Pan American Health Organization Research Articles

Description of maternal and neonatal adverse events in pregnant people immunised with COVID-19 vaccines during pregnancy in the CLAP NETWORK of sentinel sites: nested case–control analysis of the immunization-associated risk – a study protocol

IntroductionCOVID-19 is associated with higher morbimortality in pregnant people compared with non-pregnant people. At present, the benefits of maternal immunisation are considered to outweigh the risks, and therefore, vaccination is...

Pan American climate resilient health systems: a training course for health professionals.

To describe the development, implementation, and results of a training course designed to equip health professionals from the Pan American Health Organization region with the knowledge and tools needed to adapt health systems to current climate realities. The Pan American climate resilient health systems course was a 9-week live-virtual course in March-April 2023, which was delivered through Zoom and offered in English, Spanish, and French. All lectures were delivered by local and regional climate and health experts. The curricular foundation of this initiative was the Global Consortium on Climate and Health Education core competencies for health professionals. Participants completed pre- and post-course surveys. A total of 1212 participants attended at least one of the nine sessions and 489 (from 66 countries) attended at least six sessions. Of these, 291 participants completed both the pre- and post-course surveys which were used in the analysis. Longitudinal survey results suggested an improvement in participants' climate and health communication, an increased frequency of incorporating climate knowledge in professional practice, and improved confidence in engaging in climate initiatives. At the same time, many participants expressed a need for additional training. The results indicate that live-virtual courses have the potential to empower health professionals to contribute to climate resilience efforts by: increasing their communication skills; changing their professional practice; increasing their ability to lead climate and health activities; and preparing them to assess vulnerability and adaptation in health systems, measure and monitor environmental sustainability, and apply a health equity lens.

Status of the national immunization technical advisory groups in the Americas: recommendations for improvement.

To evaluate the structure and operation of national immunization technical advisory groups (NITAGs) in Latin America and the Caribbean and to make recommendations for improvement. A convenience sample of six current and eight former NITAG members representing 12 countries in the region were invited in 2022 to answer a web-based questionnaire on NITAG structure, organization, and procedures. The questionnaire used indicators similar to those in the Joint Reporting Form on Immunization. Participants were also asked about the role their NITAGs played in coronavirus disease 2019 (COVID-19) immunization policies. Brazil, Dominican Republic, and Venezuela (Bolivarian Republic of) reported not having an active NITAG. The nine active NITAGs are structured and organized according to World Health Organization and Pan American Health Organization recommendations, with variations between countries. Most NITAGs include representatives of the five recommended medical specialties with the participation of additional members possible. Only Bolivia (Plurinational State of) and Mexico have no explicit policy for managing members' potential conflicts of interest. All NITAGs have an exclusively technical advisory role and generally meet once a quarter. Usually, NITAGs are asked by health ministries to analyze issues and make recommendations. All NITAGs, except for Peru's, actively participated in supporting decision-making for immunization policy on COVID-19. NITAGs have successfully supported vaccine policy-making through evidence-based recommendations. However, improvement in their structure, operation, and transparency is needed to help them keep up with the rapidly evolving field of immunization. Research on the impact of NITAGs is important to support the development of recommendations for improvement.

A brief history of rabies in Haiti until the adoption of the One Health approach for its epidemiological surveillance and control

Rabies was first identified in dogs and humans by a French veterinarian, Jean Lompagieu Lapole, in 1788 in the colony of Saint-Domingue, which later became Haiti. Rabies has continued to persist in the country despite some intermittent successes in combating this disease over the past 20 years. We are trying to understand why rabies, which has officially existed in the country for around 250 years, is still classified as a neglected disease and continues to result in cases of human mortality. For a significant period, until the implementation of the Haiti Animal Rabies Surveillance Program (HARSP) in 2011, there was no robust initiative to fight against rabies based on regular vaccination campaigns and an effective epidemiological surveillance system despite certain efforts made by the Ministry of Agriculture and Pan American Health Organization Project of Strengthening Public Agricultural Services (RESEPAG): Projet de Renforcement des Services publics Agricoles (PAHO) to increase dog vaccinations. The HARSP program was established with technical assistance from the Center for Disease Prevention and Control of Infectious Diseases (CDC) to control and eliminate rabies in the short term, according to the One Health approach. It was a passive surveillance system based on strengthening the rabies diagnostic capacity of the Veterinary Laboratory, training veterinary and public health technicians, and supporting rabies vaccination campaigns. This approach has resulted in effective cooperation between the Ministry of Agriculture and the Ministry of Public Health based on the “One Health” enabling the Ministry of Public Health to report daily on bite to the Ministry of Agriculture for further investigations. HARSP marked a pivotal moment in the Rabies Control and Elimination Program. Between January 2013 and December 2017, there were 9,342 reported human exposures to animals suspected of carrying rabies in Haiti. The number of Human exposures to rabies suspected animals in Haiti from January 2013 to December 2017 was 9,342 heads. Among these cases, 2.4% were confirmed, 4.9% probable, 17.8% suspected, and 74.6% discarded. The One Health rabies program has demonstrated the potential for achieving control of both animal and human rabies in Haiti if the ministries of Agriculture and Health commit unequivocally to continue their collaborative development efforts and adhere to HARSP methodology, including vaccinating over 70% of the dog population.

Impact of antimicrobial resistance in critically ill patients in the intensive care unit

According to the Pan American Health Organization, multidrug-resistant pathogens are responsible for an increase in morbidity and mortality among hospitalized patients, leading to higher healthcare costs due to the need for prescribing more expensive medications. The aim of the research was to identify, through literature review, the impact of antimicrobial resistance in Intensive Care Units. The bibliographic review study employed a qualitative methodology; its scope was explanatory, and it utilized the historical-logical method for theoretical knowledge acquisition. For empirical knowledge, documentary analysis was used, including publications found in databases such as Scielo, PubMed, Lilacs, Dialnet, Redalyc, Google Scholar, Elsevier, institutional repositories, among others. It was evidenced that the direct causes of death and bacterial resistance in the Intensive Care Unit are sepsis, followed by septic shock, the multi-organ dysfunction syndrome, and some of the antimicrobials currently used in ICUs, such as Piperacillin-Tazobactam, Cefepime, Amikacin, Cefotaxime, and the germs that showed resistance to these antimicrobials, firstly identified were Enterobacter Aerogenes, Escherichia coli, Staphylococcus Aureus. It is concluded that, in terms of the incidence of healthcare-associated infections, there is a significant impact on the health system, increasing the morbidity and mortality of the patient by up to 50 %, including longer hospital stays, greater use of antibiotics, worse prognosis, higher complication rates, and even death

Obesity and comorbidities in COVID-19: a longitudinal observational retrospective study of the main relationships of life risk

Introduction: Currently, around 30% of the world's population is overweight or obese. By 2030, it is estimated that more than 60% of the world's population will be overweight or obese. The COVID19 pandemic has resulted in the worsening of obesity comorbidities. The primary increase in the inflammatory response in obese patients functions as a predictor for the hyperinflammatory state observed in COVID-19. Therefore, this primary increase can be amplified by SARS-CoV-2 infection, increasing the production of cytokines such as TNF-α, IL-1, and IL-6. Objective: It was to carry out a retrospective longitudinal observational study to quantitatively analyze how cardiovascular comorbidities such as diabetes, hypertension, obesity, smoking, and compromised immunity contribute to the increased risk of life of participants affected by COVID-19. Methods: This study followed a longitudinal observational retrospective design (STROBE). A total of 45 public and official documents from Brazil (ANVISA), WHO (World Health Organization), Pan American Health Organization (PAHO), EASO (The European Association for the Study of Obesity - The European Commission/ National Information on COVID-19, Lancet Resource Centre) and scientific articles were subjected to eligibility analysis and, after that, 32 documents dated from 2019 to 2022 were selected. Results: In total, 3,993,857 participants were found from 32 documents. The highest incidence of deaths occurred in participants who were smokers, had compromised immunity, had diabetes, and were obese. The greatest risk of death was observed among participants who smoke (HR=2.5) and those with compromised immunity (HR=2.1). Despite this, other comorbidities such as diabetes, obesity, and hypertension also presented statistically significant results for the risk of life. It was observed that only the difference between the means of the comorbidities “obesity” and “diabetes” was not statistically significant, with p<0.05, that is, both comorbidities have similar impacts on the worsening and death of participants in the presence of COVID-19. Conclusion: Cardiovascular comorbidities such as diabetes, hypertension, obesity, smoking, and compromised immunity contributed to the increased risk of life in participants affected by COVID-19, especially in those of an older age. The endothelial dysfunction caused by SARS-CoV-2 explains why participants with comorbidities related to blood vessels such as cardiovascular disease, hypertension, diabetes, and obesity are more likely to develop severe COVID-19, even death

External quality control program in infectious diseases screening at laboratories and blood banks in Latin America: an analysis of the past 5 years.

To evaluate the screening of blood samples for infectious disease markers at laboratories and blood banks in Latin America per the findings of an External Quality Assessment Program (EQAP). This qualitative analysis used data from the EQAP coordinated by the Fundação Pro Sangue Hemocentro de São Paulo with the support of the Pan American Health Organization to assess the performance of blood screening for infectious diseases from 2014 to 2018 in Latin America. Each participating laboratory or blood bank received an identical blind panel with 24 blood samples with variable reactivity for all the screening parameters. Panels were processed at each participating facility and results were returned to the Fundação Pro Sangue Hemocentro de São Paulo for individual and joint analyses. Two types of discrepant results were potential failures: false positive results (FPRs) and false nonreactive results (FNRRs). A total of 23 136 samples were evaluated. Global rates of FPR, FNRR, and concordant results were 0.3%, 1.0% and 98.7%, respectively. Seven FNRRs were found for HBsAg (1.0%), 12 for syphilis (2.6%), and 21 for Chagas disease (2.9%). No FNRRs were found for the HIV, HCV, and HTLV viruses. The average accuracy of all the laboratories and blood banks participating in the EQAP during the study period was 99.5% (standard deviation, 0.5%). The findings of this qualitative analysis are positive for blood safety in Latin America, with an average accuracy of 99.5% among the participating laboratories and blood banks. This report reflects an important improvement in blood bank serological screening EQAP-PAHO report since the 2003.

Local Diagnostic Reference Levels for Pediatric Interventional Cardiology Procedures in Argentina.

The aim of this work was to propose a preliminary local diagnostic reference levels (DRL) for pediatric interventional cardiology (PIC) procedures in Argentina, for different ranges of age and weight. This work has been conducted in the framework of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency to ensuring that radiation exposures of pediatric patients are the minimum necessary during fluoroscopy-guided interventional procedures. The local DRL values presented in this paper by weight group and age group were 7.1 Gy·cm2 (<5 kg), 10.7 Gy·cm2 (5-15 kg), 18.0 Gy·cm2 (15-30 kg), 15.9 Gy·cm2 (30-50 kg), and 28.2 Gy·cm2 (50-80 kg) and 5.3 Gy·cm2 (<1), 11.2 Gy·cm2 (1 to 5<), 19.6 Gy·cm2 (5 to 10<), and 21.4 Gy·cm2 (10 to 16<), respectively. Our dose results are among the values found in other international studies; however, there is great potential for dose optimization.

Optimization of Radiation Protection in Pediatric Interventional Radiology in Latin America and the Caribbean: Development, Advancements, Challenges and Achievements of the OPRIPALC Program.

This article presents the development, advancements, challenges and achievements of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program. This international initiative is led by the World Health Organization, the Pan American Health Organization and the International Atomic Energy Agency. The main objectives of OPRIPALC are to foster a culture of radiological protection in pediatric interventions, enhance these procedures' quality, and define optimization strategies such as the use of diagnostic reference levels (DRLs). Currently, 33 centers from 12 countries participate actively in the program. Significant progress has been made towards the proposed objectives, overcoming the challenges posed by the COVID-19 pandemic. Through many virtual meetings for coordination, planning, training and follow-up, a comprehensive set of DRLs for both diagnostic and therapeutic procedures, categorized by weight and age, have been established and are in use. A consensus document on good practices is in the final stage of development. The program's continuation into at least a second phase is essential to address pending issues, including the integration of automatic dose management systems, the levels of occupational radiation doses, their correlation with pediatric patient doses, and strategies to reduce them.

Nationwide Improvement of IPC Practices in Honduran Hospitals: a Baseline Assessment

Abstract Background Healthcare-acquired infections (HAIs) are one of the most common adverse events related to the provision of healthcare services. They constitute a significant public health problem and lead to increased morbidity and mortality, costs, and prolonged hospitalization. Essential to reducing HAIs is creating a safety culture where no infection is perceived as acceptable by the healthcare worker. Critical to prioritizing actions and implementing improvement strategies is the development of a baseline situation analysis. The World Health Organization′s IPC and Hand Hygiene assessment frameworks allow hospitals to gain understanding regarding resources and practices. Methods A survey was conducted between June 2021 and May 2022 using the World Health Organization′s Frameworks for IPC and Hand Hygiene. The IPC framework evaluates eight core components, and the hand hygiene self-assessment evaluates five. With technical assistance from the Health Policy Plus Project and the National Panamerican Health Organization, the Honduran MoH conducted the assessment in 20 public hospitals. The hospitaĹs staff involved in IPC activities attended the virtual meetings. The results were categorized into four levels of IPC promotion and practices. The results supported the identification of strengths and weaknesses that were essential to the development of improvement plans. Results Twenty of 32 (62.5%) hospitals of the Honduran MoH were evaluated, covering 75% of the health regions. Evaluation of Hand Hygiene Programs Hospitals obtained an overall median result of 353/500 points (IQR: 259-382). Ten (50%) were in the Intermediate category, 6 (30%) in the Advanced category, 3 (15%) in basic category and 1 (5%) was inadequate. After a close evaluation of each component, Component 5 Institutional safety climate for Hand Hygiene (median: 55/100) had the lowest score, followed by component 3 - Evaluation and feedback (median: 65/100). Higher scores were obtained for component 1 System Change (median: 80/100). Evaluation of Infection Prevention and Control Programs at the facility level The median score was 567/800 points, (IQR: 448-630). Eleven (55%) hospitals were in the Intermediate category, and 7 (35%) in the Advanced category. After a close evaluation, Core Component 7, Workload, staffing and bed occupancy (median: 40/100) had the lowest score, followed by Core Component 3: Education and training IPC (median: 65/100). Higher scores were obtained for Core Component 5: Multimodal strategies for implementation of infection prevention and control interventions (median: 82/100) and Core Component 6: Monitoring/auditing of IPC practices and feedback (median: 81/100). Only 3 (15%) hospitals reported having staff dedicated exclusively to IPC activities (1 per &amp;lt;250 beds). Only 10 (50%) hospitals reported having trained professionals responsible for surveillance activities (basic epidemiology, surveillance, and IPC). Table 1: Infection Prevention and Control Assessment Framework Results Conclusions This is the first IPC nationwide assessment conducted in hospitals in Honduras. Results prove that IPC promotion and practices require improvement. Baseline results allow us to understand the IPC situation to promote data-driven decision-making to improve and foster a safety culture in Honduran hospitals.

Incorporating migrants into National COVID-19 Vaccination Plans in Latin America: A comparative analysis of policies in seven countries

Vaccination against COVID-19 is an essential public health tool for pandemic control. Inclusion of migrants in COVID-19 vaccination is not only ethically necessary from a right-to-health perspective but also technically indispensable for disease control. This study aimed to characterize the inclusion of international migrants, refugees, and asylum seekers in COVID-19 vaccination policies in Latin American countries that have the greatest recent increase in the reception of migrants.We conducted a content analysis of public policy documents issued between March 11, 2020, and June 30, 2022 by the Ministries of Health of seven countries: Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico and Peru. Documents were located through Ministries of Health web pages, references in scientific literature, and the Pan American Health Organization's Information Platform on Health and Migration in the Americas. A content analysis was performed of the documents that were located, along six dimensions: migrants' right to vaccination, temporality of vaccination, administrative discretion, policies to facilitate access, language or cultural considerations, and normative, ethical or technical justifications provided.Eighty-six public policy documents were reviewed. Their contents showed that none of the countries explicitly excluded migrants from vaccination, nor did they explicitly define restrictions on this population. One barrier that was detected was to require identity documents in order to be vaccinated or to receive a vaccination certificate, which could be difficult for migrants to obtain. Few countries defined actions to facilitate or promote the vaccination of migrants. The documents that mentioned justifications for vaccinating migrants presented reasons that were mainly based on the recognition of the right to health, the principle of non-discrimination and equity.The countries studied generally had inclusive policies but were limited in terms of dealing with potential barriers to access. The lack of mechanisms to guarantee the right to health is a limitation that countries in the region should address.

Worldwide Regulatory Reliance: Launching a Pilot on a Chemistry, Manufacturing, and Control Post Approval Change for a Vaccine.

When an initial marketing authorization of a pharmaceutical product is granted, a substantial number of chemistry, manufacturing, and control (CMC) post approval changes (PACs) have to be managed by the manufacturers. Despite efforts undertaken over the years by multiple regulatory jurisdictions, there is still heterogeneity in terms of regulatory requirements and timelines across national regulatory authorities (NRAs). This creates complexity in managing global CMC PACs, putting the supply of medical products at risk. Regulators have developed regulatory mechanisms that aim at accelerating the reviews and approvals of PACs by NRAs. The World Health Organization (WHO) is supporting the concept of "reliance" among NRAs, which are encouraged to rely on the assessment completed by a "highly performing authority". The objective is to accelerate the overall process for PACs, ultimately fostering more equitable and timely access to medical products for populations who need them. With the support of Health Canada, WHO, Pan American Health Organization, and the Paul-Ehrlich-Institut, Sanofi has launched a pilot using the principles of reliance for a CMC PAC for a vaccine, with 21 NRAs who accepted to participate in the pilot. The objective of this pilot was to apply these principles to reduce the approval timeline to a maximum of 6 months in all countries after an initial approval is granted by a reference authority. We discuss the opportunities and challenges of implementing reliance principles for CMC PACs. We also describe the pilot experience by sharing initial lessons learned from the Step 1 of this pilot, which consisted of engaging the reference authority and the NRAs.

A mixed integer programming model for vaccine pricing within a group purchasing organization

Background:Setting prices for life-saving medical or pharmaceutical products needs to consider multiple factors, e.g., affordability and health outcomes across different populations. When a group of buyers (e.g., countries) combine their purchasing power (e.g., via a group purchasing organization), the average procurement price decreases in the total volume. Decisions about what price to then charge to each member in a group are particularly challenging, considering the disparities in their respective ability and willingness to pay. Tiered pricing can be an effective way to set prices for a group of buyers, but its performance needs to be quantified and evaluated. Methods:We modeled the decision of setting prices of a medical product (for example, a vaccine) for a group of buyers using a mixed integer programming model, considering the buyers’ ability and willingness to pay. The objective is to minimize the unit price disparity adjusted by the buyers’ willingness to pay, subject to the constraint that the prices decrease in the buyers’ ability to pay. We also developed an analogous subsidy allocation model that applies if the group receives philanthropic donations to support procurement. The models were illustrated with two case studies based on the Bacillus Calmette-Guerin (BCG) vaccine procurement by Gavi, the Vaccine Alliance and Pan American Health Organization, and the performances of uniform, tiered, and differentiated pricing schemes were examined. Results:The adjusted unit price disparity is non-increasing in the number of price tiers allowed. The biggest decrease in the adjusted price disparity occurs when switching to two-tier pricing from uniform pricing. Tiered pricing performs better in the Gavi group compared to the PAHO group, in part because the ability to pay and willingness to pay have a higher degree of rank correlation within the former group of countries. Conclusions:This work provides a model for price-setting (subsidy allocation) decisions for a group of buyers and provides a quantitative comparison of different pricing schemes. The results of the case studies suggest that the performance of tiered pricing depends on various factors, including the disparities in the ability and willingness to pay across the buyers. Funding:This research has been supported in part by the Center for Health and Humanitarian Systems, the William W. George endowment, and the following benefactors at Georgia Tech: Andrea Laliberte, Richard Rick E. and Charlene Zalesky, and Claudia and Paul Raines.

Epidemiology of Invasive Meningococcal Disease in Colombia: A Retrospective Surveillance Database Analysis.

Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, is associated with high morbidity and mortality. The aim of the current study was to describe the historical and recent epidemiology of IMD in Colombia. This retrospective surveillance database analysis examined all available data on IMD in Colombia. Data were extracted from publicly available disease event reports and laboratory surveillance reports or obtained directly from hospitals in Cartagena. During 2015-2021, the overall incidence of IMD was 0.04-0.18 per 100,000 based on laboratory surveillance reports. IMD incidence was highest among infants aged<1year (0.52-1.47 per 100,000), as was IMD mortality (0.00-0.65 per 100,000). Serogroup B was the dominant serogroup responsible for IMD in Colombia during 1988-2014, but, since 2015, serogroup C has been dominant in all age groups, followed by serogroups B and Y. During 2010-2021 combined, the majority of IMD cases were reported in Bogotá (31.9%) and Antioquia (21.7%). Of 42 IMD cases in the city of Cartagena, 54.8% occurred in people who lived in the poorest neighborhoods, and these patients had the highest IMD lethality (52.2%) and the shortest median hospitalization duration (3days). The overall incidence of IMD in Colombia was low but was highest among infants aged<1year. IMD cases tended to be concentrated in the more densely populated areas and in poorer neighborhoods. As the majority of IMD cases in Colombia since 2015 have been serogroup C, followed by B or Y, vaccination to protect against these serogroups could potentially be beneficial and help to achieve the World Health Organization's and Pan American Health Organization's roadmaps to defeat meningitis by 2030.

The effect of El Niño and La Niña episodes on the existing niche and potential distribution of vector and host species of American Cutaneous Leishmaniasis

Leishmaniasis is a zoonotic disease transmitted to humans by a protozoan parasite through sandfly vectors and multiple vertebrate hosts. The Pan American Health Organization reported a declining trend in cases, with Brazil, Colombia, Peru, Nicaragua, and Bolivia having the most cases in 2020. There are still knowledge gaps in transmission and the parasite-host relationship. Ecological niche modeling has been used to study host-vector relationships, disease dynamics, and the impact of climate change. Understanding these aspects can aid in early surveillance and vector control strategies. The potential distribution of five host species associated with the transmission of cutaneous leishmaniasis (CL) was modeled. Occurrence data were collected for each host species, and environmental variables were used to build the models. Climatic data from El Niño, La Niña, and Neutral episodes were used to compare the predicted distributions. Additionally, the potential distributions of four vector species were compared to identify overlaps with host species. Niche analysis was conducted to evaluate changes in vector niches across episodes and to identify host-vector pairs based on niche overlap in geographic and environmental spaces. After spatial thinning, 467 records were obtained, and 1,190 candidate models were evaluated for each species. Results showed the distribution of occurrences in the environmental space, highlighting a high risk of extrapolation beyond the calibration areas. Movement-Oriented Parity analysis revealed distinct distribution patterns under different climate conditions, with areas of environmental similarity identified. Bradypus variegatus exhibited a broad potential distribution, while Dasypus novemcinctus and Didelphis marsupialis had more restricted ranges. Sylvilagus braziliensis covered most of the Neotropics. Our study provides valuable insights into ecological niches and geographic ranges of these species, contributing to the understanding of cutaneous leishmaniasis transmission dynamics.

Fatphobia: the challenges of humanized care for patients with metabolically unhealthy obesity

Obesity is characterized by being a chronic disease deriving from the accumulation of excessive fat, used by the body as an energy reserve. It is determined by body mass index and, according to data collected from the Pan American Health Organization (PAHO), there are over a billion obese people worldwide, of all age groups. Despite the high number, the fat body became the target of prejudice, directly reaching the self-image of the obese in a negative way. The demand for the "ideal body" has intensified, and with this situation, there has been a gradual growth by medical specialists. The lack of sensitivity of the professional in question allows discriminatory acts to occur in medical consultations. It is also observed the increase in mobilizations to combat obesity, where the fat person has the obligation to lose weight, discussing serious topics such as obesity and fat phobia, overcoming this theme. Thinking about it, this article sought to analyze how the management of care with obese people occurs and verify the ability of the newly graduated physician to conduct with empathy and professionalism the care of obese patients, preserving moral integrity, physical health and mental illness of the patient in the face of fat phobia. Thus, it was verified that the practice of medical fat phobia occurs in three categories being in the professional relationship in the infrastructure and in the diagnosis and treatment. It is of a lot of importance to stimulate doctor-patient empathy, as it encompasses the emotional, ethical, intellectual and behavioral, in addition to fostering relationship, trust and respect, generating a reciprocal connection that allows benefits, such as improvement and satisfaction in the results of the health treatments of this patient, being an essential conduct for the therapeutic plan

Fractional Dosing of Yellow Fever Live Attenuated 17D Vaccine: A Perspective.

Yellow fever virus (YFV) is a mosquito-borne flavivirus that causes over 109,000 severe infections and over 51,000 deaths annually in endemic areas of sub-Saharan Africa and tropical South America. The virus has a transmission cycle involving mosquitoes and humans or non-human primates (NHPs) as the vertebrate hosts. Although yellow fever (YF) is prevented by a live attenuated vaccine (strain 17D), recent epidemics in Angola, the Democratic Republic of the Congo (DRC), and Brazil put great pressure on vaccine stockpiles. This resulted in the World Health Organization (WHO) and Pan American Health Organization (PAHO) implementing, on an emergency basis only, off-label dose-sparing techniques and policies during 2016-2018 to protect as many people in DRC and Brazil as possible from disease during unexpected large outbreaks of YF. Subsequently non-inferiority studies involving full doses compared to fractional doses indicated promising results, leading some policy-makers and scientists to consider utilizing YF vaccine fractional doses in non-emergency scenarios. Although the additional data on the immunogenicity and safety of fractional doses are promising, there are several questions and considerations that remain regarding the use of fractional doses, including differences in the initial antibody kinetics, differences in the immune response in certain populations, and durability of the immune response to fractional doses compared to full doses. Until the remaining knowledge gaps are addressed, full doses instead of fractional doses should continue to be used unless there are insufficient doses of the vaccine available to control outbreaks of YF.

Impact of piperaquine resistance in Plasmodium falciparum on malaria treatment effectiveness in The Guianas: a descriptive epidemiological study

Plasmodium falciparum is an apicomplexan parasite responsible for lethal cases of malaria. According to WHO recommendations, P falciparum cases are treated with artemisinin-based combination therapy including dihydroartemisinin-piperaquine. However, the emergence of resistant parasites against dihydroartemisinin-piperaquine was reported in southeast Asia in 2008 and, a few years later, suspected in South America. To characterise resistance emergence, a treatment efficacy study was performed on the reported patients infected with P falciparum and treated with dihydroartemisinin-piperaquine in French Guiana (n=6, 2016-18). Contemporary isolates collected in French Guiana were genotyped for P falciparum chloroquine resistance transporter (pfCRT; n=845) and pfpm2 and pfpm3 copy number (n=231), phenotyped using the in vitro piperaquine survival assay (n=86), and analysed through genomic studies (n=50). Additional samples from five Amazonian countries and one outside the region were genotyped (n=1440). In field isolates, 40 (47%) of 86 (95% CI 35·9-57·1) were resistant to piperaquine in vitro; these phenotypes were more associated with pfCRTC350R (ie, Cys350Arg) and pfpm2 and pfpm3 amplifications (Dunn test, p<0·001). Those markers were also associated with dihydroartemisinin-piperaquine treatment failure (n=3 [50%] of 6). A high prevalence of piperaquine resistance markers was observed in Suriname in 19 (83%) of 35 isolates and in Guyana in 579 (73%) of 791 isolates. The pfCRTC350R mutation emerged before pfpm2 and pfpm3 amplification in a temporal sequence different from southeast Asia, and in the absence of artemisinin partial resistance, suggesting a geographically distinctive epistatic relationship between these genetic markers. The high prevalence of piperaquine resistance markers in parasite populations of the Guianas, and the risk of associated therapeutic failures calls for caution on dihydroartemisinin-piperaquine use in the region. Furthermore, greater attention should be given to potential differences in genotype to phenotype mapping across genetically distinct parasite populations from different continents. Pan American Health Organization and WHO, French Ministry for Research, European Commission, Santé publique France, Agence Nationale de la Recherche, Fundação de Amparo à Pesquisa do Estado do Amazonas, Ministry of Health of Brazil, Oswaldo Cruz Foundation, and National Institutes of Health. For the French and Portuguese translations of the abstract see Supplementary Materials section.

Sodium and potassium consumption in Jamaica: National estimates and associated factors from the Jamaica Health and Lifestyle Survey 2016-2017.

This study aimed to estimate dietary sodium and potassium consumption among Jamaicans and evaluate associations with sociodemographic and clinical characteristics. A cross-sectional study was conducted using data from the Jamaica Health and Lifestyle Survey 2016-2017. Participants were noninstitutionalized Jamaicans aged ≥15 years. Trained staff collected sociodemographic and health data via interviewer-administered questionnaires and spot urine samples. The Pan American Health Organization formula was used to estimate 24-hour urine sodium and potassium excretion. High sodium level was defined as ≥2000 mg/day, and low potassium levels as <3510 mg/day (World Health Organization criteria). Associations between these outcomes and sociodemographic and clinical characteristics were explored using multivariable ANOVA models using log-transformed 24-hour urine sodium and potassium as outcome variables. Analyses included 1009 participants (368 males, 641 females; mean age 48.5 years). The mean sodium excretion was 3582 mg/day (males 3943 mg/day, females 3245 mg/day, P < .001). The mean potassium excretion was 2052 mg/day (males, 2210 mg/day; females, 1904 mg/day; P = .001). The prevalence of high sodium consumption was 66.6% (males 72.8%, females 60.7%, P < .001) and that of low potassium intake was 88.8% (85.1% males, 92.3% females, P < .001). Sodium consumption was inversely associated with older age, higher education, and low glomerular filtration rate but was directly associated with being male, current smoking, and obesity. Overall, males had higher sodium consumption than women, with the effect being larger among hypertensive men. Women with hypertension had lower sodium consumption than nonhypertensive women; however, hypertensive men had higher sodium consumption than nonhypertensive men. Potassium consumption was higher among men, persons with obesity, and those with high total cholesterol but was lower among men with "more than high school" education compared to men with "less than high school" education. We conclude that most Jamaican adults have diets high in sodium and low in potassium. In this study, sodium consumption was directly associated with male sex, obesity, and current smoking but was inversely associated with older age and higher education. High potassium consumption was associated with obesity and high cholesterol levels. These associations should be further explored in longitudinal studies and population-based strategies should be developed to address these cardiovascular risk factors.

Improving Children's Mental Health Literacy Through the Cocreation of an Intervention and Scale Validation: Protocol for the CHILD-Mental Health Literacy Research Study.

Children's mental health is a public health priority, with 1 in 5 European children younger than 12 years having a behavioral, developmental, or psychological disorder. Mental health literacy (MHL) is a modifiable determinant of mental health, promoting psychological well-being and reducing mental health problems. Despite its significance, no interventions or scales currently exist for increasing and measuring MHL in this population. This study has dual objectives: (1) cocreating and evaluating an intervention on children's MHL, and (2) developing and validating a scale that measures children's MHL. Our study focuses on children aged 9-11 years attending primary school classes in various settings, including urban and rural areas, and priority education zones within a French department. Using a participatory research approach, we will conduct workshops involving children, parents, teachers, and 1 artist to cocreate an intervention comprising multiple tools (eg, a pedagogical kit and videos). This intervention will undergo initial evaluation in 4 classes through observations, interviews, and satisfaction questionnaires to assess its viability. Concurrently, the artist will collaborate with children to create the initial version of the CHILD-MHL scale, which will then be administered to 300 children. Psychometric analyses will validate the scale. Subsequently, we will conduct a cluster randomized controlled trial involving a minimum of 20 classes, using the CHILD-MHL scale scores as the primary end point to evaluate the intervention's efficacy. Additional interviews will complement this mixed methods evaluation. Both the intervention and the scale are grounded in the Child-Focused MHL model. The first tool of the intervention is the pedagogical kit Le Jardin du Dedans, supported by the public organization Psycom Santé Mentale Info and endorsed by UNICEF (United Nations Children's Fund) France. The second tool is a handbook by the Pan American Health Organization and the World Health Organization, which is addressed to teachers to sensitize them to children's mental health problems. The third is a 5-page supplementary leaflet produced by the nongovernmental organization The Ink Link, which teaches children the notion of MHL. Finally, we produced 56 items of the MHL Scale and listed existing education policies for children's mental health. After its robust evaluation, the intervention could be extended to several schools in France. The scale will be the first in the world to measure children's MHL. It will be used not only to evaluate interventions but also to provide data for decision makers to include MHL in all educational policies. Both the intervention and the scale could be translated into other languages. PRR1-10.2196/51096.