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The cytokine profile during acute chikungunya infection that predicts future chronic arthritis has not yet been investigated. We conducted a nested case-control study comparing serum cytokine concentrations during acute chikungunya infection in cases (n = 121) that reported the presence of chronic joint pain versus age- and gender-matched controls (n = 121) who reported recovery at 20 months post infection. We observed that a robust cytokine response during acute infection was correlated with a decreased incidence of chronic joint pain and that low TNFα, IL-13, IL-2, and IL-4 during acute infection was predictive of chronic joint pain. These data suggest that a robust cytokine response is necessary for viral clearance and cytokines that are related to immune tolerance during acute infection may be protective for chronic arthritis pathogenesis.

In Colombia, pneumococcal conjugate vaccines (PCVs) were implemented into the infant universal mass vaccination program in a stepwise manner; PCV-7 between 2009 and 2011 in different geographic regions/cities, with nationwide introduction of a 10-valent vaccine (PHiD-CV) in 2012. We aimed to describe trends in all-cause pneumonia mortality and overall mortality, and in the incidence of all-cause pneumonia and otitis media (OM) in Colombian children

Objective: During the 2013–2016 period, Dengue, Chikungunya, and Zika affected more than 1 million people in Colombia. These arboviruses and their chronic manifestations pose a public health challenge. Therefore, we estimated the burden of disease by Dengue, Chikungunya, and Zika in Colombia between 2013 and 2016. Methods: An exploratory ecological study was carried out using the disability-adjusted life years (DALYs) as a unit of measure. The mortality databases of the National Administrative Department of Statistics (DANE) and the morbidity databases of the National Public Health Surveillance System (SIVIGILA) were used. Deaths and cases for each arbovirus were grouped and then adjusted to control biases. Subsequently, we performed a sensitivity analysis. Results: In the 2013–2016 period, 491,629.2 DALYs were lost due to arboviruses in Colombia. By disease, 26.6% of the total DALYs were caused by Dengue, 71.3% by Chikungunya, and the remaining 2.2%, by Zika. The majority of DALYs (68.2%) were caused by chronic complications. Five out of 32 departments (Valle del Cauca, Tolima, Norte de Santander, Huila, and Bolívar) contributed 50.5% of total DALYs. Conclusion: The burden of disease by arboviruses in the 2013–2016 period exceeded the burden of other infectious diseases such as HIV/AIDS and tuberculosis in Colombia. Public health efforts must be made to mitigate new epidemics of these arboviruses.

Objective. This study aimed to identify the co-circulation patterns of three viruses (dengue, Zika, and chikungunya) in Colombia from 2008 to 2018 by using notification reports provided to the national surveillance system. Methods. This cross-sectional study was conducted through a review of data for 2008 through 2018 from Colombias Public Health Surveillance System (SIVIGILA). Results. In 2015, when chikungunya was first detected, it had a higher incidence (1 359.0 cases per 100 000 persons) than did the two other diseases. In 2016, when the circulation of Zika virus was first found, the incidence was 296.4 cases per 100 000 persons; that incidence declined dramatically in the next two years. Between 2015 and 2018, there was a substantial decrease in the frequency of dengue circulation, with it going from 334.1 cases per 100 000 persons in 2015 to 90.7 cases per 100 000 in 2017 and 173.1 cases per 100 000 in 2018. Conclusions. The decrease in the number of dengue cases after co-circulation of the three viruses could indicate possible cross-protection. This finding should be further analyzed.

Resumen: De manera paralela, a raíz de la nueva evidencia científica que respalda el tratamiento intensivo de la hipertensión arterial, en 2017 el Colegio Americano de Cardiología (ACC) y la Asociación Americana del Corazón (AHA) establecieron nuevas directrices para la prevención, detección, evaluación y manejo de la hipertensión arterial en adultos.La recomendación formal fue utilizar menores umbrales de presión arterial para el inicio del tratamiento antihipertensivo. Esta consideración se derivó de la existencia de estudios que asociaban el logro de cifras menores de presión arterial con la disminución significativa en el riesgo de enfermedad cardiovascular y de la mortalidad en la población hipertensa.A la luz de esta nueva definición de hipertensión arterial, Muntner et al. consideran que su prevalencia en los Estados Unidos sería 45,6%, comparado con el 31,9%, si se usaran los parámetros previamente aceptados e implementados desde el JNC7, comité en el que el porcentaje de adultos estadounidenses recomendados para tratamiento antihipertensivo pasaría de 34,3% a 36,2%, en tanto que el porcentaje de hipertensos que no logran las metas establecidas se incrementaría de 39 a 53,4%.Por su parte, Bundy et al. llegaron a conclusiones similares, calculando que 45,4% de los adultos estadounidenses (105.3 millones) mayores de 20 años tendrían hipertensión según la nueva clasificación, comparado con los datos del año 2014, que consideraban como hipertensos al 32,0% (74.1 millones). Esta diferencia de 13,5% equivale a 31.3 millones de personas que serían clasificadas como hipertensas.En Colombia, la aplicación de la nueva clasificación supondría pasar de una prevalencia de 22,0% en 2016 a un valor estimado del 43,3% en la actualidad, tan solo por variar la cifra de corte para ser considerado hipertenso, lo cual es equivalente a catalogar como enfermos a aproximadamente 21 millones de personas. Abstract: In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) concurrently established new guidelines for the prevention, detection, assessment and management of arterial hypertension in adults, based on new scientific evidence supporting its intensive treatment.The formal recommendation was to use lower arterial pressure thresholds for initiating antihypertensive treatment. This consideration arose from studies which related the achievement of lower arterial pressure figures with a significant decrease in the risk of cardiovascular disease and mortality in the hypertensive population.In light of this new definition of arterial hypertension, Muntner et al. consider that the prevalence of hypertension in the United States would be 45.6%, compared with 31.9% if the previously accepted and implemented parameters from the JNC7 were applied. According to this committee, the percentage of American adults recommended for antihypertensive treatment would go from 34.3% to 36.2%, while the percentage of hypertensives not achieving the established goals would increase from 39 to 53.4%.Meanwhile, Bundy et al. reached similar conclusions, calculating that 45.4% of adult Americans over the age of 20 (105.3 million) would have hypertension according to the new classification, compared to data from 2014, which considered 32.0% (74.1 million) to be hypertensive. This 13.5% difference amounts to 31.3 million people who would be classified as hypertensive.In Colombia, the application of the new classification would mean going from a prevalence of 22.0% in 2016 to an estimated 43.3%, currently, just by changing the cut-off value for being considered hypertensive, which would amount to classifying approximately 21 million people as sick. Palabras clave: Hipertensión arterial, Consenso, Enfermedad cardiovascular, Keywords: Arterial hypertension, Consensus, Cardiovascular disease

In 2015, the Zika virus was introduced in Colombia. The emergence of this arbovirus is a public health challenge for the country, considering the association between the infection and congenital disorders such as microcephaly. Thus, we estimated the burden of disease due to microcephaly associated with Zika in Colombia and its administrative subdivisions for the period 2015-2016. We conducted an exploratory ecological study, using as unit of measurement disability-adjusted life years (DALYs). The cases of microcephaly were obtained from the Zika national and departmental databases built by the National Public Health Surveillance System (SIVIGILA). Deaths attributed to microcephaly were estimated from previous studies. Finally, we calculated mortality rates and incidences, then we performed a sensitivity analysis under three scenarios (conservative, medium, and extreme) to estimate the DALYs. In the 2015-2016 period, 10,609.4 DALYs were caused by microcephaly associated with Zika in Colombia. 71% of the total DALYs were years of life lost and 29% were years lived with disability. Five out of 32 departments (Meta, Córdoba, Tolima, Valle del Cauca, and Norte de Santander) contributed 71% of total DALYs. The burden of microcephaly associated with Zika outweighed the burden of other congenital anomalies such as neural tube defects and Down syndrome in children aged between 0 and 4 years in Colombia. Public health efforts must be made to prevent and monitor these cases.

Resumen Este documento fue preparado por un grupo multidisciplinario de expertos seleccionados por la Asociación Colombiana de Infectología (ACIN) para poner al día las recomendaciones previas dadas por nuestro grupo en cuanto a la inmunización del adolescente, de la población adulta y de aquellos mayores de 60 años de edad. Para este último grupo, hemos decidido, como lo han hecho en otros países, el inmunizar a esta edad (y no después), debido a la carga de enfermedad incrementada por afecciones respiratorias y otros factores propios para América Latina y las condiciones socioeconómicas de nuestro país. Esta edición reescribe ciertos párrafos y actualiza en parte las recomendaciones hechas anteriormente y publicadas en Infectio en mayo de 2012. Las guías están orientadas al uso por aquellos que cuidan de estos pacientes y hacemos énfasis en el anciano, el inmunocomprometido y en aquellos que sufren de varias comorbilidades. Aunque en un momento dado el documento pudiera parecer incompleto, la intención deseada fue la de abarcar los recientes cambios en la administración de nuevas vacunas y otros regímenes en dosificación. Se incluye por primera vez el uso de las vacunas de 4 valencias contra la influenza. El uso de la vacuna contra el herpes zóster se discute, y se toma un cuidado especial en cuanto a la redacción del "cuándo y por qué" de la vacunación contra Streptococcus pneumoniae. En la administración de esta vacuna, el tiempo de aplicación y la secuencia asociada con la aplicación de la administración de la vacuna polisacárida de 23 valencias puede variar de acuerdo con la edad del paciente,las comorbilidades y en aquellos previamente vacunados con dicha vacuna. Finalmente, exponemos las nuevas recomendaciones de vacunación contra fiebre amarilla y dengue y le damos la bienvenida a la vacuna nonavalente contra el virus humano del papiloma.