Coletânea de Respostas Rápidas-Turma 1: programa educacional em vigilância em saúde no enfrentamento da COVID-19 e de outras doenças virais VigiEpidemia / Collection of Rapid Responses-Class 1: educational program in health surveillance in coping with COVID-19 and other viral diseases VigiEpidemia

Coletânea dedicada aos estudos das respostas rápidas do Programa Educacional em Vigilância em Saúde no enfrentamento da COVID-19 e outras Doenças Virais (VigiEpidemia). Esse tema é de extrema relevância e atualidade em nosso contexto da saúde global e na resposta as emergências em saúde pública (ESP) de forma geral. As ESP, que englobam surtos e epidemias, desastres e desassistência à população, representam desafios complexos que exigem respostas ágeis e eficazes por parte das autoridades sanitárias, profissionais da saúde e comunidades como um todo. Até o momento, a pandemia de COVID-19 foi a maior ESP do Século XXI. Ela serviu como um lembrete doloroso da vulnerabilidade da humanidade diante da ameaça de doenças virais. Esta ESP, que teve resposta catastrófica em diversos momentos, evidenciou a importância do investimento em preparação, vigilância e resposta, destacando a necessidade de sistemas de vigilância robustos, colaboração internacional, Inteligência epidemiológica e comunicação transparente para mitigar o impacto devastador das doenças infecciosas na sociedade. As lições aprendidas com a pandemia de COVID-19 são vastas e multifacetadas. A importância da pesquisa, da educação em saúde e do desenvolvimento de vacinas foi evidenciada como uma prioridade crucial na proteção da saúde pública mundial. O investimento em pesquisas e em cursos para formação de profissionais que possam estar atentos as mudanças nos padrões e comportamentos das doenças infecciosas, além de atuar na resposta rápida quando necessário, é fundamental para estarmos preparados para as futuras pandemias. A vacinação, por exemplo, sempre foi uma das ferramentas mais poderosas para evitar surtos e epidemias e, durante a pandemia de COVID-19, ajudou a controlar os óbitos pela doença e possibilitou que voltássemos a ter uma vida normal. Além da vacina contra COVID-19, as vacinas de influenza e dengue também são exemplos notáveis de avanços científicos que desempenham um papel fundamental na prevenção de futuras ESP. Ao explorar os diversos aspectos da resposta, monitoramento e controle de surtos, epidemias e pandemias, esta coletânea visa fornecer uma compreensão abrangente dos desafios enfrentados, das melhores práticas e das estratégias eficazes para mitigar os impactos adversos desses eventos. Espera-se que este trabalho não apenas informe e eduque, mas também inspire ações concretas para fortalecer a recuperação e resiliência dos sistemas de saúde e proteger o bem-estar das comunidades mais vulneráveis do nosso pais.

A collection dedicated to the study of rapid responses by the Educational Program in Health Surveillance in addressing COVID-19 and other Viral Diseases (VigiEpidemia). This theme is of utmost relevance and timeliness in our context of global health and in responding to public health emergencies (PHE) in general. PHEs, which encompass outbreaks and epidemics, disasters, and neglect of the population, represent complex challenges that require swift and effective responses from health authorities, healthcare professionals, and communities as a whole. To date, the COVID-19 pandemic has been the largest PHE of the 21st century. It served as a painful reminder of humanity's vulnerability in the face of viral disease threats. This PHE, which had catastrophic responses at various times, highlighted the importance of investing in preparedness, surveillance, and response, underscoring the need for robust surveillance systems, international collaboration, epidemiological intelligence, and transparent communication to mitigate the devastating impact of infectious diseases on society. The lessons learned from the COVID-19 pandemic are vast and multifaceted. The importance of research, health education, and vaccine development was highlighted as a crucial priority in protecting global public health. Investing in research and training courses to prepare professionals who can be attentive to changes in the patterns and behaviors of infectious diseases and act quickly when needed is essential to be prepared for future pandemics. Vaccination, for example, has always been one of the most powerful tools to prevent outbreaks and epidemics, and during the COVID-19 pandemic, it helped control disease-related deaths and allowed us to return to a normal life. In addition to the COVID-19 vaccine, influenza and dengue vaccines are also notable examples of scientific advancements that play a key role in preventing future PHEs. By exploring the various aspects of response, monitoring, and control of outbreaks, epidemics, and pandemics, this collection aims to provide a comprehensive understanding of the challenges faced, best practices, and effective strategies to mitigate the adverse impacts of these events. It is hoped that this work will not only inform and educate but also inspire concrete actions to strengthen the recovery and resilience of health systems and protect the well-being of the most vulnerable communities in our country.

Varicela neonatal tardía: presentación en un paciente pediátrico / Late neonatalchickenpox: presentation in a pediatric patient

La varicela es una infección poco frecuente durante la gestación, el riesgo para el feto y las manifestaciones clínicas, variarán en función del momento del embarazo en que se produce la infección materna, cuando la erupción maculopapular materna se produce entre los 5 días previos al parto y las 48 horas posteriores, se habla de varicela neonatal tardía. La clínica es grave, con afectación visceral (pulmonar, cerebral, hepática, hemorragias cutáneas, etc.) y un 30 % de los casos desarrollarán una varicela fulminante. Se presenta el caso de neonato masculino que consultó por lesiones en piel, tipo pápulas eritematosas y vesiculares pleomorfas, de distribución dispersa. Con evolución clínica tórpida, permaneció 24 horas en la institución, con franco deterioro respiratorio y neurológico, compatible con cuadro de varicela neonatal tardía fulminante(AU)

Chickenpox is considered a rare infection during pregnancy, the risk to the fetus and the clinical manifestations will vary depending on the time of pregnancy when the maternal infection occurs, when the maternal maculo-papular injuries occurs within the previous 5 days after delivery and 48 hours after, there is talk of late neonatal chickenpox. The symptoms are severe with visceral involvement (lung, brain, liver, skin bleeding, etc.) and 30% of cases will develop fulminant chickenpox. We present the case of a male neonate who consults due to skin lesions, such as erythematous papules and pleomorphic vesicles, with scattered distribution. With a torpid clinical course, who remains in the institution for 24 hours, with frank respiratory and neurological deterioration compatible with late-neonatal fulminant varicella symptoms(AU)

Lineamientos técnicos y operativos de vacunación contra el virus de la varicela en la República de Honduras / Technical and operational guidelines for vaccination against the chickenpox virus in the Republic of Honduras

Objetivo Proporcionar los lineamientos técnicos y operativos de la vacunación contra el virus de la Varicela que regirán a partir del 15 de marzo del 2024 en el sistema de salud público y no público de la República de Honduras. Este documento define que la población objetivo de la vacunación contra la varicela, son los niños y niñas de 15 meses de edad, que serán atendidos en todos los establecimientos del sector salud público y no público que ofertan servicios de vacunación a la población hondureña. (AU)

Knowledge, perception, and practice of Libyan mothers towards varicella and its vaccination Tripoli, Libya

This study was conducted to ascertain the level of knowledge, perception and practice towards chickenpox infection and its vaccination and to find out the relationship of knowledge to some of related characteristics of the mothers and their children. A cross sectional study was conducted among Libyan mothers in Albadri polyclinic the east district of Tripoli. Data analysis was performed using the SPSS version 26. A total of 204 Libyan mothers attending Albadri polyclinic participated in the study their mean age was 32.06 (± 7.664) years. Most of the respondents (95.6%) had heard about chickenpox and (84%) stated correctly about its mode of transmission. Majority were well aware of the signs and symptoms of the infection, (51%) of the respondents knew about chickenpox vaccination, and only (43.1%) have been known that the vaccine was available in Libya. Concerning perception (81.4%) of respondents had negative perception about their child might get chickenpox. (80.9%) of the respondents were agree about their believing that chickenpox is serious disease and only 12.3% respondents believed that vaccine was effective, (77.9%) of respondents had negative perception about safety of vaccine. Concerning practice approximately (80%) of the respondents had vaccinated or had intension for vaccination their children against chickenpox. The current study indicated considerable knowledge levels and practice on varicella disease and its vaccination were observed among Libyan mothers. Addressing concerns regarding vaccine effectiveness, safety and importance through educational campaigns to ensure that all mothers are informed of the availability and benefits of the varicella vaccine

Falla de inmunoglobulina específica varicela zoster en prevenir varicela neonatal: revisión a propósito de un caso clínico / Failure of varicella zoster specific immunoglobulin to prevent neonatal varicella: a review regarding a clinical case

La varicela neonatal es una patología grave. En Chile recientemente se incorporó la vacuna varicela al programa nacional de inmunizaciones, por lo que es aún es esperable que ocurra transmisión vertical. El manejo en el recién nacido incluye inmunoglobulina específica para virus varicela zoster cuando la madre inicia una varicela periparto. Presentamos el caso clínico de un neonato que cursó con una varicela grave pese a haber recibido profilaxis con inmunoglobulina específica. Se realizó una revisión de la literatura sobre varicela neonatal para sugerir recomendaciones de manejo. El uso de inmunoglobulina específica para virus varicela zoster, como profilaxis a un recién nacido expuesto, disminuye el riesgo de varicela neonatal pero no lo elimina.

Neonatal chickenpox is a serious pathology. In Chile, the varicella vaccine was recently incorporated into the national immunization program, so vertical transmission is still expected. Newborn management includes specific immunoglobulin for varicella zoster virus when the mother initiates peripartum chickenpox. We present a case of a newborn who has severe chickenpox despite having received prophylaxis with immunoglobulin, and a review of the literature on neonatal chickenpox was carried out to suggest management recommendations. The use of specific immunoglobulin for varicella zoster virus as prophylaxis in an exposed newborn reduces the risk of neonatal chickenpox but does not eliminate it.

Cobertura y barreras de la vacunación contra la varicela en niños que consultaron a la Fundación Salud Bosque / Coverage of and Barriers to Varicella Vaccination in Children at Fundación Salud Bosque / Cobertura e barreiras à vacinação contra varicela em crianças que consultaram a Fundação Salud Bosque

Introducción. Desde la introducción de la vacuna contra la varicela a Colombia no se ha logrado una cobertura mayor al 90%. El objetivo de este trabajo es identificar las barreras de vacunación contra varicela en niños. Metodología. Estudio descriptivo realizado en la Fundación Salud Bosque; se estudiaron 27 pacientes, 18 hombres (67%) y 9 mujeres (33%), incluyendo menores de 18 años con varicela, y excluyendo pacientes con enfermedades ampollosas distintas a varicela y quemaduras. Se hizo una caracterización demográfica. Para las variables cuantitativas se emplearon promedios y desviación estándar, y para las cualitativas la razón de proporción con Stata V12®. Resultados. La incidencia de varicela fue del 0.2%, solo 9 pacientes (33%) habían recibido la primera dosis de la vacuna, ninguno la segunda dosis. El 92.5% requirió incapacidad; el 89% analgésicos; el 63% antihistamínicos y el 26% antibióticos. Discusión. El estudio realizado demuestra una incidencia significativamente menor en contraste con otras cohortes internacionales. En Colombia no se ha alcanzado la cobertura de la vacunación contra la varicela lograda en Uruguay, Costa Rica, Estados Unidos, Australia, Europa y Taiwán dadas las mismas barreras en su aplicación, mientras que en África no se ha introducido la vacuna contra la varicela porque existen otras prioridades como la desnutrición, la malaria y la infección por Virus de la Inmunodeficiencia Humana. Conclusiones. La cobertura de la vacunación no se ha logrado por barreras modificables que incrementan la incidencia y carga de la enfermedad por costos debido a incapacidad, manejo farmacológico y ausentismo escolar. Palabras clave: Cobertura de Vacunación; Incidencia; Niño; Vacuna contra la Varicela; Varicela.

Introduction. Ever since the introduction of the varicella vaccine in Colombia, coverage has not surpassed 90%. The objective of this work is to identify the barriers to varicella vaccination in children. Methodology. A descriptive study conducted at Fundación Salud Bosque. 27 patients were studied - 18 males (67%) and 9 females (33%) - including children under 18 years of age with varicella, and excluding patients with blistering diseases other than varicella and burns. A demographic characterization was conducted. Averages and standard deviations were used for quantitative variables, and the proportion ratio was used for qualitative variables with Stata V12®. Results. The incidence of varicella was 0.2%. Only 9 patients (33%) had received the first dose of the vaccine, and none had received the second dose. 92.5% required sick leave, 89% required painkillers, 63% required antihistamines, and 26% required antibiotics. Discussion. The conducted study shows a significantly lower incidence compared to other international cohorts. Colombia has not achieved the varicella vaccination coverage of Uruguay, Costa Rica, the United States, Australia, Europe and Taiwan due to the barriers to applying it. Meanwhile, the varicella vaccine has not been introduced in Africa because there are other priorities, such as malnutrition, malaria and the Human Immunodeficiency Virus infection. Conclusions. Vaccination coverage has not been achieved because of modifiable barriers that increase the incidence and burden of the disease due to costs of sick leave, pharmacological treatment and school absenteeism. Keywords: Vaccination Coverage; Incidence; Child; Chickenpox Vaccine; Chikenpox.

Introdução. Desde a introdução da vacina contra varicela na Colômbia, não foi alcançada uma cobertura superior a 90%. O objetivo deste trabalho é identificar as barreiras à vacinação contra varicela em crianças. Metodologia. Estudo descritivo realizado na Fundação Salud Bosque. Foram estudados 27 pacientes, 18 homens (67%) e 9 mulheres (33%), incluindo crianças menores de 18 anos com varicela e excluindo pacientes com outras doenças bolhosas que não varicela e queimaduras. Foi feita uma caracterização demográfica. Média e desvio padrão foram utilizados para as variáveis quantitativas e, para variáveis qualitativas, a razão de proporção com Stata V12®. Resultados. A incidência de varicela foi de 0.2%, apenas 9 pacientes (33%) receberam a primeira dose da vacina, nenhum a segunda dose. 92,5% requeriam atestado; 89% analgésicos; 63% anti-histamínicos e 26% antibióticos. Discussão. O estudo realizado mostra uma incidência significativamente menor em comparação com outras coortes internacionais. A Colômbia não tem atingido a cobertura vacinal contra a varicela alcançada no Uruguai, Costa Rica, Estados Unidos, Austrália, Europa e Taiwan, dadas as mesmas barreiras em sua aplicação, enquanto na África a vacina contra a varicela não foi introduzida porque existem outras prioridades como a desnutrição, a malária e a infecção pelo Vírus da Imunodeficiência Humana. Conclusões. A cobertura vacinal não foi alcançada dadas as barreiras modificáveis que aumentam a incidência e carga da doença devido aos custos por atestados, manejo farmacológico e absenteísmo escolar. Palavras-chave: Cobertura Vacinal; Incidência; Criança; Vacina contra Varicela; Varicela

Síndrome hemofagocítico asociado a varicela / Hemofagocytic syndrome associated with varicella

Presentación del caso. Lactante femenina de 14 meses de edad con desarrollo psicomotor normal, sin comórbidos. Con historia de un día de fiebre de 40 °C, intermitente, acompañada de evacuaciones diarreicas y vómitos. Fue llevada por sus padres a una clínica privada sin notar mejoría con el tratamiento médico indicado. Posteriormente, presentó deterioro clínico y fue llevada a un hospital, donde se diagnosticó un síndrome febril agudo, diarrea con deshidratación leve y faringitis. Al cuarto día de evolución inició con máculas y pápulas que progresaron a vesículas y costras. Además, presentó intolerancia a la vía oral, disnea, distensión abdominal, coma y desequilibrio hidroelectrolítico. Intervención terapéutica. Inició el tratamiento con hidratación parenteral, antivirales, esteroides endovenosos y antihistamínicos; se diagnosticó shock séptico con compromiso respiratorio, se proporcionó ventilación mecánica asistida y fue referida al hospital de tercer nivel para atención por medicina crítica. Los estudios reportaron un derrame pleural derecho del 40 % y hepatomegalia. Continuó el tratamiento con antibiótico terapia, hidratación parenteral, antivirales, diuréticos, antipiréticos y hemoderivados, presentó mejoría, continuó el manejo terapéutico. Evolución clínica. El día 18 presentó fiebre, hepatoesplenomegalia, los exámenes reportaron elevación de ferritina, triglicéridos y citopenia se diagnosticó un síndrome hemofagocítico que evolucionó con una falla multisistémica y falleció al siguiente día

Case presentation. A 14-month-old female infant with normal psychomotor development, without comorbidities. With a one-day history of fever of 40 °C, intermittent, accompanied by diarrhea and vomiting. She was taken by her parents to a private clinic without improvement with the indicated medical treatment. Subsequently, she presented clinical deterioration and was taken to a hospital, where she was diagnosed with acute febrile syndrome, diarrhea with mild dehydration, and pharyngitis. On the fourth day of evolution, she started with macules and papules that progressed to vesicles and crusts. In addition, she presented oral intolerance, dyspnea, abdominal distension, coma, and hydro electrolytic imbalance. Therapeutic intervention. She started treatment with parenteral hydration, antivirals, intravenous steroids, and antihistamines; septic shock with respiratory distress was diagnosed, assisted mechanical ventilation was provided, and she was referred to a tertiary hospital for critical care medicine. Studies reported a 40 % right pleural effusion and hepatomegaly. She continued treatment with antibiotic therapy, parenteral hydration, antivirals, diuretics, antipyretics, and hemoderivatives, presented improvement, and continued therapeutic management. Clinical evolution. On day 18 he presented fever and hepatosplenomegaly. Tests reported elevated ferritin, triglycerides, and cytopenia, and was diagnosed with hemophagocytic syndrome that evolved with multisystemic failure and died the following day

Research progress on drug resistance of anti-varicella-zoster virus drugs / 中华预防医学杂志

Varicella-zoster virus (VZV) causes chickenpox when it first infects humans, and the virus may reactivate in adulthood and cause herpes zoster (HZ). Broad-spectrum antiviral drugs are one of the treatments for varicella and herpes zoster, but the emergence of drug resistance poses many challenges to this treatment and increases the burden of disease on patients. This paper discusses the resistance mechanisms, resistance sites and resistance detection methods of anti-VZV drugs in order to help further research on new anti-VZV targets, new drugs and monitoring of resistance to existing drugs.

A study on knowledge, attitude, and vaccination behavior of herpes zoster vaccine among urban residents in selected areas of China / 中华流行病学杂志

Objective: To understand the knowledge, attitude, and current status of vaccination of herpes zoster vaccination among urban residents aged 25 years and above in China. Methods: In August to October 2022, a convenience sampling method was used to survey residents aged 25 years and above at 36 community centers in 9 cities across China. Questionnaires were used to collect basic information, knowledge, and attitude toward herpes zoster and its vaccination, as well as vaccination status and reasons for non-vaccination among residents. Results: A total of 2 864 urban residents were included in the study. The total score of residents' cognition of herpes zoster and its vaccine was 3.01±2.08, and the total score of their attitude was 18.25±2.76. Factors such as being male (β=-0.45, P<0.001), older than 40-59 years (β=-0.34, P=0.023) or ≥60 years (β=-0.68, P<0.001), married (β=-0.69, P=0.002) were negatively associated with knowledge score. The educational level of high school or secondary school (β=0.44, P=0.036), college (β=0.65, P=0.006), bachelor's degree and above (β=1.20, P<0.001), annual net household income ≥120 000 Yuan in 2021 (β=0.42, P=0.020), having urban employee medical insurance (β=0.62, P=0.030), having public or commercial medical insurance (β=0.65, P=0.033), and having a history of chickenpox (β=0.29, P=0.025) were positively associated with knowledge scores. Being male (β=-0.38, P=0.008) and not remembering a history of chickenpox (β=-0.49, P=0.012) were negatively associated with attitude scores. Annual net household income in 2021 was between 40 000-80 000 Yuan (β=0.44, P=0.032) or between 80 000-120 000 Yuan (β=0.62, P=0.002) or ≥120 000 Yuan (β=0.93, P<0.001), and a history of herpes zoster (β=0.59, P=0.004) were positively associated with attitude scores. Of the 2 864 residents surveyed, only 29 (1.01%) had received the herpes zoster vaccine, with a vaccination rate of 1.70% for those aged 50 years and above, with the main reason for non-vaccination being lack of knowledge about the herpes zoster vaccine, followed by the high price. 42.67% of the population said they would consider getting the herpes zoster vaccine in the future. Conclusion: Low knowledge of herpes zoster and its vaccine, positive attitudes towards the preventive effects of herpes zoster and its vaccine, and extremely low vaccination rates among the urban population in China call for multiple measures to strengthen health education and vaccination recommendations for residents, especially for the elderly, low-education and low-income populations.

Comparison of epidemic characteristics and clinical manifestation of chickenpox between adults and children in Shandong Province from 2019 to 2021 / 中华流行病学杂志

Objective: To analyze the differences between adults and children in the epidemic characteristics and clinical manifestations of chickenpox and provide a reference for the prevention strategy adjustment of chickenpox. Methods: The incidence data of chickenpox surveillance in Shandong Province from January 2019 to December 2021 were collected. Descriptive epidemiological methods were used to analyze the distribution of cases, and the chi-square test was used to compare the differences in epidemiological characteristics and clinical manifestations of varicella cases between adults and children. Results: A total of 66 182 cases of chickenpox were reported from 2019 to 2021, including 24 085 cases of adults chickenpox, the male to female sex ratio was 1∶1 (12 032∶12 053), basically the same for men and women, and 42 097 cases of children chickenpox, with a gender ratio of 1.4∶1, the male to female ratio was 1.4∶1 (24 699∶17 398). Fever in chickenpox cases was mainly low and moderate, but the proportion of moderate fever with temperature between 38.1 and 39.0 ℃ in children cases (35.0%,14 744/42 097) was significantly higher than that in adults (32.0%,7 696/24 085). The number of herpes in chickenpox cases was mainly less than 50, but the proportion of severe cases with 100-200 herpes in children was higher than that in adults. The incidence rate of complications was 1.4% (333/24 085) in adults chickenpox, the incidence rate of complications was 1.7% (731/42 097) in children chickenpox. The incidence of encephalitis and pneumonia in children was higher than in adults, and the difference was statistically significant (P<0.05). The proportion of chickenpox cases was mainly outpatient, but the hospitalization rate of children cases was 14.4% (6 049/42 097), higher than that of adults, which was 10.7% (2 585/24 085). Conclusions: There were differences between adult chickenpox and child chickenpox in terms of epidemic and clinical manifestations; the symptoms of child chickenpox were more serious than adult chickenpox. However, the adult chickenpox population is generally susceptible and lacks immune strategy protection, which calls for more attention.

Effect of the varicella vaccination on the clinical characteristics of herpes zoster cases aged 20 years and under / 中华预防医学杂志

To discuss the effect of varicella vaccination on the clinical characteristics of herpes zoster (shingles) cases aged 20 years and under, and analyze its clinical features. Based on the Yichang Health Big Data Platform, a descriptive study was conducted to collect the information of cases aged 20 years and under in three medical institutions of Yichang Central People's Hospital, Yichang First People's Hospital and Yichang Second People's Hospital from March 2019 to September 2020. According to the history of varicella vaccine, cases were divided into vaccination group and non-vaccination group, and their clinical features and outcomes were compared. The results showed that 46 shingles cases, aged from 7 to 20 years old, were included in this study. 26 males (56.5%), 20 females (43.5%), 15 cases in vaccination group (32.6%) and 31 cases in non-vaccination group (67.4%). 28 cases had thoracic involvement, followed by lumbar (n=8), cranial (n=7) involvements and extremities (n=7). The spread of herpes skin area: 2 cases involved too large area, 21 cases of 10 cm×10 cm, 14 cases of 5 cm×5 cm, 9 cases of 1 cm×1 cm. Herpes number: 26 cases had 10-49 herpes, followed by <10 herpes (n=9), uncountable herpes (n=7) and 50-99 herpes (n=4). The clinical course[M(Q1,Q3)] lasted 20.5 (13.5,24.8) d averagely, 5 cases had postherpetic neuralgia (PHN) and 1 case had respiratory complications. Shingles decrustation time was significantly shorter in vaccination group (Z=-2.01, P<0.05), and there was no significant difference in other characteristics by vaccination. In conclusion, the number and spread of shingles in most children and adolescents are less, and the complications such as PHN are less. Varicella vaccination can reduce the decrustation time and relieve shingles cases with some clinical symptoms.

Endomarketing para la adherencia al tratamiento de enfermedades dermatológicas estigmatizantes / Endomarketing for adherence to the treatment of stigmatizing dermatological diseases

Las enfermedades cutáneas son una amplia gama de afecciones que afectan la piel, de origen bacteriano, viral, fúngica, reacción alérgica, cáncer, parásito, hereditarias, ideopáticas; por sus sintomatologías pueden generar estigma. Por tal motivo, la Organización Mundial para la Salud, alienta a los Estados miembros a que se involucren en actividades de promoción para aumentar la concienciación con el fin de combatir la discriminación que perciben los pacientes con enfermedades dermatológicas estigmatizantes (EDE), tanto por la comunidad y en los establecimientos de salud, pudiendo repercutir negativamente en la adherencia del tratamiento. El objetivo de este estudio fue valorar el uso de endomarketing para la adherencia al tratamiento de EDE. Se realizó una investigación cuantitativa. Se les aplicó encuesta de endomarketing a 279 participantes; además con 147 pacientes con EDE se indago la percepción de actitudes estigmatizantes. Los resultados mostraron un alcance sobre el endomarketing de 0,62 en personal de atención directa y 0,45 para atención indirecta; los pacientes con mayor percepción de actitudes estigmatizantes fueron los que presentaban afecciones en piel tipo infecciosas, mayormente proveniente de la atención indirecta. Se infiere que el conocimiento sobre las EDE disminuye las expresiones de rechazos. Como alternativas para la formación del personal con una mayor satisfacción en el trabajo, competencia para gestionar y elevado sentido de espiritualidad corporativa, que garantice atención humanitaria a estos pacientes, se sugiere el uso de endomarketing, para conciliar los objetivos e intereses del recurso humano interno a las necesidades y expectativas de los pacientes con EDE(AU)

Skin diseases are a wide range of conditions that affect the skin, of bacterial, viral, fungal origin, allergic reaction, cancer, parasite, hereditary, idiopathic; due to their symptoms they can generate stigma. For this reason, the World Health Organization encourages Member States to engage in promotional activities to raise awareness in order to combat the discrimination perceived by patients with stigmatizing dermatological diseases (SDD), both for the community and in health establishments, which may have a negative impact on adherence to treatment. The objective of this study was to assess the use of endomarketing for adherence to DTS treatment. A quantitative investigation was carried out. An endomarketing survey was applied to 279 participants; In addition, with 147 patients with EDE, the perception of stigmatizing attitudes was investigated. The results showed a reach on endomarketing of 0.62 in direct attention personnel and 0.45 for indirect attention; The patients with the highest perception of stigmatizing attitudes were those who presented infectious-type skin conditions, mostly from indirect care. It is inferred that knowledge about DTS decreases the expressions of rejections. As alternatives for the training of personnel with greater job satisfaction, competence to manage and a high sense of corporate spirituality, which guarantees humanitarian attention to these patients, the use of endomarketing is suggested, to reconcile the objectives and interests of internal human resources. to the needs and expectations of patients with DTS(AU)

Prospective observation of breakthrough cases and analysis of antibody dynamic changes after two doses of varicella / 中华预防医学杂志

Objective: To investigate the breakthrough rate and antibody level of children vaccinated two doses varicella vaccine in Tianjin city, and to compare them with those vaccinated one dose. Methods: A total of 1 112 children who were vaccinated two doses varicella vaccine were selected as the experimental group. According to the same street and township, children who had received only one dose within one year of age difference, and whose first injection time was less than one month from the first dose of varicella vaccine in the experimental group were selected as the control group. A three-year prospective observation was conducted on the incidence of varicella in the two groups. 108 pairs of children in the two groups were selected to collect antivaricella serum in the first to third year. The rate of breakthrough cases, antibody level and antibody positive rate were compared by χ2 test, t-test and variance analysis between and within the two groups in three years. Results: The cumulative breakthrough rate of the experimental group was 0.54%(6/1 112), which was lower than that of the control group 3.96% (44/1 112, χ²=29.544, P<0.001). The GMC level of antibody in the experimental group decreased year by year (F=18.291, P<0.001), and the GMC level in the control group also decreased year by year (F=91.383, P<0.001). There was significant difference in GMC level between the two groups (P<0.001). The difference of antibody positive rate in the experimental group was statistically significant in three years (χ²=11.107, P<0.01), there was significant difference in the positive rate between the first year and third year (P<0.01), there was no significant difference in the positive rate of the control group in three years (χ²=3.351, P>0.05). The positive rate of the experimental group was higher than that of the control group (P<0.001). Conclusion: Two doses varicella vaccine can significantly improve the antibody level and positive rate, but it still shows a downward trend with the extension of time. It is necessary to consider strengthening immunization according to the actual situation.

An investigation on serum antibody level of varicella-zoster virus in healthy population in Beijing / 中华预防医学杂志

Objective: To assess the level and trend of varicella-zoster virus (VZV) antibody among healthy population in Beijing in 2017, after the five-year implementation of the two doses varicella vaccination strategy in 2012, and to provide evidence for scientific evaluation of immunization strategy. Methods: A total of 2 144 subjects in ten age groups from 8 districts of Beijing city were recruited in this study using cross-sectional survey based on multi-stage cluster random sampling method. Serum samples were collected and VZV antibody was detected by ELISA. The influencing factors of antibody concentration and positive rate were analyzed and compared with the study in 2012. The antibody concentration and antibody positive rate were analyzed by nonparametric test and χ² test respectively. Results: The ratio of subjects with registered residence in Beijing city to other provinces was 1∶1. The ratio of male to female was 1∶1.08. The median concentration of VZV antibody was 341.4 (78.6, 1 497.8) mIU/ml, and the total antibody positive rate was 71.1% (1 524/2 144). There were significant differences in antibody positive rate (χ²=736.39, P<0.01) and antibody concentration (χ²=740.34, P<0.01) among different age groups. The antibody positive rate generally increased with age (χ²trend=7.32, Ptrend<0.01). Among 862 children under 14 years old, the antibody positive rate of two doses vaccination 72.8% (182/250) was significantly higher than that of one dose vaccination 51.9% (154/297) (χ²=25.14, P<0.01). There was significant difference between 1-4 years old group (χ²=11.71, P<0.01) and 10-14 years old group (χ²=5.95, P=0.02), but not in 5-9 years old group (χ²=3.00, P=0.07). Compared with the study in 2012, the antibody positive rate increased in 5-9 years old group (χ²=14.35, P<0.01) and decreased in 1-4 years old group (χ²=11.51, P=0.01) in 2017. Conclusion: The recommended varicella booster vaccination has significantly improved the VZV antibody level of children in Beijing city. In the future, it is necessary to explore a more optimized two doses varicella vaccination schedule for children in combination with epidemiological evidence.

Caracterización clínica y de costos de la hospitalización asociada a varicela en niños de la Región Metropolitana y de Valparaíso, Chile / Clinical and cost characterization of hospitalization associated with varicella in children from the Metropolitan Region and Valparaíso, Chile

INTRODUCCIÓN: La varicela es una infección relevante en la salud pública de Chile, pudiendo causar en algunas ocasiones complicaciones graves e incluso la muerte, lo que se asocia a un significativo gasto en salud. En Chile sólo se realiza vigilancia centinela a nivel ambulatorio, sin conocerse el impacto de la varicela en casos más graves que determinan hospitalización. OBJETIVOS: Realizar una descripción clínica y de los costos asociados a la atención de niños hospitalizados con diagnóstico de varicela, en años previos a la introducción de la vacuna en el Programa Nacional de Inmunización en Chile. MATERIALES Y MÉTODOS: Estudio multicéntrico, observacional y retrospectivo, en todos los casos de niños hospitalizados (0-15 años) con diagnóstico de varicela, entre enero de 2011 y diciembre de 2015 en cinco hospitales de Chile. Se realizó revisión de fichas para evaluar características clínicas de la enfermedad y los costos asociados a la hospitalización por varicela. RESULTADOS: Un total de 685 hospitalizaciones por varicela fueron incluidas en el estudio. La mediana de edad fue de 3 años (RIC:1-5), siendo la mayoría de los niños con edades comprendidas entre los 1 y 4 años (52% del total de casos). El 56% fueron hombres y sólo 7 niño s (1%) tuvieron antecedente de vacuna varicela. La mediana de días de hospitalización fue de 3 días en cada episodio (RIC: 2-5). El 13% de los casos requirió hospitalización en unidades de mayor complejidad, 7% de los niños ingresó a Unidad de Tratamiento Intensivo y 6% ingresó a Intermedio, ambos con una mediana de 3 días de hospitalización. Las principales complicaciones fueron: infección de piel y tejidos blandos (42%), alteraciones neurológicas (8%) y shock séptico/tóxico (4%). La letalidad fue de 0,4%. El costo de un caso de varicela considerando los costos directos fue de US$417, el costo indirecto fue de US$224 y los costos proporcionales de una muerte de US$3.575. Se estima que el costo total de un caso de varicela hospitalizado en Chile, considerando todos los factores anteriores, fue de US$4.216. CONCLUSIONES: La varicela es una enfermedad inmunoprevenible frecuente. Se observaron casos con una mediana de 3 días de hospitalización por complicaciones, con 13% de los casos requiriendo hospitalización en unidades de mayor complejidad, con un alto costo asociado, que se estima podría disminuir significativamente con la reciente incorporación de la vacuna al Programa Nacional de Inmunizaciones.

BACKGROUND: Varicella is a relevant infection in Chile and may cause serious complications and death, which could be associated with significant health care resource utilization and associated costs. In Chile, sentinel surveillance is carried out only on an outpatient basis, without knowing the impact of varicella in serious cases who need to be hospitalized. AIM: To describe the clinical characteristics and the costs associated with hospitalized children with diagnosis of varicella prior to the vaccine introduction in the National Immunization Program in Chile. PATIENTS AND METHODS: A multicenter, observational, and retrospective study in hospitalized children (0-15 years) with a diagnosis of varicella, were conducted in five hospitals in Chile between January 2011 and December 2015. A review of the clinical records was performed to evaluate the clinical characteristics of the disease and costs associated with hospitalization episodes for varicella. RESULTS: A total of 685 hospitalized children for varicella were included in this study. The median age was 3 years (IQR: 1-5), most children were between 1 and 4 years of age (52% of total cases). 56% were male, and only 7 patients (1%) had a history of previous varicella vaccination. The median lenght of days of hospitalization was 3 days (IQR: 2-5). 13% of the cases required hospitalization in a more complex care unit, 6% in the intermediate unit and 7% in the pediatric intensive treatment unit, both with a median stay of 3 days. The main complications were: skin and soft tissue infections (42%), neurologic (8%) and septic or toxic shock (4%). There were 3 cases of death (0.4%). The direct cost of a varicella case was US $ 417, the indirect cost was US $ 224 and the proportional cost of a case of death was US $ 3,575. It is estimated that the total cost of a hospitalized varicella case in Chile was US $ 4,216. CONCLUSIONS: Varicella is associated with a significant burden of disease in Chile. The median hospital stay was three days with 13% of cases requiring medical care in a complex unit, with high associated costs which could be significantly reduced with the recently incorporation of the varicella vaccine into the National Immunization Program.

Asociación entre incidencia de varicela y variabilidad climática en la provincia de Tucumán, Argentina, 2005-2019 / Association between varicella incidence and climate variability in Tucumán province, Argentina, 2005-2019

INTRODUCTION: Varicella is a vaccine-preventable disease with marked seasonality. Few studies incorporate climatic variables to understand the epidemiological characteristics of this disease. The aim was to evaluate the relationship between varicella incidence and climatic variables in Tucumán (a province with temperate subtropical climate) during 2005-2019. METHODS: The relationship in pre- (2005-2014) and post-vaccination (2015-2019) periods was analyzed, identifying the associated climatic variables and the cut-off point where the risk of transmission increased. An observational ecological study was carried out with secondary data sources. R software was used. The information was split into three time series: 2005-2009, 2010-2014 and 2015-2019. For each period, a description of the time series was performed and generalized additive models (GAMs) were built using a negative binomial distribution. RESULTS: A seasonal behavior was observed, with peak incidence during spring in all periods. In the post-vaccination period, the peak occurred later (epidemiological week [EW] 46) than in the pre-vaccination periods (EW 43 and 42). Maximum temperature and relative humidity were associated during the first two periods, while minimum temperature, wind and thermal amplitude were associated in the third one. DISCUSSION: This study helped establish the relationship between climatic variables and varicella in Tucumán.

Number of cases of varicella and hospitalization in a pediatric reference hospital in brazil after introducing the vaccine / Avaliação do número de casos e do perfil de internações por varicela em hospital pediátrico após a introdução da vacina

ABSTRACT Objective: To assess the number of cases and the profile of hospitalizations from varicella after the introduction of the measles, mumps, rubella and varicella combination vaccine in the public health system. Methods: Retrospective study in an infectious diseases pediatric hospital of reference in Southeast Brazil. The cases with a clinical diagnosis of varicella, from January 2011 to June 2016, were assessed from pediatricians' medical records. The hospitalizations were classified into a pre-vaccine group and post-vaccine group, based on the date the vaccine was introduced (September 2013). Both groups were compared by age, sex, time of hospitalization, reason for hospitalization, hospital complications, duration of intensive care, and clinical outcome. Results: A total of 830 hospitalizations were recorded; 543 in the pre-vaccine period and 287 in the post-vaccine period, a reduction of 47.1% (p<0.001). In both periods, a similar profile in the hospitalizations was noticed: majority male; aged between one to five years old; most complications due to secondary causes (mainly skin infections); main outcome was clinical improvement and discharge from the hospital. In the pre-vaccine period, six deaths were recorded and two were recorded in the post-vaccine period. Conclusions: The profile of the hospitalizations was expected to stay the same since this study did not compare vaccinated with unvaccinated children, but hospitalizations before and after the vaccine was introduced. In accordance with the medical literature, we found a significant fall in the number of hospitalizations from varicella.

RESUMO Objetivo: Avaliar o número de casos e o perfil das internações por varicela após a introdução da vacina quádrupla viral na rede pública. Métodos: Estudo retrospectivo conduzido em hospital pediátrico referência em doenças infectocontagiosas na Região Sudeste do Brasil. Foram avaliados os casos com diagnóstico clínico de varicela, registrados em prontuário por médico pediatra, de janeiro de 2011 até junho de 2016. As internações foram classificadas em grupo pré-vacinal e grupo pós-vacinal, com base na data de introdução da vacina (setembro de 2013). Os grupos foram comparados em relação a: faixa etária, sexo, tempo de hospitalização, causas da internação, complicações hospitalares, tempo da internação em terapia intensiva e desfecho clínico. Resultados: Foram documentadas 830 internações, 543 no período pré-vacinal e 287 no pós-vacinal, ocorrendo redução de 47,1% nas internações (p<0,001). Em ambos os períodos, notou-se um perfil similar das internações, predominantemente: sexo masculino; faixa etária de um a cinco anos; por causas secundárias (principalmente infecções de pele); evoluindo com melhora clínica e alta hospitalar. Em relação ao número de óbitos, ocorreram seis no período pré-vacinal e dois no pós-vacinal. Conclusões: A manutenção do perfil das internações era esperada, visto que o trabalho não comparou crianças vacinadas com não vacinadas, e sim internações pré e pós-vacinais. Observou-se, em concordância com a literatura, queda substancial no número de internações por varicela.

Incorporación de segunda dosis de la vacuna de la varicela al Calendario Nacional de Vacunación de Argentina / Incorporation of the second dose of the varicella vaccine to the national vaccination schedule of Argentina

A partir de 2022, a la dosis de vacuna contra la varicela contemplada a los 15 meses de edad en el Calendario Nacional de Vacunación de Argentina, se suma una segunda dosis al ingreso escolar. En este artículo se repasan los aspectos clave para la implementación de esta práctica de inmunización universal, gratuita y obligatoria. (AU)

Starting in 2022, a second dose of the varicella vaccine will be added to the 15-month-old dose included in Argentina's National Vaccination Schedule at school entry. This article reviews the key aspects for the implementation of this universal, free and mandatory immunization practice. (AU)

Surto de varicela entre imigrantes venezuelanos alojados em abrigos e ocupações no estado de Roraima, 2019: um estudo descritivo / Brote de varicela entre inmigrantes venezolanos alojados en albergues y ocupaciones en el estado de Roraima, Brasil, 2019: estudio descriptivo / Chickenpox outbreak among Venezuelan immigrants housed in shelters and occupancies in the state of Roraima, Brazil, 2019: a descriptive study

Objetivo: Descrever o surto de varicela entre imigrantes venezuelanos em abrigos e ocupações nos municípios de Pacaraima e Boa Vista, Roraima, Brasil, e as medidas de controle implementadas. Métodos: Estudo descritivo do tipo 'série de casos', realizado entre 21 de novembro e 13 de dezembro de 2019, sobre banco de dados secundários da investigação do surto disponibilizado pela Coordenação-Geral do Programa Nacional de Imunizações. Na análise descritiva, utilizaram-se medidas de frequência simples e relativa e foram calculadas medidas de tendência central e dispersão. Resultados: Dos 9.591 imigrantes, detectaram-se 38 casos ativos e 1.459 suscetíveis à varicela. Dos casos ativos, 23 eram do sexo feminino e a faixa etária mais acometida foi a de menores de 9 anos (17 casos). Conclusão: Identificaram-se pessoas suscetíveis a varicela na investigação; foram adotadas ações de imunização que controlaram a transmissão, evitando casos graves, óbitos e sobrecarga da rede de assistência à saúde local.

Objetivo: Describir el brote de varicela entre inmigrantes venezolanos en albergues y ocupaciones en los municipios de Pacaraima y Boa Vista, Roraima, Brasil, y las medidas de control implementadas. Métodos: Estudio descriptivo del tipo "serie de casos", entre el 21 de noviembre y 13 de diciembre de 2019, utilizando datos secundarios de la investigación del brote, puesto a disposición por la Coordinación General del Programa Nacional de Inmunizaciones. En el análisis descriptivo, se utilizaron medidas de frecuencia simple y relativa y se calcularon medidas de tendencia central y dispersión. Resultados: Entre los 9.591 inmigrantes se detectaron 38 casos activos y 1.500 susceptibles a la varicela. Entre los casos activos, 23 fueron mujeres y el grupo de edad más afectado fue de menores de 9 años (17 casos). Conclusión: Se identificaron personas susceptibles a la varicela, lo que llevó a adopción de acciones de inmunización que controlaran la transmisión, previniendo casos graves, muertes y sobrecarga de la red local de atención.

Objective: To describe chickenpox outbreak among Venezuelan immigrants in shelters and occupancies in the municipalities of Pacaraima and Boa Vista, the state capital of Roraima, Brazil, and the control measures implemented. Methods: This was a descriptive case series study, conducted between November 21 and December 13, 2019, based on secondary database obtained from the outbreak investigation made available by the General Coordination for the National Immunization Program. Descriptive analysis was performed using simple and relative frequency measurements, and measures of central tendency and dispersion were calculated. Results: Of the 9,591 immigrants, 38 active cases and 1,459 susceptible to varicella were identified. With regard to active cases, 23 were female, and those aged under 9 years (17 cases) were the most affected. Conclusion: People susceptible to chickenpox were identified during the investigation. Immunization actions aimed at reducing transmission were adopted, thus preventing severe cases, deaths and overload in local health care system.