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

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.

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.

Seroprevalencia de rubeola en Colombia: un analisis por cohorte de nacimiento / Soroprevalencia de rubeola em Colombia: analise por coorte de nascimento / Seroprevalence of rubella in Colombia: a birth-year cohort analysis

OBJETIVO : Estimar la seroprevalencia de rubéola y factores asociados. METODOS : Estudio de seroprevalencia poblacional con una muestra aleatoria de 2.124 individuos de seis a 64 años, representativa por edad, sexo y área en Medellín, Colombia, 2009. Se analizó la asociación de variables biológicas y socioeconómicas con la seroprotección para rubéola, según la cohorte del año de nacimiento antes (1954 a 1990) y después (1991 a 2003) del inicio de la vacunación universal. Se determinaron los títulos de IgG con pruebas de alta sensibilidad (AxSYM ® Rubella IgG – Laboratorio Abbott) y especificidad (VIDAS RUB IgG II ® – Laboratorio BioMerieux). Se estimaron proporciones y promedios ponderados derivados de un muestreo complejo incluyendo un factor de corrección por las diferencias en la participación por sexo. Se analizó la asociación de la protección por grupos de variables biológicas y sociales con un modelo de regresión logística, según la cohorte de nacimiento. RESULTADOS : Los títulos promedio de IgG fueron más altos en los nacidos antes del inicio de la vacunación (media 110 UI/ml; IC95% 100,5;120,2) que en los nacidos después (media 64 UI/ml; IC95% 54,4;72,8), p = 0,000. La proporción de protección fue creciente de 88,9% en los nacidos en 1990-1994, de 89,2% en 1995-1999 y de 92,1% en 2000 a 2003, posiblemente relacionado con la administración del refuerzo desde 1998. En los nacidos antes del inicio de la vacunación, la seroprotección estuvo asociada con el antecedente de contacto con casos (RD 2,6; IC95% 1,1;5,9), el estado de salud (RD 2,5; IC95% 1,05;6,0), el nivel de escolaridad (RD 0,2; IC95% 0,08;0,8) y los años de residencia del hogar en el barrio (RD 0,96; IC95% 0,98;1,0), luego de ajustar por todas las variables. En los nacidos después ...

OBJETIVO : Estimar a soroprevalência de rubéola e fatores associados. MÉTODOS : Estudo de soroprevalência em população a través de uma amostra aleatória de 2.124 indivíduos de seis a 64 anos, representativa por idade, sexo e área em Medellín, Colômbia, 2009. Foi analisada a associação de variáveis biológicas e socioeconômicas com a soroproteção para rubéola, de acordo com a coorte de nascimento antes (1954 a 1990) e depois (1991 a 2003) do inicio da vacinação universal. Foram determinados os títulos de IgG com testes de alta sensibilidade (AxSYM® Rubella IgG – Laboratório Abbott) e especificidade (VIDAS RUB IgG II® – Laboratório BioMerieux). Foram estimadas proporções e médias ponderadas derivadas de amostragem complexa incluindo um fator de correição pelas diferenças na participação por sexo. Foi analisada a associação da proteção por grupos de variáveis biológicas e sociais com um modelo de regressão logística, segundo a coorte de nascimento. RESULTADOS : As médias dos títulos de IgG foram maiores nos nascidos antes do inicio da vacinação (média 110UI/ml; IC95% 100,5;120,2) do que nos nascidos posteriormente (média 64 UI/ml; IC 95% 54,4;72,8), p = 0,000. A proporção de proteção foi crescente de 88,9% nos nascidos em 1990-1994, de 89,2% em 1995-1999 e de 92,1% em 2000 a 2003, provavelmente relacionado à administração do reforço desde 1998. A soroproteção esteve associada nos nascidos antes com o fato de ter contato com casos (RD 2,6; IC95% 1,1;5,9), o estado de saúde (RD 2,5; IC95% 1,05;6,0), o nível de escolaridade (RD 0,2; IC95% 0,08;0,8) e os anos morando no bairro (RD 0,96; IC95% 0,98;1,0), após ajuste por todas ...

OBJECTIVE : To estimate the seroprevalence of rubella and associated factors. METHODS : Population-based seroprevalence study in a random sample of 2,124 individuals, aged six to 64 years, representative by age, sex and area in Medellín, Colombia, 2009. Biological and socioeconomic variables were analyzed for their association with serum protection against rubella, according to birth-year cohort; those born before (1954-1990) and after (1991-2003) the introduction of universal immunization. Titer of IgG antibodies against the rubella virus was detected using a high sensitivity (AxSYM®Rubella IgG – Abbott Laboratories) and a high specificity test (VIDAS RUB IgG II®– BioMerieux Laboratories). Proportions and weighted averages derived from a complex sample, including a correction factor for differences in gender participation, were estimated. Association with protection for groups of biological and social variables according to birth cohort was analyzed using a logistic regression model. RESULTS : Titers of IgG antibodies were higher in those born before (mean 110 UI/ml, 95%CI 100.5;120.2) compared to those born after (mean 64 UI/ml; 95%CI 54.4;72.8; p = 0.000) the introduction of mass immunization. The proportion of protection increased from 88.9% in those born 1990-1994, to 89.2% in those born 1995-1999 and to 92.1% in those born between 2000 and 2003, possibly due to boosters being administered from 1998 onwards. In those born before the introduction of the immunization, seroprotection was associated with previous contact with cases (OR 2.6; 95%CI 1.1;5.9), self- perceived health status (OR 2.5; 95%CI 1.05;6.0), educational level (OR 0.2; 95%CI 0.08;0.8) and years of residence in the neighborhood (RD 0,96; 95%CI 0.98;1.0) after adjusting for all variables. In those born after, serum protection was associated with effective sleep time (OR 1,4; 95%CI 1.09;1.8) and self-perceived health status (OR 5.5; 95%CI ...

Prevalência de sorologia positiva para HIV, hepatite B, toxoplasmose e rubéola em gestantes do noroeste paranaense / Prevalence of positive sorology for HIV, hepatitis B, toxoplasmosis and rubella in pregnant women from the northwestern region of the state of Paraná

OBJETIVO: Verificar a soroprevalência do vírus da imunodeficiência humana (HIV), hepatite B (VHB), toxoplasmose e rubéola em gestantes do noroeste paranaense. MÉTODOS: Foi realizado um estudo retrospectivo a partir dos resultados de exames sorológicos de triagem no pré-natal de 1.534 pacientes atendidas durante o primeiro semestre de 2010. Foram incluídos somente resultados do primeiro exame de pré-natal e aqueles com pesquisa simultânea de IgG e IgM para toxoplasmose e rubéola. A sorologia foi realizada por enzimaimunoensaio em micropartículas (MEIA). Para análise estatística foi empregado o teste do χ², com nível de significância de 5%. RESULTADOS: A positividade para o HIV foi de 0,3%, a sorologia para VHB pelo marcador HBsAg foi positiva em 0,5% das gestantes, enquanto a reatividade para anticorpos IgM anti-Toxoplasma gondii foi de 1,1% e para IgG de 59%. Em relação à rubéola nenhuma sorologia mostrou positividade para IgM, e para IgG a reatividade foi de 99,6%. A análise dos resultados mostrou que não há associação entre as soroprevalências estudadas e a idade das pacientes, exceto quanto à frequência de IgG anti-T. gondii, que foi mais elevada na faixa etária entre 30 e 44 anos. CONCLUSÃO: A soroprevalência dessas doenças infecciosas em gestantes do noroeste do Paraná é compatível com outras regiões do Brasil.

PURPOSE: To ascertain the seroprevalence of human immunodeficiency virus (HIV), hepatitis B (HBV), toxoplasmosis and rubella infections in pregnant women in northwestern Paraná. METHODS: We conducted a retrospective study based on the results of serological screening during prenatal care of 1,534 patients during the first half of 2010. We included only results from the first prenatal exam and with a simultaneous search for IgG and IgM antibodies to rubella and toxoplasmosis. Serology was performed by microparticle enzyme immunoassay (MEIA). Data were analyzed statistically by the χ² test, with the level of significance set at 5%. RESULTS: HIV positivity was 0.3%, positivity of HBV serology (HbsAg) was 0.5%, reactivity to IgM antibodies to Toxoplasma gondii was 1.1%, and reactivity to IgG antibodies was 59.0%. For rubella, no patient was positive for IgM, and IgG reactivity was 99.6%. Data analysis showed no statistical association between seroprevalence and patient age, except for the frequency of anti-T. gondii IgG, which was higher in the 30 to 44 year age group. CONCLUSION: The prevalence of these infectious diseases in pregnant women from northwestern Paraná is comparable to that observed in other regions of Brazil.

Molecular analysis of rubella virus in travelers suspected of measles infection in São Paulo, Brazil / Análise molecular do vírus da rubéola em turistas suspeitos de infecção por sarampo em São Paulo, Brasil

OBJECTIVE: To identify measles virus genotypes in three cases of travelers suspected of measles infection. METHODS: Samples (blood and urine) were collected for serology, virus isolation, and genotyping. Sera were analyzed for IgM antibodies against measles virus and rubella virus by enzyme-linked immunosorbent assay (ELISA) (Siemens - Marburg, Germany). Clinical samples (lymphocytes and urine) were inoculated into Statens Serum Institute rabbit corneal epithelial cell line- ATCC CL 60 (SIRC) and Vero Slam cells. RNA was extracted from clinical samples and cell culture was inoculated and processed by polymerase chain reaction (PCR) with oligonucleotides specific for measles virus (MV) and rubella virus (RV). RESULTS: All patients showed IgM negative serology for MV and positive IgM for RV. RV belonging to genotypes 1B, 1C, and 1E were isolated from patients who came from Finland, Peru, and Germany, respectively. Genotype 1B has been found in Europe and on the East Coast of South America; 1C has been found in Peru and the West Coast of South America, and 1E, first identified in 1997, now appears to have worldwide distribution. CONCLUSION: Information about RV and MV genotypes circulating in São Paulo is essential for the control of measles, rubella, and congenital rubella syndrome (CRS) in Brazil.

OBJETIVO: Identificar o genótipo do vírus do sarampo em três viajantes suspeitos de infecção por sarampo. MÉTODOS: Amostras (sangue e urina) foram coletadas para sorologia, isolamento viral e genotipagem. As sorologias para pesquisa de IgM para o vírus do sarampo e da rubéola foi realizada utilizando-se o kit de ELISA (Siemens - Marburg, Alemanha). As amostras clínicas (linfócito e urina) foram inoculadas na SIRC (Statens Serum Institute rabbit corneal epithelial cell line-ATCC CL 60) e nas células Vero Slam. O RNA foi extraído das amostras clínicas e das células inoculadas e processadas por PCR, utilizando oligonucleotideos específicos para sarampo e rubéola. RESULTADOS: Todos os pacientes apresentaram sorologia IgM negativa para sarampo e positivo para rubéola. Os vírus da rubéola isolados dos pacientes que vieram da Finlândia, Peru e Alemanha pertencem aos genótipos 1B, 1C e 1E, respectivamente. O genótipo 1B foi encontrado na Europa e na costa oriental da América do Sul, o genótipo 1C foi encontrado no Peru e na costa oeste da América do Sul e o genótipo 1E, identificado pela primeira vez em 1997, agora aparenta ser um genótipo com distribuição mundial. CONCLUSÃO: O conhecimento dos genótipos de sarampo e rubéola que circulam em São Paulo é essencial para o controle do sarampo, rubéola e síndrome da rubéola congênita.

Prevalência de anticorpos séricos contra rubéola em doenças autoimunes / Prevalence of rubella serum antibody in autoimmune diseases

INTRODUÇÃO: A associação entre infecções e doenças autoimunes (DAIs) está bem descrita na literatura médica. Vários agentes infecciosos foram implicados como indutores de respostas autoimunes, tais como o parvovírus B19, o vírus Epstein-Barr, o citomegalovírus e os vírus da hepatite. PACIENTES E MÉTODOS: Foram examinamos 1.173 soros de pacientes com 14 doenças autoimunes diferentes e 238 soros de controles saudáveis pareados geograficamente na busca por evidência de infecção rubeólica prévia. Todas as amostras foram testadas para a presença de anticorpos séricos contra rubéola usando-se o sistema Bio-Rad BioPlex 2200. RESULTADOS: Como um grupo, os pacientes com DAIs apresentaram maior prevalência de anticorpos IgM antirrubéola em comparação aos controles saudáveis (11,7% versus 5,4%; P = 0,001). A prevalência de anticorpos IgM antirrubéola foi significativamente maior em 5/14 DAIs, a saber: arterite de células gigantes (33,3%), cirrose biliar primária (24%), síndrome antifosfolipídica (20,6%), polimiosite (16%) e doença intestinal inflamatória (16%). Detectou-se prevalência semelhante de anticorpos IgM antirrubéola nos controles de diferentes países. Detectou-se alta prevalência de anticorpos IgG antirrubéola em pacientes com DAIs (89,9%) e controles. CONCLUSÃO: A prevalência aumentada de anticorpos IgM antirrubéola em DAIs sugere que a rubéola possa desempenhar um papel na etiopatogênese de várias DAIs.

INTRODUCTION: The association between infections and autoimmune diseases (AID) has been well described in the medical literature. Several infectious agents have been implicated as inducers of autoimmune responses, such as Parvovirus B19, Epstein-Barr virus, cytomegalovirus, and hepatitis viruses. PATIENTS AND METHODS: We examined 1,173 sera from patients with 14 different AID and 238 sera from geographically matched healthy controls, for evidence of prior infection with rubella. All samples were tested for the presence of serum antibodies against rubella using the Bio-Rad BioPlex 2200 system. RESULTS: As a group, patients with AID had a higher prevalence of IgM anti-rubella antibodies as compared to healthy controls (11.7% versus 5.4%; P = 0.001). The prevalence of IgM anti-rubella antibodies was significantly higher in 5/14 AID, namely in patients with giant cell arteritis (33.3%), primary biliary cirrhosis (24%), antiphospholipid syndrome (20.6%), polymyositis (16%), and inflammatory bowel disease (16%). A similar prevalence of IgM anti-rubella antibodies was detected among controls from different countries. A high prevalence of IgG anti-rubella antibodies was detected among patients with AID (89.9%) and controls. CONCLUSION: The increased prevalence of IgM anti-rubella antibodies in AID suggests a possible role for rubella in the etiopathogenesis of several AID.

Prevalence of toxoplasmosis, cytomegalovirus and rubella IgG antibodies in hatay women and children / Prevalencia de los anticuerpos IgG contra la toxoplasmosis, el citomegalovirus y la rubéola en mujeres y niños de hatay

OBJECTIVE: Toxoplasmosis, cytomegalovirus and rubella may cause congenital infections. The aim of this study is to investigate toxoplasmosis, cytomegalovirus and rubella IgG antibodies in women and children who were admitted to the Hatay Women and Children Hospital between January 1 and December 31, 2009. METHODS: Levels of IgG antibodies for toxoplasmosis, cytomegalovirus and rubella established with chemiluminescence immunoassay (Architect i2000, Abbott, USA) method were evaluated, retrospectively. RESULTS: The results were obtained from 1103 cases. Seropositivity of IgG antibodies for toxoplasmosis (n = 743), cytomegalovirus (n = 929) and rubella (n = 746) were 59.9%, 98.9% and 93.6%, respectively. CONCLUSION: Routine serological screening should be recommended in women of childbearing age. Seronegative subjects should be vaccinated for rubella and educated for protection from toxoplasmosis.

OBJETIVO: La toxoplasmosis, el citomegalovirus y la rubéola pueden causar infecciones congénitas. El objetivo de este estudio es investigar los anticuerpos IgG contra la toxoplasmosis, el citomegalovirus y la rubéola en las mujeres y ninos ingresados en el Hospital de Hatay para Mujeres y Niños, entre el 1ero de enero y el 31 de diciembre de 2009. MÉTODOS: Los niveles de anticuerpos IgG de la toxoplasmosis, el citomegalovirus, y la rubéola establecidos mediante el método de inmunoensayos por quimioluminiscencia (Architect i2000, Abbott, USA), fueron evaluados retrospectivamente. RESULTADOS: Los resultados se obtuvieron de 1103 casos. La seropositividad de anticuerpos de IgG para la toxoplasmosis (n = 743), el citomegalovirus (n = 929) y la rubéola (n = 746) fue de 59.9%, 98.9% y 93.6%, respectivamente. CONCLUSIÓN: Deben recomendarse tamizajes serológicos de rutina para las mujeres en ead de maternidad. Los sujetos seronegativos deben ser vacunados contra la rubéola y educados para protegerse contra la toxoplasmosis.

La vigilancia epidemiológica de sarampión y rubéola en el marco del plan de eliminación: Colombia 1995-2009 / Epidemiological surveillance of measles and Germán measles (rubella) within the context of the elimination plan: Colombia, 1995-2009

Objetivo Describir el comportamiento de la vigilancia epidemiológica, con el fin de aportar evidencias sobre la interrupción de la circulación endémica de los virus del sarampión y la rubéola en el país. Métodos Estudio descriptivo retrospectivo de la vigilancia epidemiológica del sarampión y rubéola en Colombia para el período 1995-2009, a través de la consulta de información disponible de notificación en el aplicativo Measles Elimination Surveillance System (MESS), Sistema Nacional de Vigilancia en Salud Pública (SIVIGILA) y el Departamento Nacional de Estadísticas (DANE) para proyecciones poblacionales. La evaluación de la calidad de la vigilancia se hizo mediante los indicadores propuestos para la vigilancia integrada de sarampión y rubéola. Resultados En el período a estudio se notificaron 28 732 casos sospechosos, 66,15 % de sarampión y 33,8 % de rubéola, mayor número de casos notificados en 2002 (22,4 %); total de casos confirmados de sarampión entre 1995-2002 (n=495) y de rubéola (n=946) en todo el período. El promedio acumulado de los indicadores fue investigación oportuna con un comportamiento por debajo de 80,5 %, notificación semanal por encima de 80 %, toma de muestra adecuada en 93,7 %, y para recepción de muestra de 65,2 % para 1995-2006 y de 83,3 % para el periodo 2007-2009. Conclusiones De acuerdo con la información aportada por la vigilancia epidemiológica, el país cumple con 4 de los 7 indicadores propuestos para evaluar su calidad. Se evidencia que la circulación endémica de los virus de sarampión y rubéola en Colombia se encuentra interrumpida.

Objective Describing the behavior of epidemiologic surveillance regarding measles and German measles (rubella) to provide evidence about the interruption of the endemic circulation of tríese viruses in Colombia. Methods This was a retrospective descriptive study of epidemiological surveillance for measles and German measles in Colombia from 1995 to 2009 by reviewing available notification information from the measles elimination surveillance system (MESS), the Colombian Public Health Surveillance System (SIVIGILA) and the Colombian Statistics Department (DANE) for population projections. Surveillance quality was evaluated by using the indicators proposed for integrated measles and German measles surveillance. Results 28,732 suspicious cases were notified during the study period (66.15 % concerned measles and 33.8 % German measles). The greatest number of notified cases occurred in 2002 (22.4 %); this was detected in the 6-11 month and 2-4 year-old groups. Confirmed measles cases amounted to 495 (1995-2002) and German measles to 946 (for the whole period). The cumulative average for indicators was as follows: timely research had a pattern below 80.5 %, weekly notification was above 80 %, suitable sampling was 93.7 % on average and sample reception was 65.2 % for 1995-2006 and 83.3 % for 2007-2009. Conclusions According to the information compiled regarding epidemiological surveillance, Colombia complied with 4 of the 7 proposed indicators for quality evaluation; these showed active surveillance having suitable indicator performance regarding laboratory and notification rate. They demonstrated interrupted endemic circulation of measles and German measles in Colombia.

Outbreak of rubella after mass vaccination of children and adult women: challenges for rubella elimination strategies / Brote epidémico de rubéola tras la vacunación masiva de niños y mujeres adultas: un reto para las estrategias de eliminación de la rubéola

OBJECTIVE: To describe rubella outbreaks and control strategies in the Brazilian state of Rio Grande do Sul before rubella elimination. METHODS: We analyzed rubella and congenital rubella syndrome surveillance data for the state of Rio Grande do Sul and calculated age- and gender-specific incidence of confirmed rubella cases in 2007. We obtained data on measles-rubella doses administered during the outbreak from the state immunization program and reviewed the timing of suspect case notification and implementation of control measures. RESULTS: Of 2 842 confirmed rubella cases reported to the state health department in 2007, 2 145 (75.5 percent) were in males (39.5 cases per 100 000 population) and 697 (24.5 percent) were in females (12.3 per 100 000 population). Incidence among 15- to 39-year-olds was 1.8 to 5.5 times higher in males than in females. Rubella genotype 2B was detected in nasopharyngeal specimens from 13 patients from multiple chains of transmission. Eight children were born with congenital rubella syndrome (5.9 cases per 100 000 births in 2008). Delayed notification of initial cases hampered early control efforts, resulting in outbreak spread throughout the state. Rubella transmission was interrupted after mass vaccination of adult men and women as part of a national vaccination campaign. CONCLUSIONS: Routine vaccination strategies and mass vaccination of adolescents and adults for accelerated rubella control and elimination should target men and women.

OBJETIVO: Describir los brotes de rubéola y las estrategias para el control de la enfermedad anteriores a la eliminación de la rubéola en el estado brasileño de Rio Grande do Sul. MÉTODOS: Se analizaron los datos de vigilancia epidemiológica sobre la rubéola y el síndrome de rubéola congénita del estado de Rio Grande do Sul y se calculó la incidencia específica por edad y sexo de los casos confirmados de rubéola en el 2007. A partir del programa de vacunación estatal se obtuvieron datos sobre las dosis de vacunación antisarampionosa y antirrubeólica administradas durante el brote y se analizaron el momento de notificación de los casos sospechosos y la puesta en práctica de medidas de control. RESULTADOS: De los 2842 casos confirmados de rubéola notificados al departamento de salud estatal en el 2007, 2 145 (75,5 por ciento) correspondieron a hombres (39,5 casos por 100000 habitantes) y 697 (24,5 por ciento) a mujeres (12,3 por 100000 habitantes). La incidencia en las personas de 15 a 39 años de edad fue de 1,8 a 5,5 veces mayor en los varones que en las mujeres. En 13 pacientes provenientes de distintas cadenas de transmisión se detectó el genotipo 2B del virus de la rubéola en muestras obtenidas de la nasofaringe. Nacieron 8 niños con síndrome de rubéola congénita (5,9 casos por 100000 nacimientos en el 2008). La demora en la notificación de los casos iniciales obstaculizó la adopción temprana de medidas de control, lo que hizo que el brote se propagara a todo el estado. La transmisión de la rubéola se interrumpió después de la vacunación masiva de varones y mujeres adultos como parte de una campaña nacional de vacunación. CONCLUSIONES: Las estrategias de vacunación sistemática y la vacunación masiva de adolescentes y adultos tendientes a acelerar el control y la eliminación de la rubéola deben dirigirse tanto a varones como a mujeres.

Seroprevalencia de IgG contra Rubeola en mujeres entre 10-49 años, en Cartagena, Colombia / The seroprevalence IgG antibodies against rubella (German measles) in 10-49 year-old women from Cartagena, Colombia

Objetivo Determinar la seroprevalencia de Inmunoglobulina G (IgG) contra Virus de la Rubéola (VR) en Cartagena y si las metas de cobertura en inmunización contra VR han sido alcanzadas. Métodos Se desarrolló un estudio transversal, durante 2009. Se incluyeron mujeres entre 10-49 años de edad. Los individuos fueron seleccionados aleatoriamente. Las variables socio-demográficas fueron registradas por entrevista directa. La IgG contra VR fue detectada mediante ELISA. Para analizar diferencias entre grupos se emplearon la prueba exacta de Fisher y X2. Se aplicó un modelo de regresión logística para correlacionar variables. Resultados Se analizaron 1 528 muestras. El 93 por ciento (n=1 422) de la población fue seropositiva. Las mujeres entre 10-14 años reportaron un menor nivel de seropositividad en relación con el resto de la población. Las diferencias entre proporciones de seroprevalencia fueron estadísticamente significativas en los rangos de edad (p<0,001) y la ocupación (p=0,042). Las mujeres entre 10-14 años reportaron riesgo elevado para seronegatividad (OR=0,27, p<0,001). Conclusiones Las metas de seroprevalencia contra VR no han sido alcanzadas en Cartagena y nuevos casos de Rubéola o Síndrome de Rubéola Congénita podrían presentarse en el Distrito. Estos hallazgos revelan que no hubo progreso significativo desde 2006, cuando el porcentaje de cobertura en vacunación contra VR oscilaba entre 90-95 por ciento. El alto riesgo en el grupo de 10-14 años sugiere falencias en la administración de las dosis iniciales en el esquema de vacunación.

Objective Determining immunoglobulin G (IgG) against the rubella virus (RV) causing German measles in Cartagena and whether vaccination goals against German measles have been achieved. Methods A cross-sectional study was carried out during 2009; females aged 10-49 years were included. Selection was randomised. Socio-demographic variables were recorded in face-to-face interviews. IgG against RV was detected by ELISA. X2 and Fisher's exact tests were used for comparing variables. A logistic regression model was used for correlating data. Results A total of 1,528 serum samples were analysed; 93 percent (n=1,422) were seropositive. The lowest seropositivity was reported in girls aged 10-14. Differences regarding seroprevalence percentages were statistically significant between age ranges (p<0.001) and employment (p=0.042). A high risk of seronegativity was reported for girls aged 10-14 (OR=0.27; p<0.001). Conclusions Seroprevalence goals against RV had not been reached in Cartagena and new cases of rubella (German measles) or congenital rubella (German measles)syndrome are still possible in the area. These findings revealed that no significant progress had been made since 2006 when German measles vaccine coverage was 90 percent-95 percent. High risk in girls aged 10-14 suggests that the local immunisation programme fails in MMR vaccine administration.

Seropositivity rates for toxoplasmosis, rubella, syphilis, cytomegalovirus, hepatitis and HIV among pregnant women receiving care at a public health service, São Paulo state, Brazil

Infectious and parasitic diseases affecting women during their reproductive age may result in vertical transmission. The aim of this study was to determine the seroprevalence for TORSCH among pregnant women receiving care at a university hospital. Records of 574 pregnant women who received medical attention from January 2006 to December 2007 were assessed. The mean age was 27.2 ± 6.5 years ranging from 13 to 44. The results of the immunodiagnostic tests were: 62.0 percent (345/556) for IgG and 3.4 percent (19/556) for IgM anti-T. gondii; 93.1 percent (433/465) for IgG and 0.6 percent (3/465) for IgM anti-rubella; 0.9 percent (5/561) for VDRL; 1.8 percent (10/554) for HBsAg; 0.7 percent (4/545) for anti-HCV and 2.1 percent (11/531) for HIV. In conclusion, the results of immunodiagnostic tests for the TORSCH panel among pregnant women attending a perinatal service of a university hospital are in agreement with those reported by previous studies and by governmental sources.

Syndromic surveillance: etiologic study of acute febrile illness in dengue suspicious cases with negative serology. Brazil, Federal District, 2008 / Vigilância sindrômica: estudo etiológico de doenças febris agudas a partir dos casos suspeitos de dengue com sorologia não reagente. Distrito Federal, Brasil, 2008

With the aim of identifying the etiology of acute febrile illness in patients suspected of having dengue, yet with non reagent serum, a descriptive study was conducted with 144 people using secondary serum samples collected during convalescence. The study was conducted between January and May of 2008. All the exams were re-tested for dengue, which was confirmed in 11.8 percent (n = 17); the samples that remained negative for dengue (n = 127) were tested for rubella, with 3.9 percent (n = 5) positive results. Among those non reactive for rubella (n = 122), tests were made for leptospirosis and hantavirus. Positive tests for leptospirosis were 13.9 percent (n = 17) and none for hantavirus. Non reactive results (70.8 percent) were considered as Indefinite Febrile Illness (IFI). Low schooling was statistically associated with dengue, rubella and leptospirosis (p = 0.009), dyspnea was statistically associated with dengue and leptospirosis (p = 0.012), and exanthem/petechia with dengue and rubella (p = 0.001). Among those with leptospirosis, activities in empty or vacant lots showed statistical association with the disease (p = 0.013). Syndromic surveillance was shown to be an important tool in the etiologic identification of IFI in the Federal District of Brazil.

Com o objetivo de identificar a etiologia de doenças febris agudas, em suspeitos de dengue com sorologia não reagente, realizou-se estudo descritivo com 144 pessoas utilizando amostras de soro coletados na convalescença, entre janeiro e março de 2008. Todos os exames foram re-testados para dengue, sendo as amostras negativas, processadas para rubéola (n = 127). Dentre as não reagentes para rubéola, submeteu-se ao teste para leptospirose (n = 122), e em se permanecendo sem diagnóstico, testou-se para hantavirose. Confirmou-se dengue em 11,8 por cento (n = 17), rubéola em 3,9 por cento (n = 5) e leptospirose em 13,9 por cento (n = 17). Os resultados não reagentes foram considerados como doença febril aguda indiferenciada (DFI) em 70.8 por cento dos casos. Verificou-se associação estatística em baixa escolaridade nos casos de dengue, rubéola e leptospirose (p = 0,009), assim como dispnéia para dengue e leptospirose (p = 0,012), e exantema/petéquias para dengue e rubéola (p = 0,001). Dentre os doentes com leptospirose, as atividades em terreno baldio mostraram-se com diferença estatística significante (p = 0,013). A vigilância sindrômica demonstrou-se como importante ferramenta na identificação de doenças febris agudas no Distrito Federal.

Investigation of measles IgM-seropositive cases of febrile rash illnesses in the absence of documented measles virus transmission, State of São Paulo, Brazil, 2000-2004 / Investigação dos casos de doenças febris exantemáticas com IgM reagente contra o sarampo na ausência de transmissão documentada do vírus do sarampo, Estado de São Paulo, 2000-2004

INTRODUCTION: To review measles IgM-positive cases of febrile rash illnesses in the State of São Paulo, Brazil, over the five-year period following interruption of measles virus transmission. METHODS: We reviewed 463 measles IgM-positive cases of febrile rash illness in the State of São Paulo, from 2000 to 2004. Individuals vaccinated against measles < 56 days prior to specimen collection were considered to be exposed to the vaccine. Serum from the acute and convalescent phases was tested for evidence of measles, rubella, parvovirus B19 and human herpes virus-6 infection. In the absence of seroconversion to measles immunoglobulin-G, measles IgM-positive cases were considered false positives in individuals with evidence of other viral infections. RESULTS: Among the 463 individuals with febrile rash illness who tested positive for measles IgM antibodies during the period, 297 (64 percent) were classified as exposed to the vaccine. Among the 166 cases that were not exposed to the vaccine, 109 (66 percent) were considered false positives based on the absence of seroconversion, among which 21 (13 percent) had evidence of rubella virus infection, 49 (30 percent) parvovirus B19 and 28 (17 percent) human herpes virus-6 infection. CONCLUSIONS: Following the interruption of measles virus transmission, thorough investigation of measles IgM-positive cases is required, especially among cases not exposed to the vaccine. Laboratory testing for etiologies of febrile rash illness aids interpretation of these cases.

INTRODUÇÃO: Revisar os casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no Estado de São Paulo, Brasil, durante os cinco anos seguidos a interrupção da transmissão do vírus do sarampo. MÉTODOS: Nós revisamos 463 casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no Estado de São Paulo, Brasil, de 2000 a 2004. Indivíduos vacinados contra o sarampo 56 dias antes da coleta de amostra foram considerados expostos à vacina. Soros da fase aguda e de convalescença foram testados para a evidência de infecção de sarampo, rubéola, parvovírus B19 e herpes vírus 6. Na ausência de soroconversão para imunoglobulina G contra o sarampo, casos com IgM reagente contra o sarampo foram considerados falsos positivos em pessoas com evidência de outras infecções virais. RESULTADOS: Entre as 463 pessoas com doenças febris exantemáticas que testaram positivo para anticorpos IgM contra o sarampo durante o período, 297 (64 por cento) pessoas foram classificadas como expostas à vacina. Entre os 166 casos não expostos à vacina, 109 (66 por cento) foram considerados falsos positivos baseado na ausência de soroconversão, dos quais 21 (13 por cento) tiveram evidência de infecção por vírus da rubéola, 49 (30 por cento) parvovírus B19 e 28 (17 por cento) infecção por herpes vírus humano 6. CONCLUSÕES: Após a interrupção da transmissão do vírus do sarampo é necessária exaustiva investigação dos casos com IgM reagente contra o sarampo, especialmente dos casos não expostos à vacina. Testes laboratoriais para etiologias das doenças febris exantemáticas ajudam na interpretação destes casos.

Prevalence of toxoplasmosis, HIV, syphilis and rubella in a population of puerperal women using Whatman 903® filter paper

OBJECTIVES: to determine the seroprevalence rate of toxoplasmosis, HIV, syphilis and rubella in a population of puerperal women. METHODS: a prospective, cross-sectional study was performed from February 2007 to April 2008 at Hospital Geral, Universidade de Caxias do Sul in a population of 1,510 puerperal women. Women that gave birth to live born or stillborn infants were included in the study; maternal and perinatal variables were analyzed. Descriptive statistics and Pearson's chi-square with occasional Fisher's correction were used for comparisons. Alpha was set in 5 percent. RESULTS: a total of 148 cases of congenital infection (9.8 percent) were identified: 66 cases of syphilis (4.4 percent), 40 cases of HIV (2.7 percent), 27 cases of toxoplasmosis (1.8 percent) and 15 cases of rubella (1.0 percent). In ten cases there was co-infection (four cases of HIV and syphilis, two cases of HIV and rubella, one case of HIV and toxoplasmosis, two cases of rubella and syphilis, and one case of toxoplasmosis and rubella). In a comparison between puerperal women with and without infection there was no statistical significance in relation to incidence of abortions, small for gestational age, prematurity, live births and stillbirths, and prenatal care. Need of neonatal intensive care unit (NICU), maternal schooling, maternal age higher than 35 years and drug use (alcohol, cocaine and crack) had statistical significance. CONCLUSION: the prevalence rate of infections was 9.8 percent. Need of NICU, maternal schooling lower than eight years, maternal age higher than 35 years and drug use were significantly associated with occurrence of congenital infection.

Simulación del nivel de eliminación de sarampión y rubéola según la estratificación e interacción social / Simulating measles and rubella elimination levels according to social stratification and interaction

Objetivo Comparar el nivel de eliminación de enfermedades como sarampión y rubéola en población homogénea y heterogénea según la existencia de estratos sociales con interacción entre individuos de estrato social alto y bajo y diversidad en el número promedio de contactos entre ellos. Métodos Simulaciones del ritmo reproductivo efectivo, derivado de un modelo matemático tipo SIR (Susceptibles Infectados Recuperados), según diferentes ritmos de inmunidad. Se utilizaron datos de incidencia de sarampión (1980 y 2005) y rubéola (1998 y 2005) de América Latina y el Caribe. Se analizó la interacción entre individuos del estrato social alto y bajo con diferente número promedio de contactos mediante análisis de red aleatoria bipartita. Las simulaciones se ejecutaron en MAPLE 12 (Maplesoft Inc, Ontario Canada). Resultados En la población socialmente homogénea se reprodujo el avance en la eliminación de ambas enfermedades entre los dos períodos de tiempo. En el estrato alto y bajo, se lograría la eliminación en sarampión (2005) pero en rubéola (2005) sólo se lograría si hay alto ritmo de inmunidad en el estrato bajo. Si varía el número promedio de contactos habituales, no se lograría la eliminación de rubéola ni con un ritmo de inmunidad de 95 por ciento. Conclusión El seguimiento del nivel de eliminación de enfermedades como sarampión y rubéola demanda la consideración de la situación socioeconómica y del patrón de interacción de la población. Especial atención se debe prestar a comunidades con diversidad en el número promedio de contactos en espacios confinados como comunidades desplazadas, carcelarias, educativas, hospitalarias, etc.

Objective The study was aimed at comparing measles and rubella disease elimination levels in a homogeneous and heterogeneous population according to socioeconomic status with interactions amongst low- and high-income individuals and diversity in the average number of contacts amongst them. Methods Effective reproductive rate simulations were deduced from a susceptibleinfected- recovered (SIR) mathematical model according to different immunisation rates using measles (1980 and 2005) and rubella (1998 and 2005) incidence data from Latin-America and the Caribbean. Low- and high-income individuals' social interaction and their average number of contacts were analysed by bipartite random network analysis. MAPLE 12 (Maplesoft Inc, Ontario Canada) software was used for making the simulations. Results The progress made in eliminating both diseases between both periods of time was reproduced in the socially-homogeneous population. Measles (2005) would be eliminated in high- and low-income groups; however, it would only be achieved in rubella (2005) if there were a high immunity rate amongst the low-income group. If the average number of contacts were varied, then rubella would not be eliminated, even with a 95 percent immunity rate. Conclusion Monitoring the elimination level in diseases like measles and rubella requires that socio-economic status be considered as well as the population's interaction pattern. Special attention should be paid to communities having diversity in their average number of contacts occurring in confined spaces such as displaced communities, prisons, educational establishments, or hospitals.

Seroprevalence of Toxoplasma gondii, Cytomegalo virus, rubella virus and chlamydia trachomatis among infertile women attending in vitro fertilization center, Gaza strip, Patestine

In the present study, the seroprevalence of Toxoplasma gondii, rubella, cytomegalovirus [CMV] and Chiamydia trachomatis in Palestinian women was determined through antenatal screening. The study included 1954 Palestinian women records which were reviewed and analyzed statistically from 2000-2005. Those women attended In vitro fertilization center in Gaza complaining from infertility and abortion. Anti-Toxoplasma, anti-rubella, anti-CMV and anti-Chiamydia IgM antibodies were assayed using an enzyme linked immunosorbent assay [ELISA]. Positive results were found in 7.9%, 6%, 7% and 12.8% for T. gondii, CMV, Rubella and C. trachomatis antibodies. A high significant infection rate was observed in year 2003 [P = 0.001] for T. gondii. A clear variation with statistical significance was observed in the seroprevalence for all the studied pathogens regarding year of collection and age of women. The study indicated that T. gondii, rubella, CMV and C. trachomatis are still constitute a public health problem among pregnant women and considered one of the abortion factors