ABSTRACT
As doenças infecciosas intestinais têm um peso importante na morbimortalidade infantil no Brasil: na primeira década do século XXI, foram responsáveis por 22.610 óbitos de crianças entre 0 e 14 anos de idade - conforme dados do Ministério da Saúde -, equivalendo a 42,6% do total de mortes registradas, do Capítulo I da CID-10, para esta faixa etária. Objetivo: Estudar a distribuição espacial e a variação temporal das internações por doenças infecciosas intestinais em crianças na faixa etária de 5 a 14 anos, no Estado de São Paulo, entre 2001 e 2010. Método: Estudo ecológico de séries temporais, utilizando dados de internações de crianças. Cálculo da morbidade hospitalar proporcional anual por Diarreias e Gastroenterites (CID A00-A09), segundo local de residência e idade. Resultados: A análise espacial auxilia na identificação dos territórios com as maiores taxas de internação, localizadas no Noroeste (2001) e no Oeste (2010) do Estado de São Paulo. O padrão da distribuição das internações, representados pela taxa de incidência nos anos estudados, mostra predomínio da doença em algumas regiões do Estado de São Paulo. Em um espaço de dez anos, as maiores taxas ocorreram nas mesmas regiões, o que denota uma provável falta de atenção nas ações de saúde. Conclusão: Os dados encontrados demonstram que, a despeito do investimento em saneamento ambiental, existiam ainda áreas endêmicas para as diarreias e gastroenterites, na faixa etária e no período, que deveriam ter sido alvos de ações de atenção básica em saúde e de políticas públicas em saneamento e educação ambiental, para minorar estes impactos.(AU)
Intestinal infectious diseases play an important role in infant morbidity and mortality in Brazil: in the first decade of the 21st century, 22,610 deaths were attributed to children between 0 and 14 years of age, according to the Ministry of Health, 6% of the total number of deaths recorded in Chapter I of ICD-10 for this age group. Objective: To study the spatial distribution and temporal variation of hospitalizations for intestinal infectious diseases in children between the ages of 5 and 14 years, in the State of São Paulo, between 2001 and 2010. Method: Ecological study of time series using hospitalization data of children. Calculation of annual proportional hospital morbidity due to Diarrhea and Gastroenteritis (CID A00-A09), second place of residence and age. Results: Spatial analysis assists in the identification of the territories with the highest hospitalization rates, located in the Northwest (2001) and West (2010) of the State of Sao Paulo. The pattern of hospitalization distribution, represented by the incidence rate in the years studied, shows a predominance of the disease in some regions of the State of Sao Paulo. Within ten years, the highest rates occurred in the same regions, which indicates a probable lack of attention in health actions. Conclusion: The data show that, despite the investment in environmental sanitation, there were still areas endemic for diarrhea and gastroenteritis, in the age group and in the period, which should have been targets of basic health care actions and public policies in sanitation and environmental education, to mitigate these impacts.(AU)
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Gastrointestinal Diseases/epidemiology , Dysentery/epidemiology , Hospitalization/statistics & numerical dataABSTRACT
As doenças infecciosas intestinais têm um peso importante na morbimortalidade infantil no Brasil: na primeira década do século XXI, foram responsáveis por 22.610 óbitos de crianças entre 0 e 14 anos de idade - conforme dados do Ministério da Saúde -, equivalendo a 42,6% do total de mortes registradas, do Capítulo I da CID-10, para esta faixa etária. Objetivo: Estudar a distribuição espacial e a variação temporal das internações por doenças infecciosas intestinais em crianças na faixa etária de 5 a 14 anos, no Estado de São Paulo, entre 2001 e 2010. Método: Estudo ecológico de séries temporais, utilizando dados de internações de crianças. Cálculo da morbidade hospitalar proporcional anual por Diarreias e Gastroenterites (CID A00-A09), segundo local de residência e idade. Resultados: A análise espacial auxilia na identificação dos territórios com as maiores taxas de internação, localizadas no Noroeste (2001) e no Oeste (2010) do Estado de São Paulo. O padrão da distribuição das internações, representados pela taxa de incidência nos anos estudados, mostra predomínio da doença em algumas regiões do Estado de São Paulo. Em um espaço de dez anos, as maiores taxas ocorreram nas mesmas regiões, o que denota uma provável falta de atenção nas ações de saúde. Conclusão: Os dados encontrados demonstram que, a despeito do investimento em saneamento ambiental, existiam ainda áreas endêmicas para as diarreias e gastroenterites, na faixa etária e no período, que deveriam ter sido alvos de ações de atenção básica em saúde e de políticas públicas em saneamento e educação ambiental, para minorar estes impactos.
Intestinal infectious diseases play an important role in infant morbidity and mortality in Brazil: in the first decade of the 21st century, 22,610 deaths were attributed to children between 0 and 14 years of age, according to the Ministry of Health, 6% of the total number of deaths recorded in Chapter I of ICD-10 for this age group. Objective: To study the spatial distribution and temporal variation of hospitalizations for intestinal infectious diseases in children between the ages of 5 and 14 years, in the State of São Paulo, between 2001 and 2010. Method: Ecological study of time series using hospitalization data of children. Calculation of annual proportional hospital morbidity due to Diarrhea and Gastroenteritis (CID A00-A09), second place of residence and age. Results: Spatial analysis assists in the identification of the territories with the highest hospitalization rates, located in the Northwest (2001) and West (2010) of the State of Sao Paulo. The pattern of hospitalization distribution, represented by the incidence rate in the years studied, shows a predominance of the disease in some regions of the State of Sao Paulo. Within ten years, the highest rates occurred in the same regions, which indicates a probable lack of attention in health actions. Conclusion: The data show that, despite the investment in environmental sanitation, there were still areas endemic for diarrhea and gastroenteritis, in the age group and in the period, which should have been targets of basic health care actions and public policies in sanitation and environmental education, to mitigate these impacts.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Dysentery/epidemiology , Gastrointestinal Diseases/epidemiology , Hospitalization/statistics & numerical dataABSTRACT
Rotavirus is one of the leading cause of hospitalization and outpatients visits among children under five years. This study evaluated overall and genotype-specific vaccine effectiveness of oral monovalent rotavirus vaccine (G1P[8] strain) in preventing hospital admission of Brazilian children with rotavirus acute diarrhea. A hospital based case-control study was conducted in five Regions of Brazil using the National Rotavirus Acute Diarrhea Surveillance System from July 2008 to August 2011. A total of 215 cases (aged 4-24 months) admitted with confirmed rotavirus diarrhea were recruited and 1961 controls hospitalized without diarrhea were frequency matched by sex and age group to cases. Two-dose adjusted vaccine effectiveness (adjusted by year of birth and the frequency matching variables) was 76% (95%CI: 58-86) lasting for two years. Effectiveness controlled by the available potential confounders was 72% (95%CI: 44-85), suggesting no appreciable confounding by those factors for which adjustment was made. In a half of the cases the rotavirus genotype was G2P[4] and in 15% G1P[8]. Genotype-specific VE (two doses) was 89% (95%CI: 78-95), for G1P[8] and 76% (95%CI: 64-84) for G2P[4]. For all G1, it was 74% (95%CI: 35-90), for all G2, 76% (95%CI: 63-84), and for all non G1/G2 genotypes, 63% (95%CI: -27-99). Effectiveness for one dose was 62% (95%CI: 39-97). Effectiveness of two-dose monovalent rotavirus vaccine in preventing hospital admission with rotavirus diarrhea was high, lasted for two years and it was similar against both G1P[8] and G2P[4]. Based on the findings of the study we recommend the continued use of rotavirus in the Brazilian National Immunization Program and the monitoring of the early emergence of unusual and novel rotavirus genotypes.