Incidence rate of community-acquired pneumonia in adults: a population-based prospective active surveillance study in three cities in South America.

OBJECTIVE: To determine the incidence rate and mortality of community-acquired pneumonia (CAP) in adults in three cities in Latin America during a 3-year period. DESIGN: Prospective population-based surveillance study. SETTING: Healthcare facilities (outpatient centres and hospitals) in the cities of General Roca (Argentina), Rivera (Uruguay) and Concepción (Paraguay). PARTICIPANTS: 2302 adults aged 18 years and older with CAP were prospectively enrolled between January 2012 and March 2015. MAIN OUTCOME MEASURES: Incidence rates of CAP in adults, predisposing conditions for disease, mortality at 14 days and at 1 year were estimated. Incidence rate of CAP, within each age group, was calculated by dividing the number of cases by the person-years of disease-free exposure time based on the last census; incidence rates were expressed per 1000 person-years. RESULTS: Median age of participants was 66 years, 46.44% were men, 68% were hospitalised. Annual incidence rate was 7.03 (95% CI 6.64 to 7.44) per 1000 person-years in General Roca, 6.33 (95% CI 5.92 to 6.78) per 1000 person-years in Rivera and 1.76 (95% CI 1.55 to 2.00) per 1000 person-years in Concepción. Incidence rates were highest in participants aged over 65 years. 82.4% had at least one predisposing condition and 48% had two or more (multimorbidity). Chronic heart disease (43.6%) and smoking (37.3%) were the most common risk factors. 14-day mortality rate was 12.1% and 1-year mortality was 24.9%. Multimorbidity was associated with an increased risk of death at 14 days (OR 2.91; 95% CI 2.23 to 3.80) and at 1 year (OR 3.00; 95% CI 2.44 to 3.70). CONCLUSIONS: We found a high incidence rate of CAP in adults, ranging from 1.76 to 7.03 per 1000 person-years, in three cities in South America, disclosing the high burden of disease in the region. Efforts to improve prevention strategies are needed.

Rol del Comité de Etica en Investigación en Proyectos de Nutrición / Role of the Research Ethics Committees in Nutrition Projects

Desde la Disposición 5330/97 de la ANMAT, ningún estudio de investigación en humanos puede ser realizado sin la evaluación y aprobación de un Comité de Etica en Investigación (CEI). El CEI se encarga de evaluar los aspectos metodológicos, éticos y legales, así como garantizar los derechos y el bienestar de los participantes involucrados en los estudios. Toda investigación, en la que haya participación de seres humanos, debe ser evaluada por un CEI antes de su inicio y luego en forma periódica hasta su finalización. El Comité tiene autoridad para aprobar, solicitar modificaciones, desaprobar, interrumpir o cancelar una investigación. Con el fin de optimizar los tiempos para el inicio de un proyecto, es importante conocer los requerimientos de presentación necesarios para que el CEI pueda realizar una adecuada evaluación.

Safety of a second dose of varicella vaccine administered at 4 to 6 years of age in healthy children in Argentina.

Varicela Biken [Live varicella Biken vaccine (strain Oka)] is an effective and safe vaccine for the prevention of varicella infection. Although the recommended schedule in all age groups (children, adolescents and adults) is a single dose, physicians in some countries follow the 2007 recommendation of the US Advisory Committee on Immunization Practices (ACIP) which recommends "implementation of a routine 2-dose varicella vaccination program for children, with the first dose administered at age 12--15 months and the second dose at age 4--6 years." ( 1) Therefore, cases can arise when two doses of Varicela Biken are given even though the ACIP guidelines are a response to the US epidemiological situation and for US licensed products based on the Oka/Merck and the Oka-RIT strains (Varicela Biken is not registered in US). The aim of this study is to ascertain the safety of a second dose of Varicela Biken in children who have been previously vaccinated with the same vaccine. In this study, children, 4-6 years of age who had been previously vaccinated with Varicela Biken, received a single 0.5 mL dose of live attenuated varicella virus vaccine containing at least 1000 Plaque Forming Units (PFU) attenuated live Varicella-zoster virus (Oka strain). Participants were monitored for 30 minutes after vaccination. Predefined injection site and systemic reactions were solicited during the subsequent seven days. Unsolicited injection site reactions and unsolicited systemic events were collected throughout the study. Any serious adverse events occurring throughout the study were reported to the sponsor's pharmacovigilance department. One hundred and twenty two children were recruited and all provided safety data. There were no immediate adverse events or injection site reactions. Forty three percent of participants reported injection site reactions and 22.1% reported systemic reactions on solicitation during the seven days after vaccination. During the 30 day monitoring period, 43 participants reported a total of 66 adverse events. Seven participants reported a total of eight unsolicited events that were assessed as related to the vaccine or where the relationship to vaccination was unknown. Five of these eight events were injection site reactions and all were mild, systemic reactions included mild rash (1 case) and fever (2 cases). There was a single serious adverse event that was not related to the study medication (subject was a passenger in a motor vehicle accident). A second dose of Varicela Biken was well tolerated and showed no significant safety issues in this population of previously vaccinated children.

[Efficacy of five disinfectants to reduce bacterial load in the household]. / Eficacia de cinco desinfectantes para la reducción bacteriana doméstica.

The proper use of products containing sodium hypochlorite,ammonium salts and triclosan has proved to be effective in the elimination of infectious agents in the household environment. Our objective was to evaluate the immediate, one-week and one-month efficacy of controlled use of five products containing these components, compared to other commonly used products. Within a six month period, thirty two middle-class homes from Buenos Aires City and suburbs were included in this open-label, randomized, parallel-group intervention study. Sixteen homes were randomized to use products containing sodium hypochlorite, ammonia and triclosan in the kitchen and bathroom during one month. The remaining maintained usual practices for domestic cleaning. Bacterial counts and identification were performed from samples taken from each study site. Baseline samples (no group discrimination) contained a mean bacterial count in kitchen of 66.0 CFU/cm2, and in bathroom 40.1 CFU/cm2. Samples taken immediately after-cleaning (no group discrimination) contained: kitchen 0.8 CFU/cm2; bathroom < 1 CFU/cm2. After one week (intervention group vs. control group) contained: kitchen 18.0 vs. 32.5 CFU/cm2; bathroom 12.7 vs. 7.7 CFU/cm2. After one month (intervention group vs. control group): kitchen 60.1 vs. 62.1 CFU/cm2; bathroom 37.0 vs. 42.0 CFU/cm2. A remarkable decrease of bacterial load was observed in both groups, which suggests that not only product quality but also education for suitable use plays a key role in successful house disinfection. This approach could be an important tool for improving prevention of foodborne infections since fecal coliforms widely predominated in all analyzed samples.

Eficacia de cinco desinfectantes para la reducción bacteriana doméstica / Efficacy of five disinfectants to reduce bacterial load in the household

El uso adecuado de hipoclorito de sodio, sales de amonio cuaternario y triclosán ha demostrado ser eficaz para eliminar gérmenes dentro del hogar. Nuestro objetivo fue evaluar la eficacia inmediata, a la semana y al mes del uso controlado de cinco productos con estos componentes, comparados con otros productos de uso habitual. Se incluyeron 32 hogares de clase media de la Ciudad de Buenos Aires y la periferia en un estudio con intervención, abierto, aleatorizado, y de grupos paralelos, durante 6 meses. La mitad de los hogares fue seleccionada para usar hipoclorito de sodio, sales de amonio cuaternario y triclosán en la cocina y el baño durante un mes. El grupo control mantuvo prácticas habituales de limpieza doméstica. Se tomaron muestras para recuento y tipificación bacteriana de los sitios estudiados: muestras basales (sin discriminación de grupo) en cocina, que presentaron recuento bacteriano promedio de 66.0 UFC/cm²; baño: 40.1 UFC/cm². Las muestras inmediatas a la limpieza (sin discriminación de grupo): en cocina: 0.8 UFC/cm²; baño: <1 UFC/cm². A la semana (grupo intervenido vs. grupo control): cocina 18.0 vs. 32.5 UFC/cm²; baño 12.7 vs. 7.7 UFC/cm². Al mes (intervenido vs. control): cocina: 60.1 vs. 62.1 UFC/cm²; baño: 37.0 vs. 42.0 UFC/cm². Se observó una notable disminución de la carga bacteriana en ambos grupos, lo que sugiere que no sólo la calidad de los productos sino también la educación en el uso desempeñan un papel clave en la desinfección del hogar. Este enfoque podría ser una herramienta importante para prevenir infecciones transmitidas por alimentos, dado que los coliformes fecales predominaron ampliamente en todas las muestras tipificadas.

The proper use of products containing sodium hypochlorite, ammonium salts and triclosan has proved to be effective in the elimination of infectious agents in the household environment. Our objective was to evaluate the immediate, one-week and one-month efficacy of controlled use of five products containing these components, compared to other commonly used products. Within a six month period, thirty two middle-class homes from Buenos Aires City and suburbs were included in this open-label, randomized, parallel-group intervention study. Sixteen homes were randomized to use products containing sodium hypochlorite, ammonia and triclosan in the kitchen and bathroom during one month. The remaining maintained usual practices for domestic cleaning. Bacterial counts and identification were performed from samples taken from each study site. Baseline samples (no group discrimination) contained a mean bacterial count in kitchen of 66.0 CFU/cm², and in bathroom 40.1 CFU/cm². Samples taken immediately after-cleaning (no group discrimination) contained: kitchen 0.8 CFU/cm²; bathroom < 1 CFU/ cm². After one week (intervention group vs. control group) contained: kitchen 18.0 vs. 32.5 CFU/cm²; bathroom 12.7 vs. 7.7 CFU/cm². After one month (intervention group vs. control group): kitchen 60.1 vs. 62.1 CFU/cm²; bathroom 37.0 vs. 42.0 CFU/cm². A remarkable dicrease of bacterial load was observed in both groups, which suggests that not only product quality but also education for suitable use plays a key role in successful house disinfection. This approach could be an important tool for improving prevention of foodborne infections since fecal coliforms widely predominated in all analyzed samples.