Carriage rate and effects of vaccination after outbreaks of serogroup C meningococcal disease, Brazil, 2010.

During 2010, outbreaks of serogroup C meningococcal (MenC) disease occurred in 2 oil refineries in São Paulo State, Brazil, leading to mass vaccination of employees at 1 refinery with a meningococcal polysaccharide A/C vaccine. A cross-sectional study was conducted to assess the prevalence of meningococci carriage among workers at both refineries and to investigate the effect of vaccination on and the risk factors for pharyngeal carriage of meningococci. Among the vaccinated and nonvaccinated workers, rates of overall meningococci carriage (21.4% and 21.6%, respectively) and of MenC carriage (6.3% and 4.9%, respectively) were similar. However, a MenC strain belonging to the sequence type103 complex predominated and was responsible for the increased incidence of meningococcal disease in Brazil. A low education level was associated with higher risk of meningococci carriage. Polysaccharide vaccination did not affect carriage or interrupt transmission of the epidemic strain. These findings will help inform future vaccination strategies.

Optimizing the management of the main acute infections in pediatric ORL: tonsillitis, sinusitis, otitis media.

UNLABELLED: Sinusitis, acute otitis media and tonsillitis are very frequent in children. Most of these infections are caused by viruses, but are generally treated with antibiotics. Inappropriate use of antibiotics favors the selection, growth and spread of resistant bacteria; these bacteria colonize the airways and affect the entire community. With the emergence of antibiotic-resistant bacteria, respiratory infections have become more difficult to treat. Effective strategies are needed to restrict the use of antibiotics without harming children that truly need these drugs. AIM: to present a critical analysis of the results of randomized and controlled studies on clinical and laboratory criteria used in diagnosing and treating tonsillitis, sinusitis and otitis. METHODS: a review of randomized and controlled studies about these conditions published in MEDLINE and SCIELO from 2000 to 2006. CONCLUSIONS: Given that most of these infections progress favorably without antibiotics, the use of these drugs should be avoided unless the child belongs to a high risk group for complications, or symptoms persist or worsen with despite symptomatic treatment. Physicians and laypersons should have better knowledge about the natural evolution of acute respiratory infections.

Reliability of information on varicella history in preschool children.

OBJECTIVE: To verify how reliable is the information provided by parents about the history of varicella in their children. METHODS: 204 parents of previously healthy children attending two municipal day-care centers of São Paulo city were interviewed between August 2003 and September 2005. A standardized form was filled out with information regarding age, sex, history of varicella and other diseases, drug use and antecedent of immunization, After medical history, physical examination and checking of immunization records, 5 ml of blood were collected for ELISA (in house) varicella test. Exclusion criteria were: age less than 1 year or more than 60 months, previous immunization against chickenpox, presence of co-morbidities or recent use of immunosuppressive drugs. Data were filed in a data bank using the Excel 2003 Microsoft Office Program and stored in a PC computer. The exact Fisher test was employed to calculate sensibility, specificity, positive and negative predictive values of history of varicella informed by children's parents. RESULTS: The age of the children varied from 12 to 54 months (median, 26 months; 49 (24%) children had positive history of varicella, 155 (76%) a negative or doubtful history. The predictive positive and negative values of the information were 90% and 93%, respectively (p = 0.0001). CONCLUSIONS: The degree of reliability of information about history of varicella informed by parents of children attending day care centers was high and useful to establish recommendations on varicella blocking immunization in day-care centers.

Varicella zoster in children attending day care centers.

OBJECTIVE: To describe morbidity associated to varicella in children attending day care centers. METHODS: Descriptive study carried out through inquiries with parents of 664 children who acquired varicella after admission to day care centers in Taubaté (population: 244,165, census of 2004), a prosperous city in the State of São Paulo. RESULTS: The median age was 36 months (range 6 to 80 months); 8.4% of the children had varicella before 1 year of age. The main symptoms were: exanthema (100.0%), fever (85.4%) anorexia (39.6%), and headache (15.3%). 517 children (77.9%) had at least 1 medical visit, and 80.6% received at least 1 medication; 73 (11.0%) received nonsteroidal antiinflammatory drugs, and 52 (7.8%) received antibiotics. Complications occurred in 38 children (5.7%; 95% confidence interval: 3% - 8%); 8 (1.2%) were hospitalized, and 5 (0.7%) had sequelae. Complications and hospitalizations rates were 3 times more frequent in children with less than 1 year of age than in older children. More than half of the children and of the working parents were absent from their regular activities for more than a week. CONCLUSIONS: Varicella was associated with significant morbidity, affected younger children, was complicated in more than 5%, and left sequelae in 0.7% of children. More than 10% of the children received nonsteroidal antiinflammatory drugs, highlighting the need to warn the population about the risks of these drugs. Although varicella vaccination is not recommended for children younger than 12 months, vaccination of the children older than a year could avoid by herd immunity the transmission to babies. Brazilian public health authorities should be alerted to this issue and offer varicella vaccine to children attending day care centers.

Impact of pneumococcal conjugate vaccine on the prevention of invasive pneumococcal diseases.

OBJECTIVES: To evaluate the impact of heptavalent pneumococcal conjugate vaccine in invasive pneumococcal diseases in the United States, and to analyze the potential impact of this vaccine in Brazil. SOURCES OF DATA: MEDLINE, LILACS, Cochrane Database Reviews, as well as the websites of the Centers for Disease Control and Prevention (CDC), Brazilian Ministry of Health and Centro de Vigilância Epidemiológica do Estado de São Paulo from January 2000 to January 2006. Articles retrieved with the keywords Streptococcus pneumoniae, pneumococcal diseases, conjugate vaccine, antimicrobial resistance and meningitis were reviewed. SUMMARY OF THE FINDINGS: The introduction of heptavalent pneumococcal conjugate vaccine caused a dramatic reduction in the incidence of invasive pneumococcal diseases in American children, reduced antibiotic use and the number of medical visits due to otitis media and pneumonia by children. The incidence of invasive pneumococcal diseases caused by resistant strains declined in immunized children, adults and elderly individuals. In Brazil, the mortality rate of pneumococcal meningitis is very high and the resistance to antibiotics has increased over the last 5 years. CONCLUSIONS: Heptavalent pneumococcal conjugate vaccine can benefit not only children, but the entire community and should be included in the Brazilian routine immunization schedule.

Varicella vaccines and measles, mumps, rubella, and varicella vaccine.

OBJECTIVES: To present an up-to-date review of studies investigating the efficacy, adverse events and vaccination regimens of the varicella vaccine and the new presentation combined with the vaccine for measles, mumps and rubella. SOURCES OF DATA: Bibliographic review of the MEDLINE and LILACS databases covering the period 1999 to 2006. SUMMARY OF THE FINDINGS: The varicella vaccine protects 70 to 90% of immunized children against any form of varicella zoster infection, but the efficacy against severe forms is higher (95 to 98%). This is a well-tolerated vaccine that causes few reactions. Since the vaccine was licensed, there have been three confirmed cases of transmission of the vaccine virus by domestic contacts to previously healthy people, who went on to develop mild disease. Despite evidence that the protection offered by this vaccine can wane over a number of years, it is not yet possible to state that a second dose is warranted, bearing in mind exposure to wild virus. After universal vaccination the chances of natural stimulation should drop and it is very probable that booster doses will become necessary. A measles, mumps, rubella, and varicella vaccine has recently been licensed that combines vaccines for measles, mumps, rubella and varicella in a single product with high rates of seroconversion. CONCLUSIONS: The Brazilian Society of Pediatrics recommends the varicella vaccine for children from 1 year on. We hope that the measles, mumps, rubella, and varicella vaccine will soon be available in Brazil, since combined vaccines facilitate wider vaccination coverage.

[Judicious use of medication in children]. / Uso judicioso de medicamentos em crianças.

OBJECTIVE: To perform a bibliographic review on criterion-based use of drugs by children. SOURCES: Articles were searched through Medline database using the terms: acute respiratory diseases, asthma, antibiotics, treatment and children. SUMMARY OF THE FINDINGS: There is an excessive use of drugs to treat acute respiratory diseases and asthma. Drugs with unproved action are frequently prescribed. CONCLUSIONS: Considering the toxicity of many drugs used in children and the emergency of bacterial strains resistant to antibiotics, it is essential to develop new methods of diagnosing bacterial infections, as well as to educate both physicians and the general public on the judicious use of drugs.

Sources of pertussis infection in young babies from São Paulo State, Brazil.

Household contacts are important sources of Bordetella pertussis in infants. A total of 353 household contacts of 97 index cases were evaluated for pertussis by culture and polymerase chain reaction. Twenty eight contacts were positive (8.0%). The presence of symptoms did not influence the rate of diagnosed bacteriologic pertussis in communicants. We conclude that contacts with an index case can be positive for B. pertussis independently of the presence of symptoms.

Should acellular pertussis vaccine be recommended to healthcare professionals?

The aim of this study was to describe recent changes in the epidemiology of pertussis and existing policies regarding recommended and mandatory occupational vaccinations for healthcare professionals (HCPs). The authors carried out an extensive review of references on the PubMed and SciELO databases and the official sites of the World Health Organization, Pan American Health Organization, Centers for Disease Control and Prevention, and Brazilian Ministry of Health, using the keywords pertussis, vaccines and healthcare professionals. Vaccination against pertussis is recommended for HCPs in the United States, Canada, nine European countries, Australia, Hong Kong, Singapore, Costa Rica, Argentina and Uruguay, and in some countries it is compulsory. In Brazil, only one publication discussing the risk of pertussis among HCPs was found. Considering the reemergence of pertussis and the great number of associated hospitalizations and deaths registered in 2011, it is necessary to review public policies regarding HCP pertussis vaccination, particularly among workers in frequent contact with young babies.

Should acellular pertussis vaccine be recommended to healthcare professionals? / A vacina pertússis acelular deve ser recomendada a profissionais de saúde? / ¿La vacuna contra la tos ferina acelular se debe recomendar a los profesionales de la salud?

The aim of this study was to describe recent changes in the epidemiology of pertussis and existing policies regarding recommended and mandatory occupational vaccinations for healthcare professionals (HCPs). The authors carried out an extensive review of references on the PubMed and SciELO databases and the official sites of the World Health Organization, Pan American Health Organization, Centers for Disease Control and Prevention, and Brazilian Ministry of Health, using the keywords pertussis, vaccines and healthcare professionals. Vaccination against pertussis is recommended for HCPs in the United States, Canada, nine European countries, Australia, Hong Kong, Singapore, Costa Rica, Argentina and Uruguay, and in some countries it is compulsory. In Brazil, only one publication discussing the risk of pertussis among HCPs was found. Considering the reemergence of pertussis and the great number of associated hospitalizations and deaths registered in 2011, it is necessary to review public policies regarding HCP pertussis vaccination, particularly among workers in frequent contact with young babies.

O objetivo deste artigo é descrever as recentes mudanças na epidemiologia da pertússis e as políticas de vacinação voltadas à prevenção da coqueluche para profissionais de saúde. Os autores fizeram um levantamento dos artigos publicados no PubMed, SciELO e páginas da Internet da Organização Mundial da Saúde, Organização Pan-Americana da Saúde, Centers for Disease Control and Prevention (Estados Unidos) e do Ministério da Saúde usando as palavras-chave: pertussis, vacinas e profissionais de saúde. A vacinação de profissionais de saúde contra coqueluche é recomendada pela OMS, OPAS, CDC, e autoridades de saúde de nove países europeus, da Austrália, Hong Kong, Cingapura, Costa Rica, Argentina e Uruguai, e em alguns países é compulsória. No Brasil, identificamos apenas um artigo abordando a vacinação de profissionais de saúde contra coqueluche, mas considerando a reemergencia da doença com grande número de hospitalizações e mortes em 2011, consideramos necessário rediscutir as políticas públicas envolvendo a vacinação dos profissionais de saúde, particularmente daqueles que têm contato frequente com lactentes jovens.

El propósito de este artículo es describir los recientes cambios en la epidemiología y políticas de vacunación para la prevención de la tos ferina en los profesionales de la salud. Los autores realizaron un estudio de los artículos publicados en PubMed, sitios como SciELO, de la OMS, OPS, CDC y Ministerio de Salud de Brasil con las siguientes palabras clave: vacunas contra la tos ferina y profesionales de la salud. La vacunación de los trabajadores de la salud contra la tos ferina es recomendada por la OMS, la OPS, CDC y por las autoridades sanitarias de 9 países europeos, de Australia, Hong Kong, Singapur, Costa Rica, Argentina y Uruguay, y en algunos países es obligatoria. En Brasil, se ha identificado un solo artículo sobre la vacunación de los trabajadores de la salud contra la tos ferina, sin embargo, frente al resurgimiento de la enfermedad con un gran número de hospitalizaciones y muertes en 2011, consideramos que es necesario revisar la política pública de vacunación de los profesionales de la salud, especialmente si tienen contacto con niños pequeños.

Desenvolvimento de uma vacina tetravalente contra dengue / Development of Sanofi Pasteur tetravalent dengue vaccine

Este artigo é uma revisão sobre o desenvolvimento de uma vacina candidata tetravalente contra a dengue (VTD) composta por 4 cepas recombinantes vivas atenuadas de vírus da dengue. Cada cepa expressa os genes da pré-membrana (prM) e do envelope de um dos quatro sorotipos do vírus da dengue e tem como base a cepa da vacina febre amarela 17D (YF17D). Os estudos pré-clínicos demonstraram que as cepas da VTD são estáveis genética e fenotipicamente, não hepatotrópicas, menos neurovirulentas do que a cepa YF 17D e não infectam mosquitos pela via oral. A VTD induz estimulação controlada das células dendríticas humanas e respostas imunes significantes...

The Sanofi Pasteur tetravalent dengue vaccine candidate is composed of 4 recombinant live attenuated vaccines based on a yellow fever vaccine 17D (YFV 17D) backbone, each expressing the prM and envelope genes of one of the four dengue virus serotypes. Pre-clinical studies have demonstrated that the TV dengue vaccine is genetically and phenotypically stable, non-hepatotropic, less neurovirulent than YFV 17D and does not infect mosquitoes by the oral route. In vitro and in vivo preclinical studies also showed that the TV dengue vaccine induced controlled stimulation in human dendritic cells, and significant immune responses in monkeys. TV dengue vaccine reactogenicity, viraemia induction and antibody responses were investigated in three Phase I trials in the USA, the Philippines and Mexico, in a two or three-dose regimen over a 12 month period...

Vaccines in pregnancy: a review of their importance in Brazil.

Neonates and young children remain susceptible to many serious infectious diseases preventable through vaccination. In general, current vaccines strategies to prevent infectious diseases are unable to induce protective levels of antibodies in the first 6 months of life. Women vaccinated during pregnancy are capable of producing immunoglobulin antibodies that are transported actively to the fetus, and maternal immunization can benefit both the mother and the child. With few exceptions, maternal immunization is not a routine, because of the concerns related to the safety of this intervention. Ethical and cultural issues make the studies on maternal immunization difficult; however, in the last decade, the development of new vaccines, which are very immunogenic and safe has reactivated the discussions on maternal immunization. In this paper we present a review of the literature about maternal immunization based on MEDLINE data (1990 to 2002). The most important conclusions are: 1) there is no evidence of risk to the fetus by immunizing pregnant women with toxoids, polysaccharide, polysaccharide conjugated and inactive viral vaccines; 2) most viral attenuated vaccines are probably safe too, but data is still insufficient to demonstrate their safety; therefore these vaccines should be avoided in pregnant women; 3) in Brazil, there is a need for a maternal immunization program against tetanus. Many new candidate vaccines for maternal immunization are available, but studies should be conducted to evaluate their safety and efficacy, as well as regional priorities based on epidemiological data.

Critical analysis of old and new vaccines against N. meningitidis serogroup C, considering the meningococcal disease epidemiology in Brazil.

UNLABELLED: Worldwide, the impact of meningococcal disease is substantial, and the potential for the introduction and spread of more virulent strains of N. meningitidis or strains with increased resistance to current antibiotics causes concern, making prevention essential. OBJECTIVES: Review the indications for meningococcal disease vaccines, considering the epidemiological status in Brazil. METHODS: A critical literature review on this issue using the Medline and Lilacs databases. RESULTS: In Brazil, MenB and MenC were the most important serogroups identified in the 1990s. Polysaccharide vaccines available against those serogroups can offer only limited protection for infants, the group at highest risk for meningococcal disease. Additionally, polysaccharide vaccines may induce a hypo-responsive state to MenC. New meningococcal C conjugate vaccines could partially solve these problems, but it is unlikely that in the next few years a vaccine against MenB that can promote good protection against multiple strains of MenB responsible for endemic and epidemic diseases will become available. CONCLUSIONS: In order to make the best decision about recommendations on immunization practices, better quality surveillance data are required. In Brazil, MenC was responsible for about 2,000 cases per year during the last 10 years. New conjugate vaccines against MenC are very effective and immunogenic, and they should be recommended, especially for children less than 5 years old. Polysaccharide vaccines should be indicated only in epidemic situations and for high-risk groups. Until new vaccines against MenC and MenB are available for routine immunization programs, the most important measure for controlling meningococcal disease is early diagnosis of these infections in order to treat patients and to offer chemoprophylaxis to contacts.

Oropharyngeal colonization by Haemophilus influenzae in healthy children from Taubaté (São Paulo), prior to the Haemophilus influenzae type B vaccination program in Brazil.

UNLABELLED: Haemophilus influenzae is one of the most important bacterial agents of otitis and sinusitis. H. influenzae type b (Hib) is one of the main causes of meningitis, pneumonia, and septicemia in nonvaccinated children under 6 years of age. The aims of this study were to determine the prevalence of H. influenzae and Hib oropharyngeal colonization prior to the onset of the Hib vaccination program in Brazil in previously healthy children and to assess the susceptibility profile of this microorganism to a selected group of antimicrobials that are used to treat acute respiratory infections. METHOD: Cultures of Haemophilus influenzae were made from oropharynx swabs from 987 children under 6 years of age who were enrolled in 29 day-care centers in Taubaté (a city of São Paulo state, Brazil) between July and December 1998. RESULTS: The prevalence of H. influenzae carriers was 17.4%, and only 5.5% of the strains were beta-lactamase producers. The prevalence of Hib carriers was high, 7.3% on average (range, 0.0 - 33.3%). CONCLUSIONS: The low prevalence of colonization by penicillin-resistant strains indicates that it is not necessary to substitute ampicilin or amoxicilin to effectively treat otitis and sinusitis caused by H. influenzae in Taubaté.

Otimizando o diagnóstico para o tratamento adequado das principais infecções agudas em otorrinopediatria: tonsilite, sinusite e otite média: [revisão] / Optimizing the management of the main acute infections in pediatric ORL: tonsillitis, sinusitis, otitis media: [review]

As sinusites, otites médias agudas e tonsilites são muito freqüentes em crianças. A maioria dessas infecções é causada por vírus, mas em geral, elas são tratadas com antibióticos. O uso inapropriado de antibióticos favorece a seleção, crescimento e disseminação de bactérias resistentes que colonizam as vias respiratórias, atingindo toda a comunidade. A emergência de bactérias resistentes dificulta os tratamentos das infecções respiratórias, sendo essencial desenvolver estratégias efetivas para restringir o uso de antibióticos sem prejudicar as crianças que realmente precisam desses medicamentos. OBJETIVO: Analisar os resultados de estudos randomizados e controlados sobre critérios clínicos e laboratoriais utilizados para diagnóstico e tratamento das tonsilites, sinusites e otites. MÉTODOS: Levantamento dos estudos randomizados e controlados sobre o tema, publicados no MEDLINE e SCIELO, de 2000 a 2006. CONCLUSÕES: Como a maioria dessas infecções evolui bem sem antibióticos, deve-se evitar o uso desses medicamentos a menos que a criança pertença aos grupos de alto risco para complicações ou apresente persistência ou piora dos sintomas com tratamento sintomático. É necessário que os médicos e leigos conheçam melhor a evolução natural das infecções respiratórias agudas e que seja garantido o acesso das crianças a serviços médicos de boa qualidade para orientação e reavaliação, quando necessária.

Sinusitis, acute otitis media and tonsillitis are very frequent in children. Most of these infections are caused by viruses, but are generally treated with antibiotics. Inappropriate use of antibiotics favors the selection, growth and spread of resistant bacteria; these bacteria colonize the airways and affect the entire community. With the emergence of antibiotic-resistant bacteria, respiratory infections have become more difficult to treat. Effective strategies are needed to restrict the use of antibiotics without harming children that truly need these drugs. AIM: to present a critical analysis of the results of randomized and controlled studies on clinical and laboratory criteria used in diagnosing and treating tonsillitis, sinusitis and otitis. METHODS: a review of randomized and controlled studies about these conditions published in MEDLINE and SCIELO from 2000 to 2006. CONCLUSIONS: Given that most of these infections progress favorably without antibiotics, the use of these drugs should be avoided unless the child belongs to a high risk group for complications, or symptoms persist or worsen with despite symptomatic treatment. Physicians and laypersons should have better knowledge about the natural evolution of acute respiratory infections.

Vacina contra poliomielite: um novo paradigma: [revisão] / Polio vaccines: a new paradigma: [review]

OBJETIVO: Analisar as estratégias propostas pela Organização Mundial da Saúde (OMS) para controle da poliomielite. FONTES DE DADOS: Levantamento das publicações sobre poliomielite indexadas no Medline, Lilacs e sites da OMS e Ministério da Saúde de janeiro de 2000 a dezembro de 2006. SÍNTESEDOS DADOS: O reconhecimento da paralisia associada aos vírus vacinais e por vírus circulantes derivados da vacina oral não deixa dúvidas de que, em breve, será necessário interromper o uso da vacina oral para poliomielite. Após os vírus selvagens serem erradicados, a vacina oral para poliomielite deverá ser interrompida, de preferência de forma sincronizada em todos os países. Após a interrupção da vacinação, as populações voltarão a ser suscetíveis à poliomielite, podendo ocorrer surtos da doença por vírus selvagens (escape dos laboratórios de forma acidental ou por bioterrorismo). Nos países que já utilizam a vacina para poliomielite com vírus inativado é pouco provável que haja interrupção da vacinação. Países que atualmente utilizam exclusivamente a vacina oral ficarão na dependência da vigilância epidemiológica e dos estoques de vacina oral para controlar eventuais surtos de pólio. Se a vacina oral para poliomielite for reintroduzida nessas populações, haverá novamente o risco de paralisia associada aos vírus vacinais e por vírus circulantes derivados da vacina oral, que podem se disseminar rapidamente para outras regiões e países vizinhos. CONCLUSÕES: É necessário planejar a introdução da vacina para poliomielite com vírus inativado no calendário de rotina brasileiro, assim como adquirir tecnologia para sua produção, que atualmente é insuficiente para as necessidades globais.

OBJECTIVE: Review the World Health Organization (WHO) strategies for poliomyelitis control. DATA SOURCES: Retrieval of publications on poliomyelitis indexed in Medline, Lilacs and in the WHO and Health Ministry sites, from January 2000 to December 2006. DATA SYNTHESIS: Acknowledgement of vaccine-associated paralysis and oral vaccine-derived circulating viruses' paralysis shall certainly require discontinuation of oral vaccination for poliomyelitis use in a short time. After eradication of the wild viruses, oral vaccination for poliomyelitis should be discontinued, preferably in a synchronized manner in all the countries. After termination of vaccination programs, people will become susceptible again to poliomyelitis virus and disease outbreaks caused by wild viruses may occur (accidental escape from laboratories or bioterrorism). In countries already using inactivated poliovirus vaccine, it is unlikely that vaccination will be interrupted. Countries that currently use exclusively oral poliovirus vaccine will have to rely on epidemiological surveillance and on oral vaccine inventories to control potential polio outbreaks. If the oral poliovirus vaccine is reintroduced in those populations, there will be again a risk for vaccine-associated paralysis and oral vaccine-derived circulating viruses' that may spread rapidly to other regions and to nearby countries. CONCLUSIONS: Inactivated poliovirus vaccine introduction in the routine Brazilian vaccination calendar should be programmed as well as acquisition of technology for inactivated poliovirus vaccine production since the latter is currently insufficient to cover global demand.

Parotidite recorrente da infância / Recurrent parotitis of childhood

OBJETIVO: Descrever um caso de parotidite recorrente em criança e revisar a abordagem clínica desse problema. DESCRIÇÃO DE CASO: Paciente de seis anos, masculino, encaminhado ao ambulatório de pediatria para avaliação após ter apresentado dois episódios de parotidite, sendo o último tratado com cefalexina. Entre os episódios de parotidite tinha exame físico normal. Foram afastadas as causas infecciosas, obstrutivas e imunodeficiências, mas a criança evoluiu com episódios recorrentes de dor e edema em região parotídea. COMENTÁRIOS: A parotidite recorrente é uma doença rara, de incidência desconhecida, que apesar de causar substancial morbidade, tem bom prognóstico com tratamento conservador.

OBJECTIVE: To present a child with recurrent parotitis and to review the clinical management of this disease. CASE DESCRIPTION: A six years old male child was admitted at a Pediatric Outpatient Unit after his second episode of parotitis, which was treated with cefalexin. Between the episodes, the child presented normal physical examination. Infectious, obstructive and immunodeficiency related causes of parotitis were excluded by appropriated diagnostic procedures, but the child persisted with recurrent episodes of parotids pain and swelling. COMMENTS: Recurrent parotitis of childhood is a rare disease that causes substantial morbidity, but has good prognosis with conservative management.

Reliability of information on varicella history in preschool children

OBJECTIVE: To verify how reliable is the information provided by parents about the history of varicella in their children. METHODS: 204 parents of previously healthy children attending two municipal day-care centers of São Paulo city were interviewed between August 2003 and September 2005. A standardized form was filled out with information regarding age, sex, history of varicella and other diseases, drug use and antecedent of immunization, After medical history, physical examination and checking of immunization records, 5 ml of blood were collected for ELISA (in house) varicella test. Exclusion criteria were: age less than 1 year or more than 60 months, previous immunization against chickenpox, presence of co-morbidities or recent use of immunosuppressive drugs. Data were filed in a data bank using the Excel 2003 Microsoft Office Program and stored in a PC computer. The exact Fisher test was employed to calculate sensibility, specificity, positive and negative predictive values of history of varicella informed by children's parents. RESULTS: The age of the children varied from 12 to 54 months (median, 26 months; 49 (24 percent) children had positive history of varicella, 155 (76 percent) a negative or doubtful history. The predictive positive and negative values of the information were 90 percent and 93 percent, respectively (p = 0.0001). CONCLUSIONS: The degree of reliability of information about history of varicella informed by parents of children attending day care centers was high and useful to establish recommendations on varicella blocking immunization in day-care centers.

OBJETIVOS: Verificar o grau de confiabilidade da informação fornecida pelos pais de crianças atendidas em creches sobre o antecedente de varicela. MÉTODOS: Os pais de 204 crianças previamente saudáveis matriculadas em duas creches da cidade de São Paulo foram entrevistados entre Agosto de 2003 e Setembro de 2005 para preenchimento de um questionário padronizado com informações sobre idade, sexo, antecedente de varicela e outras doenças, uso de medicamentos e história vacina. Após anamnese, exame físico e verificação da carteira de vacinação, foram colhidos 5 ml de sangue para realização do teste ELISA (in house) para varicela. Os critérios de exclusão foram: idade < 1 ano ou acima de 60 meses, vacinação prévia contra varicela, presença de comorbidades e uso recente de imunossupressores. Os dados foram registrados num banco de dados do programa Excel 2003 Microsoft Office e armazenados em microcomputador. Utilizou-se o teste exato de Fisher para calcular a sensibilidade, especificidade e valores preditivo positivo e negativo das informações fornecidas pelos pais sobre o antecedente de varicela das crianças. RESULTADOS: A idade das crianças variou entre 12 e 54 meses (mediana, 26 meses); 49 crianças (24 por cento) tinham antecedente positivo para varicela e 155 (76 por cento) negativo ou duvidoso. Os valores preditivo positivo e negativo da informação foram de 90 por cento e 93 por cento, respectivamente (p = 0.0001). CONCLUSÕES: O grau de confiabilidade das informações sobre varicela informadas pelos pais de crianças atendidas em creches foi elevado e útil para estabelecer recomendações para vacinação de bloqueio de surtos de varicela em creches.