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Introduction: Rotavirus-associated diarrheal diseases significantly burden healthcare systems, particularly affecting infants under five years. Both Rotarix™ (RV1) and RotaTeq™ (RV5) vaccines have been effective but have distinct application schedules and limited interchangeability data. This study aims to provide evidence on the immunogenicity, reactogenicity, and safety of mixed RV1-RV5 schedules compared to their standard counterparts. Methods: This randomized, double-blind study evaluated the non-inferiority in terms of immunogenicity of mixed rotavirus vaccine schedules compared to standard RV1 and RV5 schedules in a cohort of 1,498 healthy infants aged 6 to 10 weeks. Participants were randomly assigned to one of seven groups receiving various combinations of RV1, and RV5. Standard RV1 and RV5 schedules served as controls of immunogenicity, reactogenicity, and safety analysis. IgA antibody levels were measured from blood samples collected before the first dose and one month after the third dose. Non-inferiority was concluded if the reduction in seroresponse rate in the mixed schemes, compared to the standard highest responding scheme, did not exceed the non-inferiority margin of -0.10. Reactogenicity traits and adverse events were monitored for 30 days after each vaccination and analyzed on the entire cohort. Results: Out of the initial cohort, 1,365 infants completed the study. Immunogenicity analysis included 1,014 infants, considering IgA antibody titers ≥20 U/mL as seropositive. Mixed vaccine schedules demonstrated non-inferiority to standard schedules, with no significant differences in immunogenic response. Safety profiles were comparable across all groups, with no increased incidence of serious adverse events or intussusception. Conclusion: The study confirms that mixed rotavirus vaccine schedules are non-inferior to standard RV1 and RV5 regimens in terms of immunogenicity and safety. This finding supports the flexibility of rotavirus vaccination strategies, particularly in contexts of vaccine shortage or logistic constraints. These results contribute to the global effort to optimize rotavirus vaccination programs for broader and more effective pediatric coverage.Clinical trial registration: ClinicalTrials.gov, NCT02193061.
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Infecções por Rotavirus , Vacinas contra Rotavirus , Humanos , Lactente , Diarreia/virologia , Imunoglobulina A , Infecções por Rotavirus/complicações , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/efeitos adversos , Método Duplo-CegoRESUMO
Background: Studies have suggested that children are less likely than adults to develop COVID-19; however, with the emergence of SARS-CoV-2 variants, hospitalization and death due to this cause have increased among the youngest ones. Methods: Retrospective, descriptive analytical study of the COVID-19 cases, hospitalizations and deaths occurred in children under five years who attended in Child Day-Care Centers (Centros de Atención Infantil-CAIs) of the Mexican Social Security Institute (IMSS) from 20th July 2020 to 31st March 2023. Results were compared with Mexico's and the US's national-level data. Incidence, attack (children and workers) and mortality rates were estimated. The risks of getting sick, being hospitalized and dying due to COVID-19 were calculated by year. Results: There were 4,369 COVID-19 cases among children from IMSS CAIs; 67 (1.5%) required hospitalization and only two deaths were reported (0.04%). Both at IMSS CAIs and at a national level in Mexico and the US, the highest incidences of COVID-19 among children under five years occurred during Omicron prevalence. The attack rate among workers (32.93%) was higher than children (4.99%). Hospitalization and mortality rates in the US decreased since the anti-COVID 19 vaccine was introduced in children older than six months, unlike the rates in Mexico, where the vaccine for this age group was not available. By the year 2020, the children that attended the IMSS CAIs were 77.3% less likely to be hospitalized; 80.9% in 2021, 93.2% in 2022, and 77.7% by March 2023, compared to same age children in Mexico. In 2021, the children that attended IMSS CAIs were 90.6% less likely to die due to COVID-19, and by March 2023, this likelihood was 34.3% lower than the rest of children in this age group in Mexico. Conclusions: Children that attended IMSS CAIs had a smaller risk of hospitalization and death due to COVID-19. However, the high rates of hospitalization and death due to SARS-CoV-2 in children under five years in our country point to the need and urgency of vaccination against this virus in this age group, as well as of the adherence to strict detection and medical referral protocols.
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Background: Sudden Infant Death Syndrome (SIDS) constitutes one of the main causes of mortality in children under one year of age in developed countries; it's frequency to varies geographically. In Mexico the real incidence of SIDS is not known. Methods: National databases of deaths in children under one year of age, from 2005 to 2020, were analyzed, due to Sudden Unexpected Infant Death (SUID) [SIDS (R95), accidental suffocation in a sleeping environment (W75), and other ill-defined and unspecified causes of mortality (R99), according to the International Classification of Diseases, tenth revision (ICD 10)]. Mortality rates per year of occurrence due to SUID and their subcategories were calculated. Simple frequencies of SIDS were obtained per year and month of occurrence, state of residence, age, place of death, and access to social security services. Results: In the study period 473,545 infant deaths occurred; 7,714 (1.62%) deaths were due to SUID; of these, 6,489 (84%) were due to SIDS, which is among the 10 leading causes of infant death in Mexico. The average mortality rate for SUID was 22.4/100,000 live births, for SIDS was 18.8/100,000 live births. Mortality rates within the states were variable, ranging from 2.4/100,000 to 105.1/100,000 live births. In 81% of SIDS records there was no autopsy; 38% of deaths due to SIDS occurred in infants under one month of age, up to 87% of deaths occurred in families without social security services or it was unknown, and 76.2% of deaths occurred at home. Deaths were more frequent during the last months of autumn and during winter. Conclusion: In Mexico there is an underregistry of SIDS as cause of death, along with other SUID categories. Health workers need to be trained to improve diagnosis and data registration, including the practice of autopsies; additionally, it is necessary to implement a public health campaign.
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BACKGROUND: Beginning in March 2021, Mexico vaccinated childcare workers with a single-dose CanSino Biologics (Adv5-nCoV) coronavirus disease 2019 (COVID-19) vaccine. Although CanSino is currently approved for use in 10 Latin American, Asian, and European countries, little information is available about its vaccine effectiveness (VE). METHODS: We evaluated CanSino VE within a childcare worker cohort that included 1408 childcare facilities. Participants were followed during March-December 2021 and tested through severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction or rapid antigen test if they developed any symptom compatible with COVID-19. Vaccination status was obtained through worker registries. VE was calculated as 100% × (1 - hazard ratio for SARS-CoV-2 infection in fully vaccinated vs unvaccinated participants), using an Andersen-Gill model adjusted for age, sex, state, and local viral circulation. RESULTS: The cohort included 43 925 persons who were mostly (96%) female with a median age of 32 years; 37 646 (86%) were vaccinated with CanSino. During March-December 2021, 2250 (5%) participants had laboratory-confirmed COVID-19, of whom 25 were hospitalized and 6 died. Adjusted VE was 20% (95% confidence interval [CI], 10%-29%) against illness, 76% (95% CI, 42%-90%) against hospitalization, and 94% (95% CI, 66%-99%) against death. VE against illness declined from 48% (95% CI, 33%-61%) after 14-60 days following full vaccination to 20% (95% CI, 9%-31%) after 61-120 days. CONCLUSIONS: CanSino vaccine was effective at preventing COVID-19 illness and highly effective at preventing hospitalization and death. It will be useful to further evaluate duration of protection and assess the value of booster doses to prevent COVID-19 and severe outcomes.
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Vacinas contra COVID-19 , COVID-19 , Adulto , COVID-19/prevenção & controle , Criança , Cuidado da Criança , Feminino , Humanos , Masculino , México/epidemiologia , SARS-CoV-2 , Eficácia de VacinasRESUMO
BACKGROUND: Previous studies have found a strong correlation between internet search and public health surveillance data. Less is known about how search data respond to public health interventions, such as vaccination, and the consistency of responses in different countries. In this study, we aimed to study the correlation between internet searches for "rotavirus" and rotavirus disease activity in the United States, United Kingdom, and Mexico before and after introduction of rotavirus vaccine. METHODS: We compared time series of internet searches for "rotavirus" from Google Trends with rotavirus laboratory reports from the United States and United Kingdom and with hospitalizations for acute gastroenteritis in the United States and Mexico. Using time and location parameters, Google quantifies an internet query share (IQS) to measure the relative search volume for specific terms. We analyzed the correlation between IQS and laboratory and hospitalization data before and after national vaccine introductions. RESULTS: There was a strong positive correlation between the rotavirus IQS and laboratory reports in the United States (R2 = 0.79) and United Kingdom (R2 = 0.60) and between the rotavirus IQS and acute gastroenteritis hospitalizations in the United States (R2 = 0.87) and Mexico (R2 = 0.69) (P < .0001 for all correlations). The correlations were stronger in the prevaccine period than in the postvaccine period. After vaccine introduction, the mean rotavirus IQS decreased by 40% (95% confidence interval [CI], 25%-55%) in the United States and by 70% (95% CI, 55%-86%) in Mexico. In the United Kingdom, there was a loss of seasonal variation after vaccine introduction. CONCLUSIONS: Rotavirus internet search data trends mirrored national rotavirus laboratory trends in the United States and United Kingdom and gastroenteritis-hospitalization data in the United States and Mexico; lower correlations were found after rotavirus vaccine introduction.
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Internet/estatística & dados numéricos , Infecções por Rotavirus/epidemiologia , Vacinas contra Rotavirus/uso terapêutico , Pré-Escolar , Gastroenterite/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Comportamento de Busca de Informação , México/epidemiologia , Infecções por Rotavirus/prevenção & controle , Estações do Ano , Reino Unido/epidemiologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE:: To determine the prevalence of lead (Pb) poisoning at birth in Morelos, analyze its distribution by social marginalization level, and estimate the association with the use of lead glazed ceramics (LGC). MATERIALS AND METHODS:: Blood lead level (BLL) in umbilical cord was measured in a representative sample of 300 randomly selected births at the Morelos Health Services and state IMSS. RESULTS:: The prevalence of Pb poisoning at birth (BLL> 5µg/dL) was 14.7% (95%CI: 11.1, 19.3) and 22.2% (95%CI: 14.4, 32.5) in the most socially marginalized municipalities. 57.1% (95%CI: 51.3, 62.7) of the mothers used LGC during pregnancy, and the frequency of use was significantly associated with BLL. CONCLUSION:: This is the first study to document the proportion of newborns with Pb poisoning who are at risk of experiencing the related adverse effects. It is recommended to monitor BLL at birth and take action to reduce this exposure, especially in socially marginalized populations.
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Intoxicação por Chumbo/epidemiologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Intoxicação por Chumbo/sangue , Masculino , México/epidemiologia , Marginalização SocialRESUMO
Resumen: Objetivo: Determinar la prevalencia de intoxicación por plomo (IPb) al nacimiento en Morelos, analizar su distribución por nivel de marginación y estimar la asociación con el uso de barro vidriado (BV). Material y métodos: Se midió plomo en sangre (PbS) en cordón umbilical de una muestra representativa de 300 nacimientos seleccionados aleatoriamente de aquéllos atendidos por los Servicios de Salud de Morelos e IMSS estatal. Resultados: La prevalencia de IPb al nacimiento (PbS>5µg/dL) fue 14.7% (IC95%: 11.1, 19.3), y 22.2% (IC95%: 14.4, 32.5) en los municipios más marginados. 57.1% (IC95%: 51.3, 62.7) de las madres usaron BV durante el embarazo y la frecuencia de uso se asoció significativamente con PbS. Conclusión: Este es el primer estudio que documenta la proporción de recién nacidos con IPb que están en riesgo de sufrir los consecuentes efectos adversos. Se recomienda monitorear PbS al nacimiento y emprender acciones para reducir esta exposición, especialmente en poblaciones marginadas.
Abstract: Objective: To determine the prevalence of lead (Pb) poisoning at birth in Morelos, analyze its distribution by social marginalization level, and estimate the association with the use of lead glazed ceramics (LGC). Materials and methods: Blood lead level (BLL) in umbilical cord was measured in a representative sample of 300 randomly selected births at the Morelos Health Services and state IMSS. Results: The prevalence of Pb poisoning at birth (BLL> 5μg/dL) was 14.7% (95%CI: 11.1, 19.3) and 22.2% (95%CI: 14.4, 32.5) in the most socially marginalized municipalities. 57.1% (95%CI: 51.3, 62.7) of the mothers used LGC during pregnancy, and the frequency of use was significantly associated with BLL. Conclusion: This is the first study to document the proportion of newborns with Pb poisoning who are at risk of experiencing the related adverse effects. It is recommended to monitor BLL at birth and take action to reduce this exposure, especially in socially marginalized populations.
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Humanos , Masculino , Feminino , Recém-Nascido , Intoxicação por Chumbo/epidemiologia , Estudos Transversais , Marginalização Social , Intoxicação por Chumbo/sangue , México/epidemiologiaRESUMO
We examined potential risk factors on vaccine virus shedding and antibody seroresponse to human rotavirus vaccine (Rotarix) in Mexican infants. Two doses of Rotarix were administered to infants during the first two visits for their routine childhood immunization (â¼8 and 15weeks of age) in Mexico City. Infant's characteristics and socioeconomic indicators were obtained, including history of long-term feeding practices (exclusively/predominantly breastfed and exclusively/predominantly non-breastfed). Two serum specimens were collected, one during the second rotavirus vaccine visit and one 7weeks later. Stool specimens were collected between days 4-7 after each of the two rotavirus vaccine doses. Rotavirus IgA and IgG titers in serum were determined by enzyme immunoassays (EIA) and rotavirus shedding in stool was assessed by EIA and confirmed by RT-PCR. The overall rotavirus IgA geometric mean titers (GMT) increased significantly post dose 2 from post dose 1 [176 (95%CI: 113-273) to 335 (238-471); p=0.020). Infants who were exclusively/predominantly breastfed were less likely to shed vaccine virus in stool than those who were formula-fed (22% vs. 43%, p=0.016). Infants who were breastfed had lower rotavirus IgA titers than those who were formula-fed after dose 1 [GMT: 145 (84-250) vs. 267 (126-566) p=0.188] and dose 2 [236 (147-378) vs.578 (367-910), p=0.007]. Infants who shed vaccine virus post dose 1 had significantly higher serum IgA GMT than those who did not shed [425 (188-965) vs. 150 (84-266), p=0.038]. Breastfeeding was linked with the reduction of both stool vaccine shedding, and IgA seroresponse. The reduced rotavirus replication in the gut and shedding after dose 1 may explain in part the lower IgA response in serum.
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Anticorpos Antivirais/sangue , Aleitamento Materno , Imunoglobulina A/sangue , Vacinas contra Rotavirus/imunologia , Rotavirus/imunologia , Rotavirus/fisiologia , Eliminação de Partículas Virais , Fezes/virologia , Feminino , Humanos , Imunização , Técnicas Imunoenzimáticas , Imunogenicidade da Vacina , Lactente , Masculino , México , Leite Humano/imunologia , Rotavirus/isolamento & purificação , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Vacinas contra Rotavirus/efeitos adversos , Vacinas Atenuadas/administração & dosagem , Vacinas Atenuadas/efeitos adversos , Vacinas Atenuadas/imunologia , Replicação ViralRESUMO
BACKGROUND: Mexico implemented routine childhood vaccination against rotavirus in 2007. We describe trends in hospitalization and deaths from diarrhea among children aged <5 years in Mexico before and 7 years after implementation of rotavirus vaccination. METHODS: We obtained data on deaths and hospitalizations from diarrhea, from January 2003 through December 2014, in Mexican children <5 years of age. We compared diarrhea-related mortality and hospitalizations in the postvaccine era with the prevaccine baseline from 2003 to 2006. RESULTS: Compared with the prevaccine baseline, we observed a 53% reduction (95% confidence interval [CI], 47%-58%) in diarrhea-related mortality and a 47% reduction (95% CI, 45%-48%) in diarrhea-related hospitalizations in postvaccine years, translating to 959 deaths and 5831 hospitalizations averted every year in Mexican children aged <5 years. Prevaccine peaks in diarrhea-related mortality and hospitalizations during the rotavirus season months were considerably diminished in postvaccine years, with greater declines observed during the rotavirus season compared with non-rotavirus season months. CONCLUSIONS: We document a substantial and sustained decline in diarrhea-related hospitalizations and deaths in Mexican children associated with implementation of rotavirus vaccination. These results highlight the public health benefits that could result in countries that adopt rotavirus vaccination into their national immunization programs.
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Diarreia/mortalidade , Programas de Imunização , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Pré-Escolar , Diarreia/prevenção & controle , Diarreia/virologia , Feminino , Hospitalização , Humanos , Lactente , Masculino , México/epidemiologia , Infecções por Rotavirus/etnologia , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/imunologia , Estações do Ano , VacinaçãoRESUMO
BACKGROUND: Early detection and control of vaccine-derived poliovirus (VDPV) emergences are essential to secure the gains of polio eradication. METHODS: Serial sewage samples were collected in 4 towns of Mexico before, throughout, and after the May 2010 oral poliovirus vaccine (OPV) mass immunization campaign. Isolation and molecular analysis of polioviruses from sewage specimens monitored the duration of vaccine-related strains in the environment and emergence of vaccine-derived polioviruses in a population partially immunized with inactivated poliovirus vaccine (IPV). RESULTS: Sabin strains were identified up to 5-8 weeks after the campaign in all towns; in Aguascalientes, 1 Sabin 3 was isolated 16 weeks after the campaign, following 7 weeks with no Sabin strains detected. In Tuxtla Gutiérrez, type 2 VDPV was isolated from 4 samples collected before and during the campaign, and type 1 VDPV from 1 sample collected 19 weeks afterward. During 2009-2010, coverage in 4 OPV campaigns conducted averaged only 57% and surveillance for acute flaccid paralysis (AFP) was suboptimal (AFP rate<1 per 100,000 population<15 years of age) in Tuxtla Gutierrez. CONCLUSIONS: VDPVs may emerge and spread in settings with inadequate coverage with IPV/OPV vaccination. Environmental surveillance can facilitate early detection in these settings.
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Monitoramento Ambiental , Vacina Antipólio Oral/administração & dosagem , Poliovirus/isolamento & purificação , Esgotos/virologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México , Poliovirus/classificação , Poliovirus/genética , Fatores de TempoRESUMO
OBJECTIVE: To identify and describe 1) progress achieved thus far in meeting the commitments of the Fourth Millennium Development Goal (MDG 4) in Mexico, mainly the contribution of the Universal Immunization Program (UIP) over the last 20 years, and 2) new opportunities for further reducing mortality among children under 5 years old. METHODS: An observational, descriptive, retrospective study was carried out to examine registered causes of death in children under 5 between 1990 and 2010. Indicators were built according to the recommendations of the United Nations. RESULTS: In 2010, deaths among children under 5 decreased 64.3% compared to the baseline (1990) figure. Of the total deaths of the children under 5, the neonatal period was the most affected (52.8%), followed by the 1 to 11 months (30.9%), and the 12 to 59 months (16.2%) groups. A 34% overall mortality reduction was observed after the universalization of immunization against influenza, rotavirus, and pneumococcus in children under 5. CONCLUSIONS: Despite a significant reduction in under-5 mortality in Mexico over the last 20 years, largely due to the successes of the UIP, several challenges remain, particularly in improving preventive and curative services during pre- and postnatal care.
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Objetivos , Programas de Imunização/estatística & dados numéricos , Pré-Escolar , Desenvolvimento Humano , Humanos , Lactente , Mortalidade Infantil , México/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Nações UnidasRESUMO
OBJECTIVE: To identify and describe 1) progress achieved thus far in meeting the commitments of the Fourth Millennium Development Goal (MDG 4) in Mexico, mainly the contribution of the Universal Immunization Program (UIP) over the last 20 years, and 2) new opportunities for further reducing mortality among children under 5 years old. METHODS: An observational, descriptive, retrospective study was carried out to examine registered causes of death in children under 5 between 1990 and 2010. Indicators were built according to the recommendations of the United Nations. RESULTS: In 2010, deaths among children under 5 decreased 64.3% compared to the baseline (1990) figure. Of the total deaths of the children under 5, the neonatal period was the most affected (52.8%), followed by the 1 to 11 months (30.9%), and the 12 to 59 months (16.2%) groups. A 34% overall mortality reduction was observed after the universalization of immunization against influenza, rotavirus, and pneumococcus in children under 5. CONCLUSIONS: Despite a significant reduction in under-5 mortality in Mexico over the last 20 years, largely due to the successes of the UIP, several challenges remain, particularly in improving preventive and curative services during pre- and postnatal care.
OBJETIVO: Determinar y describir 1) el progreso logrado hasta el momento en el cumplimiento de los compromisos del cuarto Objetivo de Desarrollo del Milenio en México, principalmente la contribución del Programa de Vacunación Universal (PVU) durante los 20 últimos años; y 2) las nuevas oportunidades para reducir aún más la mortalidad en niños menores de cinco años. MÉTODOS: Se llevó a cabo un estudio de observación, descriptivo y retrospectivo para analizar las causas registradas de muerte en niños menores de cinco años entre 1990 y el 2010. Se elaboraron indicadores según las recomendaciones de las Naciones Unidas. RESULTADOS: En el 2010, las defunciones en niños menores de cinco años se habían reducido en 64,3% en comparación con las cifras de referencia (1990). La mayor disminución de la mortalidad se observó en recién nacidos (52,8%), seguidos por los lactantes de 1 a 11 meses (30,9%) y los niños de 12 a 59 meses (16,2%). Se observó una reducción total de la mortalidad de 34% tras la universalización de la vacunación contra la gripe, el rotavirus y el neumococo en niños menores de cinco años. CONCLUSIONES: A pesar de una reducción significativa de la mortalidad en menores de cinco años en México durante los 20 últimos años, en gran parte debida a los éxitos del PVU, siguen existiendo diversos retos, en particular en cuanto a la mejora de los servicios preventivos y curativos durante la atención prenatal y posnatal.
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Humanos , Lactente , Pré-Escolar , Objetivos , Programas de Imunização/estatística & dados numéricos , Desenvolvimento Humano , Mortalidade Infantil , México/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Nações UnidasRESUMO
OBJECTIVE: To assess, by socioeconomic setting, the effect of nationwide vaccination against species A rotavirus (RVA) on childhood diarrhoea-related hospitalizations in Mexico. METHODS: Data on children younger than 5 years who were hospitalized for diarrhoea in health ministry hospitals between 1 January 2003 and 31 December 2011 were collected from monthly discharge reports. Human development indexes were used to categorize the states where hospitals were located as having generally high, intermediate or low socioeconomic status. Annual rates of hospitalization for diarrhoea--per 10,000 hospitalizations for any cause--were calculated. Administrative data were used to estimate vaccine coverage. FINDINGS: In the states with high, intermediate and low socioeconomic status, coverage with a two-dose monovalent RVA vaccine--among children younger than 5 years--had reached 93%, 86% and 71%, respectively, by 2010. The corresponding median annual rates of hospitalization for diarrhoea--per 10,000 admissions--fell from 1001, 834 and 1033 in the "prevaccine" period of 2003-2006, to 597, 497 and 705 in the "postvaccine" period from 2008 to 2011, respectively. These decreases correspond to rate reductions of 40% (95% confidence interval, CI: 38-43), 41% (95% CI: 38-43) and 32% (95% CI: 29-34), respectively. Nationwide, RVA vaccination appeared to have averted approximately 16,500 hospitalizations for childhood diarrhoea in each year of the postvaccine period. CONCLUSION: Monovalent RVA vaccination has substantially reduced childhood diarrhoea-related hospitalizations for four continuous years in discretely different socioeconomic populations across Mexico.
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Diarreia/prevenção & controle , Diarreia/virologia , Hospitalização/estatística & dados numéricos , Vacinas contra Rotavirus/administração & dosagem , Pré-Escolar , Diarreia/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologiaRESUMO
OBJECTIVE: Adult booster vaccination against pertussis can help prevent severe infections in young infants. We examined influences on intention to accept pertussis booster vaccination among pregnant women in Mexico City. METHODS: We conducted a cross-sectional survey, recruiting convenience samples of pregnant women receiving prenatal care from three public healthcare centers between March and May 2012. Our primary outcome was intention to accept pertussis vaccination during pregnancy. We examined socio-demographic factors, vaccination history, pertussis knowledge, perceptions of vaccine information sources, and other potential influences on vaccine decision-making. RESULTS: A total of 402 pregnant women agreed to participate, of which 387 (96%) provided their intention to accept or decline pertussis vaccination. Among respondents, 57% intended to accept a pertussis booster vaccine if offered, but only 16% had ever heard of pertussis, and only 2% knew someone who had contracted this disease. Over 80% of respondents would accept pertussis vaccination if recommended by an obstetrician-gynecologist. The most frequently selected reasons to refuse pertussis vaccination were concerns that the vaccine might harm the unborn baby or pregnant woman. In multivariate analysis, rating doctors and nurses as good sources of vaccine information, and having ever heard of pertussis, were independently associated with intention to accept pertussis vaccination. CONCLUSIONS: Promoting patient awareness about pertussis disease and vaccine safety, and encouraging general practitioners, nurses and obstetricians to recommend pertussis booster vaccine, may increase vaccine uptake among pregnant women.
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Conhecimentos, Atitudes e Prática em Saúde , Imunização Secundária/estatística & dados numéricos , Intenção , Vacinação/psicologia , Coqueluche/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , México , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto , Vacina contra Coqueluche , Gravidez , Gestantes/psicologia , Adulto JovemRESUMO
OBJECTIVE: In Mexico, declines in childhood diarrhea deaths have been documented during 2008-2010 after rotavirus vaccine introduction in 2007. Because of concerns about variation in rotavirus vaccine efficacy by socioeconomic status, we compared reductions in diarrhea mortality in the lesser developed southern region versus the more developed northern and central regions of Mexico. METHODS: We obtained data from national vital statistics on diarrhea deaths among children aged <5 years from 2002 through 2011. We compared region-specific diarrhea mortality before (2003-2006) and after (2009-2011) vaccine introduction. Regional vaccine coverage was estimated from administrative data, and socioeconomic status was assessed by using the Human Development Index. RESULTS: In northern, central, and southern Mexico, the 2007 Human Development Index was 0.84, 0.82, and 0.77, respectively, and by 2010 an estimated 99%, 84%, and 89% of children aged <12 months had completed rotavirus vaccination. Diarrhea mortality among children <5 years old declined from 8.3, 17.9, and 28.5 deaths per 100,000 children during 2003-2006 to 4.5, 8.1, and 16.2 in 2009-2011 in northern, central, and southern Mexico, respectively, corresponding to rate reductions of 45%, 55%, and 43%. No significant differences were observed in rate reductions between regions (P > .8). CONCLUSIONS: After introduction of rotavirus vaccination, marked and sustained declines in diarrhea deaths were seen among children in all regions of Mexico, including in the least developed southern region with the highest baseline diarrhea mortality. This finding indicates equitable vaccine delivery to children with varying risk of mortality and reaffirms the beneficial effects of rotavirus vaccination against fatal diarrheal disease.
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Diarreia/mortalidade , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus , Vacinação/estatística & dados numéricos , Pré-Escolar , Diarreia/prevenção & controle , Diarreia/virologia , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido , México/epidemiologia , Infecções por Rotavirus/complicações , Infecções por Rotavirus/mortalidade , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
BACKGROUND AND AIMS: Streptococcus pneumoniae constitutes one of the main causes of sepsis, bacteremia and meningitis (pneumococcal invasive disease - PID), and pneumonia in infants and small children. Antipneumococcal vaccination in Mexico is expected to be a useful strategy to reduce morbimortality due to this cause. We undertook this study to determine the prevalence of PID and pneumonia and the PCV vaccination status of affected children as well as serotype distribution and antimicrobial susceptibility of pneumococcal strains responsible for PID in infants and small children in Mexico. METHODS: From March 2010-June 2011, a prospective multicenter study was carried out in four states in Mexico to determine the prevalence of bacteremia, meningitis, septic arthritis and pneumonia due to S. pneumoniae and other microorganisms in children from 28 days-59 months of age. Isolated pneumococcal strains were serotyped and their antimicrobial resistance determined. RESULTS: During the study period, 545 children were diagnosed with bacteremia, meningitis, septic arthritis or pneumonia; 46.7% of these clinical entities occurred among children <12 months of age. Community-acquired pneumonia was the most prevalent disease. It was possible to identify a causal microorganism in 55 cases, from which 80% were S. pneumoniae. Fifteen percent of patients with PID died. The most prevalent pneumococcal serotypes were 19A, 35B, 19F and 6A. 10.2% of nonmeningeal strains were resistant to meropenem and 82% were resistant to TMP/SMX. CONCLUSIONS: This study shows that pneumococcus was the most common bacteria isolated in the studied population, although epidemiological and laboratory-based surveillance still needs improvement.
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Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Fatores Etários , Bacteriemia/microbiologia , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Masculino , México , Infecções Pneumocócicas/sangue , Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas , Prevalência , Estudos Prospectivos , Sorotipagem , Streptococcus pneumoniae/imunologiaRESUMO
The recent introduction of a rotavirus vaccine program in Mexico to control rotavirus disease, a common killer of children worldwide, has dramatically reduced the number of Mexican children dying and being hospitalized because of diarrhea. The successful introduction of a rotavirus vaccine program was preceded by several decades of focused research efforts to document the burden of disease and to generate the knowledge base to develop and deploy a vaccine. The postlicensure experience from Mexico demonstrates that evaluating the impact and safety of the vaccination program is vitally necessary for sustaining it. All in all, the immensely successful Mexico experience with control of rotavirus disease, if copied, could yield tremendously favorable results for children and parents worldwide.
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Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Rotavirus/imunologia , Pré-Escolar , Humanos , Programas de Imunização/métodos , Lactente , México , Infecções por Rotavirus/imunologia , Vacinação/métodos , Vacinas Atenuadas/administração & dosagemRESUMO
BACKGROUND: In January 2010, surveillance detected a rotavirus gastroenteritis outbreak in Chiapas, Mexico. We aimed to identify risk and protective factors for developing rotavirus gastroenteritis of any severity among children in the epidemic setting. METHODS: A case-control study was conducted, comparing case patients (defined as children <36 months of age with acute gastroenteritis of any severity whose stool tested positive for rotavirus by enzyme immunoassay) with age- and municipality-matched controls. Information was obtained through face-to-face interviews on clinical outcome, demographics, breastfeeding history, rotavirus immunization status, and indicators of socioeconomic status. RESULTS: Eighty-five case patients and 170 controls were enrolled. Factors associated with lower risk of rotavirus gastroenteritis included current breastfeeding, owning a refrigerator, and being immunized with 1 or 2 doses of a live-attenuated monovalent rotavirus vaccine. History of previous diarrheal episodes and living with 7 or more people in the same household were associated with higher risk of developing rotavirus gastroenteritis. CONCLUSION: During this outbreak, dietary, socioeconomic, and environmental factors were independently associated with risk of developing rotavirus disease. Rotavirus vaccine also offered significant protection against rotavirus disease of any severity, emphasizing the value of vaccination as a simple and highly effective public health strategy for prevention of rotavirus illness.
RESUMO
OBJETIVO: Determinar el perfil epidemiológico de los brotes de enfermedad diarreica aguda por rotavirus (RV) ocurridos en pacientes pediátricos, mediante una revisión crítica de la literatura publicada entre 2000 y 2010. MÉTODOS: Se realizó una búsqueda de artículos publicados desde enero de 2000 hasta abril de 2010, recogidos por las bases de datos Artemisa, EBSCO, Embase, Imbiomed, Lilacs, Ovid, PubMed y Science Direct. En los estudios que cumplieron con los criterios de inclusión, se identificaron posibles factores de confusión y se atribuyeron riesgos de sesgo con base en el número de ítems considerados inadecuados en cada caso. Se describieron las características epidemiológicas y microbiológicas de los brotes. RESULTADOS: Solo 14 (10,8 por ciento) de los 129 títulos identificados formaron parte de la muestra, los cuales sumaron 91 092 casos de diarrea aguda notificados. En 5 250 de estos casos se realizó la búsqueda de RV, la cual arrojó 1 711 (32,5 por ciento) aislamientos positivos. Se observó que el RV del grupo A fue el agente causal en 100 por ciento de los brotes, mientras que el genotipo G9 fue documentado en 50 por ciento de los artículos. CONCLUSIONES: El RV, principalmente el serotipo G9, fue uno de los principales agentes responsables de los brotes de EDA en la última década. Un cuidadoso estudio de brote puede aportar información valiosa para el control y la prevención de la enfermedad por RV.
OBJECTIVE: Determine the epidemiological profile of outbreaks of acute diarrheal disease caused by rotavirus (RV) occurring in pediatric patients, based on a critical review of the literature published between 2000 and 2010. METHODS: A search was carried out for articles published from January 2000 to April 2010, collected by the Artemisa, EBSCO, Embase, Imbiomed, Lilacs, Ovid, PubMed, and Science Direct databases. In the studies that met the inclusion criteria, possible confounding factors were identified and risks of bias were attributed based on the number of items considered inadequate in each case. The epidemiological and microbiological characteristics of the outbreaks were described. RESULTS: The sample was comprised of only 14 (10.8 percent) of the 129 titles identified, which accounted for 91 092 reported cases of acute diarrhea. In 5 250 of these cases, a search for rotavirus was conducted, yielding 1 711 (32.5 percent) positive isolations. It was observed that the RV from Group A was the causative agent in 100 percent of the outbreaks, while genotype G9 was documented in 50 percent of the articles. CONCLUSIONS: Rotavirus, mainly serotype G9, was one of the principal agents responsible for outbreaks of acute diarrheal disease over the past decade. A careful outbreak study can contribute valuable information for RV disease control and prevention.