ABSTRACT
Yellow fever is an infectious disease, endemic in South America and Africa. This is a potentially serious illness, with lethality between 5 and 40% of cases. The most effective preventive vaccine is constituted by the attenuated virus strain 17D, developed in 1937. It is considered safe and effective, conferring protection in more than 90% in 10 years. Adverse effects are known as mild reactions (allergies, transaminases transient elevation, fever, headache) and severe (visceral and neurotropic disease related to vaccine). However, little is known about its potential to induce autoimmune responses. This systematic review aims to identify the occurrence of autoinflammatory diseases related to 17D vaccine administration. Six studies were identified describing 13 possible cases. The diseases were Guillain-Barré syndrome, multiple sclerosis, multiple points evanescent syndrome, acute disseminated encephalomyelitis, autoimmune hepatitis, and Kawasaki disease. The data suggest that 17D vaccination may play a role in the mechanism of loss of self-tolerance.
ABSTRACT
Propõe-se neste artigo uma reflexão sobre a necessidade de se estabelecerem objetivos bem definidos nas atividades de controle de agravos à saúde. A escolha das medidas preventivas adotadas e sua estratégia de aplicação estão intimamente ligadas aos objetivos explicitados. O conhecimento técnico-científico que se tem dos fatores de risco, da transmissão, fisiopatologia clinica e terapêutica do agravo, bem como a disponibilidade de recursos e a decisão política, influenciam na fixação dos objetivos a serem alcançados. Estes são definidos como: erradicação, eliminação, redução da incidência, redução da gravidade e redução da letalidade. Diferencia erradicação de eliminação, caracterizando esta como redução da incidência de um agravo a zero, porém sem interromper as medidas de prevenção apropriadas, enquanto na erradicação estas medidas deixam de ser necessárias para manter a incidência nula. O controle de um agravo pode contemplar mais de um obj'etivo e modificá-los ao longo do tempo. São exemplificadas alterações nos objetivos das atividades de controle da malária, poliomielite e hanseníase. E enfatizado que a diferenciação, comumente utilizada, entre erradicação e controle não permite buscar os métodos e medidas preventivas mais adequados ao planejamento, organização e avaliação das atividades de combate a agravos.
This paper argues the need for setting up well defined obj'ectives in the activities of disease control. The choice of preventive measures and the strategy of executing them depend on the obj'ectives proposed. The technologic andscientific knowledge about the risk factors, transmission, pathogenesis, clinical characteristics and treatment ofthe disease, as well as the availability offnancial and human resources and the political decision, influence the definition ofthe obj'ectives to be reached. Eradication, elimination, reduction of incidence, reduction ofthe number ofsevere cases and reduction offatality rate are the possible obj'ectives of disease control Eradication differs from elimination because in the latter the preventive measures must go on after the incidence has reached zero, while in eradication they may be interrupted and the disease does not present re-incidence. Disease control may have more than one oj'ective and may also change with time. Malaria, poliomyelitis and Hansen disease are examples of control activities that changed their oj'ectives recently. Emphasis is put on the fact that the commonly used difference between eradication and control is not enough to choose the appropriate preventive measures, for planning, organizing and evaluating disease control activities.
