Economic evaluation of meningococcal vaccination with vaccine for serogroups A, C, W e Y: A systematic revision / Avaliação económica da vacinação meningocócica com a vacina para os serogrupos A, C, W e Y: Uma revisão sistemática

Introduction: Meningococcal disease, caused by infection due to Neisseria meningitidis, have a high burden of disease and entails excess costs for countries. The purpose of this paper is to analyse meningococcal disease, the preventive strategies adopted, and to analyse economic evaluations of the meningococcal vaccine for serogroups A, C, W and Y (MenACWY). Methods: A narrative literature review and a systematic literature review were conducted, in which these databases were used: B-ON, PUBMED, EBSCO, Cochrane, NHS EED, Science Direct, Scopus and Web of Science. The inclusion criteria were based on the PICO methodology, the articles included were full economic evaluations and excluded partial. Results: Meningococcal disease still presents a high incidence in the World and in Portugal. The systematic review identified that in seven of the thirteen articles, MenACWY was not cost-effective considering the incidence of disease and the price of the vaccine. The strategies considered cost-effective had high cost-effectiveness thresholds and some even considered cost-effective despite being above. Conclusion: Incidence of this disease in Portugal is higher than in the European Union, due to serogroups B, C, W, and Y. The cost-effectiveness of the MenACWY is still dubious, so the incidence and the price are important to the introduction in the Portuguese National Vaccination Programme.

Introdução: A doença meningocócica, causada por infeção por Neisseria meningitidis, constitui uma elevada carga de doença e acarreta elevados custos aos países. Os objetivos gerais deste artigo são: analisar a doença meningocócica, as estratégias de prevenção adotadas, e analisar as avaliações económicas na utilização da vacina meningocócica para os serogrupos A, C, W e Y (MenACWY). Métodos: Foram realizadas uma pesquisa bibliográfica e uma revisão sistemática da literatura, na qual foram utilizadas as bases de dados B-ON, PUBMED, EBSCO, Cochrane, NHS EED, Science Direct, Scopus e Web of Science. Os critérios de inclusão foram construídos com metodologia PICO e incluíam avaliações económicas completas, tendo sido excluídas as parciais. Resultados: A doença meningocócica apresenta uma elevada incidência no Mundo e em Portugal. A revisão sistemática identificou em sete dos treze artigos, que a MenACWY não era custo-efetiva considerando a incidência no país e o preço da vacina. Nas estratégias que consideraram custo-efetiva, os limiares de custo-efetividade eram muito elevados e em alguns foi considerada custo-efetiva apesar de o ultrapassar. Conclusão: A incidência desta em Portugal está acima da média da União Europeia devido aos serogrupos B, C, W, e Y. A relação custo-efetividade da MenACWY é ainda dúbia, pelo que incidência e preço são importantes para a introdução no Programa Nacional de Vacinação Português.

The Impact of the COVID-19 Pandemic on Children's Health in Portugal: The Parental Perspective.

INTRODUCTION: The COVID-19 pandemic poses unprecedented challenges for healthcare services and has led to changes in the usage pattern of the pediatric population. We aimed to describe the impact of COVID-19 on children's health, wellbeing, and access to medical care in Portugal. MATERIAL AND METHODS: We conducted a cross-sectional study through an anonymous online survey via social media. The collected data refers to a period between the 16th of March and the 17th of May 2020. RESULTS: We obtained responses to the survey on 19 745 children. Of the previously scheduled outpatient consultations, 54.2% were postponed by healthcare institutions and 21.6% of planned vaccinations were missed. Parents expressed concerns regarding psychological, social, and physical consequences for their children due to the pandemic. DISCUSSION: The observed reduction of pediatric emergency department visits and the postponement of outpatient consultations and vaccine administrations are potentially harmful for non-COVID patients. The current pandemic and the imposed social distance might have an important negative impact on the mental health of children. CONCLUSION: Further studies are necessary to fully comprehend the outcomes of the decreased access to medical care, as well as the collateral damage for children beyond the clinical aspects of the pandemic. Defining strategies regarding the urge to vaccinate children and not postpone urgent evaluations should be a public health priority.

Introdução: A pandemia COVID-19 constitui um desafio sem precedentes para os serviços de saúde e conduziu a alterações no padrão de utilização dos recursos pela população pediátrica. Procurámos descrever o impacto da pandemia COVID-19 na saúde infantil e no acesso à saúde em Portugal. Material e Métodos: Realizámos um estudo retrospetivo, recolhendo dados através da aplicação de um inquérito anónimo online nas redes sociais. Os dados referem-se ao período entre 16 de março e 17 de maio de 2020. Resultados: Obtivemos respostas ao inquérito relativas a 19 745 crianças. Da análise às respostas, concluímos que 54,2% das consultas previamente agendadas foram adiadas pelas instituições de saúde e 21,6% das vacinações previstas não se realizaram. Os pais expressaram preocupação quanto às consequências psicológicas, sociais e físicas da pandemia nos seus filhos. Discussão: A reduzida utilização dos serviços de urgência pediátricos, bem como a não realização de consultas e vacinações previamente agendadas é potencialmente lesiva para os doentes não-COVID. A pandemia e o isolamento social imposto poderão causar um impacto negativo na saúde mental das crianças. Conclusão: Estudos adicionais são necessários para melhor compreender as consequências da diminuição do acesso à saúde, bem como os efeitos psicológicos, sociais e físicos nas crianças. A definição de estratégias para incentivar a vacinação e o não adiamento de avaliações médicas urgentes deveriam ser prioridades de Saúde Pública.

Postpartum histoplasmosis in an HIV-negative woman: a case report and phylogenetic characterization by internal transcribed spacer region analysis.

The present report describes the first case of postpartum disseminated histoplasmosis in a 24-year-old HIV-negative woman. On the tenth day after vaginal delivery, the patient presented with dyspnea, fever, hypotension, tachycardia, and painful hepatomegaly. Yeast-like Histoplasma capsulatum features were isolated in the buffy coat. The phylogenetic analysis demonstrated that the fungal isolate was similar to other H. capsulatum isolates identified in HIV patients from Ceará and Latin America. Thus, histoplasmosis development in individuals with transitory immunosuppression or during the period of immunological recovery should be carefully examined.

Postpartum histoplasmosis in an HIV-negative woman: a case report and phylogenetic characterization by internal transcribed spacer region analysis

Abstract The present report describes the first case of postpartum disseminated histoplasmosis in a 24-year-old HIV-negative woman. On the tenth day after vaginal delivery, the patient presented with dyspnea, fever, hypotension, tachycardia, and painful hepatomegaly. Yeast-like Histoplasma capsulatum features were isolated in the buffy coat. The phylogenetic analysis demonstrated that the fungal isolate was similar to other H. capsulatum isolates identified in HIV patients from Ceará and Latin America. Thus, histoplasmosis development in individuals with transitory immunosuppression or during the period of immunological recovery should be carefully examined.

Report of simultaneous measles outbreaks in two different health regions in Portugal, February to May 2017: lessons learnt and upcoming challenges.

In Portugal, measles vaccination coverage and population immunity are high, and no endemic measles cases had been reported since 2004. The World Health Organization classified measles as eliminated in the country in 2015 and 2016, based on data from the previous 3 years. However, in a context of increasing incidence in several European countries in 2016 and 2017, Portugal experienced two simultaneous measles outbreaks with a total of 27 laboratory-confirmed cases (0.3 cases/100,000 population) in two health regions between February and May 2017. Nineteen cases (70.1%) were adults, of whom 12 were healthcare workers. Overall, 17 cases (63.0%) were not vaccinated, of whom five were infants younger than 12 months of age. One unvaccinated teenager died. Genotype B3 was identified in 14 cases from both regions. Measles virus sequencing identified different possible origins of the virus in each region affected. Although measles transmission was stopped in less than 2 months from the first case being notified, these outbreaks represent an opportunity to reinforce awareness of measles diagnosis. We highlight the intensity of the control measures taken and their impact on the rapid control of the outbreaks and also the fact that high vaccination coverage was crucial to stop transmission.

Challenging measles case definition: three measles outbreaks in three Health Regions of Portugal, February to April 2018.

We report three simultaneous measles outbreaks with 112 confirmed cases in three Health Regions of Portugal, from February to April 2018. The mean age of cases was 30 years, 79% worked in a healthcare setting and 87% were vaccinated. Genotype B3 was identified in 84 cases from the three outbreaks. Primary cases in each outbreak were imported. Several cases presented with modified measles, highlighting the importance of rethinking the measles case definition for vaccinated cases.

Comparative evaluation of maximum parsimony and Bayesian phylogenetic reconstruction using empirical morphological data.

The use of discrete morphological data in Bayesian phylogenetics has increased significantly over the last years with the proposal of total evidence analysis and the treatment of fossils as terminal taxa in Bayesian molecular dating. Both approaches rely on the assumption that probabilistic Markov models reasonably accommodate all the complexity of morphological evolution of discrete traits. The performance of such morphological models used in Bayesian phylogenetics has been thoroughly investigated, but conclusions so far were based mostly on simulated data. In this study, we have surveyed MorphoBank and obtained a large number of morphological matrices to evaluate Bayesian phylogenetic inference (BI) under Lewis' Mk model in comparison with the maximum parsimony (MP) algorithm. We found that trees estimated by both methods frequently differed and that BI generated a larger amount of polytomic tree topologies. The number of trees contained in the 95% Bayesian credibility interval was significantly greater than the number of equally parsimonious trees. We also investigated which factors mostly influenced the topological difference between maximum parsimony and Bayesian tree topologies and found that the number of terminals in morphological matrices was the variable with the highest association with the topological distance between trees inferred by BI and MP. Surprisingly, we show that differences between both approaches were not influenced by increasing sample size. Our results, which were based on a large set of empirical matrices, corroborate recent findings that BI is less precise than MP.

Measles outbreak after 12 years without endemic transmission, Portugal, February to May 2017.

We report a measles outbreak in two Portuguese health regions (Algarve and Lisbon and the Tagus Valley) since February 2017, and which by 31 May resulted in 28 confirmed cases, of which 16 were unvaccinated. Thirteen cases were healthcare workers. One unvaccinated teenager died. Genotype B3 was identified in 14 cases from both regions. This outbreak occurs after 12 years without endemic measles transmission, and in a context of high measles vaccination coverage and immunity.

Conventional simulation of biological sequences leads to a biased assessment of multi-Loci phylogenetic analysis.

Phylogenetic analysis based on multi-loci data sets is performed by means of supermatrix (SM) or supertree (ST) approaches. Recently, methods that rely on species tree (SppT) inference by the multi-species coalescence have also been implemented to tackle this problem. Generally, the relative performance of these three major strategies has been calculated using simulation of biological sequences. However, sequence simulation may not entirely replicate the complexity of the evolutionary process. Thus, issues regarding the usefulness of in silico sequences in studying the performance of phylogenetic methods have been raised. Here, we used both classical simulation and empirical data to investigate the relative performance of ST, SM, and the SppT methods. SM analyses performed better than the ST and SppTs in simulations, but not in empirical analyses where some ST methods significantly outperformed the others. Additionally, SM was the only method that was robust under evolutionary model violations in simulations. These results show that conventional biological sequence simulation cannot adequately resolve which method is most efficient to recover the SppT. In such simulations, the SM approach recovers the established phylogeny in most instances, whereas the performance of the ST and SppT methods is downgraded in simpler cases. When compared, the analyses based on empirical and simulated sequences yielded largely inconsistent results, with the latter showing a bias towards a seemingly superiority of SM approaches.

Testing synchrony in historical biogeography: the case of new world primates and hystricognathi rodents.

The abrupt appearance of primates and hystricognath rodents in early Oligocene deposits of South America has puzzled mastozoologists for decades. Based on the geoclimatic changes that occurred during the Eocene/Oligocene transition period that may have favoured their dispersal, researchers have proposed the hypothesis that these groups arrived in synchrony. Nevertheless, the hypothesis of synchronous origins of platyrrhine and caviomorph in South America has not been explicitly evaluated. Our aim in this work was to apply a formal test for synchronous divergence times to the Platyrrhini and Caviomorpha splits. We have examined a previous work on platyrrhine and hystricognath origins, applied the test to a case where synchrony is known to occur and conducted simulations to show that it is possible to formally test the age of synchronous nodes. We show that the absolute ages of Platyrrhini/Catarrhini and Caviomorpha/Phiomorpha splits depend on data partitioning and that the test applied consistently detected synchronous events when they were known to have happened. The hypothesis that the arrival of primates and hystricognaths to the New World consisted of a unique event cannot be rejected.