Custo-efetividade de estratégias de prevenção contra a leishmaniose tegumentar americana na Argentina

The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.Fil: Orellano, Pablo Wenceslao. Ministerio de Salud de Misiones. Instituto Nacional de Medicina Tropical; Argentina;Fil: Vazquez, n. Universidad de Buenos Aires. Facultad de Medicina; Argentina;Fil: Salomon, Oscar Daniel. Ministerio de Salud de Misiones. Instituto Nacional de Medicina Tropical; Argentina

Las vacunas contra el dengue ¿una realidad para la Argentina?

Los brotes de dengue se suceden anualmente en Argentina desde el año 1998. Existen vacunas contra esta enfermedad en distintos grados de desarrollo que han sido probadas en países endémicos. La más avanzada hasta el momento fue autorizada para su comercialización en tres países de América Latina, para niños mayores de 9 años. En este artículo se discuten los beneficios e inconvenientes de las vacunas, así como los desafíos para la implementación de una estrategia de vacunación. Asimismo, se plantea la necesidad de una estratificación de riesgo con nuevos criterios y visión multidisciplinaria como un camino posiblepara evaluar la pertinencia de un programa de vacunación en las áreas con mayor riesgo de transmisión, y/o en individuos con mayor riesgo de dengue grave. Se sugiere también que la definición del estatus de endemicidad debe tomar en cuenta a las realidades locales. Por último, este artículo propone una discusión amplia de las evidencias, impacto esperado y aspectos instrumentales que estarían involucrados en la incorporación de una vacuna contra el dengue, ya en mercado o en desarrollo, en el programa nacional de inmunizaciones, y especialmente a qué subpoblaciones debería ser dirigida para que la estrategia de inmunización sea costo-efectivaDengue outbreaks have occurred yearly in Argentina since 1998. A number of candidate vaccines have been tested in endemic countries. The most advanced one was licensed in three countries of Latin America for children over 9 years of age. In the present article the benefits and drawbacks of these vaccines as well as the challenges for the implementation of a vaccination strategy in Argentina are discussed. Furthermore, a risk stratification strategy with new criteria and a multidisciplinary vision is suggested as a possible path for the assessment of the pertinence of a vaccination program in areas showing the highest risk of dengue transmission and/or for people at the greatest risk of developing severe dengue. It is also suggested that the definition regarding the status of endemicity should take into account the local realities. Finally, this paper proposes a broad discussion on the evidences, the expected impact and instrumental aspects that would be involved in the incorporation of a dengue vaccine, marketed or in development, into the national immunization program, and especially which subpopulation should be targeted for the immunization strategy to be cost-effective.Fil: Orellano, Pablo Wenceslao. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Tecnológica Nacional. Facultad Regional San Nicolás; ArgentinaFil: Salomón, Oscar Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Ministerio de Salud. Instituto Nacional de Medicina Tropical; Argentin

Google Trends relacionado a la influenza

The recent paper on Using Google Trends (GT) to Estimate the Incidence of Influenza-Like Illness in Argentina 1 is very interesting. Orellano et al. studied Google Flu Trends (GFT) and GT with a conclusion regarding “the utility of GT to complement influenza surveillance”. Indeed, the usefulness of GFT and GT has been mentioned in some earlier reports 2,3. However, as a computational model, there are several things to be considered in the simulation 4. Under- or over-estimation can be expected and this is still the present problem in using the Google system for predicting influenza 4. There is a need for modifications of GT and GFT into a more specific tool that is appropriate for each context. A good example of this is the development of FluBreaks by Pervaiz et al.Fil: Wiwanitkit, Viroj. Wiwanitkit House; Tailandia. Surin Rajabhat University; Tailandia. Hainan Medical College; ChinaFil: Orellano, Pablo Wenceslao. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Surin Rajabhat University; TailandiaFil: Reynoso, Julieta Itati. Wiwanitkit House; TailandiaFil: Antman, Julián. Hainan Medical College; ChinaFil: Argibay, Osvaldo. Hainan Medical College; Chin

Short-term exposure to particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2), and ozone (O3) and all-cause and cause-specific mortality: Systematic review and meta-analysis

Background: Air pollution is a leading cause of mortality and morbidity worldwide. Short-term exposure (from one hour to days) to selected air pollutants has been associated with human mortality. This systematic review was conducted to analyse the evidence on the effects of short-term exposure to particulate matter with aerodynamic diameters less or equal than 10 and 2.5 µm (PM10, PM2.5), nitrogen dioxide (NO2), and ozone (O3), on all-cause mortality, and PM10 and PM2.5 on cardiovascular, respiratory, and cerebrovascular mortality. Methods: We included studies on human populations exposed to outdoor air pollution from any source, excluding occupational exposures. Relative risks (RRs) per 10 µg/m3 increase in air pollutants concentrations were used as the effect estimates. Heterogeneity between studies was assessed using 80% prediction intervals. Risk of bias (RoB) in individual studies was analysed using a new domain-based assessment tool, developed by a working group convened by the World Health Organization and designed specifically to evaluate RoB within eligible air pollution studies included in systematic reviews. We conducted subgroup and sensitivity analyses by age, sex, continent, study design, single or multicity studies, time lag, and RoB. The certainty of evidence was assessed for each exposure-outcome combination. The protocol for this review was registered with PROSPERO (CRD42018087749). Results: We included 196 articles in quantitative analysis. All combinations of pollutants and all-cause and cause-specific mortality were positively associated in the main analysis, and in a wide range of sensitivity analyses. The only exception was NO2, but when considering a 1-hour maximum exposure. We found positive associations between pollutants and all-cause mortality for PM10 (RR: 1.0041; 95% CI: 1.0034–1.0049), PM2.5 (RR: 1.0065; 95% CI: 1.0044–1.0086), NO2 (24-hour average) (RR: 1.0072; 95% CI: 1.0059–1.0085), and O3 (RR: 1.0043; 95% CI: 1.0034–1.0052). PM10 and PM2.5 were also positively associated with cardiovascular, respiratory, and cerebrovascular mortality. We found some degree of heterogeneity between studies in three exposure-outcome combinations, and this heterogeneity could not be explained after subgroup analysis. RoB was low or moderate in the majority of articles. The certainty of evidence was judged as high in 10 out of 11 combinations, and moderate in one combination. Conclusions: This study found evidence of a positive association between short-term exposure to PM10, PM2.5, NO2, and O3 and all-cause mortality, and between PM10 and PM2.5 and cardiovascular, respiratory and cerebrovascular mortality. These results were robust through several sensitivity analyses. In general, the level of evidence was high, meaning that we can be confident in the associations found in this study.Fil: Orellano, Pablo Wenceslao. Universidad Tecnológica Nacional. Facultad Regional San Nicolás; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Reynoso, Julieta Itati. Hospital General “San Felipe"; ArgentinaFil: Quaranta, Nancy Esther. Universidad Tecnológica Nacional. Facultad Regional San Nicolás; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Bardach, Ariel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis

Background: WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. Methods: We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). Results: A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02–7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48–0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75–1.34). Conclusions: Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications.Fil: Mertz, Dominik. Mc Master University; CanadáFil: Lo, Calvin Ka Fung. Mc Master University; CanadáFil: Lytvyn, Lyubov. Mc Master University; CanadáFil: Ortiz, Justin R.. Organizacion Mundial de la Salud; ArgentinaFil: Loeb, Mark. Mc Master University; CanadáFil: Ang, Li Wei. Ministry of Health; SingapurFil: Anlikumar, Mehta Asmita. Amrita Vishwa Vidyapeetham; IndiaFil: Bonmarin, Isabelle. Santé publique; FranciaFil: Borja Aburto, Victor Hugo. Instituto Mexicano del Seguro Social; MéxicoFil: Burgmann, Heinz. Medical University Vienna; AustriaFil: Carratalà, Jordi. Universidad de Barcelona; España. Instituto de Investigación Biomédica de Bellvitge; España. Spanish Network for Research in Infectious Diseases; EspañaFil: Chowell, Gerardo. Georgia State University; Estados Unidos. National Institutes of Health; Estados UnidosFil: Cilloniz, Catia. Universidad de Barcelona; España. Instituto de Investigaciones Biomédicas August Pi i Sunyer; EspañaFil: Cohen, Jessica. Centers for Disease Control and Prevention; Estados UnidosFil: Cutter, Jeffery. Ministry of Health; SingapurFil: Filleul, Laurent. Santé publique; Francia. French National Public Health Agency; FranciaFil: Garg, Shikha. Centers for Disease Control and Prevention; Estados UnidosFil: Geis, Steffen. London School of Hygiene and Tropical Medicine; Reino UnidoFil: Helferty, Melissa. Public Health Agency; CanadáFil: Huang, Wan Ting. Taiwan Centers for Disease Control; ChinaFil: Jain, Seema. Centers for Disease Control and Prevention; Estados UnidosFil: Sevic, Biljana Joves. Institute for Pulmonary Diseases of Vojvodina; SerbiaFil: Kelly, Paul. Australian Capital Territory Health Directorate; Australia. Australian National University Medical School; AustraliaFil: Kusznierz, Gabriela. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorios e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Respiratorias; ArgentinaFil: Lehners, Nicola. Ruprecht Karls Universitat Heidelberg; AlemaniaFil: Lenzi, Luana. Universidade Federal do Paraná; BrasilFil: Ling, Ivan T.. Sir Charles Gairdner Hospital; AustraliaFil: Mitchell, Robyn. Public Health Agency; CanadáFil: Mulrennan, Siobhain A.. Sir Charles Gairdner Hospital; Canadá. University of Western Australia; AustraliaFil: Nishioka, Sergio A.. Ministerio de Salud de Brasil; BrasilFil: Norton, Robert. Townsville Hospital; AustraliaFil: Oh, Won Sup. Kangwon National University School of Medicine; Corea del SurFil: Orellano, Pablo Wenceslao. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Medición de mandas judiciales: Un abordaje interdisciplinario en la cuenca Matanza- Riachuelo

El artículo realiza una evaluación de los indicadoresdesarrollados por la Autoridad de la CuencaMatanza-Riachuelo (ACUMAR) para monitorear el cumplimientode las mandas judiciales en el marco de lacausa ?Mendoza? sobre daños derivados de la contaminaciónambiental del río Matanza-Riachuelo,1 a partirdel trabajo realizado en el marco de un Convenio de CooperaciónTécnica, solicitado por el Ministerio PúblicoFiscal (MPF) al Grupo Interdisciplinario de DerechosSociales y Políticas Públicas, que integra la Red de Investigadoresen Derechos Humanos y la Red de EstudiosAmbientales Bonaerenses, ambas integrantes delas Redes Institucionales Orientadas a la Solución deProblemas (RIOSP) del CONICETFil: Sambeth, Jorge Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Ciencias Aplicadas "Dr. Jorge J. Ronco". Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Ciencias Aplicadas; ArgentinaFil: Teves, Laura Susana. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Laboratorio de Investigaciones en Etnografía Aplicada; ArgentinaFil: Pasarin, Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Laboratorio de Investigaciones en Etnografía Aplicada; ArgentinaFil: Cueto, Jorge Julian. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Laboratorio de Investigaciones en Etnografía Aplicada; ArgentinaFil: Orellano, Pablo Wenceslao. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Porta, Atilio Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Tecnológica Nacional. Facultad Regional San Nicolás; ArgentinaFil: Quaranta, Nancy Esther. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; Argentina. Universidad Tecnológica Nacional; ArgentinaFil: Arias, Andres Hugo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto Argentino de Oceanografía. Universidad Nacional del Sur. Instituto Argentino de Oceanografía; ArgentinaFil: Herkovits, Jorge. Fundación Pro Salud y Medio Ambiente. Instituto de Ciencias Ambientales y Salud; ArgentinaFil: Marcovecchio, Jorge Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto Argentino de Oceanografía. Universidad Nacional del Sur. Instituto Argentino de Oceanografía; ArgentinaFil: Botté, Sandra Elizabeth. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto Argentino de Oceanografía. Universidad Nacional del Sur. Instituto Argentino de Oceanografía; ArgentinaFil: Pereyra, Marcelo Tomas. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto de Química del Sur. Universidad Nacional del Sur. Departamento de Química. Instituto de Química del Sur; ArgentinaFil: la Colla, Noelia Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto Argentino de Oceanografía. Universidad Nacional del Sur. Instituto Argentino de Oceanografía; ArgentinaFil: Girones, Lautaro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto Argentino de Oceanografía. Universidad Nacional del Sur. Instituto Argentino de Oceanografía; ArgentinaFil: Demetrio, Pablo Martin. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Pautassi, Laura Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Balardini, Lorena Soledad. Universidad de Buenos Aires. Facultad de Derecho; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Carrasco, Maximiliano. Universidad de Buenos Aires; ArgentinaFil: Messina, Giuseppe Manuel. Universidad de Buenos Aires. Facultad de Derecho; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Multicenter study of device-associated infection rates in hospitals of Mongolia: Findings of the International Nosocomial Infection Control Consortium (INICC)

Methods: A device-associated health care-associated infection prospective surveillance study in 3 adult intensive care units (ICUs) from 3 hospitals using the U.S. Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) definitions and INICC methods. Results: We documented 467 ICU patients for 2,133 bed days. The central line-associated bloodstream infection (CLABSI) rate was 19.7 per 1,000 central line days, the ventilator-associated pneumonia (VAP) rate was 43.7 per 1,000 mechanical ventilator days, and the catheter-associated urinary tract infection (CAUTI) rate was 15.7 per 1,000 urinary catheter days; all of the rates are higher than the INICC rates (CLABSI: 4.9; VAP: 16.5; and CAUTI: 5.3) and CDC-NHSN rates (CLABSI: 0.8; VAP: 1.1; and CAUTI: 1.3). Device use ratios were also higher than the CDC-NHSN and INICC ratios, except for the mechanical ventilator device use ratio, which was lower than the INICC ratio. Resistance of Staphylococcus aureus to oxacillin was 100%. Extra length of stay was 15.1 days for patients with CLABSI, 7.8 days for patients with VAP, and 8.2 days for patients with CAUTI. Extra crude mortality in the ICUs was 18.6% for CLABSI, 17.1% for VAP, and 5.1% for CAUTI. Conclusion: Device-associated health care-associated infection rates and most device use ratios in our Mongolian hospitals' ICUs are higher than the CDC-NSHN and INICC rates

Análisis costo-beneficio del control de vectores en la transmisión potencial de dengue Cost-benefit analysis of vector control in areas of potential dengue transmission

OBJETIVOS: Evaluar el costo-beneficio de una intervención de control de mosquitos adultos con fumigación, junto con actividades de control de formas inmaduras de Aedes aegypti, para evitar la transmisión en una situación de alto riesgo. MÉTODOS: Se realizó un análisis de costo-beneficio desde una perspectiva social. Se comparó una intervención para el control de mosquitos adultos y formas inmaduras contra una hipótesis de no-intervención, de enero a abril de 2007, en la ciudad de Clorinda, Argentina. Se consideraron los costos directos y los beneficios indirectos e intangibles, estandarizados a dólares internacionales (I$) utilizando la paridad de poder adquisitivo. Se asumió una incidencia de 50 casos de dengue por 1 000 habitantes en la hipótesis de no-intervención. RESULTADOS: De enero a abril de 2007 se presentaron 176 casos de dengue en Clorinda, pero sólo cinco fueron autóctonos. El valor presente neto fue de I$ 196 879 en la estrategia de aplicación de control, mientras que en la de no aplicación se calculó en I$-106 724, lo que significaría un ahorro de I$ 303 602 (I$6,46 por habitante) con la intervención. El análisis de sensibilidad evidenció que, con más de 1 363 casos de dengue (incidencia total de 29 por 1 000 habitantes) y un caso de dengue hemorrágico, la intervención es costo-benéfica. CONCLUSIONES: Los resultados sugieren que el control vectorial, incluyendo la fumigación para mosquitos adultos, debe evaluarse en situaciones de alto riesgo de transmisión como una alternativa costo-benéfica en países no endémicos.<br>OBJECTIVES: To evaluate the cost-benefit of an intervention utilizing fumigation against adult mosquitoes along with actions to control immature Aedes aegypti to prevent transmission in a high-risk area. METHODS: A cost-benefit analysis was performed from the social perspective. A program to control both adult mosquitoes and immature forms was compared to a non-intervention hypothesis, from January to April 2007, in the city of Clorinda, Argentina. Direct costs, as well as indirect and intangible benefits, were taken into account and standardized in international dollars (I$) using purchasing power parity. An incidence rate of 50 cases of dengue per 1 000 inhabitants was used in the non-intervention hypothesis. RESULTS: From January to April 2007 there were 176 cases of dengue in Clorinda, but only five were autochthonous. The net present value was I$196 879 with the control strategy, whereas the non-intervention was calculated to be I$ -106 724, indicating a savings of I$303 602 (I$ 6.46 per inhabitant) for the intervention. The sensitivity analysis showed that, with more than 1 363 cases of dengue (total incidence rate of 29 per 1 000 inhabitants) and one case of dengue hemorrhagic fever, there is a cost-benefit to intervention. CONCLUSIONS: The results suggest that vector control, including fumigation of adult mosquitoes, should be considered in high-risk areas as a cost-effective option for non-endemic countries