Long-term survival and cause-specific mortality of patients newly diagnosed with tuberculosis in São Paulo state, Brazil, 2010­15: a population-based, longitudinal study

Background Long-term survival and cause-specific mortality of patients who start tuberculosis treatment is rarely described. We aimed to assess the long-term survival of these patients and evaluate the association between vulnerable conditions (social, health behaviours, and comorbidities) and cause-specific mortality in a country with a high burden of tuberculosis. Methods In this population-based, longitudinal study in São Paulo state, Brazil, we described the 5-year survival of patients who were newly diagnosed with tuberculosis in 2010. We included patients with newly-diagnosed tuberculosis, aged 15 years or older, and notified to the São Paulo State Tuberculosis Program in 2010. We excluded patients whose diagnosis had changed during follow-up (ie, they did not have tuberculosis) and patients who had multidrug-resistant (MDR) tuberculosis. We selected our population with tuberculosis from the dedicated electronic system TBweb. Our primary objective was to estimate the excess mortality over 5 years and within the group who survived the first year, compared with the general São Paulo state population. We also estimated the association between social vulnerability (imprisonment and homelessness), health behaviours (alcohol and drug use), and comorbidities (diabetes and mental disorders) with all-cause and cause-specific mortality. We used the competing risk analysis framework, estimating cause-specific hazard ratios (HRs) adjusted for potential confounding factors. Findings In 2010, there were 19 252 notifications of tuberculosis cases. We excluded 550 cases as patients were younger than 15 years, 556 cases that were not tuberculosis, 2597 retreatments, and 48 cases of MDR tuberculosis, resulting in a final cohort of 15 501 patients with tuberculosis. Over a period of 5 years from tuberculosis diagnosis, 2660 (17%) of 15 501 patients died. Compared with the source population, matched by age, sex, and calendar year, the standardised mortality ratio was 6·47 (95% CI 6·22­6·73) over 5 years and 3·93 (3·71­4·17) among those who survived the first year. 1197 (45%) of 2660 deaths were due to infection. Homelessness and alcohol and drug use were associated with death from infection (adjusted cause-specific HR 1·60, 95% CI 1·39­1·85), cardiovascular (1·43, 1·06­1·95), and external or ill-defined causes of death (1·80, 1·37­2·36). Diabetes was associated with deaths from cardiovascular causes (1·70, 1·23­2·35). Interpretation Patients newly diagnosed with tuberculosis were at a higher risk of death than were the source population, even after tuberculosis treatment. Post-tuberculosis sequelae and vulnerability are associated with excess mortality and must be addressed to mitigate the tuberculosis burden worldwide.

Tendência temporal e desigualdades na mortalidade por diarreias em menores de 5 anos / Temporal trends and inequality in under-5 mortality from diarrhea

Objetivo: Analisar a tendência da mortalidade por diarreia entre menores de 5 anos, no município de Osasco (SP), entre 1980 e 2000. Métodos: Trata-se de estudo observacional com dois delineamentos. Um descritivo, que toma o indivíduo como unidade do estudo, e outro ecológico, analisando agregado populacional que incluiu análise de séries temporais. A fonte de dados foi o sistema de informação de mortalidade do Estado de São Paulo e censos de 1980, 1991 e 2000. Descreveu-se a variação sazonal e para a análise de tendência aplicaram-se modelos log lineares de regressão polinomiais, utilizando-se variáveis sociodemográficas da criança e da mãe. Foram analisadas a evolução de indicadores sociodemográficos do município de 1980 a 2000, as taxas médias de mortalidade por diarreia nos menores de 5 anos e seus diferenciais por distrito nos anos 90. Resultados: Dos 1.360 óbitos, 94,3 e 75,3% atingiram, respectivamente, menores de 1 ano e de 6 meses. O declínio da mortalidade foi de 98,3%, com deslocamento da sazonalidade do verão para o outono. A mediana da idade elevou-se de 2 meses nos primeiros períodos para 3 meses no último. O resíduo de óbitos manteve-se entre filhos de mães de 20 a 29 anos e escolaridade < 8 anos. O risco relativo entre o distrito mais atingido e a taxa média do município diminuiu de 3,4 para 1,3 do primeiro para o segundo quinquénio dos anos 90. Conclusão: Nossos resultados apontam uma elevação da idade mais vulnerável e a provável mudança do agente mais frequentemente associado ao óbito por diarreia.

Objective: To analyze the trend in mortality due to diarrhea among children under 5 in the town of Osasco (SP), Brazil, between 1980 and 2000. Methods: This is a descriptive observational study with two different designs, the first using individuais as the unit of study, and the other ecológica!, using groups of individuais as units of observation and including time series analysis. Data were obtained from the state of São Paulo information system of deaths and the results of the 1980, 1991 and 2000 censuses. Seasonal variations were described and log linear polynomial regres sion models were employed to analyze trends, using the sociodemographic characteristies of mothers and their children. Analyses were carried out of the changes in the town's sociodemographic indicators from 1980 to 2000, the average mortality rates among under-5s due to diarrhea and the differences between districts during the 1990s. Results: There were a total of 1,360 deaths, 94.3% of which were before 1 year of age and 75.3% of which were before 6 months. There was a 98.3% reduction in mortality and the period of peak mortality shifted from summer to autumn/fall. The median age at death increased from 2 months at the first three quinquenium of study to 3 months at the last. The residual deaths were among the children of mothers aged 20 to 29 years and of mothers who had spent less than 8 years in education. The relative risk between the worst-affected district and the average rate for the townreduced from 3.4 to 1.3 from the first 5 years of the 1990s to the second half of the decade. Conclusions: Our results demonstrate an increase in the age of greatest vulnerability and indicate that it is probable that the agent most often linked with mortality due to diarrhea has changed.

Tendência temporal e desigualdades na mortalidade por diarreias em menores de 5 anos / Temporal trends and inequality in under-5 mortality from diarrhea

OBJETIVO: Analisar a tendência da mortalidade por diarreia entre menores de 5 anos, no município de Osasco (SP), entre 1980 e 2000. MÉTODOS: Trata-se de estudo observacional com dois delineamentos. Um descritivo, que toma o indivíduo como unidade do estudo, e outro ecológico, analisando agregado populacional que incluiu análise de séries temporais. A fonte de dados foi o sistema de informação de mortalidade do Estado de São Paulo e censos de 1980, 1991 e 2000. Descreveu-se a variação sazonal e para a análise de tendência aplicaram-se modelos log lineares de regressão polinomiais, utilizando-se variáveis sociodemográficas da criança e da mãe. Foram analisadas a evolução de indicadores sociodemográficos do município de 1980 a 2000, as taxas médias de mortalidade por diarreia nos menores de 5 anos e seus diferenciais por distrito nos anos 90. RESULTADOS: Dos 1.360 óbitos, 94,3 e 75,3 por cento atingiram, respectivamente, menores de 1 ano e de 6 meses. O declínio da mortalidade foi de 98,3 por cento, com deslocamento da sazonalidade do verão para o outono. A mediana da idade elevou-se de 2 meses nos primeiros períodos para 3 meses no último. O resíduo de óbitos manteve-se entre filhos de mães de 20 a 29 anos e escolaridade < 8 anos. O risco relativo entre o distrito mais atingido e a taxa média do município diminuiu de 3,4 para 1,3 do primeiro para o segundo quinquênio dos anos 90. CONCLUSÃO: Nossos resultados apontam uma elevação da idade mais vulnerável e a provável mudança do agente mais frequentemente associado ao óbito por diarreia.

OBJECTIVE: To analyze the trend in mortality due to diarrhea among children under 5 in the town of Osasco (SP), Brazil, between 1980 and 2000. METHODS: This is a descriptive observational study with two different designs, the first using individuals as the unit of study, and the other ecological, using groups of individuals as units of observation and including time series analysis. Data were obtained from the state of São Paulo information system of deaths and the results of the 1980, 1991 and 2000 censuses. Seasonal variations were described and log linear polynomial regression models were employed to analyze trends, using the sociodemographic characteristics of mothers and their children. Analyses were carried out of the changes in the town's sociodemographic indicators from 1980 to 2000, the average mortality rates among under-5s due to diarrhea and the differences between districts during the 1990s. RESULTS: There were a total of 1,360 deaths, 94.3 percent of which were before 1 year of age and 75.3 percent of which were before 6 months. There was a 98.3 percent reduction in mortality and the period of peak mortality shifted from summer to autumn/fall. The median age at death increased from 2 months at the first three quinquenium of study to 3 months at the last. The residual deaths were among the children of mothers aged 20 to 29 years and of mothers who had spent less than 8 years in education. The relative risk between the worst-affected district and the average rate for the town reduced from 3.4 to 1.3 from the first 5 years of the 1990s to the second half of the decade. CONCLUSIONS: Our results demonstrate an increase in the age of greatest vulnerability and indicate that it is probable that the agent most often linked with mortality due to diarrhea has changed.

Economic impact of a rotavirus vaccine in Brazil.

The study was done to evaluate the cost-effectiveness of a national rotavirus vaccination programme in Brazilian children from the healthcare system perspective. A hypothetical annual birth-cohort was followed for a five-year period. Published and national administrative data were incorporated into a model to quantify the consequences of vaccination versus no vaccination. Main outcome measures included the reduction in disease burden, lives saved, and disability-adjusted life-years (DALYs) averted. A rotavirus vaccination programme in Brazil would prevent an estimated 1,804 deaths associated with gastroenteritis due to rotavirus, 91,127 hospitalizations, and 550,198 outpatient visits. Vaccination is likely to reduce 76% of the overall healthcare burden of rotavirus-associated gastroenteritis in Brazil. At a vaccine price of US$ 7-8 per dose, the cost-effectiveness ratio would be US$ 643 per DALY averted. Rotavirus vaccination can reduce the burden of gastroenteritis due to rotavirus at a reasonable cost-effectiveness ratio.

Presumptive rapid diagnosis of parvovirus infection in patients with Erythema infectiosum-like illness

In September 1987 an outbreak of exanthematous illness ressembling erythma infectiosum occurres at an elementary school of Säo Paulo city. Attempts to isolate virus from the nasofaryngeal secretion and urine and serum samples collected from the ill children in acute phase of illness resulted negative. Nevertheless, parvovirus-like particles of about 24 nm in diameter were observed by negative staining electron microscopy in concentraded urine of seven out of eight ill patients and in nasopharyngeal secretion of one out of four patients. No similar viral particle was observed in concentred urine samples collected on the same occasion from their classmates without evident signs of illness. This is a proposal of an alternative test for a rapid and sensitive presumptive diagnosis of human parvovirus infection

Preliminar characterization of a new virus isolated from the spinal fluid of patients with meningitis in Säo Paulo, Brazil

De dezembro de 1982 a março de 1983 um total de 138 pacientes com idade de 4 meses a 57 anos foram atendidos em diferentes hosptais de Säo Paulo com sintomas de meningite asséptica. Um agente transmissível foi isolado de 35 das 53 amostras de líquor. A replicaçäo desse novo vírus ou de um grupo de vírus relacioandos antigenicamente com características semelhantes foi detectada através do efeito citopático produzido em cultura de células de MDCK. O agente isolado demonstrou ter um diâmtro em torno de 40 nm quando examinado ao microscópio eletrônico através da coloraçäo negativa. Nenhuma atividade hemaglutinante foi detectada em pH 7,2 com hemácias humanas de cobaias ou de galinha e em pH 6,0 - 7,2 com hemácias de ganso. Esse agente näo se mostrou patogênico ao camundongo recém-nascido e adulto, era sensível ao clorofórmio e näo foi inibido pelo BuDR, o que indica conter o genoma RNA

Frequência de anticorpos anti-Cysticercus cellulosae em população de risco para cisticercose e em segmento de população considerado supostamente normal, em regiões do Estado de São Paulo, Brasil / Frequency of anti-cysticercus cellulosae antibodies in high risk population for cysticercosis and in a segment considered as normal population, in areas of Säo Paulo state, Brazil

Examinaram-se, através de reação de fixação de complemento, os soros de 234 pacientes internados em hospital psiquiátrico localizado no município de Presidente Prudente, considerados de risco para infecção cisticercótica, além de 454 soros de gestantes procedentes da Região Administrativa de Santos e 397 soros de indivíduos considerados supostamente normais, procedentes da Região Administrativa de Presidente Prudente. O antígeno utilizado na reação de fixação de complemento foi obtido através de extração metílica, à temperatura ambiente, dos císticercos tratados com acetona. Consideraram-se positivas as reações em que ocorreu fixação de complemento a partir da diluição 1 :2. Dos 1.085 soros testados, 27 apresentaram atividade anticomplementar e 17 (1,6%) mostraram-se reagentes. Todavia, quando se consideraram, separadamente, os grupos procedentes de Santos, Presidente Prudente e os doentes mentais, percebe-se diferença significativa nos resultados: assim, os índices de freqüência foram, respectivamente, 0,88% e 1,00% para os indivíduos procedentes de Santos e Presidente Prudente e considerados supostamente normais e 3,8% para os doentes mentais. Os resultados indicam que não é desprezível a ocorrência de anticorpos anti-Cysticercus cellulosae em nosso meio, especialmente entre pacientes de hospitais psiquiátricos (AU).