Rubella vaccination of unknowingly pregnant women: the São Paulo experience, 2001.

BACKGROUND: Rubella vaccination is contraindicated during pregnancy. During mass immunization of women of childbearing age against rubella, women unknowingly pregnant may be vaccinated. To evaluate the effects of rubella vaccination during pregnancy, the Brazilian state of São Paulo conducted a follow-up study of pregnant women vaccinated during a rubella campaign in 2001. METHODS: Women vaccinated during pregnancy were reported to a national surveillance system. In the state of São Paulo, follow-up of vaccinated women included household interviews. Serum samples from vaccinated women were tested for antirubella antibodies to classify susceptibility to rubella infection. Children born to susceptible mothers were tested for evidence of congenital rubella infection and evaluated for signs of congenital rubella syndrome. RESULTS: The São Paulo State Health Department received 6473 notifications of women vaccinated during pregnancy. Serology performed for 5580 women identified 811 (15%) that were previously susceptible. Incidence of spontaneous abortion or stillbirth among previously susceptible vaccinated women was similar to women with prior immunity. Twenty-seven (4.7%) of 580 newborns tested had evidence of congenital rubella infection; none had congenital rubella syndrome. CONCLUSIONS: Mass rubella vaccination of women of childbearing age was not associated with adverse birth outcomes or congenital rubella syndrome among children born to women vaccinated during pregnancy.

Immunogenicity and safety of a new Vero cell rabies vaccine produced using serum-free medium.

The immunogenicity and safety of a new human rabies vaccine, produced in Vero cells by a process that does not require supplementation with human or animal derived components in production, were assessed. Thus, the objective is to produce a safer vaccine at a lower cost. A total of 296 volunteers was divided into two groups: Group 1, which received the study vaccine, and Group 2, which received the Vero cells vaccine produced by Sanofi Pasteur. Five doses were given on days 0, 3, 7, 14 and 28. Blood samples for determination of rabies virus neutralizing antibodies were collected on days 0, 14, 38 and 90. The geometric mean titers (GMT) were much higher than 0.5 IU/ml in both groups on days 14, 38 and 90, indicating seroconversion according to the World Health Organization. In Group 1, however, the GMTs were higher than in Group 2, the difference being statistically significant in the two last samples. There was no statistical difference between the groups in the ratio of individuals with titers > or =0.5 IU/ml in each sample. Pain at the injection site was the most common adverse reaction and occurred most often in Group 1 (p < 0.001). All cases had a favorable evolution. There were no severe adverse reactions. It was concluded that the new vaccine is safe and immunogenic.

Leishmaniose visceral: aspectos clínicos e laboratoriais / Visceral leishmaniasis: clinical and laboratorial aspects

Objetivo: comparar os dados clínicos e laboratoriais no pré e pós-tratamento de pacientes portadores de leishmaniose visceral (LV), admitidos em hospital pediátrico localizado em área näo-endêmica, destacando a importância do reconhecimento da LV na faixa etária pediátrica. Métodos: avaliaçäo dos dados clínicos, laboratoriais e de tratamento de pacientes portadores de LV no período compreendido entre 1981 e 1992, comparando-se os valores médios de hemoglobina, leucócitos, neutrófilos, plaquetas, albumina, gamaglobulina, classes e subclasses de imunoglobulinas, tamanho do fígado e baço antes e após o tratamento, utilizando-se o teste "t" para amostras pareadas. Resultados: foram incluídos 78 pacientes, com idade variando entre 8 meses e 13,5 anos, sendo 44 casos do sexo masculino e 61 provenientes da Bahia. Febre e esplenomegalia estavam presentes em 96,1 por cento e 100 por cento dos casos, respectivamente. O diagnóstico parasitológico foi obtido em 74/78 pacientes, com positividade pelo mielograma e/ou mielocultura em 67 casos (85,7 por cento), 5 pela biópsia hepática e 2 pela punçäo esplênica. Os valores hematológicos e a albumina sérica apresentaram melhora significante ao término do tratamento (p<0,001), o mesmo näo ocorrendo com a gamaglobulina sérica (p=0,087). Houve predomínio da subclasse IgG1, com dois pacientes apresentando níveis reduzidos de IgG2. O tratamento inicial utilizou antimonial em 67 casos e Anfotericina B em 5. Onze pacientes (15,7 por cento) necessitaram segundo esquema de tratamento, com resoluçäo em todos os casos. Houve melhora significativa do tamanho do fígado e baço ao término do tratamento (p <0,001). Um paciente apresentou resoluçäo espontânea, e cinco faleceram por sangramento. Conclusöes: os autores alertam para a inclusäo da LV na suspeita diagnóstica de pacientes pediátricos apresentando febre e visceromegalia, provenientes de áreas endêmicas, para a adequada abordagem diagnóstica e tratamento, especialmente em serviços de saúde de regiöes de baixa incidência desta endemia

[Visceral leishmaniasis: clinical and laboratorial aspects]. / Leishmaniose visceral: aspectos clínicos e laboratoriais.

OBJECTIVE: To compare the clinical and laboratorial data before and after the treatment of patients with visceral leishmaniasis admitted to a pediatric hospital in a nonendemic area, highlighting the importance of recognizing visceral leishmaniasis in pediatric patients. METHODS: Clinical, laboratorial and treatment data of 78 patients with visceral leishmaniasis were evaluated from 1981 to 1992. We analyzed the average level of hemoglobin, leukocyte, neutrophil, platelet, albumin, gammaglobulin, class and subclass of immunoglobulin, size of the liver and spleen during the pre- and post-treatment using the paired t test. RESULTS: We included 78 patients with visceral leishmaniasis, 44 males, with age ranging from 8 months to 13.5 years. Sixty-one patients were from Bahia. Fever and splenomegaly were present in 96.1% and 100% of the cases, respectively. The parasitological diagnosis was obtained in 74/78 patients: 67 patients through smear and/or culture of bone marrow (85.7%), five through liver biopsy and two through spleen puncture. The hematological findings and serum albumin presented significant improvement at the end of treatment (P<0.001), differently from serum gammaglobulin levels (P=0.087). There was predominance of IgG1 subclass, with two patients presenting low levels of IgG2. Initial treatment used antimoniate in 67 cases and amphotericin B in five. Eleven patients (15.7%) needed a second treatment, and were considered cured after it. There was significant improvement in the liver and spleen size at the end of the treatment (P<0.001). One patient presented spontaneous remission and five died due to bleeding. CONCLUSIONS: In order to obtain accurate diagnosis and treatment, especially regarding health services of areas with low-incidence of visceral leishmaniasis, the diagnosis of patients with fever and visceromegaly, who come from endemic areas, should include visceral leishmaniasis.

Programa Mäe Participante: relato de experiência em enfermaria geral / Program Participant \"mother\": report of experience in a general ward

Os autores relatam a experiência da Equipe Interdisciplinar da Unidade de Patologia Geral do Instituto da Criança "Prof. Pedro de Alcântara" do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo com o programa "Mäe Participante", discutindo suas dificuldades e a viabilidade do programa

Síndrome da imunodeficiência adquirida em crianças: relato de doze casos

Säo apresentados 12 casos de crianças com a síndrome de imunodeficiência adquirida (AIDS), atendidos no Instituto da Criança "Prof. Pedro de Alcantara", no período de 1985/1986. As principais características clínicas encontradas foram linfoadenioopatia, dificuldade de ganho de peso, anorexia, hepatomegalia, esplenomegalia, assim como infecçöes causadas por germes oportunistas. Entre os achado laboratoriais destacam-se a inversäo T4/T8 e a hipergamaglobulinemia. Como meio da contaminaçäo foram detectados: uso rotineiro de derivados de sangue em cinco crianças, exsangüíneo-transfusäo em uma, transfusäo única de derivados de sangue em três, transmissäo vertical em dois e transmissäo näo bem esclarecida em um paciente. Neste artigo säo ainda discutidos os critérios para diagnóstico da síndrome no grupo pediátrico