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1.
Pediatr Infect Dis J ; 39(1): 68-69, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31725551

RESUMO

Yellow fever is an endemic disease in tropical areas in America and Africa. We report a case where the wild-type yellow fever virus was detected in a breast milk sample of a 33-year-old woman, from a rural area in the municipality of São Paulo, thus highlighting a potential risk for transmission of yellow fever virus through breast-feeding.

2.
BMJ Open ; 9(11): e027207, 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31772079

RESUMO

INTRODUCTION: An ongoing outbreak of yellow fever (YF) has been reported in Brazil with 1261 confirmed cases and 409 deaths since July 2017. To date, there is no specific treatment available for YF. Recently published papers describing in vitro and animal models suggest a potential effect of antiviral drugs (approved for the treatment of hepatitis virus) against flaviviruses, including YF. The primary aim of this study is to analyse the effect of sofosbuvir on viral kinetics and clinical outcomes among patients presenting with YF. This is a multicentre open-label randomised controlled trial with 1:1 individual allocation, stratified by severity and by recruiting centre. METHODS AND ANALYSIS: Adults with suspected or confirmed YF infection and symptoms lasting up to 15 days are screened. Eligible and consenting patients are randomised to receive oral sofosbuvir 400 mg daily for 10 days or to receive standard clinical care. Viral kinetics are measured daily and the reduction in YF plasma viral load from the sample at inclusion to 72 hours after randomisation will be compared between active and control groups. Clinical outcomes include severity meeting criteria for intensive care support, liver transplantation, in-hospital mortality and mortality within 60 days. ETHICS AND DISSEMINATION: Ethics approval was obtained at the participating sites and at the national research ethics committee (CAAE 82673018.6.1001.0068). The trial has been submitted for ethical approval at additional potential recruiting centres. Results of the study will be published in journals and presented at scientific meetings. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (RBR-93dp9n).

3.
BMJ Open ; 9(11): 027207, Nov. 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1026370

RESUMO

INTRODUCTION: An ongoing outbreak of yellow fever (YF) has been reported in Brazil with 1261 confirmed cases and 409 deaths since July 2017. To date, there is no specific treatment available for YF. Recently published papers describing in vitro and animal models suggest a potential effect of antiviral drugs (approved for the treatment of hepatitis virus) against flaviviruses, including YF. The primary aim of this study is to analyse the effect of sofosbuvir on viral kinetics and clinical outcomes among patients presenting with YF. This is a multicentre open-label randomised controlled trial with 1:1 individual allocation, stratified by severity and by recruiting centre. METHODS AND ANALYSIS: Adults with suspected or confirmed YF infection and symptoms lasting up to 15 days are screened. Eligible and consenting patients are randomised to receive oral sofosbuvir 400 mg daily for 10 days or to receive standard clinical care. Viral kinetics are measured daily and the reduction in YF plasma viral load from the sample at inclusion to 72 hours after randomisation will be compared between active and control groups. Clinical outcomes include severity meeting criteria for intensive care support, liver transplantation, in-hospital mortality and mortality within 60 days. ETHICS AND DISSEMINATION: Ethics approval was obtained at the participating sites and at the national research ethics committee (CAAE 82673018.6.1001.0068). The trial has been submitted for ethical approval at additional potential recruiting centres. Results of the study will be published in journals and presented at scientific meetings. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (RBR-93dp9n)


Assuntos
Humanos , Antivirais , Febre Amarela/tratamento farmacológico , Brasil , Sofosbuvir
4.
Acta trop ; 198: [105093], Oct. 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1024019

RESUMO

Mayaro virus (MAYV) is a pathogen endemic to South America and some Caribbean islands, with reports of occasional outbreaks. However, its current distribution and high-risk areas are little known. We conducted a modelling study to determine the areas with highest prevalence of MAYV occurrence in South America, based on confirmed cases and serological detection over the last 20 years and socio-environmental variables. We performed our analysis using Maxent software, a machine learning algorithm used for species distribution modeling. Our results showed that the occurrence of MAYV is mainly associated with the biome type, population density, annual rainfall, annual vapor rate, and elevation. Among biome types, the one most related to the occurrence of MAYV is Cerrado, probably related to the lifecycle of the Haemagogus vector and human population concentrations. According to our modelling, there is high yet undetectable MAYV concentration in the central region of Brazil and west-coastal region of the continent. A change in virus dispersion patterns was observed. The virus was previously predominantly in forests but now occupied rural areas and was becoming increasingly urbanized, which is increases the risk of outbreaks. Our results will serve to identify priority areas in the development of preventive actions and structuring of epidemiological surveillance


Assuntos
Humanos , Infecções por Arbovirus/epidemiologia , América do Sul/epidemiologia
5.
Am. j. trop. med. hyg ; 101(1): 180-188, July 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1016853

RESUMO

Faced with the reemergence of yellow fever (YF) in the metropolitan region of São Paulo, Brazil, we developed a retrospective study to describe the cases of YF attended at the Institute of Infectology Emilio Ribas from January to March 2018 and analyze the factors associated with death, from the information obtained in the hospital epidemiological investigation. A total of 72 cases of sylvatic YF were confirmed, with 21 deaths (29.2% lethality rate). Cases were concentrated in males (80.6%) and in the age group of 30 to 59 years (56.9%). Two logistic regression models were performed, with continuous variables adjusted for the time between onset of symptoms and hospitalization. The first model indicated age (odds ratiosadjusted [ORadj]: 1.038; CI 95%: 1.008-1.212), aspartate aminotransferase (AST) (ORadj: 1.038; CI 95%: 1.005-1.072), and creatinine (ORadj: 2.343; CI 95%: 1.205-4.553) were independent factors associated with mortality. The second model indicated age (ORadj: 1.136; CI 95%: 1.013-1.275), alanine aminotransferase (ALT) (ORadj: 1.118; CI 95%: 1.018-1.228), and creatinine (ORadj: 2.835; CI 95%: 1.352-5,941). The risk of death in the model with continuous variables was calculated from the increase of 1 year (age), 1 mg/dL (creatinine), and 100 U/L for AST and ALT. Another logistic regression analysis with dichotomous variables indicated AST > 1,841 IU/L (ORadj: 12.92; CI 95%: 1.50-111.37) and creatinine > 1.2 mg/dL (ORadj: 81.47; CI 95%: 11.33-585.71) as independent factors associated with death. These results may contribute to the appropriate clinical management of patients with YF in health-care services and improve the response to outbreaks and public health emergencies


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Febre Amarela/epidemiologia , Brasil/epidemiologia
6.
Am J Trop Med Hyg ; 101(1): 180-188, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31134884

RESUMO

Faced with the reemergence of yellow fever (YF) in the metropolitan region of São Paulo, Brazil, we developed a retrospective study to describe the cases of YF attended at the Institute of Infectology Emilio Ribas from January to March 2018 and analyze the factors associated with death, from the information obtained in the hospital epidemiological investigation. A total of 72 cases of sylvatic YF were confirmed, with 21 deaths (29.2% lethality rate). Cases were concentrated in males (80.6%) and in the age group of 30 to 59 years (56.9%). Two logistic regression models were performed, with continuous variables adjusted for the time between onset of symptoms and hospitalization. The first model indicated age (odds ratiosadjusted [ORadj]: 1.038; CI 95%: 1.008-1.212), aspartate aminotransferase (AST) (ORadj: 1.038; CI 95%: 1.005-1.072), and creatinine (ORadj: 2.343; CI 95%: 1.205-4.553) were independent factors associated with mortality. The second model indicated age (ORadj: 1.136; CI 95%: 1.013-1.275), alanine aminotransferase (ALT) (ORadj: 1.118; CI 95%: 1.018-1.228), and creatinine (ORadj: 2.835; CI 95%: 1.352-5,941). The risk of death in the model with continuous variables was calculated from the increase of 1 year (age), 1 mg/dL (creatinine), and 100 U/L for AST and ALT. Another logistic regression analysis with dichotomous variables indicated AST > 1,841 IU/L (ORadj: 12.92; CI 95%: 1.50-111.37) and creatinine > 1.2 mg/dL (ORadj: 81.47; CI 95%: 11.33-585.71) as independent factors associated with death. These results may contribute to the appropriate clinical management of patients with YF in health-care services and improve the response to outbreaks and public health emergencies.


Assuntos
Febre Amarela/diagnóstico , Febre Amarela/mortalidade , Adolescente , Adulto , Brasil/epidemiologia , Criança , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Febre Amarela/epidemiologia , Adulto Jovem
7.
PLoS One ; 13(3): e0194392, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29579099

RESUMO

To investigate the factors associated with death and describe the gestational outcomes in pregnant women with influenza A(H1N1)pdm09, we conducted a case-control study (deaths and recovered) in hospitalized pregnant women with laboratory-confirmed influenza A(H1N1)pdm09 with severe acute respiratory illness (SARI) in the state of São Paulo from June 9 to December 1, 2009. All cases were evaluated, and four controls that were matched by the epidemiological week of hospitalization of the case were randomly selected for each case. Cases and controls were selected from the National Disease Notification System-SINAN Influenza-web. The hospital records from 126 hospitals were evaluated, and home interviews were conducted using standardized forms. A total of 48 cases and 185 controls were investigated. Having had a previous health visit to a healthcare provider for an influenza episode before hospital admission was a risk factor for death (adjusted OR (ORadj) of 7.93, 95% CI 2.19-28.69). Although not significant in the multiple analysis (ORadj of 2.13, 95% CI 0.91-5.00), the 3rd trimester deserves attention, with an OR = 2.22, 95% CI 1.13-4.37 in the univariate analysis. Antiviral treatment was a protective factor when administered within 48 hours of symptom onset (ORadj = 0.16, 95% CI 0.05-0.50) and from 48 to 72 hours (ORadj = 0.09, 95% CI 0.01-0.87). There was a higher proportion of fetal deaths and preterm births among cases (p = 0.001) and live births with low weight (p = 0.019), compared to control subjects who gave birth during hospitalization. After discharge, control subjects had a favorable neonatal outcome. Early antiviral treatment during the presence of a flu-like illness is an important factor in reducing mortality from influenza in pregnant women and unfavorable neonatal outcomes. It is important to monitor pregnant women, particularly in the 3rd trimester of gestation, with influenza illness for diagnosis and early treatment.


Assuntos
Morte Fetal , Hospitalização , Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Complicações Infecciosas na Gravidez , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido , Influenza Humana/mortalidade , Influenza Humana/terapia , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/terapia , Terceiro Trimestre da Gravidez , Fatores de Risco , Índice de Gravidade de Doença
8.
PLoS One ; 13(3): 0194392, Mar. 2018. tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1021844

RESUMO

To investigate the factors associated with death and describe the gestational outcomes in pregnant women with influenza A(H1N1)pdm09, we conducted a case-control study (deaths and recovered) in hospitalized pregnant women with laboratory-confirmed influenza A (H1N1)pdm09 with severe acute respiratory illness (SARI) in the state of São Paulo from June 9 to December 1, 2009. All cases were evaluated, and four controls that were matched by the epidemiological week of hospitalization of the case were randomly selected for each case. Cases and controls were selected from the National Disease Notification System- SINAN Influenza-web. The hospital records from 126 hospitals were evaluated, and home interviews were conducted using standardized forms. A total of 48 cases and 185 controls were investigated. Having had a previous health visit to a healthcare provider for an influenza episode before hospital admission was a risk factor for death (adjusted OR (ORadj) of 7.93, 95% CI 2.19±28.69). Although not significant in the multiple analysis (ORadj of 2.13, 95% CI 0.91±5.00), the 3rd trimester deserves attention, with an OR = 2.22, 95% CI 1.13± 4.37 in the univariate analysis. Antiviral treatment was a protective factor when administered within 48 hours of symptom onset (ORadj = 0.16, 95% CI 0.05±0.50) and from 48 to 72 hours (ORadj = 0.09, 95% CI 0.01±0.87). There was a higher proportion of fetal deaths and preterm births among cases (p = 0.001) and live births with low weight (p = 0.019), compared to control subjects who gave birth during hospitalization. After discharge, control subjects had a favorable neonatal outcome. Early antiviral treatment during the presence of a flu-like illness is an important factor in reducing mortality from influenza in pregnant women and unfavorable neonatal outcomes. It is important to monitor pregnant women, particularly in the 3rd trimester of gestation, with influenza illness for diagnosis and early treatment


Assuntos
Humanos , Feminino , Gravidez , Gestantes , Vírus da Influenza A Subtipo H1N1 , Influenza Aviária
9.
Pediatr. infect. dis. j ; 34(11): 1197-1202, Nov. 2015.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1017000

RESUMO

BACKGROUND: In 2010, introduction of the meningococcal C conjugate vaccine in Brazil for children <2 years provided an immediate reduction in the incidence rates of disease among the age groups targeted for the vaccine, but no early impact was observed in unvaccinated age groups. Knowledge about meningococcal carriage is crucial for improving our understanding of the disease epidemiology and for designing effective vaccination programs. Taking in account the very limited published data currently available describing meningococcal carriage in Brazil, we performed a study to evaluate the prevalence of Neisseria meningitidis carriage among adolescent students. METHODS: A cross-sectional study was conducted in 2012 to assess the prevalence of meningococcal carriage among a representative sample of 1208 students 11­19 years of age in Campinas, Brazil. Genotypic and phenotypic characterization of isolated carriage strains and the effect of potential risk factors for carriage were also analyzed. Results: The overall carriage prevalence was 9.9% (95% confidence interval, 8.3­11.8%), with dominance of serogroup C (1.32%), followed by serogroups B (0.99%), E (0.74%), Y (0.49%) and W (0.25%). A lower level of education of the parents was independently associated with a higher risk of carriage. A high diversity of genotypes was found among carriage strains. CONCLUSIONS: The evidence gathered during this study provides estimates of carriage prevalence in Brazilian adolescents, showing an unusually high dominance of serogroup C. These results have important implications in future strategies to optimize the impact of the current meningococcal C vaccination program in Brazil


Assuntos
Humanos , Adolescente , Brasil/epidemiologia , Fatores de Risco , Adolescente , Meningite Meningocócica/epidemiologia , Infecções Meningocócicas/epidemiologia
10.
Mem Inst Oswaldo Cruz ; 110(6): 755-9, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26517654

RESUMO

The aim of the present study was to assess the prevalence of Haemophilus influenzae type b (Hib) nasopharyngeal (NP) colonisation among healthy children where Hib vaccination using a 3p+0 dosing schedule has been routinely administered for 10 years with sustained coverage (> 90%). NP swabs were collected from 2,558 children who had received the Hib vaccine, of whom 1,379 were 12-< 24 months (m) old and 1,179 were 48-< 60 m old. Hi strains were identified by molecular methods. Hi carriage prevalence was 45.1% (1,153/2,558) and the prevalence in the 12-< 24 m and 48-< 60 m age groups were 37.5% (517/1,379) and 53.9% (636/1,179), respectively. Hib was identified in 0.6% (16/2,558) of all children in the study, being 0.8% (11/1,379) and 0.4% (5/1,179) among the 12-< 24 m and 48-< 60 m age groups, respectively. The nonencapsulate Hi colonisation was 43% (n = 1,099) and was significantly more frequent at 48-< 60 m of age (51.6%, n = 608) compared with that at 12-< 24 m of age (35.6%, n = 491). The overall resistance rates to ampicillin and chloramphenicol were 16.5% and 3.7%, respectively; the co-resistance was detected in 2.6%. Our findings showed that the Hib carrier rate in healthy children under five years was very low after 10 years of the introduction of the Hib vaccine.


Assuntos
Portador Sadio/imunologia , Infecções por Haemophilus/prevenção & controle , Vacinas Anti-Haemophilus/uso terapêutico , Haemophilus influenzae tipo b/imunologia , Nasofaringe/microbiologia , Resistência a Ampicilina/imunologia , Cápsulas Bacterianas/imunologia , Brasil/epidemiologia , Portador Sadio/microbiologia , Pré-Escolar , Resistência ao Cloranfenicol/imunologia , Estudos Transversais , Infecções por Haemophilus/epidemiologia , Haemophilus influenzae tipo b/classificação , Humanos , Esquemas de Imunização , Lactente , Vacinação em Massa , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Prevalência , Inquéritos e Questionários
11.
Mem. Inst. Oswaldo Cruz ; 110(6): 755-759, Sept. 2015. tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1016975

RESUMO

The aim of the present study was to assess the prevalence of Haemophilus influenzae type b (Hib) nasopharyngeal (NP) colonisation among healthy children where Hib vaccination using a 3p+0 dosing schedule has been routinely administered for 10 years with sustained coverage (> 90%). NP swabs were collected from 2,558 children who had received the Hib vaccine, of whom 1,379 were 12-< 24 months (m) old and 1,179 were 48-< 60 m old. Hi strains were identified by molecular methods. Hi carriage prevalence was 45.1% (1,153/2,558) and the prevalence in the 12-< 24 m and 48-< 60 m age groups were 37.5% (517/1,379) and 53.9% (636/1,179), respectively. Hib was identified in 0.6% (16/2,558) of all children in the study, being 0.8% (11/1,379) and 0.4% (5/1,179) among the 12-< 24 m and 48-< 60 m age groups, respectively. The nonencapsulate Hi colonisation was 43% (n = 1,099) and was significantly more frequent at 48-< 60 m of age (51.6%, n = 608) compared with that at 12-< 24 m of age (35.6%, n = 491). The overall resistance rates to ampicillin and chloramphenicol were 16.5% and 3.7%, respectively; the co-resistance was detected in 2.6%. Our findings showed that the Hib carrier rate in healthy children under five years was very low after 10 years of the introduction of the Hib vaccine


Assuntos
Humanos , Criança , Brasil/epidemiologia , Vacinas Conjugadas , Haemophilus influenzae tipo b
12.
Mem. Inst. Oswaldo Cruz ; 110(6): 755-759, Sept. 2015. tab
Artigo em Inglês | LILACS | ID: lil-763097

RESUMO

The aim of the present study was to assess the prevalence of Haemophilus influenzaetype b (Hib) nasopharyngeal (NP) colonisation among healthy children where Hib vaccination using a 3p+0 dosing schedule has been routinely administered for 10 years with sustained coverage (> 90%). NP swabs were collected from 2,558 children who had received the Hib vaccine, of whom 1,379 were 12-< 24 months (m) old and 1,179 were 48-< 60 m old. Hi strains were identified by molecular methods. Hi carriage prevalence was 45.1% (1,153/2,558) and the prevalence in the 12-< 24 m and 48-< 60 m age groups were 37.5% (517/1,379) and 53.9% (636/1,179), respectively. Hib was identified in 0.6% (16/2,558) of all children in the study, being 0.8% (11/1,379) and 0.4% (5/1,179) among the 12-< 24 m and 48-< 60 m age groups, respectively. The nonencapsulate Hi colonisation was 43% (n = 1,099) and was significantly more frequent at 48-< 60 m of age (51.6%, n = 608) compared with that at 12-< 24 m of age (35.6%, n = 491). The overall resistance rates to ampicillin and chloramphenicol were 16.5% and 3.7%, respectively; the co-resistance was detected in 2.6%. Our findings showed that the Hib carrier rate in healthy children under five years was very low after 10 years of the introduction of the Hib vaccine.


Assuntos
Pré-Escolar , Humanos , Lactente , Portador Sadio/imunologia , Infecções por Haemophilus/prevenção & controle , Vacinas Anti-Haemophilus/uso terapêutico , Haemophilus influenzae tipo b/imunologia , Nasofaringe/microbiologia , Resistência a Ampicilina/imunologia , Cápsulas Bacterianas/imunologia , Brasil/epidemiologia , Estudos Transversais , Portador Sadio/microbiologia , Resistência ao Cloranfenicol/imunologia , Infecções por Haemophilus/epidemiologia , Haemophilus influenzae tipo b/classificação , Esquemas de Imunização , Vacinação em Massa , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Prevalência , Inquéritos e Questionários
13.
Pediatr Infect Dis J ; 34(11): 1197-202, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26222063

RESUMO

BACKGROUND: In 2010, introduction of the meningococcal C conjugate vaccine in Brazil for children <2 years provided an immediate reduction in the incidence rates of disease among the age groups targeted for the vaccine, but no early impact was observed in unvaccinated age groups. Knowledge about meningococcal carriage is crucial for improving our understanding of the disease epidemiology and for designing effective vaccination programs. Taking in account the very limited published data currently available describing meningococcal carriage in Brazil, we performed a study to evaluate the prevalence of Neisseria meningitidis carriage among adolescent students. METHODS: A cross-sectional study was conducted in 2012 to assess the prevalence of meningococcal carriage among a representative sample of 1208 students 11-19 years of age in Campinas, Brazil. Genotypic and phenotypic characterization of isolated carriage strains and the effect of potential risk factors for carriage were also analyzed. RESULTS: The overall carriage prevalence was 9.9% (95% confidence interval, 8.3-11.8%), with dominance of serogroup C (1.32%), followed by serogroups B (0.99%), E (0.74%), Y (0.49%) and W (0.25%). A lower level of education of the parents was independently associated with a higher risk of carriage. A high diversity of genotypes was found among carriage strains. CONCLUSIONS: The evidence gathered during this study provides estimates of carriage prevalence in Brazilian adolescents, showing an unusually high dominance of serogroup C. These results have important implications in future strategies to optimize the impact of the current meningococcal C vaccination program in Brazil.


Assuntos
Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Adolescente , Adulto , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Orofaringe/microbiologia , Prevalência , Fatores de Risco , Adulto Jovem
14.
Mem Inst Oswaldo Cruz ; 110(2): 230-4, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25946247

RESUMO

We propose a method to analyse the 2009 outbreak in the region of Botucatu in the state of São Paulo (SP), Brazil, when 28 yellow fever (YF) cases were confirmed, including 11 deaths. At the time of the outbreak, the Secretary of Health of the State of São Paulo vaccinated one million people, causing the death of five individuals, an unprecedented number of YF vaccine-induced fatalities. We apply a mathematical model described previously to optimise the proportion of people who should be vaccinated to minimise the total number of deaths. The model was used to calculate the optimum proportion that should be vaccinated in the remaining, vaccine-free regions of SP, considering the risk of vaccine-induced fatalities and the risk of YF outbreaks in these regions.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Modelos Estatísticos , Saúde Pública/métodos , Vacinação/mortalidade , Vacina contra Febre Amarela/efeitos adversos , Febre Amarela/prevenção & controle , Brasil/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Monitoramento Epidemiológico , Humanos , Medição de Risco/métodos , Febre Amarela/epidemiologia , Febre Amarela/mortalidade
15.
Bepa - Boletim Epidemiológico Paulista ; 12(137): 3-16, maio 2015. mapas, tab, graf
Artigo em Português | Sec. Est. Saúde SP, SESSP-CTDPROD, Sec. Est. Saúde SP, SESSP-CVEPROD, Sec. Est. Saúde SP | ID: ses-36335

RESUMO

Descrever a investigação do surto de febre amarela silvestre e as principais medidas de controle realizadas no estado de São Paulo. MÉTODOS: Estudo descritivo do surto de febre amarela silvestre na região sudoeste do estado, entre fevereiro e abril de 2009. Foram avaliados casos suspeitos e confirmados em humanos e primatas não humanos. A investigação entomológica, em ambiente silvestre, envolveu captura em solo e copa de árvore para identificação das espécies e detecção de infecção natural. Foram realizadas ações de controle de Aedes aegypti em áreas urbanas. A vacinação foi direcionada para residentes dos municípios com confirmação de circulação viral e nos municípios contíguos, conforme recomendação nacional. RESULTADOS: Foram confirmados 28 casos humanos (letalidade 39,3%) em áreas rurais de Sarutaiá, Piraju, Tejupá, Avaré e Buri. Foram notificadas 56 mortes de primatas não humanos, 91,4% do gênero Alouatta sp. A epizootia foi confirmada laboratorialmente em dois primatas não humanos, sendo um em Buri e outro em Itapetininga. Foram coletados 1.782 mosquitos, entre eles Haemagogus leucocelaenus, Hg. janthinomys/capricornii, Sabethes chloropterus, Sa. purpureus e Sa. undosus. O vírus da febre amarela foi isolado de um lote de Hg. leucocelaenus procedente de Buri. A vacinação foi realizada em 49 municípios, com 1.018.705 doses aplicadas e o registro de nove eventos adversos graves pós-vacinação. CONCLUSÕES: Os casos humanos ocorreram entre fevereiro e abril de 2009 em áreas sem registro de circulação do vírus da febre amarela há mais de 60 anos. A região encontrava-se fora da área com recomendação de vacinação, com alto percentual da população suscetível. A adoção oportuna de medidas de controle permitiu a interrupção da transmissão humana em um mês, assim como a confirmação da circulação viral em humanos, primatas não humanos e mosquitos. Os isolamentos facilitaram a identificação das áreas de circulação viral, mas são importantes novos estudos para esclarecer a dinâmica de transmissão da doença...(AU)


Assuntos
Humanos , Febre Amarela , Transmissão de Doença Infecciosa
16.
Mem. Inst. Oswaldo Cruz ; 110(2): 230-234, 04/2015. tab, graf
Artigo em Inglês | LILACS, SESSP-IALPROD, Sec. Est. Saúde SP, SESSP-IALACERVO | ID: lil-744473

RESUMO

We propose a method to analyse the 2009 outbreak in the region of Botucatu in the state of São Paulo (SP), Brazil, when 28 yellow fever (YF) cases were confirmed, including 11 deaths. At the time of the outbreak, the Secretary of Health of the State of São Paulo vaccinated one million people, causing the death of five individuals, an unprecedented number of YF vaccine-induced fatalities. We apply a mathematical model described previously to optimise the proportion of people who should be vaccinated to minimise the total number of deaths. The model was used to calculate the optimum proportion that should be vaccinated in the remaining, vaccine-free regions of SP, considering the risk of vaccine-induced fatalities and the risk of YF outbreaks in these regions.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , /terapia , /fisiopatologia , Estilo de Vida
17.
PLoS One ; 10(3): e0118772, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25774804

RESUMO

This case-control study aimed to assess the risk factors for death from influenza A(H1N1)pdm09 in patients with laboratory confirmation, who had severe acute respiratory illness-SARI and were hospitalized between June 28th and August 29th 2009, in the metropolitan regions of São Paulo and Campinas, Brazil. Medical charts of all the 193 patients who died (cases) and the 386 randomly selected patients who recovered (controls) were investigated in 177 hospitals. Household interviews were conducted with those who had survived and the closest relative of those who had died. 73.6% of cases and 38.1% of controls were at risk of developing influenza-related complications. The 18-to-59-year age group (OR = 2.31, 95%CI: 1.31-4.10 (reference up to 18 years of age)), presence of risk conditions for severity of influenza (OR = 1.99, 95%CI: 1.11-3.57, if one or OR = 6.05, 95%CI: 2.76-13.28, if more than one), obesity (OR = 2.73, 95%CI: 1.28-5.83), immunosuppression (OR = 3.43, 95%CI: 1.28-9.19), and search for previous care associated with the hospitalization (OR = 3.35, 95%CI: 1.75-6.40) were risk factors for death. Antiviral treatment performed within 72 hours of the onset of symptoms (OR = 0.17, 95%CI: 0.08-0.37, if within 48hours, and OR = 0.30, 95%CI: 0.11-0.81, if between 48 and 72 hours) was protective against death. The identification of high-risk patients and early treatment are important factors for reducing morbi-mortality from influenza.


Assuntos
Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Adolescente , Adulto , Antivirais/uso terapêutico , Brasil/epidemiologia , Estudos de Casos e Controles , Morte , Feminino , Hospitalização , Humanos , Influenza Humana/tratamento farmacológico , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Adulto Jovem
18.
São Paulo; s.n; 2015. 133 p.
Tese em Português | LILACS | ID: lil-790637

RESUMO

Introdução- Em abril de 2009, novo subtipo viral foi identificado, Influenza A(H1N1)pdm09. Em 11 de junho de 2009, a Organização Mundial da Saude anunciou o início de uma pandemia de influenza. Objetivo- Investigar os fatores de risco para óbito por Influenza A(H1N1)pdm09 em pacientes e em gestantes hospitalizados com Doença Respiratória Aguda Grave-DRAG. Nas gestantes, foram analisados também os desfechos gestacionais e neonatais. Metodologia- Foram realizados dois estudos caso-controles, em pacientes e em gestantes hospitalizados com Influenza A(H1N1) pdm09 confirmada laboratorialmente e DRAG. Os casos evoluíram para óbito e os controles para cura. Os casos e controles foram selecionados no Sistema de Informação de Agravos de Notificação-SINAN Influenza- web, sendo sorteados dois controles no estudo dos pacientes, e quatro no das gestantes, pareados por semana epidemiológica da data de internação do caso. O primeiro estudo foi realizado nas regiões Metropolitanas de São Paulo e de Campinas, de 28 de junho a 29 de agosto de 2009. Nas gestantes, o estudo incluiu o Estado de São Paulo, de 09 de junho a 01 de dezembro de 2009. Foram realizadas avaliações dos prontuários hospitalares e entrevistas domiciliares, a partir de formulários padronizados. Foram empregados testes de Mann-Whitney-U ou quiquadrado para comparação das variáveis, e cálculos dos odds ratio brutos-ORb e seus intervalos de confiança-IC95 por cento , para avaliação dos fatores de risco.


Introduction - In April 2009, a new viral subtype was identified, influenza A (H1N1)pdm09. On June 11, the World Health Organization announced the beginning of the influenza pandemic. Objective - To investigate the risk factors for death from influenza A(H1N1)pdm09 in hospitalized patients and pregnant women with Severe Acute Respiratory Infections-SARI. In the pregnant women, the gestational and neonatal outcomes were analyzed. Methodology - Two case control studies were performed in hospitalized patients and pregnant women with laboratory confirmed influenza A (H1N1)pdm09 and SARI. The cases died and the controls recovered. The cases and controls were selected from the Information System for Notifiable Diseases-SINAN-Influenza-web. Two controls were randomly selected in the study of patients and four in the pregnant women, matched by epidemiological week of the date of admission of the case. The first study was conducted in the metropolitan regions of São Paulo and Campinas, from June 28th to August 29th, 2009. The study on pregnant women included the State of São Paulo, from June 09th to December 1th, 2009. Evaluations of the medical records and home interviews were conducted using standardized forms. The Mann-Whitney U test or the chi-square tests were performed to compare the variables, in addition to calculations of crude odds ratio- ORc and their 95 per cent confidence intervals for the assessment of the risk factors.


Assuntos
Humanos , Feminino , Gravidez , Pacientes Internados , Influenza Humana/mortalidade , Gestantes , Doenças Respiratórias , Estudos de Casos e Controles , Saúde Materno-Infantil , Fatores de Risco
19.
Emerg Infect Dis ; 20(5): 806-11, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24751156

RESUMO

During 2010, outbreaks of serogroup C meningococcal (MenC) disease occurred in 2 oil refineries in São Paulo State, Brazil, leading to mass vaccination of employees at 1 refinery with a meningococcal polysaccharide A/C vaccine. A cross-sectional study was conducted to assess the prevalence of meningococci carriage among workers at both refineries and to investigate the effect of vaccination on and the risk factors for pharyngeal carriage of meningococci. Among the vaccinated and nonvaccinated workers, rates of overall meningococci carriage (21.4% and 21.6%, respectively) and of MenC carriage (6.3% and 4.9%, respectively) were similar. However, a MenC strain belonging to the sequence type103 complex predominated and was responsible for the increased incidence of meningococcal disease in Brazil. A low education level was associated with higher risk of meningococci carriage. Polysaccharide vaccination did not affect carriage or interrupt transmission of the epidemic strain. These findings will help inform future vaccination strategies.


Assuntos
Portador Sadio/epidemiologia , Meningite Meningocócica/classificação , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/imunologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Surtos de Doenças , História do Século XXI , Humanos , Incidência , Meningite Meningocócica/genética , Meningite Meningocócica/imunologia , Infecções Meningocócicas/história , Tipagem de Sequências Multilocus , Fatores de Risco , Sorotipagem , Vacinação , Adulto Jovem
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