II Consenso Brasileiro em Doença de Chagas, 2015 / Brazilian Consensus on Chagas Disease, 2015

A doença de Chagas é uma condição crônica negligenciada com elevada carga de morbimortalidade e impacto dos pontos de vista psicológico, social e econômico. Representa um importante problema de saúde pública no Brasil, com diferentes cenários regionais. Este documento traduz a sistematização das evidências que compõe o Consenso Brasileiro de Doença de Chagas. O objetivo foi sistematizar estratégias de diagnóstico, tratamento, prevenção e controle da doença de Chagas no país, de modo a refletir as evidências científicas disponíveis. Sua construção fundamentou-se na articulação e contribuição estratégica de especialistas brasileiros com conhecimento, experiência e atualização sobre diferentes aspectos da doença. Representa o resultado da estreita colaboração entre a Sociedade Brasileira de Medicina Tropical e o Ministério da Saúde. Espera-se com este documento fortalecer o desenvolvimento de ações integradas para enfrentamento da doença no país com foco em epidemiologia, gestão, atenção integral (incluindo famílias e comunidades), comunicação, informação, educação e pesquisas.

Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

Epidemiological profile of Trypanosoma cruzi-infected mothers and live birth conditions in the state of Minas Gerais, Brazil

INTRODUCTION: The aim of this study was to assess the epidemiological characteristics of Trypanosoma cruzi-infected mothers and the live birth conditions of neonates. METHODS: A serological survey with IgG-specific tests was conducted using dried blood samples from newborn infants in the State of Minas Gerais. T. cruzi infection was confirmed in mothers through positive serology in two different tests, and infected mothers were required to have their infants serologically tested after the age of 6 months. The birth conditions of the neonates were obtained from the System of Information on Live Births database. RESULTS: The study included 407 children born to T. cruzi-infected mothers and 407 children born to uninfected mothers. The average age of seropositive mothers was 32 years (CI95% 31.3-32.6), which was greater than the average age of seronegative mothers - 25 years (CI95% 24.8-25.2). The mothers' level of education was higher among uninfected mothers (41% had 8 or more years of education, versus 22% between the infected mothers). Vaginal delivery was more frequent among infected mothers. There was no evidence of inter-group differences with respect to the child's sex, gestational age, birth weight or Appearance, pulse, grimace, activity and respiration (APGAR) scores at 1 and 5 minutes. Conclusions: The level of education and the greater number of previous pregnancies and cases of vaginal delivery reflect the lower socioeconomical conditions of the infected mothers. In the absence of vertical transmission, neonates had similar health status irrespective of the infection status of their mothers. .

Triagem neonatal da infecção pelo Trypanosoma cruzi em Minas Gerais, Brasil: transmissão congênita emapeamento das áreas endêmicas / Neonatal screening program for the infection by Trypanosoma Cruzi in Minas Gerais, Brazil: congenital transmission and tracking of the endemic areas

No Brasil, uma vez controlada a transmissão pelas vias vetorial e transfusional, a via vertical adquiriu maior importância na transmissão da doença de Chagas (DC). A alta possibilidade de cura da doença de Chagas congênita (DCC) faz com que seu diagnóstico seja imperativo.Visando definir o risco de transmissão vertical e mapear áreas de risco, realizou-se inquérito sorológico em 63.673 neonatos do Programade Triagem Neonatal de Minas Gerais. A prevalência de DC em puérperas foi 0,5 por cento (IC95 por cento 0,37-0,54) e, as prevalências mais elevadas foram observadas na região norte do estado, variando de 2,3 por cento a 23 por cento. O risco de transmissão vertical foi 0,2 por cento (IC95 por cento 0,00-0,55) e a incidência de DCC foi 1,6 em cem mil nascidos vivos (IC95 por cento 0,00-5,00). A sorologia demonstrou ser eficiente ferramenta para o diagnóstico da DCC, e propõe-se que deva ser incluída no Programa de Triagem Neonatal nas áreas consideradas endêmicas. No estudo, a IgG materna persistiu positiva, em 17 crianças, entre seis e nove meses de idade. Portanto, filhos assintomáticos de mães chagásicas devem ser submetidos à sorologia após seis meses e, se positiva, deve ser repetida aos nove meses, antes de intervenção terapêutica.

In Brazil, once vectoral and transfusional transmissions are under control, congenital transmission of Chagas disease has become the main form. Treatment of congenital infection is often successful, so early detection becomes a relevant issue of public health. To determine the risk of congenital Chagas disease (CCD), were studied 63. 673 newborns enrolled at Neonatal Screening Program, at Minas Gerais, Brazil. The prevalence of Chagas disease in pregnant women was 0.5 per cent(IC95 per cent 0,37-0,54), varying from 2,3 to 23 per cent, with higher rates found in the northern state region. Transmission risk was estimated at 0.2 per cent(IC95 per cent 0,00-0,55) leading to an incidence rate of 1.6 per 100,000 live births(IC95 per cent 0,00-5,00) Serology survey was shown to be an efficient diagnostic tool, it should be included at neonatal screening programs in endemic areas. Asymptomatic children from infected mothers should be tested at six months of age, and if positive, serology should be repeated at nine months of age, before initiating therapeutic interventions.

Imunização: respostas a questões frequentes na prática pediátrica / Imunization: answers to common paediatrician questions

Os anos recentes trouxeram avanços enormes no campo da imunização, com melhoria na eficácia de algumas vacinas e disponibilização de novas vacinas, significando melhoria na prevenção de doenças infecciosas e conseqüentemente melhor qualidade de vida de crianças e adultos. O calendário vacinal recomendado para uso em pediatria deve ser dinâmico e adaptado às peculiaridades do indivíduo e da situação epidemiol6gica do momento. O objetivo desta revisão é oferecer ao pediatra uma atualização sobre as vacinas para uso nas redes pública e privada de saúde e responder a algumas dúvidas que freqüentemente o preocupam no exercício profissional.

Recent years brought huge advances in the immunization field, with improved efficacy of some vaccines and availa- bility of new ones, meaning improvement on infectious diseases prevention and rherefore a better life to children and adults. The advised immunization schedule for pae- diatric use must be dynamic and adapted to the needs of each person and to rhe epidemiologic overview of the momento This review's objective is to offer to the paediatrician an update on vaccines for public and private health care and answer some doubrs that often embarrass the paediatrician on medica! practice.