Invasive pneumococcal disease in HIV seropositive children and adolescents.

OBJECTIVE: Invasive pneumococcal disease (IPD) primarily affects children less than 5 years old, the elderly and certain at-risk groups; especially people infected by the human immunodeficiency virus (HIV). The objective of this study was to analyze invasive pneumococcal diseases (IPD) in children and adolescents infected by the human immunodeficiency virus (HIV), with relation to morbidity, the case fatality ratio, pneumococcus serotypes, susceptibility to penicillin and ceftriaxone and to the proportion of susceptible and resistant Streptococcus pneumoniae (Sp) included in the 7-valent pneumococcal conjugate vaccine that has already been licensed. METHODS: A total of 19 cases of IPD were identified among HIV seropositive patients aged from 1 month to 20 years and hospitalized between 1993 and 2000. Data were recorded on standardized charts containing information on age, clinical diagnosis and progression, serotypes and the susceptibility to penicillin and ceftriaxone of the Sp strains identified in cultures. When the minimum inhibitory concentration was < 0.1 mcg/mL, Sp were defined as susceptible to penicillin (SpSPn), and all other strains were defined as not susceptible (SpNSPn). RESULTS: Of the 19 HIV seropositive cases with IPD, 16 (84%) had pneumonia and three (16%), had meningitis; 13 (68%) cases were children less than 2 years old and 16 (84%) were less than 5 years old. The case fatality ratio was 10%. Seven (54%) of the 13 cases less than 2 years old were SpNSPn and 10 (77%) were caused by serotypes covered by the 7-valent pneumococcal conjugate vaccine. From the 10 isolated serotypes the most frequent were 14, 6B and 23F, all them susceptible to ceftriaxone. From the three patients with meningitis, two were caused by SpNSPn. CONCLUSION: In this study most of the IPD occurred in children less than 2 years old; 77% of the strains and 86% of the serotypes of SpNSPn were covered by the 7-valent pneumococcal conjugate vaccine.

Doença pneumocócica invasiva em crianças e adolescentes soropositivos para HIV / Invasive pneumococcal disease in HIV seropositive children and adolescents

OBJETIVO: Doença Invasiva Pneumocócica (DPI) afeta crianças principalmente menores de 5 anos, idosos e grupos de risco, especialmente pessoas infectadas pelo vírus da Imunodeficiência Humana (HIV). O objetivo deste trabalho foi analisar as doenças pneumocócicas invasivas (DPI) em crianças e adolescentes infectados pelo vírus da imunodeficiência humana (HIV), de acordo com morbiletalidade, sorotipos, sensibilidade à penicilina e ceftriaxona e distribuição de Streptococcus pneumoniae (Sp) sensíveis e resistentes presentes na vacina antipneumocócica conjugada 7-valente, já licenciada. MÉTODOS: Foram identificados 19 casos de DPI entre pacientes HIV soropositivos com idade entre 1 mês e 20 anos hospitalizados de 1993 a 2000. Os dados foram registrados em fichas padronizadas, contendo informações sobre idade, diagnóstico clínico e evolução, sorotipos e perfil de sensibilidade para penicilina e ceftriaxona das cepas de Sp isoladas em cultura. Sp com concentração inibitória mínima < 0,1 mcg/mL foi considerado sensível à penicilina (SpSPn), e as demais cepas como não sensíveis (SpNSPn). RESULTADOS: Dos 19 casos de DPI em HIV soropositivos, 16 (84 por cento) tinham pneumonia e três (16 por cento), meningite; 13 (68 por cento) ocorreram em crianças menores de 2 anos e 16 (84 por cento) em menores de 5 anos. A letalidade foi de 10 por cento. Dos 13 casos em menores de 2 anos, sete (54 por cento) foram SpNSPn e 10 (77 por cento) foram causados por sorotipos contemplados na vacina antipneumocócica conjugada 7-valente. Foram isolados 10 sorotipos, sendo mais freqüentes o 14, 6B e 23F, todos sensíveis à ceftriaxona. Dos três casos de meningite, dois foram causados por SpNSPn. CONCLUSÃO: A maioria das DPI ocorreu em menores de 2 anos de idade; 77 por cento das cepas e 86 por cento dos sorotipos de SpNSPn estão contemplados pela vacina antipneumocócica conjugada 7-valente.

OBJECTIVE: Invasive pneumococcal disease (IPD) primarily affects children less than 5 years old, the elderly and certain at-risk groups; especially people infected by the human immunodeficiency virus (HIV). The objective of this study was to analyze invasive pneumococcal diseases (IPD) in children and adolescents infected by the human immunodeficiency virus (HIV), with relation to morbidity, the case fatality ratio, pneumococcus serotypes, susceptibility to penicillin and ceftriaxone and to the proportion of susceptible and resistant Streptococcus pneumoniae (Sp) included in the 7-valent pneumococcal conjugate vaccine that has already been licensed. METHODS: A total of 19 cases of IPD were identified among HIV seropositive patients aged from 1 month to 20 years and hospitalized between 1993 and 2000. Data were recorded on standardized charts containing information on age, clinical diagnosis and progression, serotypes and the susceptibility to penicillin and ceftriaxone of the Sp strains identified in cultures. When the minimum inhibitory concentration was < 0.1 mcg/mL, Sp were defined as susceptible to penicillin (SpSPn), and all other strains were defined as not susceptible (SpNSPn). RESULTS: Of the 19 HIV seropositive cases with IPD, 16 (84 percent) had pneumonia and three (16 percent), had meningitis; 13 (68 percent) cases were children less than 2 years old and 16 (84 percent) were less than 5 years old. The case fatality ratio was 10 percent. Seven (54 percent) of the 13 cases less than 2 years old were SpNSPn and 10 (77 percent) were caused by serotypes covered by the 7-valent pneumococcal conjugate vaccine. From the 10 isolated serotypes the most frequent were 14, 6B and 23F, all them susceptible to ceftriaxone. From the three patients with meningitis, two were caused by SpNSPn. CONCLUSION: In this study most of the IPD occurred in children less than 2 years old; 77 percent of the strains and 86 percent of the serotypes of SpNSPn...

Fatores de risco clássicos e não clássicos para infecções pneumocócicas / Risk factors classic and non classic for pneumococcal infections

O Streptococcus pneumoniae é um patógeno que coloniza o trato respiratório superior, podendo-se disseminar causando doença pneumocócica invasiva (DIP) ou não invasiva. Dos fatores de risco conhecidos para as doenças invasivas a idade é dos mais importantes. Crianças com menos de 24 meses de vida têm altíssima incidência de DIP. Dos outros fatores de risco clássicos e não clássicos os mais significantes podem ser resumidos em: freqüência a creches e instituições correlatas, imunossupressão, especialmente ocasionada pelo HIV e pela asplenia funcional ou anatômica, cardiovasculopatias e nefropatias crônicas, hepatopatias crônicas, doenças crônicas com acometimento pulmonar, incluindo asma, fumo e cigarro, diabetes mellitus, fístulas liquóricas, infecções virais respiratórias prévias, variações de raças e populacionais e gênero masculino. Vários desses fatores mencionados contribuem também para o estabelecimento do estado de portador em nasofaringe. É fundamental que crianças, principalmente com fatores de risco importantes, recebam vacina conjugada antipneumocócica já nos primeiros meses de vida, medida preventiva mais eficaz contra o patógeno.

Universal use of inactivated polio vaccine.

OBJECTIVES: To present an update on the status of poliomyelitis worldwide, number of cases per year, regions most affected by the disease, vaccines currently available, their risks and benefits, monovalent vaccine use, risks of disseminating a mutant virus in the community, progress that has been made in terms of worldwide eradication and the World Health Organization's (WHO) proposals in this transition period between global eradication and the post-eradication period. SOURCES OF DATA: Data for the period from 1955 to 2005 were searched in MEDLINE, LILACS, The Web, Doctor's Guide, WHO website and the Pan American Health Organization (PAHO) website and text book. SUMMARY OF THE FINDINGS: In 1988, the WHO established the goal of eradicating the disease and interrupting transmission of the wild virus globally. Since then, there has been a dramatic decline of the disease, although in 2005 there were still some countries considered endemic and others where polio returned on account of imported viruses. The vaccines used worldwide are the classical tOPV and IPV, and in this eradication process, the use of mOPV vaccines has been encouraged in places where only one type of poliovirus circulates. In addition to spreading the virus in the community, the OPV vaccines may, however, cause paralyses by reversal of the neurovirulence process. CONCLUSIONS: For a world free of poliomyelitis disease, it would be necessary to interrupt circulation of the virus, which will only be possible if the OPV virus were to be discontinued, in accordance with the WHO proposals for this transition period and the post-eradication period.