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Resumen Introducción. La tafenoquina fue aprobada en el 2018 por la Food and Drug Administration de Estados Unidos y, en el 2019, por la Therapeutic Goods Administration en Australia. Su administración en dosis única y su mecanismo de acción en las fases aguda y latente han sido objeto de estudio para cambiar el esquema de tratamiento de la malaria por Plasmodium vivax. Objetivo. Evaluar la evidencia científica disponible sobre la eficacia de la tafenoquina en la profilaxis y el tratamiento de la malaria por P. vivax, entre el 2009 y el 2019. Materiales y métodos. Se establecieron los descriptores MeSH y DeCS. Se utilizó la sintaxis ((Malaria Vivax) AND (tafenoquine) AND (prophylaxis)) OR [(Malaria Vivax) AND (tafenoquine) AND (relapse)] en las siguientes bases de datos: Pubmed, The Cochrane Central Register of Controlled Clinical Trials (CENTRAL), ISIS Web of Science, Lilacs y Scopus. Los resultados obtenidos se sometieron a análisis crítico (matriz CASPE). El análisis cuantitativo se realizó utilizando la diferencia de riesgos en análisis de supervivencia (Kaplan-Meier) en los tres artículos finales. Resultados. Se sometieron tres estudios a metaanálisis (Llanos-Cuentas, 2014; Llanos- Cuentas, 2019, y Lacerda, 2019) para evaluar la eficacia del tratamiento con tafenoquina en comparación con primaquina. Se obtuvo una diferencia de riesgo global de 0,04 (IC95% 0-0,08; p=0,07). La tafenoquina no mostró inferioridad en la eficacia del tratamiento frente al esquema de primaquina. Conclusión. La tafenoquina es una alternativa que mejora el cumplimiento del tratamiento, lo que podría acercar a Colombia a las metas de la Estrategia Técnica Mundial contra la Malaria, 2016-2030. Abstract Introduction: Tafenoquine was approved in 2018 by the Food and Drug Administration in the United States and in 2019 by the Therapeutic Goods Administration in Australia. Its administration in a single dose and its mechanism of action in the acute and latent phases of the disease have been studied to change the treatment regimen for Plasmodium vivax malaria. Objective: To evaluate the available scientific evidence of the efficacy of tafenoquine in prophylaxis and treatment between 2009 and 2019. Materials and methods: We established the MeSH and DeCS descriptors and we used the syntax ((Malaria Vivax) AND (tafenoquine) AND (prophylaxis)) OR [(Malaria Vivax) AND (tafenoquine) AND (relapse)] in the following databases: Pubmed, The Cochrane Central Register of Controlled Clinical Trials (CENTRAL), ISIS Web of Science, Lilacs, and Scopus. The results obtained were subjected to critical analysis (CASPE matrix). The quantitative analysis was performed with risk differences in survival analysis (Kaplan Meier) in the final three articles. Results: Three studies underwent meta-analysis (Llanos-Cuentas, 2014; Llanos-Cuentas, 2019, and Lacerda, 2019) to evaluate the efficacy of the treatment with tafenoquine compared to primaquine. A global risk difference of 0.04 was obtained (95% CI: 0.00-0.08; p=0.07). Tafenoquine did not show inferiority in the efficacy of treatment compared to the primaquine scheme. Conclusion: Tafenoquine is a therapeutic alternative to primaquine that improves adherence, which could bring Colombia closer to the goals of the World Technical Strategy against Malaria 2016-2030.

Background: Disability-adjusted life years (DALYs) are a synthetic health indicator used to measure the burden of disease at the population level, which provides joint information on the fatal and non-fatal consequences of diseases, injuries and risk factors. This indicator as the number of years of healthy life lost uses both to describe the epidemiological situation in different countries or regions and to estimate the population impact of different interventions. The World Health Organization as a public health emergency of international importance (ESPII) classified the new coronavirus (COVID-19). In December 2019, an association of pneumonia cases emerged in Wuhan (Hubei province, China), with a sample common to a wholesale market for seafood, fish, and live animals. On January 7, 2020, the Chinese authorities established a new virus of the Corona viridae family as the agent promoting the outbreak, which was later designated SARS-COV-2 1. The Chinese authorities shared the genetic sequence on January 12. The disease caused by this new virus by international consensus COVID-19. The Emergency Committee of the International Health Regulations (IHR, 2005) declared the outbreak as a PHEIC at its meeting on January 30, 2020. Subsequently, the WHO considered it a global pandemic on March 11, 2020 ISCIII. Cases on all continents and on March 6 the first case in Colombia and the National Institute of Health (INS) notifies the Ministry of Health daily of the figures of accumulated confirmed cases of COVID-19, as follows: total of cases, cases in hospitalizations, ICU admissions, deaths and recovered cases. The objective of this work was to estimate the burden of disease due to COVID-19 in Bogotá for the years 2020 and 2021 in order to establish the burden of disease due to this pathology. Methods: We conducted an ecological study between Jan 1, 2020, and Dec 31, 2021. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for COVID-19 in Bogotá. Findings: The public data on COVID 19 published on the Salud-data website of the Bogotá Health Center, available at https:// saludata.saludcapital.gov.co/osb/. A total of 13,428 deaths and 482,346 laboratory-confirmed cases of COVID 19 in the study period. The discount rate that evaluates what benefits they prefer in the present and not in the future into account, so it is necessary to introduce this correction factor for future benefits, which is a procedure commonly used in economics. This same situation occurs in health, because the value given to a year of healthy life gained in the present is different and superior to that given to a year of healthy life gained in the future. The discount weight into account in the calculation as a correction since societies tend to value a year of life lost or gained differently during young adulthood than during early childhood or old age. This discount model allows the time lived at different ages to be valued using an exponential function. The burden of disease is the gap between existing health conditions and an ideal health situation. Life expectancy to calculate based on the assumption that someone is currently living and in the future to current mortality rates for each age group (42). In this case, the life table with the highest life expectancy at birth in the world used, which is that of Japan, with 80 years for men and 82.5 years for women, in addition to allowing us to compare ourselves with studies that use this value (43). This pandemic has created a greater urgency to strengthen health systems in most countries and the burden of disease must know in order to know the possible economic impact. Interpretation: This pandemic has created an increased urgency to strengthen health systems in most countries. Taking no action to address the burden of COVID-19 should not be an option.

Background: to determine the operative characteristics of the Geriatric Scale 8 versus the Comprehensive Geriatric Assessment to detect older adult patients with cancer at risk of functional decline. Methods: we conducted a systematic search for studies in three major indexed databases: Medline (PubMed), Embase and Google Scholar. We selected studies from 2010-2020, considering criteria such as older adults with some type of cancer, in which the G8 scale has been applied and has been associated with functional decline. Results: we found 690 relevant titles. After reviewing the titles, abstracts, and full articles, we selected two articles that met the inclusion criteria. From these articles, we found a sensitivity of 81%, a specificity of 38%, a positive likelihood ratio of 1.21 and a negative likelihood ratio of 0.63. Conclusions: We conclude that the G8 scale has a good sensitivity for the detection of functional decline in older adults with cancer, however, the scale does not have good results in diagnostic performance tests. The use of this scale as a predictor of functional decline should be given with caution to the results presented. More studies are required to evaluate the performance of the G8 scale against predicting functional decline.

IntroductionSince 2017, the ocrelizumab is available to treat patients with relapsing-remitting multiple sclerosis (RRMS), together with rituximab, they have a similar effectiveness but different costs. In this context, the added value provided by cost-effectiveness estimators for decision-making and drug prescription can be considered.Objectiveto determine the cost-utility of ocrelizumab versus rituximab in patients with RRMS, from the perspective of the Colombian health system.Methodologycost-utility study based on a Markov model, with a 50-year horizon and payer perspective. The currency was the US Dollar (USD) for the year 2019, with a threshold of $5,180 USD defined for Colombian health system. The model used annual cycles according to the health status determined by the disability scale. Direct costs were considered, and the incremental cost-effectiveness ratio (ICER) per 1 quality-adjusted life year (QALY) gained was used as the outcome measure. A discount rate of 5% was applied for costs and outcomes. Multiple one-way deterministic sensitivity analyzes and 10,000 modeling through Monte Carlo simulation were performed.Resultsfor the treatment of patients with RRMS, ocrelizumab versus rituximab had an ICER of $73,652 USD for each QALY gained. After 50 years, 1 subject treated with ocrelizumab earns 4.8 QALYs more than 1 subject treated with rituximab, but at a higher cost of $521,759 USD vs $168,752 USD, respectively. Ocrelizumab becomes a cost-effective therapy when its price is discounted >86%, or there is a high willingness to pay.ConclusionsOcrelizumab was not a cost-effective drug compared with rituximab to treat patients with RRMS in Colombia.

Objectives: the aim is to determine the prevalence of hypertensive disorders and to describe the sociodemographic aspects and risk factors for preeclampsia, gestational hypertension and intrauterine growth restriction. Methods: a descriptive cross-sectional study. Maternal characteristics, history from the first prenatal visit and outcomes were obtained. The prevalence and percentages were calculated and described. Results: the prevalence of hypertensive disorders was 12.7%, preeclampsia was 8.0%, followed by gestational hypertension at 4.7%. Of the preeclampsia, 54.8% were severe and 11.9% were of early onset. Moreover, 56.5% of the severe preeclampsia had preterm deliveries. IUGR had a prevalence of 5.3%. Based on maternal history, the most relevant risk factors were a family and personal history of preeclampsia and IUGR. Conclusions: we found a considerable prevalence of preeclampsia with a high percentage of preterm deliveries, associated with varying severity. This data helps health professionals to be aware of the risk factors that can be followed up for preventing complications. The determination of the risk of developing a hypertensive disorder during pregnancy is fundamental to encouraging proper counseling and care for these women through gestation.

Objective To analyze whether acetylsalicylic (ASA) intake modifies the mean uterine arteries pulsatility index (UtA-PI) at the 2nd or 3rd trimester in a cohort of pregnant women with abnormal mean UtA-PI at between 11 and 14 weeks of gestation. Methods This is a retrospective cohort study. Singleton pregnancies with abnormal mean UtA-PI at between 11 and 14 weeks of gestation were studied. The participants were divided into 3 groups: 1) If the participant did not take ASA during pregnancy; 2) If the participant took ASA before 14 weeks of gestation; and 3) If the participant took ASA after 14 weeks of gestation. The mean UtA-PI was evaluated at the 2nd and 3rd trimesters, and it was considered to improve when it decreased below the 95th percentile. The prevalence ratio (PR) and the number needed to treat (NNT) werecalculated. Results A total of 72 participants with a mean UtA-PI>95th percentile at the 1st trimester of gestation were evaluated. Out of the 18 participants who took ASA, 8 participants started it before 14 weeks of gestation and 10 after. A total of 33.3% of these participants had improved the mean UtA-PI at the 2nd and 3rd trimesters of gestation, although it was not statistically significant (p=0.154). The prevalence ratio was 0.95 (95% confidence interval [CI]: 0.31-1.89), but between the 1st and 2nd trimesters of gestation, the PR was 0.92 (95%CI: 0.21-0.99) and it was statistically significant. Conclusion The present work demonstrates a modification of the mean UtA-PI in participants who took ASA compared with those who did not. It is important to check if ASA can modify the normal limits of uterine arteries because this could have an impact on surveillance. Resumo Objetivo Analisar se a ingestão de acetilsalicílico (ASA) modifica o índice médio de pulsatilidade das artérias uterinas (UtA-PI) no 2° ou 3° trimestre em uma coorte de gestantes com média anormal de UtA-PI entre 11 e 14 semanas. Métodos Este é um estudo de coorte retrospectivo. Gravidezes únicas com média anormal de UtA-PI entre 11 e 14 semanas foram estudadas. As participantes foram divididas em 3 grupos: 1) Se a participante não tomou ASA durante a gravidez, 2) Se a participante tomou AAS antes das 14 semanas e 3) Se a participante tomou ASA após 14 semanas. A média do UtA-PI foi avaliada nos 2° e 3° trimestres e considerou-se que melhorava quando diminuía95° percentil no 1° trimestre de gravidez. Das 18 participantes que tomaram ASA, 8 participantes começaram antes de 14 semanas e 10 depois. Um total de 33,3% desses participantes melhoraram a média de UtA-PI nos 2° e 3° trimestres, embora não tenha sido estatisticamente significante (p=0,154). A razão de prevalência foi de 0,95 (intervalo de confiança [IC95%]: 0,31-1,89), mas entre os 1° e o 2° trimestres, a RP foi de 0,92 (IC95%: 0,21-0,99) e foi estatisticamente significativa. Conclusão O presente trabalho demonstra uma modificação da média de UtA-PI em participantes que faziam uso de ASA em comparação com aqueles que não faziam. É importante verificar se o ASA pode modificar os limites normais das artérias uterinas porque isso pode ter um impacto na vigilância.

Background and Aim Liver disease refers to a set of pathologies resulting from the interruption of liver function or the poor functioning of the liver. The estimation of morbidity and mortality due to liver disease and the context in which the disease develops are determining factors for public policies related to liver disease and its causes. The primary etiologies are cirrhosis and hepatocellular carcinoma, which are directly related to hepatitis B and C virus and alcohol consumption. Followed by hepatotoxic drug use, autoimmune hepatitis, cholestatic diseases, genetic abnormalities, and nonalcoholic steatohepatitis. Methods A descriptive cross‐sectional study was conducted to estimate the prevalence of liver disease in Colombia between 2009 and 2016. Using the Data Warehouse–Cube of SISPRO as the primary source of the data, prevalence proportions were calculated and adjusted according to the Bennett Horiuchi method. The relationship with alcohol consumption and the index of unsatisfied basic needs based on estimates from 2005 were considered as sociodemographic variables. Results The prevalence of liver disease differs with regard to the type of illness, sex and age of the patient, access to medical attention, and geographical location. Conclusions As liver disease is a public health problem, it requires early intervention such as raising awareness and prevention strategies, along with postdiagnosis care channels for treatment, rehabilitation, and palliation. By implementing these strategies, public health will be positively impacted, health care resources will be optimized, and more productive years of life are available for the citizens of the country., Liver disease is composed of a set of pathologies with nonspecific or without associated symptoms. Between 2009 and 2016 in Colombia, there were 649 887 cases of liver disease. We have shown that prevalence of liver disease is associated to the sales of alcohol reported by departments.

Objective To evaluate the mean uterine artery pulsatility index (UtAPI) in each trimester of pregnancy as a predictor of early or late pre-eclampsia (PE) in Colombian pregnant women. Methods The UtAPI was measured in singleton pregnancies in each trimester. Uterine artery pulsatility index as predictor of PE was evaluated by odds ratio (OR), receiver operating characteristic (ROC) curves, and Kaplan-Meier diagram. Results Analysis in the 1st and 3rd trimester showed that abnormal UtAPI was associated with early PE (OR: 5.99: 95% confidence interval [CI]: 1.64–21.13; and OR: 10.32; 95%CI: 2.75–42.49, respectively). Sensitivity and specificity were 71.4 and 79.6%, respectively, for developing PE (area under the curve [AUC]: 0.922). The Kaplan-Meier curve showed that a UtAPI of 0.76 (95%CI: 0.58–1.0) in the 1st trimester was associated with early PE, and a UtAPI of 0.73 (95%CI: 0.55–0.97) in the 3rd trimester was associated with late PE. Conclusion Uterine arteries proved to be a useful predictor tool in the 1st and 3rd trimesters for early PE and in the 3rd trimester for late PE in a pregnant population with high prevalence of PE. Resumo Objetivo Avaliar o índice médio de pulsatilidade da artéria uterina (UtAPI) em cada trimestre da gravidez como preditor de pré-eclâmpsia (PE) precoce ou tardia em gestantes colombianas. Métodos O UtAPI foi medido em gestações únicas em cada trimestre. O UtAPI como preditor de PE foi avaliado por odds ratio (OR), curvas receiver operating characteristic (ROC) e diagrama de Kaplan-Meier. Resultados A análise no 1° e 3° trimestres mostrou que um UtAPI anormal foi associado com PE inicial (OR: 5,99; intervalo de confiança [IC] 95%: 1,64–21,13; OR: 10,32; IC95%: 2,75–42,49, respectivamente). A sensibilidade e a especificidade foram de 71,4 e 79,6%, respectivamente, para o desenvolvimento de PE (area under the curve [AUC]: 0,922). A curva de Kaplan-Meier mostrou que um UtAPI de 0,76 (IC95%: 0,58– 1,0) no 1° trimestre foi associado com PE precoce, e que um UtAPI de 0,73 (IC95%: 0,55–0,97) no 3° trimestre foi associado com PE tardia. Conclusão As artérias uterinas mostraram ser uma ferramenta preditora útil no 1° e 3° trimestres para PE inicial e no 3° trimestre para PE tardia em uma população de gestantes com alta prevalência de PE.

Introducción: el cáncer es una de las enfermedades más temidas por la humanidad y el tumor maligno de ovario no es la excepción. Se caracteriza por su alta agresividad y por presentar síntomas inespecíficos, además de no contar, hasta el momento, con pruebas de tamizaje que permitan una detección precoz, convirtiéndose en uno de los cánceres femeninos con alta mortalidad ocupando el séptimo lugar a nivel mundial. Objetivo: Medir la prevalencia, mortalidad y la letalidad asociadas al cáncer de ovario entre 2009 a 2016 en la población colombiana. Método: se realizó un estudio descriptivo, transversal, ecológico. A partir de una base de datos en el RIPS de SISPRO y DANE se seleccionaron las mujeres con diagnóstico de tumor maligno de ovario. Resultados: se hallaron 36.798 mujeres con diagnóstico de cáncer de ovario, la edad media fue de 63 años con una prevalencia de 31,66 por 100.000 mujeres, en los departamentos de Antioquia, Santander, y Bogotá. Se estimó una tasa de mortalidad de 3,9 por 100.000 mujeres, predominio en educación básica primaria, y régimen de seguridad social contributivo. La letalidad fue de 15,75%. Conclusiones: En Colombia la prevalencia, mortalidad y letalidad entre 2009 a 2016 presentó una tendencia al incremento, predominio en casadas, bajo nivel educativo y menor acceso a los servicios de salud. En virtud de lo anteriormente expuesto, se abre la posibilidad de establecer prioridades sanitarias, diseño de futuras estrategias en prevención de la enfermedad en salud pública, detención precoz y con la consecuente disminución de la mortalidad. Introduction: cancer is one of the most feared diseases by humanity and malignant ovarian tumor is no exception. It is characterized by its high aggressiveness and by presenting nonspecific symptoms, in addition to not having, so far, screening tests that allow early detection, becoming one of the female cancers with high mortality occupying seventh place worldwide. Objective: To measure the prevalence, mortality and lethality associated with ovarian cancer between 2009 and 2016 in the Colombian population. Method: a descriptive, cross-sectional, ecological study was carried out. From a database in the SISPRO and DANE RIPS, women with a diagnosis of malignant ovarian tumor were selected. Results: 36,798 women were diagnosed with ovarian cancer, the mean age was 63 years with a prevalence of 31.66 per 100,000 women, in the departments of Antioquia, Santander, and Bogotá. A mortality rate of 3.9 per 100,000 women, predominance in primary basic education, and contributory social security scheme were estimated. The lethality was 15.75%. Conclusions: In Colombia the prevalence, mortality and lethality between 2009 and 2016 presented a tendency to increase, predominance in married women, low educational level and less access to health services. By virtue of the above, the possibility of establishing health priorities, design of future strategies in prevention of public health disease, early detention and with the consequent decrease in mortality is opened.

Objective.To determine the frequency of chronic joint pain and stiffness 3 years after infection with chikungunya virus (CHIKV) in a Latin American cohort.Methods.A cross-sectional followup of 120 patients from an initial cohort of 500 patients who reported joint pain 2 years after infection from the Atlántico Department, Colombia. Patients were clinically diagnosed as having CHIKV during the 2014–2015 epidemic, and baseline and followup symptoms at 40 months were evaluated in serologically confirmed cases.Results.Of the initial 500 patients enrolled in the study, 482 had serologically confirmed chikungunya infection. From this group, 123 patients reported joint pain 20 months after infection, and 54% of those patients reported continued joint pain 40 months after infection. Therefore, 1 out of every 8 people who tested serologically positive for CHIKV infection had persistent joint pain 3 years after infection. Participants who followed up in person were predominantly adult (mean ± SD age 51 ± 14 yrs) and female (86%). The most common type of pain reported in these patients at 40 months post-infection was pain with periods of relief and subsequent reoccurrence, and over 75% reported stiffness after immobility, with 39% experiencing morning stiffness.Conclusion.To our knowledge, this is the first report to describe persistent joint pain and stiffness 40 months after viral infection. The high frequency of chronic disease highlights the need to develop prevention and treatment methods. Further studies should be conducted to understand the similarities between post-chikungunya joint pain and rheumatoid arthritis.

Aim To compare the sensitivity and specificity of screening for preeclampsia and FGR including maternal characteristics, mean arterial blood pressure and uterine artery pulsatility index and the combined screening, which adds biochemical markers, such as placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A), in a sample of high risk population for hypertensive disorders. Methods This is a prospective study with 527 singleton pregnancies at 11-14 weeks of gestation. Maternal characteristics, biochemical and biophysical markers were studied to determine the development of preeclampsia and FGR by using receiver operating characteristic curves. Results For preeclampsia, screening, including sociodemographic data plus biophysical markers, had a sensitivity and specificity of 70.3% (CI% 64.3-75.2) and 93.8% (CI% 90.9-96.8), respectively. Combined screening, which includes sociodemographic data, biophysical (mean blood pressure and uterine artery pulsatility index) and biochemical markers (PlGF and PAPP-A), increased sensitivity and specificity up to 85.5% (CI% 80.2-90.3) and 96.3% (CI% 91.4-98.9), respectively. For FGR, sociodemographic data plus biophysical markers had a sensitivity and specificity of 57.8% (CI% 50.1-63.4) and 80.1% (CI% 74.3-85.9), respectively. Combined screening increased sensitivity and specificity up to 67.2% (CI% 52.1-71.3) and 82.7% (CI% 75.2-90.1), respectively. Conclusion Combined screening for preeclampsia and FGR at 11 to 14 weeks of gestation, which includes maternal characteristics, mean blood pressure, uterine artery pulsatility index, PAPP-A and PlGF, has higher sensitivity and specificity than other screening options. Therefore, considering all these variables during screening is recommended for a superior opportunity of identifying pregnant women in risk for preeclampsia and FGR, especially in a high-risk population.

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. En 2015, el virus del Zika fue introducido en Colombia. La aparición de este arbovirus es un desafío para el sistema de salud pública del país, debido a la asociación entre la infección y alteraciones congénitas como la microcefalia. Por estas razones, se estimó la carga de la enfermedad, debido a la microcefalia asociada al Zika en Colombia, así como en sus subdivisiones administrativas en el periodo 2015-2016. Se realizó un estudio ecológico de tipo exploratorio, usando como unidad de medida los años de vida ajustados por discapacidad (DALYs, por sus siglas en inglés). Los casos de microcefalia debidos al Zika se obtuvieron de bases de datos nacionales y departamentales, construidas por el Sistema Nacional de Vigilancia en Salud Pública (SIVIGILA). Finalmente, se calcularon las tasas de mortalidad e incidencias, y posteriormente realizamos un análisis de sensibilidad bajo tres escenarios (conservador, medio y extremo), con el fin de estimar los DALYs. Durante el período de 2015-2016, se estimaron 10.609, 4 DALYs por microcefalia asociada con el Zika en Colombia. El 71% de los DALYs correspondieron a los años de vida perdidos y; el restante 29%, a los años vividos con discapacidad. Cinco de los 32 departamentos de Colombia (Meta, Córdoba, Tolima, Valle del Cauca y Norte de Santander) aportaron el 71% del total de DALYs. La carga de microcefalia asociada al Zika superó con creces la carga de otras alteraciones congénitas tales como defectos del tubo neural y síndrome de Down en niños entre los 0-4 años en Colombia. Se deben realizar esfuerzos en salud pública para prevenir y monitorear estos casos. O vírus Zika foi introduzido na Colômbia em 2015. O surgimento dessa arbovirose é um desafio para a saúde pública do país, devido à associação entre a infecção e as anomalias congênitas como a microcefalia. Portanto, o estudo buscou estimar a carga de doença pela microcefalia associada ao vírus Zika na Colômbia como um todo e em duas subdivisões administrativas nos anos de 2015 e 2016. Foi realizado um estudo ecológico de tipo exploratório, usando como unidade de medida os anos de vida ajustados para incapacidade (AVAIs). Os casos de microcefalia foram coletados das bases de dados nacionais e departamentais construídos por do Sistema Nacional de Vigilância em Saúde Pública (SIVIGILA). Os óbitos por microcefalia foram estimados a partir de estudos anteriores. Através dos coeficientes de mortalidade e de incidência, realizamos uma análise de sensibilidade em três cenários distintos (conservador, médio e extremo) para estimar os AVAIs. No período de 2015-2016, foram estimados 10.609,4 AVAIs pela microcefalia associada ao Zika na Colômbia. 71% dos AVAIs correspondiam aos anos de vida perdidos, e os outros 29% representavam os anos vividos com incapacidade. Cinco dos 32 departamentos (Meta, Córdoba, Tolima, Valle del Cauca e Norte de Santander) contribuíram com 71% do total de AVAIs. A carga da microcefalia associada ao Zika ultrapassou a carga por outras anomalias congênitas, como os defeitos do tubo neural e a síndrome de Down em crianças de 0 a 4 anos na Colômbia. São necessárias medidas de saúde pública para prevenir e acompanhar esses casos.

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

Dengue is the most important arbovirosis in the world. In this study, we assessed the knowledge, attitudes, and practices (KAP) regarding dengue in parents from two small Colombian municipalities in the Cundinamarca Province. Parents and their healthy children from 4 to 14 years of age were included in some public elementary schools. After a medical examination, blood samples were taken for diagnosis of dengue using enzyme-linked immunosorbent assays (capture immunoglobulin M and capture immunoglobulin G [IgG], indirect IgG and detection non-structural viral protein 1) and detection of viral RNA by reverse transcription polymerase chain reaction. In addition, a KAP survey was applied to the children’s parents or tutors. The indirect IgG test determined that of the 347 examined children, 87.9% had a previous infection with the dengue virus (DENV), 12.7% of them were positive for viral RNA (asymptomatic infection), and 32.0% presented reinfections. Risk factors evaluation showed that children aged 8 years and older living in the municipalities for more than 7 years were more likely to be infected or reinfected by DENV. In the same way, poor nutrition, lack of water supply, sewer service, or waste disposal services could raise the likelihood of dengue infections. The surveys indicated that parents have unhealthy practices and a low knowledge about the transmission of the disease, which could result in an increase of mosquito breeding sites, allowing sustained dengue transmission.

Background Multiple myeloma (MM) is a heterogeneous and incurable disease that evolves from asymptomatic premalignant conditions. The worldwide incidence, prevalence and mortality are well known thanks to data reported by the International Agency for Research on Cancer (IARC) and by the GLOBOCAN World Cancer Observatory. The data provided by Colombia to these reports comes from the population cancer registries corresponding to 5 cities whose most up-to-date data are from 2018. National data can also be found in the base of the high-cost account. Although it is true that there are excellent sources of information, it is believed that there is a significant underreporting of the prevalence of the disease, which makes it necessary to optimize the information to achieve the establishment of programs oriented to work on better control of this type of hematological cancer. The study MiMENTe (Mieloma Múltiple Epidemiología Nacional y territorial) is a collaborative effort to know the reality of the disease in terms of incidence, prevalence and mortality in Colombia as a first step to control the disease even in the premalignant stages for the future wanting to position itself as a model for the control of MM in developing countries. Methods MiMENTE (Mieloma Múltiple, Epidemiología Nacional y territorial) is a multiphase study that is going through its first stage through a cross-sectional study in Colombia. The total population diagnosed with Multiple Myeloma (ICD Code 10 C900) during the 2008-2018 period was included in the RIPS Individual Service Delivery Registry in Colombia and a comparison was made with the available data from GLOBOCAN (Global Cancer Observatory) and High Cost Account. Records that had an unidentified diagnosis were excluded. For this phase, a comparison is made of the data from the registries of the three entities described, three measures of frequency are established: Incidence, prevalence and mortality, standardizing the latter by means of a direct method, making the Colombian population comparable with large countries such as the United States. and Spain cataloged as centers of reference in the management and diagnosis of Multiple Myeloma. Variables such as ethnicity, age, place of origin, health regime, place of death will be studied in the future in later phases of the study. Results Between 2009 and 2018 (10 years), 26,356 MM diagnoses were found throughout the national territory of Colombia. The departments where the most attention to patients with this diagnosis was presented were Cundinamarca, Valle del Cauca, Antioquia, Santander, Bolívar and Atlántico Figure 1. The standardized incidence rate for Colombia in 2018 was 1.79 x 100,000 inhabitants, being higher in the Andean region as shown in the heat map. Graph 1. The total number of prevalent cases per year varied from 1138 cases in 2009 to 4474 cases in 2018 being for this year the adjusted prevalence of 8.97 x 100,000 inhabitants / year Graph 2. When the prevalence is analyzed by regions it is higher in the Andean region Graph 3. During this entire period of time, 5481 deaths were found, being 20.80%. The highest mortality occurred in the departments of Vichada, Meta, Caquetá, Risaralda, Atlántico and the island of San Andrés. Figure 2. The age-standardized mortality rate for Colombia is 1,39x100,000 inhabitants (Adjusted with the population of the United States). The most up-to-date data from IARC and GLOBOCAN are those corresponding to the year 2018. A comparison was made of our data with those reported in this last registry for Colombia in addition to the high-cost account. Comparative data were developed with the population of the United States, standardizing this population and it was also compared with the data reported for Spain. The prevalence of the disease is higher in Colombia than reported by GLOBOCAN, IARC and High cost drug account Table 1. Conclusion This is the first report of the MiMENTe study that shows the incidence, prevalence and mortality of patients with 10-year-old multiple myeloma in Colombia. The prevalence of the disease is higher than that reported by international registries. The regions with the highest incidence were those belonging to the andean region. The highest prevalence was confirmed in Bogotá and Antioquia and the highest mortality was observed in the Orinoco region. Disclosures Idrobo: Takeda: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Tecnofarma: Honoraria, Speakers Bureau; Amgen: Honoraria, Speakers Bureau; Abbvie: Honoraria, Speakers Bureau.

Background Acute promyelocytic leukemia (APL) is a malignant hematologic disease with a high cure rate, but unfortunately it produces several serious complications at the onset of the disease that explain the high early mortality. Based on clinical experience and the papers that precede this document, it has been observed that the incidence of this type of hematological cancer tends to increase at certain times of the year. The present study aims to determine the possible variations in the time intervals of the prevalence of promyelocytic leukemia in Colombia in the decade 2009 to 2019, in order to identify the behavior of the event, seasonality and cyclicality. Methods With data from the individual records of service provision (RIPS) of the official Colombian health system, the prevalence of APL in Colombia from 2009 to 2019 was identified. A filter was made by people attended, main diagnosis, C924 - promyelocytic leukemia acute, by year, semester and month. The analysis was performed with RStudio, R version 4.0.2 (2020-06-22); The fpp2 library was used, the analysis of the monthly and quarterly time series was carried out, the decomposition of the time series was carried out, trying through this process to evaluate the seasonal indices through additive and multiplicative types. Results During the entire period 2009 to 2019, 2,986 APL diagnoses were found throughout the national territory of Colombia. A progressive increase in prevalence was determined in the period studied (Graph 1). Cycles of increasing cases were observed every 10 months in the period 2009 to 2015 and in the cycle from 2016 to 2019 there was a prolongation of the cycle every 17 months, which strongly suggested that APL has cyclical behavior. Quarterly seasonality was identified by the multiplicative method with increases and decreases that behave in a similar way throughout the period studied (Graph 2). Conclusion APL is a highly curable disease that requires adequate support at the onset of the disease to avoid early mortality. The data from this study allow us to conclude that for the period 2009 to 2019 there is a seasonal behavior of this malignant hemopathy. The possibility of predicting during which months of the year the incidence of the disease will increase can serve to properly plan the health services in charge of treating this disease. Additional studies are required to determine what is the cause of the cyclical and seasonal behavior of this APL Disclosures Idrobo: Amgen:Honoraria, Speakers Bureau;Takeda:Honoraria, Speakers Bureau;Janssen:Honoraria, Speakers Bureau;Tecnofarma:Honoraria, Speakers Bureau;Abbvie:Honoraria, Speakers Bureau.

Most alphaviruses are mosquito-borne and can cause severe disease in domesticated animals and humans. The most notable recent outbreak in the Americas was the 2014 chikungunya virus (CHIKV) outbreak affecting millions and producing disease highlighted by rash and arthralgia. Chikungunya virus is a member of the Semliki Forest (SF) serocomplex, and before its arrival in the Americas, two other member of the SF complex, Una (UNAV) and Mayaro (MAYV) viruses, were circulating in Central and South America. This study examined whether antibodies from convalescent CHIKV patients could cross-neutralize UNAV and MAYV. Considerable cross-neutralization of both viruses was observed, suggesting that exposure to CHIKV can produce antibodies that may mitigate infection with UNAV or MAYV. Understanding the impact of CHIKV exposure on population susceptibility to other emerging viruses may help predict outbreaks; moreover, identification of cross-reactive immune responses among alphaviruses may lead to the development of vaccines targeting multiple viruses.

According to the World Health Organization, dengue is a neglected tropical disease. Latin America, specifically Colombia is in alert regarding this arbovirosis as there was a spike in the number of reported dengue cases at the beginning of 2019. Although there has been a worldwide decrease in the number of reported dengue cases, Colombia has shown a growing trend over the past few years. This study performed a Poisson multilevel analysis with mixed effects on STATA® version 16 and R to assess sociodemographic, climatic, and entomological factors that may influence the occurrence of dengue in three municipalities for the period 2010–2015. Information on dengue cases and their sociodemographic variables was collected from the National Public Health Surveillance System (SIVIGILA) records. For climatic variables (temperature, relative humidity, and precipitation), we used the information registered by the weather stations located in the study area, which are managed by the Instituto de Hidrologia, Meteorologia y Estudios Ambientales (IDEAM) or the Corporación Autónoma Regional (CAR). The entomological variables (house index, container index, and Breteau index) were provided by the Health office of the Cundinamarca department. SIVIGILA reported 1921 dengue cases and 56 severe dengue cases in the three municipalities; of them, three died. One out of four cases occurred in rural areas. The age category most affected was adulthood, and there were no statistical differences in the number of cases between sexes. The Poisson multilevel analysis with the best fit model explained the presentation of cases were temperature, relative humidity, precipitation, childhood, live in urban area and the contributory healthcare system. The temperature had the biggest influence on the presentation of dengue cases in this region between 2010 and 2015., Graphical abstract Unlabelled Image, Highlights • Climate, urban residency, healthcare affiliation, childhood are key factors for dengue. • Multilevel analysis identified temperature as the most important factor. • 25% of dengue cases in this study were in rural areas. • Our research shows climate factors that could increase dengue cases probability. • Climate change trend could increase arbovirosis cases.

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.This cross-sectional study was conducted through a review of data for 2008 through 2018 from Colombia's Public Health Surveillance System (SIVIGILA).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.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.Establecer las características de la cocirculación de tres virus (dengue, Zika y chikunguña) en Colombia desde el 2008 hasta el 2018. Para ello, en este estudio se han utilizado los informes de notificación que se proporcionan al sistema nacional de vigilancia.Este estudio transversal se llevó a cabo mediante el análisis de los datos correspondientes al período 2008-2018 del Sistema Nacional de Vigilancia en Salud Pública de Colombia (SIVIGILA).En el 2015, cuando se detectó por primera vez el chikunguña, este virus tuvo una incidencia mayor (1 359,0 casos por 100 000 personas) que las otras dos enfermedades. En el 2016, cuando se detectó por primera vez la circulación del virus del Zika, la incidencia fue de 296,4 casos por 100 000 personas; el número de casos disminuyó enormemente en los siguientes dos años. Entre el 2015 y el 2018, se observó una reducción sustancial en la frecuencia de la circulación del dengue: se pasó de 334,1 casos por 100 000 personas en el 2015 a 90,7 casos por 100 000 en el 2017 y a 173,1 casos por 100 000 en el 2018.La disminución en el número de casos del dengue que siguió a la cocirculación de los tres virus podría indicar una posible protección cruzada. Este resultado debe analizarse en otros estudios.Identificar padrões de co-circulação de três vírus (dengue, Zika e chikungunya) na Colômbia de 2008 a 2018 mediante análise de casos notificados ao sistema nacional de vigilância.Estudo transversal realizado através de análise de dados de 2008 a 2018 obtidos do Sistema de Vigilância em Saúde Pública da Colômbia (SIVIGILA).Em 2015, quando o chikungunya foi detectado pela primeira vez, sua incidência foi superior à das duas outras doenças (1.359,0 casos por 100,000 habitantes). Em 2016, quando a circulação do vírus zika foi detectada pela primeira vez, a incidência foi de 296,4 casos por 100,000 pessoas, decaindo drasticamente nos dois anos seguintes. Entre 2015 e 2018, houve uma redução importante na frequência de circulação do vírus dengue, de 334,1 casos por 100,000 habitantes em 2015 a 90,7 casos por 100,000 em 2017 e 173,1 casos por 100,000 em 2018.A redução do número de casos de dengue após o estabelecimento da co-circulação dos três vírus pode indicar proteção cruzada. Este achado requer análise adicional.

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 TNF&alpha, 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.

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

OBJETIVO: Estimar el exceso de mortalidad potencialmente atribuible a los virus de la influenza A y B y al virus sincitial respiratorio humano (VSRH) en las temporadas de mayor circulación de los virus de la influenza en Bogotá, Colombia entre 1997 y 2005. MÉTODOS: Se relacionaron las tasas mensuales de mortalidad general, por neumonía en menores de 5 años y por neumonía y afecciones cardiovasculares en mayores de 60 años, en Bogotá, Colombia, con las temporadas de mayor circulación de los virus de la influenza en esa ciudad. Los datos de mortalidad se obtuvieron del Departamento Nacional de Estadísticas de Colombia; las temporadas de mayor circulación de los virus se definieron como los meses contiguos en los que el número de aislamientos era igual o superior a la mitad del total de los aislamientos del año. Se calcularon las razones de tasas de incidencia (RTI) y sus intervalos de confianza de 95% (IC95%). RESULTADOS: El virus de la influenza A mostró un patrón de circulación estacional, pero no el de la influenza B y el VSRH. La mayor circulación de los virus de la influenza se asoció con un incremento promedio anual de 5% en la mortalidad general durante el período estudiado (RTI = 1,05; IC95%: 1,046 a 1,064). En las temporadas de mayor circulación de los virus de la influenza, la mortalidad combinada por neumonía e influenza en todas las edades fue mayor en 11% que en el resto del período (RTI = 1,11; IC95%: 1,051 a 1,178). CONCLUSIONES: En las temporadas de mayor circulación de los virus de la influenza en Colombia puede aumentar la mortalidad, en particular por neumonía y afecciones cardiovasculares en mayores de 60 años. Deben emprenderse acciones de prevención específicas para prevenir la influenza, especialmente en estos dos grupos de edad.OBJECTIVE: To estimate potential excess mortality attributable to influenza viruses A and B and human respiratory syncytial virus (HRSV) during peak seasons of influenza virus circulation in Colombia from 1997 to 2005. METHODS: A comparison of monthly, general mortality rates from pneumonia in children under 5 years of age and from pneumonia and cardiovascular disease in those more than 60 years of age in Bogota, Colombia, were compared to the city's peak seasons of influenza virus circulation. Mortality data were obtained from the National Bureau of Statistics of Colombia; peak seasons of virus circulation were defined as contiguous months in which the number of isolates was equal to or greater than half the total number of isolates for the year. Incidence rate ratios (IRR) and their 95% confidence intervals (95%CI) were determined. RESULTS: Influenza A demonstrated a pattern of seasonal circulation, but influenza B and HRSV did not. The increased circulation of influenza virus was associated with an average annual increase of 5% in overall mortality during the study period (IRR = 1.05; 95%CI: 1.046-1.064). During seasons of increased circulation of influenza viruses, the combined mortality from pneumonia and influenza for all ages was 11% higher than it was at other times (IRR = 1.11; 95%CI: 1.051-1.178). CONCLUSIONS: During peak seasons of influenza virus circulation in Colombia, there can be increased mortality, particularly from pneumonia and cardiovascular disease among those more than 60 years of age. Preventive actions specific to protecting against influenza should be taken, especially in these two age groups.

INTRODUCTION: In Colombia, there are no published studies for the treatment of uncomplicated Plasmodium falciparum malaria comparing artemisinin combination therapies. Hence, it is intended to demonstrate the non-inferior efficacy/safety profiles of artesunate + amodiaquine versus artemether-lumefantrine treatments. METHODS: A randomized, controlled, open-label, noninferiority (Δ≤5%) clinical trial was performed in adults with uncomplicated P. falciparum malaria using the 28‑day World Health Organization validated design/definitions. Patients were randomized 1:1 to either oral artesunate + amodiaquine or artemether-lumefantrine. The primary efficacy endpoint: adequate clinical and parasitological response; secondary endpoints: - treatment failures defined per the World Health Organization. Safety: assessed through adverse events. RESULTS: A total of 105 patients was included in each group: zero censored observations. Mean (95%CI - Confidence interval) adequate clinical and parasitological response rates: 100% for artesunate + amodiaquine and 99% for artemether-lumefantrine; the noninferiority criteria was met (Δ=1.7%). There was one late parasitological therapeutic failure (1%; artemether-lumefantrine group), typified by polymerase chain reaction as the MAD20 MSP1 allele. The fever clearance time (artesunate + amodiaquine group) was significantly shorter (p=0.002). Respectively, abdominal pain for artesunate + amodiaquine and artemether-lumefantrine was 1.9% and 3.8% at baseline (p=0.68) and 1% and 13.3% after treatment (p

Estimating the burden of disease associated with influenza virus season and modelling the epidemiological and economic impacts of introducing an inactivated vaccine to Colombia.A complete economic evaluation was done in children aged less than 2 and adults aged over 65. The outcomes evaluated in the under 2-year olds included: the yearly number of cases of acute respiratory infection (ARI), medical visits, hospitalisations and deaths by ARI. The outcomes measured in adults were the number of yearly deaths and hospitalisations due to cardiocirculatory diseases (CCD).Influenza infection in children under 2 years old not having had vaccination may cause 4,300 cases, 2,700 medical visits, 900 hospitalisations and 230 deaths by ARI yearly. Amongst the elder group, influenza infection would be associated with 670 deaths by pneumonia and 1,870 deaths from CCD. The incremental cost effectiveness ratio (ICER) for flu vaccination among children under 2 ranged from USD$ 1,900 to USD$ 2,967 per averted death. ICER was cost saving in adults aged over 65.This study's results supported the Colombian Ministry of Health's initiative for introducing yearly flu vaccination amongst small children and older adults in Colombia.

Objetivo Estimar la carga de enfermedad asociada a influenza y modelar el impacto epidemiológico y económico de la introducción de la vacuna para influenza en Colombia. Métodos Se realizó un estudio de evaluación económica completa de la introducción de la vacuna de influenza en dos grupos poblacionales. Los desenlaces seleccionados en menores de dos años fueron la frecuencia de enfermedad respiratoria (ERA), consultas y hospitalizaciones por ERA. En mayores de 65 años se adicionaron las muertes y hospitalizaciones por enfermedad cardiosvascular y cerebrovascular. Resultados En el escenario sin vacunación, el virus de influenza produciría anualmente 4 300 casos, 2 700 consultas, 900 hospitalizaciones y 230 muertes por ERA en menores de dos años. En mayores de 65 años, se presentarían anualmente 670 muertes por neumonía, 1 150 muertes por enfermedad cardiovascular y 720 muertes por enfermedad cerebrovascular relacionadas con influenza. El costo efectividad de la vacuna en menores de dos años oscila entre US $ 1 900 y US $ 2 967 por muerte evitada mientras que para mayores de 65 años la razón de costo efectividad seria costo ahorrativa. Conclusiones Los resultados del presente estudio apoyarían la decisión del Ministerio de la Protección Social y algunas Secretarias de Salud de introducir la vacunación en Colombia para menores de dos años y mayores de 65 años.

To estimate potential excess mortality attributable to influenza viruses A and B and human respiratory syncytial virus (HRSV) during peak seasons of influenza virus circulation in Colombia from 1997 to 2005.A comparison of monthly, general mortality rates from pneumonia in children under 5 years of age and from pneumonia and cardiovascular disease in those more than 60 years of age in Bogota, Colombia, were compared to the city's peak seasons of influenza virus circulation. Mortality data were obtained from the National Bureau of Statistics of Colombia; peak seasons of virus circulation were defined as contiguous months in which the number of isolates was equal to or greater than half the total number of isolates for the year. Incidence rate ratios (IRR) and their 95% confidence intervals (95%CI) were determined.Influenza A demonstrated a pattern of seasonal circulation, but influenza B and HRSV did not. The increased circulation of influenza virus was associated with an average annual increase of 5% in overall mortality during the study period (IRR = 1.05; 95%CI: 1.046-1.064). During seasons of increased circulation of influenza viruses, the combined mortality from pneumonia and influenza for all ages was 11% higher than it was at other times (IRR = 1.11; 95%CI: 1.051-1.178).During peak seasons of influenza virus circulation in Colombia, there can be increased mortality, particularly from pneumonia and cardiovascular disease among those more than 60 years of age. Preventive actions specific to protecting against influenza should be taken, especially in these two age groups.

Objetivo Identifi car factores clínicos y sociodemográfi cos asociados a enfermedad respiratoria severa durante las temporadas de circulación de infl uenza Métodos Se realizó un estudio de casos retrospectivo en pacientes hospitalizados por enfermedad respiratoria aguda durante las temporadas de circulación del virus de la infl uenza del año 2000 al 2006 en tres hospitales de Bogota y Manizales. Se estudio la frecuencia de complicaciones, incluyendo la muerte, y su relación con la presencia de enfermedades de base. Resultados Se estudiaron 535 niños menores de dos años y 288 adultos mayores de 65 años. En los niños, la presencia de una enfermedad de base se relacionó con complicaciones como la muerte hospitalaria (OR=16,5 IC 95 % 4,7-57,7), , el ingreso a UCI (OR=6,3 IC 95 % 3,5-11,3 ), difi cultad respiratoria que ameritaba uso de ventilación mecánica (OR= 2,4 IC 95 % 1,6-3,7),) y, la neumonía multilobar (OR=2,1 IC 95 %1,3-3,4),.Esta asociación se mantenia después de ajustar por factores de confusion como edad y estrato socioeconomico. En los adultos mayores no se observó esta relación. Conclusiones Durante las temporadas de infl uenza los niños con enfermedad crónica presentan una enfermedad más severa. Los niños menores de 6 meses, que no son objeto de vacunación, mostraron tener mayor frecuencia de complicaciones importantes como la muerte y el ingreso a UCI Es necesario por tal razón tener en cuenta este aspecto para el ajuste en las medidas de prevención y control tales como la vacunación. Objective Identifying clinical factors associated with respiratory tract diseases during human infl uenza circulation seasons in children aged less than two years old and adults aged over 65 years in two hospitals in the cities of Manizales and Bogota, Colombia. Methods A retrospective case study in patients hospitalized with acute respiratory illness was carried out during infl uenza circulation seasons from 2000 to 2006 in Bogota and Manizales. Complication frequency was studied, including death, and its relationship with baseline diseases. Results 535 children under two years of age and 288 adults over 65 years old were studied. 38.9 % of the children and 27 % of the adults had at least one complication. The presence of underlying disease in children was associated with complications such as hospital death (OR=16.5; 4.7-57.7 95%CI), being admitted to an intensive care unit (OR=6.3; 3.5-11.3 95%CI), respiratory distress needing FIO2> 40 % (OR=2.4; 1.6-3.7 95 %CI), mechanical ventilation (OR=2.4; 1.6-3.7 95 %CI) and multilobar pneumonia (OR=2.1; 1.3-3.4 95 %CI). This association remained after adjusting for confounding factors such as age and socioeconomic status, whilst such relationship was not observed in older adults. Conclusion Children with underlying chronic diseases were more susceptible to clinical complications during infl uenza seasons. Those under 6 months of age were particularly prone to dying or being admitted to an ICU. These results suggested that vaccination policies need to be adjusted.