Impacto poblacional a 10 años de la vacunación contra rotavirus en México / Population impact of rotavirus vaccination in Mexico after 10 years

Resumen: Objetivo: Evaluar el impacto de la vacunación contra rotavirus (RV) a 10 años de su universalización sobre la morbimortalidad por enfermedad diarreica aguda (EDA) en niños mexicanos menores de cinco años. Material y métodos: Se compararon las medianas anuales de casos nuevos, defunciones y hospitalizaciones por EDA del periodo pre y posuniversalización; se calcularon reducciones absolutas y relativas, considerando significativos valores de p<0.05. Resultados: La mortalidad, hospitalizaciones y casos nuevos por EDA en menores de cinco años disminuyeron 52.6, 46 y 15.5% respectivamente, en el periodo posuniversalización. Durante la temporada de RV las reducciones en la mortalidad, hospitalizaciones y casos nuevos fueron de 66.9, 64.7 y 28.7%, respectivamente. Conclusiones: A partir de la universalización de la vacuna de RV en México, se aprecian reducciones importantes y sostenidas en la mortalidad, hospitalizaciones e incidencia por EDA, con menor impacto en esta última. El mayor impacto se observa durante la temporada de RV.

Abstract: Objective: To evaluate the impact of rotavirus (RV) vaccination after 10 years of it´s universalization on morbidity and mortality from Acute Diarrheal Disease (ADD) in mexican children under five years of age. Materials and methods: Annual median numbers for ADD new cases, hospitalizations and deaths were compared between pre and post universalization periods; absolute and relative reductions were calculated, considering p<0.05 values as significant. Results: Mortality, hospitalizations and new cases from ADD in children under five decreased 52.6, 46, and 15.5% respectively, in the posuniversalization period. During rotavirus seasons, reduction in mortality, hospitalizations and new cases was 66.9, 64.7, and 28.7% respectively. Conclusions: As of the universal introduction of RV vaccination in Mexico, significant and sustained reductions are appreciated for mortality and hospitalizations from ADD, less so for incidence. A most prominent effect is observed during the winter season.

Rotavirus infection in a tertiary hospital: laboratory diagnosis and impact of immunization on pediatric hospitalization

BACKGROUND AND OBJECTIVES: Rotavirus (RV) is the main etiological agent of diarrhea in childhood; its laboratory diagnosis is crucial to guide the clinical management and prevention of its spread. RV immunization was introduced in Brazilian 6-month-old children in 2006. The present study was aimed to evaluate three methodologies used for human RV detection in stool samples obtained from patients hospitalized due to gastroenteritis in a teaching hospital and report the impact of RV immunization in hospitalization by diarrhea. METHODS: 293 stool samples collected in the 2001-2008 period were analyzed by enzyme immunoassay (EIA), latex agglutination (LA) and polyacrylamide gel electrophoresis (PAGE). RESULTS: Rotavirus was detected in 34.8 percent of samples by LA assay, 28.3 percent of samples by EIA assay and in 25.6 percent of samples by PAGE assay. Considering the PAGE method as gold standard, the sensitivity, specificity and accuracy of EIA were 94.6 percent, 94.4 percent and 94.5 percent, and to LA were 82.6 percent, 81.6 percent and 81.9 percent, respectively. CONCLUSION: These results indicate that antigen detection by EIA is a rapid, sensitive and specific method, and could be used in large-scale applications for screening stool samples suspected of RV infection. This study showed decreased incidence of RV infection in hospitalized children prior to the implementation of the national immunization program against RV.

Agentes causantes de diarrea en niños menores de 5 años en Tunja, Colombia / Diarrhoea-causing agents in children aged less than five in Tunja, Colombia

Objetivos: Determinar la prevalencia y tipo de agentes infecciosos causantes de EDA en una muestra de niños menores de 5 años que consultaron a IPS de Tunja durante el año 2004. Materiales y Métodos Estudio de corte transversal, la información se recogió mediante aplicación de una encuesta a 129 niños menores de 5 años afectados de EDA. Adicionalmente se recogió una muestra de heces, en las consultas externas del Hospital San Rafael y Clínica Saludcoop de Tunja. Resultados Se encontró Rotavirus en 48,1 por ciento, Shigella 0,8 por ciento, E. coli 13,9 por ciento; Campylobacter 2,3 por ciento; Giardia lamblia 12,4 por ciento; E. histolytica 7 por ciento; en 15,5 por ciento de casos no se identificó agente causal. La asociación es creciente con la edad para Rotavirus (p<0,01), E.Coli (p<0,05) y Campylobacter (p<0,001). Conclusión Rotavirus es el mayor agente causal de EDA en menores de 1 año, y en general, en menores de 5 años. Las prevalencias encontradas coinciden con lo reportado en estudios realizados en Facatativá, Bogotá, Santander, Manizales y Chocó; también con estudios adelantados en Venezuela, Perú y México.

Objectives: Determining the prevalence and type of infectious ADD-causing agents in a sample of children aged less than five who consulted the IPS in Tunja during 2004. Material and Methods A cross-sectional study was designed. Data was obtained by surveying 129 children younger than 5 suffering from ADD. Samples of faeces were obtained following outpatient consultation at San Rafael Hospital and SaludCoopÆs clinic in Tunja. Results Rotavirus was found in 48,1 percent of cases, Shigella in 0,8 percent, E. coli in 13,9 percent, Campylobacter in 2,3 percent, Giardia lamblia in 12,4 percent and E. hitolytica in 7 percent. The causative agent could not be identified in 15,5 percent of cases. The statistical association grew with age for Rotavirus (p<0.01), E. coli (p<0.05) and campylobacter (p<0.001). Conclusion Rotavirus is the major causative agent of ADD in children younger than one year and, generally, in children aged less than five. The prevalence found was similar to data reported in studies carried out in Facatatativá, Bogotá, Santander, Manizales and the Chocó in Colombia and studies carried out in Venezuela, Peru and Mexico.

Clinical and epidemiological aspects of children hospitalized with severe rotavirus-associated gastroenteritis in Salvador, BA, Brazil

Little is known about the epidemiology of severe rotavirus-associated gastroenteritis in Brazil. Given the morbidity associated with this condition and the importance of having detailed knowledge about the impact of rotavirus infection on the epidemiology of acute diarrhea in children, especially those with the most severe diarrheal conditions, we retrospectively reviewed the medical records of all pediatric patients admitted to a tertiary hospital in Salvador, Brazil, due to rotavirus-associated gastroenteritis during one year. It was observed that rotavirus was responsible for 15.6 percent of the hospitalizations caused by diarrhea and/or vomiting during the period of the study and that 87 of 218 (39.1 percent) patients seen at the emergency room with rotavirus-associated gastroenteritis needed to be hospitalized, comprising the population of our study. Most patients presented signs of dehydration, and 41 percent of them had metabolic acidosis. Most patients (79 percent) were between six months and four years of age and 72 percent of the cases occurred in June and July. Gastrointestinal symptoms were rarely present at the beginning of the clinical presentation, and they normally did not last for more than one week.

Perfil clínico da enterocolite por Citomegalovírus (CMV) na síndrome da imunodeficiência adquirida (AIDS) / Clinical profile of Cytomegalovirus (CMV) enterocolitis in acquired immunodeficiency syndrome (AIDS)

Múltiplos agentes estão envolvidos na etiopatogenia da diarréia em Aids. O exame de fezes e a colonoscopia são elementos decisivos para o diagnóstico específico. A enterocolite por CMV pode cursar com febre, emagrecimento, diarréia intermitente e hematoquesia. Outros agentes causadores de diarréia podem ter o mesmo espectro de apresentação. OBJETIVO: Definir o perfil clínico da enterocolite por CMV em pacientes com Aids, comparando os parâmetros clínicos, endoscópicos e de tempo de sobrevida entre dois grupos com diarréia crônica, grupo A com CMV e grupo B sem CMV. MÉTODOS: Foram acompanhados 48 pacientes com Aids e diarréia de duração maior que 30 dias, sendo 27 do grupo A e 21 do grupo B. Os parâmetros analisados foram idade, situação de risco, duração da diarréia, hematoquesia, intervalo de tempo entre diagnóstico da infecção por HIV e início de diarréia, achados endoscópicos e sobrevida. Foram realizados exames parasitológicos, culturas e colonoscopia com biópsias. Foi utilizado o teste "t-student" para amostras não pareadas e o teste Qui-Quadrado com correção de Yates para variáveis não paramétricas. Foram construídas curvas de sobrevida pelo método descrito por Kaplan-Meier e aplicado o teste de Mantel - Haenszel. Foi assumido como nível de significância estatística o valor de P menor que 0.05. RESULTADOS: O padrão endoscópico da infecção por CMV correspondeu a ulcerações associadas a hemorragia de submucosa 14 (51.8 por cento) P < 0.01. O tempo de sobrevida do grupo B após o diagnóstico do HIV e após o diagnóstico específico da diarréia foi maior que o do grupo A (0.005 > P > 0.001). Os outros parâmetros estudados não mostraram significância estatística. CONCLUSÕES: A presença de enterocolite por CMV em Aids é marcador de mau prognóstico e menor sobrevida. Existe um padrão endoscópico sugestivo da infecção por CMV.