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The nematode Angiostrongylus cantonensis has been reported worldwide, however, some basic questions remain unanswered about the presence of A. cantonensis in Ecua-dor: 1) Was the invasion of A. cantonensis in Ecuador unique, or did it occur in different waves? 2) Was this invasion as recent as historical records suggest? 3) Did this inva-sion come from other regions of South America or elsewhere? To address these issues, we assessed the genetic diversity of MT-CO1 gene sequences from isolates obtained in eleven of Ecuador's 24 provinces. Our Bayesian inference phylogenetic tree recovered A. cantonensis as a well-supported monophyletic group. All eleven sequences from Ec-uador were identical and identified as AC17a. The haplotype AC17a, found in Ecuador and the USA, formed a cluster with AC17b (USA); AC13 (Thailand); and AC12a-b (Cambodia). It is notable that all the samples, obtained in different geographic and climatic regions of different Ecuadorian provinces, had no genetic difference between them. Despite the lack of genetic information on A. cantonensis in Latin America, ex-cept in Brazil, our finding differs from previous studies by its absence of genetic diver-sity in Ecuador. We concluded that the invasion of A. cantonensis in Ecuador may have occurred: 1) as a one-time event, 2) recently, and 3) from Asia via the USA. Further re-search should include samples from countries neighboring Ecuador to delve deeper in-to this.

La medicina enfrenta el reto de adquirir, analizar y aplicar conocimiento para resolver problemas clínicos complejos. Existen innumerables adelantos que involucran el uso intensivo de la tecnología para realizar correlación de datos necesarios para la toma de decisiones. En este artículo se realiza una estimación de la presencia de diarreas en niños por Rotavirus frente a condiciones climáticas a través del factor bayesiano que, incluye una correlación de Pearson, donde se caracteriza la distribución posterior y se estima el factor de Bayes. Para tal fin se analizan series de datos climático temporales y series de datos de pacientes enfermos con diarreas por rotavirus. El estudio se realiza en el municipio de Pinar del Río, en el periodo comprendido de noviembre de 2018 – mayo 2019. La población susceptible a la enfermedad es de 516 pacientes, para una muestra de 210 niños, con edad de 1 mes de nacido a 5 años de vida y que fueron hospitalizados en el Hospital Pediátrico Pepe Portilla de la provincia de Pinar del Río. Los resultados obtenidos a través de una correlación lineal de Pearson es que existe una correlación significativa muy por debajo del P valor y se plantea al respecto que, en la medida que existe un mayor número de precipitaciones, mayores son los enfermos con diarreas por rotavirus. Posteriormente se calcula el Factor Bayes para corroborar lo planteado; obteniéndose un valor igual a 0.124, resultado que demuestra la existencia de evidencia moderada de que los enfermos con diarreas por rotavirus.

Streptococcus pneumoniae isolated from patients with invasive pneumococcal disease has been subjected to laboratory-based surveillance in Latin American and Caribbean countries since 1993. Invasive pneumococcal diseases remain a major cause of death and disability worldwide, particularly in children. We therefore aimed to assess the direct effect of pneumococcal conjugate vaccines (PCVs) on the distribution of pneumococcal serotypes causing invasive pneumococcal disease in children younger than 5 years before and after PCV introduction.We did a multicentre, retrospective observational study in eight countries that had introduced PCV (ie, PCV countries) in the Latin American and Caribbean region: Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Paraguay, and Uruguay. Cuba and Venezuela were also included as non-PCV countries. Isolate data for Streptococcus pneumoniae were obtained between 2006 and 2017 from children younger than 5 years with an invasive pneumococcal disease from local laboratories or hospitals. Species' confirmation and capsular serotyping were done by the respective national reference laboratories. Databases from the Sistema Regional de Vacunas (SIREVA) participating countries were managed and cleaned in a unified database using Microsoft Excel 2016 and the program R (version 3.6.1). Analysis involved percentage change in vaccine serotypes between pre-PCV and post-PCV periods and the annual reporting rate of invasive pneumococcal diseases per 100 000 children younger than 5 years, which was used as a population reference to calculate percentage vaccine type reduction.Between 2006 and 2017, 12 269 isolates of invasive pneumococcal disease were collected from children younger than 5 years in the ten Latin American and Caribbean countries. The ten serotypes included in ten-valent pneumococcal conjugate vaccine (PCV10) decreased significantly (p0·0001) after any PCV introduction, except for the Dominican Republic. The percentage change for the ten vaccine serotypes in PCV10 countries was -91·6% in Brazil (530 [72·9%] of 727 before, 27 [6·1%] of 441 after); -85·0% in Chile (613 [72·6%] of 844 before, 44 [10·9%] of 404] after); -84·7% in Colombia (231 [63·1%] of 366 before, 34 [9·7%] of 352 after); and -73·8% in Paraguay (127 [77·0%] of 165 before, 22 [20·2%] of 109 after). In the 13-valent pneumococcal conjugate vaccine (PCV13) countries, the percentage change for the 13 vaccine serotypes was -59·6% in Argentina (853 [85·0%] of 1003 before, 149 [34·3%] of 434 after); -16·5% in the Dominican Republic (95 [80·5%] of 118 before, 39 [67·2%] of 58 after); -43·7% in Mexico (202 [73·2%] of 276 before, 63 [41·2%] of 153 after); and -45·9% in Uruguay (138 [80·7%] of 171 before, 38 [43·7%] of 87 after). Annual reporting rates showed a reduction from -82·5% (6·21 before vs 1·09 after per 100 000, 95% CI -61·6 to -92·0) to -94·7% (1·15 vs 0·06 per 100 000, -89·7 to -97·3) for PCV10 countries, and -58·8% (2·98 vs 1·23 per 100 000, -21·4 to -78·4) to -82·9% (7·80 vs 1·33 per 100 000, -76·9 to -87·4) for PCV13 countries. An increase in the amount of non-vaccine types was observed in the eight countries after PCV introduction together with an increase in their percentage in relation to total invasive strains in the post-PCV period.SIREVA laboratory surveillance was able to confirm the effect of PCV vaccine on serotypes causing invasive pneumococcal disease in the eight PCV countries. Improved monitoring of the effect and trends in vaccine type as well as in non-vaccine type isolates is needed, as this information will be relevant for future decisions associated with new PCVs.None.For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

Objectives: To evaluate the cost-effectiveness of introducing a domestic pneumococcal conjugate vaccine (PCV7-TT) into the Cuban National Immunization Program (NIP). Methods: We compared PCV7-TT given at two, four and six months of age to a scenario without PCV7-TT, over a ten-year period (2020–2029). We calculated the cost (Cuban pesos – CUP) per Disability Adjusted Life Year (DALY) averted from a Government perspective. We compared results from a static cohort model and a parsimonious prediction model informed by the serotype distribution among pneumococcal carriers and cases. We ran probabilistic and deterministic uncertainty analyses. Results: PCV7-TT could prevent 6897 (95% uncertainty interval, 4344–8750) hospitalizations and 189 (115–253) deaths in children

Background Group B streptococcus is a frequent cause of sepsis and neonatal death The objective of the present study is to characterize the behavior of Group B streptococcal meningitis in Cuban infants Methods A years lasting retrospective observational study of cases of Group B streptococcal meningitis was carried out January st December st Risk was estimated annually by age and gender as well as case fatality rate and the association of delay in medical consultation and hospitalization with death Results Overall incidence was live births mortality rate live births and case fatality rate of Sex ratio reached Infants younger than one month represented the largest proportion of cases accounting the majority of deceased with case fatality rate of Early onset of disease occurred in cases late onset in cases and presented young infant disease No deaths reported among cases with early onset of disease but in late onset and infant disease occurred and nine young infant disease respectively Around a quarter of cases share dormitories with ge individuals The overall mean time for consultation and hospital admittance was lower than hours Weak RR CI p lt in cases with late onset of disease or no association of delay in medical consultation and hospital admittance with death was demonstrated Conclusion GBS meningitis still persists as an important and preventable cause of meningitis and neonatal and infant mortality in Cuba Monitoring and detection of changes in the behavior of these infections has been demonstrated necessary and useful for prevention and control of these life threatening infections Background Group B streptococcus is a frequent cause of sepsis and neonatal death The objective of the present study is to characterize the behavior of Group B streptococcal meningitis in Cuban infants Methods A years lasting retrospective observational study of cases of Group B streptococcal meningitis was carried out January st December st Risk was estimated annually by age and gender as well as case fatality rate and the association of delay in medical consultation and hospitalization with death Results Overall incidence was live births mortality rate live births and case fatality rate of Sex ratio reached Infants younger than one month represented the largest proportion of cases accounting the majority of deceased with case fatality rate of Early onset of disease occurred in cases late onset in cases and presented young infant disease No deaths reported among cases with early onset of disease but in late onset and infant disease occurred and nine young infant disease respectively Around a quarter of cases share dormitories with ge individuals The overall mean time for consultation and hospital admittance was lower than hours Weak RR CI p lt in cases with late onset of disease or no association of delay in medical consultation and hospital admittance with death was demonstrated Conclusion GBS meningitis still persists as an important and preventable cause of meningitis and neonatal and infant mortality in Cuba Monitoring and detection of changes in the behavior of these infections has been demonstrated necessary and useful for prevention and control of these life threatening infections

Introducción: el estreptococo ß-hemolítico del grupo B es causa frecuente de sepsis y muerte neonatal. Objetivo: caracterizar el comportamiento de la meningitis por estreptococo ß-hemolítico del grupo B en Cuba. Métodos: se realizó un estudio observacional (descriptivo y analítico) de 57 casos de meningitis por ß-hemolítico del grupo B, con inicio de los síntomas entre el 1ro de enero de 1998 y 31 de diciembre de 2010. Se estimó el riesgo según el año de ocurrencia, la edad, el sexo, la provincia y el municipio, así como la letalidad y la asociación de la demora en la consulta médica y el ingreso hospitalario, con la muerte. Resultados: la incidencia de todo el período fue 0,03/1 000 nacidos vivos y la letalidad alcanzó 31,58 %. La proporción de casos en el sexo masculino (50,9 %) fue muy similar al femenino (49,1 %). Los menores de 2 meses fueron más afectados por la enfermedad (38 casos) y aportaron el 100 % de los fallecidos (18). Las provincias con mayor riesgo fueron Pinar del Río (0,09/1 000 nacidos vivos) y Santiago de Cuba (0,08/1 000 nacidos vivos). El municipio con mayor riesgo fue San Luis, en Santiago de Cuba (0,31/1 000 nacidos vivos). La media de tiempo para la consulta médica fue alrededor de 17 horas, y para el ingreso fue aproximadamente 5 horas. No hubo asociación de la demora para la consulta (RR= 0,66) y el ingreso (RR= 1,22) con la muerte. Conclusiones: la meningitis por estreptococo ß-hemolítico del grupo B constituye una causa importante y prevenible de meningitis y muerte neonatal en Cuba.

meningococcal disease is an important health problem worldwide. Since 1991 the vaccine VA-MENGOC-BC has been used in Cuban under one-year old infants.to evaluate the effectiveness of the vaccine VA-MENGO-BC METHODS: for the evaluation after licensing this vaccine, all the infants affected by meningococcal disease between 1997 and 2008 were studied.a total number of 114 cases were recorded. The annual average incidence was 7.1 per 100 000 infants. The mean vaccinal effectiveness for the period was 84.0 %, ranging from 68 % to 104 %. The frequency of disease in unvaccinated children was 20.2 % (23/114); 79.8 % (91/114) within the vaccination age, but only 75.8 % (69/91) of them had confirmed the immunization date. Only 26.4 % (24/91) had one single dose applied whereas 73.6 % (67/91) had completed their vaccination schedule (2 doses). The meningococcal disease prevailed in the first six months of life, declined afterwards and then started to rise again at 10 and 11 months of age. The meningeal form of clinical presentation predominated (89.5 %); case-fatality rate was 7.0 % (8/114), being 4.4 % for meningococcemia and 2,6 % for meningitis.the vaccine VA-MENGOC-BC effectiveness in infants was satisfactory. It is suggested that further analysis be made by a group of experts on the use of a booster dose.