Diálogos continentais sobre comunicação em saúde em tempos de pandemia / Continental dialogues on health communication in times of pandemic

Esta publicação, a 6ª da série LEIASS (Linha Editorial Internacional de Apoio aos Sistemas de Saúde), é fruto dos esforços conjuntos do Conselho Nacional de Secretários de Saúde do Brasil (CONASS) e do Instituto de Higiene e Medicina Tropical da Universidade Nova de Lisboa em reunir artigos de destacados autores, de diferentes países, sobre o importante tema da Comunicação em Saúde, nestes tempos de pandemia da Covid-19. Além de autores do Brasil e Portugal, estão também presentes neste volume artigos de especialistas do Canadá, Estados Unidos da América, Inglaterra, México e Uruguai, a quem agradecemos o valioso contributo à discussão. Um agradecimento especial deve ser feito à Profa. Dra. Ana Valéria Machado Mendonça, da Universidade de Brasília, que aceitou nosso convite para encarregar-se de organizar a presente obra. Há uma riqueza imensa de assuntos, que incluem a promoção da saúde; a revisão sistemática sobre o processo de comunicação em saúde na vigência da pandemia; a comunicação direcionada a povos indígenas; as questões afetas à saúde mental; a desinformação e o papel da mídia, dentre outros. Esperamos que a partilha de pontos de vista distintos, que envolvem realidades próprias a cada um desses países, possa auxiliar na compreensão do que se tem assistido em nível global em matéria de comunicação em saúde e suas repercussões no sucesso ou nas dificuldades enfrentadas face à pandemia da COVID-19.

Immunogenicity and safety of Southern Hemisphere inactivated quadrivalent influenza vaccine: a Phase III, open-label study of adults in Brazil

Abstract The World Health Organization influenza forecast now includes an influenza B strain from each of the influenza B lineages (B/Yamagata and B/Victoria) for inclusion in seasonal influenza vaccines. Traditional trivalent influenza vaccines include an influenza B strain from one lineage, but because two influenza B lineages frequently co-circulate, the effectiveness of trivalent vaccines may be reduced in seasons of influenza B vaccine-mismatch. Thus, quadrivalent vaccines may potentially reduce the burden of influenza compared with trivalent vaccines.In this Phase III, open-label study, we assessed the immunogenicity and safety of Southern Hemisphere inactivated quadrivalent influenza vaccine (Fluarix™ Tetra) in Brazilian adults (NCT02369341). The primary objective was to assess hemagglutination-inhibition antibody responses against each vaccine strain 21 days after vaccination in adults (aged ≥18–60 years) and older adults (aged >60 years). Solicited adverse events for four days post-vaccination, and unsolicited adverse events and serious adverse events for 21 days post-vaccination were also assessed.A total of 63 adults and 57 older adults received one dose of inactivated quadrivalent influenza vaccine at the beginning of the 2015 Southern Hemisphere influenza season. After vaccination, in adults and older adults, the hemagglutination-inhibition titers fulfilled the European licensure criteria for immunogenicity. In adults, the seroprotection rates with HI titer ≥1:40 were 100% (A/H1N1), 98.4% (A/H3N2), 100% (B/Yamagata), and 100% (B/Victoria); in older adults were 94.7% (A/H1N1), 96.5% (A/H3N2), 100% (B/Yamagata), and 100% (B/Victoria). Pain was the most common solicited local adverse events in adults (27/62) and in older adults (13/57), and the most common solicited general adverse events in adults was myalgia (9/62), and in older adults were myalgia and arthralgia (both 2/57). Unsolicited adverse events were reported by 11/63 adults and 10/57 older adults.The study showed that inactivated quadrivalent influenza vaccine was immunogenic and well-tolerated in Brazilian adults and older adults.

Influenza Vaccination Coverage Rate according to the Pulmonary Function of Korean Adults Aged 40 Years and Over: Analysis of the Fifth Korean National Health and Nutrition Examination Survey

Influenza vaccination is an effective strategy to reduce morbidity and mortality, particularly for those who have decreased lung functions. This study was to identify the factors that affect vaccination coverage according to the results of pulmonary function tests depending on the age. In this cross-sectional study, data were obtained from 3,224 adults over the age of 40 who participated in the fifth National Health and Nutrition Examination Survey and underwent pulmonary function testing in 2012. To identify the factors that affect vaccination rate, logistic regression analysis was conducted after dividing the subjects into two groups based on the age of 65. Influenza vaccination coverage of the entire subjects was 45.2%, and 76.8% for those aged 65 and over. The group with abnormal pulmonary function had a higher vaccination rate than the normal group, but any pulmonary dysfunction or history of COPD did not affect the vaccination coverage in the multivariate analysis. The subjects who were 40-64 years-old had higher vaccination coverage when they were less educated or with restricted activity level, received health screenings, and had chronic diseases. Those aged 65 and over had significantly higher vaccination coverage only when they received regular health screenings. Any pulmonary dysfunction or having COPD showed no significant correlation with the vaccination coverage in the Korean adult population.

Assessment of the safety and efficacy of low pathogenic avian influenza (H9N2) virus in inactivated oil emulsion vaccine in laying hens

In Korea, several outbreaks of low pathogenic AI (H9N2) viral infections leading to decreased egg production and increased mortality have been reported on commercial farms since 1996, resulting in severe economic losses. To control the H9N2 LPAI endemic, the Korea Veterinary Authority has permitted the use of the inactivated H9N2 LPAI vaccine since 2007. In this study, we developed a killed vaccine using a low pathogenic H9N2 AI virus (A/chicken/Korea/ADL0401) and conducted safety and efficacy tests in commercial layer farms while focusing on analysis of factors that cause losses to farms, including egg production rate, egg abnormality, and feed efficiency. The egg production rate of the control group declined dramatically 5 days after the challenge. There were no changes in feed consumption of all three groups before the challenge, but rates of the control declined afterward. Clinical signs in the vaccinated groups were similar, and a slight decline in feed consumption was observed after challenge; however, this returned to normal more rapidly than the control group and commercial layers. Overall, the results of this study indicate that the safety and efficacy of the vaccine are adequate to provide protection against the AI field infection (H9N2) epidemic in Korea.

A novel M2e-multiple antigenic peptide providing heterologous protection in mice

Swine influenza viruses (SwIVs) cause considerable morbidity and mortality in domestic pigs, resulting in a significant economic burden. Moreover, pigs have been considered to be a possible mixing vessel in which novel strains loom. Here, we developed and evaluated a novel M2e-multiple antigenic peptide (M2e-MAP) as a supplemental antigen for inactivated H3N2 vaccine to provide cross-protection against two main subtypes of SwIVs, H1N1 and H3N2. The novel tetra-branched MAP was constructed by fusing four copies of M2e to one copy of foreign T helper cell epitopes. A high-yield reassortant H3N2 virus was generated by plasmid based reverse genetics. The efficacy of the novel H3N2 inactivated vaccines with or without M2e-MAP supplementation was evaluated in a mouse model. M2e-MAP conjugated vaccine induced strong antibody responses in mice. Complete protection against the heterologous swine H1N1 virus was observed in mice vaccinated with M2e-MAP combined vaccine. Moreover, this novel peptide confers protection against lethal challenge of A/Puerto Rico/8/34 (H1N1). Taken together, our results suggest the combined immunization of reassortant inactivated H3N2 vaccine and the novel M2e-MAP provided cross-protection against swine and human viruses and may serve as a promising approach for influenza vaccine development.

Perception and Attitudes of Korean Obstetricians about Maternal Influenza Vaccination

Pregnant women are prioritized to receive influenza vaccination. However, the maternal influenza vaccination rate has been low in Korea. To identify potential barriers for the vaccination of pregnant women against influenza, a survey using a questionnaire on the perceptions and attitudes about maternal influenza vaccination was applied to Korean obstetricians between May and August of 2014. A total of 473 respondents participated in the survey. Most respondents (94.8%, 442/466) recognized that influenza vaccination was required for pregnant women. In addition, 92.8% (410/442) respondents knew that the incidence of adverse events following influenza vaccination is not different between pregnant and non-pregnant women. However, 26.5% (124/468) obstetricians strongly recommended influenza vaccination to pregnant women. The concern about adverse events following influenza vaccination was considered as a major barrier for the promotion of maternal influenza vaccination by healthcare providers. Providing professional information and education about maternal influenza vaccination will enhance the perception of obstetricians about influenza vaccination to pregnant women and will be helpful to improve maternal influenza vaccination coverage in Korea.

Comparative study of lymphocytes from individuals that were vaccinated and unvaccinated against the pandemic 2009-2011 H1N1 influenza virus in Southern Brazil

ABSTRACTINTRODUCTION:While no single factor is sufficient to guarantee the success of influenza vaccine programs, knowledge of the levels of immunity in local populations is critical. Here, we analyzed influenza immunity in a population from Southern Brazil, a region with weather conditions that are distinct from those in the rest of country, where influenza infections are endemic, and where greater than 50% of the population is vaccinated annually.METHODS:Peripheral blood mononuclear cells were isolated from 40 individuals. Of these, 20 had received the H1N1 vaccine, while the remaining 20 were unvaccinated against the disease. Cells were stimulated in vitro with the trivalent post-pandemic influenza vaccine or with conserved major histocompatibility complex I (MHC I) peptides derived from hemagglutinin and neuraminidase. Cell viability was then analyzed by [3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide)]-based colorimetric assay (MTT), and culture supernatants were assayed for helper T type 1 (Th1) and Th2-specific cytokine levels.RESULTS:Peripheral blood lymphocytes from vaccinated, but not unvaccinated, individuals exhibited significant proliferation in vitro in the presence of a cognate influenza antigen. After culturing with vaccine antigens, cells from vaccinated individuals produced similar levels of interleukin (IL)-10 and interferon (IFN)-γ, while those from unvaccinated individuals produced higher levels of IFN-γ than of IL-10.CONCLUSIONS:Our data indicate that peripheral blood lymphocytes from vaccinated individuals are stimulated upon encountering a cognate antigen, but did not support the hypothesis that cross-reactive responses related to previous infections can ameliorate the immune response. Moreover, monitoring IL-10 production in vaccinated individuals could comprise a valuable tool for predicting disease evolution.

Detection of influenza B lineages from 2001 to 2013 in a tertiary hospital in the city of São Paulo, Brazil

Two antigenically distinct lineages of influenza B viruses, the Victoria-like and Yamagata-like strains, currently circulate among humans. Surveillance from United States of America and Europe over the last 10 years showed that the chance of a correct matching between vaccine and the circulating lineage had been 50%. We investigated influenza B infection in different patient groups (asymptomatic, general community, with comorbidities and hospitalised) attended at a tertiary hospital in the city of São Paulo, Brazil between 2001-2013. All samples were screened for influenza B virus by one-step real-time reverse transcription-polymerase chain reaction. From 2,992 respiratory samples collected, 114 (3.8%) tested positive for influenza B. Teenagers (13-18 years) presented the highest rate of 18.5% (odds ratio 22.87, 95% confidence interval 2.90-180.66, p < 0.001). One hundred nine samples could be characterised: 50 were Yamagata-like and 59 were Victoria-like strains. Mismatching between the vaccine and predominant circulating strain was observed in 2002 and 2013 seasons. Based on data collected during a period of 12 years, we found that influenza B was more frequent in teenagers. Co-circulation of both lineages and mismatch with the vaccine strain can occur. Our data highlighted the importance of quadrivalent vaccines and future analysis of the age groups included in vaccination programs.

Cobertura vacinal contra influenza e motivos da não vacinação em crianças com idade de risco internadas em hospital terciário / Immunization against influenza and the reasons for non-immunization in children under age of risk hospitalized in tertiary hospital

Introdução: As crianças menores de 2 anos de idade apresentam importante fator de risco para internação e mortalidade por Influenza A H1N1. Morte é um desfecho incomum, mas seu risco é maior nesta faixa etária, especialmente, se há comorbidades associadas. As complicações incluem pneumonia viral e infecção bacteriana secundária. A principal intervenção preventiva é a imunização. O objetivo deste estudo foi descrever o percentual pediátrico imunizado, em duas campanhas consecutivas, verificar o motivo da não vacinação e comparar a frequência vacinal nos anos de 2012 e 2013. Métodos: Estudo de série histórica, abrangendo crianças internadas na faixa etária de risco - seis meses a dois anos. Foram feitos a revisão da caderneta vacinal e o inquérito aos responsáveis pelo paciente para identificar quem havia indicado a vacinação e qual o motivo da não vacinação. Resultados: Foram estudadas 191 crianças em 2012, e 226 em 2013, que se encontravam na faixa etária de risco. Em 2012, 71,2% dos pacientes foram vacinados e em 2013, 79,5% (P=0,05). A campanha foi o maior estímulo para a vacinação em 69% dos casos, e as principais causas da não vacinação foram gripe (31,4%) e desinformação (22,5%). Conclusão: Comparando os dois anos, verificou-se não haver diferença entre as coberturas vacinais, embora ainda permaneçam aquém do resultado registrado nacionalmente. A perda da campanha ainda está relacionada à gripe, neste período, fato que não é contraindicação. No entanto, ainda permanece um fator importante de impedimento, inclusive dos centros de referência em vacinação, como as Unidades Básicas de Saúde (AU)

Introduction: Children under 2 years of age present a significant risk factor for hospitalization and mortality from influenza A, H1N1. Death is an unusual outcome, but the risk is higher in this age group, especially if there are associated comorbidities. Complications include viral pneumonia and secondary bacterial infection. The main preventive intervention is immunization. The aim of this study was to describe the percentage of immunized children in two consecutive campaigns, check the reason for non-vaccination and compare the vaccination rate in years 2012 and 2013. Methods: Historical series study, including hospitalized children in the age group of risk, i.e., from six months to two years. Vaccination records were reviewed and a survey was carried out with parents/caregivers to identify who had indicated vaccination and the reason for non-vaccination. Results: 191 children were studied in 2012 and 226 in 2013, who were in the age group of risk. In 2012, 71.2% of patients were vaccinated and in 2013, 79.5% (P = 0.05). The campaign was the greatest stimulus for vaccination in 69% of cases, and the main causes of non-vaccination were influenza A (31.4%) and lack of information (22.5%). Conclusion: Comparing the two years, no difference in vaccination coverage was found, although the vaccination rates still remained below the nationally reported outcomes. During this period, missing the campaign was still related to the flu, a condition that is not a contraindication. However, it still remains an important factor of non-vaccination, even in the referral centers for vaccination, such as Basic Health Units (AU)

Caracterização fenotípica e funcional da resposta imune de voluntários imunizados contra influenza A (H1N1)pdm09

A primeira pandemia de gripe do século XXI foi declarada em junho de 2009 pela Organização Mundial de Saúde (OMS)e representou uma grande ameaça à saúde da população mundial. E uma vez que as primeiras vacinas foram licenciadas, tornou-se iminente a busca de informações mais aprofundadas sobre os mecanismos imunológicos desencadeados por estas vacinas, considerando ainda a presença ou ausência de adjuvante em sua formulação. Neste contexto,o presente trabalho objetiva avaliar aspectos fenotípicos e funcionais das imunidades celular e humoral em indivíduos vacinados contra o vírus da Influenza A (H1N1)pdm09. Para isso, 20 voluntários saudáveis foram imunizados contra H1N1pandêmico, na presença (n=10) ou ausência (n=10) de adjuvante (óleo em água), e avaliados nos tempos 0, 1, 3, 7, 30 dias pós-imunização. Desta forma, diversos parâmetros foram utilizados para caracterizar a imunidade desenvolvida por estas vacinas, dentre os quais, avaliação clínica e hematológica, sorologia, imunofenotipagem celular e análise de citocinas intracelulares e plasmáticas.

Coletivamente, os resultados demonstraram um perfil imunológico bastante distinto desencadeado pelas vacinas, embora ambas tenham induzido níveis semelhantes de anticorpos e persistência destes 6 meses após a vacinação.A vacina com adjuvante foi capaz de induzir uma resposta mais intensa de células da imunidade inata, com significativa ativação da imunidade celular, principalmente de linfócitos T CD4+e aumento na frequência de linfócitos B. Além disso, esta vacina induziu uma expressiva produção de citocinas, apresentando um padrão misto de resposta Th1/ Th2 neste grupo. Por outro lado, a vacina sem adjuvante, desencadeou uma resposta mais discreta e tardia, com menor ativação da imunidade inata e fraca indução de linfócitos T, porém com elevada ativação de linfócitos B. Esta vacina também causou uma menor produção de citocinas, desencadeando um perfil pouco inflamatório neste grupo. Em suma, as vacinas induziram perfis distintos de respostas imune inata e adaptativa, o que parece estar relacionado à presença ou ausência de adjuvante. Contudo, é importante enfatizar que ambas as vacinas foram capazes de induzir uma resposta eficaz no que diz respeito à imunogenicidade, o que sugerei munidade protetora contra o vírus H1N1pandêmico.

Caracterização fenotípica e funcional da resposta imune de voluntários imunizados contra influenza A (H1N1)pdm09 / Phenotypic and functional characterization of the immune response volunteers immunized against influenza A (H1N1) pdm09

A primeira pandemia de gripe do século XXI foi declarada em junho de 2009 pela Organização Mundial de Saúde (OMS)e representou uma grande ameaça à saúde da população mundial. E uma vez que as primeiras vacinas foram licenciadas, tornou-se iminente a busca de informações mais aprofundadas sobre os mecanismos imunológicos desencadeados por estas vacinas, considerando ainda a presença ou ausência de adjuvante em sua formulação. Neste contexto,o presente trabalho objetiva avaliar aspectos fenotípicos e funcionais das imunidades celular e humoral em indivíduos vacinados contra o vírus da Influenza A (H1N1)pdm09. Para isso, 20 voluntários saudáveis foram imunizados contra H1N1pandêmico, na presença (n=10) ou ausência (n=10) de adjuvante (óleo em água), e avaliados nos tempos 0, 1, 3, 7, 30 dias pós-imunização. Desta forma, diversos parâmetros foram utilizados para caracterizar a imunidade desenvolvida por estas vacinas, dentre os quais, avaliação clínica e hematológica, sorologia, imunofenotipagem celular e análise de citocinas intracelulares e plasmáticas...

Coletivamente, os resultados demonstraram um perfil imunológico bastante distinto desencadeado pelas vacinas, embora ambas tenham induzido níveis semelhantes de anticorpos e persistência destes 6 meses após a vacinação.A vacina com adjuvante foi capaz de induzir uma resposta mais intensa de células da imunidade inata, com significativa ativação da imunidade celular, principalmente de linfócitos T CD4+e aumento na frequência de linfócitos B. Além disso, esta vacina induziu uma expressiva produção de citocinas, apresentando um padrão misto de resposta Th1/ Th2 neste grupo. Por outro lado, a vacina sem adjuvante, desencadeou uma resposta mais discreta e tardia, com menor ativação da imunidade inata e fraca indução de linfócitos T, porém com elevada ativação de linfócitos B. Esta vacina também causou uma menor produção de citocinas, desencadeando um perfil pouco inflamatório neste grupo. Em suma, as vacinas induziram perfis distintos de respostas imune inata e adaptativa, o que parece estar relacionado à presença ou ausência de adjuvante. Contudo, é importante enfatizar que ambas as vacinas foram capazes de induzir uma resposta eficaz no que diz respeito à imunogenicidade, o que sugerei munidade protetora contra o vírus H1N1pandêmico...

Ideal Vaccination Strategy in Inflammatory Bowel Disease / 대한소화기학회지

Inflammatory bowel disease (IBD) is a long-standing disease that often requires long-term use of immunosuppressive agents including immunomodulators (such as azathioprine, 6-mercaptopurine and methotrexate) and tumor necrosis factor-alpha inhibitors (such as infliximab and adalimumab). Introduction of immunosuppressive therapies, however, involves the risk of host susceptibility to opportunistic infections in this patient population. Therefore, adequate immunization for vaccine-preventable infectious diseases is currently recommended for all patients with IBD and is emerging as an important target for quality improvements in IBD care. However, ongoing issues regarding underuse of immunization, safety and efficacy of vaccines in patients with IBD remain. For quality improvements in IBD care, all physicians should follow the recent immunization guidelines proposed by professional IBD societies. Additionally, there are ongoing needs for intensive educational programs regarding a role of immunization in long-term care of IBD and up-to-date immunization guidelines. Immunization status should be checked at the time of diagnosis of IBD and timely vaccination before initiation of immunosuppressive therapies can be a practical solution for maximizing the efficacy of vaccination at this point. Inactivated vaccines can be used safely irrespective of immunization status of patients, while attenuated vaccines are contraindicated in patients on immunosuppressive therapies. This article reviews an ideal strategy for vaccinating patients with IBD based on the currently recommended immunization guidelines.

Vaccination Policy in Korean Armed Forces: Current Status and Future Challenge

Infectious diseases have historically resulted in suspended or cancelled military operations. Vaccination for disease prevention is a critical component of the military's force readiness doctrine. Until recently, Korea had not recognized the importance of vaccinating military personnel. However, a 2011 meningococcal disease outbreak at an army recruit training center led to dramatic changes in the paradigm of traditional medical practice in the Korean armed forces. A new vaccination policy was formed by a 2012 Military Healthcare Service Act. Since then, Neisseria meningitidis, hepatitis A, and measles-mumps-rubella vaccines have been routinely administered to all new recruits early in basic training to ensure protection against these diseases. All active-duty soldiers also receive seasonal influenza vaccination annually. Despite quantitative improvements in vaccination policies, several instances of major infectious diseases and adverse vaccine reactions have threatened soldier health. In the future, vaccination policies in the Korean armed forces should be based on epidemiologic data and military medical research for vaccine use and safety management.

Estado de vacunación en embarazadas y puérperas de un hospital público polivalente / Vaccination status in pregnant and puerperal women in a public general hospital

Introducción: conocer el estado de vacunación durante la gestación tiene por objeto la protección de madre e hijo. Objetivos: caracterizar epidemiológicamente a la población. Deter-minar el estado de vacunación de embarazadas/puérperas. Anali-zar la indicación de vacuna antigripal según época del año.Materiales y Métodos: estudio analítico. Encuesta en dos tiempos: previo a época invernal (grupo1, 13/2/13-13/3/13) y durante época invernal (grupo2, 5/7/13-15/8/13) en embarazadas/puérperas inter-nadas. Variables: demográficas, cobertura de doble adultos (dT)/triple bacteriana acelular (dTpa), antihepatitis B y antigripal.Resultados: total 437 pacientes, 47 embarazadas y 390 puérperas. Edad promedio 25 años (r = 14-48). Argentinas 89,5 %. Embarazos controlados 76 %. Escolaridad: secundario completo 21,5 %, in-completo 52,6 %. En unión estable 68 %. Embarazo no planifica-do 60,2 %. Vacuna dT: vigente: 81 %. dTpa: colocada 59,5 % (93 % durante el embarazo). Antihepatitis B: 50,3 % tenían la vacuna (91,8 % esque-ma completo). Cobertura antigripal total: 54,2 %. Grupo 1: 29 % vs Grupo 2, 86 % (p< 0,001). El 99 % se colocó la vacuna durante la gestación. Coberturas según embarazo controlado/no controla-do: dT 81,5 % / 73 % (p = 0,28), dTpa 61,8 % / 23 % (p = 0,0001), antihepatitis B 46,2 % / 46,1 % (p = 0,99) y antigripal 57 % / 11,5 % (p = 0,0000). Conclusión: predominaron mujeres jóvenes, con secundario incompleto, embarazo no planificado y deficiencias en su estado vacunal. La cobertura para dTpa y antigripal fue mayor en controladas con relación esta-dísticamente significativa. La vacuna antigripal tuvo mayor indica-ción en época invernal. Preocupa el desconocimiento sobre su estado de inmunización. Es importante la intervención del equipo de salud para motivar contro-les durante el embarazo, evaluar esquema de vacunación y educar sobre enfermedades inmunoprevenibles

Introduction: Knowing the status of vaccination during pregnancy aims at the protection of mother and child. Objectives: Epidemiologically characterize the population. To determine the vaccination status of pregnant/postpartum women. Analyze the indication of influenza vaccine according to the season. Materials and Methods: analytical study. Survey in two stages: pre-winter period (group 1, 13/2/13-13/3/13) and during winter time (Group 2, 5/7/13-15/8/13) in pregnant/postpartum women admitted. Variables: demographic, adults double coverage (dT)/acellular bacterial triple (DTaP), hepatitis B and influenza. Results: Total 437 patients, 47 pregnant and 390 postpartum women. Average age 25 years (r=14-48). Argentine 89.5%. Controlled pregnancies 76%. Schooling: Secondary full 21.5%, 52.6% incomplete. Cohabitants 68%. Unplanned pregnancy 60.2%. dT vaccine: current 81%. DTaP: placed 59.5% (93% during pregnancy). Hepatitis B: 50.3 % had the vaccine (91.8% complete scheme). Total influenza coverage: 54.2%. Group 1:29% vs Group 2, 86 % (p<0.001). 99% placed the vaccine during pregnancy. Hedges as controlled/uncontrolled pregnancy: dT 81.5 %/73 % (p=0.28), DTaP 61.8% / 23% (p =0.0001), hepatitis B 46.2 %/46.1% (p=0.99) and influenza 57%/11.5 % (p= 0.0000). Conclusion: Young women predominated, with incomplete secondary, unplanned pregnancy and deficiencies in their vaccination status. Coverage for DTaP and flu vaccine was higher in controlled pregnancies statistically significant relationship. The flu vaccine had greater indication winter. Ignorance about their immunization status is concerned. Intervention is important to the health team to motivate controls during pregnancy, evaluate vaccination and education on preventable diseases

Influenza virus surveillance among young children in São Paulo, Brazil: the impact of vaccination

This study assessed the presence of influenza virus among young children and the coverage of vaccination from 2010 to 2012 in São Paulo, Brazil. Our results demonstrated a lower rate of influenza detection and a predominance of influenza B. A decrease of coverage vaccination through the surveillance periods was observed.

Current State of Influenza Vaccination and Factors Affecting Vaccination Rate among Pregnant Women

PURPOSE: This study was done to examine the actual state of influenza vaccination among pregnant women and factors affecting vaccination rate. METHODS: Data were collected using self-report questionnaires. Participants were pregnant women who participated in a prenatal education program at an acute care hospital in 2013. Data collected from 218 pregnant women were analyzed using the SPSS 18.0 Program. RESULTS: Only 48.6% of the pregnant women had received vaccination when the influenza was prevalent. Statistically significant factors affecting the influenza vaccination rate among pregnant women were vaccination experience in the previous year, knowledge and attitude about vaccination, and gestation period. CONCLUSION: Results indicate that the influenza vaccination rate among pregnant women is lower than that of elders, healthcare workers, and patients with chronic diseases, who have been considered to be the mandatory vaccination recipients. Therefore, it is necessary to develop programs and policies which provide information including safety of vaccines for pregnant women and to induce positive attitudes towards vaccination for these women, in order to ultimately improve the vaccination rate.

Immunogenicity of influenza H1N1 vaccination in mixed connective tissue disease: effect of disease and therapy

OBJECTIVE: To assess the potential acute effects regarding the immunogenicity and safety of non-adjuvanted influenza A H1N1/2009 vaccine in patients with mixed connective tissue disease and healthy controls. METHODS: Sixty-nine mixed connective tissue disease patients that were confirmed by Kasukawa's classification criteria and 69 age- and gender-matched controls participated in the study; the participants were vaccinated with the non-adjuvanted influenza A/California/7/2009 (H1N1) virus-like strain. The percentages of seroprotec-tion, seroconversion, geometric mean titer and factor increase in the geometric mean titer were calculated. The patients were clinically evaluated, and blood samples were collected pre- and 21 days post-vaccination to evaluate C-reactive protein, muscle enzymes and autoantibodies. Anti-H1N1 titers were determined using an influenza hemagglutination inhibition assay. ClinicalTrials.gov: NCT01151644. RESULTS: Before vaccination, no difference was observed regarding the seroprotection rates (p = 1.0) and geometric mean titer (p = 0.83) between the patients and controls. After vaccination, seroprotection (75.4% vs. 71%, (p = 0.7), seroconversion (68.1% vs. 65.2%, (p = 1.00) and factor increase in the geometric mean titer (10.0 vs. 8.0, p = 0.40) were similar in the two groups. Further evaluation of seroconversion in patients with and without current or previous history of muscle disease (p = 0.20), skin ulcers (p = 0.48), lupus-like cutaneous disease (p = 0.74), secondary Sjogren syndrome (p = 0.78), scleroderma-pattern in the nailfold capillaroscopy (p = 1.0), lymphopenia #1000/mm³ on two or more occasions (p = 1.0), hypergammaglobulinemia $1.6 g/d (p = 0.60), pulmonary hypertension (p = 1.0) and pulmonary fibrosis (p = 0.80) revealed comparable rates. Seroconversion rates were also similar in patients with and without immunosuppressants. Disease parameters, such as C-reactive protein (p = 0.94), aldolase (p = 0.73), creatine phosphokinase (p = 0.40) and ribonucleoprotein antibody levels (p = 0.98), remained largely unchanged pre and post-vaccination. No severe side effects were reported. CONCLUSIONS: The non-adjuvanted influenza A/H1N1 vaccination immune response in mixed connective tissue disease patients is adequate and does not depend on the disease manifestations and therapy.

Cross-Protective Immune Responses Elicited by Live Attenuated Influenza Vaccines

The desired effect of vaccination is to elicit protective immune responses against infection with pathogenic agents. An inactivated influenza vaccine is able to induce the neutralizing antibodies directed primarily against two surface antigens, hemagglutinin and neuraminidase. These two antigens undergo frequent antigenic drift and hence necessitate the annual update of a new vaccine strain. Besides the antigenic drift, the unpredictable emergence of the pandemic influenza strain, as seen in the 2009 pandemic H1N1, underscores the development of a new influenza vaccine that elicits broadly protective immunity against the diverse influenza strains. Cold-adapted live attenuated influenza vaccines (CAIVs) are advocated as a more appropriate strategy for cross-protection than inactivated vaccines and extensive studies have been conducted to address the issues in animal models. Here, we briefly describe experimental and clinical evidence for cross-protection by the CAIVs against antigenically distant strains and discuss possible explanations for cross-protective immune responses afforded by CAIVs. Potential barriers to the achievement of a universal influenza vaccine are also discussed, which will provide useful guidelines for future research on designing an ideal influenza vaccine with broad protection without causing pathogenic effects such as autoimmunity or attrition of protective immunity against homologous infection.

Comparison of adverse events following immunization with pandemic influenza A (H1N1)pdm09 vaccine with or without adjuvant among health professionals in Rio de Janeiro, Brazil

A vaccination campaign against pandemic influenza A (H1N1)pdm09 was held in Brazil in March 2010, using two types of monovalent split virus vaccines: an AS03-adjuvanted vaccine and a non-adjuvanted vaccine. We compared the reactogenicity of the vaccines in health professionals from a Clinical Research Institute in Rio de Janeiro, Brazil and there were no serious adverse events following immunization (AEFI) among the 494 subjects evaluated. The prevalence of any AEFI was higher in the AS03-adjuvanted vaccine at 2 h and 24 h post-vaccination [preva-lence ratio (PR): 2.05, confidence interval (CI) 95%: 1.55-2.71, PR: 3.42, CI 95%: 2.62-4.48, respectively]; however, there was no difference between the vaccines in the assessments conducted at seven and 21 days post-vaccination. The group receiving the AS03 post-adjuvanted vaccine had a higher frequency of local reactions at 2 h (PR: 3.01, CI 95%: 2.12-4.29), 24 h (PR: 4.57, CI 95%: 3.29-6.37) and seven days (PR: 6.05, CI 95%: 2.98-12.28) post-vaccination. We concluded that the two types of vaccines caused no serious AEFI in the studied population and the adjuvanted vaccine was more reactogenic, particularly in the 24 h following vaccination. This behaviour must be confirmed and better characterised by longitudinal studies in the general population.