Efetividade da vacina conjugada contra o meningococo C em menores de dois anos / Effectiveness of conjugate vaccine against meningococcus C in under two years

Objetivo: Estimar o impacto da vacina conjugada contra o meningococo C (VCMC), na incidência e mortalidade, nas coortes de nascidos com e sem indicação de vacinação, no município de São Paulo (MSP); e estimar a efetividade direta da VCMC segundo esquema do Programa Nacional de Imunização. Métodos: O impacto foi avaliado por estudo descritivo, abrangendo casos de doença meningocócica (DM) notificados ao MSP, de 1998 a 2012. A definição de caso é a adotada pelo Ministério da Saúde. Descreveu-se o comportamento da DM no MSP para todo período e analisou-se a tendência da incidência e mortalidade da DM global e por faixa etária de 2008 a 2012, utilizando o modelo de Poisson. O impacto da VCMC foi analisado por meio das razões de taxas de incidência e mortalidade nos períodos anterior e posterior a introdução da VCMC. Estimou-se a fração prevenida na população (FPP) para mensurar o impacto, comparando-se taxas de incidência e mortalidade globais da DM, por faixa etária e sorogrupo C, de 2012 com as de 2009. Para estimativa da efetividade da VCMC utilizou-se estudo de caso-controle de base populacional, com quatro controles para cada caso, pareado pela área de residência dos casos. Casos e controles foram selecionados entre nascidos a partir de janeiro/2009. Casos eram aqueles com DM pelo sorogrupo C confirmado por cultura e/ou reação em cadeia de polimerase em tempo real, de 2011 a 2013, internados em hospitais do MSP, notificados à vigilância do município. Controles foram selecionados entre crianças residentes na vizinhança dos casos, sem história de DM. A efetividade da vacina foi estimada pela fórmula (1-odds ratio para vacinação). As odds ratios (OR) não ajustadas e ajustadas e respectivos intervalos de confiança (IC95 por cento ) foram estimados por regressão 11 logística condicional múltipla. A associação entre ser vacinado com VCMC e a variável dependente, DM pelo sorogrupo C, foi mensurada pela estimativa da OR após ajuste para potenciais confundidores. Resultados: O impacto da VCMC na incidência da DM por todos os sorogrupos, mensurado pela FPP foi de 62,7 por cento , 69,6 por cento e 61,4 por cento para, respectivamente menores um, um e dois anos; na DM pelo sorogrupo C de 81,6 por cento e 67,9 por cento para menores de dois anos e de dois a três anos. Houve impacto na taxa de mortalidade global da DM medido pela FPP de 86,2 por cento e 77,8 por cento respectivamente para menores de dois anos e de dois a três anos e na mortalidade da DM pelo sorogrupo C a FPP foi de 84,2 por cento para menores de quatro anos. A efetividade da VCMC foi de 97,7 por cento (IC95 por cento :99,6 por cento -89,6 por cento ) ajustada para idade, número de pessoas no quarto da criança e renda familiar. Conclusões: A estratégia brasileira com a VCMC resultou em elevado impacto nas coortes de nascidos com indicação de vacinação, mais acentuado nas taxas de mortalidade, sugerindo que a vacina confere não só proteção para a doença, mas também para formas mais graves. A VCMC foi altamente efetiva na faixa etária alvo.

Objective: To assess the impact of meningococcal C conjugate vaccine (MCCV), to estimate incidence and mortality rates of meningococcal disease (MD) in birth cohorts recommended and not recommended for vaccination and to measure direct vaccine effectiveness of the National Vaccination Program immunization schedule. Methods: We assessed the impact of MCCV in a descriptive study including cases of MD reported in the city of Sao Paulo, Brazil, from 1998 to 2012. We used the standard case definition recommended by the Brazilian Ministry of Health for MD reporting. We assessed changes in the disease epidemiology in the city for the entire study period and estimated incidence and mortality rates of MD (overall and by age group) from 2008 to 2012 using Poisson regression models. We conducted an impact analysis of MCCV by comparing incidence and mortality rates of MD before and after vaccine introduction. We also estimated the population prevented fraction (PPF) by comparing incidence and mortality rates of MD between 2009 and 2012 in the entire population and by age group and serogroup C. To measure vaccine effectiveness, we carried out a population-based case-control study matched for area of residence with a 4-to-1 ratio of controls to cases. Cases and controls were selected among children born from January 2009. Cases were those children admitted to the citys hospitals who were diagnosed with MD serogroup C (MDC) confirmed by culture and/or real-time polymerase chain reaction and reported to the surveillance system from 2011 to 2013. Controls were selected among children with no history of MD from neighboring areas of cases. We calculated vaccine effectiveness using the formula (1 odds ratio [OR] for 13 vaccination) and estimated crude and adjusted ORs and related 95 per cent confidence intervals (95 per cent CI) by conditional multiple logistic regression. We assessed the association between MCCV vaccination and MDC the dependent variable by estimating OR after adjustment for the potential confounders. Results: There was an impact of MCCV on the incidence of MD in all serogroups, the PPF among children under age one, age one, and age two were 62.7 per cent , 69.6 per cent , and 61.4 per cent , respectively; and in serogroup C, the PPF in children under age two and age two to three were 81.6 per cent and 67.9 per cent . There was also an impact on the overall mortality rate of MD, the PPF in children under age two and age two to three were 86.2 per cent and 77.8 per cent ; and on mortality of MDC, the PPF was 84.2 per cent in children under age four. MCCV effectiveness in children was 97.7 per cent (95 per cent CI 99.6 per cent 89.6 per cent ) after adjusting for age, number of persons per room, and household income. Conclusions: The MCCV strategy implemented in Brazil had a high impact on birth cohorts recommended for vaccination. This impact was more pronounced on mortality rates, which suggests that, in addition to preventing disease, MCCV can prevent more severe forms of MD. MCCV proved highly effective in the age groups targeted.

Factores asociados con la mortalidad por meningitis neumocócica en hospitales de La Habana / Factors associated with mortality due to pneumococcal meningitis in Havana hospitals

Introducción: la meningitis neumocócica constituye un serio problema de salud por su alta morbilidad, letalidad y graves secuelas. Objetivos: identificar algunos factores de riesgo asociados con la mortalidad por meningitis neumocócica. Métodos: se realizó un estudio de caso-control en 7 hospitales de La Habana (enero de 2002-diciembre de 2011) de 45 pacientes (0-86 años de edad), con meningitis neumocócica confirmada: 15 fallecidos (casos) y 30 sobrevivientes (controles), a partir de la vigilancia nacional de síndromes neurológicos bacterianos, historias clínicas, movimientos hospitalarios, tarjetas de enfermedades de declaración obligatoria y registros de laboratorio. Se midió la asociación (análisis bivariado y multivariado) de algunos factores con la muerte a través de la oportunidad relativa y su intervalo de confianza a 95 por ciento, considerando asociación cuando fue mayor o igual que 2. Resultados: la letalidad general resultó de 33,3 por ciento. La media entre el inicio de los síntomas y la consulta médica fue de 2,4 días; entre la consulta y el ingreso 0,5 días; entre el ingreso y el diagnóstico 0,4 días, y entre el diagnóstico y el tratamiento 0,2 días. La estadía hospitalaria media fue de 12,2 días. El análisis bivariado y multivariado mostró asociación significativa de la inconsciencia al ingreso, con la muerte. Otras variables se asociaron con el desenlace fatal pero no fueron significativas. Conclusiones: estar inconsciente al momento del ingreso es un factor de riesgo para la muerte por meningitis neumocócica, en los pacientes con esta enfermedad de los hospitales investigados en La Habana

Introduction: pneumococcal meningitis is a critical public health problem with a high rate of morbidity and mortality and serious sequelae. Objectives: identify some risk factors associated with mortality due to pneumococcal meningitis. Methods: a case-control study was conducted of 45 patients aged 0-86 with confirmed pneumococcal meningitis cared for in seven Havana hospitals from January 2002 to December 2011. Of the 45 patients studied, 15 had died (cases) and 30 had survived (controls). The study was based on national bacterial neurological syndrome surveillance data, medical records, hospital movements, notifiable disease cards and laboratory records. Association (bivariate and multivariate analysis) of some factors with death was measured through odds ratio with a confidence interval of 95 percent, considering it an association if greater than or equal to 2. Results: overall case-fatality rate was 33.3 percent. Mean time between the onset of symptoms and medical consultation was 2.4 days; between consultation and admission 0.5 day; between admission and diagnosis 0.4 day; and between diagnosis and treatment 0.2 day. Mean hospital stay was 12.2 days. Bivariate and multivariate analysis revealed a significant association between unconsciousness at admission and death. Other variables were associated with death as well, but they were not significant. Conclusions: being unconscious at admission is a risk factor for death due to pneumococcal meningitis in patients with this disease in the Havana hospitals studied

Prevalência de sorogrupos de neisseria meningitidis causadores de doença meningocócica no estado da Bahia de 1998 a 2007 / Prevalence of neisseria meningitidis sorogroups that cause meningococcal disease in Bahia, from 1998 to 2007 / Prevalencia de serogrupos de n. meningitidis causadores de enfermedad meningocócica en el estado de la Bahia de 1998 a 2007

A Doença Meningocócica (DM), problema de saúde pública em razão da elevada morbidade e letalidade em nosso meio, tem preocupado devido à recente ascensão do sorogrupo C da N. meningitidis em detrimento do sorogrupo B, que apresenta maior potencial para causar epidemias, e ao possível surgimento de novo perfil epidemiológico da doença. O objetivo deste estudo é quantificar a prevalência dos sorogrupos de N. meningitidis causadores de DM no estado da Bahia nos últimos 10 anos. Este é um estudo descritivo que avalia casos notificados de DM na Bahia de 1998 a 2007, por sexo, idade, letalidade e sorogrupos causadores. Dos 2.070 casos de DM, foram sorogrupados 327 (34,4por cento). O sorogrupo B foi responsável por 71,9por cento dos casos e o C por 26,65por cento, entretanto foi verificada inversão da frequência a partir de 2006, com sorogrupo C representando 77,8por cento dos casos em 2007. Homens e menores de cinco anos foram mais acometidos e a letalidade em 2007 foi de 31por cento. Concluiu-se que, também na Bahia, ocorreu um aumento do sorogrupo C em detrimento do sorogrupo B, o que evidencia a mudança da prevalência do sorogrupo causador da doença meningocócica, fato que tem como consequencia a mudança no perfil epidemiológico da doença.

Meningococcal disease (MD) is a public health problem due to the high morbidity and mortality rate in our country. Recently, the rise of serogroup C of N. meningitidis serogroup B instead, worries due to the greater potential to cause epidemics of this group and the possible emergence of a new epidemiological pattern of disease. The aim of this study is to quantify the prevalence of serogroups of N. meningitidis causes of DM in the state of Bahia in the last 10 years. This is a descriptive study that evaluates reported cases of DM in Bahia from 1998 to 2007, by sex, age, cause lethality and serogroups. Of the 2,070 cases of DM were different serogroups 327 (34.4percent). The serogroup B accounted for 71.9percent of cases and 26.65percent for C, however the frequency was observed reversal from 2006, with serogroup C accounting for 77.8percent of cases in 2007. Men and children under five years were most affected and the mortality rate in 2007 was 31percent. It was concluded that, in Bahia, an increase of serogroup C at the expense of serogroup B, which shows the change in the prevalence of serogroup causing meningococcal disease, a fact that leads to change in the epidemiology of the disease.

Resumen La enfermedad meningocócica (ED) es un problema de salud pública debido a la alta morbilidad y mortalidad en nuestro medio. El reciente aumento del serogrupo C de N. meningitidis en detrimento del serogrupo B, ha despertado preocupación por su alto potencial de causar epidemias y al posible aparecimiento de un nuevo patrón epidemiológico. El objetivo de este estudio es cuantificar la prevalencia de los serogrupos de N. meningitidis causa de la ED en el estado de la Bahía, en los últimos 10 años. Es un estudio descriptivo que evalúa denuncias de casos de ED en la Bahía de 1998 a 2007, por sexo, edad, letalidad y serogrupos causadores de la enfermedad. De los 2.070 casos de ED, 327 (34,4por ciento) fueron seroagrupados. El serogrupo B representó el 71,9por ciento de los casos y el C, el 26,65por ciento, sin embargo, se observó reversión en la frecuencia a partir de 2006, con el serogrupo C representando el 77,8por ciento de los casos en 2007. 678 Los hombres y los niños menores de cinco años fueron los más afectados y la tasa de mortalidad en 2007 fue del 31por ciento. Se concluye que, también en el estado de la Bahía, hubo un aumento del serogrupo C, en detrimento del serogrupo B, lo que muestra el cambio en la prevalencia del serogrupo causador de la enfermedad meningocócica, hecho que tiene como consecuencia el cambio de patrón epidemiologico de la enfermedad.

Sporadic cases of meningitis. No outbreak reported from Sudan

The current high risk season for epidemic meningitis is phasing out in Sudan without any outbreak reported from the country. From 01 January to 22 May 2011, only 573 suspected cases of meningococcal disease including 18 deaths [CFR: 3.1%] were reported from 12 of the 15 states in northern Sudan. Laboratory samples of cerebral spinal fluid analyzed at the National Public Health Laboratory were tested positive for both Neisseria meningitides serogroup A and serogroup W135

Meningococcal disease in Sudan: no outbreak so far

During the first 11 weeks of 2010 [01 January to 16 March 2010], a total of 91 suspected cases of meningococcal meningitis including 4 deaths [CFR: 4.3%] were reported from the northern part of Sudan. Majority of cases have occurred in Greater Darfur [40 out of 91 suspected cases] and are characterized by farthe predominance of Neisseria meningitides [Nm] serogroup A. None of the districts in the affected states have, however, not crossed the alert or epidemic threshold so far

Alerts of meningococcal meningitis from countries in EMR

Since the beginning of 2009, WHO received alerts of meningococcal meningitis from two countries in the Region. By end of international epidemiological week 10, Sudan reported 138 cases of meningococcal meningitis including nine related deaths [CFR 6.5%] from Kapoeta and Budi counties, Eastern Equatoria State of southern Sudan. Nisseria Meningitidis, Serogroup A was identified in 8 out of 11 samples tested by Pasteurex, and were isolated in 4 out of 6 samples. In northern Sudan a total of 248 cases including 10 deaths [CFR=4%] from 10 states. Response efforts included risk assessment, case management and targeted immunizations of people aged 2-30 years. Qatar reported 8 isolated cases of meningococcal meningitis between January and 12th February. Three of them were fatal. N. meningitidis sero-group B and W135 were isolated from 6 samples

Meningococcal disease situation in Darfur, Sudan

A total of 180 suspected cases of meningococcal disease including 10 deaths [CFR: 5.5%] were reported from three states of Darfur in Sudan from 01 January to 13 April 2009. Although the laboratory tests has confirmed large predominance of Neisseria meningitides serogroup A as the causative strain of this disease in most parts of Darfur, two suspected cases, reported from West Darfur, have been laboratory confirmed as Neisseria meningitides seerogroup W135. Mass vaccination campaign has been implemented by the Federal Ministry of Health in both south and west Darfur states with support from WHO and other agencies

Men a conjugate vaccine: could it change epidemiology of meningococcal meningitis in Africa

Phase 2 clinical study to assess safety and immunogenicity of meningococcal A [Men A] conjugate vaccine is currently ongoing in Mali and Gambia. The results of the study, which covers children 12- to 23-month-old [the younger age group targeted by mass vaccination campaigns], is expected to be available during the first quarter of 2008. Other studies targeting 2- to 29-year-old [the older age group targeted by the mass vaccination campaigns] are currently going on in four countries: Mali, Gambia, Senegal, and India. In addition, a study protocol for use of Men A conjugate vaccine in infants has entered the ethical and regulatory submission process. The study could start as early as June 2008 in Africa

Serotyping of Neisseria meningitides in conscripts with meningitis admitted to five military hospital in Tehran between September 2004 and September 2006

Meningococcal meningitis is one of the most feared disorders with high rate morbidity and mortality. There is no exact information of meningococcal meningitis incidence in military personnel. Obligate vaccination of the military with meningococcal vaccine is a strategy with the potency to provide active protection of the conscripts before being dispatched to training centers. Although sporadic cases of meningitis in conscripts occurred The aim of this study was serotyping of the bacterium; Neisseria meningitides isolated from patients with meningitis which admited to five military Hospitals. In this cross- sectional study for determination of meningococcal meningitis serotypes in conscripts submit to five military hospitals the investigation was designed and carried out from September 2003 to September 2006. In this period, 12 cerebrospinal fluids of conscripts with clinical signs and symptoms of meningitis were collected, and the laboratory tests were done. In this study enriched Thayer Martin medium and standard bacteriological methods were used. The sample without bacterial cells or PMNs were centrifuged [10000 xg for 5 min], The precipitate was cultured and direct smear was performed.Isolated bacterial strains was recognized by biochemical tests, and Neisseria meningitides strains were serotyped by specific antiserum. During the study, 12 cases of meningitis in conscripts were seen. Neisseria meningitides was isolated only from 6 patients. Serotyping analysis revealed that 5 strains belong to Serotype C and 1 strain was to serotype B. Neisseria sica was isolated from one patient. In three patients there was no bacteriological evidence. In two patients, consumption of antibiotic before lumbar puncture results to no bacterial growth, but direct smear showed gram negative diplococci. In one patient recurrent meningococcal infection has occurred. Complement components analysis revealed deficiency in C3, C4 and CH50 [the rate was below 80 mg per deciliter]. The results of this study showed that, Neisseria meningitides was isolated from six patients which are all conscripts. It is necessary to find the reasons that why vaccinated conscripts infected by Neisseria meningitides serotype C. Further analysis showed that, five patients had complement deficiency and further research is necessary. However, 6 Neisseria meningitides strains were isolated from meningococcal vaccinated conscripts around the country [Tehran, Shiraz, Yazd and Oslavieh] in the period of study. Based on the findings of this study, effectiveness of the vaccine was desirable and the disease had been controlled in this population group. Because of complements deficiency in patients with meningococcal meningitis, other preventing methods for eradication of disease are necessary

Doença meningocócica: situação epidemiológica no Município de Manaus, Amazonas, Brasil, 1998/2002 / Meningococcal disease: epidemiological profile in the Municipality of Manaus, Amazonas, Brazil, 1998/2002

Estudou-se o comportamento da doença meningocócica no Município de Manaus, Amazonas, Brasil, no período compreendido entre 1998 a 2002, referente à incidência e letalidade, idade, sexo, forma clínica, evolução, critério diagnóstico e cepas de meningococos predominantes. Os coeficientes de incidência da doença meningocócica, em Manaus, no período do estudo, apresentaram uma média de 7,8 casos por 100 mil habitantes. A doença meningocócica incide mais no sexo masculino. A faixa etária mais acometida são os menores de 1 ano. A taxa de letalidade média apresentada foi de 14,0 por cento. No ano de 2002, o meningococo pertencente ao sorogrupo B foi o mais incidente (78,2 por cento), os pertencentes ao sorogrupo C representaram 7,2 por cento dos casos de doença meningocócica.

Situación epidemiológica de las infecciones respiratorias agudas / neumonias en Nicaraua / Epidemiological situation of the acute respiratory infections / pneumonia in Nicaraua

Presenta boletín epidemiológico correspondiente a la semana 04, del 23 al 29 de enero del 2005. En el se aborda la situación epidemiológica de las infecciones respiratorias agudas/neumonias en Nicaraua. Hasta la semana 04 del año 2005, se han registrado en el país 101,977 atenciones médicas por infecciones respiratorias agudas, para una tasa de 186 x 10,000 hab., lo que representan un leve incremento del 6 porciento (5,640 atenciones menos), en comparación a igual período del año 2004 en que se notificaron 96,337 atenciones y una tasa de 171 x 10,000 hab. Del total de atenciones por IRA, el 17 porciento corresponden a aquéllas diagnosticadas como neumonía. En el presente período se registran 17,586 casos para una tasa de morbilidad de 32 x 10,000 hab. En igual período 2004, se habían registrado un total de 15,667 casos para una tasa de 18 x 10,000 hab. El incremento observado en la notificación de neumonías es del 12 porciento (1,919). A través del sistema de vigilancia epidemiológica se han detectado un total de 11 defunciones por IRA, para un tasa de mortalidad de 0.2 x 10,000 hab. Lo que representa una reducción del 31 porciento (5 muertes menos) en comparación con igual período del año anterior en que se notificaron 16 defunciones y una tasa de 0.3 x 10,000 hab., manteniendo la redución en la mortalidad observada en el año 2004 donde se registraron 11 defuncioens por neumonía

Enfermedad meningocócica / Meningococcal disease

En Chile, en el año 2004 la incidencia de la enfermedad Meningocócica fue de 1.6 por cien mil hab., con 254 casos, representando la mitad de los casos esperados según la mediana del quinquenio anterior (483 casos), reducción que se presenta a partir del año 2001, cuando la enfermedad pasa a una situación de baja endemia, con predominio de los diagnósticos de meningitis y meningococcemias (40 y 43 por ciento del total de casos, respectivamente). La letalidad para este año fue baja (7,5 por ciento), con relación a lo esperado para esta enfermedad (10 por ciento). Las diferencias por sexo son leves, concentrando los hombres el 54 por ciento del total de casos. La región de Coquimbo presentó los riesgos más altos, con una incidencia casi el doble de la del país. El 60 por ciento de los casos de esta región se concentró en la comuna de Coquimbo (9 casos). De éstos 5 fueron confirmados por el ISP y 5 correspondieron a varones.

Situación de la mortalidad perinatal en Nicaragua / Situation of the mortality perinatal in Nicaragua

Presenta Boletín Epidemiológico del Ministerio de Salud de Nicaragua bajo la responsabilidad de Sistema de Vigilancia Epidemiológica Nacional. Contiene el registro de la situación de la mortalidad perinatal, mortalidad neonatal de los obitos fetales. Enumera las enfermedades sujetas a vigilancia epidemiológica, las muertes por SILAIS. Debido a la problemática de la mortalidad perinatal, el Ministerio de Salud realizó un diagnóstico situacional de la atención obstétrica y perinatal en 21 hospitales y su red de servicios, encontrando como causas principales asociadas a la altas tasas de mortalidad perinatal los problemas de organización del servicio, falta de control y gerencia, debilidades en el sistema de información y registro, insuficientes insumos médicos y falta de manteniento de equipos. En este sentido se plantea cuatro grandes líneas estratégicas de intervención en dicha problemática

Mortalidad materna por causa obstétrica en Nicaragua / Motherly mortality by causes obstetrics in Nicaragua

En el Boletín se incluye información sobre las estadísticas de la mortalidad materna por causas obstétricas, distribución de las muertes maternas por SILAIS, la situación de los SILAIS Río San Juan y Jinotega, así como la clasificación de las muertes, las distribución de las defunciones según grupos de edades, lugar de ocurrencia y procedencia. Se hace un comentario donde se refleja que el mayor número de muertes han ocurrido en el área rural y en el domicilio, lo cual nos indica la necesidad del trabajo intersectorial y comunitario, siendo necesario una mayor participación de las instituciones gubernamentales y las ONGs en las comisiones locales de lucha contra la mortalidad materna, para el establecimiento de mecanismos conjuntos de coordinación y de gestión. También aborda las enfermedades y las muertes que estan sujetas a vigilancia epidemiológica distribuidas por SILAIS

Management, complications, and outcome of 100 cases of meningococcal meningitis in Gezira state, Central Sudan in 1999

To determine the serogroup of the meningococcus responsible for the epidemic that occurred in Wad Medani Central Sudan in 1999; to show the effectiveness of a combination therapy of a single dose of chloramphenicol with crystalline penicillin in the management; and to determine complications which occurred at that particular time. Patients and 100 patients suspected of having meningococcal meningitis were included in the study. Thorough history and physical examinations including CSF examination were done on all patients. The CSF was examined with Gram stain, culture, and serogrouping. All patients received a single dose of 3 g of chloramphenicol and crystalline penicillin 3 mega units 6 hourly IV for 5 days. The age ranged between 15 to 65 years, and there were 64 males and 36 females. The CSF was turbid in 80% of the cases and under high pressure in 95%. Fifteen cases showed Neisseria meningitides Group A when cultured. By the 5th day of treatment, most of the patients had recovered completely. Complications included: death [2 patients], arthritis, deafness, and deterioration in vision. Neisseria meningitides Group A was responsible for the epidemic. Chloramphenicol with crystalline penicillin was an effective treatment. Monoarticular arthritis was the most common complication with the knee joint being the most frequently affected

Manual de vigilancia epidemiológica

Aborda en forma sencilla y resumida, los principales aspectos organizativos del sistema de Vigilancia Epidemiológica que permita una mejor organización y uniformidad de la notificación de los distintos eventos epidemiológicos, así como algunos elementos en el abordaje de las principales enfermedades y problema que afectan a la población y que sirvan por lo tantocomo una guía práctica y organizativa a todos los niveles del sistema

Doença meningocócica: estudo epidemiológico comparativo em nível mundial, período 1887-1997 / Meningococcal disease: comparative epidemiological study, 1887-1997

Estuda comparativamente, no período 1887-1997, o comportamento da doença meningocócica na Europa, Américas, Africa, Asia e Oceania, no que se refere a distribuiçäo geográfica, incidência e letalidade, cepas de meningococos predominantes e fatores predisponentes. Como fonte de dados, utiliza boletins epidemiológicos da Organizaçäo Mundial de Saúde, da Organizaçäo Pan-Americana de Saúde e de órgäos governamentais de saúde de vários países, e artigos publicados em livros e periódicos. Os dados relativos a casos e óbitos notificados foram agrupados em períodos: 1887 a 1913; 1914 a 1918 (Primeira Guerra Mundial); 1919 a 1928; 1929 a 1938 (Depressäo Econômica Mundial); 1939 a 1945 (Segunda Guerra Mundial); 1946 a 1949 (período pós-guerra) e as décadas de 1950 a 1990. Para a Oceania, somente há dados disponíveis a partir de 1915. Calcula os coeficientes anuais de incidência (casos/100.000 hab/ano) e de letalidade. Conclui que a doença meningocócica em sua forma extensa, sempre esteve associada com os períodos de convulsäo social e com os movimentos populacionais. Mesmo que no futuro seja produzida uma vacina anti-meningocócica polivalente, capaz de proteger o homem contra todas as cepas de meningococo, o efetivo controle dessa doença dependerá do acesso de todos os povos a essa vacina e à estabilidade sócio-econômica em nível mundial

Situación epidemiológica Nicaragua, octubre 1999 / Situation epidemic Nicaragua, October 1999

Resume la situación epidemiológica de Nicaragua durante el mes de octubre del año 1999. La incidencia y muertes y prevencion por diarrea, dengue clásico y hemorragico, colera, leptospirosis, las estadísticas de casos y defunciones por edades de la enfermedad meningococcica por silais durante el año 1999. También se incluye estadisticas de las enfermedades prevenidas por vacunas asi como el programa de inmunizaciones, los recursos financieros para gastos de operaciones de US$ 100,000