In Argentina, the National Technical Advisory Group on Immunizations is represented by the Nation... more In Argentina, the National Technical Advisory Group on Immunizations is represented by the National Immunization Commission (CoNaIn), an organization created by the Ministry of Health in 2000. Recently, the Argentine government has decided to prioritize vaccination as a state policy, emphasizing this strategy as a sign of social equity so CoNaIn was restructured to increase its capacity to formulate sound and evidence-based recommendations. The commission shall consist of a group of immunization experts, representatives of scientific societies, the immunization program and the Ministry of Health. Its functions include the formulation of recommendations on the introduction of vaccines into the immunization program. The recommendations are based on technical, programmatic and social criteria. This decisionmaking process transparent with the support and advice of experts and scientific societies and guided by available evidence decisions help strengthen the Ministry of Health immunization policy generating greater confidence and support from the population and health professionals.
Evaluación dE impacto dE dos EstratEgias combinadas para rEducir la mortalidad infantil En tucumá... more Evaluación dE impacto dE dos EstratEgias combinadas para rEducir la mortalidad infantil En tucumán, argEntina impact evaluation of two strategies combined to reduce the infant mortality in tucumán, argentina ABSTRACT. In 2003, the infant mortality rate in Tucuman was one of the highest in the country. In 2004, two strategies were implemented in order to reduce it: Strengthening the first level of care and optimization of tertiary neonatal care. OBJECTIVE: To evaluate the impact on the infant mortality of both strategies after 4 years of implementation. METHOD: The changes of three indicators were compared between 2003 and 2007 and by 4-years periods 2000-03 and 2004-07: 1) Proportion of newborns by birthweigh interval of total live births in the period in order to assess the strengthening of prenatal controls; 2) Changes in post-neonatal mortality rate, to estimate the effect of strengthening the healthy child controls; 3) Proportion of child deaths by birthweight interval of total live births in that interval in the period to measure the effect of improving the high complexity neonatal care services. The statistical analysis was performed with x2 and segmented regression. RESULTS:
Introduction: While there is much information about the burden of influenza A(H1N1)pdm09 in North... more Introduction: While there is much information about the burden of influenza A(H1N1)pdm09 in North America, little data exist on its burden in South America. Methods: During April to December 2009, we actively searched for persons with severe acute respiratory infection and influenza-like illness (ILI) in three sentinel cities. A proportion of case-patients provided swabs for influenza testing. We estimated the number of case-patients that would have tested positive for influenza by multiplying the number of untested case-patients by the proportion who tested positive. We estimated rates by dividing the estimated number of case-patients by the census population after adjusting for the proportion of case-patients with missing illness onset information and ILI case-patients who visited physicians multiple times for one illness event. Results: We estimated that the influenza A(H1N1)pdm09 mortality rate per 100,000 person-years (py) ranged from 1.5 among persons aged 5-44 years to 5.6 among persons aged $65 years. A(H1N1)pdm09 hospitalization rates per 100,000 py ranged between 26.9 among children aged ,5 years to 41.8 among persons aged $65 years. Influenza A(H1N1)pdm09 ILI rates per 100 py ranged between 1.6 among children aged ,5 to 17.1 among persons aged 45-64 years. While 9 (53%) of 17 influenza A(H1N1)pdm09 decedents with available data had obesity and 7 (17%) of 40 had diabetes, less than 4% of surviving influenza A(H1N1)pdm09 case-patients had these pre-existing conditions (p#0.001). Conclusion: Influenza A(H1N1)pdm09 caused a similar burden of disease in Argentina as in other countries. Such disease burden suggests the potential value of timely influenza vaccinations.
ABSTRACT. In 2003, the infant mortality rate in Tucuman was one of the highest in the country. In... more ABSTRACT. In 2003, the infant mortality rate in Tucuman was one of the highest in the country. In 2004, two strat-egies were implemented in order to reduce it: Strength-ening the first level of care and optimization of tertiary neonatal care. OBJECTIVE: To evaluate the ...
In Argentina, the National Technical Advisory Group on Immunizations is represented by the Nation... more In Argentina, the National Technical Advisory Group on Immunizations is represented by the National Immunization Commission (CoNaIn), an organization created by the Ministry of Health in 2000. Recently, the Argentine government has decided to prioritize vaccination as a state policy, emphasizing this strategy as a sign of social equity so CoNaIn was restructured to increase its capacity to formulate sound and evidence-based recommendations. The commission shall consist of a group of immunization experts, representatives of scientific societies, the immunization program and the Ministry of Health. Its functions include the formulation of recommendations on the introduction of vaccines into the immunization program. The recommendations are based on technical, programmatic and social criteria. This decisionmaking process transparent with the support and advice of experts and scientific societies and guided by available evidence decisions help strengthen the Ministry of Health immunization policy generating greater confidence and support from the population and health professionals.
El estreptococo beta hemolitico del grupo A ha presentado un cambio en su agresividad en estos ul... more El estreptococo beta hemolitico del grupo A ha presentado un cambio en su agresividad en estos ultimos anos,generando infecciones mas severas.Se relatan tres pacientes internados entre octubre de 1997 y enero de 1998 en una UCIP polivalente en San Miguel de Tucuman.Un nino con fascitis necrotizante y compromisohemodinamico,otro con shock septico y fallo mmultiorganico y un lactante de 10 meses que ingreso en paro cardiorespiratorio por shock septico.Se discuten las causas de este cambio en la agresividad,los signos de alarma,los criterios diagnosticos y terapeuticos actuales
El estreptococo beta hemolítico del grupo A ha presentado un cambio en su agresividad en estos úl... more El estreptococo beta hemolítico del grupo A ha presentado un cambio en su agresividad en estos últimos años, generando infecciones más severas. Se relatan tres pacientes internados entre octubre de 1997 y enero de 1998 en una UCIP polivalente en San Miguel de Tucumán. Un niño con fascitis necrotizante y compromiso hemodinámico, otro con shock séptico y fallo multiorgánico y un lactante de 10 meses que ingresó en paro cardiorrespiratorio por shock séptico. Se discuten las causas de este cambio en la agresividad, los signos de alarma, los criterios diagnósticos y terapéuticos actuales. Palabras clave: shock tóxico, fascitis necrotizante, enfermedad invasiva por estreptococo beta hemolítico. INTRODUCCION Desde 1980 la literatura médica ha venido relatando la aparición de infecciones graves por estreptococo beta hemolítico del grupo A (EBH-GA), con fascitis necrotizante o sin ella, asociadas con shock, fallo multiorgánico y muerte. La prensa no médica, sobre todo la inglesa, por su lado, alertó a la opinión pública sobre la aparición de una epidemia de "bacterias comedoras de carne" (flesheating bacteria), o "bacterias asesinas" (killer bug) con lo que esta patología cobró notoriedad. 1,2 En estos últimos años, nuevamente, el EBHGA ha presentado un cambio en su agresividad, generando infecciones severas con riesgo de fallo multiorgánico y muerte. Esto se debe a algunas cepas del EBHGA, sobre todo las M1 y M3, productoras de pirotoxinas A, B, y del superantígeno estreptocócico (SSA), una exotoxina, recientemente descripta, todas ellas acusadas de actuar como superantígenos. Estos activan directamente el sistema inmune sin requerir de las células presentadoras, consiguiendo así una producción de citoquinas cientos de veces superior desencadenando la cascada inflamatoria en forma descontrolada. 1-4 During the past years group A streptococci have changed their pathogenic potential, producing more severe infections. We report three patients in a polivalent PICU in San Miguel de Tucumán between October 1997 and January 1998. One child presented with necrotizing fasciitis and hypotension, another one with septic shock and multiorgan failure, and a 10 months old infant was admitted with cardiac arrest due to septic shock. We review the reasons of the change in the severity of the infections, the diagnostic criteria, and the current therapeutic approach.
In Argentina, the National Technical Advisory Group on Immunizations is represented by the Nation... more In Argentina, the National Technical Advisory Group on Immunizations is represented by the National Immunization Commission (CoNaIn), an organization created by the Ministry of Health in 2000. Recently, the Argentine government has decided to prioritize vaccination as a state policy, emphasizing this strategy as a sign of social equity so CoNaIn was restructured to increase its capacity to formulate sound and evidence-based recommendations. The commission shall consist of a group of immunization experts, representatives of scientific societies, the immunization program and the Ministry of Health. Its functions include the formulation of recommendations on the introduction of vaccines into the immunization program. The recommendations are based on technical, programmatic and social criteria. This decisionmaking process transparent with the support and advice of experts and scientific societies and guided by available evidence decisions help strengthen the Ministry of Health immunization policy generating greater confidence and support from the population and health professionals.
Evaluación dE impacto dE dos EstratEgias combinadas para rEducir la mortalidad infantil En tucumá... more Evaluación dE impacto dE dos EstratEgias combinadas para rEducir la mortalidad infantil En tucumán, argEntina impact evaluation of two strategies combined to reduce the infant mortality in tucumán, argentina ABSTRACT. In 2003, the infant mortality rate in Tucuman was one of the highest in the country. In 2004, two strategies were implemented in order to reduce it: Strengthening the first level of care and optimization of tertiary neonatal care. OBJECTIVE: To evaluate the impact on the infant mortality of both strategies after 4 years of implementation. METHOD: The changes of three indicators were compared between 2003 and 2007 and by 4-years periods 2000-03 and 2004-07: 1) Proportion of newborns by birthweigh interval of total live births in the period in order to assess the strengthening of prenatal controls; 2) Changes in post-neonatal mortality rate, to estimate the effect of strengthening the healthy child controls; 3) Proportion of child deaths by birthweight interval of total live births in that interval in the period to measure the effect of improving the high complexity neonatal care services. The statistical analysis was performed with x2 and segmented regression. RESULTS:
Introduction: While there is much information about the burden of influenza A(H1N1)pdm09 in North... more Introduction: While there is much information about the burden of influenza A(H1N1)pdm09 in North America, little data exist on its burden in South America. Methods: During April to December 2009, we actively searched for persons with severe acute respiratory infection and influenza-like illness (ILI) in three sentinel cities. A proportion of case-patients provided swabs for influenza testing. We estimated the number of case-patients that would have tested positive for influenza by multiplying the number of untested case-patients by the proportion who tested positive. We estimated rates by dividing the estimated number of case-patients by the census population after adjusting for the proportion of case-patients with missing illness onset information and ILI case-patients who visited physicians multiple times for one illness event. Results: We estimated that the influenza A(H1N1)pdm09 mortality rate per 100,000 person-years (py) ranged from 1.5 among persons aged 5-44 years to 5.6 among persons aged $65 years. A(H1N1)pdm09 hospitalization rates per 100,000 py ranged between 26.9 among children aged ,5 years to 41.8 among persons aged $65 years. Influenza A(H1N1)pdm09 ILI rates per 100 py ranged between 1.6 among children aged ,5 to 17.1 among persons aged 45-64 years. While 9 (53%) of 17 influenza A(H1N1)pdm09 decedents with available data had obesity and 7 (17%) of 40 had diabetes, less than 4% of surviving influenza A(H1N1)pdm09 case-patients had these pre-existing conditions (p#0.001). Conclusion: Influenza A(H1N1)pdm09 caused a similar burden of disease in Argentina as in other countries. Such disease burden suggests the potential value of timely influenza vaccinations.
ABSTRACT. In 2003, the infant mortality rate in Tucuman was one of the highest in the country. In... more ABSTRACT. In 2003, the infant mortality rate in Tucuman was one of the highest in the country. In 2004, two strat-egies were implemented in order to reduce it: Strength-ening the first level of care and optimization of tertiary neonatal care. OBJECTIVE: To evaluate the ...
In Argentina, the National Technical Advisory Group on Immunizations is represented by the Nation... more In Argentina, the National Technical Advisory Group on Immunizations is represented by the National Immunization Commission (CoNaIn), an organization created by the Ministry of Health in 2000. Recently, the Argentine government has decided to prioritize vaccination as a state policy, emphasizing this strategy as a sign of social equity so CoNaIn was restructured to increase its capacity to formulate sound and evidence-based recommendations. The commission shall consist of a group of immunization experts, representatives of scientific societies, the immunization program and the Ministry of Health. Its functions include the formulation of recommendations on the introduction of vaccines into the immunization program. The recommendations are based on technical, programmatic and social criteria. This decisionmaking process transparent with the support and advice of experts and scientific societies and guided by available evidence decisions help strengthen the Ministry of Health immunization policy generating greater confidence and support from the population and health professionals.
El estreptococo beta hemolitico del grupo A ha presentado un cambio en su agresividad en estos ul... more El estreptococo beta hemolitico del grupo A ha presentado un cambio en su agresividad en estos ultimos anos,generando infecciones mas severas.Se relatan tres pacientes internados entre octubre de 1997 y enero de 1998 en una UCIP polivalente en San Miguel de Tucuman.Un nino con fascitis necrotizante y compromisohemodinamico,otro con shock septico y fallo mmultiorganico y un lactante de 10 meses que ingreso en paro cardiorespiratorio por shock septico.Se discuten las causas de este cambio en la agresividad,los signos de alarma,los criterios diagnosticos y terapeuticos actuales
El estreptococo beta hemolítico del grupo A ha presentado un cambio en su agresividad en estos úl... more El estreptococo beta hemolítico del grupo A ha presentado un cambio en su agresividad en estos últimos años, generando infecciones más severas. Se relatan tres pacientes internados entre octubre de 1997 y enero de 1998 en una UCIP polivalente en San Miguel de Tucumán. Un niño con fascitis necrotizante y compromiso hemodinámico, otro con shock séptico y fallo multiorgánico y un lactante de 10 meses que ingresó en paro cardiorrespiratorio por shock séptico. Se discuten las causas de este cambio en la agresividad, los signos de alarma, los criterios diagnósticos y terapéuticos actuales. Palabras clave: shock tóxico, fascitis necrotizante, enfermedad invasiva por estreptococo beta hemolítico. INTRODUCCION Desde 1980 la literatura médica ha venido relatando la aparición de infecciones graves por estreptococo beta hemolítico del grupo A (EBH-GA), con fascitis necrotizante o sin ella, asociadas con shock, fallo multiorgánico y muerte. La prensa no médica, sobre todo la inglesa, por su lado, alertó a la opinión pública sobre la aparición de una epidemia de "bacterias comedoras de carne" (flesheating bacteria), o "bacterias asesinas" (killer bug) con lo que esta patología cobró notoriedad. 1,2 En estos últimos años, nuevamente, el EBHGA ha presentado un cambio en su agresividad, generando infecciones severas con riesgo de fallo multiorgánico y muerte. Esto se debe a algunas cepas del EBHGA, sobre todo las M1 y M3, productoras de pirotoxinas A, B, y del superantígeno estreptocócico (SSA), una exotoxina, recientemente descripta, todas ellas acusadas de actuar como superantígenos. Estos activan directamente el sistema inmune sin requerir de las células presentadoras, consiguiendo así una producción de citoquinas cientos de veces superior desencadenando la cascada inflamatoria en forma descontrolada. 1-4 During the past years group A streptococci have changed their pathogenic potential, producing more severe infections. We report three patients in a polivalent PICU in San Miguel de Tucumán between October 1997 and January 1998. One child presented with necrotizing fasciitis and hypotension, another one with septic shock and multiorgan failure, and a 10 months old infant was admitted with cardiac arrest due to septic shock. We review the reasons of the change in the severity of the infections, the diagnostic criteria, and the current therapeutic approach.
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