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Gastanaduy P.A.,Centers for Disease Control and Prevention | Gastanaduy P.A.,National Center for Immunization and Respiratory Disease | Sanchez-Uribe E.,National Center for Child and Adolescent Health | Esparza-Aguilar M.,National Center for Child and Adolescent Health | And 5 more authors.
Pediatrics | Year: 2013

OBJECTIVE: In Mexico, declines in childhood diarrhea deaths have been documented during 2008-2010 after rotavirus vaccine introduction in 2007. Because of concerns about variation in rotavirus vaccine efficacy by socioeconomic status, we compared reductions in diarrhea mortality in the lesser developed southern region versus the more developed northern and central regions of Mexico. METHODS: We obtained data from national vital statistics on diarrhea deaths among children aged <5 years from 2002 through 2011. We compared region-specific diarrhea mortality before (2003-2006) and after (2009-2011) vaccine introduction. Regional vaccine coverage was estimated from administrative data, and socioeconomic status was assessed by using the Human Development Index. RESULTS: In northern, central, and southern Mexico, the 2007 Human Development Index was 0.84, 0.82, and 0.77, respectively, and by 2010 an estimated 99%, 84%, and 89% of children aged <12 months had completed rotavirus vaccination. Diarrhea mortality among children <5 years old declined from 8.3, 17.9, and 28.5 deaths per 100 000 children during 2003-2006 to 4.5, 8.1, and 16.2 in 2009-2011 in northern, central, and southern Mexico, respectively, corresponding to rate reductions of 45%, 55%, and 43%. No significant differences were observed in rate reductions between regions (P < .8). CONCLUSIONS: After introduction of rotavirus vaccination, marked and sustained declines in diarrhea deaths were seen among children in all regions of Mexico, including in the least developed southern region with the highest baseline diarrhea mortality. This finding indicates equitable vaccine delivery to children with varying risk of mortality and reaffirms the beneficial effects of rotavirus vaccination against fatal diarrheal disease. Copyright © 2013 by the American Academy of Pediatrics.


Quintanar-Solares M.,National Center for Child and Adolescent Health | Yen C.,Centers for Disease Control and Prevention | Richardson V.,National Center for Child and Adolescent Health | Esparza-Aguilar M.,National Center for Child and Adolescent Health | And 2 more authors.
Pediatric Infectious Disease Journal | Year: 2011

Background: Single-strain rotavirus vaccine was added to the national immunization program in Mexico in May 2007. We assessed the impact of vaccination on the number of diarrhea-related hospitalizations in Mexican children in 2008 and 2009. Methods: We obtained data on all-cause diarrhea-related hospitalizations from January 2003 to June 2009 in Mexican children <5 years of age. We compared diarrhea-related hospitalizations during the 2008 and 2009 rotavirus seasons with the median number of diarrhea-related hospitalizations at baseline (2003-2006), before rotavirus vaccine introduction, at 306 Ministry of Health hospitals. We estimated vaccine coverage using administrative data. Results: A median number of 10,993 diarrhea-related hospitalizations (range: 9877-11958) occurred each prevaccine rotavirus season from 2003 to 2006 among children <5 years of age. Diarrhea-related hospitalizations decreased by 11% (N = 9836) in 2008 and by 40% (N = 6597) in 2009. The greatest declines occurred in infants <12 months of age during 2008 (25%) and 2009 (52%), with 1-dose rotavirus vaccination coverage of 74% and 89% during these years, respectively. A 43% decline was also noted among children 12 to 23 months of age during the 2009 season. No declines were noted during either 2008 or 2009 among unvaccinated children >24 months of age during the study period. Conclusions: Marked declines in diarrhea-related hospitalizations among vaccine-eligible Mexican children <24 months of age have occurred during the first 2 complete rotavirus seasons following rotavirus vaccination. Rotavirus-specific surveillance and epidemiologic studies are necessary for a better understanding of the changes in disease epidemiology and public health impact from rotavirus vaccination. © 2010 by Lippincott Williams & Wilkins.


Richardson V.,National Center for Child and Adolescent Health | Hernandez-Pichardo J.,National Center for Child and Adolescent Health | Quintanar-Solares M.,National Center for Child and Adolescent Health | Esparza-Aguilar M.,National Center for Child and Adolescent Health | And 4 more authors.
New England Journal of Medicine | Year: 2010

BACKGROUND: A phased introduction of a monovalent rotavirus vaccine occurred in Mexico from February 2006 through May 2007. We assessed the effect of vaccination on deaths from diarrhea in Mexican children in 2008 and 2009. METHODS: We obtained data on deaths from diarrhea, regardless of cause, from January 2003 through May 2009 in Mexican children under 5 years of age. We compared diarrhea-related mortality in 2008 and during the 2008 and 2009 rotavirus seasons with the mortality at baseline (2003-2006), before the introduction of the rotavirus vaccine. Vaccine coverage was estimated from administrative data. RESULTS: By December 2007, an estimated 74% of children who were 11 months of age or younger had received one dose of rotavirus vaccine. In 2008, there were 1118 diarrhea-related deaths among children younger than 5 years of age, a reduction of 675 from the annual median of 1793 deaths during the 2003-2006 period. Diarrhea-related mortality fell from an annual median of 18.1 deaths per 100,000 children at baseline to 11.8 per 100,000 children in 2008 (rate reduction, 35%; 95% confidence interval [CI], 29 to 39; P<0.001). Among infants who were 11 months of age or younger, diarrhea-related mortality fell from 61.5 deaths per 100,000 children at baseline to 36.0 per 100,000 children in 2008 (rate reduction, 41%; 95% CI, 36 to 47; P<0.001). As compared with baseline, diarrhea-related mortality was 29% lower for children between the ages of 12 and 23 months, few of whom were age-eligible for vaccination. Mortality among unvaccinated children between the ages of 24 and 59 months was not significantly reduced. The reduction in the number of diarrhea-related deaths persisted through two full rotavirus seasons (2008 and 2009). CONCLUSIONS: After the introduction of a rotavirus vaccine, a significant decline in diarrhea-related deaths among Mexican children was observed, suggesting a potential benefit from rotavirus vaccination. Copyright © 2010 Massachusetts Medical Society.


Patel M.M.,Centers for Disease Control and Prevention | Parashar U.D.,Centers for Disease Control and Prevention | Santosham M.,Johns Hopkins University | Richardson V.,National Center for Child and Adolescent Health
Clinical Infectious Diseases | Year: 2013

The recent introduction of a rotavirus vaccine program in Mexico to control rotavirus disease, a common killer of children worldwide, has dramatically reduced the number of Mexican children dying and being hospitalized because of diarrhea. The successful introduction of a rotavirus vaccine program was preceded by several decades of focused research efforts to document the burden of disease and to generate the knowledge base to develop and deploy a vaccine. The postlicensure experience from Mexico demonstrates that evaluating the impact and safety of the vaccination program is vitally necessary for sustaining it. All in all, the immensely successful Mexico experience with control of rotavirus disease, if copied, could yield tremendously favorable results for children and parents worldwide. © 2012 Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2012.


Esparza-Aguilar M.,National Center for Child and Adolescent Health | Gastanaduy P.A.,Centers for Disease Control and Prevention | Sanchez-Uribe E.,National Center for Child and Adolescent Health | Desai R.,Centers for Disease Control and Prevention | And 3 more authors.
Bulletin of the World Health Organization | Year: 2014

Objective To assess, by socioeconomic setting, the effect of nationwide vaccination against species A rotavirus (RVA) on childhood diarrhoea-related hospitalizations in Mexico. Methods Data on children younger than 5 years who were hospitalized for diarrhoea in health ministry hospitals between 1 January 2003 and 31 December 2011 were collected from monthly discharge reports. Human development indexes were used to categorize the states where hospitals were located as having generally high, intermediate or low socioeconomic status. Annual rates of hospitalization for diarrhoea - per 10 000 hospitalizations for any cause - were calculated. Administrative data were used to estimate vaccine coverage. Findings In the states with high, intermediate and low socioeconomic status, coverage with a two-dose monovalent RVA vaccine - among children younger than 5 years - had reached 93%, 86% and 71%, respectively, by 2010. The corresponding median annual rates of hospitalization for diarrhoea - per 10 000 admissions - fell from 1001, 834 and 1033 in the "prevaccine" period of 2003-2006, to 597, 497 and 705 in the "postvaccine" period from 2008 to 2011, respectively. These decreases correspond to rate reductions of 40% (95% confidence interval, CI: 38-43), 41% (95% CI: 38-43) and 32% (95% CI: 29-34), respectively. Nationwide, RVA vaccination appeared to have averted approximately 16 500 hospitalizations for childhood diarrhoea in each year of the postvaccine period. Conclusion Monovalent RVA vaccination has substantially reduced childhood diarrhoea-related hospitalizations for four continuous years in discretely different socioeconomic populations across Mexico.


Murguia-Peniche T.,National Center for Child and Adolescent Health | Mihatsch W.A.,Munich Municipal Hospitals | Zegarra J.,Hospital Nacional Cayetano Heredia | Supapannachart S.,Mahidol University | And 2 more authors.
Journal of Pediatrics | Year: 2013

The interplay between microorganisms and the intestine of newborn infants is associated with diverse functional and clinical outcomes that result from the specific interactions among microbial communities, their products, and the unique characteristics of the gastrointestinal tract. Multiple mechanisms of action for infant formula ingredients with probiotic activity appear to exist. These mechanisms are thought to protect the host not only from intestinal diseases but also from systemic infection. However, questions about the safety of probiotics for preterm infants remain unanswered, particularly with regard to sepsis, immunomodulatory effects, and microbial resistance. Few well-designed studies have been conducted to evaluate the effects of probiotic, prebiotic, and synbiotic ingredients on relevant clinical outcomes in preterm infants. Although existing data are encouraging, there is insufficient evidence to recommend the routine use of these ingredients in all preterm infants.


Neu J.,University of Florida | Mihatsch W.A.,Munich Municipal Hospitals | Zegarra J.,Hospital Nacional Cayetano Heredia | Supapannachart S.,Mahidol University | And 2 more authors.
Journal of Pediatrics | Year: 2013

When microbial communities colonize in the developing intestinal tract after birth, microrganisms interact with specific apical surface receptors on the enterocytes. This interaction triggers a response that prevents overexpression of inflammatory cytokines, thus providing protection from pathogen-induced mucosal damage. Multiple immune modulatory factors in human milk and innate humoral factors also control inflammatory responses, providing additional protective effects. Our understanding of the role of the luminal microbial communities or microbiota is growing rapidly as novel technologies provide new insights into their taxonomy, function during early development, and impact on life-long health. Multiple studies have evaluated the effects of the specific nutrients, glutamine, arginine, nucleotides, polyunsaturated fatty acids, and lactoferrin, on disease outcomes in premature infants. These studies support a role for nutrients to modulate host defense mechanisms in premature infants, to develop normal digestive function, to protect from bacterial translocation, and to preserve mucosal barrier integrity. These effects are clearly important. However, not enough is yet known to design specific clinical care practices that support a healthy microbiota.


Varan A.K.,Emory University | Esteves-Jaramillo A.,National Center for Child and Adolescent Health | Richardson V.,National Center for Child and Adolescent Health | Esparza-Aguilar M.,National Center for Child and Adolescent Health | And 2 more authors.
Vaccine | Year: 2014

Objective: Adult booster vaccination against pertussis can help prevent severe infections in young infants. We examined influences on intention to accept pertussis booster vaccination among pregnant women in Mexico City. Methods: We conducted a cross-sectional survey, recruiting convenience samples of pregnant women receiving prenatal care from three public healthcare centers between March and May 2012. Our primary outcome was intention to accept pertussis vaccination during pregnancy. We examined socio-demographic factors, vaccination history, pertussis knowledge, perceptions of vaccine information sources, and other potential influences on vaccine decision-making. Results: A total of 402 pregnant women agreed to participate, of which 387 (96%) provided their intention to accept or decline pertussis vaccination. Among respondents, 57% intended to accept a pertussis booster vaccine if offered, but only 16% had ever heard of pertussis, and only 2% knew someone who had contracted this disease. Over 80% of respondents would accept pertussis vaccination if recommended by an obstetrician-gynecologist. The most frequently selected reasons to refuse pertussis vaccination were concerns that the vaccine might harm the unborn baby or pregnant woman. In multivariate analysis, rating doctors and nurses as good sources of vaccine information, and having ever heard of pertussis, were independently associated with intention to accept pertussis vaccination. Conclusions: Promoting patient awareness about pertussis disease and vaccine safety, and encouraging general practitioners, nurses and obstetricians to recommend pertussis booster vaccine, may increase vaccine uptake among pregnant women. © 2013 Elsevier Ltd.


Murguia-Peniche T.,National Center for Child and Adolescent Health
Journal of Pediatrics | Year: 2013

Vitamins A and D are essential nutrients that play important roles in growth and development. Preterm and low birth weight infants have low levels of these nutrients and are at risk for developing detrimental health consequences associated with vitamin A and vitamin D deficiencies. Preliminary data suggest that vitamin A and D supplementation is needed to prevent deficiency. More work is needed to define optimal doses, timing, and modes of administration to ensure that an adequate supply of these vitamins is available to meet the critical needs during pregnancy and in high-risk neonates.


De Los Santos-Garate A.M.,Hospital Infantil Of Mexico Federico Gomez | Villa-Guillen M.,Hospital Infantil Of Mexico Federico Gomez | Villanueva-Garcia D.,Hospital Infantil Of Mexico Federico Gomez | Vallejos-Ruiz M.L.,Hospital Infantil Of Mexico Federico Gomez | Murguia-Peniche M.T.,National Center for Child and Adolescent Health
Journal of Perinatology | Year: 2011

Objective: The objective of this study is to identify adverse perinatal outcomes associated with pregnancies at or beyond 40 weeks. Study Design: Retrospective cohort study conducted in Mexico, with information obtained from the NEOSANO's Perinatal Network Database from April 2006 to April 2009. Multiple births, babies with inaccurate gestational age or babies with congenital malformations were excluded. Logistic regression models were used to analyze perinatal complications associated with pregnancies ≥40 weeks. Result: A total of 21 275 babies were analyzed; of these, 4545 (21.3%) were of 40 to 406 7 weeks, 3024 (14.2%) 41 to 416 7 weeks and 388 (1.8%) 42 to 44 weeks of gestation. Adverse perinatal outcomes associated with 40 to 406 7 weeks deliveries were (odds ratio; 95% confidence interval): macrosomia (1.9; 1.5 to 2.6), acute fetal distress (1.4; 1.2 to 1.7), emergency cesarean delivery (1.4; 1.2 to 1.5) and chorioamnionitis (1.4; 1.2 to 1.6). Adverse perinatal outcomes associated with 41 to 416 7 weeks were macrosomia (2.5; 1.8 to 3.3), chorioamnionitis (2; 1.7 to 2.3), emergency cesarean delivery (1.8; 1.6 to 2.1) and acute fetal distress (1.4; 1.1 to 1.7). Adverse perinatal outcomes associated with 42 to 44 weeks were macrosomia (7; 4.6 to 10.7), meconium aspiration syndrome (5.6; 2.8 to 11.2), neonatal death (4.8; 1.7 to 13.8), stillbirth (4.3; 1.4 to 13.5), 50 Apgar <4 (4.2; 1.1 to 15.7), chorioamnionitis (2.8; 2.2 to 3.9), admission to neonatal intensive care unit (2.7; 1.5 to 4.8), admission to neonatal intensive care unit or step-down unit (2.4; 1.5 to 3.9), acute fetal distress (1.8; 1.2 to 2.6) and emergency cesarean delivery (1.8; 1.3 to 2.4). Conclusion: An increased risk for perinatal and maternal complications were detected as early as 40 weeks' gestation. The risks of stillbirth and neonatal death were significantly higher in the post-term group than the control group. © 2011 Nature America, Inc. All rights reserved.

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