Fecal rotavirus and adenovirus antigen detection and clinical analysis of children with acute gastroenteritis in a hospital of Beijing City from 2019 to 2022 / 中华预防医学杂志

As a single-center retrospective study, we analyzed the results of rotavirus and human adenovirus antigens in stool samples with colloidal gold immunochromatography method in children with acute gastroenteritis under the age of five who were treated in our hospital from 2019 to 2022. After excluding nonconforming cases and duplicate cases, 2 896 cases were included, of which 559 cases were detected with at least one viral antigen. According to the test results, they were divided into RV positive group, HAdV positive group and RV & HAdV double positive group. The gender, age, seasonal distribution, clinical symptoms and related laboratory tests were compared and analyzed with χ2 test, analysis of variance and nonparametric test. Among the single samples from 2 896 children, the positive rate of RV antigen was 6.21% (180/2 896), the positive rate of HAdV antigen was 10.91% (316/2 896), and the double positive rate of RV & HAdV was 2.18% (63/2 896). The positive rate of HAdV antigen in 2021 was 16.11%, a significant increase compared with 6.20% in 2020. RV infection has obvious seasonality, and spring and winter are the seasons with high incidence of infection (χ2=74.018, P<0.001), while HAdV infection has no obvious seasonality (χ2=2.110, P=0.550), showing sporadic infection throughout the year. The proportions of fever and vomiting symptoms in children with RV infection were significantly higher than those in the HAdV infection group (χ2=40.401, P<0.001; χ2=32.593, P<0.001), but the positive rate of white blood cells in the stool was significantly lower than that in the HAdV infection group (χ2=13.741,P<0.01). In summary, paying attention to the epidemiological changes of RV and HAdV is of great significance for clinical diagnosis and treatment and disease prevention and control.

Epidemiological Characteristics and Spatiotemporal Distribution Patterns of Human Norovirus Outbreaks in China, 2012-2018 / 生物医学与环境科学（英文）

OBJECTIVE@#To clarify the epidemiological characteristics and spatial distribution patterns of human norovirus outbreaks in China, identify high-risk areas, and provide guidance for epidemic prevention and control.@*METHODS@#This study analyzed 964 human norovirus outbreaks involving 50,548 cases in 26 provinces reported from 2012 to 2018. Epidemiological analysis and spatiotemporal scanning analysis were conducted to analyze the distribution of norovirus outbreaks in China.@*RESULTS@#The outbreaks showed typical seasonality, with more outbreaks in winter and fewer in summer, and the total number of infected cases increased over time. Schools, especially middle schools and primary schools, are the most common settings of norovirus outbreaks, with the major transmission route being life contact. More outbreaks occurred in southeast coastal areas in China and showed significant spatial aggregation. The highly clustered areas of norovirus outbreaks have expanded northeast over time.@*CONCLUSION@#By identifying the epidemiological characteristics and high-risk areas of norovirus outbreaks, this study provides important scientific support for the development of preventive and control measures for norovirus outbreaks, which is conducive to the administrative management of high-risk settings and reduction of disease burden in susceptible areas.

Gastos de bolsillo por gastroenteritis a causa de rotavirus en el Hospital Pediátrico de Cienfuegos, 2019 - 2020 / Out-Of-Pocket Expenses for Gastroenteritis Due to Rotavirus at Cienfuegos Pediatric Hospital, 2019 - 2020

Introducción: La hospitalización por enfermedades diarreicas agudas en menores de cinco años de edad puede generar gastos importantes para la familia. Objetivo: Estimar el gasto de bolsillo y el costo indirecto por la atención a pacientes menores de cinco años de edad hospitalizados por gastroenteritis a causa de rotavirus. Métodos: Estudio de descripción de costos. Se empleó el microcosteo para estimar el costo directo médico (servicio y medicamentos) y no médico (transporte, alimentación, aseo), así como las pérdidas de productividad para el paciente y su familia y las fuentes de financiamiento. Se trabajó con 132 pacientes hospitalizados en el Hospital Pediátrico de Cienfuegos entre septiembre de 2019 y febrero de 2020 con gastroenteritis y test rápido de rotavirus positivo. El gasto se analizó según la situación económica referida y la edad del paciente. Resultados: La media del gasto de bolsillo total fue de CUP 809,66 (IC 95 por ciento 757,57 - 861,75); el 50,8 por ciento por alimentación, el 31,4 por ciento por aseo y un 17,8 por ciento por transportación. Los hogares con mejor situación económica gastaron más (< 0,001). El 87,2 por ciento de las familias utilizó alguna fuente de recursos adicional a sus ingresos habituales. Se afectaron 2,39 personas (IC 95 por ciento 2,27 - 2,52) y se reportó una pérdida de 5,51 días laborales (IC 95 por ciento 5,21 - 5,8). El costo indirecto promedio fue de CUP 418,8 (IC 95 por ciento 382,36 - 455,24). Conclusiones: La hospitalización de un menor de cinco años por gastroenteritis aguda a causa de rotavirus en Cienfuegos significa una carga económica considerable para los hogares, en especial para los de mejor situación económica(AU)

Introduction: Hospitalization for acute diarrheal diseases in children under five years of age can generate significant expenses for the family. Objective: To assess the out-of-pocket expense and the indirect cost for the care of patients under five years of age hospitalized for gastroenteritis due to rotavirus. Methods: This is cost description study. Microcosting was used to estimate the direct medical cost (service and medication) and non-medical cost (transportation, food, cleaning), as well as the productivity losses for patients and their family and the sources of financing. We worked with 132 patients hospitalized at Cienfuegos Pediatric Hospital from September 2019 to February 2020 with gastroenteritis and a positive rotavirus rapid test. Expenditure was analyzed according to the economic situation referred to and the age of the patient. Results: The mean total out-of-pocket expense was CUP 809.66 (95percent CI 757.57 - 861.75); 50.8percent for food, 31.4percent for cleaning and 17.8percent for transportation. Households with better economic situation spent more (<0.001). 87.2percent of the families used some source of resources in addition to their usual income. 2.39 people were affected (95percent CI 2.27 - 2.52) and a loss of 5.51 working days was reported (95percent CI 5.21 - 5.8). The average indirect cost was CUP 418.8 (95percent CI 382.36 - 455.24). Conclusions: The hospitalization of a child under five years of age for acute gastroenteritis due to rotavirus in Cienfuegos represents a considerable economic burden for families, especially for those with better economic situation(AU)

Epidemiología de los casos pediátricos en la sala de emergencias de un hospital general / Epidemiology of pediatric cases in the emergency room of a general hospital

Objetivos El objetivo de este estudio es determinar a qué tipo de patologías nos enfrentamos. Utilizamos la Clasificación Internacional de Atención Primaria para asegurar una nomenclatura objetiva y comparable. Métodos Se realizó un estudio descriptivo, observacional y retrospectivo de una muestra de 108102 consultas de atención primaria de pacientes que acudieron a Urgencias de nuestro hospital para evaluar la epidemiología de la atención pediátrica brindada entre 2011 y 2019. Utilizamos el sistema de clasificación diagnóstica ICPC-2. Resultados El número de asistencias fue mayor en enero, febrero y marzo, así como los fines de semana. Tras ser atendidos, el 6,7% de los pacientes ingresaron en nuestro hospital. Las patologías más frecuentes fueron las infecciones del tracto respiratorio superior, gastroenteritis, fiebre y traumatismos / lesiones. Las patologías que con mayor frecuencia dieron lugar a ingresos hospitalarios fueron fiebre, bronquitis, gastroenteritis y vómitos (p> 0,001). En los ingresos hospitalarios de menores de 1 año, la bronquitis fue la patología más frecuente, mientras que entre los de 1 a 6 años fue la gastroenteritis y entre los de 7 a 14 años fue la apendicitis aguda (p <0,001). Conclusiones Las patologías pediátricas suponen un porcentaje importante de las visitas a urgencias, destacando las infecciones del tracto respiratorio superior, las infecciones intestinales y la fiebre. Sería aconsejable incrementar los recursos de personal en los fines de semana. Es necesario enfatizar en la educación sanitaria de la población para ajustar la demanda de asistencia en los servicios públicos. Se requiere más investigación para adaptar mejor la terminología ICPC-2.

Objectives The aim of this study is to determine what type of pathologies we are facing. We use the International Classification of Primary Care to ensure an objective and comparable nomenclature. Methods We carried out a descriptive, observational, and retrospective study of a sample comprising 108102 primary care encounters of patients presenting at our hospital's Emergency Room to assess the epidemiology of the pediatric care provided between 2011 and 2019. We used the ICPC-2 diagnosis classification system. Results The number of attendances was higher in January, February, and March, as well as at weekends. After being seen, 6.7% of patients were admitted to our hospital. The most frequent pathologies were upper respiratory tract infections, gastroenteritis, fever and trauma/injury. Pathologies most frequently resulting in hospital admissions were fever, bronchitis, gastroenteritis and vomiting (p>0.001). In hospital admissions involving patients under 1 year of age, bronchitis was the most frequent pathology, while among those aged between 1 and 6 years, it was gastroenteritis and among those aged between 7 and 14 years it was acute appendicitis (p<0.001). Conclusions Pediatric pathologies account for a significant percentage of visits to the emergency room, highlighting infections of the upper respiratory tract, intestinal infections, and fever. It would be necessary to increase staff resources on the weekends. It is highly recommended to emphasize the health education of the population to adjust the demand for assistance in public services. More research is required to better adapt the ICPC-2 terminology.

Caracterización clínico epidemiológica de la gastroenteritis por rotavirus. Estudio piloto. Hospital Pediátrico de Centro Habana. Noviembre 2017- abril 2018 / Clinical epidemiological characterization of rotavirus gastroenteritis. Pilot study. Paediatric Hospital of Centro Habana

La gastroenteritis causada por rotavirus constituye un importante problema de salud mundial, por lo que se recomienda incluir la vacunación contra el rotavirus en los programas de inmunización. Para evaluar el impacto de una futura introducción en Cuba de una vacuna contra este patógeno, resulta necesario crear una línea de base pre-vacunación de la carga de la gastroenteritis causada por este virus. Entre noviembre 2017 a abril 2018 se implementó en el Hospital Pediátrico de Centro Habana un sistema de vigilancia para la gastroenteritis causada por rotavirus. Se establecieron las definiciones para las categorías de caso sospechoso, probable y confirmado. Por cada niño captado se recogió una muestra de heces que se analizó con tiras rápidas y se confirmó la presencia de rotavirus por ELISA. Para determinar la severidad de la enfermedad se utilizó la escala de Vesikari. Los resultados fueron expresados en cifras absolutas y relativas, el análisis se realizó a través de la prueba de chi-cuadrado. Del total de ingresos por enfermedad diarreica aguda, el 26 por ciento cumplió los criterios de inclusión y el 46 por ciento resultó confirmado como rotavirus. El hacinamiento en el hogar y asistir al círculo infantil se comportaron como factores de riesgo. El servicio de gastroenterología absorbió la mayor carga de ingresos hospitalarios por esta causa. Los resultados mostrados validan la funcionalidad del sistema de vigilancia implementado y brindan nuevas evidencias sobre la carga de la enfermedad y la utilización de los servicios de un hospital pediátrico cubano, debido a la gastroenteritis provocada por rotavirus, lo que justifica la introducción de la vacuna(AU)

Gastroenteritis caused by rotavirus is a major global health problem, therefore it is recommended that vaccination against rotavirus be included in immunization programs. To evaluate the impact of a future introduction in Cuba of a vaccine against this pathogen, it is necessary to have a pre-vaccination baseline of the burden of gastroenteritis caused by rotavirus. Between November 2017 and April 2018, a surveillance system for gastroenteritis caused by rotavirus was implemented in the Paediatric Hospital of Centro Habana. Definitions were established for the categories of suspected, probable and confirmed cases. For each captured child, stool samples were collected, analyzed with rapid strips and confirmated by ELISA. To determine the severity of the disease, the Vesikari score was used. The results were expressed in absolute and relative figures; the analysis was performed through chi-square. Of the total admissions for acute diarrheal disease, 26 percent met the inclusion criteria and 46 percent were confirmed for rotavirus. Overcrowding at home and attending a day care center were risk factors. The gastroenterology service absorbed the greatest burden of hospital admissions for this cause. The results shown validate the role of the implemented surveillance system and provide new evidence on the burden of disease and use of services for rotavirus gastroenteritis in a cuban pediatric hospital(AU)

A molecular epidemiological study of pediatric norovirus gastroenteritis, 2017-2019 / 中国当代儿科杂志

OBJECTIVES@#To study the molecular epidemiological characteristics of norovirus in children with acute gastroenteritis from 2017 to 2019.@*METHODS@#A retrospective analysis was performed on the medical data of children with acute gastroenteritis who were admitted to Children's Hospital of Chongqing Medical University from January 2017 to December 2019. A total of 1 458 stool samples were collected from the children, and viral RNA was extracted. Reverse transcription polymerase chain reaction was used for gene amplification, sequencing, and genotype identification of the VP1 region of capsid protein in norovirus.@*RESULTS@#Among the 1 458 stool samples, 158 (10.8%) were positive for norovirus. There was no significant difference in the positive detection rate of norovirus between different years (@*CONCLUSIONS@#Norovirus GII.4 Sydney 2012 was the major epidemic strain in the children with norovirus gastroenteritis from 2017 to 2019. Although norovirus infection can exist throughout the year, August to October is the peak period. During this period, norovirus surveillance and key population protection are strengthened to help prevent and control norovirus diarrhea.

Detection of salivirus in raw sewage samples in Rio de Janeiro, Brazil

Gastroenteric viruses are important pathogens related to cases of acute gastroenteritis, affecting millions of people worldwide with a major impact on children under five in developing countries. The introduction of metagenomic approach techniques in the 2000s has allowed the description of new viruses, among them Salivirus, which has been associated worldwide with cases of diarrhea. This study aimed to detect salivirus in raw sewage samples from a wastewater treatment plant (WWTP) collected between June 2013 and May 2014 in Rio de Janeiro, Brazil. Fifty-two samples collected weekly were tested by using a real-time quantitative PCR (qPCR). Salivirus genome was detected in 71.1% (37/52) of the samples, with viral concentration ranging from 7.56 x 104 to 7.20 x 106 genomic copies per liter. Higher viral loads were detected in the summer and fall of 2014, although these data were not sufficient to infer seasonality for this virus. The high prevalence of salivirus in sewage samples highlights the importance of viral research in wastewater to generate data on salivirus circulation, increasing understanding regarding its dissemination in the population.

Factores predictores de reconsulta por gastroenteritis aguda en urgencias pediátricas: estudio de casos y controles / Predictor factors for emergency department revisiting of children with acute gastroenteritis: case-control study

INTRODUCCIÓN: El objetivo de este trabajo es describir factores de riesgo de reconsulta en pacientes con diagnóstico de gastroenteritis aguda, identificables en su primera visita a Urgencias. PACIENTES Y MÉTODO: Estudio casos-control, incluye pacientes entre 0-16 años que consultan en Urgencias de un hospital terciario durante 4 años. Se define caso el episodio de Urgencias con diagnóstico de gastroenteritis que reconsulta durante las 72 h posteriores. Se seleccionó un control por cada caso, siendo este el primer paciente que consultó tras cada caso con el mismo diagnóstico y que no reconsultó posteriormente. Se estudiaron variables epidemiológicas, clínicas e intervenciones diagnóstico-terapéuticas llevadas a cabo durante la primera visita, realizándose análisis uni y multivariable del riesgo de reconsulta utilizando modelos de regresión logística. RESULTADOS: Los diagnósticos de gastroenteritis supusieron el 5,3% de todas las visitas a urgencias. 745 pacientes (6,2%) reconsultaron en las siguientes 72 h. En el análisis multivariado se encontró asociación entre la reconsulta con cada año de aumento de edad (OR 0,94; IC 95%: 0,91-0,97), ausencia de vacunación de rotavirus (OR 1,47; IC 95%: 1,11-1,95), no valoración previa en atención primaria (OR 1,55; IC 95%: 1,09-2,19), mayor número de deposiciones en las últimas 24 h (OR 1,06; IC 95% 1,02-1,10) y recogida de coprocultivo en Urgencias (OR 1,54; IC 95%: 1,05-2,24). CONCLUSIONES: Los pacientes de menor edad con elevada frecuencia de deposiciones son especialmente susceptibles de volver a consultar en los servicios de Urgencias. La vacunación frente a rotavirus podría disminuir las reconsultas. Ninguna de las actuaciones diagnóstico-terapéuticas realizadas parece disminuir el número de revisitas a Urgencias.

INTRODUCTION: The objective of this work is to describe risk factors for reconsultation in patients with an acute gastroenteritis diagnosis, identifiable in their first visit to the Emergency Department. PATIENTS AND METHOD: Case-control study, including patients aged between 0-16 years who consulted in the Emer gency Department (ED) of a tertiary hospital for 4 years. The case is defined as the episode with a gastroenteritis diagnosis that reconsulted within 72 hours. A control was selected for each case, which was the first patient to consult after each case with the same diagnosis and not reconsulted later. Epidemiological and clinical variables, and diagnostic-therapeutic interventions carried out during the first visit were studied. Univariate and multivariate analyses of the reconsultation risk were per formed using logistic regression models. RESULTS: Gastroenteritis diagnoses accounted for 5.3% of all ED visits. 745 patients (6.2%) reconsulted within 72 hours. Multivariate analysis found association between reconsultation with each year of increasing age (OR 0.94, 95% CI 0.91-0.97), absence of rotavirus vaccination (OR 1.47, 95% CI: 1.11-1.95), no prior assessment in primary care (OR 1.55, 95% CI 1.09-2.19), increased stool output in the last 24 hours (OR 1.06, 95% CI 1.02-1.10), and stool collection in the ED (OR 1.54, 95% CI 1.05-2.24). CONCLUSIONS: Younger patients with an increased stool output are especially susceptible to return to the ED for consultation. Rotavirus vaccination could reduce reconsultation. None of the diagnostic-therapeutic actions carried out seems to reduce the number of visits to the ED.

A common Salmonella Enteritidis sequence type from poultry and human gastroenteritis in Ibagué, Colombia / Un tipo de secuencia común de Salmonella Enteritidis de origen aviar y de humano con gastroenteritis en Ibagué, Colombia

Abstract Introduction: Salmonella Enteritidis is a major cause of human salmonellosis in the world, with contaminated eggs and raw chicken meat as the main routes of infection. The main Salmonella spp. serovars circulating in laying hen farms, the surface of eggs, and in raw chicken carcasses have been identified in Ibagué, Colombia. However, it is unknown whether those serovars are responsible for human gastroenteritis. Objective: To evaluate the genetic relationship between gastroenteritis and Salmonella Enteritidis isolates from poultry and humans using multilocus sequence typing (MLST). Materials and methods: Salmonella spp. was isolated from clinical cases of gastroenteritis (n=110). Antibiotic susceptibility tests, followed by serotyping and MLST were conducted and S. Enteritidis was compared to those from laying hen farms and marketed eggs. Results: Ten isolates of Salmonella spp. were obtained from the stools of people with gastroenteritis. The prevalence of Salmonella spp. in human stools was 9.09%, and S. Enteritidis (n=4), S. Typhymurium (n=2), S. Newport (n=1), S. Uganda (n=1), S. Grupensis (n=1), and S. Braenderup (n=1) were the main serotypes. MLST indicated that a common S. Enteritidis sequence type (ST11) was present in all three sources and showed the same antibiotic resistance pattern. Conclusion: Salmonella Enteritidis ST11 constitutes a link between consumption and manipulation of contaminated eggs and human gastroenteritis in Ibagué. Additional studies would be required to establish if other Salmonella serovars isolated from raw chicken meat are also associated with human gastroenteritis.

Resumen Introducción. Salmonella Enteritidis es una de las mayores causas de salmonelosis en el mundo; los huevos contaminados y la carne de pollo cruda son sus principales fuentes de infección. En Ibagué, Colombia, se han identificado los principales serovares que circulan en granjas, superficies de huevos y canales de pollo, pero se desconoce si esos serovares son responsables de la gastroenteritis. Objetivo. Evaluar la relación genética entre los aislamientos de Salmonella Enteritidis de aves de corral y de humanos con la gastroenteritis mediante tipificación de multiloci de secuencias (Multilocus Sequence Typing, MLST). Materiales y métodos. Se aisló Salmonella spp. de casos clínicos de gastroenteritis (n=110). Se hizo la prueba de sensibilidad antibiótica, así como la serotipificación y la tipificación mediante MLST, y se comparó S. Enteritidis de humanos con la hallada en granjas de gallinas ponedoras y en huevo comercializado (n=6). Resultados. Se aislaron 10 cepas de Salmonella spp. a partir de heces de humanos con gastroenteritis. Se obtuvo una prevalencia de Salmonella spp. de 9,09%, y se identificaron los serotipos S. Enteritidis (n=4), S. Typhymurium (n=2), S. Newport (n=1), S. Grupensis (n=1), S. Uganda (n=1) y S. Braenderup presentes en pacientes con gastroenteritis. Mediante la MLST, se comprobó que un tipo de secuencia común (ST11) de S. Enteritidis estuvo presente en todas las tres fuentes y presentó el mismo patrón de resistencia antibiótica. Conclusión. Salmonella Enteritidis ST11 constituye un vínculo entre el consumo y la manipulación de huevos contaminados, y la gastroenteritis en humanos en Ibagué. Se requieren estudios complementarios para conocer si otros serovares de Salmonella aislados de carne de pollo cruda también se asocian con la gastroenteritis en humanos.

Norovírus no município de São Paulo, 2010-2016: estudo transversal sobre a principal causa de gastroenterite infantil / Norovirus en el Municipio de São Paulo, Brasil, 2010-2016: estudio transversal sobre la principal causa de gastroenteritis infantil / Norovirus in São Paulo city, Brazil, 2010-2016: a cross-sectional study of the leading cause of gastroenteritis in children

Objetivo: descrever casos de doença diarreica aguda por norovírus em crianças menores de 5 anos do município de São Paulo, Brasil. Métodos: estudo transversal com dados provenientes da Vigilância Epidemiológica das Gastroenterites Causadas por Rotavírus; foi definido como caso o paciente internado em unidade sentinela por doença diarreica aguda e identificação laboratorial do norovírus como agente etiológico, entre os anos de 2010 e 2016. Resultados: durante o período estudado, a proporção de casos de norovírus em menores de 5 anos de idade ultrapassou a proporção de casos de rotavírus, agente considerado predominante na infância; o norovírus foi associado a 28,4% do total de casos notificados, ocorrendo o ano todo, principalmente nos meses mais quentes. Conclusão: norovírus foi o principal agente etiológico identificado em crianças menores de 5 anos com doença diarreica aguda no município de São Paulo.

Objetivo: describir casos de enfermedad diarreica aguda por Norovirus en niños menores de 5 años provenientes del Municipio de São Paulo, Brasil. Métodos: Estudio transversal con datos de la Vigilancia Epidemiológica de las Gastroenteritis causadas por Rotavirus. Se definió como caso el paciente internado en unidad centinela por enfermedad diarreica aguda e identificación de laboratorio del Norovirus como agente etiológico entre los años de 2010 y 2016. Resultados: Durante el período estudiado, la proporción de casos de Norovirus en menores de 5 años superó la proporción de casos de Rotavirus, agente considerado predominante en la infancia. El Norovirus fue asociado al 28,4% del total de los casos notificados, ocurriendo todo el año, principalmente en los meses más cálidos. Conclusión: el Norovirus fue el principal agente etiológico identificado en niños menores de 5 años con enfermedad diarreica aguda en el Municipio de São Paulo.

Objective: to describe cases of acute diarrheal disease caused by norovirus in children under 5 years old in São Paulo city, Brazil. Methods: this was a cross-sectional study using data from Epidemiological Surveillance of Gastroenteritis due to Rotavirus; cases were defined as patients hospitalized in a sentinel unit because of acute diarrheal disease and laboratory identification of norovirus as the etiological agent between 2010 and 2016. Results: during the study period, the proportion of norovirus cases in children under 5 years old exceeded the proportion of Rotavirus, an agent considered predominant in childhood; norovirus was associated with 28.4% of total reported cases, occurring all year round, especially in warmer months. Conclusion: norovirus was the leading etiological agent identified in children under 5 years old with acute diarrheal disease in São Paulo city.

Efecto de la lactancia en las infecciones pediátricas frecuentes: estudio de cohorte prospectivo de cinco años / Effect of breastfeeding on common pediatric infections: a 5-year prospective cohort study

Introducción. En los estudios realizados se encontró que la duración de la lactancia tiene un efecto reductor sobre las infecciones frecuentes en los niños durante el período de lactancia. Objetivo. El objetivo de este estudio fue abordar la asociación entre la duración de la lactancia y las enfermedades infecciosas frecuentes en los niños hasta los 5 años de edad para demostrar los efectos protectores de la leche materna. Población y métodos. Se incluyeron 411 lactantes nacidos en Rize, Turquía, entre enero de 2011 y diciembre de 2011. Este estudio de cohorte, prospectivo duró cinco años; en este período, se realizaron 11 entrevistas con cada madre de los lactantes. Se dividió a los lactantes en dos grupos: amamantados durante más y menos de 12 meses, y se estudió la asociación entre la lactancia y las infecciones, como otitis media aguda, gastroenteritis aguda, infección respiratoria aguda e infección urinaria. Resultados. De los 411 nacimientos, se incluyeron 270 lactantes, 193 (71,5%) recibieron lactancia durante más de 12 meses y 77 (28,5%), durante menos de 12 meses. Los lactantes del primer grupo tuvieron menos casos de otitis media aguda y gastroenteritis aguda (n = 77; 28,52%) en comparación con los lactantes amamantados durante menos de 12 meses en el período de cinco años (p < 0,05). Conclusiones. Con este estudio se detectó que la lactancia durante más de 12 meses reduce significativamente las infecciones frecuentes durante la niñez, como la otitis media y la gastroenteritis durante los primeros cinco años de vida.

Introduction.The studies conducted revealed that breastfeeding duration has a reducing effect on common infectious diseases in the children during breastfeeding period. Objective. The aim of the present study was to address the association between breastfeeding duration and common infectious diseases in the children until 5 years of age to show long-term protective effects of the breast milk. Material and methods. The study included 411 infants who were born in Rize (Turkey) between January 2011 and December 2011. The present prospective-cohort study lasted for 5 years and 11 interviews were conducted with each mother of the infants during this period. The infants were divided into two groups as those who were breastfed more and less than 12 months and the association between breastfeeding and infections such as acute otitis media, acute gastroenteritis, acute respiratory tract infections and acute urinary system infections was investigated. Results. Of 270 infants 193 (71.5%) were breastfed longer than 12 months and 77 (28.5%) were breastfed less than 12 months. Infants in the first group had less acute otitis media and acute gastroenteritis (n= 77, 28.52%) when compared with the infants breastfed less than 12 months during 5-year period (p <0.05). Conclusion. The present study detected that breastfeeding duration longer than 12 months significantly reduces the common childhood infections such as otitis media and gastroenteritis during the first 5 years of life.

Identification of Human Bocavirus type 4 in a child asymptomatic for respiratory tract infection and acute gastroenteritis - Goiânia, Goiás, Brazil

Abstract Human Bocavirus (HBoV) has been identified from feces and respiratory samples from cases of both acute gastroenteritis and respiratory illness as well as in asymptomatic individuals. The aim of this study was to detect and characterize HBoV from fecal samples collected from hospitalized children aged less than five years old with no symptoms of respiratory tract infection (RTI) or acute gastroenteritis (AGE). The study involved 119 children and one fecal sample was collected from each participant between 2014 and 2015. HBoV was detected using Nested-PCR, and the viral type identified by genomic sequencing. HBoV-4 was identified from one sample obtained from a hospitalized child with soft tissue tumor of the submandibular region. This is the first report of HBoV-4 identification in Brazil, but we consider that this type may be circulating in the country similar to the other types and new investigations are necessary.

High prevalence of norovirus in children with sporadic acute gastroenteritis in Manaus, Amazon Region, northern Brazil

BACKGROUND Norovirus (NoV) is a major cause of acute gastroenteritis (AGE) worldwide, especially in children under five years. Studies involving the detection and molecular characterisation of NoV have been performed in Brazil, demonstrating its importance as an etiological agent of AGE. OBJECTIVES The objectives of this study were to investigate the frequency of human NoV and to genotype the strains isolated from 0-14-year-old patients of AGE in Manaus, Brazil, over a period of two years. METHODS A total of 426 faecal samples were collected between January 2010 and December 2011. All samples were tested for the presence of NoV antigens using a commercial enzyme immunoassay kit. RNA was extracted from all faecal suspensions and reverse transcription-polymerase chain reaction (RT-PCR) for the NoV-polymerase partial region was performed as a trial test. Positive samples were then subjected to PCR with specific primers for partial capsid genes, which were then sequenced. FINDINGS NoV was detected in 150 (35.2%) faecal samples, for at least one of the two techniques used. NoV was detected in children from all age groups, with the highest positivity observed among the group of 1-2 years old. Clinically, fever was verified in 43% of the positive cases and 46.3% of the negative cases, and vomiting was observed in 75.8% and 70.8% cases in these groups, respectively. Monthly distribution showed that the highest positivity was observed in January 2010 (81.2%), followed by February and April 2010 and March 2011, when the positivity rate reached almost 50%. Phylogenetic analyses performed with 65 positive strains demonstrated that 58 (89.2%) cases of NoV belonged to genotype GII.4, five (7.7%) to GII.6, and one (1.5%) each to GII.7 and GII.3. MAIN CONCLUSIONS This research revealed a high circulation of NoV GII.4 in Manaus and contributed to the understanding of the importance of this virus in the aetiology of AGE cases, especially in a region with such few studies available.

Hospitalizations due to primary care-sensitive conditions among children under five years of age: cross-sectional study / Internações por condições sensíveis à atenção primária em crianças menores de cinco anos: estudo transversal

ABSTRACT CONTEXT AND OBJECTIVE: Hospitalizations due to primary care-sensitive conditions constitute an important indicator for monitoring the quality of primary healthcare. This study aimed to describe hospitalizations due to primary care-sensitive conditions found among children under five years of age (according to their age and sex), in two cities in Paraíba, Brazil. DESIGN AND SETTING: Cross-sectional study carried out in the municipalities of Cabedelo and Bayeux, in Paraíba, Brazil. METHODS: Data were collected from four public pediatric hospitals in Paraíba that receive children from these municipalities. Hospital admission authorizations were consulted to gather information on the children's profile and the characteristics of their hospitalizations. Differences in the causes of admissions and the respective lengths of hospital stay length were analyzed according to age group and sex. RESULTS: The proportion of hospital admissions due to primary care-sensitive conditions was 82.4%. The most frequent causes were: bacterial pneumonia (59.38%), infectious gastroenteritis and its complications (23.59%) and kidney and urinary tract infection (9.67%). Boys had higher frequency of hospitalizations due to primary care-sensitive conditions than girls. The median hospitalization due to primary care-sensitive conditions was found to be four days. The duration of hospital stays due to primary care-sensitive conditions was significantly longer than those due to conditions that were not sensitive to primary care. CONCLUSIONS: High rates of hospital admissions due to primary care-sensitive conditions were highlighted, especially among children of male sex, with long periods of hospitalization.

RESUMO CONTEXTO E OBJETIVO: As internações por condições sensíveis à atenção primária constituem importante indicador para o monitoramento da qualidade da atenção primária à saúde. O presente estudo objetivou descrever as internações por condições sensíveis à atenção primária em crianças menores de cinco anos (por idade e sexo) em duas cidades da Paraíba. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado nos municípios de Cabedelo e Bayeux, ­Paraíba, Brasil. MÉTODOS: Coletaram-se os dados nos quatro hospitais públicos pediátricos da Paraíba que internam crianças residentes nos municípios estudados. A partir das autorizações de internação hospitalar, colheram-se informações relativas ao perfil da criança e características das internações. Analisaram-se as diferenças nas causas de internações e respectivos tempos de hospitalização segundo faixa etária e sexo. RESULTADOS: A proporção de internação por condição sensível à atenção primária foi de 82,4%. As causas mais frequentes foram: pneumonias bacterianas (59,38%), gastroenterites infecciosas e suas complicações (23,59%) e infecção do rim e trato urinário (9,67%). Meninos apresentaram maior frequência de internações por condições sensíveis à atenção primária do que meninas. Verificou-se mediana de quatro dias de hospitalização para as condições sensíveis à atenção primária. O tempo de hospitalização por condição sensível à atenção primária foi significantemente maior do que o tempo da condição não sensível à atenção primária. CONCLUSÕES: Ressaltam-se altas taxas de internações por condições sensíveis à atenção primária, principalmente em crianças do sexo masculino, com longos períodos de hospitalização.

Caliciviruses in hospitalized children, São Luís, Maranhão, 1997-1999: detection of norovirus GII. 12

ABSTRACT Gastroenteritis is one of the most common diseases during childhood, with norovirus (NoV) and sapovirus (SaV) being two of its main causes. This study reports for the first time the incidence of these viruses in hospitalized children with and without gastroenteritis in São Luís, Maranhão. A total of 136 fecal samples were tested by enzyme immunoassays (EIA) for the detection of NoV and by reverse transcription-polymerase chain reaction (RT-PCR) for detection of both NoV and SaV. Positive samples for both agents were subjected to sequencing. The overall frequency of NoV as detected by EIA and RT-PCR was 17.6% (24/136) and 32.6% (15/46), respectively in diarrheic patients and 10.0% (9/90) in non-diarrheic patients (p < 0.01). Of the diarrheic patients, 17% had fever, vomiting and anorexia, and 13% developed fever, vomiting and abdominal pain. Of the 24 NoV-positive samples, 50% (12/24) were sequenced and classified as genotypes GII.3 (n = 1), GII.4 (6), GII.5 (1), GII.7 (2), GII.12 (1) and GII.16 (1). SaV frequency was 9.8% (11/112), with 22.6% (7/31) in diarrheic patients and 4.9% (4/81) in nondiarrheic (p = 0.04) ones. In diarrheic cases, 27.3% had fever, vomiting and anorexia, whereas 18.2% had fever, anorexia and abdominal pain. One SaV-positive sample was sequenced and classified as GII.1. These results show a high genetic diversity of NoV and higher prevalence of NoV compared to SaV. Our data highlight the importance of NoV and SaV as enteropathogens in São Luís, Maranhão.

Diversity of group A rotavirus genes detected in the Triângulo Mineiro region, Minas Gerais, Brazil

ABSTRACT Group A rotaviruses are the main causative agent of infantile gastroenteritis. The segmented nature of the viral genome allows reassortment of genome segments, which can generate genetic variants. In this study, we characterized the diversity of the VP7, VP4 (VP8*), VP6, NSP4, and NSP5 genes of the rotaviruses that circulated from 2005 to 2011 in the Triângulo Mineiro (TM) region of Brazil. Samples with genotypes G2 (sublineages IVa-1 and IVa-3), G1 (sublineage I-A), G9 (lineage III), G12 (lineages II and III), G8 (lineage II), G3 (lineage III), P[4] (sublineages IVa and IVb), P[8] (sublineages P[8]-3.6, P[8]-3.3, and P[8]-3.1), I2 (lineage VII), E2 (lineages VI, XII, and X), and H2 (lineage III) were identified. The associations found in the samples were G1, G9, or G12 with P[8]-I1-E1-H1; G2 or G8 with P[4]-I2-E2-H2; G12 with I3-E3-H6; and G3 with P[4]-I2-E3-H3 (previously unreported combination). Reassortment events in G2P[4] strains and an apparent pattern of temporal segregation within the lineages were observed. Five TM samples contained genes that exhibited high nucleotide and amino acid identities with strains of animal origin. The present study includes a period of pre- and post-introduction of rotavirus vaccination in all Brazilian territories, thereby serving as a basis for monitoring changes in the genetic constitution of rotaviruses. The results also contribute to the understanding of the diversity and evolution of rotaviruses in a global context.

A non-enteric adenovirus A12 gastroenteritis outbreak in Rio de Janeiro, Brazil

A gastroenteritis outbreak that occurred in 2013 in a low-income community in Rio de Janeiro was investigated for the presence of enteric viruses, including species A rotavirus (RVA), norovirus (NoV), astrovirus (HAstV), bocavirus (HBoV), aichivirus (AiV), and adenovirus (HAdV). Five of nine stool samples (83%) from patients were positive for HAdV, and no other enteric viruses were detected. Polymerase chain reaction products were sequenced and subjected to phylogenetic analysis, which revealed four strains and one strain of non-enteric HAdV-A12 and HAdV-F41, respectively. The HAdV-A12 nucleotide sequences shared 100% nucleotide similarity. Viral load was assessed using a TaqMan real-time PCR assay. Stool samples that were positive for HAdV-A12 had high viral loads (mean 1.9 X 107 DNA copies/g stool). All four patients with HAdV-A12 were < 25 months of age and had symptoms of fever and diarrhoea. Evaluation of enteric virus outbreaks allows the characterisation of novel or unique diarrhoea-associated viruses in regions where RVA vaccination is routinely performed.

Caracterização de estirpes de Campylobacter coli isoladas de carcaças de ovinos e de efluentes de abatedouro do estado de São Paulo / Characterization of Campylobacter coli strains isolated from the carcasses of sheep and of wastewater of abattoir in the state of São Paulo

Doença bacteriana zoonótica, a campilobacteriose é responsável mundialmente por frequentes casos de gastroenterite humana. Campylobacter spp. apresenta fator de virulência associado à diarreia, denominado toxina citoletal distensiva (CDT), sendo codificado pelos genes do complexo cdt. Os objetivos do presente estudo foram: 1) isolar e identificar estirpes de Campylobacter spp. de 102 suabes de carcaças e 102 suabes retais de ovinos (Ovis aries) e de sete amostras de água dos efluentes, antes e depois do tratamento de desinfecção de abatedouro localizado no estado de São Paulo; e 2) detectar, pela técnica de multiplex-PCR, a presença do complexo de genes cdt. Foram isoladas e identificadas, por métodos fenotípicos e genotípicos, sete estirpes de Campylobacter coli provenientes de 4/102 (3,92%) das amostras de suabes retais, 1/102 (0,98%) de suabes de carcaças e 2/7 (28,5%) das águas dos efluentes. Dos isolados de suabes retais, em 2/7 (28,6%) estirpes foi detectada a presença dos genes cdt. Trata-se do primeiro relato de isolamento de estirpes de Campylobacter coli provenientes de abatedouro de ovinos e das estirpes portadoras do complexo de genes cdt nessa espécie animal no Brasil.

A zoonosis and bacterial disease, campylobacteriosis is responsible for frequent cases of human gastroenteritis worldwide. Campylobacter spp. presents the virulence factor called cytolethal distensive toxine (CDT), responsible for diarrhea and codified by the cdt gene. The aims of this study were: 1) to isolate and identify Campylobacter spp. strains from 102 carcass swabs and 102 rectal swabs of sheep (Ovis aries) and seven samples of wastewater, before and after the disinfection treatment, collected from the abattoir of the state of São Paulo; and 2) to detect the presence of cdt gene complex by Multiplex-PCR in strains of Campylobacter spp. Seven strains of Campylobacter coli were isolated and identified by phenotypic and genotypic methods: 4/102 (3.92%) from rectal swabs, 1/102 (0.98%) from carcass swabs and 2/7 (28.5%) from wastewater. From the rectal swab samples 2/7 (28.6%) strains were detected with the cdt gene. This is the first report on the isolation of Campylobacter coli from sheep abattoir, and of strains carrying the cdt gene complex in this animal species in Brazil.

Rotavirus genotypes circulating in Brazil, 2007-2012: implications for the vaccine program / Genótipos de rotavírus circulando no Brasil, 2007-2012: implicações para o Programa de Vacinação

SUMMARYRegarding public health in Brazil, a new scenario emerged with the establishment of universal rotavirus (RV) vaccination programs. Herein, the data from the five years of surveillance (2007-2012) of G- and P-type RV strains isolated from individuals with acute gastroenteritis in Brazil are reported. A total of 6,196 fecal specimens were investigated by ELISA and RT-PCR. RVs were detected in 19.1% (1,181/6,196). The peak of RV incidence moved from June-August to September. RV was detected less frequently (19.5%) among children ≤ 5 years than in older children and adolescents (6-18 years) (40.6%). Genotype distribution showed a different profile for each year: G2P[4] strains were most prevalent during 2007-2010, G9P[8] in 2011, and G12P[8] in 2012. Mixed infections (G1+G2P[4], G2+G3P[4]+P[8], G2+G12P[8]), unusual combinations (G1P[4], G2P[6]), and rare strains (G3P[3]) were also identified throughout the study period. Widespread vaccination may alter the RV seasonal pattern. The finding of RV disease affecting older children and adolescents after vaccine implementation has been reported worldwide. G2P[4] emergence most likely follows a global trend seemingly unrelated to vaccination, and G12, apparently, is emerging in the Brazilian population. The rapidly changing RV genotype patterns detected during this study illustrate a dynamic population of co-circulating wildtype RVs in Brazil.

RESUMOEm relação à saúde pública no Brasil, um novo cenário emergiu com o estabelecimento dos programas universais de vacinação contra o rotavírus (RV). Os resultados de cinco anos (2007-2012) de vigilância dos genótipos G e P de cepas de RV detectadas em indivíduos com gastroenterite aguda no Brasil são descritos no presente estudo. Um total de 6196 amostras fecais foi investigado utilizando ELISA e RT-PCR. RVs foram detectados em 19,1% (1181/6196). O pico de incidência de RV se deslocou de junho-agosto para setembro. RV foi detectado com menor frequência entre crianças ≤ 5 anos (19,5%) quando comparado às crianças mais velhas e adolescentes (6-18 anos) (40,6%). A distribuição genotípica mostrou um perfil diferente a cada ano: a cepa G2P[4] foi prevalente durante 2007-2010, G9P[8] em 2011 e G12P[8] em 2012. Infecções mistas (G1+G2P[4], G2+G3P[4]+P[8], G2+G12P[8]), combinações não usuais (G1P[4], G2P[6]) e cepas atípicas (G3P[3]) também foram identificadas em todo o período do estudo. A vacinação em massa pode alterar o padrão sazonal do RV. A tendência do RV em infectar crianças mais velhas e adolescentes após a implementação da vacina tem sido relatada em todo o mundo. A emergência de G2P[4] segue provavelmente a tendência mundial e, aparentemente, não está relacionada à vacinação. G12 também parece estar emergindo na população brasileira. As rápidas mudanças nos padrões de genótipos dos RVs observados durante o período desse estudo ilustram a existência de uma população dinâmica de cepas selvagens co-circulando no Brasil.

A abordagem da sexualidade como aspecto essencial da atenção integral de pessoas com transtornos mentais / The inclusion of sexuality as an essential aspect of comprehensive care for individuals with mental disorders

Resumo O estudo teve o objetivo de compreender as representações de usuários e de profissionais de serviços de saúde mental acerca da sexualidade dos primeiros. Entrevistaram-se individualmente 39 usuários e 54 profissionais de serviços públicos de saúde mental por meio de seis grupos focais. A análise dos dados fundamentou-se na Análise Estrutural de Narração. Pessoas com transtornos mentais (PTM) não representam saúde sexual como direito e encontram dificuldades para se cuidarem em face de estereótipos de gênero e pelo contexto de exclusão e pobreza. Entre os profissionais, as representações foram de negação da sexualidade das PTM, entendendo-a como “fora do normal” e que deve ser reprimida. Diálogos sobre sexualidade com os usuários são quase inexistentes. Os profissionais não estão preparados para assistência integral, o que requer capacitação permanente nos serviços e inclusão do tema na formação básica nas carreiras da área da saúde, de forma interdisciplinar.

Abstract The scope of this study was to understand the representations of mental health service patients and professionals concerning the sexuality of the former. Thirty-nine patients and 54 professionals of the public mental health services, divided up into six focal groups, were interviewed individually. Data analysis was based on the Structural Analysis of Narrative technique. Individuals with mental disorders do not perceive sexual health as a right and have difficulty taking care of themselves in the face of gender stereotypes, and for the contexts related with exclusion and poverty. Among the mental health service professionals, sexuality negation of mentally-ill individuals had been the commom representation. They classify this behavior as “not a normal representation” and believe that it must be restrained. Dialogues about sexuality with users are almost inexistent. Mental health service professionals are not prepared for integral assistance, which requires permanent qualification and the inclusion of this subject in the fundamental formation of health related careers, in a interdisciplinary way.