Search

RESUMEN INTRODUCCIÓN : Los modelos de simulación para COVID-19 requieren una serie de parámetros epidemiológicos que varían en base a cuestiones propias de cada región y al momento de la pandemia que se esté atravesando. OBJETIVO : Esta revisión rápida presenta los parámetros epidemiológicos esenciales potencialmente utilizables en Argentina. MÉTODOS : Se realizó una búsqueda en las principales bases de datos y en buscadores de artículos en estado de preimpresión (preprínts) de parámetros relacionados con la propagación del virus y evolución de la enfermedad, y el uso del sistema de salud. Para revisar los artículos seleccionados se utilizó una herramienta de evaluación de calidad apropiada al diseño del estudio. RESULTADOS : De las variables relacionadas con la propagación y evolución; el período de incubación es de 5,8 días (intervalos de confianza IC95%: 4,83-6,85), el período de infecciosidad es de 6,25 días (IC95%: 5,09-7,51), el número básico de reproducción es de 3,32 (IC95%: 3,24-3,39), y la tasa de fatalidad en pacientes infectados fue de 0,64% (IC95%: 0,5-0,78). De las variables relacionadas con el uso del sistema de salud, el tiempo de internación hospitalaria es de 5 días (rango intercuartílico RIC: 3-9), el tiempo de internación en una unidad de cuidados intensivos (UCI) es de 7 días (RIC: 4-11), el porcentaje de pacientes internados que requieren de UCI es de 26% (IC95%: 20-33) y, de estos, el porcentaje que requieren de ventilación mecánica es de 69% (IC95%: 61-75). DISCUSION : Estudios recientes y datos de acceso públicos a nivel nacional muestran valores distintos a los relevados de la bibliografía internacional. La información recolectada en este trabajo puede contribuir a informar futuros modelamientos y tableros de control para predecir la dinámica de la epidemia en Argentina. ABSTRACT INTRODUCTION : Símulatíon models for COVID-19 requíre a set of epídemíologícal parameters that vary accordíng to regional íssues and the tímíng of the pandemíc. OBJECTIVE : Thís rapid review presents the essential epídemíologícal parameters potentíally usable in Argentina. METHODS : A search of the maín databases and search engínes for artícles ín preprínt status (preprínts) of parameters related to the spread of the virus and evolutíon of the dísease, and the use of the health system was carríed out. A qualíty assessment tool appropríate to the study desígn was used to review the selected artícles. RESULTS : Of the variables related to the spread and evolutíon; the íncubatíon períod ís 5.8 days (confídence íntervals CI95%: 4.83-6.85), the ínfectíous períod ís 6.25 days (CI95%: 5.09-7.51), the basíc reproductíon number ís 3.32 (CI95%: 3.24-3.39), and the fatalíty rate ín ínfected patíents was 0.64% (CI95%: 0.5-0.78). Of the variables related to health system use, the length of hospital stay was 5 days (ínterquartíle range IQR: 3-9), the length of stay ín an íntensíve care unít (ICU) was 7 days (IQR: 4-11), the percentage of hospítalízed patíents requíríng ICU was 26% (CI95%: 20-33) and, of these, the percentage requíríng mechanícal ventílatíon was 69% (CI95%: 61-75). DISCUSSION : Recent studíes and publícly avaílable data at the natíonal level show values dífferent from those reported ín the ínternatíonal líterature. The ínformatíon collected ín thís work may contríbute to ínform future modelíng and dashboards to predíct the dynamícs of the epídemíc ín Argentina.

Background: Pregnant women with COVID-19 are at an increased risk of severe COVID-19 illness as well as adverse pregnancy and birth outcomes. Many countries are vaccinating or considering vaccinating pregnant women with limited available data about the safety of this strategy. Early identification of safety concerns of COVID-19 vaccines, including their components, or their technological platforms is therefore urgently needed., Methods: We conducted a rapid systematic review, as the first phase of an ongoing full systematic review, to evaluate the safety of COVID-19 vaccines in pregnant women, including their components, and their technological platforms (whole virus, protein, viral vector or nucleic acid) used in other vaccines, following the Cochrane methods and the PRISMA statement for reporting (PROSPERO-CRD42021234185).We searched literature databases, COVID-19 and pregnancy registries from inception February 2021 without time or language restriction and explored the reference lists of relevant systematic reviews retrieved. We selected studies of any methodological design that included at least 50 pregnant women or pregnant animals exposed to the vaccines that were selected for review by the COVAX MIWG in August 2020 or their components or platforms included in the COVID-19 vaccines, and evaluated adverse events during pregnancy and the neonatal period.Pairs of reviewers independently selected studies through the COVIDENCE web software and performed the data extraction through a previously piloted online extraction form. Discrepancies were resolved by consensus., Results: We identified 6768 records, 256 potentially eligible studies were assessed by full-text, and 37 clinical and non-clinical studies (38 reports, involving 2,397,715 pregnant women and 56 pregnant animals) and 12 pregnancy registries were included.Most studies (89%) were conducted in high-income countries. The most frequent study design was cohort studies (n=21), followed by surveillance studies, randomized controlled trials, and registry analyses. Most studies (76%) allowed comparisons between vaccinated and unvaccinated pregnant women (n=25) or animals (n=3) and reported exposures during the three trimesters of pregnancy.The most frequent exposure was to AS03 adjuvant in the context of A/H1N1 pandemic influenza vaccines (n=24), followed by aluminum-based adjuvants (n=11). Aluminum phosphate was used in Respiratory Syncytial Virus Fusion candidate vaccines (n=3) and Tdap vaccines (n=3). Different aluminum-based adjuvants were used in hepatitis vaccines. The replication-deficient simian adenovirus ChAdOx1 was used for a Rift Valley fever vaccine. Only one study reported exposure to messenger RNA (mRNA) COVID-19 vaccines that also used lipid nanoparticles. Except for one preliminary report about A/H1N1 influenza vaccination (adjuvant AS03) - corrected by the authors in a more thorough analysis, all studies concluded that there were no safety concerns., Conclusion: This rapid review found no evidence of pregnancy-associated safety concerns of COVID-19 vaccines that were selected for review by the COVAX MIWG or of their components or platforms when used in other vaccines. However, the need for further data on several vaccine platforms and components is warranted given their novelty. Our findings support current WHO guidelines recommending that pregnant women may consider receiving COVID-19 vaccines, particularly if they are at high risk of exposure or have comorbidities that enhance the risk of severe disease.