RESUMO
Since the 1980s, 2 antigenically distinct influenza B lineages have cocirculated in the world: B/Victoria/2/87 (first appeared in the 1980s) and B/Yamagata/16/88 (became predominant in the 1990s). B/Victoria/2/87 isolates were geographically restricted to eastern Asia during 1991-2000. During 2000-2001 and 2001-2002, B/Victoria/2/87 isolates reemerged in North America, Europe, and South America, and then spread globally. During influenza virus surveillance, season 2002, an outbreak of acute respiratory illness, which quickly spread among the population, has been notified by public health authorities living in Araraquara, São Paulo, Brazil. Instituto Adolfo Lutz and Secretariat of Health of São Paulo state teams initiate an investigation towards to describe the pattern of infection in this population temporally and by age and to characterize the strains by virus isolation and hemagglutination inhibition assay. The outbreak lasted approximately 10 weeks; many cases occurred between mid-August and mid-September. Children younger than 13 years were the most affected; the elderly were mostly immune to infection. Analysis of the clinical respiratory samples helped in identifying the B/Hong Kong/330/2001 and B/Brisbane/32/2002 subtypes-recent variants of B/Victoria/02/88, a lineage restricted to Southeast Asia until 2001. The Araraquara outbreak confirms the reemergence of the B/Victoria viruses in South America and highlights the importance of monitoring local circulating strains, especially in light of the absence of cross-protection between antigenically distinct influenza lineages. Based on influenza virus surveillance, public health authorities worldwide should decide whether trivalent vaccines or quadrivalent vaccines (containing both influenza virus B lineages) are to be used in each country.
Assuntos
Surtos de Doenças , Vírus da Influenza B/genética , Vírus da Influenza B/isolamento & purificação , Vacinas contra Influenza/imunologia , Influenza Humana/epidemiologia , Influenza Humana/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Brasil/epidemiologia , Criança , Pré-Escolar , Reações Cruzadas , Feminino , Testes de Inibição da Hemaglutinação , Humanos , Lactente , Recém-Nascido , Vírus da Influenza B/classificação , Vacinas contra Influenza/administração & dosagem , Pessoa de Meia-Idade , Epidemiologia Molecular , Adulto JovemAssuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Hepatite B , Hepatite C , HIV , Síndrome da Imunodeficiência AdquiridaAssuntos
Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Síndrome da Imunodeficiência Adquirida , Hepatite B , Hepatite C , HIVRESUMO
A doença meningocócica (DM) é uma moléstia infecciosa aguda de expressiva relevância em saúde pública, devido ao seu potencial epidêmico, a elevada morbi-mortalidade e ao percentual significativo de seqüelas. Em setembro de 2006, o Município de Estrela DOeste/São Paulo confirmou a ocorrência de 3 casos de DM e letalidade de 66,7%. Os casos foram sorogrupados e todos identificados como meningococo do sorogrupo C. O objetivo da investigação foi caracterizar e confirmar a ocorrência do surto da doença na região. A investigação dos casos foi realizada a partir da análise de bancos de dados, de fichas epidemiológicas de notificação/investigação, de fichas de atendimento hospitalar e dos exames processados e de entrevistas com os médicos, casos suspeitos, contatos e familiares. Para inclusão no presente surto foram utilizadas as seguintes definições de casos: caso suspeito: todo paciente com sinais e/ou sintomas de meningite aguda, isto é, febre alta, vômitos, cefaléia intensa, rigidez de nuca ou abaulamento de fontanela; com ou sem toxemia (sonolência e/ou torpor e/ou irritação) e lesões cutâneas (petéquias ou púrpuras) residente ou que se deslocou para o Município de Estrela DOeste, no mês de setembro de 2006. Caso confirmado: caso suspeito com critério de confirmação laboratorial e/ou necropsia. Na ocasião, foi confirmado um surto de DM no Município de Estrela DOeste, com três casos e dois óbitos, desenvolvido em curso rápido e progressivo e com identificação do meningococo sorogrupo C nos três casos, o que está de acordo com a atual prevalência do sorogrupo C no Estado de São Paulo. As medidas de controle, quimioprofilaxia e vacinação, foram realizadas de forma criteriosa e oportuna. A investigação permitiu a descrição clínica e epidemiológica dos casos, com a confirmação de surto e a efetivação oportuna das ações de prevenção e controle.
Assuntos
Surtos de Doenças , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/prevenção & controle , VacinaçãoRESUMO
Serogroup B Neisseria meningitidis is the most common cause of epidemic meningococcal disease in developed countries. Until recently no vaccine has been available for prevention of infection with this organism. In an attempt to control epidemic serogroup B meningococcal disease in greater Sao Paulo, Brazil, during 1989 and 1990, a Cuban-produced outer-membrane-protein-based serogroup B meningococcal vaccine was given to about 2.4 million children aged from 3 months to 6 years. We have done a case-control study to estimate the efficacy of the vaccine in greater Sao Paulo. Microbiologically confirmed cases of serogroup B meningococcal disease were identified through hospital-based surveillance. Controls were matched by neighbourhood and age. Vaccination status was confirmed by inspection of vaccination cards. Between June, 1990, and June, 1991, 112 patients and 409 matched controls with confirmed vaccine status were enrolled. Estimated vaccine efficacy varied by age: 48 months or older = 74% (95% Cl 16 to 92%), 24 to 47 months = 47% (-72 to 84%), and less than 24 months = -37% (< -100 to 73%). Our results suggest that the Cuban-produced vaccine may be effective for prevention of serogroup B meningococcal disease in older children and adults.
PIP: In 1990, researchers compared data on 112 3 month-6 year old children who received a Cuban produced, outer-membrane-protein-based serogroup B meningococcal vaccine (cases) and lived in greater Sao Paulo, Brazil with data on 409 age and neighborhood matched controls to determine the protective efficacy of the vaccine against serogroup B meningococcal disease (Neisseria meningitidis). Health workers began administering the vaccine in 1989 to control an epidemic of serogroup B meningococcal disease in the area. In fact, in mid-1989 and early 1990, the rates of serogroup B meningococcal disease in 1-6 year old children in Sao Paulo were 2.07/100,000 and 2.3/100,000, respectively. Even though only 44% of serogroup B meningococcal isolates corresponded with the vaccine type strain (B:4:P1:15), many isolates had man of the same serotype or subtype antigens as the vaccine type strain. Thus the vaccine was able to protect against some other serogroup B meningococcal strains other than the vaccine type strain. Vaccine efficacy for 4-year old children was 74%, but was much lower for 24-47 month old children (47%) and 24-month old children (-37%). The change in the log odds ratio for vaccination by age was linear and significant (p=.057). The researchers suggested that poor vaccine efficacy among younger children may reflect a need for more boosting to achieve protective levels of immunity. The results showed that the Cuban-produced vaccine could contribute to control of outbreaks of serogroup B meningococcal disease by protecting older children and adults from the disease. Researchers need to conduct additional studies of the vaccine and other possible serogroup B meningococcal vaccines.
