Martha Avilés-Robles

Background: Chikungunya virus (CHIKV) is a mosquito-borne alphavirus transmitted predominantly by Aedes aegypti and Aedes albopictus. Infection is characterized by an acute febrile illness accompanied by debilitating polyarthralgia, myalgia, and cutaneous manifestations. Although the acute syndrome is usually self-limited, a substantial proportion of patients experience persistent musculoskeletal symptoms that may progress to chronic inflammatory arthritis, resulting in prolonged disability and impaired quality of life. Objective: To summarize current evidence on the epidemiology, virology, immunopathogenesis, clinical manifestations, laboratory diagnosis, prevention, and vaccine development of CHIKV, with particular emphasis on its implications for public health policy and immunization strategies in Mexico. Methods: This position paper was developed through a structured narrative review of the scientific literature. Publications indexed in PubMed, Scopus, and Embase, together with documents issued by the World Health Organization (WHO), Pan American Health Organization (PAHO), Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and European Medicines Agency (EMA), were critically reviewed. Evidence was selected according to its scientific quality and relevance to Mexico and Latin America. Because this work represents an expert consensus rather than a systematic review, no formal risk-of-bias assessment was performed. Results: CHIKV circulates through both urban and sylvatic transmission cycles and continues to expand into regions where competent mosquito vectors are established. Disease progression is driven by complex innate and adaptive immune responses, with exaggerated inflammatory activation contributing to chronic rheumatologic sequelae. Laboratory confirmation relies primarily on molecular assays during the viremic phase and serological testing thereafter. Recent advances in vaccine development—including live-attenuated and virus-like particle (VLP) platforms—have demonstrated favorable immunogenicity and acceptable safety profiles. However, vaccination should be considered one component of an integrated prevention strategy that also includes vector surveillance, environmental control, and rapid outbreak detection. Conclusions: Chikungunya remains an emerging global public health challenge because of its expanding geographic distribution, epidemic potential, and long-term clinical consequences. Incorporating vaccination into comprehensive arboviral control programs, together with strengthened surveillance and integrated vector management, may substantially reduce disease burden. This position paper provides evidence-based recommendations to support future chikungunya prevention and vaccination policies in Mexico.

Background: Chikungunya virus (CHIKV) is a mosquito-borne alphavirus transmitted predominantly by Aedes aegypti and Aedes albopictus. Infection is characterized by an acute febrile illness accompanied by debilitating polyarthralgia, myalgia, and cutaneous manifestations. Although the acute syndrome is usually self-limited, a substantial proportion of patients experience persistent musculoskeletal symptoms that may progress to chronic inflammatory arthritis, resulting in prolonged disability and impaired quality of life.Objective: To summarize current evidence on the epidemiology, virology, immunopathogenesis, clinical manifestations, laboratory diagnosis, prevention, and vaccine development of CHIKV, with particular emphasis on its implications for public health policy and immunization strategies in Mexico.Methods: This position paper was developed through a structured narrative review of the scientific literature. Publications indexed in PubMed, Scopus, and Embase, together with documents issued by the World Health Organization (WHO), Pan American Health Organization (PAHO), Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and European Medicines Agency (EMA), were critically reviewed. Evidence was selected according to its scientific quality and relevance to Mexico and Latin America. Because this work represents an expert consensus rather than a systematic review, formal risk-of-bias assessment was not performed.Results: CHIKV circulates through both urban and sylvatic transmission cycles and continues to expand into regions where competent mosquito vectors are established. Disease progression is driven by complex innate and adaptive immune responses, with exaggerated inflammatory activation contributing to chronic rheumatologic sequelae. Laboratory confirmation relies primarily on molecular assays during the viremic phase and serological testing thereafter. Recent advances in vaccine development—including live-attenuated and virus-like particle (VLP) platforms—have demonstrated favorable immunogenicity and acceptable safety profiles. However, vaccination should be considered as one component of an integrated prevention strategy that also includes vector surveillance, environmental control, and rapid outbreak detection.Conclusions: Chikungunya remains an emerging global public health challenge because of its expanding geographic distribution, epidemic potential, and long-term clinical consequences. Incorporating vaccination into comprehensive arboviral control programs, together with strengthened surveillance and integrated vector management, may substantially reduce disease burden. This position paper provides evidence-based recommendations to support future chikungunya prevention and vaccination policies in Mexico.

We developed SaludConectaMX as a comprehensive system to track and understand the determinants of complications throughout chemotherapy treatment for children with cancer in Mexico. SaludConectaMX is unique in that it integrates patient clinical indicators with social determinants and caregiver mental health, forming a social-clinical perspective of the patient's evolving health trajectory. The system is composed of a web application (for hospital staff) and a mobile application (for family caregivers), providing the opportunity for cooperative patient monitoring in both hospital and home settings. This paper presents the system's preliminary design and usability evaluation results from a 1.5-year pilot study. Our findings indicate that while the hospital web app demonstrates high completion rates and user satisfaction, the family mobile app requires additional improvements for optimal accessibility; statistical and qualitative data analysis illuminate pathways for system improvement. Based on this evidence, we formalize suggestions for health system development in LMICs, which HCI researchers may leverage in future work.

Introduction: Respiratory viruses are among the leading causes of disease and death among children. Co-circulation of influenza and SARS-CoV2 can lead to diagnostic and management difficulties given the similarities the clinical picture. Methods: This is a cohort of all children hospitalized with SARS-CoV2 infection from March to September 3rd 2020, and all children admitted with influenza throughout five flu-seasons (2013-2018) at a pediatric referral hospital. Patients with influenza were identified from the clinical laboratory database. All hospitalized patients with confirmed SARS-CoV2 infection were followed-up prospectively. Results: A total of 295 patients with influenza and 133 with SARS-CoV2 infection were included. The median age was 3.7 years for influenza and 5.3 years for SARS-CoV2. Comorbidities were frequent in both groups, but they were more common in patients with influenza (96.6% vs 82.7%, p <0.001). Fever and cough were the most common clinical manifestations in both groups. Rhinorrhea was present in more than half of children with influenza but was infrequent in those with COVID-19 (53.6 vs 5.8%, p<0.001). Overall, 6.4% percent of patients with influenza and 7.5% percent of patients with SARS-CoV2 infection died. In-hospital mortality and the need for mechanical ventilation among symptomatic patients were similar between groups in the multivariate analysis. Conclusions: Influenza and COVID-19 have a similar picture in pediatric patients, which makes diagnostic testing necessary for adequate diagnosis and management. Even though most cases of COVID-19 in children are asymptomatic or mild, the risk of death among hospitalized patients with comorbidities may be substantial, especially among infants.

Background: It has been suggested that low‐risk febrile neutropenia (FN) episodes can be treated in a step‐down manner in the outpatient setting. This recommendation has been limited to implementation in middle‐income countries due to concerns about infrastructure and lack of trained personnel. We aimed to determine whether early step‐down to oral antimicrobial outpatient treatment is not inferior in safety and efficacy to inpatient intravenous treatment in children with low‐risk FN.Procedure: A noninferiority randomized controlled clinical trial was conducted in three hospitals in Mexico City. Low‐risk FN was identified in children younger than 18 years. After 48 to 72 hours of intravenous treatment, children were randomly allocated to receive outpatient oral treatment (experimental arm, cefixime) or to continue inpatient treatment (standard of care, cefepime). Daily monitoring was performed until neutropenia resolution. The presence of any unfavorable clinical outcome was the endpoint of interest. We performed a noninferiority test for comparison of proportions.Results: We identified 1237 FN episodes; 117 cases were randomized: 60 to the outpatient group and 57 for continued inpatient treatment. Of the FN episodes, 100% in the outpatient group and 93% in the inpatient group had a favorable outcome (P < 0.001). The mean duration of antibiotics was 4.1 days (SD 2.5; 95% CI, 3.4‐4.8 days) in the outpatient group and 4.4 days (SD 2.5; 95% CI, 3.7‐5.0 days) in the inpatient group (P = 0.70).Conclusions: In our population, step‐down oral outpatient treatment of low‐risk FN was as safe and effective as inpatient intravenous treatment. Clinical Trials Identifier: NCT04000711.