Use of electronic immunization registry in the surveillance of adverse events following immunization.

OBJECTIVE: To describe adverse events following vaccination (AEFV) of children under two years old and analyze trend of this events from 2000 to 2013, in the city of Araraquara (SP), Brazil. METHODS: This is a descriptive study conducted with data of the passive surveillance system of AEFV that is available in the electronic immunization registry (EIR) of the computerized medical record of the municipal health service (Juarez System). The study variables were: age, gender, vaccine, dose, clinical manifestations and hospitalization. We estimated rates using AEFV as numerator and administered doses of vaccines as denominator. The surveillance sensitivity was estimated by applying the method proposed by the Centers for Disease Control and Prevention. We used Prais-Winsten regression with a significance level of 5.0%. RESULTS: The average annual rate of AEFV was 11.3/10,000 administered doses, however without a trend in the study period (p=0.491). Most cases occurred after the first dose (41.7%) and among children under one year of age (72.6%). Vaccines with pertussis component, yellow fever and measles-mumps-rubella were the most reactogenic. We highlighted the rates of hypotonic-hyporesponsive episodes and convulsion that were 4.1/10,000 and 1.5/10,000 doses of vaccines with pertussis component, respectively, most frequently in the first dose; 60,0% of cases presented symptoms in the first 24 hours after vaccination, however, 18.6% showed after 96 hours. The sensitivity of surveillance was 71.9% and 78.9% for hypotonic-hyporesponsive episodes and convulsion, respectively. CONCLUSIONS: The EIR-based AEFV surveillance system proved to be useful and highly sensitive to describe the safety profile of vaccines in a medium-sized city. It was also shown that the significant increase of the vaccines included in the basic vaccination schedule in childhood in the last decade did not alter the high safety standard of the National Immunization Program.

Use of electronic immunization registry in the surveillance of adverse events following immunization / Uso de registro informatizado de imunização na vigilância de eventos adversos pós-vacina

ABSTRACT OBJECTIVE To describe adverse events following vaccination (AEFV) of children under two years old and analyze trend of this events from 2000 to 2013, in the city of Araraquara (SP), Brazil. METHODS This is a descriptive study conducted with data of the passive surveillance system of AEFV that is available in the electronic immunization registry (EIR) of the computerized medical record of the municipal health service (Juarez System). The study variables were: age, gender, vaccine, dose, clinical manifestations and hospitalization. We estimated rates using AEFV as numerator and administered doses of vaccines as denominator. The surveillance sensitivity was estimated by applying the method proposed by the Centers for Disease Control and Prevention. We used Prais-Winsten regression with a significance level of 5.0%. RESULTS The average annual rate of AEFV was 11.3/10,000 administered doses, however without a trend in the study period (p=0.491). Most cases occurred after the first dose (41.7%) and among children under one year of age (72.6%). Vaccines with pertussis component, yellow fever and measles-mumps-rubella were the most reactogenic. We highlighted the rates of hypotonic-hyporesponsive episodes and convulsion that were 4.1/10,000 and 1.5/10,000 doses of vaccines with pertussis component, respectively, most frequently in the first dose; 60,0% of cases presented symptoms in the first 24 hours after vaccination, however, 18.6% showed after 96 hours. The sensitivity of surveillance was 71.9% and 78.9% for hypotonic-hyporesponsive episodes and convulsion, respectively. CONCLUSIONS The EIR-based AEFV surveillance system proved to be useful and highly sensitive to describe the safety profile of vaccines in a medium-sized city. It was also shown that the significant increase of the vaccines included in the basic vaccination schedule in childhood in the last decade did not alter the high safety standard of the National Immunization Program.

RESUMO OBJETIVO Descrever os eventos adversos pós-vacina ocorridos em crianças com até dois anos de idade e analisar a tendência desses eventos, entre 2000 e 2013, em Araraquara, SP, Brasil. MÉTODOS Estudo descritivo com dados da vigilância passiva de eventos adversos pós-vacina, disponíveis no registro informatizado de imunização do prontuário eletrônico do serviço municipal de saúde (Sistema Juarez). As variáveis de estudo foram: idade, sexo, vacina, dose, manifestações clínicas e hospitalização. As taxas foram estimadas tomando-se os casos de eventos adversos pós-vacina como numerador e as doses aplicadas, como denominador. Estimou-se a sensibilidade da vigilância de eventos adversos pós-vacina aplicando-se o método proposto pelo Centers for Disease Control and Prevention. Para análise de tendência utilizou-se a regressão de Prais-Winsten, considerando o nível de significância de 5,0%. RESULTADOS A taxa anual média de eventos adversos pós-vacina foi de 11,3/10.000 doses aplicadas, porém, sem tendência no período estudado (p = 0,491). Houve predomínio de casos após a primeira dose (41,7%) e entre menores de um ano de idade (72,6%). As vacinas com componente pertussis, de febre amarela e de sarampo-caxumba-rubéola foram as mais reatogênicas. Destacou-se a frequência de episódio hipotônico hiporresponsivo e convulsão, com taxas de 4,1/10.000 e 1,5/10.000 doses de vacinas com componente pertussis, respectivamente, mais elevadas na primeira dose; 60,0% dos casos apresentaram sintomas nas primeiras 24 horas após a vacinação e 18,6% apresentaram-se após 96 horas. A sensibilidade da vigilância foi estimada em 71,9% e 78,9% para episódio hipotônico hiporresponsivo e convulsão, respectivamente. CONCLUSÕES O sistema de vigilância de eventos adversos pós-vacina com base no registro informatizado de imunização mostrou-se útil e dotado de elevada sensibilidade para descrever o perfil de segurança das vacinas em um município de médio porte. Adicionalmente, a expressiva ampliação, na última década, das vacinas incluídas no esquema básico de vacinação na infância não alterou o elevado padrão de segurança do Programa Nacional de Imunizações.

Vaccination coverage according to doses received and timely administered based on an electronic immunization registry, Araraquara-SP, Brazil, 2012-2014. / Coberturas vacinais por doses recebidas e oportunas com base em um registro informatizado de imunização, Araraquara-SP, Brasil, 2012-2014.

OBJECTIVE: to describe vaccine coverage by type of vaccine at 12 and 24 months of age. METHODS: descriptive cohort study with children born in 2012, living in Araraquara-SP, Brazil, recorded in the Information System on Live Births (Sinasc); a manual linkage of Sinasc data with an electronic immunization registry (EIR) was performed; the assessment was based on vaccination status according to São Paulo State recommendations, and on doses received and timely administered. RESULTS: 2,740 children were registered on Sinasc and 99.6% of them were included into EIR; among the 2,612 (95.3%) children studied, the triple viral vaccine (measles, mumps and rubella) had the lowest coverage at 12 months for received dose (74.8%) and at 24 months for timely vaccination (53.5%) and received doses (88.0%). CONCLUSION: coverage was higher than 90% for most vaccines; however, delayed vaccination was observed, which indicates the need to intensify actions aimed at timely vaccination.

Coberturas vacinais por doses recebidas e oportunas com base em um registro informatizado de imunização, Araraquara-SP, Brasil, 2012-2014 / Coberturas de vacunación según las dosis recibidas y oportunas basada en un registro computarizado de inmunización, Araraquara-SP, Brasil, 2012-2014 / Vaccination coverage according to doses received and timely administered based on an electronic immunization registry, Araraquara-SP, Brazil, 2012-2014

OBJETIVO: descrever as coberturas vacinais por tipo de vacina aos 12 e aos 24 meses de idade. Métodos: estudo de coorte descritivo com crianças nascidas em 2012, residentes em Araraquara-SP, Brasil, registradas no Sistema de Informações sobre Nascidos Vivos (Sinasc); realizou-se relacionamento manual dos dados do Sinasc com um registro informatizado de imunização (RII); avaliou-se a situação vacinal pelas recomendações do estado de São Paulo, por doses recebidas e oportunas. Resultados: 2.740 crianças estavam registradas no Sinasc; dessas, 99,6% constavam no RII; entre as 2.612 (95,3%) crianças estudadas, a vacina tríplice viral (sarampo, caxumba e rubéola) apresentou as menores coberturas aos 12 meses por doses recebidas (74,8%) e aos 24 meses por doses oportunas (53,5%) e recebidas (88,0%). Conclusão: as coberturas foram superiores a 90% para a maioria das vacinas; entretanto, observou-se atraso vacinal, o que aponta a necessidade de intensificar ações que visem à vacinação oportuna.

OBJETIVO: describir las coberturas de vacunación, por tipo de vacuna, a los 12 y 24 meses de edad. MÉTODOS: estudio de cohorte descriptivo de nacidos en 2012, viviendo en Araraquara-SP, Brasil, registrados en el Sistema de Información de Nacidos Vivos (Sinasc); se realizó vinculación manual de Sinasc con un registro computarizado de inmunización (RCI); se evaluó el estado de vacunación siguiendo recomendaciones del estado de São Paulo, según dosis recibidas y oportunas. RESULTADOS: 2.740 niños fueron registrados en el Sinasc y 99,6% estaban en el RCI; entre los 2.612 (95,3%) niños estudiados, la vacuna triple viral (sarampión, paperas y rubéola) tuvo menor cobertura a los 12 meses según dosis recibidas (74,8%) y a los 24 meses según dosis oportunas (53,5%,) y recibidas (88,0%). CONCLUSIÓN: las coberturas fueron superiores al 90% para la mayoría de vacunas; no obstante, se observó un retraso de vacunaciones, que indica necesidad de intensificar acciones destinadas a la vacunación oportuna.

OBJECTIVE: to describe vaccine coverage by type of vaccine at 12 and 24 months of age. METHODS: descriptive cohort study with children born in 2012, living in Araraquara-SP, Brazil, recorded in the Information System on Live Births (Sinasc); a manual linkage of Sinasc data with an electronic immunization registry (EIR) was performed; the assessment was based on vaccination status according to São Paulo State recommendations, and on doses received and timely administered. RESULTS: 2,740 children were registered on Sinasc and 99.6% of them were included into EIR; among the 2,612 (95.3%) children studied, the triple viral vaccine (measles, mumps and rubella) had the lowest coverage at 12 months for received dose (74.8%) and at 24 months for timely vaccination (53.5%) and received doses (88.0%). CONCLUSION: coverage was higher than 90% for most vaccines; however, delayed vaccination was observed, which indicates the need to intensify actions aimed at timely vaccination.

Cobertura vacinal e fatores associados à vacinação incompleta em município de médio porte, Estado de São Paulo, Brasil / Vaccination coverage and factors associated with incomplete vaccination in a medium-sized municipality, São Paulo State, Brazil

Introdução: Araraquara (SP) possui um programa de vacinação bem sucedido desde a década de 80, com o mais antigo Registro Informatizado de Imunização (RII) do país. Objetivos: Estimar a cobertura vacinal (CV) aos 12 e 24 meses de vida, em crianças nascidas em 2012, no município de Araraquara, investigar fatores associados à vacinação incompleta e analisar os eventos adversos pós-vacinação (EAPV). Métodos: Estudo observacional com componentes descritivo e analítico, abrangendo a coorte de crianças nascidas em 2012, residentes no município e registradas no Sistema de Informação de Nascidos Vivos (SINASC). Foram excluídas as crianças que faleceram no primeiro ano de vida e aquelas que se mudaram de Araraquara. As variáveis do estudo incluíram dados de vacinação e características maternas, de pré- natal/nascimento, do(s) serviço(s) de saúde e da área de residência. Estimou-se as CV e respectivos intervalos de confiança de 95 por cento (IC 95 por cento ) para cada vacina e esquema completo, conforme as normas vigentes no Estado de São Paulo em 2012/2013. A associação entre o esquema vacinal incompleto e as variáveis independentes foi investigada por meio da estimativa da odds ratio (OR) bruta e ajustada, por regressão logística múltipla não condicional hierarquizada, com os respectivos IC 95 por cento . Resultados: 2740 crianças estavam registradas no SINASC como residentes e 99,6 por cento dessas constavam no RII. Após excluir 30 óbitos (1,1 por cento ) e 98 crianças que se mudaram (3,6 por cento ), foram estudadas 2612 crianças. A CV para o esquema completo por doses recebidas aos 12 meses foi 67,9 por cento e aos 24 meses 79,7 por cento ; por doses oportunas foi 46,2 por cento e 32,8 por cento , respectivamente. A vacina sarampo, caxumba e rubéola apresentou a menor CV aos 12 meses por dose recebida (74,8 por cento ) e aos 24 meses por dose oportuna (53,5 por cento ). As vacinas com componente pertussis foram responsáveis por 58,8 por cento (10/17) dos casos de EAPV e febre foi a manifestação mais comum. A distribuição espacial da CV do esquema completo por área de residência não apresentou diferença estatística. No modelo final, mostraram-se independentemente associadas à vacinação incompleta: mães com idade entre 14 e 19 anos [aos 12 meses (OR:2,0); aos 24 meses (OR:2,5)]; com 12 anos ou mais de estudo [aos 12 meses (OR:1,9), aos 24 meses (OR:2,3)]; com três ou mais filhos [aos 12 meses (OR:3,2), aos 24 meses (OR:2,1)]; com menos de sete consultas de pré-natal [aos 12 meses (OR:1,7), aos 24 meses (OR:2,3)]; a criança ter frequentado unidade de saúde (US) pública e privada [aos 12 meses (OR:6,0), aos 24 meses (OR:8,0)], sem Estratégia Saúde da Família [aos 24 meses (OR:1,5)]; e ter vínculo fraco com a US [aos 24 meses (OR:1,4)]. Conclusão: Em Araraquara, a CV por vacina não é homogênea e há atraso vacinal. O uso do RII para o seu monitoramento pode constituir uma estratégia efetiva. A ausência de disparidades nas CV entre as distintas áreas de residência sugere a efetividade do programa de imunização na promoção da equidade em saúde. Recomenda-se priorizar ações de incentivo à vacinação de crianças filhas de mulheres com alta escolaridade e que apresentam vínculo mais frágil com os serviços públicos de saúde

Introduction: Araraquara (SP) has a successful vaccination program since the 80\'s, with the oldest Electronic Immunization Registry (EIR) in the country. Objectives: To estimate vaccination coverage (VC) at 12 and 24 months of life in children born in 2012 in the city of Araraquara, to investigate factors associated with incomplete vaccination and to analyze the adverse events following immunization (AEFI). Methods: An observational descriptive and analytical study comprising the cohort of children born in 2012, living in the city of Araraquara and recorded in the Live Births Information System (SINASC). Children who died in the first year of life or who moved from Araraquara were excluded. Study variables included vaccination data and characteristics of the mother, the antenatal/birth, the health unit (HU) and the area of residence. VC and the respective 95 per cent confidence intervals (95 per cent CI) were estimated for each vaccine and complete schedule, following the São Paulo\'s State recommendations in the years 2012/2013. The association between the incomplete vaccination schedule and the independent variables was investigated by estimating the crude and adjusted odds ratio (OR) by hierarchical non-conditional multiple logistic regression with the respective 95 per cent CI. Results: 2740 children were enrolled in the SINASC as residents and 99.6 per cent of them were in the EIR. After excluding 30 deaths (1.1 per cent ) and 98 children who moved (3.6 per cent ), 2612 children were studied. VC by received doses for the complete schedule at 12 months was 67.9 per cent and at 24 months was 79.7 per cent ; by timely doses was 46.2 per cent and 32.8 per cent , respectively. The measles, mumps and rubella vaccine had the lowest VC at 12 months per received dose (74.8 per cent ) and at 24 months per timely dose (53.5 per cent ). Vaccines with pertussis componente were responsible for 58.8 per cent (10/17) of AEFI cases and fever was the most common manifestation. The spatial distribution of VC of the complete schedule by area of residence did not present statistical difference. In the final model, incomplete vaccination was associated with mother between 14 and 19 years old [at 12 months (OR: 2.0); at 24 months (OR: 2.5)]; with 12 years or more of study [at 12 months (OR: 1.9), at 24 months (OR: 2.3) ]; with three or more children [at 12 months (OR: 3.2), at 24 months (OR: 2.1)]; with less than seven antenatal visits [at 12 months (OR: 1.7), at 24 months (OR: 2.3)]; the child has attended both public and private HU [at 12 months (OR: 6.0), at 24 months (OR: 8.0)], a HU without Family Health Strategy [at 24 months (OR: 1.5)]; and who had a weak link with the HU [at 24 months (OR: 1.4)]. Conclusion: VC per vaccine is not homogeneous in Araraquara and there is a vaccine delay. The use of RII for its monitoring can be an effective strategy. The lack of disparities in VC among the different areas of residence suggests the effectiveness of the immunization program in promoting health equity. It is recommended to prioritize actions to encourage children vaccination of mothers with high schooling and who have a more fragile link with public HU

Factors associated with incomplete or delayed vaccination across countries: A systematic review.

BACKGROUND: Despite the significant decline in the incidence of vaccine-preventable diseases as a result of increased vaccination coverage worldwide, there are many children with delayed vaccination and a marked heterogeneity in vaccination coverage. OBJECTIVE: The aim of this study was to review factors that influence the adherence to childhood immunization schedule in different countries, especially related to socioeconomic conditions and health care system characteristics. METHODS: Pubmed and Web of Science databases were searched systematically for observational studies published in peer-reviewed journals in English, Spanish and Portuguese languages from January 1992 to June 2014. We included original articles that assessed vaccination schedule with at least three diphtheria-tetanus-pertussis, three polio and one measles vaccines in children aged 0-24 months. RESULTS: 491 articles were identified and 23 met the inclusion criteria and were reviewed. The most cited factors reported by countries with distinct characteristics were higher birth order (9 articles, 39.1%), and low maternal education/socioeconomic status (7 articles each one, 30.4%). Irregular monitoring by the health care services was reported by countries with "mainly private" health care system. Out-of-hospital birth, no reminder(s) about the next follow-up visit, and mother working outside the home were cited by countries with low/medium Human Development Index (HDI). Ethnicity, use of private health care services, and no health insurance were cited by countries with very high HDI. The role of migration on vaccination coverage was reported by three studies conducted in countries with distinct characteristics. CONCLUSIONS: The factors are complex and driven by context. Overall, strengthening the contacts and relationships between the health care services and mothers with several children and families with low educational level/low socioeconomic status appear to be an important action to improve vaccination coverage.

Meningococcal disease before and after the introduction of meningococcal serogroup C conjugate vaccine. Federal District, Brazil

OBJECTIVES: To analyze the behavior of meningococcal disease in the Federal District, Brazil, from 2005 to 2011, and to assess the direct impact of the meningococcal serogroup C conjugate vaccine. METHODS: A descriptive study of cases of meningococcal disease among residents of the Federal District. We included in the study confirmed cases of meningococcal disease reported to the local surveillance. To reduce underreporting we compared data to the Brazilian Mortality Database and the Public Health Laboratory Database. We studied sociodemographic, clinical, and pathogen-related variables. For the assessment of the impact of meningococcal serogroup C conjugate vaccine, which was introduced in 2010 for children under two years of age, we compared the incidence of meningococcal disease before and after vaccine introduction in the recommended age groups for vaccination. RESULTS: We identified 309 cases of meningococcal disease, of which 52.1% were males. The average case fatality rate was 20.7%, the median age was three years and there was a predominance of serogroup C (70.2%) and C:23:P1.14-6 phenotype throughout the study period. In 2005-2009, 2010 and 2011, the incidence rates of meningococcal disease were 2.0, 1.8 and 0.8/100,000 inhabitants/year, while mortality rates were 0.4, 0.4 and 0.2/100,000 inhabitants/year, respectively. In the first and last periods, the incidence in poorer and more affluent areas were, respectively, 2.0 and 0.8, and 0.9 and 0.0/100,000 inhabitants/year. Comparing 2009 (the year prior to the introduction of meningococcal serogroup C conjugate vaccine) and 2011, there was 85% reduction in the incidence of serogroup C meningococcal disease in children under four years of age, from 9.0 to 1.3/100,000 (p < 0.01). CONCLUSIONS: The meningococcal serogroup C conjugate vaccine strategy implemented in Brazil proved highly effective and had a strong direct impact on the target population. However, case ...

Meningococcal disease before and after the introduction of meningococcal serogroup C conjugate vaccine. Federal District, Brazil.

OBJECTIVES: To analyze the behavior of meningococcal disease in the Federal District, Brazil, from 2005 to 2011, and to assess the direct impact of the meningococcal serogroup C conjugate vaccine. METHODS: A descriptive study of cases of meningococcal disease among residents of the Federal District. We included in the study confirmed cases of meningococcal disease reported to the local surveillance. To reduce underreporting we compared data to the Brazilian Mortality Database and the Public Health Laboratory Database. We studied sociodemographic, clinical, and pathogen-related variables. For the assessment of the impact of meningococcal serogroup C conjugate vaccine, which was introduced in 2010 for children under two years of age, we compared the incidence of meningococcal disease before and after vaccine introduction in the recommended age groups for vaccination. RESULTS: We identified 309 cases of meningococcal disease, of which 52.1% were males. The average case fatality rate was 20.7%, the median age was three years and there was a predominance of serogroup C (70.2%) and C:23:P1.14-6 phenotype throughout the study period. In 2005-2009, 2010 and 2011, the incidence rates of meningococcal disease were 2.0, 1.8 and 0.8/100,000 inhabitants/year, while mortality rates were 0.4, 0.4 and 0.2/100,000 inhabitants/year, respectively. In the first and last periods, the incidence in poorer and more affluent areas were, respectively, 2.0 and 0.8, and 0.9 and 0.0/100,000 inhabitants/year. Comparing 2009 (the year prior to the introduction of meningococcal serogroup C conjugate vaccine) and 2011, there was 85% reduction in the incidence of serogroup C meningococcal disease in children under four years of age, from 9.0 to 1.3/100,000 (p<0.01). CONCLUSIONS: The meningococcal serogroup C conjugate vaccine strategy implemented in Brazil proved highly effective and had a strong direct impact on the target population. However, case fatality rates of meningococcal disease remain high with a wide gap in the risk of disease between poor and affluent areas, pointing to the need to reexamine the current strategy on a regular base.

Aspectos epidemiológicos da doença meningocócica no Distrito Federal, 2000 a 2011 / Epidemiological aspects of meningococcal disease in the Distrito Federal from 2000 to 2011

Objetivos: Analisar o comportamento da doença meningocócica (DM) no Distrito Federal (DF), no período de 2000 a 2011, investigar fatores associados à gravidade da doença e avaliar o impacto da introdução, em 2010, da vacina conjugada contra o meningococo C. Métodos: Trata-se de um estudo com um componente descritivo e outro analítico, abrangendo os residentes no DF que apresentaram DM. Foram incluídos os casos confirmados de DM registrados nos sistemas de informação de notificação e/ou de mortalidade e/ou do laboratório. Para a investigação de fatores associados ao óbito por DM, a variável dependente foi evolução e as variáveis independentes foram sexo, idade, forma clínica e sorogrupo da Neisseria meningitidis. Na avaliação do impacto da introdução da vacina conjugada contra o meningococo C, foram comparadas as taxas de incidência do período pré e pósvacina, por grupo etário. Resultados: Foram analisados 490 casos confirmados de DM no período. A cepa que predominou antes de 2005 foi a B:4,7:P1.19,15 com 67,8 por cento (61/90) e, a partir desse ano, predominaram as cepas C:23:P1.14-6 com 40,9 por cento (61/149) e C:2a:P1.5,2 com 12,8 por cento (19/149). As taxas médias anuais de incidência e de mortalidade por DM, no período, foram, respectivamente, 1,7 e 0,4/100.000 habitantes/ano e a letalidade média foi 21 por cento . A taxa de incidência de DM foi maior nas crianças menores de um ano, variando de 13,1 em 2011 a 38,7/100.000 habitantes/ano em 2000. A letalidade foi maior no grupo de 40 anos e mais, 40 por cento , e entre as crianças com dois anos, 32 por cento . A região administrativa (RA) do Paranoá foi a que apresentou as mais elevadas taxas médias anuais de incidência, 3,3/100.000 habitantes, e de mortalidade, 0,6/100.000 habitantes. Os menores de dois anos e os com idade maior ou igual a 30 anos tiveram risco significativamente maior para óbito, assim como as formas clínicas meningococcemia e meningite com meningococcemia. Houve uma redução estatisticamente significativa (p = 0,02) da incidência de DM em menores de dois anos do ano de 2009, 21,3/100.000 habitantes/ano, para o ano de 2011, 6,6/100.000 habitantes/ano. Conclusão: Esse estudo possibilitou verificar os grupos etários mais atingidos por DM, os fenótipos circulantes, as RA com as maiores taxas de incidência e de mortalidade e fazer uma avaliação preliminar do impacto da vacina conjugada contra o sorogrupo C, após o primeiro ano de sua introdução no calendário infantil de imunização.

[Hepatitis B mortality in Brazil, 2000-2009]. / Mortalidade por hepatite viral B no Brasil, 2000-2009.

This descriptive study focused on the mortality profile associated with hepatitis B virus (HBV) in Brazil as a whole and by region, based on data from the Mortality Information System (MIS). The study sample consisted of deaths from HBV recorded in the MIS from January 1, 2000, to December 31, 2009. The crude mortality rate remained constant in the country; the proportion of hepatocellular carcinoma with HBV as the associated cause was no greater than 7%. The standardized mortality rate was highest in the North of Brazil, and the proportional mortality rate was higher in males. In 2009, the potential years of life lost (PYLL) were highest in males in the 50-59-year age bracket and in females in the 40-49-year bracket. The largest increase in PYLL occurred in males 60 to 69 years of age. The study emphasizes the importance of scaling up preventive measures against HBV, in addition to expanding access to early diagnosis in order to reduce HBV mortality in the coming decades.

Mortalidade por hepatite viral B no Brasil, 2000-2009 / Hepatitis B mortality in Brazil, 2000-2009

Este trabalho trata-se de estudo descritivo, cujo objetivo foi descrever o perfil de mortalidade pelo vírus da hepatite B (VHB) no Brasil e regiões, com base nos dados disponíveis no Sistema de Informações sobre Mortalidade (SIM). Constituíram a população de estudo os óbitos pelo VHB registrados no SIM durante o período de 1º de janeiro de 2000 a 31 de dezembro de 2009. A taxa bruta de mortalidade no país permaneceu constante; a proporção de óbitos por hepatocarcinoma com VHB como causa associada não ultrapassou 7 por cento. A taxa de mortalidade padronizada foi maior na Região Norte, e a mortalidade proporcional foi maior no sexo masculino. Em 2009, os anos potenciais de vida perdidos (APVP) no sexo masculino foram maiores no grupo etário de 50 a 59 anos; no sexo feminino, no grupo de 40 a 49 anos. O maior aumento da taxa de APVP ocorreu no sexo masculino (60 a 69 anos). Esta pesquisa reforça a importância de se aumentarem as medidas de prevenção contra a hepatite B, além de se ampliar o acesso ao diagnóstico precoce para que haja a redução da mortalidade nas próximas décadas.

This descriptive study focused on the mortality profile associated with hepatitis B virus (HBV) in Brazil as a whole and by region, based on data from the Mortality Information System (MIS). The study sample consisted of deaths from HBV recorded in the MIS from January 1, 2000, to December 31, 2009. The crude mortality rate remained constant in the country; the proportion of hepatocellular carcinoma with HBV as the associated cause was no greater than 7 percent. The standardized mortality rate was highest in the North of Brazil, and the proportional mortality rate was higher in males. In 2009, the potential years of life lost (PYLL) were highest in males in the 50-59-year age bracket and in females in the 40-49-year bracket. The largest increase in PYLL occurred in males 60 to 69 years of age. The study emphasizes the importance of scaling up preventive measures against HBV, in addition to expanding access to early diagnosis in order to reduce HBV mortality in the coming decades.

[Prevalence of respiratory symptoms in areas of the Federal District, Brazil]. / Prevalência de sintomáticos respiratórios em regiões do Distrito Federal, Brasil.

The identification of individuals with respiratory symptoms (RS) is important for the early detection of tuberculosis. The aim of this study was to estimate the prevalence of RS in three administrative regions of the Federal District, Brazil. For this, we used the 30 by 7 cluster sampling technique proposed by the World Health Organization. Individuals with RS were defined as those aged 15 years or older living in the administrative regions of Estrutural, Itapoã, or Varjão and reporting a cough lasting at least 3 weeks at the date of the interview. The prevalence of RS was 5.7% in Estrutural and Varjão (95% CI: 2.4-9.0) and 4.8% in Itapoã (95%CI: 1.6-7.9), with a design effect close to 1.0. In Estrutural and Itapoã, fewer years of schooling, and in Itapoã and Varjão, lower income, were associated with RS. Cigarette smoking was associated with the presence of RS in all regions. The prevalence of RS in the three administrative regions investigated is consistent with that of other areas with a similar socioeconomic profile.

Prevalência de sintomáticos respiratórios em regiões do Distrito Federal, Brasil / Prevalence of respiratory symptoms in areas of the Federal District, Brazil

A captação de sintomáticos respiratórios (SR) é importante para a detecção precoce de tuberculose. O objetivo deste estudo foi estimar a prevalência de SR em três regiões administrativas (RA) do Distrito Federal, Brasil. Para tanto, foi utilizada a técnica de amostragem por conglomerados (30 por 7) proposta pela Organização Mundial da Saúde. Foram definidos como SR os indivíduos com 15 anos ou mais residentes nas RAs Estrutural, Itapoã ou Varjão e que apresentassem tosse há pelo menos 3 semanas na data da entrevista. A prevalência de SR em Estrutural e Varjão foi de 5,7 por cento (IC95 por cento: 2,4 a 9,0), e em Itapoã, de 4,8 por cento (IC95 por cento: 1,6 a 7,9), com efeito de desenho próximo de 1,0. Em Estrutural e Itapoã, menos anos de estudo, e em Itapoã e Varjão, menor renda, estiveram associados com ser SR. O tabagismo esteve associado com a presença de sintomas respiratórios em todas as RAs. A prevalência de SR está de acordo com aquela encontrada em outras áreas com perfil socioeconômico semelhante ao das áreas estudadas.

The identification of individuals with respiratory symptoms (RS) is important for the early detection of tuberculosis. The aim of this study was to estimate the prevalence of RS in three administrative regions of the Federal District, Brazil. For this, we used the 30 by 7 cluster sampling technique proposed by the World Health Organization. Individuals with RS were defined as those aged 15 years or older living in the administrative regions of Estrutural, Itapoã, or Varjão and reporting a cough lasting at least 3 weeks at the date of the interview. The prevalence of RS was 5.7 percent in Estrutural and Varjão (95 percent CI: 2.4-9.0) and 4.8 percent in Itapoã (95 percentCI: 1.6-7.9), with a design effect close to 1.0. In Estrutural and Itapoã, fewer years of schooling, and in Itapoã and Varjão, lower income, were associated with RS. Cigarette smoking was associated with the presence of RS in all regions. The prevalence of RS in the three administrative regions investigated is consistent with that of other areas with a similar socioeconomic profile.

[Hepatite A outbreak in an urban area of Luziânia, State of Goiás, Brazil, 2009]. / Surto de hepatite A em área urbana de Luziânia, Estado de Goiás, 2009.

INTRODUCTION: This paper describes the investigation to confirm an outbreak of hepatitis A, presents the case distribution by person, time and place, formulates a hypothesis concerning the mode of transmission and presents the recommended measures for prevention and control. METHODS: A descriptive study of a case series and an environmental research were conducted. RESULTS: An outbreak of hepatitis A was confirmed beginning in March 2009. Forty one (71%) individuals in the town received untreated water in their households. Thermotolerant coliform bacteria were detected in 20/58 (34%) water samples. CONCLUSIONS: Consumption of contaminated water was the main hypothesis of virus transmission.

Surto de hepatite A em área urbana de Luziânia, Estado de Goiás, 2009 / Hepatite A outbreak in an urban area of Luziânia, State of Goiás, Brazil, 2009

INTRODUÇÃO: Os objetivos desse estudo foram confirmar a existência de um surto de hepatite A, descrever o evento por pessoa, tempo e lugar, formular hipóteses sobre modo de transmissão e propor medidas de prevenção e controle. MÉTODOS: Realizado um estudo descritivo do tipo série de casos e investigação ambiental. RESULTADOS: Ocorreu um surto a partir de março de 2009. Quarenta e uma (71 por cento) pessoas recebiam água sem tratamento no seu domicílio. Foram detectados coliformes termotolerantes em 20/58 (34 por cento) amostras de água. CONCLUSÕES: A investigação sugere que a hipótese principal para esse surto foi à ingestão de água contaminada.

INTRODUCTION: This paper describes the investigation to confirm an outbreak of hepatitis A, presents the case distribution by person, time and place, formulates a hypothesis concerning the mode of transmission and presents the recommended measures for prevention and control. METHODS: A descriptive study of a case series and an environmental research were conducted. RESULTS: An outbreak of hepatitis A was confirmed beginning in March 2009. Forty one (71 percent) individuals in the town received untreated water in their households. Thermotolerant coliform bacteria were detected in 20/58 (34 percent) water samples. CONCLUSIONS: Consumption of contaminated water was the main hypothesis of virus transmission.