Impacto poblacional a 10 años de la vacunación contra rotavirus en México / Population impact of rotavirus vaccination in Mexico after 10 years

Resumen: Objetivo: Evaluar el impacto de la vacunación contra rotavirus (RV) a 10 años de su universalización sobre la morbimortalidad por enfermedad diarreica aguda (EDA) en niños mexicanos menores de cinco años. Material y métodos: Se compararon las medianas anuales de casos nuevos, defunciones y hospitalizaciones por EDA del periodo pre y posuniversalización; se calcularon reducciones absolutas y relativas, considerando significativos valores de p<0.05. Resultados: La mortalidad, hospitalizaciones y casos nuevos por EDA en menores de cinco años disminuyeron 52.6, 46 y 15.5% respectivamente, en el periodo posuniversalización. Durante la temporada de RV las reducciones en la mortalidad, hospitalizaciones y casos nuevos fueron de 66.9, 64.7 y 28.7%, respectivamente. Conclusiones: A partir de la universalización de la vacuna de RV en México, se aprecian reducciones importantes y sostenidas en la mortalidad, hospitalizaciones e incidencia por EDA, con menor impacto en esta última. El mayor impacto se observa durante la temporada de RV.

Abstract: Objective: To evaluate the impact of rotavirus (RV) vaccination after 10 years of it´s universalization on morbidity and mortality from Acute Diarrheal Disease (ADD) in mexican children under five years of age. Materials and methods: Annual median numbers for ADD new cases, hospitalizations and deaths were compared between pre and post universalization periods; absolute and relative reductions were calculated, considering p<0.05 values as significant. Results: Mortality, hospitalizations and new cases from ADD in children under five decreased 52.6, 46, and 15.5% respectively, in the posuniversalization period. During rotavirus seasons, reduction in mortality, hospitalizations and new cases was 66.9, 64.7, and 28.7% respectively. Conclusions: As of the universal introduction of RV vaccination in Mexico, significant and sustained reductions are appreciated for mortality and hospitalizations from ADD, less so for incidence. A most prominent effect is observed during the winter season.

Vacina rotavírus: segurança e alergia alimentar ­ Posicionamento das Sociedades Brasileiras de Alergia e Imunologia (ASBAI), Imunizações (SBIm) e Pediatria (SBP) / Rotavirus vaccine: safety and food allergy ­ Position paper of the Brazilian Societies of Allergy and Immunology (ASBAI), Immunizations (SBIm), and Pediatrics (SBP)

O rotavírus continua sendo o principal agente causador de diarreia na criança, a despeito da ampla utilização de vacinas nos programas públicos de vacinação em todo o mundo. No Brasil, a vacina monovalente foi introduzida no Programa Nacional de Imunizações (PNI) em 2006, e a segurança da vacina está bem documentada em diferentes estudos pré e pós-licenciamento. Embora não haja nenhuma associação entre o uso da vacina rotavírus e o desenvolvimento da alergia às proteínas do leite de vaca (APLV), existe o receio, por parte de alguns pediatras e familiares, da vacina estar relacionada ao surgimento ou desencadeamento desta reação de hipersensibilidade. Este artigo faz uma revisão dos dados de segurança da vacina e aborda aspectos imunológicos das reações de hipersensibilidade, demonstrando não haver nexo causal entre a vacina e a APLV, reforçando o posicionamento e recomendações de organismos nacionais, internacionais e das sociedades científicas.

Despite the widespread use of vaccines in public immunization programs worldwide, rotavirus remains the primary cause of diarrhea in children. In Brazil, the monovalent vaccine was introduced in the National Immunization Program (Programa Nacional de Imunizações - PNI) in 2006, and its safety is well documented in different studies carried out both before and after licensing. Even though there is no association between the use of rotavirus vaccine and the development of cow's milk protein allergy (CMPA), some pediatricians and family members fear that the vaccine may be somehow related to the emergence or outbreak of this hypersensitivity reaction. This article reviews safety data available for this vaccine and addresses the immunological aspects of hypersensitivity reactions. The findings demonstrate that there is no causal link between the rotavirus vaccine and CMPA, reinforcing the position and recommendations of national and international agencies as well as of scientific societies.

Time series investigation of changes in seasonality of acute diarrhea hospitalizations before and after rotavirus vaccine in Southern Brazil / Investigando alterações de sazonalidade nas internações por diarreia aguda antes e depois da introdução da vacina de rotavírus no Sul do Brasil / Investigando alteraciones de estacionalidad en los internamientos por diarrea aguda, antes y después de la introducción de la vacuna del rotavirus en el sur de Brasil

Abstract: Diarrhea by rotavirus is one of the main causes of mortality in children in developing countries, although the hospitalization rates (HR) for acute diarrhea have been found to have fallen since the introduction of the rotavirus vaccine. However, the patterns of the rotavirus are still not well understood and seasonal peaks occur throughout the year, with variations between countries and over time. The main objective of this study was to analyze the temporal behavior of HR caused by acute diarrhea in children under the age of one in the south of Brazil, between 2000 and 2011, and to explore changes in seasonality patters after the introduction of the vaccine against the rotavirus in 2006. Harmonic and multiscale wavelet analyses were used to detect seasonality and the points of change in the temporal scale. The statistical significance of each seasonality that was identified was tested using Fisher's test. The harmonic and wavelet analyses show annual seasonal and six-monthly patterns for HR, as well as a clear change after the introduction of the vaccine in 2006.

Resumo: A diarreia por rotavírus é uma das principais causas de mortalidade em crianças nos países em desenvolvimento, embora tenha sido observada a redução nas taxas de hospitalização (HR) por diarreias aguda desde que a vacina do rotavírus foi introduzida. A dinâmica do rotavírus, no entanto, ainda é mal compreendida e picos sazonais ocorrem durante todo o ano, com variações entre países e ao longo do tempo. O principal objetivo foi analisar o comportamento temporal das HR devido a diarreia aguda em crianças menores de um ano de idade no sul do Brasil, de 2000 a 2011, e investigar mudanças no padrão de sazonalidade após a introdução da vacina contra o rotavírus em 2006. Análises harmônica e multiescala wavelet foram utilizadas para detectar a sazonalidade e pontos de mudança na série temporal. A significância estatística de cada sazonalidade identificada foi testada pelo teste de Fisher. As análises harmônica e wavelet mostraram padrões sazonais anual e semestral das HR, bem como a nítida mudança após a introdução da vacina em 2006.

Resumen: La diarrea por rotavirus es una de las principales causas de mortalidad en niños en los países en desarrollo, aunque se haya observado una reducción en las tasas de hospitalización (HR) por diarreas agudas, desde que se introdujo la vacuna del rotavirus. La dinámica del rotavirus, no obstante, aunque está mal comprendida -y se producen picos estacionales- tiene lugar durante todo el año, con variaciones entre países y a lo largo del tiempo. El principal objetivo fue analizar el comportamiento temporal de las HR, debido a la diarrea aguda en niños menores de un año de edad en el sur de Brasil, de 2000 a 2011, e investigar cambios en el patrón de estacionalidad tras la introducción de la vacuna contra el rotavirus en 2006. Los análisis harmónico y multiescala wavelet se utilizaron para detectar la estacionalidad y puntos de cambio en la serie temporal. La significancia estadística de cada estacionalidad identificada fue testada por el test de Fisher. Los análisis harmónico y wavelet mostraron patrones estacionales anual y semestral de los HR, así como un nítido cambio tras la introducción de la vacuna en 2006.

The impact of rotavirus vaccination on emergency department visits and hospital admissions for acute diarrhea in children under 5 years / Impacto da vacinação contra rotavírus nas consultas de pronto-socorro e internações por doença diarreica aguda em crianças menores de 5 anos de idade

Summary Introduction: Acute diarrheal disease is the second cause of death in children under 5 years. In Brazil, from 2003 to 2009, acute diarrhea was responsible for nearly 100,000 hospital admissions per year and 4% of the deaths in children under 5 years. Rotavirus is the leading cause of severe acute diarrhea worldwide. In 2006, the rotavirus monovalent vaccine (RV1) was added to the Brazilian National Immunization Program. Objectives: To analyze the impact of the RV1 on emergency department (ED) visits and hospital admissions for acute diarrhea. Method: A retrospective ecologic study at the University Hospital, University of São Paulo. The study analyzed the pre-vaccine (2003–2005) and the post-vaccine (2007–2009) periods. We screened the main diagnosis of all ED attendances and hospital admissions of children under 5 years in an electronic registry system database and calculated the rates of ED visits and hospital admissions. The reduction rate was analyzed according to the following formula: reduction (%) = (1 - odds ratio) x 100. Results: The rates of ED visits for acute diarrhea was 85.8 and 80.9 per 1,000 total ED visits in the pre and post vaccination periods, respectively, resulting in 6% reduction (95CI 4 to 9%, p<0.001). The rates of hospital admissions for acute diarrhea was 40.8 per 1,000 in the pre-vaccine period and dropped to 24.9 per 1,000 hospitalizations, resulting in 40% reduction (95CI 22 to 54%, p<0.001). Conclusion: The introduction of the RV1 vaccine resulted in 6% reduction in the ED visits and 40% reduction in hospital admissions for acute diarrhea.

Resumo Introdução: a doença diarreica aguda é a segunda causa de morte em crianças abaixo de 5 anos de idade. No Brasil, entre 2003 e 2009, a diarreia aguda foi responsável por cerca de 100 mil internações por ano e por 4% das mortes em crianças abaixo de 5 anos de idade. O rotavírus é a principal etiologia de diarreia aguda grave. A vacina monovalente (RV1) contra o rotavírus foi introduzida em 2006. Objetivos: verificar o impacto da vacina monovalente contra rotavírus nas consultas de pronto-socorro e internações por doença diarreica aguda em crianças menores de 5 anos de idade. Método: foi realizado um estudo ecológico retrospectivo no Hospital Universitário da Universidade de São Paulo. O período foi dividido em pré-vacina (2003 a 2005) e pós-vacina (2007 a 2009). Foram incluídas todas as crianças abaixo de 5 anos que passaram em consulta no pronto-socorro. Foram obtidas as taxas de consultas no pronto-socorro e internações por doença diarreica aguda. A redução nas taxas foi obtida através da fórmula: redução (%) = (1 - odds ratio) x 100. Resultados: no período pré-vacina, a taxa de consultas por diarreia aguda foi de 85,8 consultas por 1.000 consultas gerais, enquanto no período pós-vacina a taxa de consultas por diarreia aguda foi 80,9 por 1.000, uma redução de 6% (IC95% 4-9, p<0,001). A taxa de internação por diarreia aguda era 40,8 internações por 1.000 e caiu para 24,9 por 1.000, redução de 40% (IC95% 22-54, p<0,001). Conclusão: após a introdução da vacina contra rotavírus houve uma redução de 6% nas consultas por diarreia aguda no pronto-socorro e de 40% nas internações por diarreia aguda.

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. .

Intervention analysis of introduction of rotavirus vaccine on hospital admissions rates due to acute diarrhea / Análise de intervenção da introdução da vacina do rotavirus nas taxas de internação hospitalar por diarreia aguda / Análisis de intervención en la introducción de la vacuna contra el rotavirus en las tasas de hospitalización por diarrea aguda

The aim of this study is to investigate the impact of rotavirus vaccine on hospitalization rates for acute diarrhea in children younger than 5 years old after the introduction of the vaccine in 2006. A descriptive analytical observational study was carried out of the hospitalization rates occurred between 2000 and 2011 in 22 Regional Health Centers of Paraná State, Brazil. The effect of the vaccine was assessed by applying the SARIMA/Box-Jenkins time series methodology of intervention analysis, which allows verifying the slopes of the series are different after the introduction of the vaccine and estimating the magnitude of these effects for children younger than five years of age, by age group, for each region center. It was verified a statistically significant reduction by center/month on hospitalization rates for children 1 year old and younger, with averages of 47% and 58%, respectively, in December 2011.

O objetivo desse estudo é investigar o impacto da vacina do rotavírus nas taxas de internação por diarreia aguda em crianças menores de cinco anos após a introdução da vacina em 2006. Foi realizado um estudo analítico observacional descritivo das taxas de hospitalização ocorridas entre 2000 e 2011, em 22 Centros Regionais de Saúde do Estado do Paraná, Brasil. O efeito da vacina foi avaliado por séries temporais aplicando a metodologia SARIMA/Box-Jenkins com análise da intervenção, a qual permite verificar que os declives das séries são diferentes após a introdução da vacina, bem como estimar a magnitude desses efeitos para crianças menores de cinco anos de idade, por faixa etária, para cada região. Verificou-se redução estatisticamente significativa por centro/mês nas taxas de internação por diarreia aguda para as crianças menores de 1 ano de idade e de 1 ano de idade, com médias de 47% e 58%, respectivamente, em dezembro de 2011.

El objetivo de este estudio es investigar el impacto de la vacuna contra el rotavirus en las tasas de hospitalización, relacionadas con diarrea aguda en niños menores de 5 años, después de que se introdujese la vacuna en 2006. Se trata de un estudio observacional, analítico descriptivo de las tasas de hospitalización acaecidas entre 2000 y 2011 en 22 centros regionales de salud del estado de Paraná, Brasil. El efecto de la vacuna se evaluó mediante la aplicación de la serie de tiempo SARIMA/metodología de Box-Jenkins de análisis de intervención, lo que demuestra que los declives de las series son diferentes después de la introducción de la vacuna, con el fin de estimar la magnitud de estos efectos en los niños menores 5 años de edad, por grupos de edad para cada región. Se ha encontrado una reducción estadísticamente significativa de centro/mes en las tasas de hospitalización para niños menores de 1 año de edad y de 1 año de edad, con un promedio de 47% y 58%, respectivamente, en diciembre de 2011.

Conocimiento materno sobre estrategias básicas de prevención en enfermedad diarreica aguda / Maternal knowledge of basic prevention strategies in acute diarrheal disease

El impacto socioeconómico y la mortalidad que producen la enfermedad diarreica aguda (EDA) ha sido preocupación delas organizaciones internacionales. La prevención en EDA agrupa estrategias básicas de saneamiento ambiental y atención primaria. Unasolución es promover la educación en la población de riesgo. Estimar el conocimiento materno sobre estrategias primarias deprevención de diarrea. Se realizó un estudio observacional de corte transversal, tipo encuesta a madres que acuden a losservicios de pediatría del Instituto Autónomo Hospital Universitario de Los Andes durante el lapso noviembre – marzo 2012. Se utilizóChi cuadrado de Pearson (p <0,05) para el análisis estadístico. Resultados Se incluyeron 111 madres: 50,4% tenían entre 20 y 35 añosde edad, 40,6% provenientes del distrito sanitario Mérida, de estratos sociales Graffar IV-V; 33.3% tenían enseñanza secundaria. Sinembargo, solo 14,4% tuvo conocimiento adecuado sobre estrategias primarias de prevención en diarrea, 85% con desconocimiento de laexistencia de la vacuna antirotavirus. Solo 28% utiliza suero oral. Se estableció asociación significativa entre bajo nivel de instrucciónmaterna y nivel socioeconómico, con pobre conocimiento en prevención en EDA (p=0,002). El desconocimiento maternode estrategias de prevención en EDA tuvo relación directa con bajos niveles de instrucción materna y nivel socioeconómico; por ello lascampañas de educación deben dirigirse a estos grupos. Alimentación, rehidratación oral y vacunas son tópicos a reforzar. El saneamientoy la promoción de la higiene con participación de la comunidad pueden llevar a una reducción significativa de la incidencia de diarreaen niños

Socioeconomic impact and mortality caused by acute diarrheal disease (ADD) has been a concern of international organizations. One solution is to promote education in the population at risk. ADD prevention basic strategies include measures such as hand washing, food hygiene, proper disposal of excreta and vaccination. To determine maternal knowledge in primary strategies for preventing diarrhea. This is a cross-sectional observational survey study that included mothers attending pediatric services at the Instituto Autónomo Hospital Universitario de Los Andes, November - March 2012. Pearson Chi-square was utilized (p < 0,05) for statistical analysis. 111 mothers were included, 50.4% were between 20 - 35 years of age; 40.6% were from the sanitary district of Merida and were classified as social strata Graffar IV-V; 33.3% had high school education. However, only 14.4% had adequate knowledge in regard to strategies in primary prevention in diarrhea, with lack of knowledge in 85% of the availability of the vaccine anti-rotavirus. Only 28% had employed oral hydration solutions. A significant association between low maternal education level and socioeconomic level with poor knowledge in prevention in ADD was found (p = 0.002). Lackof maternal knowledge of prevention in ADD strategies is in direct relation with low level of maternal education and socio-economic level, which emphasizes the importance of educational campaigns directed to these groups. Food, oral rehydration and vaccines are topics to reinforce. Sanitation and promoting hygiene with community participation may lead to a significant reduction of the incidence of diarrhea in children

Oral live attenuated human rotavirus vaccine (RotarixTM) offers sustained high protection against severe G9P[8] rotavirus gastroenteritis during the first two years of life in Brazilian children

In a large Phase III trial conducted in 10 Latin American countries, the safety and efficacy of the live attenuated monovalent rotavirus vaccine RIX4414 was evaluated in 15,183 healthy infants followed up during the first two years of life. Belém was the only site in Brazil included in this multicentre trial. The study in Belém included a subset of 653 infants who were followed up until 24 months of age for protection against severe rotavirus gastroenteritis. These subjects were randomly assigned in a 1:1 ratio to receive two doses of vaccine (n = 328) or two doses of placebo (n = 325) at approximately two and four months of age. Of the 653 enrolled infants, 23 dropped out during the study period. For the combined two-year period, the efficacy of RIX4414 was 72.3% [95% confidence interval (CI) 37.5-89.1%] against severe rotavirus-related gastroenteritis, reaching a protection rate of 81.8% (95% CI 36.4-96.6%) against circulating wild-type G9 rotavirus strains. It is concluded that two doses of RIX4414 are highly efficacious against severe rotavirus gastroenteritis in Belém during the first two years of life and provide high protection against the worldwide emergence and spread of G9P[8] strains.

Rotavirus / Rotavirus

la infección por rotavirus es responsable de 125 millones de casos, de más 500.000 defunciones anuales y de 40% de la hospitalización por diarrea en menores de 5 años de edad. en países en desarrollo la tasa de infección es más alta en el grupo de edad de 3 a 11 meses, quienes presentan mayor letalidad producto de la desnutrición y de la dificultad para acceder oportunamente a los servicios de salud; se observa que al año de vida, 65-80 % de los niños han desarrollado anticuerpos contra el rotavirus y 95% a los 2 años. Actualmente se utilizan dos vacunas contra el rotavirus, las cuales han demostrado ser seguras, eficaces y poco relacionadas con invaginación intestinal. En venezuela, la vacuna monovalente-humana se introdujo en el Programa Ampliado de Inmunizaciones en abril de 2006. un estudio previo mostró que la administración masiva de dos dosis de esta vacuna contra el rotavirus es altamente costo-efectiva. cuatro años después en un estudio nacional se evaluó el impacto y se evidenció reducción de 50% de la tasa de mortalidad en los menores de 5 años, siendo mayor en el grupo de menores de 1 año con 55% y en el grupo de 1-4 años de 44%. sin embargo el seguimiento de este programa nos indica que las coberturas de inmunización contra rotavirus en venezuela siguen siendo bajas

Infection by rotavirus is responsible for 125 million cases, 500,000 annual deaths and 40% of hospitalizations for diarrhea in children under 5 years of age. In developing countries the rate of infection is higher in the group of 3 to 11 months of age, which present a higher lethality, product of undernourishment and difficulties to accede opportunely to health services. during the first year of life, 65 to 80%of children have developed antibodies against rotavirus and 95% will achieve this by the age of two. At the moment two vaccines against rotavirus are available, and have demonstrated to be safe, effective and with very low association with intestinal invagination. In venezuela, the monovalent-human vaccine was introduced in the extended Program of Immunizations in April of 2006. A previous study showed that the massive administration of two doses of this vaccine against rotavirus is highly cost-effective. Four years later, a national study showed a reduction of mortality rate of 50% in children under 5 years of age, 55% reduction in those less than one year and 44% reduction in the group of 1-4 years of age. nevertheless the follow up of this program indicates that immunization coverage against rotavirus in venezuela continues to be low

Reduction in morbidity and mortality from childhood diarrhoeal disease after species A rotavirus vaccine introduction in Latin America : a review

Countries in Latin America were among the first to implement routine vaccination against species A rotavirus (RVA). We evaluate data from Latin America on reductions in gastroenteritis and RVA disease burden following the introduction of RVA vaccine. Published literature was reviewed to identify case-control studies of vaccine effectiveness and population-based studies examining longitudinal trends of diarrhoeal disease reduction after RVA vaccine introduction in Latin American countries. RVA vaccine effectiveness and impact on gastroenteritis mortality and hospitalization rates and RVA hospitalization rates are described. Among middle-income Latin American countries with published data (Mexico, Brazil, El Salvador and Panama), RVA vaccine contributed to a gastroenteritis-associated mortality reduction of 22-41 percent, a gastroenteritis-associated hospitalization reduction of 17-51 percent and a RVA hospitalization reduction of 59-81 percent among children younger than five years of age. In Brazil and El Salvador, case-control studies demonstrated that a full RVA vaccination schedule was 76-85 percent effective against RVA hospitalization; a lower effectiveness of 46 percent was seen in Nicaragua, the only low-income country with available data. A growing body of literature offers convincing evidence of "real world" vaccine program successes in Latin American settings, which may be expanded as more countries in the region include RVA vaccine in their immunization programs.

A rotavirose e a vacina oral de rotavírus humano no cenário Brasileiro: revisão integrativa da literatura / The rotavirus disease and the oral human rotavirus vaccination in the Brazilian scenario: an integrative literature review

Diante da relevância epidemiológica da rotavirose no panorama mundial como importante causa de morbimortalidade no público infantil e da ainda incipiente produção de estudos que versem sobre a problemática no cenário nacional, sem falar na necessidade ímpar de se incentivar o fomento de fazeres educativos que conjuguem o cuidado e a educação como fatores indissociáveis nos espaços de saúde, foi delimitado como objeto de estudo do presente artigo a rotavirose no cenário brasileiro, destacando a vacinação como estratégia de combate a esse mal. Assim, objetiva-se analisar as publicações sobre rotavirose no contexto do nosso país, ressaltando a vacina contra rotavírus (VORH) como a mencionada estratégia. Trata-se de uma pesquisa bibliográfica realizada nos bancos de dados BDENF, Lilacs, SciELO e Medline, no mês de fevereiro de 2010. No decorrer do estudo, são discutidos os seguintes pilares temáticos: propriedades do rotavírus; a rotavirose como um problema de saúde pública; e a vacinação contra o rotavírus como ação primordial de proteção à saúde. O estudo evidenciou a importância epidemiológica da rotavirose no cenário mundial e a relevância da vacinação como estratégia de combate a tal problemática.

Due to the epidemiological relevance of rotavirus disease on the worldwide panorama as an important cause of morbid-mortality in the infantile public and to the still incipient production of studies concerning the problematic in the nationwide scenario, not to mention the unique necessity of encouraging the promotion of care and education as inseparable factors in the health spaces, it was delimited as study object of the present article the rotavirus disease in the Brazilian scenario, emphasizing the vaccination as preventive measure against this ill. Thus it is aimed to analyze the publications about rotavirus disease in our country's contexture, stressing the vaccination against the Rotavirus (VORH) as the strategy mentioned. It is a bibliographic research performed on the BDENF, Lilacs, SciELO and Medline databases, in February 2010. During the study the following thematic pillars were discussed: rotavirus characteristics; the rotavirus disease as a public health issue; and the vaccination against rotavirus as primordial action of health care. The study evidenced the epidemiological importance of rotavirus disease in the worldwide scenario and the relevance of vaccination as preventive measure against such problematics.

Caracterização de genótipos de rotavírus em creches: era pré e pós-vacinação contra o rotavírus / Characterization of rotavirus strains from day care centers: pre-and post-rotavirus vaccine era

OBJETIVOS: Em 2006, a vacina contra rotavírus foi incluída no Programa Nacional de Imunização. Este estudo teve como objetivo analisar os resultados da vigilância de genótipos de rotavírus em crianças < 5 anos com gastrenterites agudas provenientes de creches no estado de São Paulo por um período de 5 anos. MÉTODOS: Este estudo retrospectivo foi realizado em 30 creches no período de 2004 a 2008, com amostras fecais convenientes da vigilância das diarreias agudas, analisadas por ELISA, SDS-PAGE, RT-PCR e sequenciamento genético para caracterização do genótipo. RESULTADOS: Infecções por rotavírus foram detectadas em 28,3 por cento de amostras (38/134). Os genótipos mais frequentes detectados foram: G9P[8] e G1P[8] em 2004; G1P[8] em 2005; GNTP[NT] em 2006; G2P[4] em 2007; e nenhum caso foi relatado em 2008. Infecções mistas não foram observadas. A taxa de detecção diminuiu de 65,7 por cento (23/35) em 2004 para 50 por cento (9/18) em 2007. CONCLUSÕES: A distribuição do genótipo variou de acordo com os anos, acompanhada pela redução no número de casos detectados. É necessário intensificar a vigilância pós-implantação da vacina contra rotavírus, visando monitorar as linhagens circulantes e sua eficácia contra possíveis genótipos emergentes.

OBJECTIVES: In 2006 the rotavirus vaccine was included in the Brazilian Immunization Program. The aim of this study was to report the results of a 5-year surveillance study of rotavirus strains in children < 5 years with acute gastroenteritis from day care centers in the state of São Paulo, Brazil. METHODS: This retrospective study was conducted with 30 day care centers from 2004 to 2008 with convenient surveillance fecal specimens, investigated by ELISA, SDS-PAGE, RT-PCR and gene sequencing to genotype characterization. RESULTS: Rotavirus infection was detected in 28.3 percent of samples (38/134). The most frequent genotypes detected were G9P[8] and G1P[8] in 2004; G1P[8] in 2005; GNTP[NT] in 2006; G2P[4] in 2007; and there were no cases in 2008. Mixed infections were not observed. Detection rate declined from 65.7 percent (23/35) in 2004 to 50 percent (9/18) in 2007. CONCLUSIONS: Genotype distribution varied according to collection year, accompanied by a reduction in detection rate. Use of rotavirus vaccine requires implementation of post-marketing surveillance to monitor rotavirus strain diversity and its efficacy against possible new emerging genotypes.

Inmunizaciones: [revisión] / Immunizations: [review]

Los avances en la prevención de la enfermedad diarreica aguda con el uso de vacunas orales están presentes gracias a las investigaciones en el área de los trabajos realizados en cólera, fiebre tifoidea y con más éxito en la prevención de la diarrea por rotavirus. en este consenso desarrollamos los elementos actualizados en la inmunización contra cólera, fiebre tifoidea, indicaciones y futuras vacunas. en especial, se hace referencia a la vacunación contra rotavirus, sus estudios iniciales, evaluación de la investigación en fase III (realizada en Venezuela), las características particulares de cada vacuna desarrollada y en uso hoy en día, su aplicación y seguimiento una vez iniciado el plan nacional de vacunación, finalizando con los estudios de impacto económico y costo-efectividad.

Advances in prevention of acute diarrheal disease with the use of oral vaccines have been accomplished thanks to research in cholera, typhoid fever and, with more success, in the prevention of rotavirus diarrhea. This consensus addresses updates in immunization against cholera, typhoid fever, indications and future vaccines. In particular, we refer to vaccinations against rotavirus, their initial studies, research evaluation in phase III (held in Venezuela), particular characteristics of each vaccine developed and in use today, and the follow up of its implementation once the national vaccination plan is initiated. Final considerations in relation to the economic impact and cost effectiveness studies are stated.

Rotavírus e as perspectivas para seu controle por terapia vacinal / Rotavirus and prospects for their control by vaccine therapy

A presente revisão tem por objetivo a descrição da infecção gastrointestinal por rotavírus no âmbito de sua epidemiologia e da importância do seu tratamento, na forma vacinal, que abrange bons resultados contra a maioria dos genótipos e sorotipos mais comuns no planeta. Neste caso, a vacina denominada de Vacina Oral de Rotavírus Humano (VORH), de origem humana, G1P[8] da cepa R1X4414, atualmentefoi a que demonstrou melhoreficácia. Como a vacinação específica é a medida mais eficaz na prevenção e controle, são necessários estudos da eficácia de novas candidatas a vacinas contra o rotavírus no Brasil e no mundo.

This review describes the gastrointestinal infection by rotavirus in the ambit of its epidemiology and the importance of its treatment by vaccines that embrace good results against most of the genotypes and more common sorotypes in the planet. In this case, the vaccine denominated Oral Vaccine of Human Rotavirus (OVHR), from human origin, G1P [8] of thestump R1X4414, now has demonstrated bettereffectiveness. Considering that thespecific vaccination is the most effective way to prevention and control, we need studies about the effectiveness of new vaccines against the rotavirus in Brazil and in the whole world.

Impacto de la introducción de la vacuna contra el rotavirus en la hospitalización por gastroenteritis aguda grave en el Hospital del Niño de la Ciudad de Panamá / Impact of rotavirus vaccine introduction on hospital admissions for severe acute gastroenteritis at the Children's Hospital in Panama City

OBJETIVOS: Determinar si la introducción de la vacunación infantil contra el rotavirus en Panamá permitió reducir la tasa de hospitalización por gastroenteritis en niños menores de 5 años. MÉTODOS: Estudio observacional de corte transversal en dos períodos: del 1 de enero al 31 de agosto de 2005 (antes de la introducción de la vacunación contra el rotavirus) y del 1 de enero al 31 de agosto de 2007 (un año después de la introducción). Se estudiaron todos los niños y niñas entre 2 meses y 5 años de edad hospitalizados con diagnóstico de gastroenteritis aguda grave en la sala de corta estancia de gastroenteritis del Hospital del Niño, en Ciudad de Panamá, Panamá. Las variables fueron: número de episodios de gastroenteritis, número de casos hospitalizados por gastroenteritis aguda grave, días de hospitalización y uso de antibióticos, según dos grupos de edad (de 2 meses a 1 año y de más de 1 año a 5 años). Se calculó el riesgo relativo (RR) con intervalos de confianza de 95 por ciento (IC95 por ciento) y un nivel de significación P < 0,05. RESULTADOS: Se contabilizaron 1 240 episodios de gastroenteritis aguda grave en 1 222 niños. No se encontraron diferencias significativas entre los dos períodos de estudio en cuanto al número de complicaciones (P = 0,92) y defunciones (P = 1,00). Hubo más episodios de gastroenteritis aguda grave después de la introducción de la vacuna contra el rotavirus humano que en el período previo, pero esta diferencia no fue estadísticamente significativa (RR = 1,12; IC95 por ciento: 0,87 a 1,44; P = 0,39). No se encontraron diferencias significativas en relación al tiempo de hospitalización por grupos de edad en los periodos analizados. La proporción de casos tratados con antibióticos fue similar en ambos períodos de estudio (29,7 por ciento contra 25,2 por ciento; P = 0,08). CONCLUSIONES: No se encontró que la introducción de la vacunación infantil contra el rotavirus en Panamá llevara a una reducción significativa...

OBJECTIVES: To determine if infant rotavirus vaccination in Panama has reduced the rate of hospital admission for gastroenteritis among children under 5 years of age. METHODS: An observational, cross-sectional study of two time periods: 1 January-31 August 2005 (prior to initiating rotavirus vaccination) and 1 January-31 August 2007 (one year after introducing rotavirus vaccination). All the children from 2 months-5 years of age admitted with a diagnosis of acute gastroenteritis to the short-stay gastroenteritis area of the Children's Hospital in Panama City, Panama, were studied. The variables were: number of gastroenteritis episodes; number of cases admitted for severe acute gastroenteritis; number of days hospitalized; and antibiotics treatment for each of the two age groups (2 months-1 year and >1-5 years). The relative risk (RR) was calculated with a 95 percent confidence interval (95 percentCI) and a significance level of P < 0.05. RESULTS: There was a total of 1 240 episodes of severe acute gastroenteritis in 1 222 children. No significant differences were found between the two study periods regarding the number of complications (P = 0.92) and deaths (P = 1.00). Although there were more episodes of severe acute gastroenteritis after initiating vaccination against human rotavirus than there were in the period prior, the difference was not statistically significant (RR = 1.12; 95 percentCI: 087-1.44; P = 0.39). There were no significant differences found in the length of hospital stay by age groups studied in each time period. The percent of cases treated with antibiotics was similar in both study periods (29.7 percent versus 25.2 percent; P = 0.08). CONCLUSIONS: The introduction of infant rotavirus vaccination was not found to lead to a significant reduction in hospital admission rates for gastroenteritis among children less than 5 years of age. Significant changes in morbidity and in antibiotics use were not found after the introduction...

Natural immunity to rotavirus infection in children.

Annual deaths in infants and young children due to rotavirus (RV) infection are around 100,000 in India and about 600,000 globally. Development of a vaccine for this disease is a high priority. The protective mechanisms for RV diarrhea in human are not fully understood, but it is known that children develop natural immunity against RV. Early exposure to RV results in most severe episode of diarrhea and subsequent infections are milder or asymptomatic. Of the immune responses measured during natural infection, RV-specific antibodies have been well documented, whereas data on cellular immunity in humans are sparse. It is generally thought that two outer capsid proteins VP4 and VP7 play a critical role in protective immunity by stimulating production of neutralizing antibodies. While serotype- specific protection mediated by antibodies directed against the outer capsid proteins may be a mechanism of protection, such a correlate for protection has been difficult to demonstrate in humans during clinical trials. Increasing evidences suggest that viral proteins that lack a capacity of eliciting neutralizing antibody response also induce protective immunity. Limited efforts have focused on the role of non-structural proteins in protective immunity. This review describes current understanding of antibody responses in children with focus on responses specific to viral antigens with their possible role in protective immunity. We have also briefly reviewed the responses elicited to non-antibody effectors during RV infection in human subjects.

Evaluation of immune response to bovine rotavirus following oral and intraperitoneal inoculation in mice.

With a view to use mice as an experimental model for studying immune response to bovine rotavirus (BRV), the kinetics of humoral and cellular immune responses to BRV in mice were evaluated by immunizing through intraperitoneal and oral route with UK strain of BRV. Following immunization with BRV, anti-rotavirus antibodies was developed in mice. The mean log antibody titres as measured by ELISA in mice immunized by intraperitoneal route were significantly higher than those immunized by oral route. Significant cellular immune response was observed in BRV-immunized mice on stimulation with BRV antigen, as measured by lymphocyte proliferation assay. The thymidine uptake by splenic and mesenteric lymph-node cells of intraperitoneally immunized mice on stimulation with BRV was 21328 +/- 1225 and 739 +/- 55 CPM, respectively. The splenic cells showed significantly higher stimulation (stimulation index 12.98) as compared to those of mesenteric cells (stimulation index 1.57). Foot pad inoculation test showed maximum virus-specific delayed type hypersensitivity reaction at 24 hr post-challenge following primary immunization and at 18 hr post-challenge following secondary immunization. The results indicate that BRV immunization by intraperitoneal route generates more efficient immune response in mice than by oral route and this route may be used for immune response studies involving BRV infection.