Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 157 Records) |
Query Trace: Gutierrez M[original query] |
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Seroepidemiology of human leptospirosis in the Dominican Republic: A multistage cluster survey, 2021
Nilles EJ , Paulino CT , Galloway R , de St Aubin M , Mayfield HJ , Cadavid Restrepo A , Dumas D , Garnier S , Etienne MC , Duke W , Peña F , Iihoshi N , Abdalla G , Lopez B , de la Cruz L , Henríquez B , Durski K , Baldwin M , Loevinsohn G , Rees EM , Martin B , Sartorius B , Skewes-Ramm R , Gutiérrez EZ , Kucharski A , Lau CL . PLoS Negl Trop Dis 2024 18 (12) e0012463 Little is known about the epidemiology of leptospirosis in the Dominican Republic, the second most populous country in the Caribbean. We report on findings from a multi-stage household survey across two regions in the country that reveals a previously under-estimated burden of human Leptospira infection. Our findings, based on the reference-standard microscopic agglutination test, indicate a complex picture of serogroup diversity, spatial heterogeneity in infection and risk, and a marked discrepancy between reported cases and serologically estimated infections. Given an overall seroprevalence of 11.3% (95% CI: 10.8-13.0%) and a lower estimated force of infection (0.30% per year [0.27%-0.35%]) the number of infections may exceed national reported case data by 145-fold or more. Icterohaemorrhagiae, associated with severe Weil's disease, was the most commonly identified serogroup with a serogroup-specific prevalence of 4.4%. Consistent with other settings, risk factors including age, male sex, and rat exposure were associated with higher seroprevalence. Our study highlights the need for targeted public health interventions informed by serogroup-specific dynamics, detailed spatial analyses, knowledge of local animal reservoirs, and strengthened laboratory surveillance to effectively control this pathogen. |
Impact of metabolism-disrupting chemicals and folic acid supplementation on liver injury and steatosis in mother-child pairs
India-Aldana S , Midya V , Betanzos-Robledo L , Yao M , Alcalá C , Andra SS , Arora M , Calafat AM , Chu J , Deierlein A , Estrada-Gutierrez G , Jagani R , Just AC , Kloog I , Landero J , Oulhote Y , Walker RW , Yelamanchili S , Baccarelli AA , Wright RO , Téllez Rojo MM , Colicino E , Cantoral A , Valvi D . J Hepatol 2024 ![]() BACKGROUND AND AIMS: Scarce knowledge about the impact of metabolism-disrupting chemicals (MDCs) on steatotic liver disease limits opportunities for intervention. We evaluated pregnancy MDC-mixture associations with liver outcomes, and effect modification by folic acid (FA) supplementation in mother-child pairs. METHODS: We studied ∼200 mother-child pairs from the Mexican PROGRESS cohort, with measured 43 MDCs during pregnancy (estimated air pollutants, blood/urine metals or metalloids, urine high- and low-molecular-weight phthalate [HMWPs, LMWPs] and organophosphate-pesticide [OP] metabolites), and serum liver enzymes (ALT, AST) at ∼9 years post-parturition. Outcomes included elevated liver enzymes in children and established clinical scores for steatosis and fibrosis in mothers (i.e. , AST: ALT, FLI, HSI, FIB-4). Bayesian Weighted Quantile Sum regression assessed MDC-mixture associations with liver outcomes. We further examined chemical-chemical interactions and effect modification by self-reported FA supplementation. RESULTS: In children, many MDC-mixtures were associated with liver injury. Per quartile HMWP-mixture increase, ALT increased by 10.1% (95%CI: 1.67%, 19.4%) and AST by 5.27% (95% CI: 0.80%, 10.1%). LMWP-mixtures and air pollutant-mixtures were associated with higher AST and ALT, respectively. Air pollutant and non-essential metal/element associations with liver enzymes were attenuated by maternal cobalt blood concentrations (p-interactions<0.05). In mothers, only the LMWP-mixture was associated with odds for steatosis [OR=1.53 (95%CI: 1.01, 2.28) for HSI>36, and OR=1.62 (95%CI: 1.05, 2.49) for AST:ALT<1]. In mothers and children, most associations were attenuated (null) at FA supplementation≥600mcg/day (p-interactions<0.05). CONCLUSIONS: Pregnancy MDC exposures may increase risk for liver injury and steatosis, particularly in children. Adequate FA supplementation and maternal cobalt levels may attenuate these associations. IMPACT AND IMPLICATIONS: The effects of environmental chemical exposures on steatotic liver diseases are not well understood. In a parallel investigation of mothers and children, we found that pregnancy exposures to metabolism-disrupting chemicals may increase the risk for liver injury and steatosis, especially in the child, and that these associations could be attenuated by higher folic acid and/or cobalt levels. These findings can inform policies to decrease environmental chemical pollution and contribute to the design of clinical interventions addressing the MASLD epidemic. |
Utility of the 2019 EULAR/ACR SLE classification criteria for predicting mortality and hospitalisation: development and cross-validation of ominosity score
Figueroa-Parra G , Hanson AC , Sanchez-Rodriguez A , Meade-Aguilar JA , González-Treviño M , Cuéllar-Gutiérrez MC , Barbour KE , Duarte-García A , Crowson C . RMD Open 2024 10 (4) OBJECTIVE: The 2019 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria score (≥20 points) has been associated with poor outcomes. We aimed to evaluate its utility as a predictor for mortality and hospitalisation and to derive and validate an ominosity score based on the SLE classification criteria set. METHODS: Incident patients with SLE in a population-based cohort were included. The association between the 2019 EULAR/ACR SLE score and mortality and hospitalisation was assessed using Cox regression adjusted for age, sex and calendar year. An ominosity score for mortality was developed based on the SLE criteria set. The least absolute shrinkage and selection operator method was used to estimate model coefficients. Concordance and calibration were assessed by cross-validation and by plotting the observed event rates against the deciles of predicted probabilities. RESULTS: Among 374 patients with incident SLE, a EULAR/ACR score ≥20 points was not associated with an increased risk of mortality (HR 1.17, 95% CI 0.67 to 2.03) or first hospitalisation (HR 1.14, 95% CI 0.79 to 1.64) compared with a score ≤19 points. The derived ominosity score for mortality included age, sex, thrombocytopaenia, neuropsychiatric manifestations, subacute cutaneous or discoid lupus, non-scarring alopecia, inflammatory arthritis, renal involvement, antiphospholipid antibodies and hypocomplementaemia. This model demonstrated a concordance=0.76 with adequate calibration. Age and sex were the main predictors, as seen in the model including just age, sex and year (concordance=0.77). CONCLUSION: The 2019 EULAR/ACR SLE criteria score was not associated with mortality and hospitalisation. The derived ominosity score for mortality presented good prediction for mortality but was not better than age and sex alone. |
Chikungunya outbreak risks after the 2014 outbreak, Dominican Republic
Loevinsohn G , Paulino CT , Spring J , Hughes HR , Restrepo AC , Mayfield H , de St Aubin M , Laven J , Panella A , Duke W , Etienne MC , Abdalla G , Garnier S , Iihoshi N , Lopez B , de la Cruz L , Henríquez B , Baldwin M , Peña F , Kucharski AJ , Vasquez M , Gutiérrez EZ , Brault AC , Skewes-Ramm R , Lau CL , Nilles EJ . Emerg Infect Dis 2024 30 (12) 2679-2683 The 2014 chikungunya outbreak in the Dominican Republic resulted in intense local transmission, with high postoutbreak seroprevalence. The resulting population immunity will likely minimize risk for another large outbreak through 2035, but changes in population behavior or environmental conditions or emergence of different virus strains could lead to increased transmission. |
Rocky Mountain spotted fever in Mexico: A call to action
Álvarez-Hernández G , López-Ridaura R , Cortés-Alcalá R , García Rodríguez G , Calleja-López JRT , Rivera-Rosas CN , Alomía-Zegarra JL , Brophy M , Brito-Lorán CB , Del Carmen Candia-Plata M , Ceballos-Liceaga SE , Correa-Morales F , Dzul-Rosado KR , Foley J , Galván-Moroyoqui JM , Ganta R , Gutiérrez-Cedillo V , Hernández-Milán NS , López-Pérez AM , López-Soto LF , Martínez-Soto JM , Mata-Pineda AL , Paddock CD , Ruiz-González ILJ , Salinas-Aguirre JE , Salzer JS , Sánchez-Montes S , Soto-Guzmán A , Tamez-Rivera Ó , Wagner DM , Walker DH . Am J Trop Med Hyg 2024 111 (5) 1070-1077 Rocky Mountain spotted fever (RMSF) is an ongoing public health crisis in Mexico, particularly in states bordering the United States. The national highest incidence and mortality of RMSF occur in this region, resulting in a case-fatality rate that ranges annually between 10% and 50%, primarily affecting vulnerable groups such as children, elderly adults, and persons living in poverty. Multiple biological, environmental, and social determinants can explain its growing presence throughout the country and how it challenges the health system and society. It is necessary to integrate resources and capacities from health authorities, research centers, and society to succeed in dealing with this problem. Through a scientific symposium, a group of academicians, U.S. health officials, and Mexican health authorities met on November 8-10, 2023, in Hermosillo, Mexico, to discuss the current situation of RMSF across the country and the challenges associated with its occurrence. An urgent call for action to improve national capacity against RMSF in the aspects of epidemiological and acarological surveillance, diagnosis, medical care, case and outbreak prevention, health promotion, and research was urged by the experts. The One Health approach is a proven multidisciplinary strategy to integrate policies and interventions to mitigate and prevent the burden of cases, deaths, and suffering caused by RMSF in Mexico. |
Longitudinal changes in hand hygiene adherence among healthcare workers during the COVID-19 pandemic, Dominican Republic
Daniel Schnorr C , Roberts KW , Payano EC , Guzmán PM , de StAubin M , Lozier M , Garnier S , Dumas D , McDavid K , Paulino CJT , Skewes-Ramm R , Craig C , Gutierrez EZ , Duke W , Nilles E . PLOS Water 2024 3 Hand hygiene (HH) can reduce transmission of healthcare-associated infections (HAIs) in healthcare facilities and is especially important in low- and middle-income countries where HH infrastructure may be insufficient and the burden of HAIs is highest. At baseline, we assessed HH infrastructure and practices among healthcare workers (HCWs) at two large hospitals in the Dominican Republic during the COVID-19 pandemic. HCWs were observed for HH adherence (HHA) (defined as the use of alcohol-based hand rub (ABHR) or handwashing with soap and water) before and after patient contact and donning new gloves before patient contact. The baseline assessment was repeated following implementation of local production and distribution of ABHR and a HH promotion campaign. Descriptive analyses and regression models evaluated predictors of HHA and glove use. Cumulative HHA was 18.9%. While patient-care areas with a functional HH resource increased from 47% at baseline to 92% after the intervention, HHA declined from 23.0% to 16.7%. HHA was higher after patient contact (aOR = 5.88; 95% CI = 4.17–8.33), during a period of increased COVID-19 risk (aOR = 1.69; 95% CI = 1.05–2.77), during invasive patient contacts (aOR = 1.64; 95% CI = 1.23–2.17) and when gloves were not used (aOR = 1.25; 95% CI = 1.01–1.56). The negative association between glove use and HHA diminished when access to HH resources increased. New gloves were donned before 39.6% of patient contacts. Glove use was higher among nurses (aOR = 7.12; 95% CI = 3.02–16.79) and during invasive contacts (aOR = 4.76; 95% CI = 2.27–10.0). While access to HH resources increased after the interventions, HHA did not increase. HHA was lower when COVID-19 risk was lower. Findings from this study may guide future efforts to increase HHA among HCWs. Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. |
Epidemiology of pediatric astrovirus gastroenteritis in a Nicaraguan Birth Cohort
Rubinstein RJ , Gutiérrez L , Toval-Ruíz C , Hammond K , Bode L , Vinjé J , Vilchez S , Becker-Dreps S , Bucardo F , Vielot NA , Reyes Y . Open Forum Infect Dis 2024 11 (9) ofae465 ![]() BACKGROUND: Astrovirus is a leading cause of acute gastroenteritis in children worldwide. However, few prospective studies have analyzed astrovirus in community-dwelling pediatric populations in low- and middle-income countries. METHODS: We assessed the incidence, risk factors, clinical characteristics, genotypes, viral coinfections, and time distribution of astrovirus gastroenteritis in 443 healthy Nicaraguan children born in 2017 to 2018 who were followed for 36 months. Children were recruited from hospitals and birth records in an economically diverse neighborhood of León city. Astrovirus-positive episodes and genotypes were identified from stool with reverse transcription quantitative polymerase chain reaction and Sanger sequencing. RESULTS: Of 1708 total specimens tested, 80 children (18%) experienced at least 1 astrovirus episode, and 9 experienced repeat episodes, mostly during the rainy season (May-October). Initial astrovirus episodes were not associated with a lowered risk against future episodes. In exploratory analyses, home toilets were associated with a lower risk of future astrovirus episodes (hazard ratio, 0.19; 95% CI, .04-.91). Human astrovirus 5 episodes, representing 15% of all typed episodes, were associated with longer diarrhea and more symptomatic rotavirus coinfections. CONCLUSIONS: Astrovirus was a common cause of gastroenteritis in this cohort, and future studies should clarify the role of astrovirus genotype in clinical infection severity. |
Charting the impact of maternal antibodies and repeat exposures on sapovirus immunity in early childhood from a Nicaraguan birth cohort
Bucardo F , Mallory ML , González F , Reyes Y , Vielot NA , Yount BL , Sims AC , Nguyen C , Cross K , Toval-Ruíz C , Gutiérrez L , Vinjé J , Baric RS , Lindesmith LC , Becker-Dreps S . J Infect Dis 2024 ![]() BACKGROUND: Sapovirus is an important cause of acute gastroenteritis in childhood. While vaccines against sapovirus may reduce gastroenteritis burden, a major challenge to their development is a lack of information about natural immunity. METHODS: We measured sapovirus-specific IgG in serum collected, between 2017 and 2020, of mothers soon after delivery and at 6 time points in Nicaraguan children until 3 years of age (n=112 dyads) using virus-like particles representing three sapovirus genotypes (GI.1, GI.2, GV.1). RESULTS: Sixteen (14.3%) of the 112 children experienced at least one sapovirus gastroenteritis episode, of which GI.1 was the most common genotype. Seroconversion to GI.1 and GI.2 was most common between 5 and 12 months of age, while seroconversion to GV.1 peaked at 18 to 24 months of age. All children who experienced sapovirus GI.1 gastroenteritis seroconverted and developed genotype-specific IgG. The impact of sapovirus exposure on population immunity was determined using antigenic cartography: newborns share their mothers' broadly binding IgG responses, which declined at 5 months of age and then increased as infants experienced natural sapovirus infections. CONCLUSION: By tracking humoral immunity to sapovirus over the first 3 years of life, this study provides important insights for the design and timing of future pediatric sapovirus vaccines. |
Case series of patients with Marburg Virus Disease, Equatorial Guinea, 2023
Fontana L , Ondo Avomo CO , Ngomo Mikue LE , Fuga Eyemam DÑ , Nguere MA , Mometolo IE , Bibang Nzang RN , Nguema Maye DM , Giuliani R , Jacquerioz F , Lang HJ , Kojan R , Chaillon A , Ngai S , le Polain de Waroux O , Silenzi A , Di Marco M , Negrón ME , Klena JD , Choi MJ , Mayer O , Scholte FEM , Welch SR , Zielinski-Gutierrez E , Diaz J . N Engl J Med 2024 391 (3) 283-285 |
Prevalence of Post-COVID conditions among Mexican COVID-19 survivors: a nationwide cross-sectional study
Ramírez-Toscano Y , Torres-Ibarra L , Carnalla M , Basto-Abreu A , Vidaña-Perez D , Colchero MA , Bautista-Arredondo S , Saydah S , Barrientos-Gutiérrez T . BMC Public Health 2024 24 (1) 1729 BACKGROUND: There are limited population-representative data that describe the potential burden of Post-COVID conditions (PCC) in Mexico. We estimated the prevalence of PCC overall and by sociodemographic characteristics among a representative sample of adults previously diagnosed with COVID-19 in Mexico. We additionally, characterized the PCC symptoms, and estimated the association between diagnosed type-2 diabetes and hypertension with PCC. METHODS: We used data from the 2021 National Health and Nutrition Survey in Mexico, a nationally and regionally representative survey, from August 1st to October 31st, 2021. Using the WHO definition, we estimated the prevalence of PCC by sociodemographics and prevalence of PCC symptoms. We fit multivariable log-binomial regression models to estimate the associations. RESULTS: The prevalence of PCC was 37.0%. The most common persistent symptoms were fatigue (56.8%), myalgia or arthralgia (47.5%), respiratory distress and dyspnea (42.7%), headache (34.0%), and cough (25.7%). The prevalence was higher in older people, women, and individuals with low socioeconomic status. There was no significant association between hypertension and PCC or diabetes and PCC prevalence. CONCLUSIONS: About one-third of the adult Mexican population who had COVID-19 in 2021 had Post-COVID conditions. Our population-based estimates can help assess potential priorities for PCC-related health services, which is critical in light of our weak health system and limited funding. |
Seroprevalence of anti-SARS-CoV-2 IgG antibodies in healthcare personnel in El Salvador prior to vaccination campaigns
Ramírez JEA , Maliga A , Stewart A , Lino A , Oliva JE , Sandoval X , Zielinski-Gutierrez E , Chacon-Fuentes R , Suchdev PS , Zelaya S , Sánchez M , Recinos DL , López B , Hawes E , Liu J , Ronca SE , Gunter SM , Murray KO , Domínguez R . Infect Dis Rep 2024 16 (3) 531-542 COVID-19, caused by the SARS-CoV-2 virus, is a highly pathogenic emerging infectious disease. Healthcare personnel (HCP) are presumably at higher risk of acquiring emerging infections because of occupational exposure. The prevalence of COVID-19 in HCP is unknown, particularly in low- to middle-income countries like El Salvador. The goal of this study was to determine the seroprevalence of anti-SARS-CoV-2 antibodies among HCP in El Salvador just prior to vaccine rollout in March 2021. We evaluated 2176 participants from a nationally representative sample of national healthcare institutions. We found 40.4% (n = 880) of the study participants were seropositive for anti-spike protein antibodies. Significant factors associated with infection included younger age; living within the central, more populated zone of the country; living in a larger household (≥7 members); household members with COVID-19 or compatible symptoms; and those who worked in auxiliary services (i.e., housekeeping and food services). These findings provide insight into opportunities to mitigate SARS-CoV-2 risk and other emerging respiratory pathogens in HCP in El Salvador. |
Trust and COVID-19 vaccine hesitancy in the Dominican Republic: a national cross-sectional household survey, June-October 2021
Garnier S , Then C , de St Aubin M , Cadavid Restrepo A , Mayfield HJ , Dumas D , Duke W , Peña F , Kucharski AJ , Skewes R , Zielinski Gutiérrez E , Coyoli J , Etienne MC , Lau CL , Vázquez M , Nilles E . BMJ Open 2024 14 (5) e081523 OBJECTIVE: This study investigates the role of trust in shaping COVID-19 vaccine acceptance in the Dominican Republic (DR) during the COVID-19 pandemic. DESIGN: Cross-sectional household survey. SETTING: Randomly selected households across 134 clusters in the DR, from 30 June 2021 to 12 October 2021. PARTICIPANTS: 5999 participants ≥16 years of age were enrolled. OUTCOME MEASURES: COVID-19 vaccine hesitancy (CVH) data were collected from participants ≥16 years of age and analysed as both an ordinal and binary variable. RESULTS: Overall, CVH was low (5.2% (95% CI 4.6% to 5.8%)), but more common among younger individuals, women and individuals of Mestizo ethnicity. Higher trust in local government, national government, scientists and local doctors (considered official sources) was associated with lower odds of CVH (OR 0.89 (95% CI 0.72 to 0.88), 0.89 (95% CI 0.81 to 0.98), 0.87 (95% CI 0.80 to 0.94) and 0.70 (95% CI 0.62 to 0.80), respectively). Higher trust in religious leaders, social media and traditional media (considered unofficial sources) was associated with higher odds of CVH, with respective ORs of 1.32 (95% CI 1.18 to 1.47), 1.30 (95% CI 1.19 to 1.41) and 1.08 (95% CI 0.97 to 1.22). CONCLUSION: We report findings on CVH from a national household survey in the DR and identify overall low rates of CVH but marked heterogeneity by age, gender and ethnicity. Trust in unofficial versus official sources of information is associated with increased CVH. These findings highlight and quantify the importance of trust as a key parameter when considering public health communication strategies. |
Subcutaneous phaeohyphomycosis due to Phaeoacremonium venezuelense: The first clinical case report in Costa Rica
Cob M , López LF , Sexton DJ , Fallas A , Muñoz JD , Gutiérrez R . Med Mycol Case Rep 2024 44 100650 Phaeoacremonium is a genus of dematiaceous fungi that rarely causes human infections. We describe a case of subcutaneous infection in a 70-year-old diabetic man with lesions on the dorsum of the one foot. The agent was isolated, and for the final identification we performed matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and DNA sequencing. After diagnosis, the patient underwent curettage of the cyst and received 100mg of Itraconazole, twice daily for 6 months. Clinical resolution of the lesion was observed after treatment. This is the first case of infection by Phaeoacremonium venezuelense reported in Costa Rica. |
The role of funded partnerships in working towards decreasing COVID-19 vaccination disparities, United States, March 2021-December 2022
Fiebelkorn AP , Adelsberg S , Anthony R , Ashenafi S , Asif AF , Azzarelli M , Bailey T , Boddie TT , Boyer AP , Bungum NW , Burstin H , Burton JL , Casey DM , Chaumont Menendez C , Courtot B , Cronin K , Dowdell C , Downey LH , Fields M , Fitzsimmons T , Frank A , Gustafson E , Gutierrez-Nkomo M , Harris BL , Hill J , Holmes K , Huerta Migus L , Jacob Kuttothara J , Johns N , Johnson J , Kelsey A , Kingangi L , Landrum CM , Lee JT , Martinez PD , Medina Martínez G , Nicholls R , Nilson JR , Ohiaeri N , Pegram L , Perkins C , Piasecki AM , Pindyck T , Price S , Rodgers MS , Roney H , Schultz EM , Sobczyk E , Thierry JM , Toledo C , Weiss NE , Wiatr-Rodriguez A , Williams L , Yang C , Yao A , Zajac J . Vaccine 2024 During the COVID-19 vaccination rollout from March 2021- December 2022, the Centers for Disease Control and Prevention funded 110 primary and 1051 subrecipient partners at the national, state, local, and community-based level to improve COVID-19 vaccination access, confidence, demand, delivery, and equity in the United States. The partners implemented evidence-based strategies among racial and ethnic minority populations, rural populations, older adults, people with disabilities, people with chronic illness, people experiencing homelessness, and other groups disproportionately impacted by COVID-19. CDC also expanded existing partnerships with healthcare professional societies and other core public health partners, as well as developed innovative partnerships with organizations new to vaccination, including museums and libraries. Partners brought COVID-19 vaccine education into farm fields, local fairs, churches, community centers, barber and beauty shops, and, when possible, partnered with local healthcare providers to administer COVID-19 vaccines. Inclusive, hyper-localized outreach through partnerships with community-based organizations, faith-based organizations, vaccination providers, and local health departments was critical to increasing COVID-19 vaccine access and building a broad network of trusted messengers that promoted vaccine confidence. Data from monthly and quarterly REDCap reports and monthly partner calls showed that through these partnerships, more than 295,000 community-level spokespersons were trained as trusted messengers and more than 2.1 million COVID-19 vaccinations were administered at new or existing vaccination sites. More than 535,035 healthcare personnel were reached through outreach strategies. Quality improvement interventions were implemented in healthcare systems, long-term care settings, and community health centers resulting in changes to the clinical workflow to incorporate COVID-19 vaccine assessments, recommendations, and administration or referrals into routine office visits. Funded partners' activities improved COVID-19 vaccine access and addressed community concerns among racial and ethnic minority groups, as well as among people with barriers to vaccination due to chronic illness or disability, older age, lower income, or other factors. |
Novel species of Triatoma (Hemiptera: Reduviidae) identified in a case of vectorial transmission of Chagas disease in northern Belize
Gunter SM , Nelson A , Kneubehl AR , Justi SA , Manzanero R , Zielinski-Gutierrez E , Herrera C , Thompson J , Mandage R , Desale H , Maliga A , Bautista K , Ronca SE , Morey F , Fuentes RC , Lopez B , Dumonteil E , Morazan GH , Murray KO . Sci Rep 2024 14 (1) 1412 Chagas disease is a leading cause of non-ischemic cardiomyopathy in endemic regions of Central and South America. In Belize, Triatoma dimidiata sensu lato has been identified as the predominate taxon but vectorial transmission of Chagas disease is considered to be rare in the country. We recently identified an acute case of vector-borne Chagas disease in the northern region of Belize. Here we present a subsequent investigation of triatomines collected around the case-patient's home. We identified yet undescribed species, closely related to Triatoma huehuetenanguensis vector by molecular systematics methods occurring in the peridomestic environment. The identification of a T. cruzi-positive, novel species of Triatoma in Belize indicates an increased risk of transmission to humans in the region and warrants expanded surveillance and further investigation. |
Associations of diabetes, hypertension and obesity with COVID-19 mortality: a systematic review and meta-analysis
Li C , Islam N , Gutierrez JP , Gutiérrez-Barreto SE , Prado AC , Moolenaar RL , Lacey B , Richter P . BMJ Glob Health 2023 8 (12) e012581 Introduction Despite a growing body of scholarly research on the risks of severe COVID-19 associated with diabetes, hypertension and obesity, there is a need for estimating pooled risk estimates with adjustment for confounding effects. We conducted a systematic review and meta-analysis to estimate the pooled adjusted risk ratios of diabetes, hypertension and obesity on COVID-19 mortality.Methods We searched 16 literature databases for original studies published between 1 December 2019 and 31 December 2020. We used the adapted Newcastle-Ottawa Scale to assess the risk of bias. Pooled risk ratios were estimated based on the adjusted effect sizes. We applied random-effects meta-analysis to account for the uncertainty in residual heterogeneity. We used contour-funnel plots and Egger’s test to assess possible publication bias.Results We reviewed 34 830 records identified in literature search, of which 145 original studies were included in the meta-analysis. Pooled adjusted risk ratios were 1.43 (95% CI 1.32 to 1.54), 1.19 (95% CI 1.09 to 1.30) and 1.39 (95% CI 1.27 to 1.52) for diabetes, hypertension and obesity (body mass index ≥30 kg/m2) on COVID-19 mortality, respectively. The pooled adjusted risk ratios appeared to be stronger in studies conducted before April 2020, Western Pacific Region, low- and middle-income countries, and countries with low Global Health Security Index scores, when compared with their counterparts.Conclusions Diabetes, hypertension and obesity were associated with an increased risk of COVID-19 mortality independent of other known risk factors, particularly in low-resource settings. Addressing these chronic diseases could be important for global pandemic preparedness and mortality prevention.PROSPERO registration number CRD42021204371.Data are available in a public, open access repository. Not applicable. |
Prevalence and missed cases of respiratory distress syndrome disease amongst neonatal deaths enrolled in the Kenya Child Health and Mortality Prevention Surveillance Network (CHAMPS) Program Between 2017 and 2021
Owuor HO , Akelo V , Murila F , Onyango D , Kuria M , Rogena E , Revathi G , Mitei P , Sava S , Were J , Igunza A , Khagayi S , Zielinski-Gutierrez E , Hawi S , Gethi D , Verani JR , Onyango C , Blau DM , Tippett Barr BA . Glob Pediatr Health 2023 10 2333794x231212819 Objectives. To describe RDS in neonatal deaths at the CHAMPS-Kenya site between 2017 and 2021. Methods. We included 165 neonatal deaths whose their Causes of death (COD) were determined by a panel of experts using data from post-mortem conducted through minimally invasive tissue specimen testing, clinical records, and verbal autopsy. Results. Twenty-six percent (43/165) of neonatal deaths were attributable to RDS. Most cases occurred in low birthweight and preterm neonates. From these cases, less than half of the hospitalizations were diagnosed with RDS before death, and essential diagnostic tests were not performed in most cases. Most cases received suboptimal levels of supplemental oxygen, and critical interventions like surfactant replacement therapy and mechanical ventilation were not adequately utilized when available. Conclusion. The study highlights the urgent need for improved diagnosis and management of RDS, emphasizing the importance of increasing clinical suspicion and enhancing training in its clinical management to reduce mortality rates. |
Barriers and facilitators to HIV service access among Hispanic/Latino gay, bisexual, and other men who have sex with men in metropolitan Atlanta-a qualitative analysis
Hassan R , Saldana CS , Garlow EW , Gutierrez M , Hershow RB , Elimam D , Adame JF , Andía JF , Padilla M , Gonzalez Jimenez N , Freeman D , Johnson EN , Reed K , Holland DP , Orozco H , Pedraza G , Hayes C , Philpott DC , Curran KG , Wortley P , Agnew-Brune C , Gettings JR . J Urban Health 2023 100 (6) 1193-1201 Hispanic/Latino persons are disproportionately impacted by HIV in the US, and HIV diagnoses among Hispanic/Latino men in Georgia have increased over the past decade, particularly in metropolitan Atlanta. In 2022, the Georgia Department of Public Health detected five clusters of rapid HIV transmission centered among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM) in metropolitan Atlanta. We conducted in-depth interviews with 65 service providers and 29 HLMSM to identify barriers and facilitators to HIV service access for HLMSM. Interviews were audio recorded, transcribed, and translated, if needed. Initial data analyses were conducted rapidly in the field to inform public health actions. We then conducted additional analyses including line-by-line coding of the interview transcripts using a thematic analytic approach. We identified four main themes. First, inequity in language access was a predominant barrier. Second, multiple social and structural barriers existed. Third, HLMSM encountered intersectional stigma. Finally, the HLMSM community is characterized by its diversity, and there is not a one-size-fits-all approach to providing appropriate care to this population. The collection of qualitative data during an HIV cluster investigation allowed us to quickly identity barriers experienced by HLMSM when accessing HIV and other medical care, to optimize public health response and action. Well-designed program evaluation and implementation research may help elucidate specific strategies and tools to reduce health disparities, ensure equitable service access for HLMSM, and reduce HIV transmission in this population. |
Using regional sero-epidemiology SARS-CoV-2 Anti-S antibodies in the Dominican Republic to inform targeted public health response
Mario Martin B , Cadavid Restrepo A , Mayfield HJ , Then Paulino C , De St Aubin M , Duke W , Jarolim P , Zielinski Gutiérrez E , Skewes Ramm R , Dumas D , Garnier S , Etienne MC , Peña F , Abdalla G , Lopez B , de la Cruz L , Henríquez B , Baldwin M , Sartorius B , Kucharski A , Nilles EJ , Lau CL . Trop Med Infect Dis 2023 8 (11) Incidence of COVID-19 has been associated with sociodemographic factors. We investigated variations in SARS-CoV-2 seroprevalence at sub-national levels in the Dominican Republic and assessed potential factors influencing variation in regional-level seroprevalence. Data were collected in a three-stage cross-sectional national serosurvey from June to October 2021. Seroprevalence of antibodies against the SARS-CoV-2 spike protein (anti-S) was estimated and adjusted for selection probability, age, and sex. Multilevel logistic regression was used to estimate the effect of covariates on seropositivity for anti-S and correlates of 80% protection (PT(80)) against symptomatic infection for the ancestral and Delta strains. A total of 6683 participants from 134 clusters in all 10 regions were enrolled. Anti-S, PT80 for the ancestral and Delta strains odds ratio varied across regions, Enriquillo presented significant higher odds for all outcomes compared with Yuma. Compared to being unvaccinated, receiving ≥2 doses of COVID-19 vaccine was associated with a significantly higher odds of anti-S positivity (OR 85.94, [10.95-674.33]) and PT(80) for the ancestral (OR 4.78, [2.15-10.62]) and Delta strains (OR 3.08, [1.57-9.65]) nationally and also for each region. Our results can help inform regional-level public health response, such as strategies to increase vaccination coverage in areas with low population immunity against currently circulating strains. |
Engagement with traditional healers for early detection of plague in Uganda
Apangu T , Candini G , Abaru J , Candia B , Okoth FJ , Atiku LA , Griffith KS , Hayden MH , Zielinski-Gutiérrez E , Schwartz AM , McCormick DW , Mead PS , Kugeler KJ . Am J Trop Med Hyg 2023 109 (5) 1129-1136 In rural Uganda, many people who are ill consult traditional healers prior to visiting the formal healthcare system. Traditional healers provide supportive care for common illnesses, but their care may delay diagnosis and management of illnesses that can increase morbidity and mortality, hinder early detection of epidemic-prone diseases, and increase occupational risk to traditional healers. We conducted open-ended, semi-structured interviews with a convenience sample of 11 traditional healers in the plague-endemic West Nile region of northwestern Uganda to assess their knowledge, practices, and attitudes regarding plague and the local healthcare system. Most were generally knowledgeable about plague transmission and its clinical presentation and expressed willingness to refer patients to the formal healthcare system. We initiated a public health outreach program to further improve engagement between traditional healers and local health centers to foster trust in the formal healthcare system and improve early identification and referral of patients with plaguelike symptoms, which can reflect numerous other infectious and noninfectious conditions. During 2010-2019, 65 traditional healers were involved in the outreach program; 52 traditional healers referred 788 patients to area health centers. The diagnosis was available for 775 patients; malaria (37%) and respiratory tract infections (23%) were the most common diagnoses. One patient had confirmed bubonic plague. Outreach to improve communication and trust between traditional healers and local healthcare settings may result in improved early case detection and intervention not only for plague but also for other serious conditions. |
Acceptability of minimally invasive autopsy by community members and healthcare workers in Siaya and Kisumu counties, western Kenya, 2017-2018
Otieno P , Akelo V , Khagayi S , Omore R , Akoth K , Nyanjom M , Ngere S , Ochola K , Maixenchs M , Kone A , Blevins J , Zielinski-Gutierrez E , Barr BAT . PLOS Glob Public Health 2023 3 (9) e0001319 Worldwide, nearly six million children under the age of five (<5s) die annually, a substantial proportion of which are due to preventable and treatable diseases. Efforts to reduce child mortality indicators in the most affected regions are often undermined by a lack of accurate cause of death data. To generate timely and more accurate causes of death data for <5s, the Child Health and Mortality Prevention Surveillance (CHAMPS) Network established mortality surveillance in multiple countries using Minimally Invasive Tissue Sampling (MITS) in <5 deaths. Here we present acceptability of MITS by community members and healthcare workers in Siaya and Kisumu counties, western Kenya. From April 2017 to February 2018, we conducted 40 in-depth interviews and five focus group discussions with healthcare workers and community members, before and during CHAMPS implementation. Participants were purposively selected. Field observations to understand traditional death-related practices were also performed. Interviews were transcribed into Nvivo 11.0 for data organization and management. Analysis was guided by the grounded theory approach. Facilitators of acceptability were desire to understand why death occurred, timely performance of MITS procedures, potential for MITS results in improving clinical practice and specific assistance provided to families by the CHAMPS program. However, cultural and religious beliefs highlighted important challenges to acceptability, including CHAMPS teams recruiting after a child's death, rumours and myths, unmet expectations from families, and fear by healthcare workers that some families could use MITS results to sue for negligence. Increasing MITS uptake requires sustained strategies to strengthen the identified facilitators of acceptability and simultaneously address the barriers. MITS acceptance will contribute to better characterization of causes of death and support the development of improved interventions aimed at reducing <5 mortality. |
Per- and polyfluoroalkyl substances (PFAS) and lipid trajectories in women 45-56 years of age: The study of women's health across the nation
Kang H , Ding N , Karvonen-Gutierrez CA , Mukherjee B , Calafat AM , Park SK . Environ Health Perspect 2023 131 (8) 87004 BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are associated with less favorable blood lipid profiles in epidemiological studies. However, little is known about the potential role of PFAS in longitudinal changes in lipids among midlife women even though women become more susceptible to metabolic alterations during the menopausal transition. OBJECTIVES: To examine associations of serum PFAS concentrations with longitudinal trajectories of blood total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides in midlife women undergoing menopausal transition. METHODS: The sample included 1,130 women from the Study of Women's Health Across the Nation 45-56 y of age at baseline (1999-2000). We measured serum PFAS concentrations including linear perfluorooctanoic acid (n-PFOA), perfluorononanoic acid (PFNA), linear and branched perfluorooctanesulfonic acid (n-PFOS and Sm-PFOS, respectively), and perfluorohexanesulfonic acid (PFHxS) at baseline. We used k-means clustering to identify subgroups with different patterns of PFAS mixture. Blood lipids were measured annually or biannually through 2016 with an average follow-up of 14.8 y. We identified longitudinal trajectories of each lipid using latent class growth models. We used multinomial log-linear models adjusted for covariates to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of lipid trajectory classes by PFAS and their mixtures. RESULTS: Three distinct trajectories (low, middle, high) of total, LDL, and HDL cholesterol and two distinct trajectories (low and high) of triglycerides were identified. n-PFOS, Sm-PFOS, and PFHxS were positively associated with total and LDL cholesterol trajectories. n-PFOS was inversely associated with triglycerides trajectories. PFAS mixtures (high vs. low) showed positive associations with total and LDL cholesterol trajectories (high vs. low), showing ORs (95% CIs) of 1.69 (95% CI: 1.36, 2.12) and 1.79 (95% CI: 1.44, 2.22), respectively. DISCUSSION: Concentrations of serum PFAS were positively associated with trajectories of total and LDL cholesterol, providing a line of evidence supporting adverse effects of PFAS on lipid homeostasis. https://doi.org/10.1289/EHP12351. |
Operationalizing the Centers for Disease Control and Prevention's Vaccinate with Confidence framework during the COVID-19 emergency response in the United States
Holmes K , Gutierrez-Nkomo M , Donovan J , Manns BJ , Griswold S , Edwards R , Flores SA , Parker Fiebelkorn A . Health Promot Pract 2023 15248399231188106 In December 2020, 11 months after identifying the first laboratory-confirmed case of COVID-19 in the United States, the U.S. Food and Drug Administration authorized emergency use of two COVID-19 vaccines. To prepare the public for a large-scale vaccination campaign and build confidence in COVID-19 vaccines, the U.S. Centers for Disease Control and Prevention (CDC) funded more than 200 partners and developed a national Vaccinate with Confidence (VwC) COVID-19 framework to support Americans in their decision to get vaccinated. The evolving nature of the pandemic and highly variable confidence in vaccines across populations has resulted in many unique complexities and challenges to reaching universally high vaccination coverage. Here, we describe how 23 professional health associations and national partner organizations, focused solely on building vaccine confidence, operationalized CDC's VwC COVID-19 framework from February 2021 to March 2022. Capturing how partners deployed and adapted their activities to meet a shifting pandemic landscape, which began with high demand for vaccines that waned over time, is an important first step to understanding how this new strategy was utilized and could be implemented for future surges in COVID-19 cases and other routine immunization efforts. Going forward, evaluation of partner activities should be prioritized to capture learnings and assess VwC program effectiveness. |
Immunofocusing humoral immunity potentiates the functional efficacy of the AnAPN1 malaria transmission-blocking vaccine antigen (preprint)
Bender NG , Khare P , Martinez J , Tweedell RE , Nyasembe VO , López-Gutiérrez B , Tripathi A , Miller D , Hamerly T , Vela EM , Howard RF , Nsango S , Cobb RR , Harbers M , Dinglasan RR . bioRxiv 2020 2020.11.29.402669 Malaria transmission-blocking vaccines (TBVs) are a critical tool for disease elimination. TBVs prevent completion of the developmental lifecycle of malarial parasites within the mosquito vector, effectively blocking subsequent infections. The mosquito midgut protein Anopheline alanyl aminopeptidase N (AnAPN1) is the leading, mosquito-based TBV antigen and structure-function studies have identified two Class II epitopes that induce potent transmission-blocking (T-B) antibodies. Here, we functionally screened new immunogens and down-selected to the UF6b construct that has two glycine-linked copies of the T-B epitopes. We established a process for manufacturing UF6b and evaluated in outbred female CD1 mice the immunogenicity of the preclinical product with the human-safe adjuvant Glucopyranosyl Lipid Adjuvant in a liposomal formulation with saponin QS21 (GLA-LSQ). UF6b:GLA-LSQ was immunogenic and immunofocused the humoral response to one of the key T-B epitopes resulting in potent T-B activity and establishing UF6b as a prime TBV candidate to aid in malaria elimination and eradication efforts.Competing Interest StatementThe authors have declared no competing interest. |
Use of undetectable viral load to improve population-based survey estimates of known HIV-positive status and antiretroviral treatment coverage in Kenya (preprint)
Young PW , Zielinski-Gutierrez E , Wamicwe J , Mukui I , Kim AA , Waruru A , Zeh C , Kretzschmar ME , De Cock KM . medRxiv 2019 19002592 Introduction Underreporting of prior HIV diagnosis and antiretroviral therapy (ART) use based on self-report is well-documented in national surveys. Antiretroviral (ARV) testing has been used to improve survey estimates, by reclassifying respondents with ARVs detected in blood as previously-diagnosed and on ART. Viral load testing, which is more affordable and more routinely available than ARV testing, is also an indicator of ART use. We examined the impact of adjusting estimated knowledge of HIV-positive status and antiretroviral therapy (ART) use based on self-report with biomarkers for antiretroviral (ARV) drug detection and undetectable viral load (UVL).Methods We reclassified HIV-positive participants aged 15-64 years in the 2012 Kenya AIDS Indicator Survey (KAIS) that were unaware of their HIV-positive status by self-report as aware and on ART if either ARVs were detected or viral load was undetectable (<550 copies/mL) on dried blood spots. We compared self-report to adjustments for ARVs measurement, UVL, or both. We calculated measures of accuracy for UVL and UVL & ARV-adjusted versions of knowledge of status and ART use versus ARV-adjusted self-report as a reference standard.Results Among 235 of 648 HIV-positive respondents with UVL, self-reported status was: 65 unaware (28.7%), 25 aware, not on ART (9.9%) and 145 aware, on ART (61.3%). Treatment coverage among all HIV-positive respondents increased from 31.8% for self-report to 42.5% [95% confidence interval (CI) 37.4-47.8] based on ARV detection alone, to 42.8% (95% CI 37.9-47.8) when ARV-adjusted, 46.2% (95% CI 41.3-51.1) when UVL-adjusted and 48.8% (95% CI 43.9-53.8) when adjusted for ARV and UVL. Awareness of positive status increased from 46.9% for self-report to 56.2% (95% CI 50.7-61.6) when ARV-adjusted, 57.5% (95% CI 51.9-63.0) when UVL-adjusted, and 59.8% (95% CI 54.2-65.1) when adjusted for ARV and UVL. Sensitivity and specificity of UVL-adjusted known HIV-positive status were 95.8% and 91.3%, and of UVL-adjusted ART use were 93.0% and 88.8% respectively, versus ARV-adjusted self-report.Conclusions Undetectable viral load may be a useful adjunct or alternative to ARV detection for adjusting knowledge of status and ART use indicators in population-based surveys.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThe 2012 Kenya AIDS Indicator Survey has been supported by the President?s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC) under the terms of #PS001805, GH000069, and PS001814. The survey was also funded in part by support from the Global Fund, World Bank, and the Joint United Nations Programme on HIV/AIDS.Author DeclarationsAll relevant ethical guidelines have been followed and any necessary IRB and/or ethics committee approvals have been obtained.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesAny clinical trials involved have been registered with an ICMJE-approved registry such as ClinicalTrials.gov and the trial ID is included in the manuscript.Not ApplicableI have followed all appropriate research reporting guidelines and uploaded the relevant Equator, ICMJE or other checklist(s) as supplementary files, if applicable.YesData for KAIS 2012 are available upon request from NASCOP by emailing head@nascop.or.ke, or from the Kenya National Bureau of Statistics by requesting at http://statistics.knbs.or.ke/nada/index.php |
A distinct cross-reactive autoimmune response in multisystem inflammatory syndrome in children (MIS-C) (preprint)
Bodansky A , Sabatino JJ , Vazquez SE , Chou J , Novak T , Moffitt KL , Miller HS , Kung AF , Rackaityte E , Zamecnik CR , Rajan JV , Kortbawi H , Mandel-Brehm C , Mitchell A , Wang CY , Saxena A , Zorn K , Yu DJL , Asaki J , Pluvinage JV , Wilson MR , Loftis LL , Hobbs CV , Tarquinio KM , Kong M , Fitzgerald JC , Espinal PS , Walker TC , Schwartz SP , Crandall H , Irby K , Staat MA , Rowan CM , Schuster JE , Halasa NB , Gertz SJ , Mack EH , Maddux AB , Cvijanovich NZ , Zinter MS , Zambrano LD , Campbell AP , Randolph AG , Anderson MS , DeRisi JL , Kelley H , Murdock M , Colston C , Typpo KV , Sanders RC , Yates M , Smith C , Port E , Mansour R , Shankman S , Baig N , Zorensky F , Chatani B , McLaughlin G , Jones K , Coates BM , Newhams MM , Kucukak S , McNamara ER , Moon HK , Kobayashi T , Melo J , Jackson SR , Rosales MKE , Young C , Chen SR , Da Costa Aguiar R , Gutierrez-Arcelus M , Elkins M , Williams D , Williams L , Cheng L , Zhang Y , Crethers D , Morley D , Steltz S , Zakar K , Armant MA , Ciuculescu F , Flori HR , Dahmer MK , Levy ER , Behl S , Drapeau NM , Kietzman A , Hill S , Cullimore ML , McCulloh RJ , Nofziger RA , Rohlfs CC , Burnett R , Bush J , Reed N , Ampofo KK , Patel MM . medRxiv 2023 30 Multisystem inflammatory syndrome in children (MIS-C) is a severe, post-infectious sequela of SARS-CoV-2 infection, yet the pathophysiological mechanism connecting the infection to the broad inflammatory syndrome remains unknown. Here we leveraged a large set of MIS-C patient samples (n=199) to identify a distinct set of host proteins that are differentially targeted by patient autoantibodies relative to matched controls. We identified an autoreactive epitope within SNX8, a protein expressed primarily in immune cells which regulates an antiviral pathway associated with MIS-C pathogenesis. In parallel, we also probed the SARS-CoV-2 proteome-wide MIS-C patient antibody response and found it to be differentially reactive to a distinct domain of the SARS-CoV-2 nucleocapsid (N) protein relative to controls. This viral N region and the mapped SNX8 epitope bear remarkable biochemical similarity. Furthermore, we find that many children with anti-SNX8 autoantibodies also have T-cells cross-reactive to both SNX8 and this distinct domain of the SARS-CoV-2 N protein. Together, these findings suggest that MIS-C patients develop a distinct immune response against the SARS-CoV-2 N protein that is associated with cross reactivity to the self-protein SNX8, demonstrating a link from the infection to the inflammatory syndrome. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license. |
Integrated SARS-CoV-2 serological and virological screening across an acute fever surveillance platform to monitor temporal changes in anti-spike antibody levels and risk of infection during sequential waves of variant transmission - Dominican Republic, March 2021 to August 2022 (preprint)
Nilles EJ , Aubin MDSt , Dumas D , Duke W , Etienne MC , Abdalla G , Jarolim P , Oasan T , Garnier S , Iihoshi N , Lopez B , de la Cruz L , Puello YC , Baldwin M , Roberts KW , Pena F , Durski K , Sanchez IM , Gunter SM , Kneubehl AR , Murray KO , Lino A , Strobel S , Baez AA , Lau CL , Kucharski A , Gutierrez EZ , Skewes-Ramm R , Vasquez M , Paulino CT . medRxiv 2022 26 The global SARS-CoV-2 immune landscape and population protection against emerging variants is largely unknown. We assessed SARS-CoV-2 antibody changes in the Dominican Republic and implications for immunological protection against variants of concern. Between March 2021 and August 2022, 2,300 patients with undifferentiated febrile illnesses were prospectively enrolled. Sera was tested for total anti-spike antibodies and simultaneously collected nasopharyngeal samples for acute SARSCoV-2 infection with RT-PCR. Geometric mean anti-spike titers increased from 6.6 BAU/ml (95% CI 5.1-8.7) to 1,332 BAU/ml (1055-1,682). Multivariable binomial odds ratios for acute SARS-CoV-2 infection were 0.55 (0.40-0.74), 0.38 (0.27-0.55), and 0.27 (0.18-0.40) for the second, third, and fourth versus the first anti-S quartile, with similar findings by viral strain. Integrated serological and virological screening can leverage existing acute fever surveillance platforms to monitor population-level immunological markers and concurrently characterize implications for emergent variant transmission in near real-time. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license. |
COVID-19 attitudes and vaccine hesitancy among an agricultural community in southwest Guatemala: A cross-sectional survey
Rojop N , Calvimontes DM , Barrios E , Lamb MM , Paniagua-Avila A , Monzon J , Duca LM , Iwamoto C , Chard AN , Gomez M , Arias K , Roell Y , Bolanos GA , Zielinski-Gutierrez E , Azziz-Baumgartner E , Lopez MR , Cordon-Rosales C , Asturias EJ , Olson D . Vaccines (Basel) 2023 11 (6) Despite offering free-of-charge COVID-19 vaccines starting July 2021, Guatemala has one of the lowest vaccination rates in Latin America. From 28 September 2021 to 11 April 2022, we conducted a cross-sectional survey of community members, adapting a CDC questionnaire to evaluate COVID-19 vaccine access and hesitancy. Of 233 participants ≥ 12 years, 127 (55%) received ≥1 dose of COVID-19 and 4 (2%) reported prior COVID-19 illness. Persons ≥ 12 years old who were unvaccinated (n = 106) were more likely to be female (73% vs. 41%, p < 0.001) and homemakers (69% vs. 24%, p < 0.01) compared with vaccinated participants (n = 127). Among those ≥18 years, the main reported motivation for vaccination among vaccinated participants was to protect the health of family/friends (101/117, 86%); on the other hand, 40 (55%) unvaccinated persons reported little/no confidence in public health institutions recommending COVID-19 vaccination. Community- and/or home-based vaccination programs, including vaccination of families through the workplace, may better reach female homemakers and reduce inequities and hesitancy. |
SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection - A multistage national household survey and modelling study, Dominican Republic, June-October 2021.
Nilles EJ , Paulino CT , de St Aubin M , Restrepo AC , Mayfield H , Dumas D , Finch E , Garnier S , Etienne MC , Iselin L , Duke W , Jarolim P , Oasan T , Yu J , Wan H , Peña F , Iihoshi N , Abdalla G , Lopez B , Cruz L , Henríquez B , Espinosa-Bode A , Puello YC , Durski K , Baldwin M , Baez AA , Merchant RC , Barouch DH , Skewes-Ramm R , Gutiérrez EZ , Kucharski A , Lau CL . Lancet Reg Health Am 2022 16 100390 ![]() ![]() BACKGROUND: Population-level SARS-CoV-2 immunological protection is poorly understood but can guide vaccination and non-pharmaceutical intervention priorities. Our objective was to characterise cumulative infections and immunological protection in the Dominican Republic. METHODS: Household members ≥5 years were enrolled in a three-stage national household cluster serosurvey in the Dominican Republic. We measured pan-immunoglobulin antibodies against the SARS-CoV-2 spike (anti-S) and nucleocapsid glycoproteins, and pseudovirus neutralising activity against the ancestral and B.1.617.2 (Delta) strains. Seroprevalence and cumulative prior infections were weighted and adjusted for assay performance and seroreversion. Binary classification machine learning methods and pseudovirus neutralising correlates of protection were used to estimate 50% and 80% protection against symptomatic infection. FINDINGS: Between 30 Jun and 12 Oct 2021 we enrolled 6683 individuals from 3832 households. We estimate that 85.0% (CI 82.1-88.0) of the ≥5 years population had been immunologically exposed and 77.5% (CI 71.3-83) had been previously infected. Protective immunity sufficient to provide at least 50% protection against symptomatic SARS-CoV-2 infection was estimated in 78.1% (CI 74.3-82) and 66.3% (CI 62.8-70) of the population for the ancestral and Delta strains respectively. Younger (5-14 years, OR 0.47 [CI 0.36-0.61]) and older (≥75-years, 0.40 [CI 0.28-0.56]) age, working outdoors (0.53 [0.39-0.73]), smoking (0.66 [0.52-0.84]), urban setting (1.30 [1.14-1.49]), and three vs no vaccine doses (18.41 [10.69-35.04]) were associated with 50% protection against the ancestral strain. INTERPRETATION: Cumulative infections substantially exceeded prior estimates and overall immunological exposure was high. After controlling for confounders, markedly lower immunological protection was observed to the ancestral and Delta strains across certain subgroups, findings that can guide public health interventions and may be generalisable to other settings and viral strains. FUNDING: This study was funded by the US CDC. |
Sociodemographic factors associated with COVID-19 vaccination among people in Guatemalan municipalities
Choudhary R , Carter E , Monzon J , Stewart A , Slotnick J , Samayoa Jerez LL , Rodriguez Araujo DS , Zielinski-Gutierrez E , Suchdev PS . Vaccines (Basel) 2023 11 (4) The Republic of Guatemala's reported COVID-19 vaccination coverage is among the lowest in the Americas and there are limited studies describing the disparities in vaccine uptake within the country. We performed a cross-sectional ecological analysis using multi-level modeling to identify sociodemographic characteristics that were associated with low COVID-19 vaccination coverage among Guatemalan municipalities as of 30 November 2022. Municipalities with a higher proportion of people experiencing poverty (β = -0.25, 95% CI: -0.43--0.07) had lower vaccination coverage. Municipalities with a higher proportion of people who had received at least a primary education (β = 0.74, 95% CI: 0.38-1.08), children (β = 1.07, 95% CI: 0.36-1.77), people aged 60 years and older (β = 2.94, 95% CI: 1.70-4.12), and testing for SARS-CoV-2 infection (β = 0.25, 95% CI: 0.14-0.36) had higher vaccination coverage. In the simplified multivariable model, these factors explained 59.4% of the variation in COVID-19 vaccination coverage. Poverty remained significantly associated with low COVID-19 vaccination coverage in two subanalyses restricting the data to the time period of the highest national COVID-19-related death rate and to COVID-19 vaccination coverage only among those aged 60 years or older. Poverty is a key factor associated with low COVID-19 vaccination and focusing public health interventions in municipalities most affected by poverty may help address COVID-19 vaccination and health disparities in Guatemala. |
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