entre la diarrea con deshidratación y la presencia de rotavirus en las muestras de heces (razón de posibilidades [RP] = 3,46; intervalo de confianza de 95% [IC95%]: 1,71 a 7,00), el peso al nacer <2 600 g (RP = 7,79; IC95%: 3,47 a 18,01) y el tiempo de lactancia materna inferior a 3 meses (RP = 3,17; IC95%: 1,66 a 6,13). El riesgo de presentar deshidratación se asoció con las condiciones socioeconómicas desfavorables, los hábitos higiénicos inadecuados de la familia del niño y una menor escolaridad materna. CONCLUSIONES: La calidad inadecuada de las acciones de promoción y prevención en una población con fácil acceso a los servicios de salud favoreció la aparición de casos de diarrea con deshidratación. La infección por rotavirus desempeña un papel importante en la gravedad de la EDA en niños colombianos.<br>OBJECTIVES: To establish the relationship between rotavirus infection and dehydration from diarrhea in Colombian children under 5 years of age, and to identify risk factors for diarrhea with dehydration. METHODS: A case-control study was performed in an urban hospital in Bogotá, Colombia, between April 2000 and February 2001. The sample was composed of 290 children of both sexes under 5 years of age; of these children, 145 of them were hospitalized for acute diarrheal disease (ADD) with dehydration (cases), and 145 had a diagnosis of ADD but no signs of dehydration (controls). All children underwent a complete physical examination. Mothers responded to a questionnaire containing items on demographic and socioeconomic variables, as well as on knowledge, attitudes, and practices with regard to hygiene, and on access to health services. RESULTS: An association was detected between diarrhea with dehydration and the presence of rotavirus in fecal samples (odds ratio [OR] = 3.46; 95% confidence interval [95% CI]: 1.71 to 7.00), birth weight < 2 600 g (OR = 7.79; 95% CI: 3.47 to 18.01), and breastfeeding for less than 3 months (OR = 3.17; 95% CI: 1.66 to 6.13). The risk of having dehydration was associated with low socioeconomic status, poor hygienic practices among the child's family members, and mother's low educational level. CONCLUSIONS: The ineffectiveness of health promotion and disease prevention activities in a population with easy access to health services set the stage for the appearance of cases of diarrhea with dehydration. Rotavirus infection plays an important role in the severity of ADD among Colombian children

Pneumococcal meningitis trends after pneumococcal conjugate vaccine introduction in Colombia: An interrupted time-series analysis

Colombia introduced mass pneumococcal conjugate vaccination at the end of 2011. Using 2005–2015 surveillance data, we conducted a retrospective interrupted time-series analysis. A significant trend towards reduced monthly was observed in the post-vaccination period (2012–2015) compared with the expected rate, reaching in 2015 a reduction of 90.5% of pneumococcal meningitis. This trend was not observed for control diseases

The Health Economic Impact of Universal Infant Vaccination with the 10-Valent Pneumococcal Nontypeable Haemophilus influenzae Protein D Conjugate Vaccine as Compared with 13-Valent Pneumococcal Conjugate Vaccine in Hong Kong

AbstractBackgroundPneumococcal universal vaccination in Hong Kong was introduced in 2009.ObjectivesWe assessed the health and economic impact of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PCV-10) compared with the current 13-valent pneumococcal conjugate vaccine (PCV-13) recommended for Hong Kong in 2011, providing new elements to be considered by public health authorities in the future decision-making process for pneumococcal vaccines in this country.MethodsAn analytical model was used to estimate the annual economic and health outcomes of invasive pneumococcal disease (IPD), community-acquired pneumonia, and acute otitis media (AOM), including nontypeable H. influenzae–related AOM, for a birth cohort in Hong Kong from the payer perspective with a 10-year horizon. Clinical impact including morbidity-mortality, quality-adjusted life-years (QALYs), incremental costs, and cost-effectiveness comparing PCV-10 and PCV-13 were estimated. Probabilistic sensitivity analyses by using alternate scenarios were performed.ResultsModel projections indicate that PCV-13 and PCV-10 have approximately equivalent impact on the prevention of deaths caused by IPD and pneumonia. PCV-13 is projected to prevent 6 additional cases of IPD, whereas PCV-10 is projected to prevent 13,229 additional AOM cases and 101 additional QALYs. For the base case, PCV-10 vaccination is estimated to save 44.6 million Hong Kong dollars (34.1 million Hong Kong dollars discounted). Sensitivity analysis indicated that PCV-10 would generate more QALYs and save costs as compared with PCV-13.ConclusionsUniversal infant vaccination with new available pneumococcal vaccines is expected to generate a significant additional impact on reducing the burden of pneumococcal diseases in Hong Kong. PCV-10 vaccination would be potentially a cost-saving strategy compared with PCV-13 vaccination, generating better cost offsets and higher QALY gains