Therapeutic approaches are needed to improve outcomes in patients with COVID-19. Ivermectin, a widely used drug with a favorable safety profile,¹ is thought to act at different protein-binding sites to reduce viral replication.^2-5 Because of evidence of activity against SARS-CoV-2 in vitro⁶ and in animal models,^7,8 ivermectin has attracted interest in the global scientific community⁹ and among policy makers.¹⁰ Several countries have included ivermectin in their treatment guidelines,^11-13 leading to a surge in the demand for the medication by the general population and even alleged distribution of veterinary formulations.¹⁴ However, clinical trials are needed to determine the effects of ivermectin on COVID-19 in the clinical setting.

: Dengue is the most important viral vector-borne disease in the tropics, with Colombia being one of the most affected countries. In this context, it is essential to identify and synthesize the existing evidence on the epidemiology of dengue in Colombia. A systematic review (PROSPERO CRD42021257985) was conducted by searching for epidemiological data in populations with suspected or confirmed dengue in Colombia from 2012 to 2020. We searched PubMed, EMBASE, the Cochrane Library, the LILACS, and SciELO databases, and 104 publications out of 1,234 records were selected. The dengue annual incidence rate varied through the years without a clear trend. The lowest annual incidence rate was observed in 2017 (90.7 per 100,000 population) and the highest in 2013 (476.2 per 100,000 population). The proportion of severe cases in the same period ranged between 0.89% in 2016 and 2.7% in 2012. The four dengue virus (DENV) serotypes co-circulated in the country, and DENV-2 was the predominant serotype. Fifty percent of dengue cases occurred in people under 20 years, and those between 5 and 14 years had the highest incidence rate. The mortality rate for all dengue cases ranged from 0.07% in 2020 to 0.16% in 2012 and 2015. In conclusion, dengue is a hyperendemic disease in Colombia with the circulation of four serotypes. New strategies must be implemented to prevent the contagion and impact of the disease on the population at risk.

Immunobridging is an important methodology that can be used to extrapolate vaccine efficacy estimates to populations not evaluated in clinical studies, and that has been successfully used in developing many vaccines. Dengue, caused by a mosquito-transmitted flavivirus endemic to many tropical and subtropical regions, is traditionally thought of as a pediatric disease but is now a global threat to both children and adults. We bridged immunogenicity data from a phase 3 efficacy study of a tetravalent dengue vaccine (TAK-003), performed in children and adolescents living in endemic areas, with an immunogenicity study in adults in non-endemic areas. Neutralizing antibody responses were comparable in both studies following receipt of a two-dose TAK-003 schedule (months 0 and 3). Similar immune responses were observed across exploratory assessments of additional humoral responses. These data support the potential for clinical efficacy of TAK-003 in adults.

Epidemiological data from Latin America on acute gastroenteritis (AGE) in the post rotavirus vaccine era obtained using highly sensitive molecular techniques are scarce. This prospective surveillance study was performed between March 15, 2015 and March 19, 2016 in two municipal health networks (MHNs) in Cali, Colombia to detect AGE in children <5 years of age. Consecutive sampling was performed simultaneously in all health facilities belonging to both MHNs until completion of the required sample size. Stool samples from AGE patients were tested with a nucleic acid assay for 16 pathogens. Detection frequency and incidence rates were obtained for specific pathogens according to age-group in children with AGE leading to hospitalization or outpatient care. Overall incidence rates of AGE-related hospitalization and outpatient care were 20 and 237 per 1000 children <5 years of age, respectively. Despite almost complete rotavirus vaccine uptake, rotavirus was the most common etiology overall, including hospitalization and outpatient treatment of 0-23-month-olds, with incidence rates of 12 and 108 per 1000 children, respectively. Norovirus incidence rates were similar to rotavirus rates in this age group and associated with high Vesikari scores. Shigella predominated in 24-59-month-olds. AGE remains an important cause of morbidity in children under 5 years of age, especially in those under 2 years. Rotavirus remains the leading AGE-associated pathogen, followed closely by norovirus in younger children. Preventive measures, including novel vaccination strategies, are necessary in this population to further reduce AGE-related morbidity.

Background: Limited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19. Objective: To describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America. Method: Multicenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children <18 years of age with COVID-19 confirmed by polymerase chain reaction or antigen detection from the nasopharynx were included. Children with multisystem inflammatory syndrome in children (MIS-C) were excluded. Associations were assessed using univariate and multivariable logistic regression models. Results: A total of 1063 children with COVID-19 were included; 500 (47%) hospitalized, with 419 (84%) to the pediatric wards and 81 (16%) to the ICU. In multivariable analyses, age <1 year (Odds Ratio [OR] 1.78; 95% CI 1.08–2.94), native race (OR 5.40; 95% CI 2.13–13.69) and having a co-morbid condition (OR 5.3; 95% CI 3.10–9.15), were associated with hospitalization. Children with metabolic or endocrine disorders (OR 4.22; 95% CI 1.76–10.11), immune deficiency (1.91; 95% CI 1.05–3.49), preterm birth (OR 2.52; 95% CI 1.41–4.49), anemia at presentation (OR 2.34; 95% CI 1.28–4.27), radiological peribronchial wall thickening (OR 2.59; 95% CI 1.15–5.84) and hypoxia, altered mental status, seizures, or shock were more likely to require PICU admission. The presence of pharyngitis (OR 0.34; 95% CI 0.25–0.48); myalgia (OR 0.47; 95% CI 0.28–0.79) or diarrhea (OR 0.38; 95% CI 0.21–0.67) were inversely associated with hospital admission. Conclusions: In this data analysis reported to the SLIPE research network in Latin America, infants, social inequalities, comorbidities, anemia, bronchial wall thickening and specific clinical findings on presentation were associated with higher rates of hospitalization or PICU admission. This evidence provides data for prioritization prevention and treatment strategies for children suffering from COVID-19.