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We aimed to estimate vaccination coverage and factors associated in completing schemes in children under 5 years old between 2000 and 2018. A secondary analysis was carried out on five national health surveys between 2000 and 2018 in Mexico. The sample was 53,898 children under 5 years old, where 30% of missing vaccination information was imputed using chained equations. During this period two basic vaccination schemes (CBS) were identified. For each doses and vaccines of both schemes and completed CBS, the coverage was estimated using weighted logistic regression models. Additionally, the factors associated with incomplete schemes were reported. Between 2000 and 2018, the caretakers who did not show the vaccination card went from 13.8% to 45.6%. During this period, the estimated vaccination coverages did not exceed 95%, except for BCG and marginally the first doses of vaccines against pneumococcus, acellular pentavalent, and Sabin. In the same period, the CBS estimated coverage decreased steadily and was under 90%, except for children aged 6–11 months (92.6%; 91.5–93.7) in 2000. Not having health insurance stands out as an associated factor with incomplete vaccination schemes. In conclusion, the imputation allowed to recuperate information and obtain better data of vaccination coverage. The estimated vaccination coverage and CBS do not reach sufficient levels to guarantee herd immunity, hence innovative strategies to improve vaccination must be established in Mexico.

Background Dengue imposes a substantial economic and disease burden in most tropical and subtropical countries. Dengue incidence and severity have dramatically increased in Mexico during the past decades. Having objective and comparable estimates of the economic burden of dengue is essential to inform health policy, increase disease awareness, and assess the impact of dengue prevention and control technologies. Methods and Findings We estimated the annual economic and disease burden of dengue in Mexico for the years 2010–2011. We merged multiple data sources, including a prospective cohort study; patient interviews and macro-costing from major hospitals; surveillance, budget, and health data from the Ministry of Health; WHO cost estimates; and available literature. We conducted a probabilistic sensitivity analysis using Monte Carlo simulations to derive 95% certainty levels (CL) for our estimates. Results suggest that Mexico had about 139,000 (95%CL: 128,000–253,000) symptomatic and 119 (95%CL: 75–171) fatal dengue episodes annually on average (2010–2011), compared to an average of 30,941 symptomatic and 59 fatal dengue episodes reported. The annual cost, including surveillance and vector control, was US$170 (95%CL: 151–292) million, or $1.56 (95%CL: 1.38–2.68) per capita, comparable to other countries in the region. Of this, $87 (95%CL: 87–209) million or $0.80 per capita (95%CL: 0.62–1.12) corresponds to illness. Annual disease burden averaged 65 (95%CL: 36–99) disability-adjusted life years (DALYs) per million population. Inclusion of long-term sequelae, co-morbidities, impact on tourism, and health system disruption during outbreaks would further increase estimated economic and disease burden. Conclusion With this study, Mexico joins Panama, Puerto Rico, Nicaragua, and Thailand as the only countries or areas worldwide with comprehensive (illness and preventive) empirical estimates of dengue burden. Burden varies annually; during an outbreak, dengue burden may be significantly higher than that of the pre-vaccine level of rotavirus diarrhea. In sum, Mexico’s potential economic benefits from dengue control would be substantial., Author Summary During the past decades, dengue fever has become the most common arthropod-borne viral disease, imposing a substantial economic and disease burden in most tropical and subtropical countries, including Mexico. Dengue incidence and severity have dramatically increased in Mexico, with transmission regularly reported in 28 of 32 states. Objective estimates of the burden of dengue are important to inform policy decisions and priorities. We merged multiple data sources to estimate (i) total episodes, (ii) costs per episode, (iii) surveillance and vector control costs, and (iv) disease burden (2010–2011). Results suggest that Mexico had about 139,000 symptomatic and 119 fatal dengue episodes per year on average. The annual cost, including surveillance and vector control, was about US$170 million, or $1.56 per capita, comparable to other countries in the Americas. Annual disease burden averaged 65 disability-adjusted life years per million population, with most of the years lost to disability corresponding to ambulatory episodes. The results show a substantial burden of dengue on the health care system and economy of Mexico. This quantification of the economic burden should help public health officials make informed decisions about current and promising new preventive and control measures to reduce dengue infections.

A consortium of institutions from Texas and Mexico has launched a new initiative for developing vaccines and other tools to control and eliminate neglected tropical diseases in Mesoamerica.

Dengue presents a formidable and growing global economic and disease burden, with around half the world's population estimated to be at risk of infection. There is wide variation and substantial uncertainty in current estimates of dengue disease burden and, consequently, on economic burden estimates. Dengue disease varies across time, geography and persons affected. Variations in the transmission of four different viruses and interactions among vector density and host's immune status, age, pre-existing medical conditions, all contribute to the disease's complexity. This systematic review aims to identify and examine estimates of dengue disease burden and costs, discuss major sources of uncertainty, and suggest next steps to improve estimates. Economic analysis of dengue is mainly concerned with costs of illness, particularly in estimating total episodes of symptomatic dengue. However, national dengue disease reporting systems show a great diversity in design and implementation, hindering accurate global estimates of dengue episodes and country comparisons. A combination of immediate, short-, and long-term strategies could substantially improve estimates of disease and, consequently, of economic burden of dengue. Suggestions for immediate implementation include refining analysis of currently available data to adjust reported episodes and expanding data collection in empirical studies, such as documenting the number of ambulatory visits before and after hospitalization and including breakdowns by age. Short-term recommendations include merging multiple data sources, such as cohort and surveillance data to evaluate the accuracy of reporting rates (by health sector, treatment, severity, etc.), and using covariates to extrapolate dengue incidence to locations with no or limited reporting. Long-term efforts aim at strengthening capacity to document dengue transmission using serological methods to systematically analyze and relate to epidemiologic data. As promising tools for diagnosis, vaccination, vector control, and treatment are being developed, these recommended steps should improve objective, systematic measures of dengue burden to strengthen health policy decisions., Author Summary Dengue is the most common mosquito-transmitted viral disease. It represents a formidable public health problem that is expanding in both infection rates and geographical range. Fortunately, vaccines, improved diagnostics, innovative vector control approaches, and other disease control methods are under development. Despite the importance of dengue, there is substantial uncertainty about the magnitude of the disease burden and economic cost of dengue, particularly in the number of symptomatic dengue infections. There is substantial variation in national reporting systems for dengue, which hinders accurate estimates of total cases and, therefore, of economic burden. Here we suggest a combination of immediate, short-term, and longer term strategies to address this knowledge gap. Immediate strategies include, for example, documenting the number of ambulatory visits before and after hospitalization. Short-term recommendations include merging multiple data sources, such as cohort and surveillance data to improve estimates of dengue incidence. Long-term efforts include increasing the collection and analysis of seroprevalence and economic data, use of enhanced surveillance (e.g., use of incentives to improve reporting, include private sector sentinel sites). Implementing these steps would give policy makers more reliable, systematic data for strengthening and refining policies about the application and financing of new technologies to control dengue.

In North America, Chagas disease (American trypanosomiasis caused by Trypanosoma cruzi) was first reported in Mexico in 1940 [1] and in the United States in Texas in 1955 [2]. However, based on ancient mummified remains discovered in the Rio Grande Valley, human T. cruzi infection has been present in North America since prehistoric times [3].