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1.
BMC Infect Dis ; 21(1): 551, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112091

RESUMO

BACKGROUND: Recent conflict and war in Yemen lead to collapse of the health system, decrease of immunization coverage and spread of many outbreaks. On May 22, 2018, the surveillance officer in Shabwah governorate reported an increased number of suspected measles. On May 24, 2018, a team from Yemen-Field Epidemiology Training Program was sent to investigate. The aims were to describe the outbreak, determine the risk factors for measles infection and recommend control measures. METHODOLOGY: A descriptive followed by case-control study design (1:2 ratio) were performed. National Measles Surveillance Program case definition and predesigned questionnaire were used to collect data from 73 cases and 146 controls. Attack rate (AR), adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated. P value < 0.05 was considered as the cut point for significant. Epi info version 7.2 was used. RESULTS: A total of 73 suspected cases were found. Almost 53% were from Habban district, 63% were males and 56% were among age group < 5 years. The overall AR was 82/100,000 population. Measles was significantly associated with contact with case (aOR = 27.3, 95% CI:1.3-551.7), malnourished children aged 6-60 months (aOR = 24.9, 95% CI;1.9-329.6) and unvaccinated children (aOR = 17.2, 95% CI:2.9-100.7). The six collected blood samples found to be positive for measles IgM. CONCLUSIONS: Measles outbreak in Ataq and Habban districts was confirmed. Contact with measles cases, malnutrition and un-vaccination were the potential contributing factors of measles outbreak in Shabwah governorate. An urgent vaccination campaign with health education interventions are highly recommended. Reactivation of the outreach immunization services and strengthening surveillance and response systems are top priority to take place at district and governorate levels.


Assuntos
Surtos de Doenças , Sarampo/epidemiologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Incidência , Lactente , Masculino , Sarampo/diagnóstico , Sarampo/prevenção & controle , Morbillivirus/isolamento & purificação , Razão de Chances , Fatores de Risco , Inquéritos e Questionários , Vacinação/estatística & dados numéricos , Iêmen
2.
World J Gastroenterol ; 27(15): 1655-1663, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33958850

RESUMO

BACKGROUND: Gastrointestinal cytomegalovirus (CMV) disease occurs commonly in immunocompromised/immunodeficient patients with advanced human immunodeficiency virus infection, neoplasm, solid organ transplantation, hematopoietic stem cell transplantation, or treatment with immunosuppressants, but is rarely reported in association with measles infection. CASE SUMMARY: We describe a case of extensive gastrointestinal CMV disease secondary to measles infection in a 9-mo-old boy who presented with persistent fever and bloody diarrhea. His condition was improved after ganciclovir treatment. Serological analysis of CMV showed negative immunoglobulin (Ig) M and positive IgG. Blood CMV-DNA was 9.26 × 103 copies/mL. The diagnosis of gastrointestinal CMV disease was confirmed by histopathological findings of intranuclear and intracytoplasmic inclusions and Owl's eye inclusion. This case highlights the differential diagnosis and histopathological characteristics of gastrointestinal CMV infection and laboratory tests. CONCLUSION: Extensive gastrointestinal CMV lesions can be induced by the immune suppression secondary to measles infection. Rational, fast, and effective laboratory examinations are essential for suspected patients.


Assuntos
Infecções por Citomegalovirus , Gastroenteropatias , Sarampo , Citomegalovirus , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Ganciclovir/uso terapêutico , Humanos , Lactente , Sarampo/complicações , Sarampo/diagnóstico
3.
Clin Microbiol Rev ; 34(3)2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-33980686

RESUMO

Public health laboratories (PHLs) continue to face internal and external challenges to their abilities to provide successful, timely responses to public health crises and emerging threats. These laboratories are mandated to maintain the health of their communities by identifying, diagnosing, and warning constituents of potential and real health emergencies. Due to the changing characteristics of public health threats and their cross-jurisdictional nature, laboratories are facing increased pressure to ensure that they respond in a consistent and coordinated manner. Here, the Association of Public Health Laboratories (APHL) Emerging Leader Program Cohort 11 members have compiled stories from subject matter experts (SMEs) at PHLs with direct involvement in crises to determine the characteristics of a successful response. Experts examined a diverse selection of emerging threats from across PHLs, including infectious diseases, opioids, natural disasters, and government shutdowns. While no public health crisis will be identical to another, overarching themes were consistent across subjects. Experiences from SMEs that could improve future responses to emerging threats are highlighted.


Assuntos
Teste para COVID-19/métodos , COVID-19/diagnóstico , Doença pelo Vírus Ebola/diagnóstico , Sarampo/diagnóstico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Saúde Pública/métodos , COVID-19/epidemiologia , Técnicas de Laboratório Clínico , Doença pelo Vírus Ebola/epidemiologia , Humanos , Laboratórios , Sarampo/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia
5.
BMC Infect Dis ; 21(1): 279, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33740895

RESUMO

BACKGROUND: Case fatality ratio (CFR) among all age groups during the 2016-2018 measles outbreak in Romania was increased compared with previous outbreaks. To identify risk factors for measles death, we conducted a case-control study among infants and children hospitalized for measles. METHODS: National surveillance data were used to identify hospitalized cases of laboratory-confirmed or epidemiologically linked measles in infants and children aged < 59 months with rash onset from January 2016 to July 2018. We abstracted medical records of 50 fatal cases ("cases") and 250 non-fatal cases ("controls") matched by age, sex, district of residence, and urban/rural place of residence. We calculated univariable and multivariable matched odds ratios (OR) and 95% confidence intervals (CIs) for risk factors. RESULTS: Ninety-three percent of case-patients and controls had not received a valid dose of a measles-containing vaccine; only 5 % received Vitamin A supplementation once diagnosed with measles. In the univariable analysis, cases were more likely than controls to have had a healthcare-related exposure to measles manifesting as inpatient admission for pneumonia during the 7 to 21 day measles incubation period (OR: 3.0; 95% CI [1.2, 7.2]), to have had a history of malnutrition (OR: 3.4; 95% CI [1.1, 9.9]), and to have had pneumonia as a complication of measles (OR:7.1; 95% CI [2.0-24.8]). In the multivariable analysis, pneumonia as a measles complication remained a risk for death (OR: 7.1; 95% CI [1.4-35.3]). CONCLUSIONS: Implementing infection prevention and control practices, ensuring immunization of healthcare workers, and hospitalizing only severe measles cases may minimize the risk of nosocomial measles transmission. Implementing World Health Organization (WHO) recommendations for Vitamin A supplementation, improving immunization of children to prevent influenza, pneumococcal, and other bacterial respiratory diseases may decrease complications and deaths due to measles in Romania.


Assuntos
Sarampo/diagnóstico , Pneumonia/diagnóstico , Estudos de Casos e Controles , Pré-Escolar , Surtos de Doenças , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Desnutrição/patologia , Sarampo/epidemiologia , Sarampo/mortalidade , Vacina contra Sarampo/imunologia , Razão de Chances , Pneumonia/etiologia , Fatores de Risco , Romênia/epidemiologia , Vacinação/estatística & dados numéricos , Vitamina A/administração & dosagem
6.
J Immunol Methods ; 492: 112996, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33582147

RESUMO

Dried blood spots (DBS) are routinely used in screening newborns for treatable disorders. Immunoglobulin extraction from DBS, serum or other biological fluids loaded on filter paper cards could represent a valuable method of specimen preservation in monitoring immune response against pathogens as well as vaccination efficiency. In this study using different sources including serum, and monoclonal antibodies we established parameters for antibody extraction from the filter cards to assess antibody reactivity against Helicobacter pylori, measles virus (MV) and the novel coronavirus SARS-CoV-2 antigens. We demonstrated that DBS and dried undiluted serum result in completely preserved antibody activity for immunoassays, including in virus neutralization assays against MV. Extraction efficiency was determined by IgG concentration measurements. The plaque-reduction neutralization titer 50% of dried human serum spots remained stable after more than 10-day storage - 1:359 vs. 1:345 for the corresponding frozen sample. DBSs could be used to monitor immune response to bacterial and viral antigens following natural exposure or immunization. Mice immunized with recombinant spike protein receptor-binding domain of SARS-CoV-2 developed a strong antibody response by day 14 and reached titers above 1:64,000 on day 21 following the secondary boost immunization as measured on DBS samples in antigen-mediated ELISA. Variability in IgG concentration of eluted DBS could be influenced by factors involved in sample application, extraction process and sample characteristics. Adjustment of antibody specific activity to the eluted IgG concentration can increase accuracy of the result interpretation, including in SARS-CoV-2 serological diagnostics.


Assuntos
Anticorpos Antivirais/isolamento & purificação , COVID-19/diagnóstico , Teste em Amostras de Sangue Seco , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/fisiologia , Imunoensaio/métodos , Vírus do Sarampo/fisiologia , Sarampo/diagnóstico , Monitorização Imunológica/métodos , SARS-CoV-2/fisiologia , Animais , Anticorpos Monoclonais , Formação de Anticorpos , Teste em Amostras de Sangue Seco/métodos , Feminino , Humanos , Imunidade Humoral , Camundongos , Camundongos Endogâmicos BALB C , Testes Sorológicos , Glicoproteína da Espícula de Coronavírus/imunologia , Vacinação
7.
Intern Med ; 60(12): 1971-1976, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-33456033

RESUMO

Measles encephalitis rarely affects young adults and has no established treatment strategy. This brief report described the rare case of an immunocompetent 30-year-old man with severe measles pneumonia and encephalitis, following the autoimmune disease acute disseminated encephalomyelitis, during a large measles outbreak in 2018 in Japan. With multidisciplinary treatments, including corticosteroids, intravenous immunoglobulins, vitamin A, and therapeutic plasma exchange, the patient was successfully treated. This case provides a new strategy for treating measles encephalitis and its complications during measles outbreak.


Assuntos
Encefalite , Encefalomielite Aguda Disseminada , Sarampo , Adulto , Encefalomielite Aguda Disseminada/diagnóstico , Humanos , Japão/epidemiologia , Imageamento por Ressonância Magnética , Masculino , Sarampo/complicações , Sarampo/diagnóstico , Adulto Jovem
8.
PLoS One ; 16(1): e0245512, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33471833

RESUMO

BACKGROUND AND AIM: A measles outbreak occurred in Greece during 2017-2018 affecting mainly pediatric population. The aim of the study was to describe the epidemiological and clinical characteristics of the cases diagnosed in the major pediatric tertiary hospital of Athens, where 26.5% of national pediatric measles cases were diagnosed and treated. METHODS: This is a retrospective study of children 0-16 years old, who presented at the emergency department and/or were hospitalized with clinical presentation compatible with measles and diagnosis was confirmed with molecular detection of the measles RNA in pharyngeal swabs. Epidemiological, clinical and laboratory characteristics were retrieved from medical records and analyzed. RESULTS: A total of 578 children with measles were identified during the study period. 322 (55.7%) were male with median age 36 months (range:1-193), while the largest number of documented cases (251; 43.4%) were children aged 1-5 years. Most children (429/578; 74.2%) belonged to the Roma minority and only 64 (11.1%) had Greek origin. 497 (91.5%) children were unvaccinated and 37 (6.8%) were partially vaccinated with measles vaccine. Hospitalization was required for 342 (59.2%) children, whereas one or more complications were reported in 230 (67.2%) of them. Most frequent complications were elevated transaminases (139; 40.6%), acute otitis media (72; 21%), dehydration (67; 19.6%) and pneumonia (58; 16.9%). 11 children (3.2%) required intensive care admission for altered mental status/status epilepticus (3), sepsis (2) and ARDS (6). 119/342 (34.8%) children were treated with antibiotics because of possible or confirmed bacterial coinfection. One death was reported, concerning an 11-month-old unvaccinated infant, with underlying dystrophy, who died of sepsis. CONCLUSION: Measles is not an innocent viral infection, as it is still characterized by high morbidity and complications rates. Unvaccinated or partially vaccinated populations could trigger new outbreaks, resulting in significant cost in public health. To avoid future measles outbreaks, high vaccination coverage should be achieved, as well as closing immunity gaps in the population and ensuring high-quality measles surveillance.


Assuntos
Epidemias , Sarampo/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Grécia/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Sarampo/diagnóstico , Sarampo/terapia , Prognóstico
11.
Praxis (Bern 1994) ; 109(15): 1179-1181, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33234038

RESUMO

CME Dermatology 22/Answers: Measles - Empidemiology and Clinical Manifestations Abstract. Measles is a highly contagious, acute and febrile illness that results from infection with measles virus. The World Health Organization (WHO) estimates a worldwide prevalence of ten million patients per year, leading to approximately 142 000 deaths (case fatality rate 1.4 %). The illness begins with fever, malaise and typically with at least one of the following signs: cough, coryza and/or conjunctivitis. Three to four days later, the characteristical rash appears. The primary clinical diagnosis needs to be confirmed by detection of specific IgM antibodies in serum or viral RNA by a throat swap. The management mainly consists of supportive therapy, a specific antiviral treatment does not exist. Therefore, prevention by widespread measles vaccination has absolute priority.


Assuntos
Dermatologia , Exantema , Sarampo , Exantema/etiologia , Humanos , Sarampo/diagnóstico , Sarampo/epidemiologia , Vírus do Sarampo , Vacinação
12.
Praxis (Bern 1994) ; 109(14): 1109-1116, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33108997

RESUMO

CME Dermatology 22: Measles - Empidemiology and Clinical Manifestations Abstract. Measles is a highly contagious, acute and febrile illness that results from infection with measles virus. The World Health Organization (WHO) estimates a worldwide prevalence of ten million patients per year, leading to approximately 142 000 deaths (case fatality rate 1.4 %). The illness begins with fever, malaise and typically with at least one of the following signs: cough, coryza and/or conjunctivitis. Three to four days later, the characteristical rash appears. The primary clinical diagnosis needs to be confirmed by detection of specific IgM antibodies in serum or viral RNA by a throat swap. The management mainly consists of supportive therapy, a specific antiviral treatment does not exist. Therefore, prevention by widespread measles vaccination has absolute priority.


Assuntos
Exantema , Sarampo , Dermatologia , Humanos , Sarampo/diagnóstico , Sarampo/epidemiologia , Vírus do Sarampo , Vacinação
13.
BMC Infect Dis ; 20(1): 753, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054715

RESUMO

BACKGROUND: Safety of live vaccines in patients treated with immunosuppressive therapies is not well known, resulting in contradictory vaccination recommendations. We describe here the first case of vaccine-associated measles in a patient on natalizumab treatment. CASE PRESENTATION: A young female patient with relapsing-remitting multiple sclerosis on natalizumab treatment received the live attenuated measles, mumps, and rubella vaccine in preparation for a change in her treatment in favour of fingolimod, with established immunosuppressive qualities. Seven days after receiving the vaccine, our patient experienced diffuse muscle pain, fatigue, and thereafter developed a fever and then an erythematous maculopapular rash, compatible with vaccine associated measles. This was later confirmed by a positive measles RT-PCR throat swab. The patient's symptoms resolved without any sequelae. CONCLUSION: In this case report we review the immunosuppressive qualities of natalizumab and the evidence in favour and against live vaccines in patients on this treatment. Our findings reveal the insufficient understanding of the immunosuppressive effects of new immunomodulators, and thus of the safety of live vaccines in patients on such medications. While this case triggers precaution, there is insufficient evidence to conclude that natalizumab treatment could favor the onset of vaccine-associated measles.


Assuntos
Vacina contra Sarampo/efeitos adversos , Vacina contra Sarampo-Caxumba-Rubéola/uso terapêutico , Sarampo/etiologia , Natalizumab/uso terapêutico , Adulto , Exantema/induzido quimicamente , Feminino , Febre/etiologia , Humanos , Fatores Imunológicos/uso terapêutico , Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Sarampo/diagnóstico , Vacina contra Sarampo/uso terapêutico , Vacina contra Sarampo-Caxumba-Rubéola/efeitos adversos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Natalizumab/imunologia , Vacinas Atenuadas/efeitos adversos , Vacinas Atenuadas/imunologia , Vacinas Atenuadas/uso terapêutico
17.
Artigo em Inglês | MEDLINE | ID: mdl-32605070

RESUMO

On 22 March 2019 the Thai Department of Disease Control (DDC) was notified that 16 workers, including Thai and Myanmar migrant workers, from two factories located in Nakhon Phathom Province, had presented with a fever with rash during the previous 2 weeks. Active case finding was conducted among workers in both factories using face-to-face interviews. Suspected cases were defined as a worker who developed fever with rash with one of the following symptoms: cough, coryza or conjunctivitis. Testing for measles IgM antibodies and viral identification through throat swabs by polymerase chain reaction (PCR) were performed to confirm diagnosis. Vaccination history among cases was reviewed. Nationality and age-specific attack rates (AR) were calculated. An environmental study and a social network analysis were conducted to better understand the transmission process. A total 56 cases (AR = 0.97%) were identified. Of 21 serum measles IgM collected, 8 (38.0%) were positive. Of 8 throat swabs collected, 5 (62.5%) were positive for measles genotype D8. The disease attack rate in migrant employees was twice as large as the rate in Thai counterparts (AR = 0.7 and 1.4%). The first case was identified as a Myanmar worker who arrived in Thailand two weeks prior to his illness. The Myanmar workers' accommodation was more crowded than that for Thai workers. The hot spots of transmission were found at a drinking water tank which had shared glasses. Among the cases, 62.5% could not recall their vaccination history, and 25% had never had an injection containing a measles vaccination. The majority of migrant cases had never completed a two-dose measles vaccination. To halt the outbreak, measles vaccines were administered to the employees, particularly those working in the same sections with the cases and shared glasses were removed. For future policy action, a vaccination program should be incorporated into the work permit issuance process.


Assuntos
Sarampo , Migrantes , Surtos de Doenças , Humanos , Sarampo/diagnóstico , Sarampo/epidemiologia , Mianmar/epidemiologia , Tailândia/epidemiologia
19.
BMC Infect Dis ; 20(1): 398, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503450

RESUMO

BACKGROUND: Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated the outbreak to assess the scope, factors facilitating transmission, and recommend control measures. METHODS: We defined a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with serum positivity of measles-specific IgM. We conducted a neighborhood- and age-matched case-control study to identified exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage. RESULTS: We identified 81 cases (75 probable, 6 confirmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7-21 days before case-patient's onset (ORadj = 34, 95%CI: 5.1-225). Estimated vaccine effectiveness was 95% (95%CI: 75-99%) and vaccination coverage was 76% (95%CI: 68-82%). During the outbreak, an "isolation" ward was established inside the general pediatric ward where there was mixing of both measles and non-measles patients. CONCLUSIONS: This outbreak was amplified by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.


Assuntos
Sarampo/diagnóstico , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Infecção Hospitalar/diagnóstico , Surtos de Doenças , Feminino , Hospitais Pediátricos , Humanos , Imunoglobulina M/sangue , Lactente , Masculino , Sarampo/epidemiologia , Morbillivirus/imunologia , Uganda/epidemiologia , Cobertura Vacinal
20.
Asclepio ; 72(1): 0-0, ene.-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-195643

RESUMO

Las encuestas serológicas, que adquirieron gran relevancia a mediados del siglo XX, siguen siendo herramienta clave para abordar las enfermedades infecciosas. El artículo, utilizando fuentes archivísticas e impresas de la OMS, prensa médica y general, analiza el papel de médicos y científicos, gobierno y la OMS en la implementación de los estudios serológicos para evaluar la situación de la poliomielitis, sarampión y rubeola en España y establecer un plan de actuación contra ellas. El trabajo muestra el protagonismo de Florencio Pérez Gallardo y su grupo de la Escuela Nacional de Sanidad, privilegiado por el régimen franquista para recibir el apoyo de los programas colaborativos de la OMS, tras la entrada de España en ella en 1951, y el impacto de dichos programas en la transformación científico-profesional del núcleo virológico de Madrid, acompañado del establecimiento de nuevas instituciones, que permitieron modernizar la virología, paralelamente al desarrollo y ejecución de las encuestas serológicas mencionadas. El estudio revela igualmente el desarrollo paralelo de grupos científicos catalanes, que gozaron de reconocimiento internacional y dinamizaron la lucha contra las enfermedades estudiadas, pero también el papel clave de la circulación de los expertos de la OMS y los investigadores españoles para vehicular conocimiento científico y prácticas


Serological surveys, which acquired considerable importance in the mid twentieth century, are still a key tool to address infectious diseases. This article, using archival and printed sources from the WHO and the medical and general press, analyses the role of doctors and scientists, government, and the WHO in the implementation of serological surveys to evaluate the situation of poliomyelitis, measles and rubella in Spain and to set up a plan of action against them. The paper shows the role of Florencio Pérez Gallardo and his group at the National School of Health, favoured by the Franco regime to receive the support of WHO collaborative programmes after Spain joined in 1951, and the impact of these programmes on the scientific and professional transformation of the virological nucleus of Madrid, together with the establishment of new institutions enabling the modernisation of virology, in parallel with the development and execution of the serological surveys. The study also reveals the parallel development of Catalan scientific groups, who enjoyed international recognition and boosted the fight against the diseases studied, as well as the key role of the circulation of WHO experts and Spanish researchers in the spreading of scientific knowledge and practices


Assuntos
Humanos , História do Século XX , Rubéola (Sarampo Alemão)/prevenção & controle , Sarampo/prevenção & controle , Poliomielite/prevenção & controle , Estudos Soroepidemiológicos , Rubéola (Sarampo Alemão)/diagnóstico , Rubéola (Sarampo Alemão)/história , Sarampo/diagnóstico , Sarampo/história , Poliomielite/diagnóstico , Poliomielite/história , Vacina contra Sarampo-Caxumba-Rubéola , Organização Mundial da Saúde , Governo , Espanha
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