Computerized immunization record agreement in Araraquara, São Paulo, Brazil, 2018. / Concordância do registro informatizado de imunização de Araraquara, São Paulo, 2018.

OBJECTIVE: To describe agreement between the Juarez System immunization data and information in vaccination record booklets and vaccination coverage in children aged 12 to 24 months. METHODS: This was a descriptive study to assess the vaccination status at 12 and 24 months of age of children born in 2015 and recorded on the Juarez System. The levels of agreement between the Juarez System data and the information in vaccination record booklets were verified. RESULTS: 429 children were included. It was found that agreement ranged between 84.1% and 99.1%. The vaccine survey found that coverage for each vaccine ranged from 86.01% to 100% and for the full schedule, from 77.1% (12 months) to 68.8% (24 months). The spatial distributions of vaccine coverage ranged from 28% to 100%. CONCLUSION: There was excellent agreement between the data, with high vaccination coverage, but heterogeneity in their spatial distributions.

SARS-CoV-2 reinfection caused by the P.1 lineage in Araraquara city, Sao Paulo State, Brazil.

Reinfection by the severe acute respiratory syndrome coronavirus type 2 (SARS-COV-2) has been reported in many countries, suggesting that the virus may continue to circulate among humans despite the possibility of local herd immunity due to massive previous infections. The emergence of variants of concern (VOC) that are more transmissible than the previous circulating ones has raised particular concerns on the vaccines effectiveness and reinfection rates. The P.1 lineage was first identified in December 2020 in Manaus city and is now globally spread. We report the first case of reinfection of SARS-CoV-2 caused by the P.1 variant outside of Manaus. The potential of these new variants to escape naturally and vaccine- induced immunity highlights the need for a global vigilance.

Agreement of the computerized immunization record of Araraquara, São Paulo, Brazil, 2018 / Concordancia del registro de vacunación computarizado de Araraquara, São Paulo, Brasil, 2018 / Concordância do registro informatizado de imunização de Araraquara, São Paulo, 2018

Objective: To describe the agreement between the immunization data of the Juarez System and the information in the vaccination booklet and vaccination coverage in children aged 12 to 24 months. Methods: Descriptive study to assess the vaccination status at 12 and 24 months of age of children born in 2015 and registered in the Juarez System. The levels of agreement between the Juarez System data and the information in the vaccination booklet were verified. Results: 429 children were included. it was found that the agreement varied between 84.06 and 99.06%. The coverage (vaccine survey) for each vaccine ranged from 86% to 100% and for the complete schedule, 77.1% (12 months) and 68.8% (24 months). The spatial distributions of vaccine coverage ranged from 28% to 100%. Conclusion: excellent agreement between the data, high vaccination coverage, but heterogeneity in their spatial distributions.

Objetivo: Descrever a concordância entre os dados de imunização do Sistema Juarez e as informações da caderneta de vacinação e as coberturas vacinais em crianças de 12 a 24 meses. Métodos: Estudo descritivo, para avaliar a situação vacinal aos 12 e 24 meses de idade de crianças nascidas em 2015 e registradas no Sistema Juarez. Foram verificados os níveis de concordância entre os dados do Sistema Juarez e as informações da caderneta de vacinação. Resultados: Foram incluídas 429 crianças. Verificou-se que a concordância variou entre 84,06 e 99,06%. As coberturas no inquérito vacinal para cada vacina variaram de 86 a 100%; e para o esquema completo, de 77,1 (12 meses) a 68,8% (24 meses). As distribuições espaciais da cobertura vacinal foram de 28 a 100%. Conclusão: Observou-se ótima concordância entre os dados, com altas coberturas vacinais, muito embora heterogeneidade em suas distribuições espaciais.

Concordância do registro informatizado de imunização de Araraquara, São Paulo, 2018 / Concordancia del registro de vacunación computarizado de Araraquara, São Paulo, Brasil, 2018 / Computerized immunization record agreement in Araraquara, São Paulo, Brazil, 2018

Objetivo: Descrever a concordância entre os dados de imunização do Sistema Juarez e as informações da caderneta de vacinação e as coberturas vacinais em crianças de 12 a 24 meses. Métodos: Estudo descritivo, para avaliar a situação vacinal aos 12 e 24 meses de idade de crianças nascidas em 2015 e registradas no Sistema Juarez. Foram verificados os níveis de concordância entre os dados do Sistema Juarez e as informações da caderneta de vacinação. Resultados: Foram incluídas 429 crianças. Verificou-se que a concordância variou entre 84,1 e 99,1%. As coberturas no inquérito vacinal para cada vacina variaram de 86,1 a 100%; e para o esquema completo, de 77,1 (12 meses) a 68,8% (24 meses). As distribuições espaciais da cobertura vacinal foram de 28 a 100%. Conclusão: Observou-se ótima concordância entre os dados, com altas coberturas vacinais, muito embora heterogeneidade em suas distribuições espaciais.

Objetivo: Describir la concordancia entre los datos de vacunación del Sistema Juárez y la información de la cartilla de vacunación y cobertura vacunal en niños de 12 a 24 meses. Métodos: Estudio descriptivo para evaluar el estado de vacunación a los 12 y 24 meses de edad de los niños nacidos en 2015 e inscritos en el Sistema Juárez. Se verificaron los niveles de concordancia entre los datos del Sistema Juárez y la información del carné de vacunación. Resultados: Se incluyeron 429 niños. Se encontró que la concordancia varió entre 84,1 y 99,1%. La cobertura (encuesta de vacunas) para cada vacuna varió de 86% a 100% y para el esquema completo, 77,1% (12 meses) y 68,8% (24 meses). Las distribuciones espaciales de la cobertura vacunal oscilaron entre el 28% y el 100%. Conclusión: excelente concordancia entre los datos, alta cobertura de vacunación, pero heterogeneidad en sus distribuciones espaciales.

Objective: To describe agreement between the Juarez System immunization data and information in vaccination record booklets and vaccination coverage in children aged 12 to 24 months. Methods: This was a descriptive study to assess the vaccination status at 12 and 24 months of age of children born in 2015 and recorded on the Juarez System. The levels of agreement between the Juarez System data and the information in vaccination record booklets were verified. Results: 429 children were included. It was found that agreement ranged between 84.1% and 99.1%. The vaccine survey found that coverage for each vaccine ranged from 86.01% to 100% and for the full schedule, from 77.1% (12 months) to 68.8% (24 months). The spatial distributions of vaccine coverage ranged from 28% to 100%. Conclusion: There was excellent agreement between the data, with high vaccination coverage, but heterogeneity in their spatial distributions.

Influenza A and B in a cohort of outpatient children and adolescent with influenza like-illness during two consecutive influenza seasons

ABSTRACT Introduction Influenza is an important cause of morbimortality worldwide. Although people at the extremes of age have a greater risk of complications, influenza has been more frequently investigated in the elderly than in children, and inpatients than outpatients. Yearly vaccination with trivalent or quadrivalent vaccines is the main strategy to control influenza. Objectives Determine the clinical and molecular characteristics of influenza A and B infections in children and adolescents with influenza-like illness (ILI). Methods: A cohort of outpatient children and adolescents with ILI was followed for 20 months. Influenza was diagnosed with commercial multiplex PCR platforms. Results: 179 patients had 277 episodes of ILI, being 79 episodes of influenza A and 20 episodes of influenza B. Influenza A and B cases were mild and had similar presentation. Phylogenetic tree of influenza B viruses showed that 91.6% belonged to the B/Yamagata lineage, which is not included in trivalent vaccines. Conclusions: Influenza A and B are often detected in children and adolescents with ILI episodes, with similar and mild presentation in outpatients. The mismatch between the circulating influenza viruses and the trivalent vaccine offered in Brazil may have contributed to the high frequency of influenza A and B in this population.

Influenza A and B in a cohort of outpatient children and adolescent with influenza like-illness during two consecutive influenza seasons.

INTRODUCTION: Influenza is an important cause of morbimortality worldwide. Although people at the extremes of age have a greater risk of complications, influenza has been more frequently investigated in the elderly than in children, and inpatients than outpatients. Yearly vaccination with trivalent or quadrivalent vaccines is the main strategy to control influenza. OBJECTIVES: Determine the clinical and molecular characteristics of influenza A and B infections in children and adolescents with influenza-like illness (ILI). METHODS: A cohort of outpatient children and adolescents with ILI was followed for 20 months. Influenza was diagnosed with commercial multiplex PCR platforms. RESULTS: 179 patients had 277 episodes of ILI, being 79 episodes of influenza A and 20 episodes of influenza B. Influenza A and B cases were mild and had similar presentation. Phylogenetic tree of influenza B viruses showed that 91.6% belonged to the B/Yamagata lineage, which is not included in trivalent vaccines. CONCLUSIONS: Influenza A and B are often detected in children and adolescents with ILI episodes, with similar and mild presentation in outpatients. The mismatch between the circulating influenza viruses and the trivalent vaccine offered in Brazil may have contributed to the high frequency of influenza A and B in this population.

Zika virus infection among symptomatic patients from two healthcare centers in Sao Paulo State, Brazil: prevalence, clinical characteristics, viral detection in body fluids and serodynamics.

Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest <14 days after the symptoms onset (86%), decreasing >28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance.

Potential effect of Zika virus infection on human male fertility?

BACKGROUND: Zika virus (ZIKV) sexual transmission and prolonged viral shedding in semen have been previously reported, suggesting a strong viral affinity for genital tissues. A transient impact of ZIKV on male fertility was shown in animal and human studies. METHODS: Adult male patients with confirmed ZIKV infection diagnosed in the city of Araraquara, Brazil during the epidemic season of 2016 were invited one year after the acute infection to respond to a questionnaire of genital symptoms and to provide a semen sample for molecular ZIKV testing and spermogram analysis, as well as a serum sample for hormonal testing. RESULTS: 101 of 187 tested patients had positive ZIKV RT-PCR in plasma and/or urine samples (54%, 72 women and 29 men). Of 15 adult male participants for whom telephone contact was successful, 14 responded to the questionnaire of genital symptoms and six consented to provide a semen sample at a median of 12 months after the acute infection. We report abnormal spermogram results from patients one year after confirmed ZIKV infection. CONCLUSIONS: Our findings suggest a possible long-term detrimental effect of ZIKV infection on human male fertility that has to be further explored in well-characterized samples from cohort studies conducted in ZIKV-endemic areas.

Manual Operated Ultraviolet Surface Decontamination for Healthcare Environments.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a new handheld equipment based on a mercury low-pressure vapor lamp. The Surface UV® device was tested in Staphylococcus aureus, Streptococcus mutans, Streptococcus pneumoniae, two strains of Escherichia coli, Pseudomonas aeruginosa, Candida albicans, and other clinical microorganisms isolated from different surfaces of a public health hospital. BACKGROUND DATA: The incidence of hospital infections has increased in recent years. Despite the variety of available chemicals to reduce the microorganisms, the search for antimicrobial agents and the characterization of novel targets are a continued need. Also, the minimization of chemical procedures is a constant need, and the use of ultraviolet (UV) light as a germicidal device for microorganisms' inactivation has been an alternative and one possible approach for the reduction of contamination. MATERIALS AND METHODS: The in vitro decontamination was performed by application of Surface UV in different species of microorganisms (study 1). The surface decontamination was carried out by application of Surface UV on each surface of hospital environment (study 2). The device presents ultraviolet C (UV-C) light at 254 nm and produces an irradiance of 13 mW/cm2 at a distance of 1 cm of the surfaces. The light dose was 0.78 J/cm2 for 60 sec of application in both studies. RESULTS: The results for in vitro decontamination indicated a log10 reduction factor of 6.5 for S. aureus, 6.7 for S. mutans, 6.2 for S. pneumoniae, 5.4 for E. coli, 5.2 for E. coli (ATCC 8739), 5.4 for P. aeruginosa, and 6.7 for C. albicans. The hospital level of microorganisms decreases more by 75% after the procedure. CONCLUSIONS: The study highlights the development and successful application of a new portable device that can reduce the risk of contamination in health settings. Our results suggest that Surface UV is efficient and may be an alternative decontamination method.

Case-control study of an outbreak of acute toxoplasmosis in an industrial plant in the state of São Paulo, Brazil / Estudo caso-controle de surto de toxoplasmose aguda em indústria no estado de São Paulo, Brasil

Foodborne diseases represent operational risks in industrial restaurants. We described an outbreak of nine clustered cases of acute illness resembling acute toxoplasmosis in an industrial plant with 2300 employees. These patients and another 36 similar asymptomatic employees were diagnosed with anti-T. gondii IgG titer and avidity by ELISA. We excluded 14 patients based on high IgG avidity and chronic toxoplasmosis: 13 from controls and one from acute disease other than T. gondii infection. We also identified another three asymptomatic employees with T.gondii acute infection and also anti-T. gondii IgM positive as remaining acute cases. Case control study was conducted by interview in 11 acute infections and 20 negative controls. The ingestion of green vegetables, but not meat or water, was observed to be associated with the incidence of acute disease. These data reinforce the importance of sanitation control in industrial restaurants and also demonstrate the need for improvement in quality control regarding vegetables at risk for T. gondii oocyst contamination. We emphasized the accurate diagnosis of indexed cases and the detection of asymptomatic infections to determine the extent of the toxoplasmosis outbreak.

Doenças transmitidas por alimentos representam riscos operacionais em restaurantes industriais. Descrevemos surto de nove casos agrupados de doença aguda semelhante à toxoplasmose em indústria de 2300 funcionários. Estes pacientes e outros 36 funcionários assintomáticos foram diagnosticados por ELISA para o título e avidez de IgG anti-T. gondii. Foram excluídos 14 pacientes com toxoplasmose crônica e alta avidez: 13 de controles e um de doença aguda não relacionada à infecção por T. gondii. Também identificamos três empregados assintomáticos com infecção aguda por T.gondii, que como os restantes agudos apresentavam anti-T.gondii IgM ELISA positivo. Conduzimos estudo caso controle por entrevista em 11 infecções agudas e 20 controles negativos. A ingestão de vegetais, mas não de carne ou água, foi associada com a incidência da doença aguda. Esses dados reforçam a importância do controle sanitário em restaurantes industriais e também demonstram a necessidade de melhoria no controle de qualidade sobre vegetais em risco de contaminação por oocistos de T. gondii. Enfatizamos o diagnóstico preciso de casos e a detecção de infecções assintomáticas para determinar a extensão do surto de toxoplasmose.

Case-control study of an outbreak of acute toxoplasmosis in an industrial plant in the state of São Paulo, Brazil.

Foodborne diseases represent operational risks in industrial restaurants. We described an outbreak of nine clustered cases of acute illness resembling acute toxoplasmosis in an industrial plant with 2300 employees. These patients and another 36 similar asymptomatic employees were diagnosed with anti-T. gondii IgG titer and avidity by ELISA. We excluded 14 patients based on high IgG avidity and chronic toxoplasmosis: 13 from controls and one from acute disease other than T. gondii infection. We also identified another three asymptomatic employees with T.gondii acute infection and also anti-T. gondii IgM positive as remaining acute cases. Case control study was conducted by interview in 11 acute infections and 20 negative controls. The ingestion of green vegetables, but not meat or water, was observed to be associated with the incidence of acute disease. These data reinforce the importance of sanitation control in industrial restaurants and also demonstrate the need for improvement in quality control regarding vegetables at risk for T. gondii oocyst contamination. We emphasized the accurate diagnosis of indexed cases and the detection of asymptomatic infections to determine the extent of the toxoplasmosis outbreak.