Alejandro Macchia

Background: HPV vaccination prevents infection with oncogenic HPV types and high-grade cervical lesions, but population-level evidence from Latin America on invasive cervical cancer and mortality remains scarce. Argentina introduced HPV vaccination in 2011 for 11-year-old girls born in 2000 or later. We assessed early mortality and cytology patterns in birth cohorts potentially eligible for vaccination.Methods: We did an ecological time-series study using national vital statistics for deaths from cervical cancer (ICD-10 C53) among women aged 20–69 years in Argentina from 2005 to 2024, with official annual female population denominators. Women aged 20–24 years in 2024 were defined as the index group. We compared 2024 with 2005–2018 using Poisson models and log woman-years as offset. As a complementary precursor outcome, we analysed HSIL or worse among evaluable cervical cytology samples from the public health-care network of Buenos Aires city in 2019–2025.Findings: We analysed 19 080 cervical cancer deaths and 259 538 948 woman-years. Among women aged 20–24 years, mortality decreased from 0·44 per 100 000 woman-years in 2005–2018 to 0·23 in 2024 (rate ratio 0·51, 95% CI 0·19–1·40; p=0·19). In women aged 25–69 years, mortality increased from 7·99 to 10·14 per 100 000 woman-years (1·27, 1·20–1·34; p<0·0001). In Buenos Aires city, HSIL or worse decreased in women aged 20–24 years from 0·93% in 2019–2022 to 0·46% in 2023–2025, but increased in women aged 25–64 years from 2·24% to 2·64%.Interpretation: Mortality and cytology data showed divergent patterns in birth cohorts potentially eligible for HPV vaccination at the target age. Although ecological and still early, these findings are consistent with an emerging cohort signal and support continued population-level monitoring of HPV vaccination impact in Argentina.

Objective: Dengue is a rapidly growing global health issue. In Argentina, the disease burden is primarily based on case reports or retrospective series; however, there are no prospective probabilistic studies available. To estimate the seroprevalence of antibodies against the dengue virus (DENV) in adult residents of Buenos Aires, at the end of the 2023 season, which culminated in Argentina’s largest recorded dengue outbreak, and immediately before the subsequent outbreak at the beginning of 2024. Methods: A stratified, multi-stage probabilistic population survey was conducted to ensure representativeness of the adult population of Buenos Aires, considering geographical and socio-economic diversity.The survey determined the seroprevalence rate of DENV IgG and IgM antibodies using a rapid chromatographic immunoassay. Antibody positive participants were invited for re-testing to confirm antibody result using an enzyme-linked fluorescence assay (ELFA) technique. Results: Out of a sampling frame of 2,998 selected households, the interviewers visited 100% of the residences. The overall response rate was 26.8%. A total of 804 participants were enrolled, representing the city’s 2.38 million adult population. Weighted estimates showed a total of 193,707 people aged 18 and over have antibodies to DENV. This implies a weighted prevalence [95% CI] of 8.12% [8.08%–8.15%]. The prevalence varied across different areas of the city. In the slums, the overall prevalence was twice as high (14.7% [14.5%–14.9%]) compared to the rest of the city (7.67% [7.63%–7.70%]). Conclusion: Seroprevalence results in adults in Buenos Aires show a moderate DENV infection rate, although still far from the thresholds usually considered for initiating a mass vaccination campaign. These results underscore the need for frequent surveys.

Objective. This study evaluated the association between serologically confirmed prior dengue infection and the subsequent risk of virologically confirmed dengue, severe dengue, dengue hospitalization, denguerelated death and all-cause mortality. Methods. A systematic review and meta-analysis were conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, CINAHL, MEDLINE, the Cochrane Library and Web of Science were searched for reports of phase III randomized controlled trials of vaccine efficacy that had data about the placebo group and information about prior infections and were published between January 1994 and March 2024. Random-effects models were used to calculate combined odds ratios (ORs), and heterogeneity was assessed. Results. Four studies from three phase III trials were included. Participants with prior infection had a lower likelihood of developing virologically confirmed dengue during follow up (OR: 0.85, 95% confidence interval [CI]: 0.75 to 0.98, P = 0.024) and the same risk of dengue hospitalization as those without prior infection (OR: 1.18, 95% CI: 0.92 to 1.53, P = 0.198). However, they had a higher rate of severe dengue (OR: 2.91, 95% CI: 1.23 to 6.87, P = 0.015). No dengue-related deaths occurred during follow up. There were no statistically significant differences in all-cause mortality between individuals with and without prior dengue (OR: 1.74, 95% CI: 0.21 to 14.08, P = 0.76). Conclusions. Prior dengue infection significantly reduced the risk of virologically confirmed dengue and increased the risk of severe dengue, but had no significant effect on dengue hospitalization, dengue-related death or all-cause mortality during follow up. These findings suggest the need to reconsider prior infection as an independent risk factor.

Importance: The increasing incidence and prevalence of dengue in Latin America is well-documented. Historical case-control series also highlight that secondary infections are a risk factor for severe dengue, hospitalization, and death. This has generated alarm among some sectors of the population and the scientific community. However, there has been no examination based on the results of randomized clinical trials that analyzes the risk of severe events in individuals with and without prior dengue infection. Objective: To evaluate the association between serologically confirmed prior dengue infection (DVC) and the subsequent risk of DVC, severe dengue (DS), dengue hospitalization (DHOSP), dengue-related death, and all-cause mortality. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies were searched in PubMed, CINAHL, Medline, Cochrane Library, and Web of Science, including only phase III randomized clinical trials of vaccine efficacy with data on participants in the placebo groups and information on previous infections. Random-effects models were applied to calculate combined odds ratios (OR), and heterogeneity among studies was assessed. Results: A total of four studies corresponding to three phase III clinical trials were included. Participants with prior infection had a lower likelihood of developing DVC during follow-up (OR: 0.85; 95% CI: [0.75; 0.98]; p=0.024) and the same risk of dengue hospitalization as those without prior dengue (OR: 1.18; 95% CI: [0.92; 1.53]; p=0.198). However, they had a higher rate of DS during follow-up (OR: 2.91; 95% CI: [1.23; 6.87]; p=0.015). No dengue-related deaths were observed in any of the clinical trials during follow-up. Conclusions: Prior dengue infection significantly reduces the risk of DVC and increases the risk of DS, although it does not significantly affect the risk of dengue hospitalization or dengue-related death during follow-up. The findings of this study highlight the need to reconsider the value of prior infection as an independent risk factor.

Access to medicines, integral to health rights, faces a global, chronic, and multicausal gap between declared rights and actual availability, particularly affecting at-risk groups.^1,2 In Argentina, the disparity is pronounced with two-thirds of retirees living on minimal pensions. Recent economic policies have exacerbated challenges by deregulating drug prices, following a 100% devaluation of the peso against the US dollar. Previously, drug price increases required government approval, but recent shifts have led to a deregulated pharmaceutical market, allowing companies to set prices freely. This study explores the associations between inflation, economic policy changes, and retirees’ access to medicines.