Browsing by Author "Icaza, Gloria"
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Item First wave of SARS-CoV-2 in Santiago Chile: Seroprevalence, asymptomatic infection and infection fatality rate(2022) Vial, Pablo; González, Claudia; Apablaza, Mauricio; Vial, Cecilia; Lavín, M. Estela; Araos, Rafael; Rubilar, Paola; Icaza, Gloria; Florea, Andrei; Pérez, Claudia; Concha, Paula; Bastías, Diego; Errázuriz, María Paz; Pérez, Ruth; Guzmán, Francisco; Olea, Andrea; Guzmán, Eugenio; Correa, Juan; Munita, José; Aguilera, XimenaBackground: The first wave of SARS-CoV-2 infection in Chile occurred during the cold season reaching a peak by the end of June 2020, with 80 % of the cases concentrated in its capital, Santiago. The main objective of this study was to estimate the attack rate during this first wave of SARS-CoV-2 in a large, densely populated city with more than seven million inhabitants. Since the number of confirmed cases provides biased information due to individuals’ potential self-selection, mostly related to asymptomatic patients and testing access, we measured antibodies against SARS-CoV-2 to assess infection prevalence during the first wave in the city, as well as estimate asymptomatic cases, and infection fatality ratio. To our knowledge this is one of the few population-based cross- sectional serosurvey during the first wave in a highly affected emerging country. The challenges of pandemic response in urban settings in a capital city like Santiago, with heterogeneous subpopulations and high mobility through public transportation, highlight the necessity of more accurate information regarding the first waves of new emerging diseases. Methods: From April 24 to June 21, 2020, 1326 individuals were sampled from a long-standing panel of household representatives of Santiago. Immunochromatographic assays were used to detect IgM and IgG anti-body isotypes. Results: Seroprevalence reached 6.79 % (95 %CI 5.58 %− 8.26 %) in the first 107 days of the pandemic, without significant differences among sex and age groups; this figure indicates an attack rate 2.8 times higher than the one calculated with registered cases. It also changes the fatality rate estimates, from a 2.33 % case fatality rate reported by MOH to an estimated crude 1.00 % (CI95 % 0.97–1.03) infection fatality rate (adjusted for test performance 1.66 % [CI95 % 1.61–1.71]). Most seropositive were symptomatic (81,1 %). Conclusions: Despite the high number of cases registered, mortality rates, and the stress produced over the health system, the vast majority of the people remained susceptible to potential new epidemic waves. We contribute to the understanding of the initial spread of emerging epidemic threats. Consequently, our results provide better information to design early strategies that counterattack new health challenges in urban contexts.Publication Immunization and SARS-CoV-2 Antibody Seroprevalence in a Country with High Vaccination Coverage: Lessons from Chile(2022) Aguilera, Ximena; González, Claudia; Apablaza, Mauricio; Rubilar, Paola; Icaza, Gloria; Ramírez, Muriel; Pérez, Claudia; Cortes, Lina; Núñez, Loreto; Quezada, Rubén; Castillo, Carla; Correa, Juan; Said, Macarena; Hormazábal, Juan; Vial, Cecilia; Vial, PabloChile is among the most successful nations worldwide in terms of its COVID-19 vaccine rollout. By 31 December 2021, 84.1% of the population was fully vaccinated, and 56.1% received booster doses using different COVID-19 vaccines. In this context, we aimed to estimate the prevalence of anti-SARS-CoV-2 antibodies following the infection and vaccination campaign. Using a three-stage stratified sampling, we performed a population-based cross-sectional serosurvey based on a representative sample of three Chilean cities. Selected participants were blood-sampled on-site and answered a short COVID-19 and vaccination history questionnaire using Wantai SARS-CoV-2 Ab ELISA to determine seroprevalence. We recruited 2198 individuals aged 7-93 between 5 October and 25 November 2021; 2132 individuals received COVID-19 vaccinations (97%), 67 (3.1%) received one dose, 2065 (93.9%) received two doses, and 936 received the booster jab (42.6%). Antibody seroprevalence reached 97.3%, ranging from 40.9% among those not vaccinated to 99.8% in those with booster doses (OR = 674.6, 154.8-2938.5). SARS-CoV-2 antibodies were associated with vaccination, previous COVID-19 diagnosis, age group, and city of residence. In contrast, we found no significant differences in the type of vaccine used, education, nationality, or type of health insurance. We found a seroprevalence close to 100%, primarily due to the successful vaccination program, which strongly emphasizes universal access.Item Immunization and SARS-CoV-2 antibody seroprevalence in a country with high vaccination coverage: Lessons from Chile(2022) Aguilera, Ximena; González, Claudia; Apablaza, Mauricio; Rubilar, Paola; Icaza, Gloria; Ramírez-Santana, Muriel; Pérez, Claudia; Cortés, Lina Jimena; Núñez-Franz, Loreto; Quezada-Gaete, Rubén; Castillo-Laborde, Carla; Correa, Juan; Said, Macarena; Hormazábal, Juan; Vial, Cecilia; Vial, PabloObjective: Chile is among the most successful nations worldwide in COVID-19 vaccine rollout. By December 31st, 2021, 84.1% of the population was fully vaccinated, and 56.1% received booster doses using DIFFERENT TYPES OF COVID-19 VACCINES. In this context, we aimed to estimate the anti-SARSCoV-2 antibodies following the infection and vaccination campaign. Study design: Population-based cross-sectional serosurvey based on a representative sample of the cities of Santiago, Coquimbo/La Serena, and Talca used in a previous study. Methods: We selected the participants using a three-stage stratified sampling. They were blood-sampled on-site and answered a questionnaire regarding COVID-19-associated variables and vaccination antecedents using Wantai SARS-CoV-2 Ab ELISA to determine seroprevalence. This research followed the generic protocol of World Health Organization Unity studies. Results: We recruited 2,198 individuals aged 7-93 between October 5th and November 25th, 2021. In our sample, 2,132 individuals received COVID-19 vaccinations (97%); 67 (3.1%) received one dose; 2,065 (93.9%) received the complete scheme; and 936 received the booster jab (42.6%). Antibody seroprevalence reached 97.3%, ranging from 40.9% among those not vaccinated to 99.8% in those with booster doses (OR=674.6, 154.8-2938.5). SARS-CoV-2 antibodies were associated with vaccination, previous COVID-19 diagnosis, age group, and city of residence. In contrast, we found no significant differences in the type of vaccine used, education, nationality, or type of health insurance. Conclusion: We found a seroprevalence close to 100% in the population aged seven years and older, primarily due to the successful vaccination program, which has a strong emphasis on universal access.Item SARS-CoV-2 Neutralizing Antibodies in Chile after a Vaccination Campaign with Five Different Schemes(2022) Aguilera, Ximena; Hormazábal, Juan; Vial, Cecilia; Cortés, Lina Jimena; González, Claudia; Rubilar, Paola; Apablaza, Mauricio; Ramírez-Santana, Muriel; Icaza, Gloria; Núñez-Franz, Loreto; Castillo-Laborde, Carla; Ramírez-Riffo, Carolina; Pérez, Claudia; Quezada-Gate, Rubén; Said, Macarena; Vial, PabloUsing levels of neutralizing antibodies (nAbs), we evaluate the successful Chilean SARS-CoV-2 vaccine campaign, which combines different vaccine technologies and heterologous boosters. From a population-based study performed in November 2021, we randomly selected 120 seropositive individuals, organized into six groups of positive samples (20 subjects each) according to natural infection history and the five most frequent vaccination schemes. We conclude that the booster dose, regardless of vaccine technology or natural infection, and mRNA vaccines significantly improve nAbs response.Item Seroprevalence of Natural and Acquired Immunity against the SARS-CoV-2 Virus in a Population Cohort from Two Chilean Cities, 2020–2022(2023) Núñez-Franz, Loreto; Ramírez-Santana, Muriel; Rubilar, Paola; Vial, Cecilia; Apablaza, Mauricio; González, Claudia; Said, Macarena; Olivares, Kathya; Cortés, Lina Jimena; Hormazábal, Juan; Canales, Luis; Vial, Pablo; Icaza, Gloria; Quezada-Gaete, Rubén; Aguilera, XimenaBackground: Chile has achieved the highest coverage for vaccines against the SARS-CoV-2 virus worldwide. Objective: To assess the progression of immunity (natural and acquired by vaccine) in a cohort from two Chilean cities. Methods: Individuals (n = 386) who participated in three phases of population-based serial prevalence studies were included (2020–2021 and 2022). Presence of SARS-CoV-2 antibodies was measured in serum. Data including time of vaccination and type of vaccine received were analysed with descriptive statistics. Results: Seroprevalence was 3.6% in the first round and increased to 96.9% in the second and 98.7% in the third. In the third round, 75% of individuals who had received the basal full scheme were seropositive at 180 days or more since their last dose; 98% of individuals who received one booster dose were seropositive at 180 days or more, and 100% participants who received two boosters were seropositive, regardless of time since their last dose. Participants receiving mRNA vaccines had higher seroprevalence rates over time. Conclusions: The high vaccination coverage in Chile enabled the population to maintain high levels of antibodies. Vaccination boosters are essential to maintain immunity over time, which also depends on the type of vaccine administered.Item Seroprevalence, spatial distribution, and social determinants of SARS-CoV-2 in three urban centers of Chile(2022) Vial, Pablo; González, Claudia; Icaza, Gloria; Ramirez‐Santana, Muriel; Quezada‐Gaete, Rubén; Núñez‐Franz, Loreto; Apablaza, Mauricio; Vial, Cecilia; Rubilar, Paola; Correa, Juan; Pérez, Claudia; Florea, Andrei; Guzmán, Eugenio; Lavín, María Estela; Concha, Paula; Nájera, Manuel; Aguilera, XimenaBackground: Seroprevalence studies provide an accurate measure of SARS-CoV-2 spread and the presence of asymptomatic cases. They also provide information on the uneven impact of the pandemic, pointing out vulnerable groups to prioritize which is particularly relevant in unequal societies. However, due to their high cost, they provide limited evidence of spatial spread of the pandemic specially in unequal societies. Our objective was to estimate the prevalence of SARS-CoV-2 antibodies in Chile and model its spatial risk distribution. Methods: During Oct–Nov 2020, we conducted a population-based serosurvey in Santiago, Talca, and Coquimbo–La Serena (2493 individuals). We explored the individual association between positive results and socio-economic and health-related variables by logistic regression for complex surveys. Then, using an Empirical Bayesian Kriging model, we estimated the infection risk spatial distribution using individual and census information, and compared these results with ofcial records. Results: Seroprevalence was 10.4% (95% CI 7.8–13.7%), ranging from 2% (Talca) to 11% (Santiago), almost three times the number ofcially reported. Approximately 36% of these were asymptomatic, reaching 82% below 15 years old. Seroprevalence was associated with the city of residence, previous COVID-19 diagnosis, contact with confrmed cases (especially at household), and foreign nationality. The spatial model accurately interpolated the distribution of disease risk within the cities fnding signifcant diferences in the predicted probabilities of SARS-CoV-2 infection by census zone (IQR 2.5–15.0%), related to population density and education. Conclusions: Our results underscore the transmission heterogeneity of SARS-CoV-2 within and across three urban centers of Chile. Socio-economic factors and the outcomes of this seroprevalence study enable us to identify priority areas for intervention. Our methodological approach and results can help guide the design of interdisciplinary strate‐ gies for urban contexts, not only for SARS-CoV-2 but also for other communicable diseases.Item Under five and infant mortality in Chile (1990- 2016): Trends, disparities, and causes of death(2020) Aguilera, Ximena; Delgado, Iris; Icaza, Gloria; Apablaza, Mauricio; Villanueva, Loreto; Castillo-Laborde, Carla; PublicadoBackground Child health has been a health policy priority for more than a century in Chile. Since 2000, new health and intersectoral interventions have been implemented. However, no recent analyses have explored child mortality and equity in Chile, an indispensable input to guide policies towards the achievement of the Sustainable Development Goals, specially, in the context of a deeply unequal country such as many other Latin American countries. Thus, the objectives of this study are to analyze the variations in the risk and the causes of death among Chilean children aged <5 years, to identify the determinants, and to measure inequality of infant mortality from 1990 to 2016. Materials and methods An observational study was conducted to analyze the Chilean children's mortality from 1990 to 2016 using under five deaths and live births data from the Vital Statistics System. To describe the variation in the risk of death, a time series analysis was performed for each of the under five mortality rate components. A comparative cause of death analysis was developed for Neonatal and 1–59 months’ age groups. The determinants of infant mortality were studied with a descriptive analysis of yearly rates according to mother’s and child factors and bivariate logistic regression models at the individual level. Finally, simple and complex measures of inequality at individual level were estimated considering three-year periods. Results Regarding under 5 mortality: (i) Child survival has improved substantially in the last three decades, with a rapid decline in under five mortality rate between 1990 and 2001, followed by a slower reduction; (ii) early neonatal mortality has become the main component of the under five mortality rate (50.6%); (iii) congenital abnormalities have positioned as the leading cause of death; (iv) an important increase in live births below 1,000 grs. Regarding infant mortality: (i) birth weight and gestational age are the two most relevant risk factors in the neonatal period, while social variables are more significant for post-neonatal mortality and, (ii) the inequality according to mother’s education has shown a steady decline, with persistent inequalities in post-neonatal period. Conclusions The Chilean experience illustrates child health achievements and challenges in a country that transitioned from middle-to high-income in recent decades. Although inequity is one of the main challenges for the country, the health sector by granting universal access was able to reduce disparities. However, closing the gap in post-neonatal mortality is still challenging. To overcome stagnation in neonatal mortality, new and specific strategies must address current priorities, emphasizing the access of vulnerable groups.