RESUMEN Introducción: A nivel mundial, la cobertura de vacunación contra el COVID-19, así como contra la influenza es baja tanto en la población general como en los profesionales de la salud a pesar de que la vacuna es gratuita y obligatoria en el personal sanitario. Objetivo: Describir la cobertura de vacunación contra el COVID -19, y la influenza en personal de salud y administrativo de un hospital de referencia del Ministerio de Salud Pública y Bienestar Social en el periodo 2021-2022. Metodología: Estudio observacional descriptivo de corte trasverso. Se hizo la revisión de los registros del personal sanitario y administrativo del centro vacunatorio del Hospital Nacional de Itauguá de la campaña vacunal contra el COVID-19 y de anti-influenza en el periodo 2021- 2022. Resultados: De los 3.586 funcionarios, 999 (27,9 %) eran médicos, 1494 (41,7 %) personal de enfermería, 366 (10,2 %) otra categoría de personal sanitario, y 727 (20,3 %) personal administrativo. En forma global, el 86,5 % de los funcionarios recibió por lo menos las dos dosis que constituyen el esquema primario y el 73 % la dosis de refuerzo. El 2,1 % del personal no recibió ninguna dosis de vacuna anti covid-19, la cifra fue mayor en el personal administrativo (4,8 %). La cobertura de vacunación contra la influenza fue de 20 % en el 2021 y 25 % en el 2022. Discusión: Si bien cobertura de vacunación anti-COVID-19 fue comparable a otros países, la vacunación contra la influenza fue muy baja. Es urgente implementar estrategias dirigidas a aumentar la percepción de riesgo y aceptabilidad de las vacunas obligatorias para el personal sanitario.

ABSTRACT Introduction: Worldwide, vaccination coverage against COVID-19, as well as against influenza, is low both in the general population and in health professionals, despite the fact that the vaccine is free and mandatory for health personnel. Objective: To describe the COVID -19 and influenza vaccination coverage in health and administrative personnel of a reference hospital of the Ministry of Public Health and Social Welfare in the period 2021-2022. Methods: Cross-sectional descriptive observational study. Charts of the health and administrative personnel of the vaccination center of the Itauguá National Hospital of the COVID-19 and influenza vaccination campaign in the period 2021-2022 were reviewed. Results: Of the 3,586 personnel, 999 (27.9%) were medical personnel, 1,494 (41.7%) nursing personnel, 366 (10.2%) other category of health personnel, and 727 (20.3%) administrative personnel. Overall, 86.5% of the employees received at least the two doses that constitute the primary schedule and 73% the booster dose; 2.1% of the staff did not receive any dose of the anti COVID-19 vaccine, which was higher in the administrative staff (4.8%). Influenza vaccination coverage was 20% in 2021 and 25% in 2022. Discussion: Even though the vaccination coverage of anti-COVID-19 was comparable to other countries, vaccination anti-influenza was very low. It is urgent to implement strategies aimed at increasing the perception of risk and acceptability of mandatory vaccines for health personnel.

Resumo Surtos frequentes do vírus da gripe aviária H9N2 no Paquistão revelaram que esse subtipo se tornou endêmico na avicultura e, além das perdas econômicas, representa uma ameaça à saúde pública. O presente estudo descreve a caracterização molecular e as alterações patológicas em frangos de corte naturalmente infectados com a atual cepa H9N2 e sua dinâmica filogenômica. Neste estudo, amostras de tecidos (traqueia, pulmões, rim e intestino) de 100 lotes comerciais de frangos foram coletadas de julho de 2018 a agosto de 2019. As amostras foram submetidas à detecção molecular, filogenia e posterior exame patológico. O comprimento completo do gene HA foi amplificado com sucesso em cinco amostras. O sequenciamento de nucleotídeos revelou amostras positivas colocadas em um clado pertencente à sublinhagem B2 do genótipo G1 e categorizado como LPAIV com base na sequência de aminoácidos do gene da hemaglutinina (HA) no local de clivagem (PAKSSR/G). A análise genética do gene da HA revelou: nt = 80,5%-99,5%; aa = 83,8%-98,9% de homologia com cepas de H9N2 relatadas anteriormente no Paquistão e em países vizinhos (A/Quail/Hong Kong/G1/97). As lesões macroscópicas incluíram aerossaculite leve, hemorragias leves, congestão difusa e exsudato purulento na mucosa traqueal, cilindro fibrinonecrótico no lúmen da traqueia e congestão pulmonar leve. As alterações histopatológicas incluíram descamação de células epiteliais, infiltração de células inflamatórias na traqueia, infiltração de células mononucleares (MNCs), congestão pulmonar e exsudato no lúmen dos parabrônquios, congestão peritubular nos rins com degeneração das células epiteliais tubulares, alterações degenerativas nas células epiteliais das vilosidades intestinais e hiperplasia de células caliciformes. A análise imunoistoquímica confirmou a presença do antígeno AIVH9N2 na traqueia, nos pulmões, no rim e no intestino. A microscopia eletrônica revelou alterações ultraestruturais na traqueia, incluindo cílios degenerados, inchaço mitocondrial e retículo endoplasmático aumentado. Com base em todas as análises, o presente estudo revelou a distribuição do vírus H9N2 do genótipo G1 em Punjab, Paquistão, com patogenicidade de leve a moderada.

Abstract Frequent outbreaks of avian influenza H9N2 virus in Pakistan revealed that this subtype has become endemic in the poultry industry and, besides economic losses, poses a threat to public health. The present study describes the molecular characterization and pathological alterations in naturally infected broiler chickens with the current H9N2 field strain and their phylogenomic dynamics. In this study, tissue samples (trachea, lung, kidney and intestine) from 100 commercial chicken flocks were collected from July 2018 to August 2019. Samples were subjected to molecular detection, phylogeny and subsequent pathological examination. The complete length of the HA gene was successfully amplified in five samples. Nucleotide sequencing revealed positive samples placed in a clade belonging to the B2 sub-lineage of the G1 genotype and categorized as LPAIV based on the amino acid sequence of the HA gene at the cleavage site (PAKSSR/G). Genetic analysis of the haemagglutinin (HA) gene revealed nt: 80.5%-99.5%; aa: 83.8%-98.9% homology to H9N2 strains reported previously from Pakistan, neighbouring countries, and (A/Quail/Hong Kong/G1/97). Gross lesions include a slight airsacculitis, mild hemorrhages, diffuse congestion and purulent exudate in tracheal mucosa, fibrinonecrotic cast in the trachea lumen and mild pulmonary congestion. Histopathological alterations include sloughing of epithelial cells and infiltration of inflammatory cells in the trachea, mononuclear cells (MNCs) infiltration, pulmonary congestion and exudate in the lumen of parabronchi, peritubular congestion in the kidneys with degeneration of tubular epithelial cells and degenerative changes in the intestinal villi epithelial cells and goblet cell hyperplasia. Immunohistochemistry analysis confirmed the presence of AIVH9N2 antigen in the trachea, lungs, kidney and intestine. Electron microscopy revealed ultrastructural changes in the trachea, including degenerated cilia, mitochondrial swelling and enlarged endoplasmic reticulum. Based on all essential analysis, the present study revealed the distribution of the H9N2 virus of G1 genotype in Punjab, Pakistan, with mild to moderate pathogenicity.

RESUMO Objetivo: Analisar os fatores associados à hospitalização em enfermaria e unidade de terapia intensiva (UTI), e ao óbito pela COVID-19 em gestantes com caso confirmado. Métodos: Pesquisa observacional, transversal, realizada com dados de gestantes com caso confirmado para COVID-19 provenientes do Sistema de Informação de Vigilância Epidemiológica da Gripe e do Sistema Estadual Notifica COVID-19, do Paraná. Investigou-se a associação entre variáveis independentes e dependentes (hospitalização em enfermaria e UTI, e óbito) pelo modelo de regressão de Poisson com variância robusta. Resultados: 4.719 gestantes compuseram a população do estudo; 9,6 e 5,1% foram hospitalizadas em enfermaria e UTI, respectivamente; 1,9% evoluíram para óbito. Houve associação entre a idade materna avançada e internação em enfermaria (RP=1,36; IC95% 1,10–1,62) e UTI (RP=2,25; IC95% 1,78–2,71), e óbito (RP=3,22; IC95% 2,30–4,15). Verificou-se associação entre o terceiro trimestre gestacional e hospitalização em enfermaria (RP=5,06; IC95% 2,82–7,30) e UTI (RP=6,03; IC95% 3,67–8,39) e óbito (RP=13,56; IC95% 2,90–24,23). O segundo trimestre associou-se à internação em UTI (RP=2,67; IC95% 1,36–3,99). Gestantes com cardiopatia apresentaram maior frequência de hospitalização em enfermaria (RP=2,24; IC95% 1,43–3,05) e UTI (RP=2,66; IC95% 1,46–3,87). A obesidade foi associada à admissão em UTI (RP=3,79; IC95% 2,71–4,86) e ao óbito (RP=5,62; IC95% 2,41–8,83). Conclusão: A idade materna avançada, o final do período gestacional e comorbidades foram fatores associados a quadros graves de COVID-19.

ABSTRACT Objective: To analyze the factors associated with hospitalization in the ward and intensive care unit (ICU), and with death from COVID-19 in pregnant women with confirmed cases. Methods: Observational, cross-sectional study, carried out with data from pregnant women with a confirmed case of COVID-19 from the Influenza Epidemiological Surveillance Information System and the Paraná’s state COVID-19 notification system. The association between the independent and dependent variables (hospitalization in the ward and ICU, and death) was investigated using the Poisson regression model with robust variance. Results: 4,719 pregnant women comprised the study population. 9.6 and 5.1% were hospitalized in wards and ICU, respectively. 1.9% died. There was an association between advanced maternal age and hospitalization in wards (PR=1.36; 95%CI 1.10–1.62) and ICU (PR=2.25; 95%CI 1.78–2.71), and death (PR=3.22; 95%CI 2.30–4.15). An association was found between the third trimester and hospitalization in wards (PR=5.06; 95%CI 2.82–7.30) and ICU (PR=6.03; 95%CI 3.67–8.39) and death (PR=13.56; 95%CI 2.90–24.23). The second trimester was associated with ICU admission (PR=2.67; 95%CI 1.36–3.99). Pregnant women with cardiovascular disease had a higher frequency of hospitalization in wards (PR=2.24; 95%CI 1.43–3.05) and ICU (PR=2.66; 95%CI 1.46–3.87). Obesity was associated with ICU admission (PR=3.79; 95%CI 2.71–4.86) and death (PR=5.62; 95%CI 2.41–8.83). Conclusions: Advanced maternal age, the end of the gestational period and comorbidities were associated with severe COVID-19.

ABSTRACT Objective: To analyze the spatio-temporal dynamics of COVID-19 in the Rio de Janeiro state within the nine health regions, between March 2020 and December 2022. Methods: The Poisson model with random effects was used to smooth and estimate the incidence of COVID-19 hospitalizations reported in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) to verify the synchronicity of the epidemic in the state. Results: The COVID-19 epidemic in the state is characterized by the presence of seven peaks during the analyzed period corresponding to seven found. An asynchrony in hospitalizations was identified, varying according to the different virus variants in the nine health regions of the state. The incidence peaks of hospitalizations ranged from 1 to 12 cases per 100,000 inhabitants during the pandemic. Conclusion: This spatio-temporal analysis is applicable to other scenarios, enabling monitoring and decision-making for the control of epidemic diseases in different areas.

RESUMO Objetivo: Analisar a dinâmica espaço-temporal de COVID-19 no estado do Rio de Janeiro nas nove regiões de saúde, entre março de 2020 e dezembro de 2022. Métodos: Utilizou-se o modelo de Poisson com efeitos aleatórios para suavizar a curva de incidência de hospitalizações por COVID-19 notificadas no Sistema de Informação da Vigilância Epidemiológica da Gripe (Sivep-Gripe) para verificar a sincronicidade da epidemia no estado. Resultados: A epidemia de COVID-19 no estado é caracterizada pela presença de sete picos no período analisado correspondentes a sete variantes encontradas. Identificou-se uma assincronicidade nas hospitalizações, variando de acordo com as diferentes variantes do vírus nas nove regiões de saúde do estado. Os picos de incidência das hospitalizações variaram de 1 a 12 casos por 100 mil habitantes no decorrer da pandemia. Conclusão: Essa análise espaço-temporal é extensível em outros cenários, sendo possível o monitoramento e a tomada de decisões de controle de doenças epidêmicas em várias áreas.

ABSTRACT Objective: To evaluate severe acute respiratory syndrome surveillance in a pediatric unit. Methods: Descriptive study of reported severe acute respiratory syndrome cases with the detection of respiratory viruses in the nasopharyngeal sample of patients hospitalized between 2013 and 2019, in a reference hospital in the Federal District, Brazil. Results: A total of 269 children had one or more viruses detected, resulting in 280 viruses, of which 152 (54%) were respiratory syncytial virus. The detection of respiratory syncytial virus was higher during the autumn-winter period. Children´s median age was 6.9 months, 156 (58%) were male, 104 (39%) had comorbidity, 197 (73%) required mechanical ventilation, 241 (90%) received antibiotics, and 146 (54%) oseltamivir. There were 19 (7%) deaths. The median time from symptom onset to sample collection was 5 days and the median time from sample collection to final results was 6 days. Conclusions: The system needs to reduce the time to deliver results so that inappropriate use of antibiotics and antivirals can be avoided. Moreover, the burden of viral pneumonia was relevant and the system must be flexible enough to include emerging viruses in order to be useful in responding to public health emergencies caused by respiratory viruses.

RESUMO Objetivo: Avaliar a vigilância da síndrome respiratória aguda grave em uma unidade pediátrica. Métodos: Estudo descritivo dos casos de síndrome respiratória aguda grave, notificados e com a detecção de vírus respiratório em amostra de nasofaringe de pacientes internados entre 2013 e 2019, em um hospital de referência do Distrito Federal. Resultados: Um total de 269 crianças tiveram algum vírus detectado, resultando em 280 vírus, sendo 152 (54%) vírus sincicial respiratório. A detecção do vírus sincicial respiratório foi maior durante o período de outono-inverno. A mediana da idade das crianças foi de 6,9 meses, 156 (58%) eram do sexo masculino, 104 (39%) tinham comorbidade, 197 (73%) necessitaram de ventilação mecânica, 241 (90%) receberam antibióticos e 146 (54%) oseltamivir. Ocorreram 19 (7%) óbitos. A mediana do tempo desde o início dos sintomas até a coleta da amostra foi de 5 dias, e do tempo da coleta até o resultado foi de 6 dias. Conclusões: O sistema necessita reduzir o tempo do resultado final para que seja possível evitar o uso inadequado de antibióticos e antivirais. Ademais, o impacto das pneumonias virais foi relevante e o sistema deve ser flexível suficiente para incluir vírus emergentes, para ser útil na resposta às emergências de saúde pública causada por vírus respiratórios.

RESUMO Objetivo: Analisar a influência dos fatores individuais e contextuais do hospital e do município de assistência sobre a sobrevida de pacientes com Síndrome Respiratória Aguda Grave por COVID-19. Métodos: Estudo de coorte hospitalar com dados de 159.948 adultos e idosos com Síndrome Respiratória Aguda Grave por COVID-19 internados de 01 de janeiro a 31 de dezembro de 2022 e notificados no Sistema de Informação de Vigilância Epidemiológica da Influenza. As variáveis contextuais foram relacionadas à estrutura, aos profissionais e equipamentos dos estabelecimentos hospitalares e indicadores socioeconômicos e de saúde dos municípios. O desfecho foi a sobrevida hospitalar em até 90 dias. Árvore de sobrevida e curvas de Kaplan-Meier foram utilizados para analisar a sobrevida. Resultados: A letalidade hospitalar foi de 30,4%. Idosos submetidos à ventilação mecânica invasiva e internados em cidades com baixo percentual de arrecadação de impostos apresentaram menor sobrevida quando comparados aos demais grupos identificados na árvore de sobrevida (p<0,001). Conclusão: O estudo indicou a interação de fatores contextuais com os individuais, e evidencia que características hospitalares e dos municípios aumentam o risco de óbito, destacando a atenção à organização, ao funcionamento e desempenho da rede hospitalar.

ABSTRACT Objective: To analyze the influence of individual and contextual factors of the hospital and the municipality of care on the survival of patients with Severe Acute Respiratory Syndrome due to COVID-19. Methods: Hospital cohort study with data from 159,948 adults and elderly with Severe Acute Respiratory Syndrome due to COVID-19 hospitalized from January 1 to December 31, 2022 and reported in the Influenza Epidemiological Surveillance Information System. The contextual variables were related to the structure, professionals and equipment of the hospital establishments and socioeconomic and health indicators of the municipalities. The outcome was hospital survival up to 90 days. Survival tree and Kaplan-Meier curves were used for survival analysis. Results: Hospital lethality was 30.4%. Elderly patients who underwent invasive mechanical ventilation and were hospitalized in cities with low tax collection rates had lower survival rates compared to other groups identified in the survival tree (p<0.001). Conclusion: The study indicated the interaction of contextual factors with the individual ones, and it shows that hospital and municipal characteristics increase the risk of death, highlighting the attention to the organization, operation, and performance of the hospital network.

ABSTRACT Equine influenza is a highly contagious viral disease, specially among 1-5 years old naive horses. Vaccination is considered the best way to control the disease spread and outbreaks. Although foals are the main animal used for evaluation of equine influenza vaccines, guinea pigs were chosen as an alternative model in the present work, as they have a negligible antibody titer against equine influenza virus and are cheaper and easier to handle than foals. Five equine influenza vaccine batches were evaluated in two animal models, foals and guinea pigs, by injection of two doses/animal with 4 weeks apart using 2 mL/animal/dose and evaluation of immune responses by hemagglutination inhibition test and enzyme-linked immunosorbent assay. On the 7th week post vaccination, equine influenza antibodies titers reached maximum values of 9-10.2 and 8.7-10 hemagglutination inhibition units for foals and guinea pigs, respectively; sample/negative ratios were 0.126-0.464 and 0.128-0.445 for both animals, respectively. The use of guinea pigs as an animal model for the evaluation of equine influenza vaccines could be recommended instead of foals.

RESUMEN La gripe equina es una enfermedad viral muy contagiosa, especialmente entre los caballos jóvenes de 1 a 5 años de edad. La vacunación se considera la mejor forma de controlar la propagación y los brotes de la enfermedad. Aunque los potros son el principal animal utilizado para la evaluación de vacunas contra la gripe equina, en el presente trabajo se eligieron cobayos como modelo alternativo, ya que tienen un título insignificante de anticuerpos contra el virus de la gripe equina y son más baratos y fáciles de manejar que los potros. Se evaluaron cinco lotes de vacunas contra la gripe equina en dos modelos animales, potros y cobayos, mediante la inyección de dos dosis/animal con 4 semanas de intervalo utilizando 2 mL/animal/dosis y la evaluación de las respuestas inmunitarias mediante la prueba de inhibición de la hemaglutinación y el ensayo inmunoenzimático. En la 7ª semana posvacunación, los títulos de anticuerpos contra la gripe equina alcanzaron valores máximos de 9-10,2 y 8,7-10 unidades de inhibición de la hemaglutinación para potros y cobayos, respectivamente; las relaciones muestras/negativos fueron de 0,126-0,464 y 0,128-0,445 para ambos animales, respectivamente. Podría recomendarse el uso de cobayos como modelo animal para la evaluación de vacunas contra la gripe equina, en lugar de potros.

Abstract This study aimed to evaluate in feral pigs the presence of Salmonella spp (Spp), porcine reproductive and respiratory syndrome virus (PRRSV), porcine circovirus type 2 (PCV2), swine influenza virus (SIV), porcine epidemic diarrhea virus (PEDV), Mycoplasma hyopneumoniae (Mhyo) and Actinobacillus pleuropneumoniae (App). The samples were obtained from pigs in the states of Chihuahua and Durango, Mexico. The tests analyzed for the animals from Chihuahua were nasal swabs for SIV, rectal swabs for Spp and PEDV, serum for PRRSV and PCV2, lung, liver, and lymph nodes for Spp, SIV, PRRSV, and PCV2, as well as serum for serological tests. From animals in the state of Durango, the following was collected: nasal swabs for SIV, rectal swabs for Spp and PEDV, and serum for PCV2 for molecular and serological studies. The molecular results in both states showed samples positive for PCV2, 73.3 % in Chihuahua and 91.3 % in Durango; likewise, two positive samples were obtained for Spp in the state of Chihuahua (13.3 %) and one in Durango (6.6 %), for SIV there were two positive (8.7 %) in Durango. For PRRSV and PEDV, samples were negative in both states. Serological results in pigs from the two states showed positivity for PCV2, Spp, and App. Samples were negative for PRRSV, PEDV, and Mhyo in both states. It is important to highlight the molecular and serological detection of feral pigs positive for various infectious agents important in pig production with zoosanitary repercussions on public health, which implies an epidemiological relevance of these animals in the context of “one health”.

Resumen El objetivo de este trabajo fue evaluar en cerdos ferales la presencia de Salmonella spp (Spp), el virus del síndrome reproductivo y respiratorio porcino (VPRRS), circovirus porcino tipo 2 (PCV2), virus de influenza porcina (VIP), virus de diarrea epidémica porcina (VDEP), Mycoplasma hyopneumoniae (Mhyo) y Actinobacillus pleuropneumoniae (App). Las muestras se obtuvieron de cerdos en los estados de Chihuahua y Durango, México. Las pruebas analizadas para los animales de Chihuahua fueron hisopado nasal para VIP, hisopado rectal para Spp y VDEP, suero para VPRRS y PCV2, pulmón, hígado y linfonodos para Spp, VIP, VPRRS y PCV2, así como suero para pruebas serológicas. De los animales del estado de Durango se recolectó hisopado nasal para VIP, hisopado rectal para Spp y VDEP, y suero para PCV2 para estudios moleculares y serológicos. Los resultados moleculares en ambos estados mostraron muestras positivas para PCV2, 73.3 % en Chihuahua y 91.3 % para Durango, de igual forma se obtuvieron dos muestras positivas para Spp en el estado de Chihuahua (13.3 %) y una en Durango (6.6 %), para VIP hubo dos positivas (8.7 %) en Durango. Para VPRRS y VDEP, las muestras fueron negativas en ambos estados. Los resultados serológicos en cerdos de los dos estados mostraron positividad para PCV2, Spp y App. Las muestras fueron negativas para VPRRS, VDEP y Mhyo en ambos estados. Es importante remarcar la detección molecular y serológica de cerdos ferales positivos a diversos agentes infecciosos importantes en la producción porcina con repercusiones zoosanitarias en la salud pública, que implica una relevancia epidemiológica de estos animales en el contexto de “una salud”.

Background: In June 2009, the World Health Organization (WHO) raised the global alert level for the A(H1N1)pdm09 influenza pandemic and at that time sustained transmission in Brazil was established. It was urgent to carry out studies that evaluated possible risk factors for death from Influenza A(H1N1) to improve case management strategies to reduce the lethality of the disease. This study aimed to identify risk factors for death from Influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. Methods: A case-control of incident cases of influenza A(H1N1) reported in the Epidemiological Information Systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. Results: 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas – 9 cases/10 controls, Pará – 22 cases/77 controls, São Paulo – 19 cases/49 controls, Paraná – 10 cases/54 controls, Rio Grande do Sul – 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from Influenza A(H1N1) were identified. Conclusion: The risk factors identified in this investigation allowed subsidizing the elaboration of clinical conducts, but also indicate important aspects for facing “new” influenza epidemics that are likely to occur in our country.

Resumo Introdução: Um teste rápido de diagnóstico de pneumonia tem o potencial de orientar decisões clínicas, como o início de antibioterapia, permitindo a redução do uso de antibióticos de amplo espectro. Contudo, a aceitação desses testes de diagnóstico está dependente da sua precisão. De forma a avaliar a assertividade diagnóstica e a precisão do painel de pneumonia BioFire® FilmArray® (BFFA) na identificação de microorganismos em secreções brônquicas, realizamos este estudo retrospetivo, que decorreu no Serviço de Medicina Intensiva (SMI) do CMHT. Métodos: Neste estudo foram incluídos todos os doentes (n = 104) internados no nosso SMI com pneumonia e que realizaram o teste BFFA, entre dezembro de 2019 e março de 2021. As amostras do trato respiratório inferior foram colhidas e analisadas simultaneamente pelo BFFA e pela cultura microbiológica. O painel BFFA incluiu 18 bac-térias e 8 vírus, que comumente causam pneumonia, bem como 7 genes de resistência a antibióticos, identificados a partir de amostras quer de aspirado traqueal, quer de lavado broncoalveolar (LBA). Resultados: Este estudo incluiu 104 pacientes, com idade média de 62 anos. O BFFA foi positivo em 111/125 (88%) das amostras colhidas. As bactérias mais comummente detetadas foram Staphylococcus aureus (19%), Klebsiella pneumonia (14%) e Haemophilus influenza (10%). Discussão: Foi possível inferir a forte concordância entre os resultados do BFFA e do exame cultural na deteção de bactérias. De facto, a maioria das bactérias (76/106 [72%]) detetadas pelo BFFA também foram identificadas na cultura. Por outro lado, é de realçar que de todos os BFFA negativos, apenas um teve isolamento de agente no exame cultural. Conclusão: A análise de amostras de secreções respiratórias em tempo real com o BFFA tem o potencial de identificar microorganismos, assim como marcadores de resistência, mais rapidamente do que os métodos tradicionais baseados no exame cultural. De facto, o BFFA é um método rápido e preciso para deteção de microorganismos causadores de infeções do trato respiratório inferior com proporção de concordância positiva de 72% e proporção de concordância negativa próxima de 100%, na população estudada.

Abstract Introduction: Rapid diagnostic testing for pneumonia has the presume potential to guide clinical decisions in reducing the use of broad-spectrum antibiotics. These benefits should be dependent upon the accuracy of these test. In order to evaluate the diagnostic yield and accuracy of the BioFire® FilmArray® pneumonia panel (BFFA) for pathogens identification in lower respiratory tract specimens, we conduct this retrospective study in a intensive care unit (ICU). Methods: In this study were included all patients (n = 104) admitted in our ICU with pneumonia who underwent BFFA test, between December 2019 and March 2021. Lower respiratory tract samples were collected and analysed simultaneously with BFPP and microbiological culture, as part of standard-of-care testing. The BFFA panel includes for 18 bacteria and 8 virus, that commonly cause pneumonia as well 7 antibiotic resistance genes, identified from tracheal aspirate or bronchial alveolar lavage (BAL) specimens. Results: This study included 104 patients, with an average age of 62 years. The BFFA was positive in 111/125 (88%) samples. The most common bacteria detected were Staphylococcus aureus (19%), Klebsiella pneumonia (14%) and Haemophilus influenza (10%). Discussion: There was strong concordance between BFFA and culture for detection of bacteria. In fact, most bacteria (76/106 [72%]) detected by BFFA were also identified in culture. In other hand, it is relevant that only one negative BFPP had an isolated agent in the cultural exam. Conclusion: Real-time specimen analysis with BFFA has the potential to identify bacterial and viral pathogens and theirs resistance markers, faster than traditional culture-based methods. In fact, the BFFA is a rapid and accurate method for detection of pathogens from lower respiratory tract infections with a 72% sensitivity and 100% specificity, in our studied population.

Resumen: En este artículo se analiza y compara la Iniciativa Conjunta México y Estados Unidos para Combatir la Pandemia de COVID-19, con respecto al Plan de América del Norte para la Influenza Animal y Pandémica, y su aporte para promover una frontera segura en el contexto de la pospandemia, con base en un enfoque de gobernanza. La metodología se fundamenta en un análisis de la Iniciativa Conjunta y del Plan, al igual que de las órdenes emitidas bajo las secciones 362 y 365 de la Ley de Servicio de Salud Pública del gobierno de Estados Unidos. Además, se analiza un modelo de gobernanza para promover una mejor gestión transfronteriza de la pandemia, hacia una frontera segura. Entre las conclusiones, se plantean las siguientes: el Plan consideró una gobernanza eficaz, que contribuyó a reducir la pandemia H1N1, lo cual no sucedió con la Iniciativa Conjunta, en el caso de la pandemia COVID-19. Aunque se cerró la frontera estadounidense a los residentes mexicanos con visa de Estados Unidos durante 18 meses (20 de marzo de 2020 a 7 de noviembre de 2021), con un criterio de seguridad nacional, no disminuyeron los contagios y fallecimientos en la frontera México-Estados Unidos, a causa de un déficit de gobernanza.

Abstract: From a governance approach, this article analyzes and compares the United States-Mexico Joint Initiative to Combat the COVID-19 Pandemic, with respect to the North American Plan for Animal and Pandemic Influenza, and its contribution to promoting a secure border in the context of post-pandemic. The methodology is based on an analysis of the Joint Initiative and the North American Plan for Animal and Pandemic Influenza, as well as the orders issued under sections 362 and 365 of the United States government's Public Health Service Act. In addition, a governance model to promote better cross-border management of the pandemic toward a secure border is analyzed. Among the conclusions, the following are stated: the Plan considered effective governance that had an impact on the reduction of the H1N1 pandemic, which did not happen with the Joint Initiative in the case of the COVID-19 pandemic. Although the US border was closed to Mexican residents with a United States visa, for 18 months (March 20, 2020 to November 7, 2021), with a national security criterion, the number of infections and deaths on the United States-Mexico border did not decrease, due to a governance deficit.

Resumo: Este artigo analisa e compara a Iniciativa Conjunta Estados Unidos-México para Combater a Pandemia de COVID-19, no que diz respeito ao Plano Norte-Americano de Influenza Animal e Pandêmica, e sua contribuição para a promoção de uma fronteira segura no contexto da pós-pandemia, com base em uma abordagem de governança. A metodologia baseia-se na análise da Iniciativa Conjunta e do Plano, bem como nas ordens emitidas sob as seções 362 e 365 da Lei do Serviço de Saúde Pública do Governo dos Estados Unidos. Além disso, é analisado um modelo de governação para promover uma melhor gestão transfronteiriça da pandemia, rumo a uma fronteira segura. Entre as conclusões, propõem-se: o Plano considerou uma governança efetiva, que contribuiu para a redução da pandemia de H1N1, o que não ocorreu com a Iniciativa Conjunta, no caso da pandemia de COVID-19. Embora a fronteira com os EUA tenha sido fechada para residentes mexicanos com vistos americanos por 18 meses (20 de março de 2020 a 7 de novembro de 2021), com base em critérios de segurança nacional, as infecções e mortes na fronteira México-México não diminuíram. de um déficit de governança.

Resumen Introducción: La Asociación para el Cuidado de la Diabetes en Argentina - CUI.D.AR, realizó una encuesta online, diseñada para recabar conocimientos y apre ciaciones de las personas con diabetes mellitus y su entorno cercano sobre el virus Influenza y los riesgos potenciales asociados con la infección, y explorar el nivel de confianza en las vacunas en general y en la vacuna antigripal en particular. Métodos: Entre el 30 de septiembre y el 15 de noviem bre de 2021, un total de 1425 participantes completaron el cuestionario de forma anónima y voluntaria. La población que respondió la encuesta incluyó personas con distinto tipo de diabetes (n = 822), familiares, cuidadores y/o con tactos cercanos (n = 603), principalmente residentes en diferentes áreas geográficas del país y de diversas edades. Resultados: El 85% de los participantes, en conjunto, consideraba que el virus Influenza y la gripe son un ries go para la salud de las personas con diabetes. El 72% de los participantes refirió que la persona con diabetes se había aplicado la vacuna anualmente, incluso durante la pandemia de COVID-19. El nivel expresado de confianza en las vacunas fue elevado. Los participantes asigna ron un rol importante a los profesionales de la salud en la indicación de la vacuna antigripal y expresaron la necesidad de mayor información en los medios de comunicación sobre las vacunas. Discusión: La presente encuesta aporta datos obte nidos en el contexto de la vida real que podrían contri buir a optimizar la inmunización de las personas con diabetes.

Abstract Introduction: The Asociación para el Cuidado de la Diabetes en Argentina - CUI.D.AR, carried out an online survey specifically designed to collect the knowledge and perceptions people who suffered from diabetes mellitus and their close contacts had on the Influenza virus and the potential risks associated with the infection. The survey also explored the confidence level in vaccines in general and in anti-influenza vaccines in particular. Methods: Between September 30th and November 15th 2021, 1425 participants anonymously and voluntarily completed the questionnaire. The survey respondents included people with different types of diabetes (n=822), their relatives, carers and close contacts (n=603). They were of diverse ages, most of whom lived in different geographical areas of the country. Results: Overall, 85% of the participants considered that the Influenza virus and the disease represent a risk for people with diabetes. Seventy-two percent of the participants expressed that the person with diabetes had received their annual immunization, even during the COVID-19 pandemic. The referred level of confidence in vaccines was high. The participants assigned an important role to health professionals in vaccines prescription and expressed the need for more information about vaccines in the media. Discussion: The present survey contributes real-world data that could help optimize diabetic people’s immunization.

Resumen: En este artículo se mide el impacto demográfico de la influenza de 1918 a partir del análisis de las actas de defunción del Registro Civil en Uruapan, además de la mortalidad causada por epidemias, endemias y la violencia, así como en los años de régimen “normal”. Asimismo, se diferencia el impacto por grupos de edad y sexo. La influenza se manifestó entre los años 1918 y 1920 en diferentes oleadas. El periodo de 1909 a 1923 mostró brotes epidémicos de enfermedades que adquirieron un carácter endémico, como la viruela y el tifo, así como la presencia de otros padecimientos contagiosos como el sarampión y el paludismo. Otro factor de mortandad fue la violencia que se desató a partir del inicio de la revolución mexicana reflejado en el aumento de homicidios.

Abstract: The demographic impact of the 1918 flu pandemic is measured by analyzing the death certificates of the Civil Registry in Uruapan, together with the number of lives claimed by epidemics, endemics, and violence. Death rates during normal periods are also examined, with the impact being disaggregated by age group and sex. Several waves of flu took place between 1918 and 1920. The period between 1909 and 1923 saw epidemic outbreaks of diseases that became endemic, such as smallpox and typhus, as well as other contagious diseases such as measles and malaria. Another factor contributing to the death rate was the violence that erupted following the onset of the Mexican Revolution, reflected in the increase in homicides.