Roadmap for the Introduction of a New Dengue Vaccine

Dengue remains the most common vector-transmitted disease in the world despite enormous prevention and control efforts by endemic countries and regions. Today, after decades of research, public health programs contemplate as part of the intervention to control the disease, a safe and effective vaccine against dengue. In this chapter, we review general principles for developing a safe and efficacious vaccine against dengue virus, the current vaccine candidates approved and under research, and the roadmap for the introduction of a new dengue vaccine, based on the procedures, carried out by Mexico, for the licensure and eventual adoption of CYD-TDV vaccine, which concluded with Mexico becoming the first country in the world to grant licensure to a Dengue vaccine in December of 2015. Finally, we discuss the rationale for the adoption of dengue vaccines a public health policy and the paradigm shift required for the efficient adoption of vaccines in low- and middle-income countries

The prevalence of chronic diseases and major disease risk factors at different ages among 150 000 men and women living in Mexico City: cross-sectional analyses of a prospective study

<p>Abstract</p> <p>Background</p> <p>While most of the global burden from chronic diseases, and especially vascular diseases, is now borne by low and middle-income countries, few large-scale epidemiological studies of chronic diseases in such countries have been performed.</p> <p>Methods</p> <p>From 1998–2004, 52 584 men and 106 962 women aged ≥35 years were visited in their homes in Mexico City. Self reported diagnoses of chronic diseases and major disease risk factors were ascertained and physical measurements taken. Age- and sex-specific prevalences and means were analysed.</p> <p>Results</p> <p>After about age 50 years, diabetes was extremely common – for example, 23.8% of men and 26.9% of women aged 65–74 reported a diagnosis. By comparison, ischaemic heart disease was reported by 4.8% of men and 3.0% of women aged 65–74, a history of stroke by 2.8% and 2.3%, respectively, and a history of cancer by 1.3% and 2.1%. Cancer history was generally more common among women than men – the excess being largest in middle-age, due to breast and cervical cancer. At older ages, the gap narrowed because of an increasing prevalence of prostate cancer. 51% of men and 25% of women aged 35–54 smoked cigarettes, while 29% of men and 41% of women aged 35–54 were obese (i.e. BMI ≥30 kg/m²). The prevalence of treated hypertension or measured blood pressure ≥140/90 mmHg increased about 50% more steeply with age among women than men, to 66% of women and 58% of men aged 65–74. Physical inactivity was highly prevalent but daily alcohol drinking was relatively uncommon.</p> <p>Conclusion</p> <p>Diabetes, obesity and tobacco smoking are highly prevalent among adults living in Mexico City. Long-term follow-up of this and other cohorts will establish the relevance of such factors to the major causes of death and disability in Mexico.</p

1358-P: Point of Care OGTT for the Screening of Gestational Diabetes: A Feasible Proposal for Low-Resource Settings

Due to the ubiquity of risk factors associated with gestational diabetes (GDM) in Mexican women and the low availability of the Oral Glucose Tolerance Test (OGTT), we compared the efficacy of two point of care (POC) models for GDM detection against the plasmatic 2hr OGTT-75gr in primary health care clinics in Mexico. We evaluated 328 pregnant women without previous diabetes diagnosis from a prospective cohort study “Cuido mi embarazo”; all of them were tested with the gold standard plasmatic 2hr OGTT-75gr for the diagnosis of GDM based on the ADA 2019 criteria. Simultaneously, we measured with a glucometer (ACCU-CHEK instant®) the glucose concentration either by capillary whole blood (172 measures) or from venous whole blood (156 measures). We evaluated the diagnostic accuracy by calculating the sensitivity, specificity, and ROC curve of each of the glucometer test results compared to the plasmatic test. For the first model, POC venous OGTT, the incidence of GDM was 41.66% compared to 7.05% of the plasmatic test. The ROC area under the curve for GDM prediction was 0.81 (95% CI 0.77-0.85), with a sensitivity of 100% and specificity of 62.8%. The low specificity is dependent on the fasting venous value of 64% since it was compared to 95% and 97% specificity of the 1hr and 2hr values, respectively. The second model, POC capillary OGTT, had an incidence of GDM of 30.23% compared to 8.13% of the plasmatic test. It had lower sensitivity (78.57%) and higher specificity (74.1%) compared to the first model, having an overall 0.76 (95% CI 0.65-0.88) ROC area under the curve for GDM prediction. We propose POC venous OGTT as a feasible diagnostic alternative for low resource settings where laboratory infrastructure is not available. Its positive bias could be beneficial since the treatment and control of early cases is related to better health outcomes for the moms and their babies. Further analysis is needed to improve GDM, POC screening interventions. Disclosure H. Gallardo: None. J. Lomelin-Gascon: Other Relationship; Self; Lilly Global Health Partnership. L.A. Martinez: Other Relationship; Self; Lilly Global Health Partnership. A. Montoya: None. E. Reyes-Muñoz: None. R.C. Tapia-Conyer: None. Funding Eli Lilly and Company </jats:sec

The MONITOR Ecosystem: A Digital Health Intervention for the Early Detection, Control, Follow-Up, and Management of COVID-19 in Mexico

In fighting infectious disease outbreaks, a basic epidemiological principle is to detect cases quickly and to isolate each case, to interrupt transmission. This principle has been the cornerstone of the Carso Group (CG) COVID Protocol, a systematic blueprint for the reopening of operations of workplaces in the context of ongoing disease transmission in Mexico. The CG comprises over 50 companies with approximately 180,000 employees engaged in economic activities including telecommunications, retail, construction, banking, mining, and manufacturing, among others. To cope with the COVID-19 pandemic within the CG, the Carlos Slim Foundation designed, developed and implemented MONITOR, a digital health ecosystem comprising a mobile phone application, web portal, and analytics platform, to assess the infection risk of each employee, follow-up their health status, and detect early symptoms of COVID-19. MONITOR provides daily notifications for any suspected cases and activates a COVID-19 testing request and follow-up of results. This intervention helps rapidly identify and isolate suspected cases, as well as follow-up of work and family contacts, to prevent further outbreaks. Use of MONITOR has thus enabled containment of COVID-19 in workplaces and safe return to work. MONITOR is an example of the implementation of public health practices in workplaces and can serve as the basis for larger deployment in population-wide settings

1068-P: Diabetes and Comorbidities Risk Assessment in Hospitalization and Fatalities from the Mexican COVID-19 Surveillance System

The SARS-CoV-2 outbreak poses a challenge to the Mexican health care system due to its high complication and lethality rates in patients with diabetes and comorbidities. Here, we evaluate the association among diabetes and main comorbidities [obesity, hypertension and chronic kidney disease (CKD)] on COVID-19 outcomes (prevalence, hospitalization, lethality and hospital fatality) in Mexican population. We used available public data released by the Mexican COVID-19 surveillance system (MC-19SS) from January 1st to December 31st of 2020. All 3,401,172 records of SARS-CoV-2 suspected population over or equal to 20 years old were included, out of whom 1,384,470 tested positive. Multiple logistic regression models were fitted to assess the risk over several outcomes (hospitalization and fatality), with self-reported diabetes and comorbidities in confirmed cases, adjusting for age, sex, smoking status and marginalization of the place of residence. Overall population tested, 399,953 (11.8%) subjects had diabetes. Of them, 47.8% also had hypertension, 9.0% obesity and 7.0% CKD. Patients who tested positive to COVID-19 had a higher proportion of diabetes (14.7%). From the 203,310 COVID-19 positive patients with diabetes, 95,225(46.8%) were hospitalized and of those 45,128(47.4%) died; also 4,701 died without had been hospitalized. People with diabetes had significant (p&amp;lt;.005) higher odds of hospitalization OR:2.2, hospital 1.27 and non-hospital 1.98 fatality. Nevertheless, subjects with diabetes and other chronic disease experience higher rates of several outcomes. Diabetes and CKD had the highest odds of hospitalization 7.3 died in hospital (2.14) or out of hospital (6.5) compared with cases without diabetes. This analysis points out that diabetes contributes to the risk of infection and worse outcomes for those infected by SARS-CoV-2. More must be done to combat and prevent diabetes and comorbidities to reduce the burden of COVID-19. Disclosure H. Gallardo-rincón: None. A. Montoya: None. L. Martinez-juarez: Research Support; Self; Lilly Global Health Partnership. J. Lomelin-gascon: None. E. R. Saucedo-martinez: None. R. Mujica-rosales: None. R. Tapia-conyer: None

Integrated Measurement for Early Detection (MIDO) as a digital strategy for timely assessment of non-communicable disease profiles and factors associated with unawareness and control: a retrospective observational study in primary healthcare facilities in Mexico.

Objectives The Carlos Slim Foundation implemented the Integrated Measurement for Early Detection (MIDO), a screening strategy for non-communicable diseases (NCDs) in Mexico as part of CASALUD, a portfolio of digital health services focusing on healthcare delivery and prevention/management of NCDs. We investigated the disease profile of the screened population and evaluated MIDO's contribution to the continuum of care of the main NCDs. Design Using data from MIDO and the chronic diseases information system, we quantified the proportion of the population screened and diagnosed with NCDs, and measured care linkage/retention and level of control achieved. We analysed comorbidity patterns and estimated prevalence of predisease stages. Finally, we estimated characteristics associated with unawareness and control of NCDs, and examined efficacy of the CASALUD model in improving NCD control.SettingPublic primary health centres in 27/32 Mexican states. Participants Individuals aged ≥20 years lacking healthcare access. Results From 2014 to 2018, 743 000 individuals were screened using MIDO. A predisease or disease condition was detected in ≥70% of the population who were unaware of their NCD status. The screening identified 38 417 new cases of type 2 diabetes, 53 133 new cases of hypertension and 208 627 individuals with obesity. Dyslipidaemia was found in 77.3% of individuals with available blood samples. Comorbidities were highly prevalent, especially in people with obesity. Only 5.47% (n=17 774) of individuals were linked with their corresponding primary health centre. Factors associated with unawareness of and uncontrolled NCDs were sex, age, and social determinants, for example, rural/urban environment, access to healthcare service, and education level. Patients with type 2 diabetes treated at clinics under the CASALUD model were more likely to achieve disease control (OR: 1.32, 95% CI: 1.09 to 1.61). Conclusion Patient-centred screening strategies such as MIDO are urgently needed to improve screening, access, retention and control for patients with NCDs