RESUMO
Background: The Brazilian state of Paraná conducted a mass vaccination campaign against dengue with the tetravalent attenuated vaccine CYD-TDV. The campaign targeted thirty endemic municipalities. The objective of this study was to assess the effectiveness of CYD-TDV in preventing symptomatic virologically confirmed dengue cases according to specific age groups in five of the municipalities. Methods: A case-control study was carried out in the five most populous municipalities targeted by the vaccination, with a vaccine uptake of 25%. Symptomatic dengue cases were identified by the municipal health departments. The age groups targeted were 15-18 and 19-27 in four municipalities and 9-14 and 28-44 in one municipality. All cases were confirmed by real time reverse transcription quantitative polymerase chain reaction (RT-qPCR). For each case, two controls were selected: a neighbourhood control and a workplace or school/college control, matched by age group. A conditional logistic regression model was used to determine the odds ratio for vaccination and the vaccine effectiveness. Findings: Study participants included 618 RT-qPCR-confirmed dengue cases and 1,236 matched controls (with a non-reactive dengue IgM serologic test). Vaccine effectiveness against dengue due to any serotype was 11·1% (95% CI: -19·0%; 33·6%). Effectiveness against DENV-1 was 33·3% (95% CI: -5·0%; 57·6%) and against DENV-2 was -56·7% (95% CI: -142·2%; -5·0%). No DENV-3 was detected. The vaccine was significantly effective in the prevention of DENV-4 cases (VE = 93·3%; 95% CI: 47·7%; 99·2%). Interpretation: CYD-TDV was effective in the prevention of symptomatic cases due to DENV-4, but not due to any serotype. The low dengue seroprevalence in the target population could possibly be related to these results. Funding: This study was supported through a grant to the Sabin Vaccine Institute from Sanofi-Pasteur. Sanofi-Pasteur had no role in the study design, protocol development, data collection, analysis, or publication of results.
RESUMO
A síndrome cardiopulmonar por hantavírus(SCPH), uma forma grave de infecção por hantavírus, foi identificada no continente americano em 1993, nos Estados Unidos da América(EUA). No mesmo ano, um surto de SCPH ocorreu no Brasil, no Município paulista de Juquitiba. Com os objetivos de descrever os componentes e analisar os atibutos, a utilidade e os recursos necessários para operação do Sistema de Vigilância , dos Centers for Disease Control and Prevention(CDC,EUA). Os resultados evidenciaram que o SVH é complexo, pouco flexível, instável, com baixa aceitabilidade, sensibilidade, valor preditivo positivo e representatividade, além da insatisfatória qualidade dos dados. Ademais, o sistema carece de grandes quantidades de recursos. Entretanto, mostrou ser de grande utilidade para detectar casos de SCPH e identificar surtos, orientar medidas de prevenção e controle e erar mudanças nas práticas clínicas e de vigilância. Com base nesses resultados, recomenda-se aos Estados e Municípios que: implementem, de forma plena, ações de vigilância da doença e de capacitação dos profissionais de saúde; definam serviços de referência para notificação, diagnóstico e tratamento; e promovam o uso dos dados da vigilância, a divulgação das informações para profissionais de saúde e a informação à população sobre como prevenir a síndrome...
