esquema de vacunacion propuesto para tijuana, b.c. · esquema de vacunacion propuesto para tijuana,...
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• SAN LUIS POTOSI:
(1945 – 1949)
• 753 PEOPLE AFFECTED
• SAME TIME IN THE US
THE LAST
SEROGROUP A
OUTBREAK
Almeida-González L, et al. Sal Pub Mex 2004; 46(5): 438-50
MENINGOCOCCAL DISEASE (MED)
IN MEXICO
40’s OUTBREAK
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MED IN MEXICO1990 - 2009
# O
F C
AS
ES
*JulySUIVE - INDRE
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TWO KINDS OF SURVEILLANCE:ACTIVE AND PASSIVE
• Active:
Starts at the ER
Much more information
Less number of strains
Less number of Hospitals ($)
• Passive:
Starts in the Lab
Less information
More number of strains
More Hospitals
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BACTERIAL MENINGITIS IN TIJUANA, MEXICO
ACTIVE SURVEILLANCE FROM OCT / 2005 - SEPT / 2014 (9 YEARS)
ONLY CULTURE-CONFIRMED BACTERIAL ISOLATES FROM BLOOD AND/OR CSF, AND CLINICALLY / CSF-CYTOCHEMICAL ANALYSIS CONSISTENT WITH MENINGITIS
DEMOGRAPHIC, CLINICAL, MICROBIOLOGICAL STUDY
ALL CHILDREN < 16 YEARS OLD ADMITTED AT THE ER OF THE GENERAL HOSPITAL OF TIJUANA
6 PEDIATRIC PATIENTS FROM THE 2013-OUTBREAK NOT INCLUDED
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TOTAL CASES OF GRANULOCITIC MENINGITIS
• TOTAL = 71
• WITH ISOLATION = 60 (84.5%)
• NO ISOLATION = 11 (15.5%)
– 3 HAD PURPURA (27.27%)
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CAUSES OF CONFIRMED BACTERIAL MENINGITIS (%)
(n = 60)
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MENINGOCOCCAL MENINGITISBEFORE / AT ADMISSION (n=38)
• MEDIAN AGE: 2.5 yo (3 months - 15 yo)
47.3% < 2 yo
63% < 5 yo
• 57.8% MALE, 42.2% FEMALE
• PREDISPOSING FACTORS: 3 (7.9%): SEL, ALL, HIV
• PREVIOUS USE OF ANTIBIOTICS: 15 (39.5%)
• MEDIAN DAYS OF ANTIBIOTICS: 2 (1 - 7)
• MENINGOCOCCAL VACCINE: ONLY 1 PATIENT, WITH MCV4-D, 3 MONTHS BEFORE = "B" DISEASE
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MENINGOCOCCAL MENINGITISAT ADMISSION (n=38)
• MEDIAN DURATION OF SYMPTOMS: 2 (1 - 14)
• MENINGITIS: 100%
• PURPURA: 16 (42%)
• OTHERS: URTI = 18 (47.3%), PLEURAL EFFUSION = 1 (2.6%), DIARRHEA = 1 (2.6%)
• CBC:
MEDIAN WBC: 16300 (500 - 52300), >10000 = 24 (68.6%), < 5000 = 5 (14.3%)
MEDIAN NEUTROPHILS (%): 77 (8 - 94)
MEDIAN PLATELETS: 180000 (2000 - 428000), < 150000 = 6 (42.8%)
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MENINGOCOCCAL DISEASE CASESPER YEAR (9 YEARS, n = 38)
AVG / YEAR:
4.2
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MENINGOCOCCAL MENINGITISAT ADMISSION AND OUTCOMES
(n=38)
• PROLONGED CLOTTING TIMES: 40%
• MEDIAN CSF-WBC: 115 (0 - 30400)
• MEDIAN CSF-PMN's (%): 89.5 (0 - 100)
• MEDIAN CSF-GLUCOSE (mgs/dL): 41.5 (3 - 110)
• MEDIAN CSF-PROTEINS (mgs): 85 (12 - 473)
• MEDIAN HOSPITALIZATION DAYS: 10 (1 - 21)
• OVERALL MORTALITY: 10 (26.3%)
• CAUSES OF DEATH: 100% SEPTIC SHOCK ± IDC (79%)
• NEUROLOGIC SEQUELAE AT DISCHARGE: 9 (32%)
MILD SEQUELAE: 8 (88.9%)
SEVERE SEQUELAE: 1 (11.1%)
• ALL PATIENTS WITH PURPURA WHO SURVIVED HAD SCARS AS SEQUELAE, ONE DIED DURING AMPUTATION
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CLINICAL / LABORATORY VARIABLES ASSOCIATED WITH LETHALITY
• VARIABLE p:
PURPURA <0.05
WBC < 5000 <0.05
PLTS < 150000 <0.05
PROLONGED <0.05
CLOTT - TIMES
WITH PRED <0.05
CONDITIONS
(SEL, ALL, HIV)
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MENINGOCOCCAL SEROGROUPS DISTRIBUTION IN % (n=38)
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BINATIONAL STUDY, SAN DIEGO - HGTCASES BY SEROGOUP
(TOTAL OF 16 IN HG-TIJUANA AND 13 IN SD)
p < 0.004
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POSTER IB-009Mexico- United States – Surveillance of Meningococcal Disease in ChildrenE. CHACON-CRUZ1, D. SUGERMAN2, M. GINSBERG3, J. HOPKINS3, JL. LOPEZ-VIERA1, CA. LARA-MUÑOZ1, RM. RIVAS-LANDEROS1, ML. VOLKER1, JA. HURTADO-MONTALVO1, J. LEAKE4
1 General Hospital of Tijuana, Mexico 2 CDC Epidemic Intelligence Officer3 Health and Human Services Agency, San Diego, CA. 4 San Diego Childrens Hospital
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MENINGOCOCCAL DISEASE:RATES PER AGE GROUP
RA
TE
/ 100,0
00
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NATIONAL ACTIVE
SURVEILLANCE, MED AND
MENINGITIS IN MEXICO
FEB/2010 – JAN/2013
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MonterreyH. UniversitarioDr César Martínez
GuadalajaraH. CivilDr Antonio Luevanos
DFINPDr José L Castañeda
H Médica SurDr Fernando Aguilar
H PEMEXDra Ana Limón
MoreliaH. Infantil de MoreliaDr Jorge Vázquez
Tuxtla GtzH Gral de ChiapasDra Sandra Beltrán
CuliacánH. Pediátrico de SinaloaDr Eduardo Llausas
TijuanaH. Gral de TijuanaDr Enrique Chacón
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TOTAL REPORTS
201 MENINGITIS
GRANULOCITIC
129 (64.2%)
VIRALS
72 (35.8%)
NO ISOLATION
56 (43.4%)
WITH ISOLATION
73 (56.5%)
MENINGOCOCCAL24 (32.8%)
PNEUMOCOCCAL
17 (23.3%) S. agalactiae
6 (8.2%)
OTHERS
17 (23.3%)
FINAL REPORT (3 YEARS)
18 (75%) - IN TIJUANAChacon-Cruz E, et al. ESPID-2015, abstract # 808
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MED OUTBREAKTIJUANA, MEXICO
• 19 CASES
• 30 - JAN - 30 - MAR - 2013
• MEDIAN AGE= 16 yo (2 - 47)
• 74% > 13 yo - “TYPICAL FROM AN OUTBREAK“
• 11 FROM HG-TIJUANA (58%), 5 FROM IMSS (26%)
• ALL DIAGNOSED BY CULTURE AT HG-TIJUANA
• NO SPECIFIC CLUSTER
• SOME INTRAFAMILIAR (7)
• ALL BY SEROGROUP "C"
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MED OUTBREAK, TIJUANATIMELINE
DEATHS
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CASES AFTER THE OUTBREAK
• APR-AUG/2013
• FIVE CASES
• 3 BY SEROGROUP B
• 2 BY SEROGROUP C
• ONE FATALITY
• OCT 3rd – DEC 10th/2013
• SEVEN CASES (“SMALL OUTBREAK”?)
• SIX BY SEROGROUP C, ONE BY SEROGROUP Y
• FIVE FATALITIES!!!! (INCLUDING A MEDICINE STUDENT)
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• SPEAKER – PFIZER VACCINES
• SPEAKER – MSD VACCINES
• FORMER SPEAKER AND INDEPENDENT RESEARCHER – NOVARTIS VACCINES
• FORMER SPEAKER – GSK VACCINES
• FORMER SPEAKER – SANOFI VACCINES