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When fever is not malaria in Latin America: a systematic review.

ABSTRACT: BACKGROUND:In malaria-endemic countries, febrile episodes caused by diseases other than malaria are a growing concern. However, limited knowledge of the prevalent etiologic agents and their geographic distributions restrict the ability of health services to address non-malarial morbidity and mortality through effective case management. Here, we review the etiology of fever in Latin America (LA) between 1980 and 2015 and map significant pathogens commonly implicated in febrile infectious diseases. METHODS:A literature search was conducted, without language restrictions, in three distinct databases in order to identify fever etiology studies that report laboratory-confirmed fever-causing pathogens that were isolated from usually sterile body sites. Data analyses and mapping was conducted with Tableau Desktop (version 2018.2.3). RESULTS:Inclusion criteria were met by 625 publications corresponding to data relative to 34 countries. Studies using serology (n?=?339) predominated for viral infections, culture (n?=?131) for bacteria, and microscopy (n?=?62) for fungi and parasites. The pathogen groups most frequently reported were viral infections (n?=?277), bacterial infections (n?=?265), parasitic infections (n?=?59), fungal infections (n?=?47), and more than one pathogen group (n?=?24). The most frequently reported virus was dengue virus (n?=?171), followed by other arboviruses (n?=?55), and hantavirus (n?=?18). For bacteria, Staphylococcus spp. (n?=?82), Rickettsia spp. (n?=?70), and Leptospira spp. (n?=?55) were frequently reported. Areas with biggest gaps on etiology of fever were apparent. CONCLUSIONS:This review provides a landscape of pathogens causing febrile illness other than malaria in LA for over 30?years. Our findings highlight the need to standardize protocols and report guidelines for fever etiology studies for better comparability of results and improved interpretation. Lastly, we should improve existing national laboratory surveillance systems, especially from low- to middle-income countries, to inform global fever policy priorities and timely identify emerging infections threats. STUDY REGISTRATION:PROSPERO systematic review registration number: CRD42016049281.

SUBMITTER: Moreira J

PROVIDER: S-EPMC7504635 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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When fever is not malaria in Latin America: a systematic review.

Moreira José J Barros Janaina J Lapouble Oscar O Lacerda Marcus V G MVG Felger Ingrid I Brasil Patricia P Dittrich Sabine S Siqueira Andre M AM

BMC medicine 20200921 1

<h4>Background</h4>In malaria-endemic countries, febrile episodes caused by diseases other than malaria are a growing concern. However, limited knowledge of the prevalent etiologic agents and their geographic distributions restrict the ability of health services to address non-malarial morbidity and mortality through effective case management. Here, we review the etiology of fever in Latin America (LA) between 1980 and 2015 and map significant pathogens commonly implicated in febrile infectious ...[more]

PMID: 32951589

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Project description:BACKGROUND:National pediatric vaccination programs have been introduced in Latin America (LatAm) to reduce the burden of diseases due to pathogens such as rotavirus, Haemophilus influenzae type b (Hib) and pneumococcus. Vaccination health benefits may extend to unvaccinated populations by reducing pathogen transmission. Understanding herd effect is important for implementation and assessment of vaccination programs. The objective was to conduct a systematic review of published epidemiological evidence of herd effect with Hib, rotavirus and pneumococcal conjugate vaccines (PCV) in LatAm. METHODS:Searches were conducted in PubMed, Virtual Health Library (VHL), SciELO and SCOPUS databases, for studies reporting data on herd effect from Hib, rotavirus and PCV vaccination in LatAm, without age restriction. Searches were limited to articles published in English, Spanish or Portuguese (1990-2016). After screening and full-text review, articles meeting the selection criteria were included to be critically appraised following criteria for observational and interventional studies. The presence of a herd effect was defined as a significant decrease in incidence of disease, hospitalization, or mortality. RESULTS:3,465 unique articles were identified, and 23 were included (Hib vaccine n = 5, PCV n = 8, rotavirus vaccine n = 10). Most studies included children and/or adolescents (age range varied between studies). Studies in adults, including older adults (aged > 65 years), were limited. Few studies reported statistically significant reductions in disease incidence in age groups not targeted for vaccination. Hib-confirmed meningitis hospitalization decreased in children but herd effect could not be quantified. Some evidence of herd effect was identified for PCV and rotavirus vaccine in unvaccinated children. Evidence for herd effects due to PCV in adults was limited. CONCLUSION:After introduction of Hib, PCV and rotavirus vaccination in LatAm, reductions in morbidity/mortality have been reported in children not targeted for vaccination. However, due to methodological limitations (e.g. short post-vaccination periods and age range studied), there is currently insufficient evidence to quantify the herd effect in adult populations. More research and higher quality surveillance is needed to characterize herd effect of these vaccines in LatAm.

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When fever is not malaria in Latin America: a systematic review.

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When fever is not malaria in Latin America: a systematic review.

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