Objectives. To examine published antimicrobial stewardship (AMS) initiatives in hospitals in Latin America and the Caribbean (LAC) in order to characterize AMS terminology usage, geotemporality, and elements of structure (human resources), process (interventions), and outcomes, and to set priority areas for improving AMS reporting. Methods. This was a scoping review that searched PubMed, LILACS, EMBASE, and 12 other databases, along with a manual search for academic and grey literature to identify documents on AMS initiatives in hospitals in 33 countries of LAC, up to August 2019. Keywords included ‘antibiotic’ or ‘antimicrobial’ AND ‘stewardship, policy, strategies, management, control, rational use, appropriate use, surveillance, or interventions’ and 33 country names. Results. Selected articles totalled 147 studies published in 1985 – 2019; of those, 22% used ‘antimicrobial stewardship’ in the title. Eighteen countries published AMS hospital initiatives, one-half of which were implemented in capital cities. Brazil, Argentina, Colombia, Cuba, Mexico, and Chile, in descending frequency, made up > 59% of published initiatives. Educational interventions were the most frequently reported, followed by persuasive and restrictive strategies. Antimicrobial consumption was the most common outcome measure reported. About one-third of the studies (35%) referred to baseline measures-only in preparation for AMS interventions. Fifty-nine studies from 6 countries reported AMS comprehensively, using structure, process, and outcome (SPO) elements. Conclusions. Published hospital AMS initiatives have increased over time and have expanded across LAC. However, more programs need to be developed. Complete reporting of SPO elements is imperative to evaluating and replicating AMS actions.

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Pregnant women constitute a promising sentinel group for continuous monitoring of malaria transmission. To identify antibody signatures of recent Plasmodium falciparum exposure during pregnancy, we dissected IgG responses against VAR2CSA, the parasite antigen that mediates placental sequestration. We used a multiplex peptide-based suspension array in 2,354 samples from pregnant women from Mozambique, Benin, Kenya, Gabon, Tanzania, and Spain. Two VAR2CSA peptides of limited polymorphism were immunogenic and targeted by IgG responses readily boosted during infection and with estimated half-lives of <2 years. Seroprevalence against these peptides reflected declines and rebounds of transmission in southern Mozambique during 2004–2012, reduced exposure associated with use of preventive measures during pregnancy, and local clusters of transmission that were missed by detection of P. falciparum infections. These data suggest that VAR2CSA serology can provide a useful adjunct for the fine-scale estimation of the malaria burden among pregnant women over time and space.

BackgroundThe European Commission (EC) Horizon 2020 (H2020)-funded ZIKAlliance Consortium designed a multicentre study including pregnant women (PW), children (CH) and natural history (NH) cohorts. Clinical sites were selected over a wide geographic range within Latin America and the Caribbean, taking into account the dynamic course of the ZIKV epidemic.MethodsRecruitment to the PW cohort will take place in antenatal care clinics. PW will be enrolled regardless of symptoms and followed over the course of pregnancy, approximately every 4 weeks. PW will be revisited at delivery (or after miscarriage/abortion) to assess birth outcomes, including microcephaly and other congenital abnormalities according to the evolving definition of congenital Zika syndrome (CZS).After birth, children will be followed for 2 years in the CH cohort. Follow-up visits are scheduled at ages 1–3, 4–6, 12, and 24 months to assess neurocognitive and developmental milestones. In addition, a NH cohort for the characterization of symptomatic rash/fever illness was designed, including follow-up to capture persisting health problems.Blood, urine, and other biological materials will be collected, and tested for ZIKV and other relevant arboviral diseases (dengue, chikungunya, yellow fever) using RT-PCR or serological methods. A virtual, decentralized biobank will be created. Reciprocal clinical monitoring has been established between partner sites.Substudies of ZIKV seroprevalence, transmission clustering, disabilities and health economics, viral kinetics, the potential role of antibody enhancement, and co-infections will be linked to the cohort studies.DiscussionResults of these large cohort studies will provide better risk estimates for birth defects and other developmental abnormalities associated with ZIKV infection including possible co-factors for the variability of risk estimates between other countries and regions. Additional outcomes include incidence and transmission estimates of ZIKV during and after pregnancy, characterization of short and long-term clinical course following infection and viral kinetics of ZIKV.Study registrationsclinicaltrials.gov NCT03188731 (PW cohort), June 15, 2017; clinicaltrials.gov NCT03393286 (CH cohort), January 8, 2018; clinicaltrials.gov NCT03204409 (NH cohort), July 2, 2017.

La sífilis congénita continúa siendo un problema de salud pública en México. Objetivo: Evaluar las similitudes y diferencias entre normas nacionales, guías y documentos internacionales relacionados con la detección de sífilis en embarazadas y sífilis congénita. Método: Se elaboraron dos algoritmos basados en las normas sobre atención de la mujer durante el embarazo y sobre prevención y control de infecciones de transmisión sexual. A partir de la guía de Centers for Disease Control and Prevention (CDC) se realizaron algoritmos sobre sífilis durante el embarazo, sífilis en recién nacido y contactos sexuales. Resultados: La norma sobre embarazo menciona que la prueba de sífilis debe efectuarse a toda mujer embarazada en su primer contacto o durante el parto, sin especificar pruebas diagnósticas. La norma oficial mexicana (NOM) sobre infecciones de transmisión sexual menciona el algoritmo tradicional para detección de sífilis, seguimiento al tratamiento, coinfección con virus de inmunodeficiencia humana y criterios de sífilis congénita. CDC recomienda algoritmo reverso, título de anticuerpos, tratamiento y seguimiento como parte del diagnóstico. Conclusiones: La eliminación de la transmisión maternoinfantil de sífilis requiere actualizar y homogeneizar las NOM, así como el estudio de mortinatos y de recién nacidos de madres con sífilis.

Objective. To estimate the seroprevalence of CHKV antibodies and assess correlates of seropositivity at a small geographical scale. Materials and methods. A community-based serosurvey of 387 households in Puente de Ixtla, Morelos (central Mexico). Serum IgG antibodies to CHKV were detected by immunoassay. Results. From 27 April to 29 May 2016, we interviewed and collected blood samples from 387 individuals at the same number of households. A total of 114 (29.5%) participants were seropositive to CHK, 36 (31.6%) of them reported no symptoms of CHKV infection within 12 months before the survey. Conclusion. The estimated seroprevalence to CHKV antibodies was higher than expected by the small number of confirmed cases of CHKV infection reported in Mexico by the National Surveillance System.

Introduction: Congenital syphilis continues to be a public health problem in Mexico. Objective: To assess the similarities and differences between national standards, guidelines and international documents related to the detection of syphilis in pregnant women and congenital syphilis. Method: Two algorithms were developed based on the standard of female care during pregnancy and on the standard for prevention and control of sexually transmitted infections. Based on the Centers for Disease Control (CDC) guidelines, algorithms were developed for syphilis during pregnancy, syphilis in the newborn and sexual contacts. Results: The standard for pregnancy mentions that syphilis testing should be carried out in every pregnant woman on her first contact or at delivery, without diagnostic tests being specified. The Official Mexican Standard (NOM) on sexually transmitted infections mentions the traditional algorithm for syphilis detection, treatment follow-up, coinfection with human immunodeficiency virus and congenital syphilis criteria. The CDC recommend reverse algorithm, antibody titer, treatment and follow-up as part of diagnosis. Conclusions: The elimination of mother-to-child transmission of syphilis requires NOMs updating and homogenizing, as well as the study of stillbirths and neonates born to mothers with syphilis.

La pandemia por Covid-19 llegó a México en febrero de 2020. Las autoridades sanitarias promovieron medidas de prevención no farmacológicas para contrarrestar el avance de la epidemia y a finales del año se anunció la aplicación de las primeras vacunas. A nivel global y local, las vacunas marcaron un hito al erigirse como “balas mágicas”, sin em­bargo, enfrentaron diversas dificultades como la producción masiva, la logística de distribución, la efectividad, su aplicación escalonada que priorizó a grupos vulnerables, el rechazo y la baja percepción de riesgo por parte de algunos grupos de la población; por tanto, el énfasis sobre las medidas preventivas o “escudos sociales” se diluyó con el avance de la estrategia de vacunación. Este ensayo resalta la importancia de man­tener “los escudos sociales” como medidas fundamentales y complementarias a la aplicación de vacunas, puesto que, por sí solas, las “balas mágicas” presentan retos que podrían comprometer su eficacia.