Boletim Epidemiológico dos Casos de Covid-19 no Estado do Rio de Janeiro 2020 - 2021 / Epidemiological Bulletin of Covid-19 Cases in the State of Rio de Janeiro 2020 - 2021

Esta edição do boletim apresenta a análise do total de casos confirmados de COVID-19 de residentes no estado do Rio de Janeiro e suas nove regiões de saúde, incluindo os casos de Síndrome Gripal (SG) ou casos leves, as internações ou casos de Síndrome Respiratória Aguda Grave (SRAG) e os óbitos, ocorridos desde o início da pandemia em 2020 até 26 de fevereiro de 2022 (8ª Semana Epidemiológica).

Diseño y validación de los instrumentos cuantitativo y cualitativo 0-6 lme para determinar los factores de riesgo de la interrupción de la lactancia materna exclusiva / Design and validation of the quantitative and qualitative instruments 0-6 lme to determine the risk factors of the interruption of exclusive breastfeeding

La lactancia materna exclusiva (LME) ha sido considerada una práctica saludable, ya que contribuye con nutrientes esenciales para la salud y crecimiento del niño. Desde esta perspectiva se considera necesario disponer de instrumentos de medición como herramientas para el levantamiento de información sobre problemáticas de salud. Por consiguiente, para garantizar la calidad del instrumento, es indispensable que éste sea sometido a un proceso de validación por juicio de expertos. Objetivo: Validar los instrumentos cuantitativo y cualitativo 0-6 LME para establecer los factores de riesgo que determinan la interrupción de la lactancia materna exclusiva. Método: La metodología empleada tuvo un enfoque mixto (cuantitativo.- cualitativo) de corte transversal, exploratorio, descriptivo y de campo. El enfoque cualitativo es fenomenológico e interpretativo. El instrumento cuantitativo se diseñó con respuestas dicotómicas y polinómicas y el instrumento cualitativo fue diseñado con preguntas abiertas para realizar la entrevista a profundidad o saturación. Como responsables de la validación de los instrumentos estuvieron 2 PhD, 1 especialista y 2 investigadores. Resultados: La validación por parte de los expertos determinó para el criterio de pertinencia 93,18 puntos, para el criterio validez 93,07 puntos y para el criterio coherencia 92,67. Del mismo modo fueron obtenidos los resultados para el instrumento cualitativo, el criterio validez 95,73 puntos, para el criterio pertinencia 95,73 y para coherencia 95,73 puntos. Conclusión: se establece que los instrumentos son considerados confiables de acuerdo al juicio de los expertos, por lo tanto, fueron validados y servirán como aporte para obtener los datos requeridos en la investigación científica(AU)

Exclusive breastfeeding (EBF) has been considered a healthy practice, since it contributes essential nutrients for the health and growth of the child. From this perspective, it considered necessary to have measurement instruments as tools for gathering information on health problems. Therefore, to guarantee the quality of the instrument, it is essential to submit these instruments to an expert validation process based on expert judgment. Objective: To validate the quantitative and qualitative instruments 0-6 LME to establish the risk factors that determine the interruption of exclusive breastfeeding. Method: The methodology used had a mixed approach (quantitative-qualitative) of cross-sectional, exploratory, descriptive and field sections. The qualitative approach is phenomenological and interpretive. The quantitative instrument was designed with dichotomous and polynomial responses and the qualitative instrument was designed with open questions to carry out the interview in depth or saturation. Responsible for the validation of the instruments were 2 PhD, 1 specialist and 2 researchers. Results: The validation by the experts determined for the relevance criterion 93.18 points, for the validity criterion 93.07 points and for the coherence criterion 92.67. In the same way, the results obtained for the qualitative instrument, the validity criterion 95.73 points, for the relevance criterion 95.73 and for coherence 95.73 points. Conclusion: it established that the instruments are considered reliable according to the judgment of the experts; therefore, they were validated and will serve as a contribution to obtain the data required in scientific research(AU)

Mortality from respiratory infections and chronic non-communicable diseases before the COVID-19 pandemic in Cali, Colombia / Mortalidad por infecciones respiratorias y enfermedades crónicas no trasmisibles antes de la pandemia por COVID-19 en Cali, Colombia

Abstract Introduction: The COVID-19 disease pandemic is a health emergency. Older people and those with chronic noncommunicable diseases are more likely to develop serious illnesses, require ventilatory support, and die from complications. Objective: To establish deaths from respiratory infections and some chronic non-communicable diseases that occurred in Cali, before the SARS-CoV-2 disease pandemic. Methods: During the 2003-2019 period, 207,261 deaths were registered according to the general mortality database of the Municipal Secretary of Health of Cali. Deaths were coded with the International Classification of Diseases and causes of death were grouped according to WHO guidelines. Rates were standardized by age and are expressed per 100,000 people-year. Results: A direct relationship was observed between aging and mortality from respiratory infections and chronic non-communicable diseases. Age-specific mortality rates were highest in those older than 80 years for all diseases evaluated. Seasonal variation was evident in respiratory diseases in the elderly. Comments: Estimates of mortality rates from respiratory infections and chronic non-communicable diseases in Cali provide the baseline that will serve as a comparison to estimate the excess mortality caused by the COVID-19 pandemic. Health authorities and decision makers should be guided by reliable estimates of mortality and of the proportion of infected people who die from SARS-CoV-2 virus infection.

Resumen Introducción: La pandemia de la enfermedad COVID-19 es una emergencia sanitaria. Las personas mayores y aquellos con enfermedades crónicas no trasmisibles tienen más probabilidades de desarrollar enfermedades graves, requerir soporte ventilatorio y morir a causa de las complicaciones. Objetivo: Establecer las defunciones por infecciones respiratorias y por algunas enfermedades crónicas no trasmisibles ocurridas en Cali, antes de la pandemia de la enfermedad por el SARS-CoV-2. Métodos: Durante el periodo 2003-2019, se registraron 207,261 defunciones información obtenida de la base de datos de mortalidad general de la Secretaria de Salud Municipal de Cali. Las defunciones se codificaron con la Clasificación Internacional de Enfermedades y las causas de muerte se agruparon según las guías de la OMS. Las tasas se estandarizaron por edad, son expresadas por 100,000 personas-año. Resultados: Se observó una relación directa entre envejecimiento y la mortalidad por infecciones respiratorias y enfermedades crónicas no trasmisibles. Las tasas de mortalidad específicas por edad fueron más altas en los mayores de 80 años para todas las enfermedades evaluadas. En las enfermedades respiratorias fue evidente una variación estacional en los ancianos. Comentario: Las estimaciones de las tasas de mortalidad por infecciones respiratorias y enfermedades crónicas no trasmisibles para Cali proporcionan la línea de base que servirá de comparación para estimar el exceso de mortalidad que ocasionará la pandemia de COVID-19. Las autoridades sanitarias y los tomadores de decisiones deben guiarse por estimaciones fiables de la mortalidad y de la proporción de infectados que mueren por la infección del virus SARS-CoV-2.

Host characteristics predict outcome among adult patients admitted by severe acute respiratory infection / Características del huésped predicen el desenlace en adultos hospitalizados por infección respiratoria aguda grave

Background: Except for influenza pandemics, different observational studies have failed to demonstrate differences in mortality between various etiologies in adult patients hospitalized for respiratory infections. Aim: To compare clinical and mortality differences between different viral pathogens associated with severe acute respiratory infections (SARI) in hospitalized adults. Material and Methods: One-year prospective study in a sentinel center. We included 132 patients with SARI hospitalized for any of the nine viruses under study by PCR. Clinical variables were compared, excluding cases of coinfection. Results: A viral coinfection was identified in 12% and influenza infection in 56% of cases. Eighty percent of patients were aged ≥ 65 years, with a high frequency of comorbidities, 27% were bedridden. Twenty four percent were admitted to critical care units, 20% required ventilatory assistance and 16% died. Cases occurred throughout the year, with an expected seasonal peak between autumn and spring and a predominance of infections not associated with influenza during summer months. In the multivariate analysis, only being bedridden was significantly associated with mortality at discharge (Odds ratio 23.46; 95% confidence intervals 3.33-165.12, p < 0.01), without association with age, comorbidity, viral pathogen involved, laboratory parameters, clinical presentation or CURB65 score. No major clinical dissimilarities were found between different viral pathogens. Conclusions: In our series of patients, mostly elderly, only bedridden status was significantly associated with mortality at discharge in patients hospitalized for SARI. Viral pathogens were not relevant.

Los factores del huésped son más importantes que el tipo viral para predecir el desenlace en pacientes hospitalizados por infecciones respiratoria aguda grave. Exceptuando las pandemias de influenza, diferentes estudios observacionales no han logrado demostrar diferencias en mortalidad entre diferentes patógenos en pacientes adultos hospitalizados por infecciones respiratorias. Objetivo: Comparar diferencias clínicas y en mortalidad entre diferentes patógenos virales asociados a infección respiratoria aguda grave (IRAG) en adultos hospitalizados. Método: Estudio prospectivo durante un año en un centro centinela. Se incluyeron casos de IRAG hospitalizados por alguno de los 9 virus bajo estudio por RCP. Se compararon variables clínicas y desenlace. Resultados: Ingresaron 132 pacientes con IRAG. Se identificó coinfección viral en 12,1% e infección por influenza en 56,1%. La mayor parte era de la tercera edad (80,3%) con una alta frecuencia de comorbilidad y 27,3% estaba postrado. Veintitres coma cinco por ciento ingresó a unidad de cuidados críticos, 19,7% requirió asistencia ventilatoria y 15,9% fallecieron. Los casos ocurrieron todo el año, con un aumento estacional esperado entre otoño y primavera y predominio de infecciones no asociadas a influenza en verano. En el análisis multivariado, sólo la postración se asoció significativamente a mortalidad al egreso (ORa 23,46 IC95 3,33-165,12, p = 0,002), sin asociación con la edad, comorbilidad, patógeno viral involucrado, parámetros de laboratorio, presentación clínica o puntuación CURB65. No se encontraron discordancias clínicas mayores entre diferentes agentes virales. Conclusiones: En nuestra serie de pacientes, mayoritariamente de la tercera edad, sólo la postración se asoció significativamente a mortalidad al egreso en pacientes hospitalizados por IRAG. El patógeno viral no resultó ser relevante.

Infecciones respiratorias agudas bajas en niños menores de 2 años: hospitalizaciones durante el invierno del año 2014 / Low acute respiratory infections in children under 2 years: 2014 winter hospitalizations / Infecções agudas das vias respiratórias inferiores em crianças menores de 2 anos: hospitalizações em 2014

Durante el invierno las infecciones respiratorias agudas bajas (IRAB) determinan un incremento en la demanda asistencial, afectando sobre todo a los niños más pequeños. El objetivo de la investigación fue describir las características clínicas, modalidades de tratamiento y evolución de los menores de 2 años hospitalizados en el Hospital Pediátrico-Centro Hospitalario Pereira Rossell por IRAB de etiología viral durante el invierno de 2014. Se realizó un estudio descriptivo, retrospectivo, describiendo las características de los menores de 2 años hospitalizados del 9/6 al 21/9/2014 por IRAB de probable etiología viral. Se describieron las características epidemiológicas y clínicas, el tratamiento realizado y la evolución de los pacientes. En el período evaluado egresaron 742 niños (34% de los egresos de la institución). Tenían una mediana de edad de 4 meses; 18% presentaba al menos un factor de riesgo de IRAB grave. Se identificó al virus respiratorio sincicial en 59,6%. La estadía hospitalaria tuvo una mediana de 4 días. En las salas de cuidados moderados se aplicó ventilación no invasiva a 46 niños, y oxigenación de alto flujo a 129 niños, logrando una mejoría clínica en el 87,0% y el 87,6% respectivamente. Ingresaron a unidades de cuidados intensivos 217 niños, 54% requirió asistencia ventilatoria mecánica. Dos pacientes fallecieron. En el período evaluado los niños pequeños con IRAB representaron una importante proporción de los egresos, con importante carga asistencial. La mayoría eran niños sin factores de riesgo. La aplicación de las técnicas de tratamiento en cuidados moderados fue efectiva, permitiendo disminuir la demanda de camas de cuidados intensivos.

During the winter, low acute respiratory infections (LARI) determine an increase in care demand, especially affecting younger children. The objective of the research was to describe the clinical characteristics, treatment modalities and evolution of children under 2 years of age hospitalized at the Hospital Pediátrico-Centro Hospitalario Pereira Rossell for viral etiology LARI during the 2014 winter. A descriptive, retrospective study was conducted, describing the characteristics of children under 2 years hospitalized between 9/6 and 9/21/2014 for LARI of probable viral etiology. The following features were described: epidemiological and clinical characteristics, treatment performed and patient's evolution. During the period evaluated, 742 children were discharged (34% of the institution's admissions). They had a median age of 4 months; 18% had at least one risk factor for severe LARI. Respiratory syncytial virus was identified in 59.6%. The hospital stay had a median of 4 days. In moderate care rooms noninvasive ventilation was applied to 46 children, and high flow oxygenation to 129 children, achieving clinical improvement in 87.0% and 87.6%, respectively. Two hundred and seventeen children were admitted 54% required mechanical ventilation. Two patients died. In the evaluated period small children with LARI represented a significant proportion of the discharges, with an important burden of care. The majority were children without risk factors. The application of treatment techniques in moderate care was effective, allowed a decrease in the demand for intensive care beds.

Durante o inverno, as infecções respiratórias agudas baixas (IRAB) determinam o aumento da demanda de cuidados, afetando especialmente as crianças menores. O objetivo da pesquisa foi descrever as características clínicas, as modalidades de tratamento e a evolução de crianças menores de dois anos hospitalizados no Hospital Pediátrico-Centro Hospitalario Pereira Rossell devido a IRAB de etiologia viral, durante o inverno de 2014. Foi realizado um estudo descritivo e retrospectivo, descrevendo as características das crianças menores de 2 anos hospitalizadas entre 9/6 e 21/9/2014 devido a IRAB de provável etiologia viral. Descreveram-se: características epidemiológicas e clínicas, tratamento realizado e evolução dos pacientes. Durante o período avaliado, 742 crianças foram hospitalizadas (34% dos ingressos da instituição). Tinham uma idade média de 4 meses; 18% tinham pelo menos um fator de risco para IRAB severa. O vírus sincicial respiratório foi identificado em 59,6%. A estadia hospitalaria teve uma mediana de 4 dias. Em salas de cuidados moderados, a ventilação não invasiva foi aplicada a 46 crianças e a oxigenação de alto fluxo a 129 crianças, atingindo melhora clínica em 87,0% e 87,6%, respectivamente. Foram internadas em unidades de terapia intensiva 217 crianças, 54% necessitaram de ventilação mecânica. Dois pacientes faleceram. No período avaliado, as crianças pequenas com IRAB representaram uma proporção significativa das despesas, com um carga importante de atendimento. A maioria carecia de fatores de risco. A aplicação de técnicas de tratamento em cuidados moderados foi eficaz, permitindo uma diminuição da demanda por leitos de terapia intensiva.

Home care in the Federal District: factors associated with the first occurrence of acute lower respiratory infection and death

Abstract INTRODUCTION: We aimed to evaluate the frequency and associated factors of acute respiratory infection and death among home care patients in Sobradinho/DF, Brazil. METHODS: Data were obtained from patients' medical records. Bivariate and multivariate analyses were performed. Odds ratio and 95% confidence interval were estimated. RESULTS: Factors associated with respiratory infection were ages <40 and >80 years and accommodation. Female sex was a protective factor. Age >30 years and dependency for daily activities were associated with death. CONCLUSIONS: These factors can improve clinical results in this specific home care and open new opportunities and questions for future research.

Carga de doença por infecções do trato respiratório inferior no Brasil, 1990 a 2015: estimativas do estudo Global Burden of Disease 2015 / Burden of disease by lower respiratory tract infections in Brazil, 1990 to 2015: estimates of the Global Burden of Disease 2015 study

RESUMO: Introdução: Infecções do trato respiratório inferior (ITRi) apresentam incidência e mortalidade significativas no mundo. Este artigo apresenta o impacto das ITRi na carga de doença, segundo as métricas utilizadas no estudo Global Burden of Disease 2015 (GBD 2015) para o Brasil, em 1990 e 2015. Métodos: Análise de estimativas do GBD 2015: anos de vida perdidos por morte prematura (YLLs), anos vividos com incapacidade (YLDs) e anos de vida perdidos por morte ou incapacidade (DALYs = YLLs + YLDs). Resultados: As ITRi foram a terceira causa de mortalidade no Brasil em 1990 e 2015, com 63,5 e 47,0 mortes/100 mil habitantes, respectivamente. Embora o número absoluto de óbitos tenha aumentado 26,8%, houve redução de 25,5% nas taxas de mortalidade padronizadas por idade, sendo a redução mais marcante em menores de 5 anos. Também houve redução progressiva da carga da doença, expressa em DALYs. Discussão: Apesar da redução da carga da doença no período, as ITRi foram importante causa de incapacidade e a terceira causa de mortes no Brasil em 2015. O aumento do número de óbitos ocorreu devido ao aumento e envelhecimento populacional. A redução das taxas de mortalidade acompanhou a melhora das condições socioeconômicas, do acesso mais amplo aos cuidados de saúde, da disponibilidade nacional de antibióticos e das políticas de vacinação adotadas no país. Conclusão: Apesar das dificuldades socioeconômicas vigentes, constatou-se uma redução progressiva da carga das ITRi, principalmente na mortalidade e na incapacidade, e entre os menores de cinco anos de idade.

ABSTRACT: Introduction: Lower respiratory tract infections (LRTIs) present significant incidence and mortality in the world. This article presents the impact of LRTIs in the burden of disease, according to the metrics used in the Global Burden of Disease study (GBD 2015) for Brazil in 1990 and 2015. Methods: Analysis of estimates from the GBD 2015: years of life lost due to premature death (YLLs), years lived with disability (YLDs), years of life lost due to death or disability (DALYs = YLLs + YLDs). Results: LRTIs were the third cause of mortality in Brazil in 1990 and 2015, with 63.5 and 47.0 deaths/100,000 people, respectively. Although the number of deaths increased 26.8%, there was a reduction of 25.5% in mortality rates standardized by age, with emphasis on children under 5 years of age. The disability indicators, as measured by the DALYs, demonstrate a progressive reduction of the disease burden by LRTIs. Discussion: Despite the reduction in mortality rates in the period, LRTIs were an important cause of disability and still the third cause of death in Brazil in 2015. The increase in the number of deaths occurred due to the increase in population and its aging. The reduction in mortality rates accompanied the improvement of socioeconomic conditions, broader access to health care, national availability of antibiotics, and vaccination policies adopted in the country. Conclusion: Despite the current socioeconomic difficulties, there has been a progressive reduction of the LRTIs load effect in Brazil, mostly in mortality and disability, and among children under 5 years of age.

Monitoramento de vírus respiratórios na região metropolitana de Belo Horizonte, 2011 a 2013 / Monitoreo de vírus respiratórios en la región metropolitana de Belo Horizonte, 2011-2013 / Monitoring respiratory virus infection in the metropolitan area of Belo Horizonte, Brazil, 2011-2013

OBJETIVO: analisar a circulação dos vírus respiratórios em residentes na região metropolitana de Belo Horizonte, Brasil, hospitalizados em Belo Horizonte, de 2011 a 2013. MÉTODOS: estudo descritivo de 5.158 indivíduos com síndrome respiratória aguda grave; foram comparadas as características dos casos confirmados com casos descartados ou sem coleta de swab. RESULTADOS: metade dos vírus isolados foi da influenza A, especialmente os subtipos A(H1N1)pdm09 em pessoas de 20-59 anos e A(H3N2) naquelas com 60 anos ou mais; crianças menores de cinco anos tiveram identificado, com maior frequência, o vírus sincicial respiratório (65,6%), seguido pelo vírus da influenza A (21,2%); o vírus da influenza circulou em todas as estações do ano, e seus períodos de maior incidência intercalaram-se com os de maior atividade do vírus sincicial respiratório. CONCLUSÃO: o monitoramento dos vírus respiratórios contribui para o conhecimento dos períodos de circulação viral e a adoção de medidas de controle específicas.

OBJETIVOS: analizar la circulación de virus respiratorios en residentes de la región metropolitana de Belo Horizonte, Brasil, hospitalizados entre 2011 y 2013. MÉTODOS: estudio descriptivo de 5.158 individuos con infección respiratoria aguda grave; fueron comparadas las características de los casos confirmados con los descartados o sin colecta de swab. RESULTADOS: la mitad de los virus aislados fueron influenza A, especialmente subtipos A(H1N1)pdm09 en personas entre 20-59 años, y A(H3N2) en personas de 60 años o más; los niños menores de cinco años presentaron, con mayor frecuencia, el virus sincicial respiratorio (65,6%), seguido por influenza tipo A (21,2%); el virus de la Influenza circuló en todas las estaciones y los periodos de mayor incidencia se intercalaron con los de mayor actividad del virus sincicial. CONCLUSIÓN: el monitoriamente del virus respiratorio contribuyo para el conocimiento de los periodos de circulación viral y la adopción de medidas de control específicas.

OBJECTIVE: to analyze the circulation of respiratory viruses in people living in the metropolitan area of Belo Horizonte, Brazil, and hospitalized in Belo Horizonte from 2011 to 2013. METHODS: this is a descriptive study of 5,158 patients with Severe Acute Respiratory Syndrome; a comparison was made between the characteristics of confirmed cases and those of discarded cases or cases without swab samples. RESULTS: Influenza A virus accounted for half the isolated viruses, especially subtype A(H1N1)pdm09 among patients aged 20-59 years old, and subtype A(H3N2) in those aged 60 or over; the most frequently identified respiratory virus among children under five years old was respiratory syncytial virus (65.6%), followed by influenza A virus (21.2%); influenza virus circulated in all seasons of the year and its periods of greatest incidence were interspersed with those of higher Respiratory Syncytial Virus activity. CONCLUSION: monitoring respiratory viruses contributes to knowledge about periods of virus circulation and the adoption of specific control measures.

Hospitalizaciones por IRAB de probable etiología viral en niños durante el año 2012: estrategia asistencial / Child hospitalizations for acute lower respiratory infections probably caused by virus in 2012: a healthcare strategy

Introducción: en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR) durante los meses fríos, las infecciones respiratorias agudas bajas (IRAB) determinan gran demanda asistencial. Para afrontarlas se pone en práctica una estrategia de diagnóstico y tratamiento denominada Plan de Invierno (PI), que se planifica anualmente, en función de las características de los pacientes tratados en años anteriores. Objetivos: describir las características epidemiológicas, clínicas y evolutivas de los niños que requirieron admisión por IRAB en el HP-CHPR durante los meses fríos del 2012 y describir las principales acciones de la estrategia Plan Invierno del año 2012 (PI-2012). Metodología: se describieron las características epidemiológicas, clínicas y evolutivas de los menores de 24 meses que egresaron del HP-CHPR, en el marco de la estrategia PI-2012, por IRAB de probable etiología viral. Se describió las principales acciones de la estrategia de diagnóstico y tratamiento realizada. Resultados: durante el PI-2012 egresaron 887 niños (25,5% de los egresos hospitalarios). La mediana de edad fue 4 meses. Menos de 10% tenía factores de riesgo para enfermedad grave. El virus respiratorio sincitial (VRS) fue el más frecuentemente identificado. Se aplicó un protocolo de diagnóstico y tratamiento. Se pusieron en práctica técnicas especiales de tratamiento en salas de cuidados moderados. Se aplicó ventilación no invasiva (VNI) en 87 niños, con éxito en 80% de los casos. Se realizó oxigenación de alto flujo (OAF) a 22 niños, con éxito en 100%. Requirieron ingreso a terapia intensiva (CTI) 149 niños, 55,7% requirió asistencia ventilatoria mecánica (AVM). Dos pacientes fallecieron en salas de cuidados moderados, cuatro en CTI. Conclusiones: las IRAB representaron una causa muy importante de morbimortalidad durante el período descripto. Los niños que requirieron ingreso hospitalario eran en su mayoría pequeños. Un porcentaje importante cursó una enfermedad grave, requiriendo modalidades especiales de tratamiento. Es importante continuar en la búsqueda de la mejor estrategia terapéutica para estos niños.

Introduction: during the colder months, acute lower respiratory infections (ALRI) determine a considerable increase in the demand for care at the Pereira Rossell Pediatric Hospital (HP-CHPR). In order to respond to such demand the hospital implements a diagnosis and treatment strategy called Winter Plan (WP), which is planned annually based on the characteristics of patients treated in previous years. Objectives: to describe the epidemiological and clinical characteristics and evolution of children with ALRI who required hospitalization in the HP-CHPR during the cold months of 2012, and to describe the main actions of the 2012 Winter Plan strategy (2012 WP). Methodology: epidemiological, clinical and evolution characteristics of children under 24 months discharged from HP-CHPR within the 2012WP strategy were described. The strategy’s main action for diagnosis and treatment were described. Results: 887 children were discharged during the 2012 WP strategy, representing 25.5% of hospital discharges. Median age was 4 months. Less than 10% presented risk factors for severe disease. Respiratory syncytial virus (RSV) was the most frequently identified virus. A protocol for diagnosis and treatment was applied. Special techniques for treatment were implemented in transitional care rooms. 87 children were administered non-invasive ventilation, which was successful in 80% of cases. High-flow oxygen was used in 22 children, being this successful in all patients. 149 children required admission to intensive care unit (ICU) , 55.7% needed mechanical ventilation assistance. Two patients died in the medium unit and four in the ICU. Conclusions: ALRI represent a major cause of morbidity and mortality during the period described . Most children who required hospitalization were young. A significant percentage presented a severe disease, requiring special treatment modalities. It is important to continue searching for the best therapeutic strategy for these children.

Circulation of Respiratory Syncytial Virus in Morocco during 2014-2016: Findings from a sentinel-based virological surveillance system for influenza

Respiratory syncytial virus [RSV] is a leading cause of mortality and morbidity in young infants, little was known on its circulation types and patterns in Morocco. We conducted a prospective study using sentinel-based influenza surveillance to detect RSV by real time PCR in patients with acute respiratory infections, enrolled during two seasons [2014/15, 2015/16]. During September 2014-April 2016, we obtained 1450 specimens, of which 267 [18.4%] tested positive for RSV. The proportion of positive RSV infection was higher in patients hospitalized with acute respiratory infection compared to those with mild symptoms in out-patient clinics. The proportion of RSV infection was highest in children aged 0-6 months [45%; P < 0.001]. Higher positivity rate was observed between months of December and March. RSV remains important viral etiological agent causing influenza-like illness and severe acute respiratory infections especially among infants in Morocco. Further surveillance, is required to understand better the risk factors of RSV infections

Impact of respiratory infection in the results of cardiac surgery in a tertiary hospital in Brazil / Impacto da infecção respiratória nos resultados da cirurgia cardíaca em hospital terciário no Brasil

AbstractObjective:To assess the impact of respiratory tract infection in the postoperative period of cardiac surgery in relation to mortality and to identify patients at higher risk of developing this complication.Methods:Cross-sectional observational study conducted at the Recovery of Cardiothoracic Surgery, using information from a database consisting of a total of 900 patients operated on in this hospital during the period from 01/07/2008 to 1/07/2009. We included patients whose medical records contained all the information required and undergoing elective surgery, totaling 109 patients with two excluded. Patients were divided into two groups, WITH and WITHOUT respiratory tract infection, as the development or respiratory tract infection in hospital, with patients in the group without respiratory tract infection, the result of randomization, using for the pairing of the groups the type of surgery performed. The outcome variables assessed were mortality, length of hospital stay and length of stay in intensive care unit. The means of quantitative variables were compared using the Wilcoxon and student t-test.Results:The groups were similar (average age P=0.17; sex P=0.94; surgery performed P=0.85-1.00) Mortality in the WITH respiratory tract infection group was significantly higher (P<0.0001). The times of hospitalization and intensive care unit were significantly higher in respiratory tract infection (P<0.0001). The presence of respiratory tract infection was associated with the development of other complications such as renal failure dialysis and stroke P<0.00001 and P=0.002 respectively.Conclusion:The development of respiratory tract infection postoperative cardiac surgery is related to higher mortality, longer periods of hospitalization and intensive care unit stay.

ResumoObjetivo:Avaliar o impacto da infecção do trato respiratório no pós-operatório da cirurgia cardíaca no Hospital Português de Pernambuco em relação à mortalidade hospitalar e identificar os pacientes com maior risco de desenvolver essa complicação.Métodos:Estudo do tipo transversal observacional realizado na Unidade de Recuperação de Cirurgia Cardiotorácica, utilizando informações de um banco de dados composto por um total de 900 pacientes operados nesse hospital no período de 01/07/2008 a 31/07/2009. Foram incluídos pacientes cujos prontuários continham todas as informações necessárias, totalizando 109 pacientes, havendo exclusão de dois. Os pacientes foram divididos em dois grupos, com e sem infecção do trato respiratório, conforme o desenvolvimento ou não infecção do trato respiratório no internamento, sendo os pacientes do grupo sem infecção do trato respiratório, fruto de randomização, utilizando-se para o pareamento dos grupos o tipo de cirurgia realizada. As variáveis de desfecho avaliadas foram mortalidade, tempo de internamento hospitalar e tempo de internamento em unidade de terapia intensiva. As médias das variáveis quantitativas foram comparadas por meio do teste de Wilcoxon e t de student.Resultados:Os grupos mostraram-se semelhantes. A mortalidade no grupo RTI foi significativamente maior (P<0,0001). Os tempos de internamento hospitalar e em unidade de terapia intensiva foram significativamente maiores no grupo infecção do trato respiratório (P<0,0001). A presença de infecção do trato respiratório associou-se ao desenvolvimento de outras complicações como insuficiência renal dialítica e acidente vascular cerebral, P<0,00001 e P=0,002, respectivamente.Conclusão:O desenvolvimento de infecção do trato respiratório no pós-operatório de cirurgia cardíaca relaciona-se a maior mortalidade, maiores tempos de internamento e permanência em unidade de terapia intensiva.

Aspectos de interés clínico epidemiológico en las infecciones respiratorias de pacientes VIH/SIDA / Aspects of clinical epidemiological interest in respiratory infections in HIV/AIDS patient

El aumento de la incidencia de la enfermedad HIV-SIDA a nivel nacional y mundial, justifica el estudio exhaustivo de este tema. Objetivo: describir la epidemiología de las infecciones respiratorias en esta población, su etiología, determinar la estadía hospitalaria, e identificar factores relacionados con la morbimortalidad: grado de inmunodepresión, terapia antirretroviral previa, la asociación con hábitos tóxicos e ingresos a CTI. Se analizaron historias clínicas de los ingresos hospitalarios de pacientes HIV/SIDA con infección respiratoria del Servicio de Medicina, en el período comprendido entre enero/2008-agosto/2011. Metodología: estudio descriptivo, retrospectivo, transversal y observacional. Conclusiones: la patología infecciosa respiratoria es la primera causa de ingreso hospitalario en estos pacientes. Predominan las infecciones a gérmenes no oportunistas; de los gérmenes oportunistas el más frecuente fue Pneumocystis jirovecii (PCJ), destacándose en segundo lugar la infección por BK. La estadía hospitalaria y la mortalidad fue mayor que la de la población HIV ingresada por otras causas. Estos pacientes ingresan en una etapa avanzada de la enfermedad, en su mayoría sin tratamiento antirretroviral de gran actividad (TARGA), con una inmunodepresión muy severa y con un alto índice de enfermedades oportunistas. Todo esto revela que en esta población aún no se produjo el cambio epidemiológico vigente en los países desarrollados.

The increased incidence of HIV- AIDS disease globally and nationally, justifies an exhaustive study of this subject. Objective: To describe the epidemiology of respiratory infections in this population, determine the hospital stay, the etiology and identify factors related to morbidity: degree of immunosuppression, germs, antiretroviral therapy and association with toxic habits and income to CTI . We analyzed medical records of HIV/AIDS patients with respiratory infection Medicine Service in August/2011-january/2008 period. Methodology: A descriptive, retrospective, cross-sectional, observational study. Conclusions: respiratory infectious disease is the leading cause of hospitalization in these patients. Predominate germs opportunistic infections. As for the most common opportunistic pathogens was Pneumocystis jirovecii (PCj), standing second BK infection. The hospital stay and mortality was greater than the HIV population admitted for other causes. These patients are admitted to an advanced stage of the disease with severe immunosuppression, with a high rate of opportunistic infections and a low number under treatment with HAART. All this supports that in this population has not yet produced the current epidemiological shift in developed countries.

Mortalidad por Influenza pA(H1N1) 2009 en el noreste de México / Mortality from pandemic influenza A (H1N1) in northeast of Mexico

Objetivo. Determinar los factores asociados a la mortalidad por influenzapA(H1N1) en los pacientes hospitalizados por infección respiratoria agudagrave (IRAG) confirmada por reacción en cadena de la polimerasa (PCR)en el Instituto Mexicano del Seguro Social (IMSS).Material y métodos. En el IMSS en la delegación de Nuevo León entre el1 de junio de 2009 y 9 de marzo de 2010 se realizó un estudio observacionalretrospectivo de casos y controles, utilizando la base de datos del Sistemade Información en Línea para la Vigilancia Epidemiológica de Influenza(SINOLAVE). Se incluyeron 278 pacientes hospitalizados con IRAG (controles)y 50 pacientes con IRAG que fallecieron (casos) debido a la infecciónpor virus influenza pA(H1N1).Resultados. Los factores asociados a la mortalidad en los pacientes hospitalizadospor IRAG debida a influenza pA(H1N1) fueron la edad (OR: 1,03IC95% 1,01-1,05) y la obesidad (OR: 4,44 IC95% 1,85-1,6), utilizando unmodelo de regresión logística.Conclusión. Podemos concluir que en la delegación de Nuevo León delIMSS, la influenza pA(H1N1) afectó principalmente a adultos jóvenes, sinembargo las muertes se presentaron en mayor número en los pacientes alincrementar la edad y en pacientes con alguna comorbilidad.Palabras clave: Influenza pandémica A(H1N1), mortalidad, infección respiratoriaaguda grave, factores de riesgo, razón de probabilidad.

Objective. To determine factors associated with mortality from pAinfluenzA(H1N1) – confirmed by polymerase chain reaction (PCR) – Inhospitalized patients with severe acute respiratory infection (SARI) in theMexican Social Security Institute (IMSS). Methods. In the IMSS in the Delegation of Nuevo Leon between June 1, 2009 and March9, 2010 a retrospective observational case-control study was conducted using the database ofOnline Information System for Epidemiological Surveillance of Influenza (SINOLAVE). 278inpatients with SARI (controls) and 50 SARI patients who died (cases) due to infection withinfluenza virus pA(H1N1) were included.Results. In the logistic regression model factors associated with mortality in patientshospitalized due to SARI pA influenzA(H1N1) were age (OR: 1.03 95% CI 1.01-1.05) andobesity (OR: 4.44 95 1.85 to 1%, 0.6).Conclusion. We can conclude that the delegation of Nuevo León of the IMSS, pAinfluenzA(H1N1) affects mainly young adults, though the deaths occurred in greater numbersin patients with increasing age and in patients with comorbidities.

Evaluation of IgG antibodies against respiratory syncytial virus (RSV), and associated risk factors for severe respiratory tract infections in pre-school children in North-central, Nigeria

Background: Childhood mortality and morbidity due to RSV is increasing. Our current study was aimed at determining the sero-prevalence rate of RSV IgG antibodies and investigates certain known risk factors for RSV disease severity in infants and pre-school children presenting with various forms of respiratory tract infections in Ilorin, Nigeria. Materials and Methods: About 280, children and 30, aged matched controls were enrolled into the study at the specialist hospital Ilorin. Blood testing for anti RSV IgG was done using a commercial ELISA kit by IVD Research Inc® Carlsbad. California U.S.A. Information regarding Nutritional status, socio-economic status and other demographic variables were collected. Results: A prevalence rate of 85.7% was recorded among tested children and 23.3%, in controls, across age groups and gender. A statistically significant difference in age groups were recorded among patients with LRTI, (p <0.05), age <1 41%, age 1 <5, 27.6%. This was also the case for children with SRTI (Pneumonia and Bronchiolitis), with age < 1yr, 9%, and 1 <5yr, 19.8%. Analysed risk factors for disease severity showed thatnutritional status of children were statistically significant for disease severity, p-value, 0.039 (Chi square test). Conclusions: We report a high level of exposure to RSV in infancy and early childhood among children from a representative population in a major central Nigerian City, further studies into neutralising antibody levels and subtype distribution of RSV are advocated

Compromiso respiratorio en embarazadas: puérperas hospitalizadas en el contexto de la Pandemia 2009 de Influenza A (H1N1)pdm09 / Respiratory compromise in hospitalised pregnant women: postpartum during Pandemic Influenza A (H1N1) pdm09, 2009

Introducción: el diagnóstico de influenza en gestantes está asociado a un alto riesgo de morbi-mortalidad. Objetivos: describir características clínico-epidemiológicas de embarazadas/puérperas cursando enfermedad tipo influenza (ETI) y el compromiso respiratorio durante la pandemia de influenza A (H1N1) pdm09. Comparar severidad según edad gestacional. Material y métodos: estudio retrospectivo, descriptivo mediante revisión de historias clínicas de embarazadas/puérperas internadas por ETI en dos maternidades, período: 27/06/09-14/08/09. Se tabularon en dos grupos: G1, n= 35 (1º y 2º trimestre); G2, n= 49 (3º trimestre/puerperio). Resultados: se incluyeron 84 pacientes, edad promedio 25 años (R: 14-42). 81% sin comorbilidades. 20% ingresaron a Unidad de Terapia Intensiva (UTI). El 54% consultó tardíamente. Presentaron neumonía el 50%. Recibió tratamiento antiviral el 89%. El 23% terminó su embarazo durante la internación por indicación obstétrica. El 94% del total presentó evolución favorable. Comparando G1 vs G2: necesidad de UTI (5/35 vs 12/49, p=0.25), roncus/sibilancias (8/35 vs. 18/49, p= 0,17), saturación de oxígeno menor de 96 % (6/35 vs 15/49 p=0,15), número de muertes (1/35 vs. 4/49, p= 0,30). Internación prolongada (3/35 vs 14/49, p= 0,02). La mortalidad general fue 6%. Conclusiones: la mayoría de las pacientes no presentaba comorbilidades y se encontraba cursando el tercer trimestre de embarazo o puerperio al momento de la internación. Hubo mayor frecuencia de compromiso respiratorio severo, internación en UTI y mortalidad en las pacientes en este grupo, sin diferencia significativa respecto al primer y segundo trimestre de embarazo. La mortalidad fue comparable a la reportada en la bibliografía.

Introduction: diagnosis of influenza in pregnant women is associated with a high risk of morbidity and mortality. Objectives: To describe clinical and epidemiological characteristics and respiratory compromise of hospitalized pregnant/postpartum women suffering from influenza like illness, assisted during the pandemic of influenza A (H1N1)pdm09 and compare serverity of respiratory compromise according to gestational age. Material and methods: retrospective, descriptive study through a review of medical charts of pregnant/postpartum women asisted in two maternity hospitals, period: 27/June to 14/August 2009. The data was tabulated into two groups: G1, n=35 (1st and 2nd Trimester), and G2, n=49, 3rd Trimester/puerperium. Results: 84 patients was included. Average age 25 years (R: 15-42). 81% without comorbidities. 20% was admitted on Intensive Care Unit (ICU). Pneumonia was diagnosed in 50%. 89% received antiviral treatment. 23% ended their pregnancy during the hospitalization for obstetric indication. 94% of the population presents favorable clinical evolution. Comparing G1 vs. G2: need for ICU admission (5/35 vs 12/49, p=0.25), presence of rhonchi/wheezing (8/35 vs 18/49, p=0.17), oxygen saturation < 96% (6/35 vs 15/49, p=0.15), mortality (1/35 vs 4/49, p=0.30), prolonged hospitalization (3/35 vs 14/49, p=0.02). Overall mortality was 6%. Conclusions: Most patientes had not comorbidities and was enrolled in the third trimester of pregnancy or puerperium at the time of hospitalization. There was a higher frequency of severe respiratory compromise, hospitalization in ICU and mortality in patients in this group, without significant difference compared to the first and second trimester. Mortality was comparable to that reported in the literature.

Cobertura vacinal está relacionada à menor mortalidade por doenças respiratórias / Vaccine coverage related to lower mortality for respiratory diseases

As infecções respiratórias constituem um conjunto de doenças comumente relacionadas aos idosos, considerando que o vírus da influenza é um dos principais agentes etiológicos. A vacinação desses indivíduos é considerada pela Organização Mundial de Saúde como a mais efetiva estratégia para a redução da morbimortalidade pela doença. O Brasil tem buscado nesses últimos anos, como meta vacinar 80% da população alvo. Este estudo objetivou relacionar a cobertura vacinal da influenza e a taxa de mortalidade por doenças respiratórias em idosos. Trata-se de um estudo transversal com análise secundária de dados. Os dados sobre cobertura vacinal no ano de 2010 em idosos dos 496 municípios gaúchos foram obtidos na página do Programa Nacional de Imunização e de mortalidade no Sistema Informação de Mortalidade. Os resultados evidenciaram que 49% municípios gaúchos atingiram a meta de 80% de idosos vacinados, nos municípios com cobertura vacinal abaixo da meta o número de mortes foi de 5,2 por 1.000 idosos, média essa significativamente maior que nos municípios com cobertura igual ou maior que 80%. Concluímos que a meta proposta pelo Ministério da Saúde Brasileiro de vacinar 80% ou mais de idosos é eficiente para a diminuição da mortalidade por doenças respiratórias.

Respiratory infections are a group of diseases commonly related to the elderly, since the influenza virus is one of the main etiological agents. Vaccination of these individuals is considered by the World Health Organization to be the most effective strategy to reduce morbidity and mortality from the disease. Brazil has sought in recent years to vaccinate 80% of the target population. This study sought to relate the vaccination coverage for influenza and the mortality rate from respiratory diseases in the elderly. This was a cross-sectional study with secondary data analysis. Data on vaccination coverage in 2010 of the 496 municipalities of the elderly in Rio Grande do Sul were obtained from the website of the National Immunization Program and mortality in the Mortality Information System. The results showed that 49% of municipalities reached the target of 80% of seniors vaccinated. In municipalities with below target vaccination coverage, the number of deaths was 5.2 per 1,000 elderly. This average is significantly higher than in municipalities with coverage equal to or above 80%. The conclusion is that the target proposed by the Brazilian Ministry of Health to vaccinate 80% or more of the elderly is effective in reducing mortality from respiratory diseases.

Perfil epidemiológico dos atendimentos de emergência por sintomas respiratórios em um hospital terciário / Epidemiological aspects of respiratory symptoms treated in the emergency room of a tertiary care hospital

OBJETIVO: Avaliar a prevalência de sintomas respiratórios como motivo para procura de atendimento de emergência por pacientes adultos e pediátricos, descrevendo as principais síndromes clínicas diagnosticadas e o desfecho dos pacientes. MÉTODOS: Estudo transversal, realizado na emergência de um hospital universitário terciário. Entre novembro de 2008 e novembro de 2009, o número total de atendimentos foi revisado diariamente. Foram incluídos no estudo crianças e adultos com pelo menos um sintoma respiratório. Os prontuários eletrônicos foram revisados e foram registradas as principais características dos pacientes. RESULTADOS: Durante o período do estudo, houve 37.059 admissões na emergência, das quais 11.953 (32,3%) foram motivadas por sintomas respiratórios. A prevalência de atendimentos por sintomas respiratórios foi 28,7% e 38,9% nos adultos e crianças, respectivamente. As taxas de internação hospitalar e de mortalidade nos adultos foram 21,2% e 2,7%, respectivamente, comparadas com 11,9% e 0,3%, respectivamente, nas crianças. Nos adultos, quanto maior o tempo entre o início dos sintomas e a visita à emergência, maiores foram a necessidade de hospitalização (p< 0,0001), o tempo de hospitalização (p < 0,0001) e a mortalidade (p = 0,028). CONCLUSÕES: Encontramos uma prevalência elevada de atendimentos por sintomas respiratórios entre os pacientes adultos e pediátricos. Nossos resultados podem contribuir para o planejamento de medidas de prevenção. Futuros estudos epidemiológicos poderão colaborar para a melhor elucidação dos fatores de risco para a presença de sintomas respiratórios nesses pacientes.

OBJECTIVE: To evaluate the prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients, describing the major clinical syndromes diagnosed and the outcomes of the patients. METHODS: A cross-sectional study conducted in the emergency room of a tertiary care university hospital. Between November of 2008 and November of 2009, we reviewed the total number of emergency room visits per day. Children and adults who presented with at least one respiratory symptom were included in the study. The electronic medical records were reviewed, and the major characteristics of the patients were recorded. RESULTS: During the study period, there were 37,059 emergency room visits, of which 11,953 (32.3%) were motivated by respiratory symptoms. The prevalence of emergency room visits due to respiratory symptoms was 28.7% and 38.9% among adults and children, respectively. In adults, the rates of hospitalization and mortality were 21.2% and 2.7%, respectively, compared with 11.9% and 0.3%, respectively, in children. Among the adults, the time from symptom onset to emergency room visit correlated positively with the need for hospitalization (p < 0.0001), the length of the hospital stay (p < 0.0001), and the mortality rate (p = 0.028). CONCLUSION: We found a high prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients. Our results could inform decisions regarding the planning of prevention measures. Further epidemiological studies are needed in order to clarify the risk factors for severe respiratory symptoms.

Doenças respiratórias por influenza e causas associadas em idosos de um município do Nordeste brasileiro / Influenza-related respiratory illnesses and associated causes among the elderly in a city in Northeast Brazil / Enfermedades respiratorias por gripe y causas asociadas en ancianos de un municipio del Nordeste brasileño

As campanhas de vacinação antiinfluenza para idosos são realizadas anualmente no mesmo período nos estados brasileiros. Objetivou-se avaliar óbitos decorrentes de doenças respiratórias por influenza e causas associadas em idosos do Município de Aracaju, Sergipe, Brasil. Avaliaram-se dados do Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP_GRIPE), do Sistema de Informações Hospitalares (SIH), do Sistema de Informações sobre Mortalidade (SIM) e do Departamento de Informática do SUS (DATASUS), no período de 1998 a 2007, além de registros do Laboratório Central de Sergipe (LACEN-SE) e dados pluviométricos do Instituto Nacional de Meteorologia (INMET). O ano de 2007 apresentou a maior taxa de mortalidade por influenza e causas associadas na população idosa no período avaliado. A faixa etária de 70 anos ou mais apresentou a maior mortalidade (p < 0,0001). No período de 1998 a 2007, as taxas de mortalidade de doenças respiratórias por influenza e causas associadas, em Aracaju, foram elevadas em comparação às dos Estados brasileiros, o que indica necessidade de reformulação no calendário de vacinação contra gripe nos idosos desse município.

Nationwide influenza vaccination campaigns are held annually in Brazil during the same time of the year. This study aimed to analyze deaths from respiratory illnesses and influenza-related causes among the elderly in the city of Aracaju, capital of Sergipe State, Brazil. Data were analyzed from the following databases: Information System on Influenza Epidemiological Surveillance (SIVEP_GRIPE), Hospital Information System (SIH), Mortality Information System (SIM), and Health Informatics Department (DATASUS), from 1998 to 2007, Sergipe State Central Laboratory (LACEN-SE), and rainfall data from the National Meteorology Institute (INMET). The year 2007 showed the highest mortality rate from influenza and related causes in elderly individuals. From 1998 to 2007, mortality rates from influenza-related respiratory illnesses and associated causes in Aracaju city were higher than in the States of Brazil, indicating the need to reformulate the influenza vaccination schedule in elderly residents of this city.

Las campañas de vacunación contra la gripe para la tercera edad se realizan anualmente durante el mismo período en los estados brasileños. El objetivo del estudio fue evaluar óbitos derivados de enfermedades respiratorias por gripe y causas asociadas en enfermos del Municipio de Aracaju, Sergipe, Brasil. Se evaluaron datos del Sistema de Información de Vigilancia Epidemiológica de la Gripe (SIVEP_GRIPE), del Sistema de Información Hospitalaria (SIH), del Sistema de Información sobre Mortalidad (SIM) y del Departamento de Informática del SUS (DATASUS), durante el período de 1998 a 2007, además de registros del Laboratorio Central de Sergipe (LACEN-SE) y datos pluviométricos del Instituto Nacional de Meteorología (INMET). El año 2007 presentó la mayor tasa de mortalidad por gripe y causas asociadas en la población de la tercera edad durante el período evaluado. La franja edad de 70 años o más presentó la mayor mortalidad (p < 0,0001). Durante el período de 1998 a 2007, las tasas de mortalidad de enfermedades respiratorias por gripe y causas asociadas, en Aracaju, fueron elevadas en comparación a la de los Estados brasileños, lo que indica la necesidad de reformulación en el calendario de vacunación contra la gripe en los ancianos de ese municipio.