The effectiveness of a rotavirus vaccine in preventing hospitalizations and deaths presumably due to acute infectious diarrhea in Brazilian children: a quasi-experimental study

INTRODUCTION: Rotavirus is the main etiologic agent of acute infectious diarrhea in children worldwide. Considering that a rotavirus vaccine (G1P8, strain RIX4414) was added to the Brazilian vaccination schedule in 2006, we aimed to study its effectiveness and safety regarding intestinal intussusception. METHODS: A quasi-experimental trial was performed in which the primary outcome was the number of hospitalizations that were presumably due to acute infectious diarrhea per 100,000 children at risk (0-4 years old). The secondary outcomes included mortality due to acute infectious diarrhea and the intestinal intussusception rates in children in the same age range. We analyzed three scenarios: Health Division XIII of the State of São Paulo (DRS XIII) from 2002 to 2008, the State of São Paulo, and Brazil from 2002 to 2012. RESULTS: The averages of the hospitalization rates for 100,000 children in the pre- and post-vaccination periods were 1,413 and 959, respectively, for DRS XIII (RR=0.67), 312 and 249, respectively, for the State of São Paulo (RR=0.79), and 718 and 576, respectively, for Brazil (RR=0.8). The mortality rate per 100,000 children in the pre- and post-vaccination periods was 2.0 and 1.3, respectively, for DRS XIII (RR=0.66), 5.5 and 2.5, respectively, for the State of São Paulo (RR=0.47), and 15.0 and 8.0, respectively, for Brazil (RR=0.53). The average annual rates of intussusception for 100,000 children in DRS XIII were 28.0 and 22.0 (RR=0.77) in the pre- and post-vaccination periods, respectively. CONCLUSIONS: A monovalent rotavirus vaccine was demonstrated to be effective in preventing the hospitalizations and deaths of children that were presumably due to acute infectious diarrhea, without increasing the risk of intestinal intussusception. .

Vacinação contra rotavírus e intussuscepção intestinal em crianças: artigo de revisão / Rotavirus vaccination and bowel intussusception in children: review article

A doença causada pelo rotavírus é responsável por elevada taxa de hospitalização e de mortes em crianças. O desenvolvimento de vacina eficaz contra o vírus assumiu caráter prioritário para organismos como a Organização Mundial de Saúde (OMS). A intussuscepção intestinal, entretanto, representa manifestações relacionadas ao uso da vacina que ainda constitui preocupação quanto ao seu uso disseminado. No Brasil, encontram-se disponíveis as vacinas do tipo RV1 e RV5, não sendo observado aumento de risco significativo de intussuscepção nas crianças com menos de sete dias de vida. Os benefícios que as vacinações trouxeram, pelas reduções de hospitalizações e mortalidade infantil no mundo, continuam a indicar a sua vacinação. (AU)

The overall impact of the disease caused by rotavirus is still a major cause of hospitalizations and deaths in children. The development of an effective vaccine against the virus became a priority for organizations like WHO (World Health Organization). Intestinal intussusception is one manifestation of which was related to vaccine use. In Brazil, are available vaccines RV1and RV5 type, and there was no significant increase in the risk of intussusception in children less than seven days. The benefits brought vaccinations, by reductions in hospitalizations and mortality in the world, continue to indicate the worldwide vaccination against rotavirus by WHO. (AU)

Manejo anestésico en un paciente de 8 años de edad con diagnóstico de obstrucción intestinal en el Hospital Manuel de Jesús Rivera La Mascota noviembre 2004 / I manage anesthetic in a 8 year-old patient with diagnosis of intestinal obstruction in the Hospital Manuel of Jesus Rivera The Mascot November 2004

Presente analisis del estudio de caso del Manejo anestésico en un paciente de 8 años de edad con diagnóstico de obstrucción intestinal en el Hospital Manuel de Jesús Rivera La Mascota noviembre 2004, realizado para obtar el título de anestesia y reanimación en enfermería. Se analiza paciente con manejo anestesico sometido a cirugia por obstrucción intestinal causada por invaginación. Hace 11 meses fue intervenido quirúrgicamente a causa de una invaginación Ileocecocolica Ascendente en la cual no presentó ningún tipo de dificultad, actualmente paciente cursa con un estado de diarrea aguda mas ascaridiasis, presenta estado de palidez. Paciente activo, reactivo, hidratado, no alérgico, no presenta dificultad aparente para intubación endotraqueal, paciente NPO. Durante el durante el acto operatorio se tomaron medidas inmediatas como la toma del pulso, presión y temperatura, asi como la saturación de oxígeno en la sangre y la capacidad del paciente de eliminar bióxido de carbono del pulmón utilizando métodos no invasivos (que no le duelan al niño). En conclusión es importante para el medico y el anestesista conocer la fisiopatología de la enfermedad del paciente para determinar el mejor protocolo anestésico y quirúrgico que permita correcto manejo de la anestesia y la cirugía conforme a cada paciente.