ABSTRACT
A cohort study was performed from January 2014 to December 2016 in a Brazilian neonatal intensive care unit, including neonates with high risk for infection and death. We estimated bloodstream infection (BSI) incidence and conducted a survival analysis, considering the time to death and to the first episode of BSI as outcomes, comparing very low birth weight (VLBW) neonates with the remaining neonates. An extended Cox model was performed and the hazard ratio (HR) was calculated for different time periods. The study had 1560 neonates included, the incidence and the incidence density of BSI was 22% and 18.6 per 1000 central venous catheter-days, respectively. Considering VLBW neonates as the reference group, the HR for time to death was 4.06 (95% CI 2.75-6.00, P < 0.01) from day 0 to 60 and for time to the first episode of BSI was 1.76 (95% CI 1.31-2.36, P < 0.01) from day 0 to 36. Having the heavier neonates group as reference, the HR for time to the first episode of BSI was 2.94 (95% CI 1.92-4.34, P < 0.01) from day 37 to 90. Late-onset neonatal sepsis prevention measures should consider the differences in risk during time, according to neonates' birth weight.
Subject(s)
Late Onset Disorders/epidemiology , Late Onset Disorders/mortality , Neonatal Sepsis/epidemiology , Neonatal Sepsis/mortality , Birth Weight , Brazil/epidemiology , Cohort Studies , Female , Gestational Age , Humans , Incidence , Infant , Infant, Newborn , Intensive Care Units , Male , Risk Factors , Survival AnalysisABSTRACT
In order to estimate influenza-associated excess mortality in southern Brazil, we applied Serfling regression models to monthly mortality data from 1980 to 2008 for pneumonia/influenza- and respiratory/circulatory-coded deaths for all ages and for those aged ≥60 years. According to viral data, 73â5% of influenza viruses were detected between April and August in southern Brazil. There was no clear influenza season for northern Brazil. In southern Brazil, influenza-associated excess mortality was 1â4/100,000 for all ages and 9â2/100,000 person-years for persons aged ≥60 years using underlying pneumonia/influenza-coded deaths and 10â0/100,000 for all ages and 86â6/100,000 person-years for persons aged ≥60 years using underlying respiratory/circulatory-coded deaths. Influenza-associated excess mortality rates for southern Brazil are similar to those published for other countries. Our data support the need for continued influenza surveillance to guide vaccination campaigns to age groups most affected by this virus in Brazil.
Subject(s)
Influenza, Human/complications , Influenza, Human/mortality , Models, Biological , Adolescent , Adult , Age Distribution , Aged , Brazil/epidemiology , Child , Child, Preschool , Epidemics , Humans , Infant , Influenza, Human/epidemiology , Middle Aged , Pneumonia/complications , Pneumonia/epidemiology , Pneumonia/mortality , Regression Analysis , Respiratory Tract Diseases/complications , Respiratory Tract Diseases/epidemiology , Respiratory Tract Diseases/mortality , Young AdultABSTRACT
We investigated the first cluster of pandemic influenza H1N1 2009 reported in Brazil in May 2009. The index case-patient had travelled from the USA and had contact with 11 relatives before she presented with symptoms. We conducted face-to-face or telephone interviews with the index case-patient and all suspect cases. We found evidence of pre-symptomatic transmission of the virus to four of her contacts. This finding has public health implications because it indicates that viral transmission in communities may not be prevented solely by isolating symptomatic case-patients.
