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.

Staphilococcus aureus enterotoxigênicos em manipuladores de alimentos, Distrito Federal, Brasil / Enterotoxigenci Staphylococcus Aureus in Food Handlers in Distrito Federal, Brazil

Este estudo avalia a freqüência da bactéria Staphilococcus aureus produtora de enterotoxinas em 53 (cinqüenta e três) manipuladores de alimentos pertencentes a 06 (seis) cozinhas industriais, instaladas no Distrito Federal. As amostras de material dos manipuladores foram coletadas das fossas nasais, de ambas narinas, ferimentos e lesão subungueal quando presentes, por duas vezes consecutivas, no intervalo de quinze dias. Os resultados revelaram que cerca de 34 amostras apresentaram-se positivas para S. aureus e 91 por cento delas foram produtoras de, no mínimo, um tipo de toxina. Foram identificadas toxinas dos tipos A, B e C, sendo a do tipo C, a que obteve maior freqüência no conjunto. A presença de S. aureus enterotoxigênico nesta categoria de trabalhadores (41,5) por cento aponta para a importância da adoção de procedimentos de manipulação corretos na elaboração das refeições, com fins de evitar a ocorrência de surtos de intoxicação alimentar por S. aureus entre os comensais que freqüentam cozinhas industriais e estabelecimentos alimentares similares

Staphylococcus aureus and salmonella enteritidis present in food implicated in food poisoning

Duzentas e oitenta pessoas foram acometidas por diarréia, vômito, febre, cólica intestinal e dores de cabeça em um período de 6 a 15 horas, após a ingestäo de maionese em um restaurante de Brasilia. Salmonella enteritidis e Staphylococcus aureus foram isolados a partir deste alimento. Os sintomas observados säo típicos de salmoneloses como de enterotoxinas estafilococicas, com exceçäo da febre, que é mais comum na primeira. O período de incubaçäo está dentro daquele observado nas salmoneloses, enquanto as toxinfecçöes estafilocócicas o tempo máximo é de 6 horas. O S. aureus deveter tido a sua origem dos manipuladores enquanto a S. enteritidis, nos ovos utilizados no preparo da maionese. Surtos de salmoneloses por S. enteritidis, em decorrência do consumo de ovos, foram relatados na Inglaterra e Estados Unidos. A contagem elevada de S. aureus no alimento é suficiente para produzir enterotoxina, porém os sintomas devem ter sido brandos, porque uma pequena quantidade do alimento deve ter sido consumida. As linhagens S. aureus isoladas näo foram testadas quanto à produçäo de enterotoxina e nem a presença de enteroxina foi pesquisada no alimento. Devido à presença de S. aureus no alimento, os manipuladores foram submetidos a exame microbiológico e constatou-se que, dentre estes, vários eram portadores de S.aureus enterotoxigênicos. Estas informaçöes säo importantes, pois a maioria das toxinfecçöes alimentares por enterotoxina estafilocócicas é de corrente da contaminaçäo do alimento pelos manipuladores