Epidemiology and molecular characterization of Neisseria lactamica carried in 11-19 years old students in Salvador, Brazil.

Neisseria lactamica is a nonpathogenic commensal bacterium that is potentially associated with the development of natural immunity against N. meningitidis. However, the genetic variation present in natural populations of N. lactamica has not been fully investigated. To better understand its epidemiology and genetic variation, we studied N. lactamica carriage in 1200 students aged 11-19 years old in Salvador, Brazil. The carriage prevalence was 4.5% (54/1200), with no statistical difference among sex and age, although we observed a trend towards higher carriage prevalence among 11-year-old individuals. Whole genome sequence analysis revealed a high genetic diversity among the isolates, with the presence of 32 different STs, 28 (87.5%) of which were new. A total of 21/50 (42%) isolates belonged to three different clonal complexes. While none of the isolates contained nadA or fHpb alleles, we detected 21 FetA variants, 20 NhbA variants and two variants of PorB. The data provide detailed information on circulating N. lactamica isolates in adolescents in Brazil and are complementary to studies in other countries.

Care for the spiritual dimension provided by caregivers in a nursing home.

OBJECTIVES: to understand care for the spiritual dimension provided by caregivers in a Nursing Home. METHODS: this is a qualitative research, carried out in a geriatric center of a philanthropic hospital in the city of Salvador, Bahia. Eighteen formal caregivers participated, through a semi-structured interview, between January and February 2019. The data were analyzed in the light of Jean Watson's Theory of Transpersonal Caring. RESULTS: formal caregivers discuss the spiritual dimension based on older adults' religious beliefs, encourage religious practices and exercise spiritual care according to older adults' physical, emotional and spiritual demands. FINAL CONSIDERATIONS: formal caregivers understand that older adults' religious or spiritual experiences should be included in their work routine. Care for the spiritual dimension occurs by stimulating faith in God, encouraging religious practices and embracing their beliefs in the face of physical, emotional and spiritual demands.

Faith and spirituality in the meaning of life of the elderly with Chronic Kidney Disease.

OBJECTIVE: to understand faith and spirituality in the meaning of life of the elderly with Chronic Kidney Disease. METHODS: a qualitative research based on Viktor Emil Frankl's Logotherapy and Existential Analysis. Twenty elderly people were interviewed between August 2018 and January 2019, between 60 and 79 years old, who underwent dialysis in a private unit, a reference in nephrology in the city of Salvador, Bahia, Brazil. RESULTS: two categories of analysis emerged: Meaning of faith in the lived of the elderly with Chronic Kidney Disease; Faith as a forerunner of the meaning of life. Final considerations: faith and spirituality were understood as a fundamental foundation in the search for the meaning of the study participants' lives, besides unveiling itself as an important strategy of resilience to the experienced of the elderly person with Chronic Kidney Disease.

Clinical and epidemiological features of pertussis in Salvador, Brazil, 2011-2016.

Pertussis, a severe respiratory infection caused by Bordetella pertussis, is distributed globally. Vaccination has been crucial to annual reductions in the number of cases. However, disease reemergence has occurred over the last decade in several countries, including Brazil. Here we describe the clinical and epidemiological aspects of suspected pertussis cases in Salvador, Brazil, and evaluate factors associated with case confirmation. This descriptive and retrospective study was conducted in the five hospitals in Salvador that reported the highest number of pertussis cases between 2011-2016. Demographic and clinical data were recorded for each patient. Bivariate analysis was performed to evaluate differences between groups (confirmed vs. unconfirmed cases) using Pearson's Chi-square test or Fisher's exact test. Results: Of 529 suspected pertussis cases, 29.7% (157/529) were confirmed by clinical, clinical-epidemiological or laboratory criteria, with clinical criteria most frequently applied (63.7%; 100/157). Unvaccinated individuals (43.3%; 68/157) were the most affected, followed by age groups 2-3 months (37.6%; 59/157) and <2 months (31.2%; 49/157). Overall, ≤50% of the confirmed cases presented a complete vaccination schedule. All investigated cases presented cough in association with one or more symptoms, especially paroxysmal cough (66.9%; 105/529) (p = 0.001) or cyanosis (66.2%; 104/529) (p<0.001). Our results indicate that pertussis occurred mainly in infants and unvaccinated individuals in Salvador, Brazil. The predominance of clinical criteria used to confirm suspected cases highlights the need for improvement in the laboratory tools used to perform rapid diagnosis. Fluctuations in infection prevalence demonstrate the importance of vaccination strategies in improving the control and prevention of pertussis.

Meningococcal carriage in young adults six years after meningococcal C conjugate (MCC) vaccine catch-up campaign in Salvador, Brazil.

Meningococcal carriage studies are important to improve the knowledge of disease epidemiology as well as to support appropriate vaccination strategies. We conducted a cross-sectional study to determine the prevalence and genotypic characteristics of meningococci collected from young adults in Salvador, Brazil six years after a meningococcal C conjugate vaccine catch-up campaign. From August through November 2016, oropharyngeal swabs were collected from 407 students aged 1824 years attending a private college in Salvador, Brazil. Neisseria meningitidis was identified by standard microbiology methods and real time PCR. Genetic characteristics of meningococci were assessed by rt-PCR and/or whole genome sequencing. We also investigated potential factors associated with carriage. N. meningitidis was detectable in 50 students, 39 by both culture and rt-PCR, 7 by culture alone and 4 by rt-PCR alone, resulting in an overall meningococcal carriage prevalence of 12.3% (50/407). Carriage was independently associated with male sex (adjusted PR: 1.97; 95% CI: 1.12-3.46; p = 0.018) and attending bars or parties at least once per month (aPR: 3.31; 95% CI: 1.49-7.38; p = 0.003). Molecular tests identified 92% (46/50) N. meningitidis as non-groupable, of which 63% (29/46) had the capsule null genotype; 14 NG isolates contained disrupted capsule backbones and belonged to the following genogroups: 7 B, 3 Z, 3 E and 1 W. One isolate belonged to genogroup C tested only by PCR; 3 isolates contained a complete B capsule backbones, 2 of which were determined to be NG by slide agglutination serogrouping. While most meningococcal carriage isolates were non-groupable, there was a high degree of genetic diversity present in the collection, as evidenced by 25 unique STs being detected. The carriage prevalence of meningococcal serogroup C was low among young adults. Continuous vaccination is important to maintain reduced meningococcal carriage and transmission, inducing herd protection.

Impact of meningococcal C conjugate vaccination programs with and without catch-up campaigns in adolescents: Lessons learned from Bahia, Brazil.

The significant increase in the incidence rates and ongoing outbreaks of serogroup C meningococcal (MenC) disease, associated with the sequence type-103 complex, motivated the incorporation of the meningococcal C conjugate (MCC) vaccine in the routine immunization program in the State of Bahia, Brazil in early 2010, targeting children younger than 5 years of age. In its capital, Salvador, the program also included a catch-up campaign for individuals 10-24 years of age. We performed an observational, ecological study, analyzing data collected from 2007 to 2015, to compare the impact of these two immunization strategies on meningococcal disease incidence and mortality rates. In Salvador, following the vaccination program, a dramatic early impact on MenC disease and mortality rates could be observed, with significant reductions in incidence rates of MenC disease in all age groups, including individuals that were too old to have been vaccinated, indicating the presence of herd protection. Compared to the pre-vaccine period, a virtual disappearance of MenC disease was observed in 2015. However, in the state of Bahia (excluding the city of Salvador), no herd protection could be observed, with significant impact only among vaccine-eligible children within 5 years of introduction of the MCC vaccination program. These results highlight the importance of catch-up campaigns, including adolescents and young adults, to induce herd protection compared to immunization strategies restricted to infants and young children. This information is crucial for identifying optimal immunization policies and future strategies, focused on adolescents, to optimize the impact of MCC vaccination programs.

Care for the spiritual dimension provided by caregivers in a nursing home / Atención a la dimensión espiritual proporcionada por los cuidadores en un hogar para ancianos / Cuidado à dimensão espiritual prestado por cuidadores em instituição de longa permanência para idosos

ABSTRACT Objectives: to understand care for the spiritual dimension provided by caregivers in a Nursing Home. Methods: this is a qualitative research, carried out in a geriatric center of a philanthropic hospital in the city of Salvador, Bahia. Eighteen formal caregivers participated, through a semi-structured interview, between January and February 2019. The data were analyzed in the light of Jean Watson's Theory of Transpersonal Caring. Results: formal caregivers discuss the spiritual dimension based on older adults' religious beliefs, encourage religious practices and exercise spiritual care according to older adults' physical, emotional and spiritual demands. Final Considerations: formal caregivers understand that older adults' religious or spiritual experiences should be included in their work routine. Care for the spiritual dimension occurs by stimulating faith in God, encouraging religious practices and embracing their beliefs in the face of physical, emotional and spiritual demands.

RESUMEN Objetivos: aprehender el cuidado de la dimensión espiritual que brindan los cuidadores en un centro de cuidados de larga duración para personas mayores. Métodos: investigación cualitativa, realizada en un centro geriátrico de un hospital filantrópico de la ciudad de Salvador, Bahía. Dieciocho cuidadores formales participaron, a través de la entrevista semiestructurada, entre enero y febrero de 2019. Los datos fueron analizados a la luz de la Teoría del Cuidado Transpersonal de Jean Watson. Resultados: el cuidador formal dialoga sobre la dimensión espiritual a partir de las creencias religiosas del anciano, incentiva las prácticas religiosas y ejerce el cuidado espiritual de acuerdo con las demandas físicas, emocionales y espirituales del anciano. Consideraciones Finales: los cuidadores formales entienden que las experiencias religiosas o espirituales del anciano deben incluirse en su rutina laboral. El cuidado de la dimensión espiritual ocurre estimulando la fe en Dios, fomentando las prácticas religiosas y abrazando sus creencias frente a las demandas físicas, emocionales y espirituales.

RESUMO Objetivos: apreender o cuidado à dimensão espiritualprestado porcuidadoresem instituição de longa permanência para idosos. Métodos: pesquisa qualitativa, realizada em um centro geriátrico de hospital filantrópico na cidade de Salvador, Bahia. Participaram 18 cuidadores formais, por meio da entrevista semiestruturada, entre janeiro e fevereiro de 2019. Os dados foram analisados à luz da Teoria do Cuidado Transpessoal de Jean Watson. Resultados: o cuidador formal dialoga sobre a dimensão espiritual a partir das crenças religiosas do idoso, incentiva as práticas religiosas e exerce o cuidado espiritual de acordo com as demandas físicas, emocionais e espirituais da pessoa idosa. Considerações Finais: os cuidadores formais compreendem que as vivências religiosas ou espirituais da pessoa idosa devem ser incluídas na sua rotina de trabalho. O cuidado à dimensão espiritual ocorre pelo estímulo a fé em Deus, incentivo às práticas religiosas e acolhimento de suas crenças frente às demandas físicas, emocionais e espirituais.

Molecular characterization of Neisseria meningitidis isolates recovered from 11-19-year-old meningococcal carriers in Salvador, Brazil.

Characterization of meningococci isolated from the pharynx is essential towards understanding the dynamics of meningococcal carriage and disease. Meningococcal isolates, collected from adolescents resident in Salvador, Brazil during 2014, were characterized by multilocus sequence typing, genotyping or whole-genome sequencing. Most were nongroupable (61.0%), followed by genogroups B (11.9%) and Y (8.5%). We identified 34 different sequence types (STs), eight were new STs, distributed among 14 clonal complexes (cc), cc1136 represented 20.3% of the nongroupable isolates. The porA and fetA genotypes included P1.18,25-37 (11.9%), P1.18-1,3 (10.2%); F5-5 (23.7%), F4-66 (16.9%) and F1-7 (13.6%). The porB class 3 protein and the fHbp subfamily A (variants 2 and 3) genotypes were found in 93.0 and 71.0% of the isolates, respectively. NHBA was present in all isolates, and while most lacked NadA (94.9%), we detected the hyperinvasive lineages B:P1.19,15:F5-1:ST-639 (cc32); C:P1.22,14-6:F3-9:ST-3780 (cc103) and W:P1.5,2:F1-1:ST-11 (cc11). This is the first report on the genetic diversity and vaccine antigen prevalence among N. meningitidis carriage isolates in the Northeast of Brazil. This study highlights the need for ongoing characterization of meningococcal isolates following the introduction of vaccines and for determining public health intervention strategies.

Meningococcal Carriage among Adolescents after Mass Meningococcal C Conjugate Vaccination Campaigns in Salvador, Brazil.

Neisseria meningitidis is a commensal bacterium of the human nasopharynx. In rare cases, it penetrates the mucosa, entering the blood stream and causing various forms of disease. Meningococcal conjugate vaccines can prevent invasive disease not only by direct effect in vaccinated individuals but also by herd protection, preventing acquisition of carriage, which interrupts transmission and leads to protection of unvaccinated persons. In 2010 in Salvador, Brazil, an outbreak of group C meningococcal disease led to a mass meningococcal serogroup C conjugate vaccination drive, targeting those <5 and 10-24 years of age. The present study aimed to estimate the prevalence of and identify factors associated with N. meningitidis carriage among adolescents from Salvador, Brazil, in the post-vaccination period. In spring 2014, we performed a cross-sectional study involving 1,200 public school students aged 11-19 years old. Oropharyngeal swabs were collected to identify N. meningitidis. Of the 59 colonized participants, 36 (61.0%) carried non-groupable N. meningitidis, while genogroup B (11.9%), Y (8.5%), E (6.8%), Z (5.1%), C (3.4%), and W (3.4%) were also detected. The overall prevalence of N. meningitidis carriage was 4.9% (95% confidence interval [CI], 3.6-6.1%); the prevalence of N. meningitidis genogroup C was 0.17% (95% CI, 0.0-0.40%). There was no difference by age. Factors associated with carriage were having only one, shared, bedroom in the household (PR, 2.02; 95% CI, 0.99-4.12, p = 0.05); the mother being the only smoker in the home (PR, 2.48; 95% CI, 1.16-5.29; p = 0.01); and going to pubs/parties more than 5 times/month (PR, 2.61; 95% CI, 1.38-4.92; p = 0.02). Our findings show that the N. meningitidis carriage rate in adolescents from Salvador, Bahia, is low and is potentially influenced by the low prevalence of N. meningitidis genogroup C. However, continued surveillance is important to identify changes in the dynamics of N. meningitidis, including the emergence of diseases due to a non-C serogroup.

Faith and spirituality in the meaning of life of the elderly with Chronic Kidney Disease / Fe y espiritualidad en el significado de la vida de los ancianos con Insuficiencia Renal Crónica / Fé e espiritualidade no sentido da vida do idoso com insuficiência renal crônica

ABSTRACT Objective: to understand faith and spirituality in the meaning of life of the elderly with Chronic Kidney Disease. Methods: a qualitative research based on Viktor Emil Frankl's Logotherapy and Existential Analysis. Twenty elderly people were interviewed between August 2018 and January 2019, between 60 and 79 years old, who underwent dialysis in a private unit, a reference in nephrology in the city of Salvador, Bahia, Brazil. Results: two categories of analysis emerged: Meaning of faith in the lived of the elderly with Chronic Kidney Disease; Faith as a forerunner of the meaning of life. Final considerations: faith and spirituality were understood as a fundamental foundation in the search for the meaning of the study participants' lives, besides unveiling itself as an important strategy of resilience to the experienced of the elderly person with Chronic Kidney Disease.

RESUMEN Objetivo: comprender la fe y la espiritualidad en el sentido de la vida de los ancianos con Insuficiencia Renal Crónica. Métodos: es una investigación cualitativa basada en la logoterapia y el Análisis Existencial de Viktor Emil Frankl. Se entrevistó a veinte personas mayores, entre agosto de 2018 y enero de 2019, con edades entre 60 y 79 años, sometidas a hemodiálisis en una unidad privada, una referencia en Nefrología en la ciudad de Salvador, Bahía, Brasil. Resultados: se revelaron dos categorías de análisis: significado de la fe en la experiencia de los ancianos con insuficiencia renal crónica; La fe como precursora del sentido de la vida. Consideraciones finales: la fe y la espiritualidad se entendieron como una base fundamental en la búsqueda del significado de la vida de los participantes del estudio, además de ser reveladas como una estrategia de resiliencia importante frente a la experiencia de los ancianos con Insuficiencia Renal Crónica.

RESUMO Objetivo: compreender a fé e a espiritualidade no sentido da vida do idoso com Insuficiência Renal Crônica. Métodos: trata-se de uma pesquisa qualitativa fundamentada na logoterapia e Análise Existencial de Viktor Emil Frankl. Foram entrevistadas 20 pessoas idosas, entre agosto de 2018 e janeiro de 2019, com idade entre 60 e 79 anos, que realizam hemodiálise em uma unidade privada, referência em Nefrologia na cidade de Salvador, Bahia, Brasil. Resultados: desvelaram-se duas categorias de análise: Significado da fé no vivido do idoso com insuficiência renal crônica; Fé como precursora do sentido da vida. Considerações finais: a fé e a espiritualidade foram compreendidas como alicerce fundamental na busca do sentido da vida dos participantes do estudo, além de se desvelar como importante estratégia de resiliência frente ao vivido da pessoa idosa com Insuficiência Renal Crônica.