Factors associated with the incomplete opportune vaccination schedule up to 12 months of age, Rondonópolis, Mato Grosso / Fatores associados ao esquema vacinal oportuno incompleto até os 12 meses de idade, Rondonópolis, Mato Grosso

Abstract Objective: To analyze factors associated with the incomplete timely vaccination schedule up to 12 months of age, in children born in 2015, in the municipality of Rondonópolis, Mato Grosso. Methods: Population survey, August/2017 to February/2018, which used the method proposed by the World Health Organization to collect information about routine vaccination. For analysis of the associated factors, the recommendations of the National Immunization Program of the Ministry of Health were considered. Univariate analysis was performed, and the factors associated with p<0.20 entered in the multiple analysis, with hierarchical entry of individual variables and contextual indicator of concentration of the income extremes. Results: The incomplete timely vaccination schedule up to 12 months was 82.03% (95%CI 78.41-86.63). In the final model, the following remained independently associated: having one or more siblings at home (OR 3.18; 95%CI 1.75-5.76) and not receiving a visit from a community health worker in the last 30 days (OR 1.93; 95%CI 1.04-3.57). Conclusions: It is necessary to implement an active search for children with vaccination delay in relation to the recommended interval for each vaccine, in addition to the need to strengthen the link of the family health strategy and child caregivers.

RESUMO Objetivo: Analisar fatores associados ao esquema vacinal oportuno incompleto até os 12 meses de idade, em crianças nascidas em 2015, no município de Rondonópolis, Mato Grosso. Métodos: Inquérito populacional, agosto/2017 a fevereiro/2018, que utilizou o método proposto pela Organização Mundial da Saúde para coletar informações sobre a vacinação de rotina. Para analisar os fatores associados, consideraram-se as recomendações do Programa Nacional de Imunização do Ministério da Saúde. Realizou-se análise univariada e os fatores associados com p<0,20 entraram na análise múltipla, com entrada hierarquizada das variáveis individuais e indicador contextual de concentração de extremos de renda. Resultados: O esquema vacinal oportuno incompleto até os 12 meses foi de 82,03% (IC95% 78,41-86,63). No modelo final, permaneceram independentemente associados: possuir um irmão ou mais no domicílio (OR 3,18; IC95% 1,75-5,76) e não receber visita de agente comunitário de saúde nos últimos 30 dias (OR 1,93; IC95% 1,04-3,57). Conclusões: É necessário implementar busca ativa de crianças com atraso vacinal em relação ao intervalo recomendado para cada vacina, além da necessidade de fortalecer o vínculo da estratégia de saúde da família e cuidadores de crianças.

Clinical and Genetic Findings of the First Report of PAPA Syndrome in Brazil.

BACKGROUND: PAPA syndrome (MIM #604416) is a rare monogenic autoinflammatory disease genetically transmitted in an autosomal dominant trait that results from missense mutations in the proline-serine-threonine phosphatase-interactive protein 1 (PSTPIP1) gene located on chromosome 15 and is characterized by sterile pyogenic arthritis, pyoderma gangrenosum, and cystic acne. We describe the clinical and molecular findings of two related Brazilian patients with PAPA syndrome. Case Presentation. A 7-year-and-3-month-old boy with nonconsanguineous parents had had recurrent pyoarthritis since the age of 5 years and 8 months. During his last and long hospitalization, the lack of improvement with antibiotics, evidence of increased inflammatory activity, repeated arthrotomies, draining purulent fluid that had negative cultures, and the history of trauma, all on in a clinical background of pyoarthritis, led to the suspicion of an autoinflammatory syndrome. This was confirmed by the good clinical response to corticotherapy. Genetic sequencing confirmed the diagnosis of PAPA syndrome, with the pathogenic mutation c.688 G > A (p. Ala230Thr) in the PSTPIP1 gene present in the patient and in the mother. CONCLUSIONS: This case illustrates that in children with recurrent/recalcitrant sterile recurrent pyogenic arthritis/osteomyelitis, the possibility of an underlying immunological condition should be considered. In both, recurrent infections or recurrent inflammation, many genes involved in the inborn errors of immunity can be associated, and a correct and precocious diagnosis is necessary to avoid mobility and mortality. To the best of our knowledge, this is the first report of PAPA syndrome in Brazil.

Factors associated with the incomplete opportune vaccination schedule up to 12 months of age, Rondonópolis, Mato Grosso.

OBJECTIVE: To analyze factors associated with the incomplete timely vaccination schedule up to 12 months of age, in children born in 2015, in the municipality of Rondonópolis, Mato Grosso. METHODS: Population survey, August/2017 to February/2018, which used the method proposed by the World Health Organization to collect information about routine vaccination. For analysis of the associated factors, the recommendations of the National Immunization Program of the Ministry of Health were considered. Univariate analysis was performed, and the factors associated with p<0.20 entered in the multiple analysis, with hierarchical entry of individual variables and contextual indicator of concentration of the income extremes. RESULTS: The incomplete timely vaccination schedule up to 12 months was 82.03% (95%CI 78.41-86.63). In the final model, the following remained independently associated: having one or more siblings at home (OR 3.18; 95%CI 1.75-5.76) and not receiving a visit from a community health worker in the last 30 days (OR 1.93; 95%CI 1.04-3.57). CONCLUSIONS: It is necessary to implement an active search for children with vaccination delay in relation to the recommended interval for each vaccine, in addition to the need to strengthen the link of the family health strategy and child caregivers.

Desenvolvimento neuropsicomotor de crianças expostas à infecção congênita pelo Zika vírus / Neuropsychomotor development of children with congenital Zika virus infection

INTRODUÇÃO: A comprovação da associação de microcefalia no Brasil com a infecção congênita pelo Zika vírus, leva a necessidade de estudos sobre a repercussão no desenvolvimento das crianças decorrentes do comprometimento do sistema nervoso central (SNC). OBJETIVO: Avaliar o desenvolvimento neuropsicomotor (DNPM) de crianças expostas à infecção congênita pelo Zika vírus e sua associação com características e diagnósticos pré natais, neonatais e pós natais da mãe/criança. MÉTODOS: Estudo transversal com crianças de zero a três anos, nascidas entre 2015 e 2018, classificadas com infecção congênita pelo Zika vírus. Na coleta das características clínicas e sócio demográficas, utilizou-se um questionário semiestruturado e na avaliação do DNPM o Teste de Triagem de Denver II. Na associação, utilizou-se o teste exato de Fisher (p<0,05). RESULTADOS: Avaliou-se 30 crianças, 46,67% apresentavam alterações do DNPM, os maiores foram na linguagem (46,67%) e motricidade fina (43,33%). 23,33% tinham mais que 24 meses, idade que se associou a alterações do DNPM (p<0,012). A infecção predominou entre 4 e 12 semanas de gestação e obteve associação com os atrasos do DNPM (p<0,002). 46,67% das crianças apresentaram microcefalia e 40% calcificações cerebrais, ambos com associação a atrasos no DNPM (p<0,001). Em exame físico 36,7% apresentaram alterações de postura e persistência de reflexos primitivos, 40% hiperirritabilidade, 33,33% disfagia e deformidades articulares, todas com associação importante com as alterações no DNPM (p<0,001). CONCLUSÕES: Crianças expostas à infecção congênita pelo Zika vírus apresentaram atrasos no DNPM e quanto mais precoce a infecção na gravidez, maior o envolvimento do sistema nervoso central.

INTRODUCTION: The proof of the association of microcephaly in Brazil with congenital Zika virus infection leads to the need for studies on the impact on children's development resulting from the involvement of the central nervous system (CNS). OBJECTIVE: To evaluate the neuropsychomotor development (NPMD) of children exposed to congenital Zika virus infection and its association with prenatal, neonatal, and postnatal characteristics and diagnoses of the mother/child. METHODS: Cross-sectional study with children aged zero to three years, born between 2015 and 2018, classified with congenital Zika virus infection. In the collection of clinical and socio-demographic characteristics, a semistructured questionnaire was used, and the Denver II Screening Test was used to assess the DNPM. In the association, Fisher's exact test was used (p<0.05). RESULTS: Thirty children were evaluated; 46.67% had DNPM alterations, the greatest ones were in the language (46.67%) and fine motor skills (43.33%). 23.33% were older than 24 months, an age-associated with changes in DNPM (p<0.012). Infection predominated between 4 and 12 weeks of gestation and was associated with DNPM delays (p<0.002). 46.67% of children had microcephaly and 40% cerebral calcifications, both associated with DNPM delays (p<0.001). On physical examination, 36.7% had changes in posture and persistence of primitive reflexes, 40% hyperirritability, 33.33% dysphagia, and joint deformities, all with an important association with changes in DNPM (p<0.001). CONCLUSIONS: Children exposed to congenital Zika infection had developmental delays. It is noteworthy that the earlier the infection in pregnancy, the greater the involvement of the central nervous system of children.

Outcome of SARS-CoV-2 Infection in 121 Patients with Inborn Errors of Immunity: A Cross-Sectional Study.

PURPOSE: There is still scarce data on SARS-CoV-2 infection in patients with Inborn Errors of Immunity (IEI) and many unresolved questions. We aimed to describe the clinical outcome of SARS-CoV-2 infection in Brazilian IEI patients and identify factors influencing the infection. METHODS: We did a cross-sectional, multicenter study that included patients of any age affected by IEI and SARS-CoV-2 infection. The variables studied were sex, age, type of IEI, comorbidities (number and type), treatment in use for IEI, clinical manifestations and severity of SARS-CoV-2 infection. RESULTS: 121 patients were included: 55.4% female, ages from six months to 74 yo (median age = 25.1 yo). Most patients had predominantly antibody deficiency (n = 53). The infection was mostly asymptomatic (n = 21) and mild (n = 66), and one child had multisystem inflammatory syndrome (MIS-C). We could not observe sex-related susceptibility, and there was a weak correlation between age and severity of infection. The number of comorbidities was higher in severe cases, particularly bronchiectasis and cardiopathy. There were no severe cases in hereditary angioedema patients. Six patients aged 2 to 74 years died, three of them with antibody deficiency. CONCLUSION: The outcome was mild in most patients, but the Case Fatality Ratio was higher than in the general population. However, the type of IEI was not a determining factor for severity, except for complement deficiencies linked to milder COVID-19. The severity of SARS-CoV-2 infection seems to be more related to older age, a higher number of comorbidities and type of comorbidities (bronchiectasis and cardiopathy).

Sibilância em lactentes: o que mudou? / Wheezing in infants: what has changed?

O objetivo deste artigo foi avaliar a prevalência e fatores de risco para sibilância recorrente e asma em lactentes. Foi realizada pesquisa de artigos originais, revisões, consensos indexados e publicações on-line, nos últimos 15 anos, nos bancos de dados PubMed, MEDLINE, LILACS e SciELO. Conhecer a prevalência de sibilância recorrente e os fatores a ela associados é imprescindível, visto a sibilância recorrente ser uma das principais manifestações clínicas da asma na infância, sendo inclusive considerada por alguns autores como sinônimo desta doença, somado ao fato de que alguns dos fatores associados à sibilância no primeiro ano de vida também o são ao desenvolvimento de asma em crianças e adolescentes. A realização e aprofundamento de pesquisas sobre a sibilância e a asma na infância se fazem necessárias, e podem colaborar com a implantação de políticas públicas de saúde e programas educacionais objetivando o diagnóstico precoce de asma, e a adoção de medidas preventivas que favoreçam seu controle e evolução.

The objective of this study was to evaluate the prevalence and risk factors of recurrent wheezing and asthma in infants. MEDLINE (via PubMed), LILACS, and SciELO databases were searched for original articles, reviews, indexed guidelines, and online resources published in the past 15 years. It is essential to know the prevalence of recurrent wheezing and its associated factors, since recurrent wheezing is one of the main clinical manifestations of childhood asthma, being considered by some authors a synonym of this disease. Also, some factors associated with wheezing in the first year of life may influence the development of asthma in children and adolescents. Further research on wheezing and asthma in childhood is needed and may contribute to the implementation of public health policies and educational programs aimed at the early diagnosis of asthma and to the adoption of preventive measures to improve asthma control and reduce disease burden.

Acquisition of specific antibodies and their influence on cell-mediated immune response in neonatal cord blood after maternal pertussis vaccination during pregnancy.

Maternal immunization with pertussis acellular vaccine (Tdap) is an intervention that provides protection to newborns. However, it has been reported that high maternal antibody levels may adversely affect the immune response of infants after active immunization. In this study, we evaluated neonatal passive acquisition of pertussis-specific antibodies and their influence on the neonatal cell-mediated immune response. Pregnant women were either vaccinated with Tdap vaccine (case group, n = 66) or received no vaccine (control group, n = 101). Whole-cell Bordetella pertussis (Bp), pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN)-specific serum IgG were quantified in paired maternal-cord sera, and Bp- and PT-specific IgA were evaluated in colostrum by ELISA. Ex vivo neonatal blood lymphocyte responsiveness after Bp stimulation was assessed in case (n = 17) and control (n = 15) groups using flow cytometry to detect proliferation, cytokine production and activation phenotype of lymphocytes in the context of high specific IgG acquired after maternal vaccination. Anti-Bp, PT, FHA and PRN IgG concentrations in maternal and cord sera from case group were higher than those in control group with positive correlation indexes in both groups for all pertussis antigens. The control group presented higher placental transfer ratios of specific antibodies and, in the case group, vaccination between 26 and 31 gestation weeks was associated with the best placental transfer ratios. Specific IgA concentrations in colostrum were not affected by vaccine status. Whole blood assays revealed that newborns responded to Bp stimulation with higher expression of CD40L, CD69 and CD4+ T cell proliferation compared to unstimulated cells, and a lower Th1 response, while a preserved Th2 response compared to adults, but there were no differences between the neonatal groups for any of the studied parameters. Our results indicate that higher pertussis-specific IgG levels in newborn sera after maternal vaccination do not affect the neonatal ex vivo cell-mediated immune response.

Population-based study on infant mortality. / Estudo de base populacional sobre mortalidade infantil.

Although Brazil has reduced social, economic and health indicators disparities in the last decade, intra- and inter-regional differences in child mortality rates (CMR) persist in regions such as the state capital of Mato Grosso. This population-based study aimed to investigate factors associated with child mortality in five cohorts of live births (LB) of mothers living in Cuiabá (MT), Brazil, 2006-2010, through probabilistic linkage in 47,018 LB. We used hierarchical logistic regression analysis. Of the 617 child deaths, 48% occurred in the early neonatal period. CMR ranged from 14.6 to 12.0 deaths per thousand LB. The following remained independently associated with death: mothers without companion (OR = 1.32); low number of prenatal consultations (OR = 1.65); low birthweight (OR = 4.83); prematurity (OR = 3.05); Apgar ≤ 7 at the first minute (OR = 3.19); Apgar ≤ 7 at the fifth minute (OR = 4.95); congenital malformations (OR = 14.91) and male gender (OR = 1.26). CMR has declined in Cuiabá, however, there is need to guide public healthcare policies in the prenatal and perinatal period to reduce early neonatal mortality and further studies to identify the causes of preventable deaths.

Estudo de base populacional sobre mortalidade infantil / Population-based study on infant mortality

Resumo Embora o Brasil tenha diminuído na última década as disparidades sociais, econômicas e de indicadores de saúde, as diferenças intra e inter-regionais das taxas de mortalidade infantil (TMI) persistem em regiões como a capital do estado de Mato Grosso. Estudo de base populacional que objetivou investigar fatores associados à mortalidade infantil em cinco coortes de nascidos vivos (NV) de mães residentes em Cuiabá (MT), Brasil, 2006-2010, através de linkage probabilístico em 47.018NV. Utilizou-se regressão logística, por meio de análise hierarquizada. Dos 617 óbitos infantis, 48% ocorreram no período neonatal precoce. A TMI variou de 14,6 a 12,0 óbitos por mil NV. Permaneceram independentemente associados ao óbito: mães sem companheiro (OR = 1,32); baixo número de consultas de pré-natal (OR = 1,65); baixo peso ao nascer (OR = 4,83); prematuridade (OR = 3,05); Apgar ≤ 7 no 1º minuto (OR = 3,19); Apgar ≤ 7 no 5º minuto (OR = 4,95); malformação congênita (OR = 14,91) e sexo masculino (OR = 1,26). Houve redução da mortalidade infantil em Cuiabá, porém, há necessidade de direcionamento de políticas públicas de saúde de assistência no período pré-natal e perinatal para alcançar a diminuição da mortalidade neonatal precoce e novos estudos para identificar quais as causas de óbitos evitáveis.

Abstract Although Brazil has reduced social, economic and health indicators disparities in the last decade, intra- and inter-regional differences in child mortality rates (CMR) persist in regions such as the state capital of Mato Grosso. This population-based study aimed to investigate factors associated with child mortality in five cohorts of live births (LB) of mothers living in Cuiabá (MT), Brazil, 2006-2010, through probabilistic linkage in 47,018 LB. We used hierarchical logistic regression analysis. Of the 617 child deaths, 48% occurred in the early neonatal period. CMR ranged from 14.6 to 12.0 deaths per thousand LB. The following remained independently associated with death: mothers without companion (OR = 1.32); low number of prenatal consultations (OR = 1.65); low birthweight (OR = 4.83); prematurity (OR = 3.05); Apgar ≤ 7 at the first minute (OR = 3.19); Apgar ≤ 7 at the fifth minute (OR = 4.95); congenital malformations (OR = 14.91) and male gender (OR = 1.26). CMR has declined in Cuiabá, however, there is need to guide public healthcare policies in the prenatal and perinatal period to reduce early neonatal mortality and further studies to identify the causes of preventable deaths.

Passive acquisition of anti-Staphylococcus aureus antibodies by newborns via transplacental transfer and breastfeeding, regardless of maternal colonization

OBJECTIVE: To investigate the transmission of anti-Staphylococcus aureus (Sa) IgG, IgG1 and IgG2 via placental transfer and the transfer of IgA via the colostrum according to maternal Sa carrier status at delivery. METHODS: We evaluated anti-Sa IgG, IgG1 and IgG2 in maternal and cord sera and IgA in colostrum from a case (n=49, Sa+) and a control group (n=98, Sa-). RESULTS: Of the 250 parturients analyzed for this study, 49 were nasally colonized with S. aureus (prevalence of 19.6%). Ninety-eight non-colonized subjects were selected for the control group. The anti-Sa IgG, IgG1 and IgG2 levels and the IgG avidity indexes in the maternal and cord sera did not differ between the groups, with a low transfer ratio of anti-Sa IgG to the newborns in both groups. The anti-Sa IgG2 titers were significantly higher than the IgG1 titers in the maternal and cord sera. Inversely, the transfer ratios were higher for anti-Sa IgG1 compared with IgG2; however, no differences between the groups were detected. The Sa-specific IgA levels and avidity indexes in the colostrum were equivalent between groups. CONCLUSIONS: Maternal Sa nasal colonization at delivery is not associated with higher antibody levels in the mother or newborns. The high titers of anti-Sa IgG2 found in the cord serum indicate a greater reactivity with non-protein antigens, which may further contribute to the susceptibility to staphylococcal infections at birth. The presence of IgA in the colostrum with avidity to S. aureus reinforces the importance of breastfeeding shortly after birth.

Factors associated to fetal death in Cuiabá, Mato Grosso / Fatores associados à ocorrência de óbitos fetais em Cuiabá, Mato Grosso

Abstract Objectives: to investigate the causes and the factors associated to fetal death in Cuiaba, Mato Grosso, 2006-2010. Methods: a population based case-control study in a ratio of 1:3 (300:900), was based on secondary data on Live Births and Mortality Information Systems. A hierarchical logistic regression was used. Results: remains independently associated to fetal death: low maternal schooling (OR=1.58, CI95%=1.02;2.47), low weight (OR=5.59, CI95%=3.22;9.70) gestational age <37 weeks (OR=9.34, CI95%=5.38;16.21), previous fetal death (OR=6.65, CI95%=4.35;10.15). The type of cesarean delivery remained as a protective factor (OR=0.35, CI95%=0.24;0.54). The main causes of fetal deaths were by unspecified cause (15.4%), followed by maternal hypertensive disorders (14.7%). The fetal mortality rate (TMF) decreased from 10.0 in 2006 to 7.5 deaths per thousand births in 2010 (decreased 24.5%). The TMF during the study period was below the goal set for 2030 by the World Health Organization. Conclusions: approximately one third of fetal deaths causes were potentially avoidable. Factors such as low maternal schooling, low birth weight, prematurity and previous fetal death history constitute as main determinants for fetal deaths in Cuiaba and suggests that socioeconomic situation still determines quality care for pregnant women and that actions should be directed to improve prenatal care.

Resumo Objetivos: investigar as causas de óbitos fetais e os fatores associados, em Cuiabá, Mato Grosso, 2006-2010. Métodos: estudo de caso-controle de base populacional, numa razão de 1:3 (300:900), baseado em dados secundários dos Sistemas de Informação sobre Nascidos Vivos e sobre Mortalidade. Utilizou-se regressão logística hierarquizada. Resultados: permaneceram independentemente associados ao óbito fetal: baixa escolari-dade materna (OR=1,58, IC95%=1,02; 2,47), baixo peso (OR=5,59, IC95%=3,22; 9,70), idade gestacional <37 semanas (OR=9,34, IC95%=5,38; 16,21), óbito fetal anterior (OR=6,65, IC95%=4,35; 10,15). O tipo de parto cesáreo permaneceu como fator protetor (OR=0,35, IC95%=0,24; 0,54). As principais causas de óbitos fetais foram por causa não especificada (15,4%), seguidas de transtornos maternos hipertensivos (14,7%). A taxa de mortalidade fetal (TMF) diminuiu de 10,0 em 2006, para 7,5 óbitos por mil nascimentos em 2010 (reduziu 24,5%). A TMF no período estudado esteve abaixo da meta estipulada para 2030 pela Organização Mundial de Saúde. Conclusões: aproximadamente um terço das causas de óbitos fetais foram potencialmente evitáveis. Fatores como baixa escolaridade materna, baixo peso ao nascer, prematuridade e história de óbito fetal anterior se constituem como principais determinantes dos óbitos fetais em Cuiabá, sugerindo que a situação socioeconômica ainda determina a assistência de qualidade à gestante e que ações devem ser direcionadas para a melhoria do pré-natal.

Passive acquisition of anti-Staphylococcus aureus antibodies by newborns via transplacental transfer and breastfeeding, regardless of maternal colonization.

OBJECTIVE:: To investigate the transmission of anti-Staphylococcus aureus (Sa) IgG, IgG1 and IgG2 via placental transfer and the transfer of IgA via the colostrum according to maternal Sa carrier status at delivery. METHODS:: We evaluated anti-Sa IgG, IgG1 and IgG2 in maternal and cord sera and IgA in colostrum from a case (n=49, Sa+) and a control group (n=98, Sa-). RESULTS:: Of the 250 parturients analyzed for this study, 49 were nasally colonized with S. aureus (prevalence of 19.6%). Ninety-eight non-colonized subjects were selected for the control group. The anti-Sa IgG, IgG1 and IgG2 levels and the IgG avidity indexes in the maternal and cord sera did not differ between the groups, with a low transfer ratio of anti-Sa IgG to the newborns in both groups. The anti-Sa IgG2 titers were significantly higher than the IgG1 titers in the maternal and cord sera. Inversely, the transfer ratios were higher for anti-Sa IgG1 compared with IgG2; however, no differences between the groups were detected. The Sa-specific IgA levels and avidity indexes in the colostrum were equivalent between groups. CONCLUSIONS:: Maternal Sa nasal colonization at delivery is not associated with higher antibody levels in the mother or newborns. The high titers of anti-Sa IgG2 found in the cord serum indicate a greater reactivity with non-protein antigens, which may further contribute to the susceptibility to staphylococcal infections at birth. The presence of IgA in the colostrum with avidity to S. aureus reinforces the importance of breastfeeding shortly after birth.

[Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil]. / Prevalência e características clínicas da sibilância em crianças no primeiro ano de vida, residentes na cidade de Cuiabá, Mato Grosso, Brasil.

OBJECTIVE: To evaluate the prevalence and the clinical characteristics of wheezing in 12-15 months old infants in the city of Cuiabá, Mato Grosso State, Midwest Brazil. METHODS: Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the "Estudio Internacional de Sibilancia en Lactantes" (EISL) - phase 3 at primary health care clinics at the same day of children vaccination or at home, from August 2009 to November 2010. RESULTS: 1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beginning at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥ 3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled ß2-agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress and hospitalization due to severe episodes were significantly more frequent. Physician-diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization, neverthless no differences between occasional and recurrent wheezing infants were found. CONCLUSIONS: The prevalence of recurrent wheezing and physician-diagnosed asthma in infants were lower compared with those found in other Brazilian studies Recurrent wheezing had early onset and high morbity.

Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil / Prevalência e características clínicas da sibilância em crianças no primeiro ano de vida, residentes na cidade de Cuiabá, Mato Grosso, Brasil

OBJECTIVE: To evaluate the prevalence and the clinical characteristics of wheezing in infants aged 12 to 15 months in the city of Cuiabá, Mato Grosso State, Midwest Brazil. METHODS: Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the Estudio Internacional de Sibilancia en Lactantes (EISL) - phase 3 at primary healthcare clinics at the same day of children vaccination or at home, from August of 2009 to November of 2010. RESULTS: 1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled β2-agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress, and hospitalization due to severe episodes were significantly more frequent. Physician-diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization; neverthless, no differences between occasional and recurrent wheezing infants were found. CONCLUSIONS: The prevalence of recurrent wheezing and physician-diagnosed asthma in infants were lower compared with those observed in other Brazilian studies. Recurrent wheezing had early onset and high morbity...

OBJETIVO: Determinar a prevalência e as características clínicas da sibilância em lactentes (12-15 meses) residentes em Cuiabá (MT). MÉTODOS: Pais e/ou responsáveis pela criança foram entrevistados e responderam ao questionário escrito padronizado do "Estudio Internacional de Sibilancia en Lactantes" (EISL) - fase 3, em unidades básicas de saúde por ocasião da vacinação de rotina ou durante visitas nos domicílios de crianças matriculadas nos programas de saúde da família no período de agosto de 2009 a novembro de 2010. RESULTADOS: 1060 pais e/ou responsáveis responderam ao questionário escrito, sendo 514 (48,5%) lactentes do sexo masculino. Dos lactentes, 294 (27,7%) tiveram pelo menos um episódio de sibilância no primeiro ano de vida, com início aos 5,8±3,0 meses e predomínio em meninos. A prevalência de sibilância ocasional (<3 episódios de sibilância) foi 15% e a recorrente (≥3 episódios) foi 12,7%. Entre estes, o uso de broncodilatador inalado, corticosteroide oral, antileucotrieno, presença de sintomas noturnos, dificuldade para respirar e internação por sibilância foram significantemente mais frequentes. Diagnóstico médico de asma foi evidenciado em 28 (9,5%) dos lactentes sibilantes. Dos lactentes sibilantes, 80 (27,7%) relataram ocorrência prévia de pneumonia, sendo que 33 (11,2%) necessitaram internação para tratamento, porém não houve diferença entre os grupos de sibilantes. CONCLUSÃO: A prevalência de sibilância recorrente em lactentes foi mais baixa em comparação a outros estudos brasileiros, assim como o diagnóstico médico de asma. Sibilância recorrente teve início precoce e alta morbidade...

Desempenho nas habilidades da linguagem em crianças nascidas prematuras e com baixo peso e fatores associados / Language abilities performance of children born preterm and low birth weight and associated factors

Objetivo: Analisar as habilidades do desenvolvimento da linguagem em crianças de 2 a 3 anos de idade, nascidas prematuras e com baixo peso e os fatores de risco associados. Métodos Estudo transversal com aplicação do teste de Denver II (Denver Developmental Screening Test) e escala ELM (Early Language Milestone Scale). Foi utilizado o teste de Qui-quadrado e todas variáveis com p<0,20 entraram no modelo de regressão logística binária, nível de significância (p<0,05). Resultados: Das 77 crianças avaliadas, 36,4% apresentaram desempenho global alterado no teste de Denver II, considerando os quatro setores, e 37,6% apresentaram cautelas e atrasos no setor da linguagem, especificamente na avaliação da habilidade de linguagem pela escala ELM, 32,5% das crianças apresentaram alterações. O desempenho alterado, considerando os quatro setores do teste de Denver II e da linguagem na escala ELM, após regressão logística, permaneceu associado com: suspeita dos pais de alterações no desenvolvimento (Denver II e ELM); peso <1500 g e cesariana (Denver II somente); hemorragia intracraniana e renda familiar mensal per capita ≤1/2 salário mínimo (ELM somente). Conclusão Crianças nascidas prematuras e com baixo peso apresentaram atraso na aquisição de habilidades no desenvolvimento da linguagem, com maior comprometimento da função auditiva expressiva, associado a fatores de risco socioeconômicos e de histórico. .

Purpose : To examine the language development at chronological age 2 to 3 years of children born preterm with low birth weight and its associated risk factors. Methods In this cross-sectional study, children were assessed using the Denver Developmental Screening Test (Denver II test) and Early Language Milestone Scale (ELM scale). The chi-square test was used and all variables with p<0.20 were entered in a binary logistic regression model; statistical significance was set at p<0.05. Results Among the 77 children studied, 36.4% had abnormal Denver II test performance in its four sectors and 37.6% had cautions and delays in the area of language specifically. On assessment of language ability by the ELM scale, 32.5% of the children showed altered responses. The abnormal performance of the four sectors of the Denver II and language in the ELM scale, after logistic regression, remained associated with suspected developmental abnormalities by parents (Denver II and ELM), weight less than 1500 g and caesarean section (Denver II only), and intracranial hemorrhage and family per capita income less than half the minimum wage (ELM only). Conclusion Children born preterm with low birth weight showed delayed language development, with greater impairment in the expressive auditory function associated with socioeconomic risk factors and child’s history. .

Purpose: To examine the language development at chronological age 2 to 3 years of children born preterm with low birth weight and its associated risk factors. Methods In this cross-sectional study, children were assessed using the Denver Developmental Screening Test (Denver II test) and Early Language Milestone Scale (ELM scale). The chi-square test was used and all variables with p<0.20 were entered in a binary logistic regression model; statistical significance was set at p<0.05. Results Among the 77 children studied, 36.4% had abnormal Denver II test performance in its four sectors and 37.6% had cautions and delays in the area of language specifically. On assessment of language ability by the ELM scale, 32.5% of the children showed altered responses. The abnormal performance of the four sectors of the Denver II and language in the ELM scale, after logistic regression, remained associated with suspected developmental abnormalities by parents (Denver II and ELM), weight less than 1500 g and caesarean section (Denver II only), and intracranial hemorrhage and family per capita income less than half the minimum wage (ELM only). Conclusion Children born preterm with low birth weight showed delayed language development, with greater impairment in the expressive auditory function associated with socioeconomic risk factors and child’s history. .

[Asthma prevalence and risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil]. / Prevalência e fatores de risco para asma em adolescentes de 13 a 14 anos do Município de Cuiabá, Mato Grosso, Brasil.

The objective of this study was to estimate the prevalence of active asthma and identify associated risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil. A cross-sectional population-based and a subsequently a nested case-control study was conducted in 2008 using the protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). Risk factor analysis used the chi-square test, Fisher's exact test, and binary logistic regression. Variables with p < 0.20 in the bivariate analysis entered the logistic regression model, with six variables remaining in the final model (p < 0.05). Prevalence of active asthma was 19.1%. Risk factors for active asthma (p = 0.01) were: smoking during pregnancy, exclusive breastfeeding < 6 months, family income < 3 minimum wages, female gender, pets currently in the home, and absence of fish in the diet. Prevalence of active asthma was high, but with a significant reduction compared to 1998.

Prevalência e fatores de risco para asma em adolescentes de 13 a 14 anos do Município de Cuiabá, Mato Grosso, Brasil / Asthma prevalence and risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil

Estimar a prevalência de asma ativa e identificar possíveis fatores de risco associados em adolescentes de 13 a 14 anos, residentes na cidade de Cuiabá, Mato Grosso, Brasil. Estudo transversal de base populacional sendo posteriormente aninhado a estudo caso-controle, realizado em 2008, utilizando o protocolo do International Study of Asthma and Allergies in Childhood (ISAAC). A análise dos possíveis fatores de risco foi realizada pelo teste do qui-quadrado, teste exato de Fisher e por regressão binária logística. As variáveis com p < 0,20 na análise bivariada entraram no modelo de regressão logística, permanecendo no modelo final seis variáveis (p < 0,05). A prevalência de asma ativa foi de 19,1%. Os fatores de risco para asma ativa (p = 0,01) foram: tabagismo na gestação, seio materno exclusivo < 6 meses, renda familiar < 3 salários mínimos, sexo feminino, animais em casa no presente e ausência de peixe na dieta. A prevalência de asma ativa foi alta com redução significante à encontrada em 1998.

The objective of this study was to estimate the prevalence of active asthma and identify associated risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil. A cross-sectional population-based and a subsequently a nested case-control study was conducted in 2008 using the protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). Risk factor analysis used the chi-square test, Fisher's exact test, and binary logistic regression. Variables with p < 0.20 in the bivariate analysis entered the logistic regression model, with six variables remaining in the final model (p < 0.05). Prevalence of active asthma was 19.1%. Risk factors for active asthma (p = 0.01) were: smoking during pregnancy, exclusive breastfeeding < 6 months, family income < 3 minimum wages, female gender, pets currently in the home, and absence of fish in the diet. Prevalence of active asthma was high, but with a significant reduction compared to 1998.

[Evaluation of the Brazilian surveillance system for adverse events following vaccination]. / Avaliação do sistema brasileiro de vigilância de eventos adversos pós-vacinação.

OBJECTIVES: To describe and evaluate the Brazilian system of passive surveillance of adverse events following immunization (PSAEFI). METHODS: The description and evaluation of PSAEFI were undertaken using the reported cases of adverse events following immunization with DTwP-Hib vaccine (AEFI-T), during the period from 2002 to 2005, using the Centers for Disease Control methodology. RESULTS: The PSAEFI system, which provides national coverage, is designed to standardize practices in cases of adverse events following immunization (AEFI) and to identify highly reactogenic lots of vaccine. The PSAEFI system proved its usefulness, simplicity and flexibility; despite low sensitivity, overestimate the proportion of sever events, but it consistently described AEFI-T, identifying fever, convulsions and hypotonic-hyporesponsive episodes as the most common events. It showed that 49.7% of AEFI-T occur after the first dose, and that 72.8% occur within the first six hours after vaccination. It facilitates public health decisions and epidemiological investigations. It is timely, 46.1% of all AEFI-T being reported within 10 days after vaccination and its completeness ranges from 70 to 90%, depending on the item evaluated. CONCLUSIONS: The PSAEFI system proved useful for monitoring DTwP-Hib vaccine safety. We recommended the incorporation of new methodologies, such the use of sentinel cities/hospitals and computerized immunization registries in order to increase its sensitivity.

Avaliação do sistema brasileiro de vigilância de eventos adversos pós-vacinação / Evaluation of the Brazilian surveillance system for adverse events following vaccination

OBJETIVOS: Descrever e avaliar o Sistema brasileiro de vigilância passiva de eventos adversos pós-vacinação (SPVEAPV). MÉTODOS: A descrição e avaliação do SPVEAPV fundamentaram-se nas notificações de eventos adversos pós-vacina Tetravalente ou DTwP/Hib - vacina adsorvida difteria, tétano, pertussis e Haemophilus influenzae b (conjugada) - (EAPV-T), durante o período de 2002 a 2005. Empregou-se a metodologia proposta pelo Centers for Disease Control and Prevention. RESULTADOS: O SPVEAPV apresenta abrangência nacional, tem por objetivos identificar e padronizar condutas frente a casos de eventos adversos pós-vacinação (EAPV) e identificar lotes reatogênicos. A vigilância é útil, simples e flexível, sua sensibilidade é baixa, superestima os eventos mais graves, mas descreve de forma consistente os EAPV-T, identificando a convulsão, a febre e o episódio hipotônico-hiporresponsivo como os mais frequentes, apontando a maior proporção de EAPV na primeira dose (49,7 por cento) e nas primeiras seis horas após a vacinação (72,8 por cento); é útil ao subsidiar decisões e investigações complementares; 46,1 por cento das notificações são feitas até 10 dias após a vacinação; sua completude varia de 70 por cento a 90 por cento, conforme o item. CONCLUSÕES: O SPVEAPV mostra-se útil no monitoramento da segurança da vacina DTwP/Hib, sendo, porém, recomendável a incorporação de novas metodologias como a de municípios e/ou hospitais sentinelas e a de sistemas informatizados de registros de imunização com a finalidade de elevar sua sensibilidade.

OBJECTIVES: To describe and evaluate the Brazilian system of passive surveillance of adverse events following immunization (PSAEFI). METHODS: The description and evaluation of PSAEFI were undertaken using the reported cases of adverse events following immunization with DTwP-Hib vaccine (AEFI-T), during the period from 2002 to 2005, using the Centers for Disease Control methodology. RESULTS: The PSAEFI system, which provides national coverage, is designed to standardize practices in cases of adverse events following immunization (AEFI) and to identify highly reactogenic lots of vaccine. The PSAEFI system proved its usefulness, simplicity and flexibility; despite low sensitivity, overestimate the proportion of sever events, but it consistently described AEFI-T, identifying fever, convulsions and hypotonic-hyporesponsive episodes as the most common events. It showed that 49.7 percent of AEFI-T occur after the first dose, and that 72.8 percent occur within the first six hours after vaccination. It facilitates public health decisions and epidemiological investigations. It is timely, 46.1 percent of all AEFI-T being reported within 10 days after vaccination and its completeness ranges from 70 to 90 percent, depending on the item evaluated. CONCLUSIONS: The PSAEFI system proved useful for monitoring DTwP-Hib vaccine safety. We recommended the incorporation of new methodologies, such the use of sentinel cities/hospitals and computerized immunization registries in order to increase its sensitivity.

[Infant mortality rate in Cuiabá, Mato Grosso State, Brazil, 2005: a comparison between direct calculation and linkage between the live birth and infant mortality databases]. / Mortalidade infantil em Cuiabá, Mato Grosso, Brasil, 2005: comparação entre o cálculo direto e após o linkage entre bancos de dados de nascidos vivos e óbitos infantis.

This study aimed to analyze the infant mortality rate (IMR) by linking the Live Birth Information System (SINASC) and the Mortality Information System (SIM) and comparing the result to direct calculation using crude data provided by the same databases. The systems used were SINASC, containing 9,590 certificates of live birth from January 1 to December 31, 2005, and SIM, containing 156 death certificates from the reference population (2005). Of the 156 deaths in the year 2005, 126 (80.8%) were paired by the direct method and 11 (7%) by manual search, totaling 137 deaths (87.8%). The rates found with the linkage method allowed calculating the real IMR (14.2 deaths/1,000 live births) and its components. The IMR using linkage was 17.3% lower than as calculated using crude SIM data. The early neonatal component (7.2 deaths/1,000 live births) accounted for half of the deaths in the first year of life (50.4%).