Mauricio Cerpa

World Health Organization Regional Office for the Americas

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Rakhee Palekar

Mitre (United States)

Jacques Boncy

National Public Health Laboratory

Mentor Ali Ber Lucien

Laboratoire National de Santé

Gérard Joseph

Ministère de la Santé

Patrick Dély

Ministère de la Santé Publique

Alfredo Bruno

Instituto Nacional de Investigación en Salud Pública

Hatim Sati

World Health Organization

Jairo Méndez‐Rico

World Health Organization Regional Office for the Americas

Alba María Ropero-Álvarez

World Health Organization Regional Office for the Americas

Nathalie El Omeiri

World Health Organization Regional Office for the Americas

Cooperative Institutions

World Health Organization Regional Office for the Americas

Centers for Disease Control and Prevention

Pan American Health Organization (Cuba)

World Health Organization

Administración Nacional de Laboratorios e Institutos de Salud

Secretaria de Salud

Instituto de Medicina Tropical “Pedro Kourí”

National Center for Immunization and Respiratory Diseases

Center for Surveillance, Epidemiology, and Laboratory Services

Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud

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A Multicenter Point-Prevalence Survey of Antibiotic Use in Haiti, June–August 2019: Findings and Implications

Infection Control and Hospital Epidemiology (2020)

Hatim Sati Mentor Ali Ber Lucien Jenny Hsieh Théodule Jean-Baptiste Mauricio Cerpa

Background: Inappropriate use of antibiotics in hospitalized settings contributes to the selection and emergence of antimicrobial-resistant pathogens. This trend is particularly challenging in resource-constrained settings where the high burden of infectious diseases, combined with suboptimal infection prevention and control measures, are further complicated by limited access to reliable microbiological services to inform antimicrobial prescription at the patient level. In this study, we describe the use of antibiotics in selected Haitian hospitals; we aimed to create a baseline to inform antimicrobial stewardship interventions. Methods: WHO/PAHO Hospital Antibiotic Use Point Prevalence Survey (HAMU-PPS) were conducted in 6 acute-care Haitian hospitals: La-Paix and Hospital-Albert (June 2019) and Hospital-Universitaire-Justinien, Hospital-Bienfaisance-de-Pignon, Hospital-Sacre-Coeur-de-Milot, and Hospital Immaculee-Conception-des-Cayes (July-August 2019) in 6 different cities. Trained data collectors completed electronic forms using REDCap software including data related to antibiotic use, indications, and utilization of laboratory services from medical records of all inpatients meeting study inclusion criteria. Analyses were done using Microsoft Excel software (v2016). Results: In total, 510 inpatients records were surveyed. Patients ages ranged from 0 to 92, with median age of 27 years (IQR, 4–47); 269 were women (57.7%) and 239 were men (46.9%). The prevalence of antibiotic use was 73% (95% CI, 68.2%–81.8 %); this prevalence was 74.5% among men (178 of 239) and 70.6% among women (190 of 269). The highest antibiotic use was observed among children aged <1 year (98 of 108, 90.7%). Of the patients on antibiotics, 63% were treated with >1 antibiotic. In addition, 384 indications for antibiotic prescription were reported. Of the indications for antibiotics therapy, 49.7% (191 of 384) were for treatment, and 49% (188 of 384) were for prophylaxis. Of the treatments, 92% were empiric with 6% reported as targeted. Only 13% (50 of 370) of the patient records indicated that samples were taken for microbiological identification. Of those, 9 had results for culture, and 1 had results for drug susceptibility. The most commonly reported antibiotic was ceftriaxone (n = 110, 23%) followed by ampicillin (n = 153, 21.4%) and metronidazole (n = 135, 20%). Conclusions: This study shows high use of antibiotics among hospitalized patients in Haitian hospitals, especially in children aged <1 year. Almost all the antibiotics were prescribed as either empiric or prophylaxis therapy, with very few microbiology samples collected. These results suggest limited laboratory corroboration across hospitals to inform antibiotic use. Implementation of antimicrobial stewardship interventions is recommended to optimize antibiotic therapy and to mitigate antimicrobial resistance in hospital care settings, but adaptation of the methodology should be done in settings with limited laboratory capacity. Funding: None Disclosures: None

Antimicrobial Stewardship

Medical record

10.1017/ice.2020.495

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Strengthening the Surveillance and Response to Public Health Events with a One Health approach: a perspective from 12 countries in Latin America and the Caribbean

The Journal of Infectious Diseases (2025)

Angel Rodríguez Paula Couto Alejandra Acevedo Belsy Acosta Herrera Olaya Astudillo

Caribbean region

10.1093/infdis/jiae629

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Estimating the burden of influenza‐associated hospitalizations and deaths in Central America

Influenza and Other Respiratory Viruses (2016)

M.Á. Descalzo Wilfrido Clará Guzman Guiselle Ricardo Mena Julio Armero

Our objective was to estimate the incidence of influenza-associated hospitalizations and in-hospital deaths in Central American Region.We used hospital discharge records, influenza surveillance virology data, and population projections collected from Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua to estimate influenza-associated hospitalizations and in-hospital deaths. We performed a meta-analysis of influenza-associated hospitalizations and in-hospital deaths.The highest annual incidence was observed among children aged <5 years (136 influenza-associated hospitalizations per 100 000 persons).Annually, 7 625-11 289 influenza-associated hospitalizations and 352-594 deaths occurred in the subregion.Our results suggest that a substantive number of persons are annually hospitalized because of influenza. Health officials should estimate how many illnesses could be averted through increased influenza vaccination.

10.1111/irv.12385

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Antibiotics and Antimicrobial Resistance in the COVID-19 Era.

International Journal of Infectious Diseases (2021)

Mentor Ali Ber Lucien Michael F. Canarie Paul E. Kilgore Gladzdin Jean-Denis Natael Fénélon

Antimicrobial Stewardship

Pandemic

Superinfection

Source

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Citations (1)

Determination of Predominance of Influenza Virus Strains in the Americas

Emerging infectious diseases (2015)

Eduardo Azziz‐Baumgartner Rebecca Garten Rakhee Palekar Mauricio Cerpa Sara A. Mirza

During 2001-2014, predominant influenza A(H1N1) and A(H3N2) strains in South America predominated in all or most subsequent influenza seasons in Central and North America. Predominant A(H1N1) and A(H3N2) strains in North America predominated in most subsequent seasons in Central and South America. Sharing data between these subregions may improve influenza season preparedness.

Influenza season

Preparedness

10.3201/eid2107.140788

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Timing of influenza epidemics and vaccines in the American tropics, 2002–2008, 2011–2014

Influenza and Other Respiratory Viruses (2015)

Lizette O. Durand Po‐Yung Cheng Rakhee Palekar Alexey Clara Jorge Jara

Background Influenza‐associated illness results in increased morbidity and mortality in the Americas. These effects can be mitigated with an appropriately chosen and timed influenza vaccination campaign. To provide guidance in choosing the most suitable vaccine formulation and timing of administration, it is necessary to understand the timing of influenza seasonal epidemics. Objectives Our main objective was to determine whether influenza occurs in seasonal patterns in the American tropics and when these patterns occurred. Methods Publicly available, monthly seasonal influenza data from the Pan American Health Organization and WHO , from countries in the American tropics, were obtained during 2002–2008 and 2011–2014 (excluding unseasonal pandemic activity during 2009–2010). For each country, we calculated the monthly proportion of samples that tested positive for influenza. We applied the monthly proportion data to a logistic regression model for each country. Results We analyzed 2002–2008 and 2011–2014 influenza surveillance data from the American tropics and identified 13 (81%) of 16 countries with influenza epidemics that, on average, started during May and lasted 4 months. Conclusions The majority of countries in the American tropics have seasonal epidemics that start in May. Officials in these countries should consider the impact of vaccinating persons during April with the Southern Hemisphere formulation.

Pandemic

Seasonal influenza

10.1111/irv.12371

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From Epidemics to Pandemics: Over a Decade of SARInet Strengthening and Laboratory Surveillance and Response for Respiratory Viruses in the Americas

The Journal of Infectious Diseases (2025)

Juliana Almeida Leite Priscila Born Angel Rodríguez Paula Couto Mauricio Cerpa

Pandemic

2019-20 coronavirus outbreak

10.1093/infdis/jiaf046

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Antibiotics and antimicrobial resistance in the COVID-19 era: Perspective from resource-limited settings

International Journal of Infectious Diseases (2021)

Mentor Ali Ber Lucien Michael F. Canarie Paul E. Kilgore Gladzdin Jean-Denis Natael Fénélon

The dissemination of COVID-19 around the globe has been followed by an increased consumption of antibiotics. This is related to the concern for bacterial superinfection in COVID-19 patients. The identification of bacterial pathogens is challenging in low and middle income countries (LMIC), as there are no readily-available and cost-effective clinical or biological markers that can effectively discriminate between bacterial and viral infections. Fortunately, faced with the threat of COVID-19 spread, there has been a growing awareness of the importance of antimicrobial stewardship programs, as well as infection prevention and control measures that could help reduce the microbial load and hence circulation of pathogens, with a reduction in dissemination of antimicrobial resistance. These measures should be improved particularly in developing countries. Studies need to be conducted to evaluate the worldwide evolution of antimicrobial resistance during the COVID-19 pandemic, because pathogens do not respect borders. This issue takes on even greater importance in developing countries, where data on resistance patterns are scarce, conditions for infectious pathogen transmission are optimal, and treatment resources are suboptimal.

Antimicrobial Stewardship

Pandemic

10.1016/j.ijid.2020.12.087

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Citations (223)

Seasonal influenza vaccine effectiveness against laboratory-confirmed influenza hospitalizations – Latin America, 2013

Vaccine (2017)

Nathalie El Omeiri Eduardo Azziz‐Baumgartner Mark G. Thompson Wilfrido Clará Mauricio Cerpa

Despite widespread utilization of influenza vaccines, effectiveness (VE) has not been routinely measured in Latin America. We used a case test-negative control design to estimate trivalent inactivated influenza VE against laboratory-confirmed influenza among hospitalized children aged 6 months-5 years and adults aged ≥60 years which are age-groups targeted for vaccination. We sought persons with severe acute respiratory infections (SARI), hospitalized at 71 sentinel hospitals in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Honduras, Panama, and Paraguay during January–December 2013. Cases had an influenza virus infection confirmed by real-time reverse transcription PCR (rRT-PCR); controls had a negative rRT-PCR result for influenza viruses. We used a two-stage random effects model to estimate pooled VE per target age-group, adjusting for the month of illness onset, age and preexisting medical conditions. We identified 2620 SARI patients across sites: 246 influenza cases and 720 influenza-negative controls aged ≤5 years and 448 cases and 1206 controls aged ≥60 years. The most commonly identified subtype among participants (48%) was the influenza A(H1N1)pdm09 virus followed by influenza A(H3N2) (34%) and influenza B (18%) viruses. Among children, the adjusted VE of full vaccination (one dose for previously vaccinated or two if vaccine naïve) against any influenza virus SARI was 47% (95% confidence interval [CI]: 14–71%); VE was 58% (95% CI: 16–79%) against influenza A(H1N1)pdm09, and 65% (95% CI: −9; 89%) against influenza A(H3N2) viruses associated SARI. Crude VE of full vaccination against influenza B viruses associated SARI among children was 3% (95% CI: −150; 63). Among adults aged ≥60 years, adjusted VE against any influenza SARI was 48% (95% CI: 34–60%); VE was 54% (95% CI: 37–69%) against influenza A(H1N1)pdm09, 43% (95% CI: 18–61%) against influenza A(H3N2) and 34% (95% CI: −4; 58%) against B viruses associated SARI. Influenza vaccine provided moderate protection against severe influenza illness among fully vaccinated young children and older adults, supporting current vaccination strategies.

10.1016/j.vaccine.2017.06.036

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Citations (26)