Catarata congênita nas infecções intrauterinas mais comuns (STORCH): revisão de literatura / Congenital cataract in the most common intrauterine infections (STORCH): a review of the literature

RESUMO Objetivo: O objetivo deste estudo foi revisar os aspectos clínicos e patológicos da catarata congênita secundária às infecções por sífilis, toxoplasmose, rubéola, citomegalovírus e herpes simples. Métodos: Trata-se de uma revisão de literatura, na qual foram incluídos artigos de periódicos indexados às bases de dados PubMed®, Cochrane, Lilacs, Embase e SciELO de 2010 a 2023. Resultados: Foram encontrados 45 artigos, e, após seleção, restaram 9 artigos. Além disso, foram adicionados artigos para enriquecer a discussão. A infecção por sífilis está relacionada a alterações corneanas. O citomegalovírus e a toxoplasmose estão relacionados com a coriorretinite e/ou microftalmia. A rubéola é responsável por causar catarata, glaucoma, microftalmia e retinite em sal e pimenta. Conclusão: Foram abordadas as principais etiologias infecciosas e seu quadro clínico na CC. O melhor tratamento para CC é cirúrgico associado a acompanhamento clínico, mas a prevenção é a maneira mais eficaz de combater a CC de etiologia infecciosa. O diagnóstico precoce e o tratamento efetivo previnem alterações e sequelas visuais irreversíveis. Nesse contexto, mostram-se importantes as ações de políticas públicas para o melhor desfecho clínico e melhor qualidade de vida.

ABSTRACT Objective: To review the clinical and pathological aspects of CC secondary to infections by syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes simplex. Methods: This is a literature review. Articles from journals indexed to PubMed, COCHRANE, LILACS, EMBASE and SCIELO from 2010 to 2023 were included. Results: A total of 45 articles were found, which, after selection, remained in 9 articles. Some articles were included to enrich the discussion in this topic. The infection caused by syphilis is related to corneal changes. Cytomegalovirus and Toxoplasmosis due to chorioretinitis and/or microphthalmia. Rubella is responsible for causing cataracts, glaucoma, microphthalmia, and salt and pepper retinitis. Conclusion: The main infectious etiologies and their clinical status in CC were addressed. The best treatment for CC is surgery associated with clinical follow-up, but prevention is the most effective way to combat CC of infectious etiology. Early diagnosis and effective treatment prevent irreversible visual changes and sequelae. In this context, public policy actions are important for the best clinical outcome and better quality of life.

Perfil epidemiológico dos casos suspeitos de sarampo e rubéola notificados no SINAN, Brasil, 2007 a 2016 / Epidemiological profile of suspected cases of measles and rubella notified on SINAN, Brazil, 2007 to 2016

Descrever os casos suspeitos de sarampo e rubéola notificados no Sistema de Informação de Agravos de Notificação (Sinan), Brasil, 2007 a 2016. Métodos: Os dados foram extraídos do Sinan, referentes aos anos de 2007 a 2016. As variáveis utilizadas foram os números de notificações de casos de sarampo e rubéola por regiões e ano, idade, sexo, hospitalização, estado gestacional, histórico vacinal, realização de bloqueio vacinal, coletas sorológicas (S1 e S2), sinais e sintomas, investigação adequada, critério de confirmação ou descarte e classificação final do caso. Resultados: Entre 2007 e 2016 houve 127.802 casos suspeitos de sarampo e rubéola notificados. Aproximadamente 92% dos casos foram investigados, a maioria em menores de cinco anos. Os sintomas mais frequentes foram tosse (40%) e coriza (38%). Como instrumento de vigilância foi coletado sangue para confirmação laboratorial em 87% das notificações. A maioria dos casos de sarampo ocorreu entre os anos de 2011 e 2015, relacionados a casos importados, totalizando 1.443 casos; para rubéola, 10.125 casos foram confirmados. Foram descartados 1,3% (1.698/127.802) e 5,1% (6.555/127.802) das notificações de sarampo e rubéola, respectivamente. Foram ignorados 9% (11.523/127.802) para sarampo e 49% (62.978/127.802) para rubéola. Conclusão: A vigilância dos casos de doenças exantemáticas permitiu demonstrar a situação dos casos de doenças exantemáticas circulantes no país como importante ferramenta de saúde pública. O grande número de casos descartados classificados como ignorados merece atenção, no sentido de melhorar o encerramento dos casos suspeitos notificados

To describe the suspected cases of measles and rubella notified in the Notifiable Diseases Information System (Sinan), Brazil, from 2007 to 2016. Methods: Data were extracted from Sinan referring to the years 2007 to 2016. The variables used were the number of notifications of measles and rubella cases by region and year, age, gender, hospitalization, gestational status, vaccination history, vaccination blockade, serological collections (S1 and S2), signs and symptoms, adequate investigation, confirmation criteria or disposal and final case classification. Results: Between 2007 and 2016, there were 127,802 suspected cases of measles and rubella reported. Approximately 92% of cases were investigated, mostly in children under five years of age. The most frequent symptoms were cough (40%) and runny nose (38%). As a surveillance tool, blood was collected for laboratory confirmation in 87% of notifications. Most Measles cases occurred between 2011 and 2015, related to imported cases, totaling 1,443 cases; for Rubella 10,125 cases were confirmed. 1.3% (1,698/127,802) and 5.1% (6,555/127,802) of measles and rubella notifications, respectively, were discarded. 9% (11,523/127,802) for measles and 49% (62,978/127,802) for rubella were ignored. Conclusion: Surveillance of cases of exanthematous diseases allowed demonstrating the situation of cases of exanthematous diseases circulating in the country as an important public health tool. The large number of discarded cases classified as ignored deserves attention, in order to improve the closing of notified suspected cases

Sí­ndrome da rubéola congênita: análise dos casos notificados no Brasil entre 1990 a 2016 / Congenital rubella syndrome: analysis of cases notified in Brazil from 1990 to 2016

Objetivo: analisar os casos de Síndrome da Rubéola Congênita notificados no Brasil durante o período de 1990 a 2016. Método: estudo transversal realizado no Brasil, cuja amostra foi de 122 casos notificados com Síndrome da Rubéola Congênita. Os dados foram disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. A coleta de dados foi realizada durante os meses de fevereiro e março de 2021. O tratamento dos dados se deu por análise estatística uni-variada. Resultados: observa-se prevalência no Estado de São Paulo cuja capital apresentou o maior número destas notificações. O ano em que houve prevalência do diagnóstico foi em 2008 e o mês de maior notificação foi dezembro. Todos os pacientes apresentavam idade menor que um ano, sexo feminino, com confirmação final para a doença por meio de critérios laboratoriais, e evolução para a cura. Conclusão: a idade apresentou significância no estudo. A terapêutica mostrou-se eficiente para um melhor prognóstico de cura, bem como a vacinação como medida preventiva.(AU)

Objective: to analyze the cases of Congenital Rubella Syndrome notified in Brazil from 1990 to 2016. Method: cross-sectional study conducted in Brazil, whose sample consisted of 122 cases notified with Congenital Rubella Syndrome. Data were made available by the Departamento de Informática do Sistema Único de Saúde. Data collection was conducted during February and March 2021. The data were processed using univariate statistical analysis. Results: prevalence was observed in the state of São Paulo, whose capital city had the highest number of these notifications. The year in which there was prevalence of the diagnosis was 2008, and the month of greatest notification was December. All patients were less than one year old, female, with final confirmation of the disease through laboratory criteria, and progression to cure. Conclusion: Age was significant in this study. Therapy proved to be efficient for a better prognosis of cure, as well as vaccination as a preventive measure.(AU)

Objetivo: analizar los casos de Síndrome de Rubéola Congénita notificados en Brasil entre 1990 a 2016. Método: estudio transversal realizado en Brasil, cuya muestra fue 122 casos notificados con Síndrome de Rubéola Congénita. Los datos fueron facilitados por el Departamento de Informática del Sistema Único de Salud. La recogida de datos se realizó durante los meses de febrero y marzo de 2021. El tratamiento de los datos se realiza mediante un análisis estadístico univariante. Resultados: se observa una prevalencia en el Estado de São Paulo, cuya capital presenta el mayor número de notificaciones. El año y mes en que se produjo la prevalencia del diagnóstico fue 2008 y diciembre. Todos los pacientes presentaban una edad inferior a un año, sexo femenino, con confirmación final de la enfermedad mediante criterios de laboratorio y evolución para la cura. Conclusión: la edad presentó un significado en el estudio. El tratamiento es eficiente para un mejor pronóstico de curación, así como la vacunación como medida preventiva.(AU)

Exanthematic dengue fever mimicking rubella

Abstract The authors present a case of dengue fever mimicking rubella. Male patient, in the second episode of dengue fever, presented afebrile, with diffuse morbilliform rash and craniocaudal progression, having subsequently affected his palms and soles. On the third day of clinical evolution, serologies did not indicate IgM, IgG, or NS1, but on the sixth day of evolution, IgM and IgG were reactive for dengue fever. Previous episodes of dengue are a risk factor for the development of more severe conditions, but this was atypical because the patient was afebrile and had a rubelliform rash. The case also illustrates an early IgG anamnestic response, as it was a reinfection.

Factors associated with adults' actions to confirm their own rubella immune status in Japan's drive toward rubella elimination: Cross-sectional online survey of non-healthcare workers in their 20s to 40s

BACKGROUND@#Rubella outbreaks occurred among adults in Japan in 2013-2014 and 2018-2019 due to immunity gaps. In response and aiming at rubella elimination by 2020, the government introduced countermeasures comprising supplementary immunization activities for voluntary testing of adult non-healthcare-related workers and vaccination of susceptible individuals. However, as of October 2020, rubella immunity testing and vaccination rates remained low. This study was conducted to identify factors associated with adults voluntarily confirming their rubella immune status, to help develop effective promotion activities for hard-to-reach and left-behind populations.@*METHODS@#In this cross-sectional study, a general population sample of non-healthcare workers aged 20-49 years in Japan completed an online survey in November 2020. Univariate analysis was performed to examine associations of specific actions taken to confirm rubella immune status with social background characteristics, knowledge of rubella, and attitude to testing and vaccination. Log binomial regression analysis was performed to explore the associations following adjustment for social background characteristics.@*RESULTS@#Among 1,854 respondents (927 men, 927 women), only 23.4% of men and 39.4% of women in their 20s to 40s have taken some action related to rubella prevention. Three major factors were associated with the targeted population having taken voluntary action: (1) knowing about testing for confirmation of immunity status (adjusted odds ratio [AOR] 4.29 men, 2.89 women), the rubella outbreak in 2013 among men in their 20s to 40s (AOR 2.79 men, 1.64 women), and congenital rubella syndrome (AOR 1.89 men, 3.10 women); (2) having acquaintances who were vaccinated against or tested for rubella (AOR 2.98 men, 1.95 women); and (3) having a positive attitude toward influenza vaccination (AOR 2.48 men, 1.83 women). Marriage, desire for pregnancy, and having children were weakly associated with taking action.@*CONCLUSIONS@#Currently, insufficient voluntary action is being taken by high-risk adult populations to close the identified immunity gaps. In this last mile to rubella elimination, our findings and suggested potential interventions via annual health check-ups and occupational health and public health initiatives could prove helpful in developing further countermeasures that actively promote and implement supplementary immunization activities targeting all adult generations.

Meningitis aséptica por virus parotídeo asociada a la vacuna

Resumen Comunicamos el caso de un lactante mayor previamente sano, que luego de tres semanas de recibir la vacuna SPR (sarampión, parotiditis, rubeola) presentó fiebre, aumento de volumen parotídeo y compromiso de conciencia. Se diagnosticó una meningitis aséptica, con pleocitosis en el LCR de predominio mononuclear, detectándose virus parotídeo en LCR por biología molecular. En el Instituto de Salud Pública de Chile se realizó serología (IgM e IgG) que resultó positiva. La muestra de saliva confirmó la etiología por virus parotídeo con genotipo N. La evolución fue favorable, sin secuelas al seguimiento a seis meses. Ante esta situación clínica, se revisó la información respecto a la asociación y causalidad de esta entidad clínica y vacuna SPR, focalizado en diferentes cepas del virus parotiditis.

Abstract We report the case of an older infant with no prior morbidity that approximately 3 weeks after receiving MMR vaccination (measles, mumps, rubella) was hospitalized for feverish symptoms, increased parotid volume and compromised consciousness. Aseptic meningitis was diagnosed, detecting pleocytosis in the CSF, predominantly mononuclear, and confirming by molecular biology, presence of parotid virus in CSF. A study was carried out by the Institute of Public Health of Chile, where serology (IgM and IgG) was positive. Saliva sample confirmed the etiology of parotid virus with genotype N. The evolution was favorable and at 6-month follow-up, there were no sequelae. Given this clinical situation, information regarding the association and causality of this clinical entity and the MMR vaccine, focused on different strains of the mumps virus, was reviewed.

Evaluation of Toxoplasma, Rubella, and Cytomegalovirus serological results in women of childbearing age

SUMMARY OBJECTIVE This study aimed to determine the rates of IgG and IgM antibodies against cytomegalovirus, rubella, and Toxoplasma gondii (all of which may cause congenital infections) in women of childbearing age who were admitted to Bolu Abant İzzet Baysal University Training and Research Hospital. METHODS Between January 2015 and December 2017, Toxoplasma gondii, rubella, and cytomegalovirus IgM and IgG antibody levels were studied using the ELISA method (Architect i2000SR, Abbott, Germany) in patients aged 15 to 45 who attended the obstetrics and gynecology outpatient clinics. Toxoplasma gondii and cytomegalovirus IgG avidity levels were analyzed retrospectively. RESULTS A total of 13.470 tests were conducted in the laboratory. Seropositivity percentages of IgM antibodies were found to be 1.3%, 0.5%, and 1.6% for Toxoplasma (n = 3607), rubella (n = 3931), and cytomegalovirus (n = 3795), respectively. The seropositivity percentages of IgG antibodies were 22%, 94.2%, and 98.2% for Toxoplasma (n = 702), rubella (n = 693), and cytomegalovirus (n = 679), respectively. Primary infection (acute, recently acquired) was found in 7 (35%) patients with low Toxoplasma IgG avidity. One (3%) patient with low cytomegalovirus IgG avidity had a primary infection. CONCLUSION Toxoplasma gondii seronegativity was found to be high in the region. Therefore, screening women of childbearing age may be important for the prevention of congenital infections caused by Toxoplasma gondii.

RESUMO OBJETIVO O objetivo deste estudo foi determinar as taxas de anticorpos IgG e IgM contra citomegalovírus, rubéola e Toxoplasma gondii (todos os quais podem causar infecções congênitas) em mulheres em idade fértil que foram admitidas no Hospital de Pesquisa e Treinamento da Universidade Bolu Abant İzzet Baysal. MÉTODOS Entre janeiro de 2015 e dezembro de 2017, os níveis de anticorpos IgG e IgM para Toxoplasma gondii, rubéola e citomegalovírus foram estudados usando o método Elisa (Architect i2000SR, Abbott, Alemanha) em pacientes de 15 a 45 anos que compareceram a ambulatórios de obstetrícia e ginecologia. Os níveis de avidez de IgG para Toxoplasma gondii e citomegalovírus foram analisados retrospectivamente. RESULTADOS Um total de 13.470 testes foram realizados em laboratório. As porcentagens de soropositividade dos anticorpos IgM foram de 1,3%, 0,5% e 1,6% para Toxoplasma (n=3.607), rubéola (n=3.931) e citomegalovírus (n=3.795), respectivamente. As porcentagens de soropositividade dos anticorpos IgG foram 22%, 94,2% e 98,2% para Toxoplasma (n=702), rubéola (n=693) e citomegalovírus (n=679), respectivamente. Infecção primária (aguda, adquirida recentemente) foi encontrada em sete (35%) pacientes com baixa avidez para Toxoplasma IgG. Um (3%) paciente com baixa avidez para citomegalovírus IgG teve uma infecção primária. CONCLUSÃO A soronegatividade do Toxoplasma gondii foi alta na região. Portanto, testar mulheres em idade fértil pode ser importante para a prevenção de infecções congênitas causadas pelo Toxoplasma gondii.

Measles, rubella, mumps and Toxoplasma gondii antibodies in saliva of vaccinated students of schools and universities in São Paulo City, Brazil

ABSTRACT Introduction: Vaccines are well-established public health interventions with major impacton the prevalence of infectious diseases, but outbreaks are occurring frequently due to pri-mary and secondary failures, despite high coverage. Surveillance of efficacy and duration ofinduced immunity is a difficult task as it requires invasive blood sampling in children andteenagers. Saliva can be an acceptable alternative source of IgG to assess vaccine efficacyand toxoplasmosis incidence. We investigated IgG response for measles, mumps, rubella,and T. gondii in saliva samples of vaccinated young people. Methods: Saliva was collected from 249 public schools students from São Paulo, Brazil, aged7 to 13 years old, during an interactive exhibition on hygiene. We used S. aureus proteinA solid phase capture assay for IgG reactive to biotinylated purified proteins. Paired salivaand serum (47) were tested from young adults with serum evidence of T. gondii infectionand from negative children less than 12 month old for standardization. Reproducibility wasgreater than 98% and sensitivity and specificity of the saliva assays were greater than 95%,as well as the concordance of paired saliva and serum samples. Results: Saliva from high school students showed a prevalence of 8.5% (95% CI: 5.0-11.9%)for anti T. gondii IgG; 96.8% (94.6-99%) of anti-measles IgG; 59.1% (53-65%) of anti-rubella IgG,and 57.5% (51.3-63.6%) of anti-mumps IgG. Discussion: The prevalence of antibodies against mumps and rubella after 6-8 years of vaccination was lower than against measles among students. The findings of this study demonstrate the feasibility of saliva sampling for follow-up of vaccine immune status in teenagers. This useful approach allows for IgG detection for vaccine control or epidemio- logical studies.

Falhas vacinais: avaliando vacinas febre amarela, sarampo, varicela e caxumba / Fallos en vacunas: evaluando vacunas de fiebre amarilla, sarampión, varicela y parotiditis / Vaccine failures: assessing yellow fever, measles, varicella, and mumps vaccines

Resumo: A vacinação é uma das maiores intervenções em saúde pública pela segurança e efetividade, porém nem sempre vacinar significa imunizar. Inúmeros aspectos relacionados tanto ao indivíduo que recebe a vacina, quanto à especificidade de cada imunobiológico administrado compõem o processo para a obtenção de uma adequada imunização, sendo essencial que sejam observados para não culminar em falhas vacinais. A análise dos estudos de imunogenicidade e efetividade para as vacinas sarampo, varicela e caxumba apontam para a necessidade da incorporação de duas doses aos calendários básicos de vacinação para o controle das referidas doenças. Estudos epidemiológicos que analisaram surtos dessas doenças identificaram casos em indivíduos que receberam duas doses da vacina, o que pode apontar provável falha secundária. Para a vacina febre amarela, a discussão atual reside no número de doses ideal para a proteção individual. A Organização Mundial da Saúde recomenda dose única para toda a vida. Apesar dos poucos relatos em literatura a respeito das falhas vacinais, os estudos de imunogenicidade demonstram perda de proteção ao longo dos anos, principalmente na faixa etária pediátrica. Num cenário atual de eliminação e controle de doenças, associado à diminuição da circulação de vírus selvagens, o papel da vigilância epidemiológica é fundamental para aprofundar o conhecimento a respeito dos múltiplos fatores envolvidos, que culminam com falhas vacinais e surgimento de surtos. A ocorrência de surtos de doenças imunopreveníveis impacta negativamente a credibilidade dos programas de imunização, acarretando baixas coberturas vacinais e interferindo no êxito da vacinação.

Resumen: La vacunación es una de las mayores intervenciones en salud pública, por su seguridad y efectividad, sin embargo, no siempre vacunar significa inmunizar. Innumerables aspectos relacionados tanto con el individuo que recibe la vacuna, como con la especificidad de cada inmunobiológico administrado, componen el proceso para conseguir una adecuada inmunización, siendo esencial que sean observados para no acabar con fallos en las vacunas. El análisis de los estudios de inmunogenicidad y efectividad para las vacunas sarampión, varicela y parotiditis, apuntan hacia la necesidad de la incorporación de dos dosis a los calendarios básicos de vacunación para el control de las mencionadas enfermedades. Estudios epidemiológicos que analizaron brotes de esas enfermedades identificaron casos en individuos que recibieron dos dosis de la vacuna, lo que puede apuntar un probable fallo secundario. Para la vacuna de fiebre amarilla la discusión actual reside en el número de dosis ideal para protección individual. La Organización Mundial de la Salud recomienda una dosis única para toda la vida. A pesar de los pocos relatos en la literatura, respecto a los fallos en las vacunas, los estudios de inmunogenicidad demuestran una pérdida de protección a lo largo de los años, principalmente en la franja de etaria pediátrica. En un escenario actual de eliminación y control de enfermedades, asociado a la disminución de la circulación de virus salvajes, el papel de la vigilancia epidemiológica es fundamental para profundizar el conocimiento respecto a los múltiples factores implicados, que culminan con fallos en las vacunas y surgimiento de brotes. La ocurrencia de brotes de enfermedades inmunoprevenibles impacta negativamente en la credibilidad de los programas de inmunización, acarreando bajas coberturas de vacunación e interfiriendo en el éxito de la vacunación.

Abstract: Vaccination is one of the greatest public health interventions, based on its safety and effectiveness, but vaccination does not always mean immunization. Numerous aspects related both to the individual that receives the vaccine and the specificity of each vaccine administered are part of the process of obtaining adequate immunization, and it is essential to observe the aspects in order to avoid vaccine failures. The analysis of immunogenicity and effectiveness studies for the measles, varicella, and mumps vaccines point to the need to incorporate two doses into the basic vaccination calendars in order to control these diseases. Epidemiological studies that analyzed outbreaks of these diseases identified cases in individuals that received two doses of the vaccine, which may indicate likely secondary failure. For the yellow fever vaccine, the current discussion lies in the ideal number of doses for individual protection. The World Health Organization recommends a single dose for life. Despite the few reports in the literature concerning vaccine failures, immunogenicity studies demonstrate waning protection over the years, mainly in the pediatric age bracket. In the current scenario of elimination and control of diseases, associated with the decrease in the circulation of the wild-type viruses, the role of epidemiological surveillance is crucial for expanding knowledge on the multiple factors involved, culminating in vaccine failures and the emergence of outbreaks. Outbreaks of vaccine-preventable diseases negatively impact the credibility of immunization programs, leading to low vaccination coverage rates and interfering in vaccination's success.

Prevalence of coinfections in women living with human immunodeficiency virus in Northeast Brazil

Abstract INTRODUCTION: Despite the success of antiretrovirals, human immunodeficiency virus (HIV) coinfections continue to cause mortality. We investigated the prevalence of coinfections in women with HIV/acquired immunodeficiency syndrome in Sergipe, Brazil. METHODS: We conducted a cross-sectional study. The coinfections investigated were syphilis, hepatitis B and C, toxoplasmosis, rubella, tuberculosis, and cytomegalovirus. RESULTS: Among the 435 women, 85 (19.5%) had coinfections. The most prevalent was HIV/syphilis, followed by tuberculosis, toxoplasmosis, hepatitis C, hepatitis B, and rubella. Additionally, 300 (96.2%) were seropositive for cytomegalovirus immunoglobulin G. CONCLUSIONS: Despite significant progress in the treatment for people with HIV, coinfections continued to affect this population.

Frecuencia de anticuerpos IgG a seis agentes infecciosos en los estudiantes de la carrera de Química Biológica / Frequency of IgG antibodies to six infectious agents in students of the Biological Chemistry degree

Se determinó la frecuencia de anticuerpos IgG para Toxoplasma gondii y los virus de paperas, sarampión, rubéola, varicela y hepatitis B en 90 estudiantes de la carrera de Química Biológica de la Facultad de CCQQ y Farmacia. La mayor frecuencia se encontró para rubéola y sarampión, 98.9% para cada prueba y la menor frecuencia fue para T. gondii con 23.3%. No se encontró asociación significativa entre la positividad y el género, entre la positividad a paperas, sarampión, varicela y el haber sufrido la infección o haber estado en contacto con personas infectadas y entre la positividad a T. gondii y el consumir carne roja y/o comida callejera (p > .05). Únicamente en el caso de la hepatitis B se encontró una asociación significativa entre la positividad y la edad (p = < .001), el hecho de estar vacunado (p < .001) y el ser sexualmente activo (p = .004). Los porcentajes de vacunación en la población en estudio fue alta únicamente para hepatitis B (80%), mientras que para las otras infecciones fue 35.6% para rubéola y sarampión, 22.2% para varicela y 10% para paperas. Más de 82% de los estudiantes presentaron protección a los seis agentes estudiados y se recomienda realizar encuestas sero-epidemiológicas constantes, evaluar los programas de inmunización, identificar los grupos a riesgo y que las personas que no presenten anticuerpos se vacunen.

The frequency of IgG antibodies for Toxoplasma gondii and the mumps, measles, rubella, varicella and hepa-titis B viruses was determined in 90 students of the Biological Chemistry career of the Faculty of CCQQ and Pharmacy. The highest frequency was found for Rubella and Measles, 98.9% each, and the lowest frequency was for T. gondii with 23.3%. No significant difference was found between positivity and gender, between positivity to mumps, measles, chicken pox and having suffered infection or having been in contact with infected persons and between positivity to T. gondii and consuming red meat and / or street food (p > .05). Only in the case of Hepatitis B a significant difference between positivity and age (p = .001), the fact of being vaccinated (p = .001) and being sexually active (p = .004 was found. The percentage of vaccination in the study population was high only for He-patitis B (80%), while for the other infections it was 35.6% for rubella and measles, 22.2% for varicella and 10% for mumps. More than 82% of the students presented protection to the six agents studied and it is recommended to carry out constant sero-epidemiological surveys, to evaluate the immunization programs, to identify the risk groups and that people who do not present antibodies get vaccinated.

Updates of adult immunization in Korea

An increase in the number of patients with infectious diseases in Korea, can be attributed to various factors, such as the prevalence of new infectious diseases of the 21st century, the re-emergence of past infectious diseases, an increase in the number of elderly individuals, patients with chronic diseases, immune deficiency, and globalization. In this context, vaccination becomes vital for the adult population. Although, the guidelines for adult immunization are currently being updated, the rate of adult vaccination remains lower than that of infant vaccination. At present, the major challenges for increasing the rate of adult immunization include negative views on the need for some immunizations and a lack of understanding of group immunity among the youth. Consequently, a successful immunization program will be required to direct efforts towards educating patients and spreading awareness. Based on the current guidelines and practical applications, varicella zoster; Japanese encephalitis; tetanus, diphtheria, and pertussis; pneumococcus; measles, mumps, and rubella; and hepatitis A vaccines could effectively be considered for adult vaccination.

Diagnostic algorithm for the confirmation of cases of measles and rubella in Mexico

Due to the successful implementation of measles and rubella elimination strategies, Mexico announced the interruption of endemic transmission of measles in 1996 and that of rubella in 2008. After a verification process, the region of the Americas was declared free of rubella and congenital rubella syndrome in 2015 and of measles in 2016. In order to maintain the elimination status in Mexico, it is essential to continue laboratory surveillance within the framework of the Global Measles and Rubella Laboratory Network. The Institute of Epidemiological Diagnosis and Reference, through the National Network of Public Health Laboratories, guarantees timely and reliable results in view of the possible reintroduction of these and other emerging pathogens.

Molecular aspects of the teratogenesis of rubella virus

Rubella or German measles is an infection caused by rubella virus (RV). Infection of children and adults is usually characterized by a mild exanthematous febrile illness. However, RV is a major cause of birth defects and fetal death following infection in pregnant women. RV is a teratogen and is a major cause of public health concern as there are more than 100,000 cases of congenital rubella syndrome (CRS) estimated to occur every year. Several lines of evidence in the field of molecular biology of RV have provided deeper insights into the teratogenesis process. The damage to the growing fetus in infected mothers is multifactorial, arising from a combination of cellular damage, as well as its effect on the dividing cells. This review focuses on the findings in the molecular biology of RV, with special emphasis on the mitochondrial, cytoskeleton and the gene expression changes. Further, the review addresses in detail, the role of apoptosis in the teratogenesis process.

Epidemiological profile of 39 cases of microcephaly caused by congenital infections diagnosed in the state of Rio Grande do Sul between 2015-2017

Introduction: Microcephaly is a clinical finding that can arise from congenital anomalies or emerge after childbirth. Maternal infections acquired during pregnancy can result in characteristic brain damage in the newborn (NB), which may be visible even in the fetal stage. To describe the epidemiological profile of newborns with reported microcephaly and diagnosed with congenital infections in the state of Rio Grande do Sul between 2015 and 2017. Methods: A cross-sectional study was carried out on data collected from the Public Health Event Registry as well as from medical records. The investigation included serologies for toxoplasmosis and rubella; polymerase chain reaction (PCR) for Zika virus (ZIKV) in the blood and cytomegalovirus in the urine; non-treponemal tests for syphilis; and brain imaging tests. Results: Of the 257 reported cases of microcephaly, 39 were diagnosed with congenital infections. Severe microcephaly was identified in 13 patients (33.3%) and 51.3% of the cases showed alterations in brain imaging tests. In relation to the diagnosis of congenital infections, three patients (7.7%) were diagnosed with ZIKV, nine (23.1%) with cytomegalovirus, nine (23.1%) with toxoplasmosis, and 18 (46.1%) with congenital syphilis. The three cases of ZIKV showed calcification in brain imaging tests, signs of arthrogryposis, excess occipital skin and irritability, characterizing the typical phenotype of ZIKV infection. Conclusions: Most cases of congenital infection had severe neurological lesions, particularly the cases of ZIKV, which can cause neurodevelopmental delays and sequelae in these infants throughout early childhood.

Immunogenicity and safety of the combined vaccine for measles, mumps, and rubella isolated or combined with the varicella component administered at 3-month intervals: randomised study

BACKGROUND Field testing required to license the combined measles, mumps, and rubella (MMR) vaccine must take into account the current recommendation of the vaccine in Brazil: first dose at 12 months and second dose at 15 months of age in combination with a varicella vaccine. OBJECTIVES This study aimed to evaluate the clinical consistency, immunogenicity, and reactogenicity of three batches of MMR vaccine prepared with active pharmaceutical ingredients (API) from Bio-Manguinhos, Fiocruz (MMR-Bio), and compare it to a vaccine (MMR produced by GlaxoSmithKline) with different API. METHODS This was a phase III, randomised, double-blind, non-inferiority study of the MMR-Bio administered in infants immunised at health care units in Pará, Brazil, from February 2015 to January 2016. Antibody levels were titrated by immunoenzymatic assays. Adverse events were recorded in diaries. FINDINGS Seropositivity levels after MMR-Bio were 97.6% for measles, 84.7% for mumps, and 98.0% for rubella. After the MMRV vaccine, seroconversion rates and GMT increased substantially for mumps. In contrast, approximately 35% of the children had no detectable antibodies to varicella. Systemic adverse events were more frequent than local events. CONCLUSION The demonstration of batch consistency and non-inferiority of the Bio-MMR vaccine completed the technology transfer. This is a significant technological achievement with implications for immunisation programs.

Epidemiological characteristics of mumps in mainland China from 2004 to 2018 and key population for prevention and control / 中国当代儿科杂志

OBJECTIVE@#To investigate the epidemiological characteristics of mumps in mainland China from 2004 to 2018, and to provide data for the key population for prevention and control of mumps.@*METHODS@#The epidemiological characteristics of mumps were analyzed with reference to the data of the cases of mumps reported in the National Scientific Data Sharing Platform for Population and Health and Disease Prevention and Control Bureau of National Health Commission of the People's Republic of China. Descriptive epidemiology was used to analyze the epidemiological characteristics of mumps.@*RESULTS@#A total of 4 272 368 cases of mumps were reported in China during 2004-2018, with an average annual reported incidence rate of 21.44/100 000. A single dose of mumps-containing vaccine was added to the national Expanded Program of Immunization in 2008, but the annual incidence rate ranged from 12.84/100 000 to 35.59/100 000. The second dose of measles, mumps and rubella combined attenuated live vaccine was included in the routine immunization in Beijing, Tianjin and Shanghai, and then the average incidence rate of mumps reported in these three regions dropped to about 10/100 000. From 2004 to 2016, the population aged 3-14 years accounted for 81.16% of all patients with mumps. The children aged 6 years had the highest incidence rate of mumps during 2004-2013.@*CONCLUSIONS@#A single dose of mumps-containing vaccine has no obvious effect on the incidence rate of mumps. Children aged 6 years have the highest incidence rate of mumps. A booster dose of mumps-containing vaccine should be given to preschool children.

A case of immune-mediated type 1 diabetes mellitus due to congenital rubella ınfection

Congenital rubella infection is a transplacental infection that can cause intrauterine growth retardation, cataracts, patent ductus arteriosus, hearing loss, microcephaly, thrombocytopenia, and severe fetal injury. It has been shown that type 1 diabetes mellitus develops in 12%–20% of patients with congenital rubella infection, and disorders in the oral glucose tolerance test is observed in 40% of patients. No biochemical or serological markers exist which could indicate that type 1 diabetes was caused by a congenital rubella infection. We report a 13-year-old male patient who was admitted to our hospital with complaints of new-onset polyuria, polydipsia, urination, and weight loss. In addition, he was found to have neurosensory hearing loss, patent ductus arteriosus, and microcephaly. Immunemediated type 1 diabetes mellitus was considered due to the fact that the autoantibodies of diabetes mellitus were positive.

A Review of Traditional Vaccine-Preventable Diseases and the Potential Impact on the Otolaryngologist

Abstract Introduction A majority of otolaryngologists have not had direct experience with many vaccine-preventable diseases since the creation of national vaccination programs. Despite the elimination of endemic transmission of some of these diseases in the United States, outbreaks can occur anywhere and still pose a threat to public health around the world. Recent outbreaks and changing trends in exemption rates indicate that it is important for physicians to maintain a working knowledge of how these diseases present and of the recommended treatment guidelines. Objectives This review will evaluate the current state of vaccination rates, vaccine exemption rates and disease incidence in the United States and in the world. It will also examine the clinical presentation and treatment recommendations of these diseases. Data Synthesis United States estimated vaccination rates, vaccine exemption rates and vaccine-preventable disease incidences were obtained from data compiled by the Centers for Disease Control and Prevention. World vaccination rates and disease incidences were obtained from the World Health Organization databases, which compile official figures reported by member states. A PubMed literature review provided information on the current state of vaccination exemptions and outbreaks in the United States. Conclusion Vaccination and vaccine exemption rates continue to put the United States and many areas of the world at risk for outbreaks of vaccine-preventable diseases. Clinical guidelines should be reviewed in the event of a local outbreak.