Trends in Pneumococcal and Bacterial Meningitis in Brazil from 2007 to 2019.

The pneumococcal conjugate vaccination (PCV) was introduced into the Brazilian Childhood National Immunization Program in 2010; however, universal pneumococcal vaccination for older adults has not been implemented yet. Our aim is to evaluate the trends in pneumococcal meningitis incidence and case fatality rate (CFR) across all age groups from 2007 to 2019 using data from the National Surveillance System. The pre-PCV (2007-2009) and post-PCV (2011-2019) periods were compared; changes in incidence and CFR were assessed by joinpoint regression. Additional analyses of bacterial meningitis were performed to compare the patterns and trends. Over the 13-year period, 81,203 and 13,837 cases were classified as bacterial and pneumococcal meningitis, respectively. S. pneumoniae was the main etiological agent of bacterial meningitis in adults aged ≥50 years and the most lethal in all age groups. In the post-PCV period, a 56.5% reduction in the average incidence was seen in pneumococcal meningitis in the pediatric population. In contrast, there was an increasing trend among adults. The CFR for pneumococcal and bacterial meningitis remained stable in most age groups during the study period. These findings highlight the value of expanding pneumococcal vaccination policies, including vaccines that provide better indirect protection from children to adults and broadening vaccination to older adults.

Invasive Pneumococcal Disease Characterization in Adults and Subgroups aged < 60 years and ≥ 60 years in Bogota, Colombia.

Background: There is scarce information on the burden of invasive pneumococcal disease (IPD) among adults in low- and middle-income countries. This study aimed to describe the clinical outcomes and microbiological characteristics associated with IPD in adults and subgroups aged 18-59 years and ≥60 years in Colombia. Methods: A retrospective chart review study was conducted in five institutions of Bogotá from January 2011 to December 2017. Analyses were carried out for overall population and stratified by age group (18-59; ≥ 60 years). Results: There were 169 IPD cases; median age was 58 years, 51.5% were male, and 80.5% had at least one comorbidity. Bacteremic pneumonia was the most common presentation (63.9%). The median length of hospital stay was 12 days with high healthcare resource utilization (HCRU): 58.6% required ICU and 53.3% inotropic support. Overall case-fatality rate (CFR) was 41.4%. Clinical outcomes were worse in patients ≥60 years old with significantly higher CFR and HCRU (ICU admission, mechanical ventilation, and inotropic support) compared to those aged 18-59 years. The most frequent serotypes were 3, 6 A/C, 14, and 19A. The sensitivity to penicillin in meningitis and non-meningitis isolates were 75% and 89.1% respectively. Conclusions: IPD was associated with a substantial burden in adults and worse clinical outcomes and HCRU in older adults in Colombia. Surveillance data combined with clinical outcomes have the potential to inform age-based pneumococcal vaccination policies.

The Impact of an Inactivated Hepatitis A Vaccine with One Dose in Brazil: A Retrospective Time-Series.

BACKGROUND: In 2014, a recommended one-dose of inactivated hepatitis A vaccine was included in the Brazilian National Immunization Program targeting children 12-24 months. This decision addressed the low to intermediate endemicity status of hepatitis A across Brazil and the high rate of infection in children and adolescents between 5 and 19 years old. The aim of the study was to conduct a time-series analysis on hepatitis A incidence across age groups and to assess the hepatitis A distribution throughout Brazilian geographic regions. METHODS: An interrupted time-series analysis was performed to assess hepatitis A incidence rates before (2010-2013) and after (2015-2018) hepatitis A vaccine program implementation. The time-series analysis was stratified by age groups while a secondary analysis examined geographic distribution of hepatitis A cases. RESULTS: Overall incidence of hepatitis A decreased from 3.19/100.000 in the pre-vaccine period to 0.87/100.000 (p = 0.022) post-vaccine introduction. Incidence rate reduction was higher among children aged 1-4 years old, with an annual reduction of 67.6% in the post-vaccination period against a 7.7% annual reduction in the pre-vaccination period (p < 0.001). Between 2015 and 2018, the vaccination program prevented 14,468 hepatitis A cases. CONCLUSION: Our study highlighted the positive impact of a recommended one-dose inactivated hepatitis A vaccine for 1-4-years-old in controlling hepatitis A at national level.

Burden of varicella in Latin America and the Caribbean: findings from a systematic literature review.

BACKGROUND: Varicella is typically mild and self-limiting, but can be associated with complications and even death. The limited data available on varicella in Latin America and the Caribbean (LAC) indicate substantial burden in countries where varicella vaccine is not part of publicly funded childhood national immunization programs. METHODS: A systematic literature review of published studies was complemented by "gray" literature on varicella incidence, complications, mortality, and economic consequences, in the absence and presence of universal varicella vaccination (UVV) in LAC. RESULTS: Seroprevalence data indicate that varicella is usually a disease of childhood in LAC. Varicella incidence rates, while unreliable in the absence of mandatory reporting, show a trend to increased incidence due to greater urbanization and population density. The introduction of UVV in national immunization programs has led to significant reductions in varicella incidence in these areas. CONCLUSIONS: Varicella continues to pose a substantial healthcare burden in LAC. The future introduction of UVV in additional countries is predicted to provide substantial reductions in cases, with important economic benefits. For countries that have already implemented UVV, the challenge is to maintain high rates of coverage and, where relevant, consider inclusion of a second dose to reduce breakthrough cases. Given the significant proportion of the region now implementing UVV, a regional recommendation in order to prevent any potential for age-shifts in varicella infection might be considered.

Diagnostico e terapeutica da neoplasia intra-epitelial cervical de baixo grau / Diagnosis and treatment of low-grade cervical intraepithelial neoplasia

Este trabalho de revisao comenta aspectos sobre a historia natural da neoplasia intra-epitelial cervical de baixo grau, bem como os metodos utilizados...

Cancer do colo uterino e terapia de reposicao hormonal / Cervical cancer and hormone replacement therapy

O objetivo deste estudo foi determinar o efeito da terapia de reposicao hormonal(TRH) em mulheres previamente tratadas por cancer cervical. Foram selecionadas quinze mulheres climatericas, em seguimento no Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, tratadas de cancer cervical do estadio...

Síndrome de Ehlers-Danlos: relato de 3 casos de uma família através de nova mutaçäo / Ehlers-Danlos syndrome: report of 3 cases in a family through new mutation

Os autores descrevem três casos de síndrome de Ehlers-Danlos (SED) em uma família, considerados pela anamnese e heredograma como oriundos de mutaçao genética em um dos gametas que deram origem ao pai da probanda. Pesquisas laboratoriais revelam coagulograma com discreto aumento no tempo de protrombina em dois casos; teste de fragilidade capilar de Hess positivo nos três casos; biópsia de pele, estudada com a técnica de hematoxilina-eosina e Verhoeff, mostrando acantose irregular e aumento de fibras elásticas na derme. Discutindo as manifestaçoes clínicas, a transmissao hereditária, as complicaçoes e os exames complementares próprios dos 11 tipos descritos da SED, incluem os três novos casos no tipo II. Concluem ser necessário aconselhamento genético nessa doença rara, hereditária e de padrao autossômico dominante, e que nao há tratamento específico para a SED, mas é possível a expectativa de uma vida melhor, se nao houver outras patologias associadas a ela.