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Background A growing literature base supports the use of tests developed in high‐income countries to assess children in low resource settings when carefully translated, adapted, and applied. Evaluation of psychometric properties of adapted and translated measures within populations is necessary. The current project sought to evaluate the reliability and validity of an adapted and translated version of the Mullen Scales of Early Learning (AT‐MSEL) in rural Guatelama. Methods The reliability and validity of the AT‐MSEL in rural Guatemala were analyzed for children ages 0–5 years. Results Interrater reliability coefficients (ICC = 0.99–1.0) and internal consistency (Cronbach's alpha = 0.91–0.93) were excellent for all subscales. General linear models utilizing paired data showed consistency between standard scores (p < 0.0001). Mean raw scores increased with chronological age, as expected. Across age groups, subscales were significantly, positively correlated with one another (p < 0.05 ‐ < 0.001) with one exception, visual reception and expressive language at the 0–10 month age range (p = 0.43). Conclusions The AT‐ MSEL showed strong psychometric properties in a sample of young children in rural Guatemala. Findings demonstrate that the AT‐MSEL can be used validly and reliably within this specific population of children. This work supports the concept that tests developed in high‐income countries can be used to assess children in low resource settings when carefully translated, adapted and applied.

BackgroundTreatments for paediatric diarrhoeal disease are limited. We assessed the impact of a bovine colostrum and egg-based treatment designed to reduce diarrhoea duration through non-specific and pathogen-directed mechanisms in children.MethodsRandomised, double-blind, placebo-controlled trial of PTM202, derived from bovine colostrum and hyperimmune hen’s egg on the duration of acute diarrhoeal disease in Guatemalan children. PTM202 contains specific immunoglobulins that target rotavirus, enterotoxigenic Escherichia coli, Shiga toxin-producing E. coli and Salmonella. Children aged 6–35 months presenting to three sites (one rural and two urban) with acute non-bloody diarrhoea were computer randomised to receive three daily doses of PTM202 or placebo. The primary outcome was the post-treatment duration of diarrhoea assessed in the per protocol population. Diarrhoeal pathogens were identified in stool by multiplex PCR (FilmArray Gastrointestinal-Panel, BioFire, Salt Lake City, Utah, USA). Key secondary outcomes included postdiarrhoeal weight gain and impact on diarrhoeal duration stratified by study site and presence of PTM202-targeted organisms in stool at enrolment. Safety was assessed in all participants.ResultsFrom 9 March 2015 to 25 January 2016, 325 children were enrolled, and 301 (154 intervention and 147 placebo) were analysed for the primary outcome. No difference in diarrhoea duration was observed between intervention and placebo in the total population, but a significant reduction was observed in the treatment group among children with at least one targeted pathogen in stool (HR=1.46, P=0.02), an effect most pronounced in urban subjects (HR 2.20, P=0.007) who had fewer stool pathogens and better nutritional status. No impact on 2-week or 4-week weight gain was noted. No adverse events attributed to PTM202 occurred.ConclusionResults demonstrate the potential to target specific pathogens occurring in children with acute non-bloody diarrhoea and shorten illness duration using a novel, safe, nutrition-based intervention. PTM202 may represent a new tool to ameliorate the effects of acute diarrhoeal disease in low/middle-income populations.Trial registration numberNCT02385773; Results.

We evaluated the clinical and socioeconomic burdens of respiratory disease in a cohort of Guatemalan banana plantation workers. All eligible workers were offered enrollment from June 15–December 30, 2020, and annually, then followed for influenza-like illnesses (ILI) through: 1) self-reporting to study nurses, 2) sentinel surveillance at health posts, and 3) absenteeism. Workers with ILI submitted nasopharyngeal swabs for influenza, RSV, and SARS-CoV-2 testing, then completed surveys at days 0, 7, and 28. Through October 10, 2021, 1,833 workers developed 169 ILIs (12.0/100 person-years) and 43 (25.4%) of these ILIs were laboratory-confirmed SARS-CoV-2 (3.1/100 person-years). Workers with SARS-CoV-2-positive ILI reported more anosmia (p<0.01), dysgeusia (p<0.01), difficulty concentrating (p=0.01), and irritability (p=0.01), and greater clinical and well-being severity scores (Flu-iiQ) than test-negative ILIs; they also had greater absenteeism (p<0.01) and lost income (median US$127.1, p<0.01). These results support the prioritization of Guatemalan farm workers for COVID-19 vaccination.

We evaluated clinical and socioeconomic burdens of respiratory disease in banana farm workers in Guatemala. We offered all eligible workers enrollment during June 15–December 30, 2020, and annually, then tracked them for influenza-like illnesses (ILI) through self-reporting to study nurses, sentinel surveillance at health posts, and absenteeism. Workers who had ILI submitted nasopharyngeal swab specimens for testing for influenza virus, respiratory syncytial virus, and SARS-CoV-2, then completed surveys at days 0, 7, and 28. Through October 10, 2021, a total of 1,833 workers reported 169 ILIs (12.0 cases/100 person-years), and 43 (25.4%) were laboratory-confirmed infections with SARS-CoV-2 (3.1 cases/100 person-years). Workers who had SARS-CoV-2‒positive ILIs reported more frequent anosmia, dysgeusia, difficulty concentrating, and irritability and worse clinical and well-being severity scores than workers who had test result‒negative ILIs. Workers who had positive results also had greater absenteeism and lost income. These results support prioritization of farm workers in Guatemala for COVID-19 vaccination.

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Essential agricultural workers work under occupational conditions that may increase the risk of SARS-CoV-2 exposure and transmission. Data from an agricultural worker cohort in Guatemala, and anti-SARS-CoV-2 nucleocapsid IgG (anti-N IgG) testing were used to estimate past infections and analyze risk factors associated with seropositivity at enrollment and association with SARS-CoV-2 infection. The stability of neutralizing antibody (NAb) responses were assessed in a subset of participants. The adjusted relative risk (aRR) for seroprevalence at enrollment was estimated accounting for correlations within worksites. At enrollment, 616 (46.2%) of 1334 (93.2%) participants had anti-N IgG results indicating prior SARS-CoV-2 infection. A cough ≤ 10 days prior to enrollment (aRR = 1.28, 95% CI: 1.13–1.46) and working as a packer (aRR = 2.00, 95% CI: 1.67–2.38) or packing manager within the plants (aRR = 1.82, 95% CI: 1.36–2.43) were associated with increased risk of seropositivity. COVID-19 incidence density among seronegative workers was 2.3/100 Person-Years (P-Y), higher than seropositive workers (0.4/100 P-Y). Most workers with follow-up NAb testing (65/77, 84%) exhibited a 95% average decrease in NAb titers in <6 months. While participants seropositive at baseline were less likely to experience a symptomatic SARS-CoV-2 infection during follow-up, NAb titers rapidly waned, underscoring the need for multipronged COVID-19 prevention strategies in the workplace, including vaccination.

BackgroundLittle is known about the epidemiology and risk factors for Clostridium difficile infection (CDI) among children in low and middle-income countries (LMICs). We sought to characterize the clinical, demographic, and environmental factors associated with C.difficile acquisition and persistence over time, and assess the relationship between CDI and additional diarrheal pathogens among rural and urban Guatemalan children.MethodsChildren 6–35 months old with acute nonbloody diarrhea (<72 hours) were enrolled in an acute diarrhea clinical trial between March 2015 and January 2016 at two sites (one rural and one urban) in Guatemala. Stool samples collected at baseline and 30 days later were analyzed by multiplex PCR (FilmArray™ GI-Panel, BioFire, USA) that identifies 22 viral, parasitic and bacterial diarrheal pathogens including C. difficile. Subjects were characterized by combination of baseline and 30-day C.difficile sample results: −/+ (new acquisition), +/− (clearance), and +/+ (persistence). Associations between these categorizations and demographic, epidemiologic, and co-infecting pathogenic organisms were assessed using multivariable generalized linear models.ResultsCDI was present in 26 of 298 subjects at baseline; 13 (50%) had persistence at 30 days and 13 (50%) cleared. New acquisition at day 30 occurred in 23 subjects. In multivariable analysis adjusted for age, recent hospitalization was marginally significantly associated with C. difficile presence in stool at baseline (prevalence ratio [PR] 2.65, P = 0.07). In subjects with either new C. difficile acquisition or persistence between baseline and day 30, residence in the rural site (PR 0.33, P = 0.003)) and presence of E. coli pathotypes: enteropathogenic (EPEC), enteroaggregative (EAEC), and enterotoxigenic (ETEC) (PR 0.43, P = 0.01)) were associated with reduced risk of CDI.ConclusionIn an LMIC pediatric population, the presence of E. coli pathotypes appeared protective against C. difficile persistence/new acquisition. These findings add to our current understanding that CDI occurs in part as a result of competition within the intestinal microbiota, which may be independent of the potential pathogenicity of competing microbes. We hypothesize that this phenomenon could be suppressing the C. difficile burden among children in LMICs.Disclosures All authors: No reported disclosures.