Background: Surgical site infection (SSI) is both the most frequently studied healthcare-associated infection and the most common healthcare-associated infection in the developing world. A systematic review and meta-analysis was conducted to evaluate the relative size of this burden and to estimate the prevalence of SSI in clean and clean-contaminated surgeries in a large sample of countries in the developing world. Methods: A systematic search of the MEDLINE/PubMed, Scopus, and LILACS databases was conducted to identify studies providing the prevalence of SSI in elective clean and clean-contaminated surgeries in 39 countries or regions around the world. Data of interest were limited to publications from January 2000 to December 2017. Studies with information on the number of cases of SSI and number of total elective clean and clean-contaminated surgeries during the same period were included in this evaluation. Studies lacking clear definition of the total number of exposed patients were excluded. Results: Based on the combined data from the 99 articles evaluated in this analysis, the overall prevalence of SSI in elective clean and clean-contaminated surgeries was estimated to be 6% (95% confidence interval (CI) 5-7%). This increased to 15% (95% CI 6-27%) when considering only those reports with post-discharge surveillance data. The overall prevalence of SSI in Africa/Middle East, Latin America, Asia, and China was 10% (95% CI 6-15%), 7% (95% CI 5-10%), 4% (95% CI 4-5%), and 4% (95% CI 2-6%), respectively. Significant variability in the data was confirmed by both the funnel plot and the Egger test (p = 0.008). Conclusions: Although the data are variable, it is clear that the incidence of SSI in the developing world is higher than that in the developed world.

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Introduction The prevalence of Clostridium difficile infection is rapidly increasing worldwide, but prevalence is difficult to estimate in developing countries where awareness, diagnostic resources, and surveillance protocols are limited. As diarrhea is the hallmark symptom, we conducted a systematic review and meta-analysis to determine the prevalence and incidence of C. difficile infection in patients in these regions who presented with diarrhea. Methods We conducted a systematic literature search of MEDLINE/PubMed, Scopus, and Latin-American and Caribbean Health Sciences Literature databases to identify and analyze data from recent studies providing prevalence or incidence rates of C. difficile -associated diarrhea in developing countries within four regions: Africa–Middle East, developing Asia, Latin America, and China. Our objectives were to determine the current prevalence and incidence density rates of first episodes of C. difficile -associated diarrhea in developing countries. Results Within the regions included in our analysis, prevalence of C. difficile infection in patients with diarrhea was 15% (95% CI 13–17%) (including community and hospitalized patients), with no significant difference across regions. The incidence of C. difficile infection in 17 studies including this information was 8.5 per 10,000 patient-days (95% CI 5.83–12.46). Prevalence was significantly higher in hospitalized patients versus community patients ( p = 0.0227). Conclusion Our prevalence estimate of 15% is concerning; however, low awareness and inconsistent diagnostic and surveillance protocols suggest this is markedly underestimated. Enhanced awareness and management of C. difficile infection in patients with diarrhea, along with improvements in infection control and surveillance practices, should be implemented to reduce prevalence of C. difficile -associated diarrhea in developing countries. Funding Pfizer Inc. Electronic supplementary material The online version of this article (10.1007/s40121-019-0231-8) contains supplementary material, which is available to authorized users.

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The ORs for CAP and IPD of patients with two or more comorbidities, with or without smoking, were found to be similar to the ORs for CAP and IPD described in the literature for patients currently classified as high risk. The potential impact of multiple, stacking comorbidities is underestimated and there is a need for the risk categories for pneumococcal disease to be redefined.

Background Among older adults, 13-valent pneumococcal conjugate vaccine (PCV13) has been found efficacious against non-bacteremic pneumonia associated with vaccine-serotype pneumococci. However, the burden of lower-respiratory tract infection (LRTI) and pneumonia preventable by direct immunization of older adults continues to be debated. Methods We analyzed data from an open cohort of adults aged ≥65 years enrolled in Kaiser Permanente Southern California health plans from 2016 to 2019, who received PCV13 concordant with US Advisory Committee on Immunization Practices guidelines. We estimated PCV13 vaccine effectiveness (VE) via the adjusted hazards ratio (aHR) for first LRTI and pneumonia episodes during each respiratory season, comparing PCV13-exposed and PCV13-unexposed time at risk for each participant using a self-matched inference framework. Analyses used Cox proportional hazards models, stratified by individual. Results Among 42,700 adults who met inclusion criteria, VE was 9.5% (95% confidence interval: 2.2% to 16.3%) against all-cause medically-attended LRTI and 8.8% (–0.2% to 17.0%) against all-cause medically-attended pneumonia. In contrast, we did not identify evidence of protection against LRTI and pneumonia following receipt of 23-valent pneumococcal polysaccharide vaccine. PCV13 prevented 0.7 (0.2 to 1.4) and 0.5 (0.0 to 1.0) cases of LRTI and pneumonia, respectively, per 100 vaccinated persons annually; over 5 years, one case of LRTI and one case of pneumonia were prevented for every 27 and 42 individuals vaccinated, respectively. Conclusions PCV13 vaccination among older adults substantially reduced incidence of medically-attended respiratory illness. Direct immunization of older adults is an effective strategy to combat residual disease burden associated with PCV13-type pneumococci.

The aim of this study was to evaluate the epidemiological profile of invasive meningococcal disease (IMD) in Brazil, the first Latin American country to introduce the group C meningococcal conjugate vaccine (included in the vaccination schedule in 2010). Methods: A systematic review was conducted, covering the years 2005-2017, to identify epidemiological information on IMD and Neisseria meningitidis carriers in Brazil. Documents from the Brazilian Ministry of Health and two public databases were analyzed to determine annual incidence rates, absolute numbers of diagnosed cases, serogroups identified, the relative distribution of cases per serogroup, and the case fatality rate (CFR). Results: Sixteen studies were selected. The incidence rate ranged from 0.88 to 5.3 cases per 100 000 inhabitants per year. According to secondary data, the annual incidence of IMD in 2015 was highest in males <1 year old (7.1/100 000). The number of diagnosed cases declined significantly over the years. In the literature, IMD showed a CFR from 20.0% to 50.0%, and a higher CFR for serogroup W (17.8%). Secondary data showed an absolute reduction in meningitis-attributable deaths between 2007 and 2015; however, the CFR remained stable (11.1% in 2007 and 8.4% in 2015). In 2015, serogroup W showed the highest CFR (24.1%), followed by serogroups C (19.2%), B (17.7%), and Y (14.3%). Conclusions: Despite a reduction in cases, the CFR remained stable and similar in the different age groups, even for disease caused by different serogroups. The highest CFR was found to be associated with serogroup W.

To evaluate the epidemiological profile of invasive meningococcal disease (IMD), meningococcal meningitis, and Neisseria meningitidis carriers in Latin America. Methods: A systematic review was conducted to identify and analyze studies published in 2008-2018. Incidence rates, case fatality rates (CFRs), and the relative distribution of cases per serogroup by country were assessed. Results: Meningococcal surveillance in Latin America differs among countries, and most systems are based on passive sentinel surveillance. Thirty-nine studies were selected. In 2006, the incidence rate of IMD per 100 000 inhabitants was highest in Brazil (1.9), followed by Uruguay (1.3), Chile (0.8), Argentina (0.7), Colombia and Venezuela (0.3 each), and Mexico (0.06). Brazil reported the highest CFR (20%), followed by Uruguay (15%), Chile (11%), and Venezuela and Argentina (10% each). In 2012, the CFR in Chile increased to approximately 27%. The most frequent serogroups among IMD cases were C in