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El síndrome de Guillain Barré es una enfermedad derivada del compromiso en las neuronas del sistema nervioso periférico por una respuesta descontrolada del sistema inmune que conduce daño axonal y/o desmielinización. El objetivo de este reporte fue describir los 10 primeros casos sospechosos de Síndrome de Guillain Barré en Piura. Se logró identificar la presencia de Campylobacter jejuni en las muestras de heces del 80% de los pacientes reportados. Es muy importante reconocer rápida y oportunamente al paciente con diagnóstico sospechoso de Guillain Barré, y realizar los estudios necesarios en un brote para identificar los agentes desencadenantes del cuadro.

Guillain Barré syndrome is a disease derived from compromise in neurons of the peripheral nervous system by an uncontrolled response from the immune system that leads to axonal damage and/or demyelination. The objective of this report was to describe the first 10 suspected cases of Guillain Barre Syndrome in Piura. It was possible to identify the presence of Campylobacter jejuni in the stool samples of 80% of the reported patients. It is very important to quickly and opportunely recognize the patient with a suspected diagnosis of Guillain Barré, and to carry out the necessary studies in an outbreak to identify the triggering agents of the condition.

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OBJECTIVES: . To evaluate the IgG antibody response by ELISA using Wuhan and Lambda antigens in health care workers with and without history of SARS-CoV-2 infection prior to immunization with the first and second doses of Sinopharm vaccine (BBIBP-CorV). MATERIALS AND METHODS: . An analytical study was carried out in health care workers over 18 years of age. Fifty-one participants with history and 100 participants without history of SARS-CoV-2 infection, who received two doses of Sinopharm vaccine, were included. IgG antibodies were assessed 21 days after the first dose, 21 days after the second dose and 3 months after the second dose by in-house ELISA using the complete antigen of the Wuhan variant (B.1.1) and lambda variant (C-37) of SARS-CoV-2 virus. RESULTS: . Both groups showed a large increase in the percentage of people with antibodies after the second dose, however, this percentage decreased 3 months after the second dose. The difference between the antibody index measured by ELISA with Wuhan variant antigen versus the ELISA with lambda variant was significant (p<0.001). CONCLUSIONS: . There is a significant increase in the presence of IgG type antibodies after 15 days of the second dose of BBIBP-CorV vaccination in participants without previous infection and a decrease after 3 months of the second dose in the ratio of IgG antibody reactivity indexes in ELISAs with the variant antigen as with ELISAs with the lambda variant.

OBJETIVOS.: Evaluar la respuesta de anticuerpos IgG determinada mediante ELISA utilizando antígenos de los linajes Wuhan y Lambda en trabajadores de la salud con y sin antecedente de infección por SARS-CoV-2 previa a la inmunización con la primera y segunda dosis de la vacuna Sinopharm (BBIBP-CorV). MATERIALES Y MÉTODOS.: Se realizó un estudio analítico en trabajadores de salud mayores de 18 años. Se incluyeron 51 participantes con antecedente y 100 participantes sin antecedente de infección por SARS-CoV-2, quienes recibieron dos dosis de la vacuna Sinopharm. Los anticuerpos IgG se evaluaron 21 días después de la primera dosis, 21 días después de la segunda dosis y 3 meses después de la segunda dosis mediante una prueba de ELISA in house desarrollado utilizando el antígeno completo del linaje Wuhan (B) y del linaje Lambda(C.37) del virus de SARS-CoV-2. RESULTADOS.: En ambos grupos se observó un incremento del porcentaje de personas con anticuerpos luego de la segunda dosis, sin embargo, este porcentaje disminuyó luego de 3 meses de la segunda dosis. Se halló una diferencia significativa entre el índice de anticuerpos medido por ELISA con el antígeno del linaje Wuhan versus el ELISA con el linaje Lambda (p<0,001). CONCLUSIONES.: Existe un aumento significativo de la presencia de anticuerpos tipo IgG luego de 15 días de la segunda dosis de la vacunación con BBIP-CORV en los participantes sin infección previa y una disminución, luego de 3 meses de la segunda dosis, de la razón de índices de reactividad de anticuerpos IgG en los ELISA desarrollados con el antígeno de la variante como en los ELISA desarrollados con la variante Lambda.

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RESUMEN Objetivos. Evaluar la respuesta de anticuerpos IgG determinada mediante ELISA utilizando antígenos de los linajes Wuhan y Lambda en trabajadores de la salud con y sin antecedente de infección por SARS-CoV-2 previa a la inmunización con la primera y segunda dosis de la vacuna Sinopharm (BBIBP-CorV). Materiales y métodos. Se realizó un estudio analítico en trabajadores de salud mayores de 18 años. Se incluyeron 51 participantes con antecedente y 100 participantes sin antecedente de infección por SARS-CoV-2, quienes recibieron dos dosis de la vacuna Sinopharm. Los anticuerpos IgG se evaluaron 21 días después de la primera dosis, 21 días después de la segunda dosis y 3 meses después de la segunda dosis mediante una prueba de ELISA in house desarrollado utilizando el antígeno completo del linaje Wuhan (B) y del linaje Lambda(C.37) del virus de SARS-CoV-2. Resultados. En ambos grupos se observó un incremento del porcentaje de personas con anticuerpos luego de la segunda dosis, sin embargo, este porcentaje disminuyó luego de 3 meses de la segunda dosis. Se halló una diferencia significativa entre el índice de anticuerpos medido por ELISA con el antígeno del linaje Wuhan versus el ELISA con el linaje Lambda (p<0,001). Conclusiones. Existe un aumento significativo de la presencia de anticuerpos tipo IgG luego de 15 días de la segunda dosis de la vacunación con BBIP-CORV en los participantes sin infección previa y una disminución, luego de 3 meses de la segunda dosis, de la razón de índices de reactividad de anticuerpos IgG en los ELISA desarrollados con el antígeno de la variante como en los ELISA desarrollados con la variante Lambda.

ABSTRACT Objectives . To evaluate the IgG antibody response by ELISA using Wuhan and Lambda antigens in health care workers with and without history of SARS-CoV-2 infection prior to immunization with the first and second doses of Sinopharm vaccine (BBIBP-CorV). Materials and methods . An analytical study was carried out in health care workers over 18 years of age. Fifty-one participants with history and 100 participants without history of SARS-CoV-2 infection, who received two doses of Sinopharm vaccine, were included. IgG antibodies were assessed 21 days after the first dose, 21 days after the second dose and 3 months after the second dose by in-house ELISA using the complete antigen of the Wuhan variant (B.1.1) and lambda variant (C-37) of SARS-CoV-2 virus. Results . Both groups showed a large increase in the percentage of people with antibodies after the second dose, however, this percentage decreased 3 months after the second dose. The difference between the antibody index measured by ELISA with Wuhan variant antigen versus the ELISA with lambda variant was significant (p<0.001). Conclusions . There is a significant increase in the presence of IgG type antibodies after 15 days of the second dose of BBIBP-CorV vaccination in participants without previous infection and a decrease after 3 months of the second dose in the ratio of IgG antibody reactivity indexes in ELISAs with the variant antigen as with ELISAs with the lambda variant.

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Background: Coronavirus disease 2019 (COVID-19) infection is a major public health problem in the world and reinfections are becoming more frequent. Our main objective was to describe the epidemiological, clinical, and genomic characteristics of the confirmed cases of reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the capital of Lima and Callao, Peru. Methods: We searched in the Peruvian laboratory information system from April 2020 up to May 2021, looking for cases having 2 positive molecular tests for SARS-CoV-2 with more than 90 days between them. We performed genomic sequencing to the available pairs of samples and described the clinical characteristics, epidemiological impact, and genomic analysis of the confirmed reinfections. Results: There were 1 694 164 people with a positive diagnostic test for SARS-CoV-2 in Lima/Callao during the study period. Of these, 1695 had 2 positive molecular tests with more than 90 days between them. Two hundred eleven had both samples available for genomic analysis according to our selection criteria, and these were retrieved and submitted to sequencing. Thirty cases were confirmed to be SARS-CoV-2 reinfections with 2 different lineages in the 2 episodes. The variant Lambda (C.37) was the most common during the second infection and accounted for 19 (63.3%) of the 30 cases. Conclusions: We report 30 cases of confirmed SARS-CoV-2 reinfections. The Lambda variant was the most common cause of the second infections, in concordance with its predominant circulation during Peru's second wave. This report describes the largest series of confirmed reinfections by SARS-CoV-2 in Latin America.We describe the epidemiological, clinical, and genomic characteristics of the confirmed cases of reinfection by severe acute respiratory syndrome coronavirus 2 in Lima and Callao, durante la segunda ola en Peru. The Lambda variant (C.37) was the most common cause of the second infections.

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One of the biggest challenges during the pandemic has been obtaining and maintaining critical material to conduct the increasing demand for molecular tests. Sometimes, the lack of suppliers and the global shortage of these reagents, a consequence of the high demand, make it difficult to detect and diagnose patients with suspected SARS-CoV-2 infection, negatively impacting the control of virus spread. Many alternatives have enabled the continuous processing of samples and have presented a decrease in time and cost. These measures thus allow broad testing of the population and should be ideal for controlling the disease. In this sense, we compared the SARS-CoV-2 molecular detection effectiveness by Real time RT-PCR using two different protocols for RNA extraction. The experiments were conducted in the National Institute of Health (INS) from Peru. We compared Ct values average (experimental triplicate) results from two different targets, a viral and internal control. All samples were extracted in parallel using a commercial kit and our alternative protocol-samples submitted to proteinase K treatment (3 µg/µL, 56°C for 10 minutes) followed by thermal shock (98°C for 5 minutes followed by 4°C for 2 minutes); the agreement between results was 100% in the samples tested. In addition, we compared the COVID-19 positivity between six epidemiological weeks: the initial two in that the Real time RT-PCR reactions were conducted using RNA extracted by commercial kit, followed by two other using RNA obtained by our kit-free method, and the last two using kit once again; they did not differ significantly. We concluded that our in-house method is an easy, fast, and cost-effective alternative method for extracting RNA and conducing molecular diagnosis of COVID-19.

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RESUMEN Introducción. Existe limitada evidencia acerca de la exposición al hantavirus en el Perú. Los casos sintomáticos y estudios de seroprevalencia en febriles y población asintomática provienen de la región Loreto; sin embargo, existen grupos ocupacionales expuestos a los reservorios en regiones sin circulación conocida del virus. Objetivo. Determinar la frecuencia de anticuerpos contra el hantavirus en arroceros de un valle ubicado en una zona subtropical del Perú. Métodos. Estudio transversal en una muestra aleatoria de 250 agricultores de arroz obtenida en 2010 en el valle Alto Mayo (región San Martín), que incluyó la obtención de una muestra de sangre en cuyo suero se determinó la presencia de anticuerpos inmunoglobulinas G (IgG) mediante ELISA indirecto, y anticuerpos inmunoglobulinas M (IgM) mediante ELISA de captura. Resultados. Identificamos un caso con anticuerpos IgM (0,40%, IC95%: 0,01 a 2,21), pero no encontramos agricultores con anticuerpos IgG. El caso tenía contacto frecuente con ratas y roedores en la vivienda y campo de cultivo. Conclusión. Mostramos la primera evidencia serológica de infección por hantavirus en la región San Martín.

ABSTRACT Introduction. There is little evidence of hantavirus exposition in Peru. Cases and seroprevalence studies in febrile and asymptomatic persons are from Loreto region; however, there are occupational groups exposure to reservoirs in areas without know virus circulation. Objectives. To determinate the frequency of antibodies against hantavirus in rice farmers of a valley in a subtropical area of Peru. Methods. Cross-sectional study in a random sample of 250 rice farmers enrolled in 2010 in Alto Mayo Valley (San Martin region) that included blood sample obtention, in whose serum the presence of IgG antibodies was determined by indirect ELISA, and IgM antibodies by capture ELISA. Results. We identified a case with IgM antibodies (0,40%, 95% CI: 0,01 to 2,21), we did not find farmers with IgG antibodies. The case had frequent contact with rats and rodents in the home and crop field. Conclusion. We show the first serological evidence of hantavirus infection in the San Martin region.

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A health problem each time more frequent and dispersed in tropical and subtropical areas of the world, including Peru where it entered in 1990, is dengue. It is produced by the dengue virus with four serotypes and transmitted by Aedes aegypti, a vector that coexists with humans and whose presence is favored by deficient sanitary, social and economic conditions. Manifestations of severe forms of the disease such as shock and bleeding, are related to the frequent co-circulation of the four serotypes and the emergence of new genotypes such as American/Asian serotype 2. The new classification of the disease by WHO as dengue with or without warning signs and severe dengue, is contributing to more timely diagnosis and treatment, enabling reductions in mortality. Of note is the need to highlight the surveillance of acute febrile illness and Aedes indices that contribute to a timely diagnosis and guide vector control measures through sanitary education and environmental management with community and intersectoral participation, in a creative manner according to ecological niches. An alternative for complementary prevention would be vaccination using tetravalent vaccines whose safety and efficacy must be guaranteed before its use in the population under the framework of comprehensive strategies.

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Un problema sanitario cada vez más frecuente y disperso en áreas tropicales y subtropicales del mundo, incluido el Perú donde ingresó en 1990, es el dengue. Es producido por el virus del dengue con cuatro serotipos y transmitido por el Aedes aegypti, vector que convive con los humanos y cuya presencia es favorecida por deficientes condiciones sanitarias, sociales y económicas. Manifestaciones de formas severas de la enfermedad como el choque y sangrado, están relacionadas con la frecuente cocirculación de los cuatro serotipos y la aparición de nuevos genotipos como el americano/asiático del serotipo 2. La nueva clasificación de la enfermedad por la OMS como dengue con o sin signos de alarma y dengue grave, está contribuyendo a un diagnóstico y tratamiento más oportunos, permitiendo reducir la letalidad. Debe destacarse la necesidad de la vigilancia del síndrome febril y los índices aédicos que contribuyan a un diagnóstico oportuno y orienten las medidas de control vectorial mediante educación sanitaria y manejo ambiental con participación comunitaria e intersectorial, de manera creativa según los nichos ecológicos. Una alternativa de prevención complementaria sería la vacunación utilizando vacunas tetravalentes cuya seguridad y eficacia deben estar garantizadas antes de su uso poblacional en el marco de estrategias integrales.

A health problem each time more frequent and dispersed in tropical and subtropical areas of the world, including Peru where it entered in 1990, is dengue. It is produced by the dengue virus with four serotypes and transmitted by Aedes aegypti, a vector that coexists with humans and whose presence is favored by deficient sanitary, social and economic conditions. Manifestations of severe forms of the disease such as shock and bleeding, are related to the frequent co-circulation of the four serotypes and the emergence of new genotypes such as American / Asian serotype 2. The new classification of the disease by WHO as dengue with or without warning signs and severe dengue, is contributing to more timely diagnosis and treatment, enabling reductions in mortality. Of note is the need to highlight the surveillance of acute febrile illness and Aedes indices that contribute to a timely diagnosis and guide vector control measures through sanitary education and environmental management with community and intersectoral participation, in a creative manner according to ecological niches. An alternative for complementary prevention would be vaccination using tetravalent vaccines whose safety and efficacy must be guaranteed before its use in the population under the framework of comprehensive strategies.

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Objetivo: Estudiar la capacidad neutralizante de muestras séricas humanas para ser empleada como prueba de confirmación frente a otras técnicas y evaluar la relación de neutralización en diferentes poblaciones para cepas de FA: 287-78 (negativa y 17D (referencial). Materiales y métodos: Se empleó la cepa 17D para estandarización de la prueba en células VERO utilizando dos métodos (sólido y semi-líquido), además, se seleccionaron muestras séricas humanas en base al antecedente vacunal (presente o ausente), a la procedencia (endémica y no endémica) y la positividad a virus del dengue, las cuáles fueron evaluadas por ELISA. Las poblaciones seleccionadas se enfrentaron por la prueba estandarizada (PRNT) frente a las cepas de FA: 17D (cepa vacunal derivada del prototipo Asibi) y 287-78 (primer aislamiento de FA del Instituto Nacional de Salud del Perú). Resultados: Se obtuvieron buenos resultados con el método semi-líquido, siendo el séptimo día el óptimo de coloración de las placas. De los cuatro seleccionados, tres fueron positivos por ELISA y los resultados por PRNT fueron para la suspensión 17D. 29 negativos y 67 positivos con títulos entre 1:10 y 1.2560; y para la cepa 28-78, 17 negativos y 79 positivos con títulos entre 1:10 y 1.2560. Conclusiones: La técnica semi-líquida con tiempo de coloración al séptimo día ofrece óptimos resultados en plaqueo y neutralización. Además, el ELISA resultó ser menos específico frente al PRNT y se encontró variación en relación a títulos y capacidad neutralizante en algunos sueros para ambas cepas.

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