Occurrence of musculoskeletal disorders, burnout, and psychological suffering in Brazilian nursing workers: A cross-sectional study.

Background: Musculoskeletal disorders (MSDs) pose a pervasive concern among nursing professionals due to the high physical workload. Simultaneously, the complex relationship between MSDs and mental health outcomes in this population remains an area of significant interest and importance. Objective: This study aimed to investigate the occurrence of MSDs and their relationships with burnout and psychological suffering within the nursing workforce. Methods: A cross-sectional study was conducted in 2020 involving 291 nursing professionals in Brazil. Standardized questionnaires were employed to gather information on MSDs, mental health outcomes, and pertinent work-related factors. Robust statistical analyses were conducted to ascertain the prevalence of MSDs, establish associations between MSDs and mental health outcomes, and delineate the influence of work-related factors on these associations. Statistical analysis was performed using the R software. Results: The study revealed a significant prevalence of musculoskeletal injuries (MSIs) among nursing workers, focusing on regions that include the lower back, upper back, neck, and shoulders. Individuals with MSIs in the lower back showed a marked increase in emotional exhaustion (p = 0.02), as did those with MSIs in the upper back (p <0.01) and depersonalization (p = 0.07). On the other hand, nursing professionals who reported MSIs in the neck and shoulders had considerably higher scores in emotional exhaustion (p <0.01 and p = 0.01, respectively) and depersonalization (p = 0.05 and p = 0.05, respectively). However, no significant correlations emerged between MSIs and depression or work-related factors. Conclusions: This study highlights the urgency of implementing proactive measures to prevent and manage MSDs within the nursing profession. Moreover, it emphasizes the critical need to enhance working conditions and provide robust support mechanisms to safeguard the mental health of nursing professionals.Open AccessOpen Access.

Assessment of Soiling on Highly Touched Clinical Surfaces in Intensive Care Units.

AIM: The aim of this study is to evaluate highly touched clinical surfaces using visual inspection methods and adenosine triphosphate by bioluminescence to identify soiling in intensive care units. METHOD: Descriptive, cross-sectional study carried out in three intensive care units located in Belo Horizonte, MG, Brazil. Data collection included 142 assessments of environmental surfaces. For data analysis, the Pareto diagram and descriptive statistics were used through measures of central tendency. RESULTS: The visual inspection identified dirtiness in the infusion pump, alcohol dispenser, and telephone. The surface that showed a high level of contamination by organic matter identified by the adenosine triphosphate bioluminescence test was the telephone, with a median of 1012 RLU/cm2 (±348.8). CONCLUSION: The surface evaluation methods used in the intensive care units made it possible to identify dirt on surfaces highly touched by hands, reinforcing the need for investments in training and audits in the process of cleaning and disinfecting surfaces.

Analysis of theses and dissertations on hand hygiene in Brazil: a bibliometric study / Análise de teses e dissertações sobre higienização das mãos no Brasil: estudo bibliométrico / Análisis de tesis y disertaciones sobre higiene de manos en Brasil: un estudio bibliométrico

Background and Objectives: in relation to hand hygiene, it is important to highlight the absence of documented investigations in the scientific literature that address the analysis of theses and dissertations related to this practice. This gap justifies the carrying out of this study, which aims to strengthen and expand the knowledge base related to this topic, highlighting its relevance in the areas of teaching, research, extension and innovation. The objective was to analyze theses and dissertations published in stricto sensu graduate programs on hand hygiene practices in Brazil. Methods: this is a bibliometric study conducted in the Coordination for the Improvement of Higher Education Personnel Theesis and Dissertation Catalog, considering the period from 2013 to 2022. Results: thirty-one (100%) studies were included, 21 (67.7%) dissertations and six (19.3%) theses. Nursing was the main area of assessment (65.6%), which mainly analyzed adherence to hand hygiene practices (29.0%), health education (12.9%), and carried out microbiological analysis of hands (12.9%). Only three publications used theoretical bases as the central core of the research. Conclusion: this study allowed us to identify the need to study the topic at doctoral level, using theoretical bases that will provide the conceptual and philosophical foundation for clinical practice.(AU)

Justificativa e Objetivos: em relação à higienização das mãos, é importante ressaltar a ausência de investigações documentadas na literatura científica que abordem a análise de teses e dissertações relacionadas a essa prática. Tal lacuna justifica a realização deste estudo, que visa fortalecer e expandir a base de conhecimento relativa a essa temática, destacando sua relevância nos domínios do ensino, da pesquisa, extensão e inovação. Objetivou-se analisar teses e dissertações publicadas em programas de pós-graduação stricto sensu sobre as práticas de higienização das mãos no Brasil. Métodos: estudo bibliométrico, realizado no Catálogo de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, considerando o período de 2013 a 2022. Resultados: foram incluídos 31 (100%) estudos, sendo 21 (67,7%) dissertações e seis (19,3%) teses. A enfermagem foi a principal área de avaliação (65,6%) que analisou, principalmente, a adesão às práticas de higiene das mãos (29,0%), a educação em saúde (12,9%), e realizou análise microbiológica das mãos (12,9%). Apenas três publicações utilizaram bases teóricas como núcleo central da pesquisa. Conclusão: este estudo permitiu identificar a necessidade de estudar a temática em nível de doutorado, utilizando bases teóricas que fornecerão o alicerce conceitual e filosófico para a prática clínica.(AU)

Justificación y Objetivos: en relación a la higiene de manos, es importante resaltar la ausencia de investigaciones documentadas en la literatura científica que aborden el análisis de tesis y disertaciones relacionadas con esta práctica. Este vacío justifica la realización de este estudio, que tiene como objetivo fortalecer y ampliar la base de conocimientos relacionados con este tema, destacando su relevancia en las áreas de docencia, investigación, extensión e innovación. El objetivo fue analizar tesis y disertaciones publicadas en programas de posgrado estricto sensu sobre prácticas de higiene de manos en Brasil. Métodos: estudio bibliométrico realizado en el Catálogo de Tesis y Disertaciones de la Coordinación de Perfeccionamiento del Personal de Educación Superior, considerando el período de 2013 a 2022. Resultados: se incluyeron 31 (100%) estudios, 21 (67,7%) disertaciones y seis (19,3%) tesis. Enfermería fue la principal área de evaluación (65,6%), que analizó principalmente la adherencia a las prácticas de higiene de manos (29,0%), educación para la salud (12,9%) y realizó análisis microbiológicos de las manos (12,9%). Sólo tres publicaciones utilizaron bases teóricas como núcleo central de la investigación. Conclusión: este estudio identificó la necesidad de estudiar el tema a nivel de doctorado, utilizando marcos teóricos que proporcionarán la base conceptual y filosófica para la práctica clínica.(AU)

Nasopharyngeal colonization by Streptococcus pneumoniae in children and adults before the introduction of the 10-valent conjugate vaccine, Paraguay.

Streptococcus pneumoniae is a cause of invasive diseases such as pneumonia, meningitis, and other serious infections among children and adults in Paraguay. This study was conducted to establish S. pneumoniae baseline prevalence, serotype distribution, and antibiotic resistance patterns in healthy children aged 2 to 59 months and adults ≥60 years of age prior to the introduction of PCV10 in the national childhood immunization program in Paraguay. Between April and July 2012, a total of 1444 nasopharyngeal swabs were collected, 718 from children aged 2 to 59 months and 726 from adults ≥60 years of age. The pneumococcal isolation, serotyping, and antibiotic susceptibility testing were performed using standard tests. Pneumococcal colonization prevalence was 34.1% (245/718) in children and 3.3% (24/726) in adults. The most frequent pneumococcal vaccine-types (VT) detected in the children were 6B (42/245), 19F (32/245), 14 (17/245), and 23F (20/245). Carriage prevalence with PCV10 serotypes was 50.6% (124/245) and PCV13 was 59.5% (146/245). Among colonized adults, prevalence of PCV10 and PCV13 serotypes were 29.1% (7/24) and 41.6% (10/24), respectively. Colonized children were more likely to share a bedroom, have a history of respiratory infection or pneumococcal infection compared to non-colonized children. no associations were found in adults. However, no significant associations were found in children and neither in adults. Vaccine-type pneumococcal colonization was highly prevalent in children and rare in adults in Paraguay prior to vaccine introduction, supporting the introduction of PCV10 in the country in 2012. These data will be useful to evaluate the impact of PCV introduction in the country.

Agreement between Subjective Global Nutritional Assessment and the nutritional assessment of the World Health Organization / Concordância entre Avaliação Nutricional Subjetiva Global e Avaliação Nutricional da Organização Mundial da Saúde

Abstract Objective: To assess the agreement between the results of the Subjective Global Nutritional Assessment questionnaire, adapted for children and adolescents of the Brazilian population, and the nutritional status assessment method through growth curves and the classification of the World Health Organization in a pediatric hospital service. Methods: This was an analytical, quantitative, cross-sectional study. During the data collection period, the nutritional status of all patients from 0 to 12 years of age, admitted to the pediatric unit of a university hospital, was concomitantly assessed according to the Subjective Global Nutritional Assessment and World Health Organization curves. To determine the assessment and agreement between these methods, the Kappa and Kendall coefficients were used, respectively, considering a significance level of 5%. Results: Sixty-one children participated, with a predominance of males. It was observed that the highest frequency of equivalent results occurred among the group classified as well nourished, and that only the height/age variable showed a close agreement between the methods. Additionally, there was a good correlation only for the weight/height variable between the assessment tools used. Conclusion: Due to the low agreement between the methods, the combination of both may be beneficial for the nutritional assessment of pediatric patients, collaborating with the early diagnosis of nutritional alterations and facilitating the use of adequate dietary therapy.

Resumo Objetivo: Avaliar a concordância entre os resultados do questionário da Avaliação Nutricional Subjetiva Global adaptado para crianças e adolescentes da população brasileira e do método de avaliação do estado nutricional por meio de curvas de crescimento e a classificação da Organização Mundial da Saúde em um serviço pediátrico hospitalar. Métodos: Trata-se de um estudo analítico, quantitativo, de caráter transversal. Durante o período de coleta de dados, foi avaliado o estado nutricional de todos os pacientes até 12 anos admitidos na Enfermaria de Pediatria de um hospital universitário segundo a Avaliação Nutricional Subjetiva Global e as curvas da Organização Mundial da Saúde, concomitantemente. Para determinar a avaliação e a concordância entre esses métodos, os coeficientes de Kappa e de Kendall foram usados, respectivamente, considerou-se nível de significância de 5%. Resultados: Participaram do trabalho 61 crianças, com predominância do sexo masculino. Observou-se que a maior frequência de resultados iguais ocorreu entre o grupo classificado como bem nutrido e que somente a variável altura/idade demonstrou íntima concordância entre os métodos. Além disso, verificou-se uma boa correlação somente para a variável peso/altura entre os instrumentos usados. Conclusão: Devido à baixa concordância entre os métodos, a combinação de ambos pode ser benéfica para a avaliação nutricional dos pacientes pediátricos e colaborar com o diagnóstico precoce de alterações nutricionais, facilitar a aplicação do tratamento dietoterápico adequado.

Effectiveness of 13-pneumococcal conjugate vaccine (PCV13) against invasive pneumococcal disease in children in the Dominican Republic.

BACKGROUND: Limited data are available on the effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) in resource-poor settings and PCV naïve populations. The Dominican Republic introduced PCV13 in September 2013 using a 2 + 1 schedule (2, 4, and 12 months) without a catch-up campaign. We evaluated PCV13 effectiveness against vaccine-type (VT) invasive pneumococcal disease (IPD) among children in the Dominican Republic. METHODS: We conducted a matched case-control study. A case-patient was defined as VT-IPD identified by culture or polymerase chain reaction (PCR) from a normally sterile-site in a hospitalized child who was age-eligible to have received ≥1 PCV13 dose. Four age- and neighborhood-matched controls were enrolled for each case-patient. We collected demographic, vaccination history, and risk factor data. Conditional logistic regression was performed. Vaccine effectiveness was calculated as (1- adjusted matched odds ratio for vaccination) X 100%. RESULTS: We enrolled 39 case-patients and 149 matched-controls. Most case-patients had pneumonia with pleural effusion (64%), followed by meningitis (28%) and septicemia (13%). The most common pneumococcal serotypes identified included 14 (18%), 3 (13%), 19A (10%), and 1 (8%). Fewer case-patients had ≥1 PCV13 dose as compared to controls (61.5% vs. 80.0%; p = 0.006). Adjusting for malnutrition and socioeconomic status, VE of ≥1 PCV13 dose compared to no doses was 67.2% (95% CI: 2.3% to 90.0%). Only 44% of controls were up-to-date for PCV13, suggesting low vaccine coverage in the population. CONCLUSIONS: We found that PCV13 provided individual protection against VT-IPD in this resource-poor setting with a PCV-naïve population, despite low PCV13 coverage. Expanding vaccination coverage might increase PCV13 impact.

Nasopharyngeal carriage of Streptococcus pneumoniae among HIV-infected and -uninfected children <5 years of age before introduction of pneumococcal conjugate vaccine in Mozambique

Nasopharyngeal carriage is a precursor for pneumococcal disease and can be useful for evaluating pneumococcal conjugate vaccine (PCV) impact. We studied pre-PCV pneumococcal carriage among HIV-infected and -uninfected children in Mozambique. Between October 2012 and March 2013, we enrolled HIV-infected children age <5 years presenting for routine care at seven HIV clinics in 3 sites, including Maputo (urban-south), Nampula (urban-north), and Manhiça (rural-south). We also enrolled a random sample of HIV-uninfected children <5 years old from a demographic surveillance site in Manhiça. A single nasopharyngeal swab was obtained and cultured following enrichment in Todd Hewitt broth with yeast extract and rabbit serum. Pneumococcal isolates were serotyped by Quellung reaction and multiplex polymerase chain reaction. Factors associated with pneumococcal carriage were examined using logistic regression. Overall pneumococcal carriage prevalence was 80.5% (585/727), with similar prevalences among HIV-infected (81.5%, 339/416) and HIV-uninfected (79.1%, 246/311) children, and across age strata. Among HIV-infected, after adjusting for recent antibiotic use and hospitalization, there was no significant association between study site and colonization: Maputo (74.8%, 92/123), Nampula (83.7%, 82/98), Manhiça (84.6%, 165/195). Among HIV-uninfected, report of having been born to an HIV-infected mother was not associated with colonization. Among 601 pneumococcal isolates from 585 children, serotypes 19F (13.5%), 23F (13.1%), 6A (9.2%), 6B (6.2%) and 19A (5.2%) were most common. The proportion of serotypes included in the 10- and 13-valent vaccines was 44.9% and 61.7%, respectively, with no significant differences by HIV status or age group. Overall 36.9% (n = 268) of children were colonized with a PCV10 serotype and 49.7% (n = 361) with a PCV13 serotype. Pneumococcal carriage was common, with little variation by geographic region, age, or HIV status. PCV10 was introduced in April 2013; ongoing carriage studies will examine the benefits of PCV10 among HIV-infected and-uninfected children.

Burden of invasive pneumococcal disease among children in rural Mozambique: 2001-2012

: Invasive pneumococcal disease (IPD) is a major cause of illness and death among children worldwide. 10-valent pneumococcal conjugate vaccine (PCV10) was introduced as part of the Mozambican routine immunization program in April 2013. We characterized the IPD burden in a rural area of Mozambique before PCV introduction and estimated the potential impact of this intervention. Methods: We conducted population-based surveillance for IPD, defined as S. pneumoniae isolated from blood or cerebrospinal fluid, among children <5 years old admitted to Manhiça District Hospital, a referral hospital in a rural area with high prevalence of human immunodiciency virus infection. S. pneumoniae was identified using standard microbiologic methods and serotyped using sequential multiplex PCR or Quellung. IPD incidence was calculated among cases from a defined catchment area. Results: From January 2001 through December 2012, we isolated 768 cases of IPD, 498 (65%) of which were bacteraemic pneumonia episodes. A total of 391 (51%) were from the catchment area, yielding IPD incidence rates of 479, 390 and 107 episodes per 100,000 children-years at risk among children <12, 12-23 and 24-<60 months old, respectively. The overall IPD incidence fluctuated and showed a downward trend over time. In these same age groups, in-hospital death occurred in 48 (17%), 26 (12%), and 21 (13%) of all IPD cases, respectively. Overall 90% (543/603) of IPD isolates were available for serotyping; of those, 65% were covered by PCV10 and 83% by PCV13. Among 77 hospital deaths associated with serotyped IPD, 49% and 69% were caused by isolates included in the PCV10 and PCV13, respectively. Conclusions: We describe very high rates of IPD among children in rural Mozambique that were declining before PCV introduction. Children <1 year old have the greatest incidence and case fatality; although the rates remain high among older groups as well. Most IPD episodes and many deaths among children <5 years old will likely be prevented through PCV10 introduction in Mozambique.

Agreement between Subjective Global Nutritional Assessment and the nutritional assessment of the World Health Organization.

OBJECTIVE: To assess the agreement between the results of the Subjective Global Nutritional Assessment questionnaire, adapted for children and adolescents of the Brazilian population, and the nutritional status assessment method through growth curves and the classification of the World Health Organization in a pediatric hospital service. METHODS: This was an analytical, quantitative, cross-sectional study. During the data collection period, the nutritional status of all patients from 0 to 12 years of age, admitted to the pediatric unit of a university hospital, was concomitantly assessed according to the Subjective Global Nutritional Assessment and World Health Organization curves. To determine the assessment and agreement between these methods, the Kappa and Kendall coefficients were used, respectively, considering a significance level of 5%. RESULTS: Sixty-one children participated, with a predominance of males. It was observed that the highest frequency of equivalent results occurred among the group classified as well nourished, and that only the height/age variable showed a close agreement between the methods. Additionally, there was a good correlation only for the weight/height variable between the assessment tools used. CONCLUSION: Due to the low agreement between the methods, the combination of both may be beneficial for the nutritional assessment of pediatric patients, collaborating with the early diagnosis of nutritional alterations and facilitating the use of adequate dietary therapy.

Pneumococcal Serotype 5 Colonization Prevalence Among Newly Arrived Unaccompanied Children 1 Year After an Outbreak-Texas, 2015.

In 2014, an acute respiratory illness outbreak affected unaccompanied children from Central America entering the United States; 9% of 774 surveyed children were colonized with Streptococcus pneumoniae serotype 5. In our 2015 follow-up survey of 475 children, serotype 5 was not detected, and an interim recommendation to administer 13-valent pneumococcal conjugate vaccine to all unaccompanied children was discontinued.

How to avoid cross contamination during handling resin composites with spatulas / Como evitar a contaminação cruzada durante a manipulação de resinas compostas com espátulas

Incremental technique for resin composite restorations requires multiple physical contacts between spatulas, tooth cavities and the restorative material recipient. Thus, the decontamination of the tip's of spatula by chemical agents between each resin composite increment placement is important to reduce chances of potential cross-contamination. Objectives: To evaluate the efficacy of different solutions for decontamination of tips of spatula used in restorative procedures and to establish a decontamination standard protocol. Material and Methods: Spatulas were sterilized in autoclave at 127°C for 20 minutes and then contaminated with: 1) a suspension of half 1.0 MacFarland scale turbidity of different microorganisms, 2) the pool of equal amounts of these microorganisms; except for the control group. Decontamination techniques consisted of rubbing the tip of the spatulas (1 to 5 consecutive times) using a 2ml 70% ethanol or 2% glutaraldehyde embedded gauze. After decontamination, spatulas were immersed in thioglycolate broth and incubated for 48 hours at 37°C. Broth with visible microbial detection was submitted to bacterial identification by Gram stain. Results: Low uniformity of rubbings number was observed to eliminate different microorganisms due to different tested disinfectant agents. Four or five rubbings were needed to decontamination of the tested microorganisms using 70% ethanol. Three rubbings using 2% glutaraldehyde were able to eliminate tested microorganisms. Conclusion: The results demonstrated that 70% ethanol by friction, counting four or five rubbings, was effective to decontaminate spatula's tip.

A técnica incremental para restaurações de resina composta requer vários contatos físicos entre as espátulas, o preparo cavitário e a embalagem do material restaurador. Assim, a descontaminação da ponta da espátula por meio de agentes químicos entre cada inserção de um novo incremento de resina composta é importante para reduzir as chances de uma potencial de contaminação cruzada. Objetivos: Avaliar a eficácia de diferentes soluções para descontaminação das pontas das espátulas utilizadas em procedimentos restauradores e estabelecer um protocolo padrão de descontaminação. Material e Métodos: espátulas foram esterilizadas em autoclave a 127 °C durante 20 minutos e, em seguida, contaminadas com: 1) uma suspensão de diferentes microorganismos com turbidez equivalente ao padrão 1,0 da escala de McFarland, 2) pool de quantidades iguais destes microrganismos; exceto para o grupo de controle. As técnicas de descontaminação consistiram em esfregar a ponta das espátulas (1 a 5 vezes consecutivas) utilizando 2 ml de álcool 70% ou 2% de glutaraldeído embebidos em gazes. Após a descontaminação, as espátulas foram imersas em caldo de tioglicolato e incubadas durante 48 horas a 37 °C. O caldo com visível detecção microbiana foi submetido à identificação bacteriana pela coloração de Gram. Resultados: Baixa uniformidade do esfregaço foi observada para a eliminação de diferentes microrganismos, devido aos diferentes agentes desinfetantes testados. Quatro ou cinco esfregaços foram necessários para a descontaminação dos microrganismos testados usando álcool 70%. Três esfregaços na espátula usando glutaraldeído a 2% foram capazes de eliminar os microrganismos testados. Conclusão: Os resultados demonstraram que o álcool 70% por fricção, contando quatro ou cinco esfregaços na espátula com gazes embebida nas soluções desinfetantes, foi eficaz para descontaminar a ponta da espátula.

Multistate Outbreak of Respiratory Infections Among Unaccompanied Children, June 2014-July 2014.

BACKGROUND: From January 2014-July 2014, more than 46 000 unaccompanied children (UC) from Central America crossed the US-Mexico border. In June-July, UC aged 9-17 years in 4 shelters and 1 processing center in 4 states were hospitalized with acute respiratory illness. We conducted a multistate investigation to interrupt disease transmission. METHODS: Medical charts were abstracted for hospitalized UC. Nonhospitalized UC with influenza-like illness were interviewed, and nasopharyngeal and oropharyngeal swabs were collected to detect respiratory pathogens. Nasopharyngeal swabs were used to assess pneumococcal colonization in symptomatic and asymptomatic UC. Pneumococcal blood isolates from hospitalized UC and nasopharyngeal isolates were characterized by serotyping and whole-genome sequencing. RESULTS: Among 15 hospitalized UC, 4 (44%) of 9 tested positive for influenza viruses, and 6 (43%) of 14 with blood cultures grew pneumococcus, all serotype 5. Among 48 nonhospitalized children with influenza-like illness, 1 or more respiratory pathogens were identified in 46 (96%). Among 774 nonhospitalized UC, 185 (24%) yielded pneumococcus, and 70 (38%) were serotype 5. UC transferring through the processing center were more likely to be colonized with serotype 5 (odds ratio, 3.8; 95% confidence interval, 2.1-6.9). Analysis of core pneumococcal genomes detected 2 related, yet independent, clusters. No pneumococcus cases were reported after pneumococcal and influenza immunization campaigns. CONCLUSIONS: This respiratory disease outbreak was due to multiple pathogens, including Streptococcus pneumoniae serotype 5 and influenza viruses. Pneumococcal and influenza vaccinations prevented further transmission. Future efforts to prevent similar outbreaks will benefit from use of both vaccines.

Direct effect of 10-valent conjugate pneumococcal vaccination on pneumococcal carriage in children Brazil.

BACKGROUND: 10-valent conjugate pneumococcal vaccine/PCV10 was introduced in the Brazilian National Immunization Program along the year of 2010. We assessed the direct effectiveness of PCV10 vaccination in preventing nasopharyngeal/NP pneumococcal carriage in infants. METHODS: A cross-sectional population-based household survey was conducted in Goiania Brazil, from December/2010-February/2011 targeting children aged 7-11 m and 15-18 m. Participants were selected using a systematic sampling. NP swabs, demographic data, and vaccination status were collected from 1,287 children during home visits. Main outcome and exposure of interest were PCV10 vaccine-type carriage and dosing schedules (3p+0, 2p+0, and one catch-up dose), respectively. Pneumococcal carriage was defined by a positive culture and serotyping was performed by Quellung reaction. Rate ratio/RR was calculated as the ratio between the prevalence of vaccine-types carriage in children exposed to different schedules and unvaccinated for PCV10. Adjusted RR was estimated using Poisson regression. PCV10 effectiveness/VE on vaccine-type carriage was calculated as 1-RR*100. RESULTS: The prevalence of pneumococcal carriage was 41.0% (95%CI: 38.4-43.7). Serotypes covered by PCV10 and PCV13 were 35.2% and 53.0%, respectively. Vaccine serotypes 6B (11.6%), 23F (7.8%), 14 (6.8%), and 19F (6.6%) were the most frequently observed. After adjusted for confounders, children who had received 2p+0 or 3p+0 dosing schedule presented a significant reduction in pneumococcal vaccine-type carriage, with PCV10 VE equal to 35.9% (95%CI: 4.2-57.1; p = 0.030) and 44.0% (95%CI: 14.-63.5; p = 0.008), respectively, when compared with unvaccinated children. For children who received one catch-up dose, no significant VE was detected (p = 0.905). CONCLUSION: PCV10 was associated with high protection against vaccine-type carriage with 2p+0 and 3p+0 doses for children vaccinated before the second semester of life. The continuous evaluation of carriage serotypes distribution is likely to be useful for evaluating the long-term effectiveness and impact of pneumococcal vaccination on serotypes reduction.

Aetiology of paediatric pneumonia with effusion in the Dominican Republic and the potential impact of pneumococcal conjugate vaccines.

Pleural effusion is a serious complication of pneumonia, and Streptococcus pneumoniae is a leading cause. We describe the aetiology of pneumonia with effusion among children in the Dominican Republic before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV) in 2013 and the performance characteristics of a rapid immunochromatographic test (ICT) for detecting S. pneumoniae in pleural fluid. From July 2009 to June 2011, we enrolled children <15 years old admitted with pneumonia and pleural effusion to Robert Reid Cabral Children's Hospital, Dominican Republic. Pleural fluid was tested by culture, polymerase chain reaction (PCR) for bacterial (S. pyogenes, S. pneumoniae) and viral (respiratory syncytial virus and human rhinovirus) pathogens, and by ICT for S. pneumoniae. We calculated the performance of ICT and culture compared with PCR. Among 121 cases, the median age was 31 months (range 1 week to 14 years). Pleural fluid culture (n = 121) and PCR testing (n = 112) identified an aetiology in 85 (70.2%) cases, including 62 S. pneumoniae (51.2%) and 19 Staphylococcus aureus (15.7%). The viruses tested were not detected. The most prevalent pneumococcal serotypes were 14 (n = 20), 1 (n = 13), and 3 (n = 12). Serotype coverage of the 10- and 13-valent PCVs would be 70.5% and 95.1%, respectively. The sensitivity of point-of-care ICT was 100% (95% confidence interval [CI] 94.1%-100%), while specificity was 86.3% (95% CI 73.7%-94.3%). S. pneumoniae caused more than half of paediatric pneumonia with effusion cases; introduction of PCV in the Dominican Republic could reduce the burden by 36-49%. ICT is a practical, valid diagnostic tool for clinical care and surveillance in settings with limited laboratory capacity.

Biofilms of black tooth stains: PCR analysis reveals presence of Streptococcus mutans

This study investigated the presence of the black-pigmented bacteria Prevotella nigrescens and Prevotella intermedia, the non-black-pigmented bacteria Actinomyces spp and particularly the cariogenic pathogen Streptococcus mutans in the dental biofilms of patients with or without black extrinsic tooth stains, using the multiplex polymerase chain reaction (PCR) technique. Analysis of the dental biofilms of patients with (n=26) or without (n=26) black tooth stains was performed using duplex PCR for the 16S ribosomal RNA gene (P. nigrescens, P. intermedia, Actinomyces spp) and glucosyltransferase-I gene for S. mutans. P. nigrescens and S. mutans were the most frequent bacteria detected in both groups. The least frequently detected were P. intermedia and Actinomyces spp. The similar bacterial composition of dental biofilms of black tooth stains and healthy tooth surfaces indicates that black tooth stains are not free of cariogenic bacteria.

O objetivo deste estudo foi investigar a presença das bactérias pigmentadoras de negro Prevotella nigrescens e Prevotella intermedia, da não pigmentadora de negro Actinomyces spp e particularmente a bactéria cariogênica Streptococcus mutans, no biofilme dentário de pacientes com ou sem manchas dentárias extrínsecas negras, utilizando a técnica multiplex PCR (reação em cadeia da polimerase). Análises do biofilme dentário de pacientes com manchas (n=26) e sem manchas (n=26) foram realizadas utilizando a multiplex PCR para o gene 16S RNA ribosomal (P. nigrescens, P. intermedia, Actinomyces spp) e o gene glucosiltransferase-I para S. mutans. P. nigrescens e S. mutans foram as bactérias mais frequentemente detectadas em ambos os grupos. As menos frequentemente detectadas foram P. intermedia e Actinomyces spp. A similaridade entre a composição bacteriana dos biofilmes dentários das manchas dentárias extrínsecas negras e das superfícies dentárias sem manchas indicam que as manchas dentárias extrínsecas negras não estão livres de bactérias cariogênicas.

Molecular epidemiological investigation to determine the source of a fatal case of serotype 22F pneumococcal meningitis.

A child's death due to pneumococcal meningitis after contracting the disease in an after-school programme prompted an investigation to assess nasopharyngeal (NP) carriage among her contacts. The serotype of the meningitis case isolate was determined, together with the serotypes of the NP specimens of contacts, comprising the case patient's brother, the case patient's after-school programme contacts and the brother's day-care centre (DCC) contacts. NP swabs from 155 children and 69 adults were obtained. Real-time PCR and conventional multiplex PCR (CM-PCR) assays were used to detect pneumococcal carriage and determine serotypes. Broth-enriched culture of NP specimens followed by pneumococcal isolation and Quellung-based serotyping were also performed. DNA extracts prepared from cerebrospinal fluid of the index case and from the NP strain isolated from the brother and from one attendee of the brother's DCC were subjected to genotyping. Pneumococcal carriage assessed by real-time PCR and culture was 49.6 and 36.6%, respectively (P<0.05). Twenty-three serotypes were detected using CM-PCR, with serotypes 6A/6B, 14, 19F, 6C/6D, 22F/22A, 23F and 11A/11D being the most frequent. All eight serotype 22F/22A NP specimens recovered were from children attending the brother's DCC. The meningitis case isolate and the NP carriage isolate from the patient's brother were both serotype 22F and shared the same new multilocus sequence type (ST6403) with the attendee of the brother's DCC. CM-PCR proved to be useful for assessing carriage serotype distribution in a setting of high-risk pneumococcal transmission. The causal serotype appeared to be linked to the brother of the case patient and attendees of his DCC.

Biofilms of black tooth stains: PCR analysis reveals presence of Streptococcus mutans.

This study investigated the presence of the black-pigmented bacteria Prevotella nigrescens and Prevotella intermedia, the non-black-pigmented bacteria Actinomyces spp and particularly the cariogenic pathogen Streptococcus mutans in the dental biofilms of patients with or without black extrinsic tooth stains, using the multiplex polymerase chain reaction (PCR) technique. Analysis of the dental biofilms of patients with (n=26) or without (n=26) black tooth stains was performed using duplex PCR for the 16S ribosomal RNA gene (P. nigrescens, P. intermedia, Actinomyces spp) and glucosyltransferase-I gene for S. mutans. P. nigrescens and S. mutans were the most frequent bacteria detected in both groups. The least frequently detected were P. intermedia and Actinomyces spp. The similar bacterial composition of dental biofilms of black tooth stains and healthy tooth surfaces indicates that black tooth stains are not free of cariogenic bacteria.