Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines.

BACKGROUND: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. METHODS: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others RESULTS: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. CONCLUSION: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others RESULTS: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly. Keywords: Antimicrobial resistance; Chronic diseases; Comorbidity; Invasive pneumococcal diseases; Pneumococcal conjugate vaccine; Pneumococcal serotypes; Pneumococcal vaccine.

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

ABSTRACT Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

Unveiling the contributions of immunization for progressing towards Universal Health Coverage.

The aim of the United Nations' Sustainable Development Goal (SDG)3 is to ensure healthy lives and promote well-being for all, at all ages; including reducing maternal and child mortality, combating communicable and non-communicable diseases, and achieving Universal Health Coverage (UHC). UHC aims to provide everyone with equal access to quality essential and comprehensive healthcare services including preventions, interventions, and treatments, without exposing them to financial hardship. Making progress toward UHC requires significant investment in technical and financial resources and countries are pursuing the implementation of cost-saving measures within health systems to help them achieve UHC. Whilst many countries are far from attaining UHC, all countries, particularly low- and middle-income countries, can take steps toward achieving UHC. This paper discusses key data showing how immunization is a fundamental, cost-effective tool for reducing morbidity and mortality associated with infectious disease in all populations, creating more productive communities, reducing treatment costs, and consequently, facilitating social and economic advancement. Immunization is key to advancing toward UHC by relieving the burden that diseases place on the healthcare services, freeing essential resources to use elsewhere within the healthcare system. Immunization is an essential, readily available strategy that countries can deploy to achieve UHC and the SDG3 agenda.

Evaluation of protection in grazing lambs immunised with different doses of Haemonchus contortus gut membrane glycoproteins in Southern Brazil.

A vaccine containing doses ranging from 2 µg to 50 µg of integral membrane proteins from Haemonchus contortus intestinal cells (H11 and H-gal-GP complex) has been shown to be effective for lambs. A vaccine for H. contortus was tested in two-month old grazing Corriedale lambs during an eight-month trial on the outskirts of Bagé, Rio Grande do Sul, Brazil. The animals were kept in a single paddock and allocated to five similar groups according to weight, sex and faecal egg counts (FEC). Vaccinated lambs received 0, 2, 5, 10 or 50 µg of the same antigen diluted in QuilA adjuvant. Vaccine injections were given at days 0, 21, 49, 91, 133, and 175. Lambs were sampled weekly for FEC, packed cell volume (PCV), and plasma ELISA antibody titre. Lambs with PCVs ≤15 % were drenched with levamisole (7.5 mg/kg body weight) as a salvage treatment. During days 77-98 an artificial challenge was administered to increase parasite transmission. Post-artificial challenge (from day 98-217), the FEC of the vaccinated lambs were 59.3 % lower than those of the control lambs. Antigen dose correlated with changes in PCV (r = 0.387 p-value < 0.001). Vaccinated lambs also had higher PCV than controls (p < 0.001; contrast analysis). Salvage treatment was needed in 16.7 % of vaccinated lambs and 88 % of control lambs.

Effect of medroxy-progesterone acetate on follicular growth and endometrial cycloxygenase-2 (COX-2) expression during the bovine estrous cycle / Efeito do acetato de medroxi-progesterona sobre o crescimento filicular e expressão endometrial de ciclooxigenase-2 (COX-2) durante o ciclo estral de bovinos

The objective of this study was to evaluate the effect of medroxy-progesterone acetate (MAP) with or without estradiol benzoate (EB) on follicular growth during the estrous cycle in cattle. In the first experiment, Hereford cows were synchronized with a synthetic analogue of PGF2 alpha and were treated with two different doses of MAP (250 or 500 mg) with or without EB for 7 days starting on day 8 of the estrous cycle. Follicular growth was inhibited (P<0.05) in all cows except controls and those receiving 250mg MAP without EB. Seventy-five percent of the animals (15/20) showed estrus on days 21 and 22 of the cycle rather than at MAP withdrawal, demonstrating that these treatments did not induce estrus. To determine whether the EB treatment altered endometrial sensitivity to oxytocin and thus the luteolytic cascade, multiparous pre-synchronized cows received 5 mg of EB followed 6 hours later with 50 IU of oxytocin (OT; n=9). Eight hours after EB injection, endometrial fragments were collected from the cows on days 4, 13 and 17 of the estrous cycle and COX-2 gene expression was measured by PCR. EB increased COX-2 mRNA levels only on day 17 of the estrous cycle (P<0.05). In conclusion, MAP alone or associated with EB is able to suppress bovine follicular growth. However, EB in the presence of MAP is not efficient to induce luteolysis in cows when injected on day 8 of the estrous cycle.

Este estudo teve como objetivo avaliar o efeito do acetato de medroxi-progesterona (MAP) com ou sem benzoato de estradiol (BE) sobre o crescimento folicular durante o ciclo estral bovino. No primeiro experimento, vacas da raça Hereford foram sincronizadas com um análogo sintético de PGF2á e tratadas com duas doses diferentes de MAP (250 ou 500mg), com ou sem EB, durante 7 dias, iniciando-se no oitavo dia do ciclo estral. Observou-se uma inibição do crescimento folicular (P<0,05) em todas as vacas, exceto no grupo controle e no grupo que recebeu 250mg de MAP sem BE. Os 75 por cento dos animais não exibiu estro no momento da remoção do MAP, mas sim nos dias 21 e 22 do ciclo, demonstrando que os tratamentos não induziram cio. Para se determinar se o tratamento com BE alterou a sensibilidade endometrial à ocitocina e, assim, a cascata luteolítica, vacas multíparas pré-sincronizadas receberam 5mg de BE, seguidos, após 6 horas, de 50 UI de ocitocina (OT; n=9). Oito horas após a administração de BE, colheram-se fragmentos endometriais das vacas, nos dias 4, 13 e 17 do ciclo estral, mensurando-se a expressão gênica de COX-2 através de PCR. O BE aumentou os níveis de RNAm de COX-2 apenas no dia 17 do ciclo estral (P<0,05). Em conclusão, o MAP isolado ou associado a BE é capaz de suprimir o crescimento folicular bovino. Entretanto, o BE, na presença de MAP é ineficaz na indução da luteólise bovina, quando injetado no oitavo dia do ciclo estral.

Genetic polymorphisms at the leptin receptor gene in three beef cattle breeds

The genetic diversity of a single nucleotide polymorphism (SNP) at the exon 20 (T945M) of the leptin receptor gene (LEPR) and of three short tandem repeats (STRs BM7225, BMS694, and BMS2145) linked to LEPR was investigated in three beef cattle herds (Brangus Ibagé, Charolais, and Aberdeen Angus). A cheap and effective new method to analyze the T945M polymorphism in cattle populations was developed and the possible role of these polymorphisms in reproduction and weight gain of postpartum cows was evaluated. High levels of genetic diversity were observed with the average heterozygosity of STRs ranging from 0.71 to 0.81. No significant association was detected between LEPR markers and reproductive parameters or daily weight gain. These negative results suggest that the LEPR gene polymorphisms, at least those herein described, do not influence postpartum cows production.

Reproductive deficiency in bulls from synthetic breeds according to the type of crossbreed and the morphology of the Y chromosome

We used 550 Braford and 214 Brangus-Ibagé bulls to study the association between Y chromosome morphology and the evaluation of breeding-soundness, karyotyping and breeding records were used to assess Y chromosome morphology. In general, no direct association was detected between the individual type of Y chromosome and reproductive fitness as previously estimated through breeding soundness examination. The type of breeding strategy used to form the synthetic breeds was also analyzed. The Braford breed is about 3/8 Zebu (Bos taurus indicus) and 5/8 Hereford (Bos taurus taurus) but when the breeding strategy used 1/4 Zebu animals to produce Braford bulls which were 3/8 Zebu a greater percentage of the bulls had to be culled due to reproductive problems. Our study shows that certain interactions between genotypes can be detrimental to the reproductive efficiency of 3/8 Zebu animals and that breeding strategies avoiding or favoring certain genotypes can be used to reduce the percentage of bulls from synthetic breeds that are culled due to problems with semen quality.

Qual é a cobertura vacinal real? / What is the real vaccination coverage?

O Programa Nacional de Imunizações (PNI) constitui peça importante no controle das doenças transmissíveis que podem ser prevenidas mediante imunizações. Consideraremos a cobertura vacinal em menores de 1 ano; porém, os mesmosprincípios aplicam-se às demais faixas etárias. A cobertura vacinal pode ser entendida como a proporção de crianças menores de um ano que receberam o esquema completo de vacinação em relação aos menores de 1 ano existentes na população, entendendo-se por esquema completo a aplicação de todas as vacinas preconizadas pelo PNI, cujas doses foram aplicadas nas idades corretas (adequação epidemiológica) e com os intervalos corretos (adequação imunológica). O objetivo deste artigo édemonstrar, por meio de dados empíricos obtidos em inquéritos domiciliares, que a cobertura obtida para cada vacina específica não corresponde à cobertura pelo esquema completo para cada criança, fornecendo, geralmente, valores superestimados; que há diferença significativa entre doses aplicadas e doses corretas; que existem divergências entre dados de produção e dados de inquéritos, problemas de acesso ou adesão ao Programa; e que diferenças intra-estaduais e intramunicipais importantes devem ser consideradas

Genetic homogeneity of measles viruses associated with a measles outbreak, São Paulo, Brazil, 1997.

During a resurgence of measles in São Paulo, Brazil, in 1997, >40,000 cases (peak incidence rate of 246/100,000 inhabitants) and 42 measles-related deaths were reported. Reverse transcriptase-polymerase chain reaction and nucleotide sequencing were used to analyze specimens from patients who had typical clinical measles infection during this outbreak and from six patients who had had measles in 1995 and 1996. Although wild-type measles viruses (genotypes D5 and D6) were present in São Paulo before this resurgence, we detected only D6 viruses. The genotype D6 viruses isolated during this outbreak had identical sequences to genotype D6 viruses isolated in other parts of Brazil and South America in 1997 and 1998, suggesting that a single chain of transmission was responsible. We also identified genotype A viruses in two vaccine-associated cases from 1995 and 1996. Our findings extend the knowledge of the circulation patterns of measles virus in South America, contributing to measles control efforts in the Americas.