Prospective cohort study with active surveillance for fever in four dengue endemic countries in Latin America.

To prepare for a Phase III dengue vaccine efficacy trial, 20 investigational sites were selected for this observational study to identify dengue infections in a closed cohort (N = 3,000 children 9-16 years of age). Of 255 acute febrile episodes experienced by 235 children, 50 (21.3%) were considered serologically probable dengue, and 18 (7.7%) were considered virologically confirmed (i.e., dengue NS1 antigen positive) dengue cases. Considering the disease-free and at-risk period from study start to onset of symptoms, the overall incidence density of acute febrile episodes was 17.7 per 100 person-years of follow-up, ranging from 15.3 in Colombia to 22.0 in Puerto Rico. This study showed that all sites were capable of capturing and following up acute febrile episodes within a specific timeframe among the established cohort and to detect dengue cases.

Carência de preparações medicamentosas para uso em crianças no Brasil / Lack of drug preparations for use in children in Brazil

OBJETIVO: Identificar medicamentos que apresentam dificuldades para seu uso pediátrico no Brasil. MÉTODOS: Estudo descritivo envolvendo a composição de uma listagem nacional de medicamentos não-licenciados ou não-padronizados para uso em crianças (medicamentos problema em pediatria, MPP), através de revisão bibliográfica, comparação com fontes do mercado farmacêutico brasileiro e inquérito com pediatras. Os medicamentos foram codificados pela classificação anatômica, terapêutica e química (Anatomic Therapeutic Chemical Classification System, ATC) e analisados quanto ao licenciamento no país e indicação/ recomendação em pediatria, tendo como referências básicas o bulário da ANVISA (2005), Dicionário de Especialidades Farmacêuticas (2005/06/07) e o site de bulas. RESULTADOS: Foram identificados na literatura 126 MPP e excluídos 24 não referidos nas fontes nacionais investigadas. A listagem foi complementada com 24 outros medicamentos referidos pelos pediatras. Do total de 126 MPP, 23 não tinham registro no país para o uso em crianças e 24 dos 103 licenciados apresentavam restrições de faixa etária. A lista envolveu 42 grupos terapêuticos e 68 subgrupos. Os grupos com maior número de MPP foram os antibacterianos de uso sistêmico (15), antiepilépticos (8), antiasmáticos (7) e analgésicos (7). Os problemas mais frequentes foram: dosagem inapropriada (43), forma farmacêutica inadequada (35), não-licenciamento para uso pediátrico (28), restrições de faixa etária (23). CONCLUSÕES: A carência de medicamentos desenvolvidos para uso em crianças envolve ampla gama de produtos clinicamente importantes. Algumas dessas formulações e dosagens já comercializadas em outros países não são disponibilizadas no mercado brasileiro sem nenhuma justificativa plausível.

OBJECTIVE: To identify drugs which are not suited for pediatric use in Brazil. METHODS: A descriptive study involving the development of a national list of unlicensed and off-label medications for pediatric use (problem drugs in pediatrics, PDP) through a literature review, a comparison among sources of the Brazilian pharmaceutical industry, and a survey with pediatricians. Drugs coded at the Anatomic Therapeutic Chemical (ATC) classification system were analyzed regarding licensing status in Brazil and recommendations/indications in pediatrics, based on the following reference sources: the list of licensed drugs of the Brazilian National Health Surveillance Agency (2005), the Brazilian Dictionary of Pharmaceutical Specialties (2005-2007) and the website www.bulas.med.br. RESULTS: Our literature search returned 126 PDP, but 24 drugs were excluded due to absence of national reference. To compose the final list, 24 other drugs referred by pediatricians were added. Of the 126 PDP, 23 drugs were not licensed in the country for use in children; and of the 103 licensed drugs, 24 presented age-related restrictions for pediatric use. The pharmaceutical list included 42 therapeutic groups and 68 subgroups. The groups containing larger numbers of PDP were: antibiotics for systemic use (15), antiepileptics (8), antiasthmatics (7), and analgesics (7). The most frequent problems were: inappropriate dosage (35), unlicensed for pediatric use (28), age-related restrictions (23). CONCLUSIONS: The lack of pediatric drug formulations in Brazil shows a profile similar to that observed in other countries, which involves a wide range of clinically important products. This study brings a contribution to the evaluation of the needs and priorities that support the development of suitable medicines for the pediatric patient.

Lack of drug preparations for use in children in Brazil.

OBJECTIVE: To identify drugs which are not suited for pediatric use in Brazil. METHODS: A descriptive study involving the development of a national list of unlicensed and off-label medications for pediatric use (problem drugs in pediatrics, PDP) through a literature review, a comparison among sources of the Brazilian pharmaceutical industry, and a survey with pediatricians. Drugs coded at the Anatomic Therapeutic Chemical (ATC) Classification System were analyzed regarding licensing status in Brazil and recommendations/indications in pediatrics, based on the following reference sources: the list of licensed drugs of the Brazilian National Health Surveillance Agency (2005), the Brazilian Dictionary of Pharmaceutical Specialties (2005-2007) and the website www.bulas.med.br. RESULTS: Our literature search returned 126 PDP, but 24 drugs were excluded due to absence of national reference. To compose the final list, 24 other drugs referred by pediatricians were added. Of the 126 PDP, 23 drugs were not licensed in the country for use in children; and of the 103 licensed drugs, 24 presented age-related restrictions for pediatric use. The pharmaceutical list included 42 therapeutic groups and 68 subgroups. The groups containing larger numbers of PDP were: antibiotics for systemic use (15), antiepileptics (8), antiasthmatics (7), and analgesics (7). The most frequent problems were: inappropriate dosage (35), unlicensed for pediatric use (28), age-related restrictions (23). CONCLUSIONS: The lack of pediatric drug formulations in Brazil shows a profile similar to that observed in other countries, which involves a wide range of clinically important products. This study brings a contribution to the evaluation of the needs and priorities that support the development of suitable medicines for the pediatric patient.

Segurança, imunogenicidade e eficácia da vacina contra o vírus influenza em crianças / Safety, immunogenicity and efficacy of influenza vaccine in children

OBJETIVOS: Revisar a imunogenicidade, segurança e eficácia das vacinas trivalentes inativadas e atenuadas contra o vírus influenza em crianças FONTE DOS DADOS: Pesquisa na literatura médica nas bases MEDLINE, LILACS e Biblioteca Cochrane. Artigos de revisão, ensaios clínicos e epidemiológicos foram selecionados para análise no período de 1990 a 2006 SíNTESE DOS DADOS: A influenza é uma doença infecciosa universal e sazonal que incide em todos os grupos etários e apresenta epidemias anuais caracterizadas por excesso de morbidade e mortalidade. Os idosos e pessoas com comorbidades são grupos de alto risco para influenza grave. Recentemente, foi comprovado que os lactentes saudáveis apresentam morbidade semelhante aos outros grupos de risco, e, portanto, têm indicação para a vacinação contra influenza, que se constitui na ação mais efetiva para a prevenção da infecção por vírus influenza. A segurança das vacinas contra influenza em crianças parece ser adequada, com reações adversas mais observadas do tipo local ou febre. A imunogenicidade em crianças varia de 30 a 90 por cento, sendo diretamente proporcional à idade. A eficácia depende do objetivo primário, podendo ser semelhante ao placebo ou chegar até 91 por cento de eficácia contra infecção comprovada por influenza A. As crianças em idade escolar exercem importante papel na disseminação do vírus influenza, e estudos populacionais mostram imunidade de rebanho. CONCLUSÕES:As vacinas trivalentes contra influenza, inativadas ou atenuadas, são pouco reatogênicas e apresentam imunogenicidade e eficácia variáveis em crianças. A vacinação é efetiva para prevenção de infecção por vírus influenza e para redução de morbidade. Estudos mais potentes de eficácia e segurança em lactentes ainda são desejáveis.

Safety, immunogenicity and efficacy of influenza vaccine in children.

OBJECTIVES: To review the immunogenicity, safety and efficacy of inactivated and attenuated trivalent influenza vaccines in children. SOURCES OF DATA: Database search of the medical literature indexed on MEDLINE, LILACS and in the Cochrane Library. Review articles, clinical trials and epidemiological studies published from 1990 to 2006 were selected for analysis. SUMMARY OF THE FINDINGS: Influenza is an infectious disease that is both universal and seasonal, with incidence in all age groups and annual epidemics characterized by excessive morbidity and mortality. The elderly and people with comorbidity are high risk groups for severe influenza. It has recently been proven that healthy infants suffer similar morbidity to other risk groups, and therefore vaccination against influenza is indicated for them too, as being the most effective means of preventing infection by the influenza virus. The safety of influenza vaccines in children appears adequate, with the most often observed adverse effects being local reactions or fever. Immunogenicity in children varies from 30 to 90%, being directly proportional to age. Efficacy depends on the primary objective and can range from levels comparable with placebo to up to 91% efficacy against confirmed influenza A infection. Schoolchildren play an important role in the dissemination of the influenza virus, and population studies have demonstrated herd immunity. CONCLUSIONS: Trivalent influenza vaccines, whether inactivated or attenuated, have low reactogenicity and offer variable immunogenicity and efficacy in children. Vaccination is effective for prevention of infections by the influenza virus and for reducing morbidity. More powerful studies of efficacy and safety in infants are still required.

Comparison between normal saline and a polyelectrolyte solution for fluid resuscitation in severely dehydrated infants with acute diarrhoea.

UNLABELLED: The optimal intravenous solution for rehydration of infants and children with severe dehydration is debated. AIM: The aim was to compare the efficacy of a polyelectrolyte solution (group PS) with sodium chloride 0.9% solution (group NS) in rapid parenteral rehydration of severely dehydrated infants with acute diarrhoea. METHODS: Primary outcomes were volume and time to hydration. Secondary outcomes were urea, creatinine, electrolytes, glucose, arterial pH and bicarbonate levels. Patients were assigned randomly and openly to one of the two treatment groups. Severe dehydration was defined as one or more of the following associated with any other sign of dehydration: depressed consciousness, a weak or absent pulse or capillary refill time > 10 sec. Peripheral blood samples for chemical pathology were collected before and after rapid fluid therapy. The mean age of the 36 enrolled infants was 9.1 mths. All had depressed consciousness or severe hypotension/shock. The fluid infusion rate was 50 ml/kg/hr until haemodynamic stability was restored (absence of severe hypotension and two urine emissions). Fluid volume, time to rehydration and weight before and after rehydration were recorded. RESULTS: All infants recovered full pulse within 1 hr; most had a better level of consciousness or capillary refill <3 sec. Group NS (15 infants) showed (before and after treatment, respectively) a decrease of plasma potassium (3.4 to 3.1 mmol/L, p=0.07), bicarbonate (13.3 to 12.2 mmol/L, p=0.01) and glucose (8.2 to 5.8 mmol/L, p<0.01). Group PS (21 infants) showed a decrease of potassium (4.4 to 3.2 mmol/L, p<0.01) but an increase in bicarbonate (11.6 to 13.3 mmol/L, p<0.01) and glucose (11.4 to 14.8 mmol/L, p=0.08). CONCLUSION: Polyelectrolyte solution was as effective as normal saline on volume expansion and better for correcting acidosis.

American visceral leishmaniasis (kala-azar) in hospitalized children from an endemic area.

OBJECTIVE: To study epidemiological and clinical aspects of American visceral leishmaniasis in hospitalized children in Ceará, Brazil. METHODS: A retrospective and observational study was carried out with children suffering from American visceral leishmaniasis admitted to Hospital Infantil Albert Sabin in Fortaleza. Medical records were reviewed consistently. Inclusion criteria were children with amastigote-positive smears in bone marrow or in splenic aspirates, or a positive Leishmania sp immunofluorescence assay. RESULTS: From January 1995 to December 2002, 450 children with American visceral leishmaniasis were identified, accounting for 9 to 27% of all reported cases in Ceará in that period, with peak hospitalization rates in 1995 and 2000. The mean age was 4.4 years (12% < 1 year and 65% < 5 years of age). The overall male: female ratio was 1.1 and 1.48 in children > 5 year (p = 0.04). Urban patients infected by American visceral leishmaniasis increased steadily over an 8-year period (chi2 p = 0.01). The main clinical complaints on admission were fever (96%), pallor (90%) and abdominal swelling (75%). Clinical cure was defined as the absence of fever, regression of splenic and hepatic enlargement and of pancytopenia. Overall mortality was 9.2% and 21.2% in patients younger than one year. Malnutrition, edema, bleeding, jaundice, and concomitant infections were related to higher mortality. CONCLUSIONS: Cases of American visceral leishmaniasis spiked with a 5-year interval, and affected most under-five urban children. Mortality was related to low age, signs of severe disease and concomitant infection.

American visceral leishmaniasis (kala-azar) in hospitalized children from an endemic area

OBJETIVOS: Estudar os aspectos epidemiológicos e clínicos da leishmaniose visceral americana em crianças hospitalizadas do Ceará. MÉTODOS: Estudo retrospectivo e observacional de crianças com leishmaniose visceral americana admitidas no Hospital Infantil Albert Sabin, em Fortaleza. Os prontuários foram revistos sistematicamente. Os critérios de inclusão foram crianças com esfregaços positivos para Leishmania em aspirado de medula óssea ou de baço, ou teste de imunoensaio positivo para Leishmania sp. RESULTADOS: Entre janeiro de 1995 e dezembro de 2002, foram identificados 450 pacientes, perfazendo 9 a 27 por cento dos casos de leishmaniose visceral americana notificados no Ceará no período, com picos de admissão em 1995 e 2000. A idade média foi de 4,4 anos (12 por cento < 1 ano e 65 por cento < 5 anos de idade). A relação masculino:feminino foi de 1,1 em geral e de 1,48 em < 5 anos (p = 0,04). Os pacientes urbanos aumentaram regularmente no período de 8 anos (X², p = 0,01). As principais queixas foram febre (90 por cento), palidez (90 por cento) e aumento abdominal (75 por cento). A cura clínica foi constatada por ausência de febre, regressão da hepato-esplenomegalia e da pancitopenia. A letalidade geral foi de 9,2 por cento, e 21,2 por cento em lactentes < 1 ano. Desnutrição, edema, sangramento, icterícia e infecção intercorrentes foram fatores relacionados com maior letalidade. CONCLUSÕES: Casos hospitalizados de leishmaniose visceral americana apresentaram picos a cada 5 anos e afetaram crianças urbanas < 5 anos. A mortalidade esteve associada à baixa idade, sinais de gravidade e infecção concomitante.

Common infectious diseases and skin test anergy in children from an urban slum in Northeast Brazil

BACKGROUND: Acute respiratory infection (ARI), diarrheal disease (DD) and infective dermatitis (ID) are important causes of morbidity in children under five, in Northeast Brazil. Objectives: (a) to evaluate the morbidity of ARI, DD and ID; and (b) to determine their association with cellular immunity in poor urban children from Fortaleza, Brazil. MATERIALS AND METHODS: A prospective cohort study. At enrollment, multipuncture skin-tests (Multitest CMI) were performed and interpreted according to standard procedures. Children were followed for infectious diseases by weekly home visits. RESULTS: Seventy-one children aged 6 to 21 months were recruited in an ongoing cohort of newborns. A mean of 39 (6 to 63) home visits per child were made, which detected 184.5 symptomatic days per child-year of observation. ARI was present in 62 percent of the days of illness (6,378 out of 10,221), DD in 23 percent (2,296 days), ID in 6 percent (597) and other infections in 4 percent (373). Episodes per child-year were: 10 for ARI, 7 for DD and 1 for ID. Twelve (17 percent) out of 71 children were anergic. The incidences of ARI, DD and ID were similar in responsive versus anergic children. The mean duration of ID in anergy was 8.5 days, while it was 4.3 in the responsive group (P=0.007). Anergy was independent of age, sex and nutritional status. CONCLUSIONS: A high incidence of ARI and DD was found in these poor urban children. Skin-test responsiveness was not related to malnutrition, nor to morbidity due to ARI and DD, however anergic children had a longer duration of infective dermatitis.

Common infectious diseases and skin test anergy in children from an urban slum in northeast Brazil.

BACKGROUND: Acute respiratory infection (ARI), diarrheal disease (DD) and infective dermatitis (ID) are important causes of morbidity in children under five, in Northeast Brazil. OBJECTIVES: (a) to evaluate the morbidity of ARI, DD and ID; and (b) to determine their association with cellular immunity in poor urban children from Fortaleza, Brazil. MATERIALS AND METHODS: A prospective cohort study. At enrollment, multipuncture skin-tests (Multitest CMI) were performed and interpreted according to standard procedures. Children were followed for infectious diseases by weekly home visits. RESULTS: Seventy-one children aged 6 to 21 months were recruited in an ongoing cohort of newborns. A mean of 39 (6 to 63) home visits per child were made, which detected 184.5 symptomatic days per child-year of observation. ARI was present in 62% of the days of illness (6,378 out of 10,221), DD in 23% (2,296 days), ID in 6% (597) and other infections in 4% (373). Episodes per child-year were: 10 for ARI, 7 for DD and 1 for ID. Twelve (17%) out of 71 children were anergic. The incidences of ARI, DD and ID were similar in responsive versus anergic children. The mean duration of ID in anergy was 8.5 days, while it was 4.3 in the responsive group (P=0.007). Anergy was independent of age, sex and nutritional status. CONCLUSIONS: A high incidence of ARI and DD was found in these poor urban children. Skin-test responsiveness was not related to malnutrition, nor to morbidity due to ARI and DD, however anergic children had a longer duration of infective dermatitis.

Comparing pharmacokinetics of amoxicillin given twice or three times per day to children older than 3 months with pneumonia.

For children with ambulatory pneumonia, the World Health Organization (WHO) recommends oral amoxicillin (15 mg/kg of body weight/dose) thrice daily (t.i.d.) or oral cotrimoxazole (4 mg of trimethoprim/kg/dose) twice daily (b.i.d.). The more frequent amoxicillin dosing may lead to compliance problems. To compare the pharmacokinetics and levels of amoxicillin in plasma in the current WHO acute respiratory infection recommendations with the 25-mg/kg/dose b.i.d. regimen, we performed a two-group parallel study of 66 children ages 3 to 59 months with pneumonia. Amoxicillin was given orally at 25 mg/kg/dose b.i.d. or 15 mg/kg/dose t.i.d. Amoxicillin concentrations were determined by high-performance liquid chromatography after the first dose on days 1 and 3. After the first dose on day 1, the mean area under the concentration-time curve (AUC) for amoxicillin after the 25-mg/kg dose was 54.7 versus 24.9 micro g. h/ml after the 15-mg/kg dose. After the first dose on day 3, the mean AUC was 44.1 versus 28.5 micro g. h/ml. All but two children had plasma amoxicillin concentrations above 0.5 micro g/ml for >50% of the dose interval on both days. Six children on day 1 and five children on day 3 had concentrations above 1.0 micro g/ml for <50% of the dose interval. On day 1, 16 of 27 children in the b.i.d. group and 11 of 26 children in the t.i.d. group had concentrations that were above 2.0 micro g/ml for <50% of the dose interval, and on day 3, 18 of 31 children in the b.i.d. group and 8 of 31 children in the t.i.d. group had concentrations that were above 2.0 micro g/ml for <50% of the dose interval. Amoxicillin b.i.d. is a feasible alternative for t.i.d. dosing. To lengthen the time above the MIC at higher concentration levels, a 30- to 40-mg/kg/dose b.i.d. should be considered instead of the 25 mg/kg/dose used in this study.

Antimicrobial susceptibility and serotypes of nasopharyngeal Streptococcus pneumoniae in children with pneumonia and in children attending day-care centres in Fortaleza, Brazil.

The susceptibility of nasopharyngeal Streptococcus pneumoniae to eight antibiotics was studied in 482 children under 5 years of age with community-acquired pneumonia and in 429 healthy pneumococci carriers in Fortaleza, Brazil. Serotyping of strains with pooled and type-specific antisera was also performed. Overall, S. pneumoniae was isolated from 499/911 (55%) children. The carriage rate in children attending day-care centres was higher (72%) than in children with pneumonia (50%) (P<0.001). MIC determination in 441 strains revealed 45% to be intermediate penicillin-resistant and 4% high penicillin-resistant strains. Resistance rates to co-trimoxazole and erythromycin were 42 and 23%, respectively. Serotyping of 211 penicillin-resistant and 58 randomly selected penicillin-susceptible isolates showed that 78% of the strains belonged to paediatric serogroups 6, 14, 19 and 23 (86% of the penicillin-resistant and 51% of the penicillin-susceptible strains, P=0.001). Resistance rates of S. pneumoniae to penicillin and co-trimoxazole in Fortaleza were higher than previously reported in Brazil and associated with paediatric serogroups 6, 14, 19 and 23.

S. pneumoniae isolados da nasofaringe de crianças sadias e com pneumonia: taxa de colonização e suscetibilidade aos antimicrobianos / Nasopharyngeal isolates of S. pneumoniae from healthy carriers and children with pneumonia: colonization rates and antimicrobial susceptibility

Objetivos: comparar as taxas de colonizaçäo e a resistência antimicrobiana de pneumococos em nasofaringe de crianças sadias e com pneumonia. Métodos: estudo de tipo transversal. As crianças sadias foram recrutadas em centros de vacinaçäo (CV) e creches públicas (CP), selecionados aleatoriamente, e aquelas com pneumonia em emergências pediátricas. Foram utilizados swabs flexíveis de alginato para a colheita do material de nasofaringe. O isolamento e a identificaçäo dos pneumococos seguiram procedimentos padronizados. As concentraçöes inibitórias mínimas (CIM) foram determinadas por microdiluiçäo em placas. Resultados: foram estudadas 911 crianças, 429 sadias (60 por cento portadoras de pneumococo, sendo 72 por cento destas recrutadas em CP e 49 por cento em CV) e 482 com pneumonia (50 por cento de portadoras) (p=0,002). De 441 isolados com CIM determinadas, 198 (45 por cento) apresentavam resistência intermediária, e 16 (4 por cento) apresentavam resistência plena à penicilina. As taxas de resistência dos pneumococos isolados de portadores sadios e com pneumonia, respectivamente, foram: penicilina 48 por cento (CV 37 por cento e CP 55 por cento) e 50 por cento (p>0,05); eritromicina: 28 por cento e 19 por cento (p=0,05); cotrimoxazol 81 por cento e 76 por cento (p>0,05); cloranfenicol 6 por cento e 7 por cento (p>0,05), rifampicina 5 por cento e 3 por cento (p>0,05), ceftriaxone 2 e 4 por cento (p>0,05) e vancomicina 0 por cento, para ambos grupos. Foi constatada associaçäo entre as resistências do pneumococo à penicilina, eritromicina e ao cotrimoxazol. Conclusöes: a taxa de portador de pneumococos foi maior em crianças sadias do que naquelas com pneumonia. As resistências dos pneumococos à penicilina e ao cotrimoxazol foram elevadas, sobretudo entre os usuários de creches públicas

[Nasopharyngeal isolates of S. pneumoniae from healthy carriers and children with pneumonia: colonization rates and antimicrobial susceptibility]. / S. pneumoniae isolados da nasofaringe de crianças sadias e com pneumonia: taxa de colonização e suscetibilidade aos antimicrobianos.

OBJECTIVES: To compare colonization rates and antimicrobial resistance of nasopharyngeal pneumococci in healthy carriers and children with pneumonia. METHODS: A cross-sectional study. Healthy subjects of this study were selected from randomly chosen immunization centers and day-care centers, and those with pneumonia were selected in pediatric emergency rooms. Flexible perinasal alginate swabs were employed to collect nasopharyngeal pneumococci specimens. Isolation and identification were performed according to standard procedures. Minimum Inhibitory Concentrations were assessed by microdilution techniques. RESULTS: We studied 911 children, 429 healthy controls (60% of carriers, 72% attending day care centers and 49% recruited in immunization centers) and 482 children with pneumonia (50% of carriers) (P=0.02). The Minimum Inhibitory Concentration of penicillin to 441 isolates detected 198 (45%) of intermediate and 16 (4%) fully resistant pneumococci. Antimicrobial resistance rates of isolates from healthy carriers and children with pneumonia were, respectively: penicillin 48% (37% for immunization centers and 55% for day-care centers) and 50% (P>0.05), erythromycin 28% and 19% (P=0.05); cotrimoxazole 81% and 76% (P>0.05), chloramphenicol 6% and 7% (P>0.05), rifampin 5 and 3% (P>0.05) ceftriaxone 2 and 4% (P>0.05) and vancomycin 0% in both groups. An association among pneumococcal resistance to penicillin, erythromycin and cotrimoxazole was detected. CONCLUSIONS: Pneumococcal carriage rate was higher in healthy children than in children with pneumonia. Penicillin and cotrimoxazole resistance rates were high, especially among those attending day-care centers.

Seroprevalence of toxoplasmosis in Fortaleza, Ceara, Brazil

Foi realizado um inquerito sorologico de infeccao por Toxoplasma gondii em grupos populacionais de Fortaleza, para identificar as taxas de prevalencia por idades e fatores de risco associados com a infeccao adquirida. Um teste imunoenzimatico com anticorpos IgG anti-Toxoplasma (Sanofi Pasteur Diagnostics, Marnes La Coquette, Franca) foi utilizado para testar a imunidade. Creches e escolas publicas foram selecionadas aleatoriamente e duas maternidades e tres servicos de pre-natal foram designados pela importancia. A composicao...

Inquérito sorológico de rubéola na era pré-vacinaçäo, em creches, escolas e maternidades de Fortaleza / Serologic survey of rubella in the pre-vacine era in child-care centers, schools and maternity units of Fortaleza

Objetivo: identificar a prevalência de rubéola em diversas idades e grupos populacionais e a suscetibilidade de mulheres gestantes e puérpuras segundo idade, número de filhos e aborto espoatâneo. Métodos: Estudo transversal de tipo inquérito sorológico. Pré-escolares e escolare foram selecionados em creches e escolas públicas distribuídas por distritos sanitários de Fortaleza. As gestantes e puérperas saudáveis foram recrutadas em duas grandes maternidades e três ambulatórios públicos de pré-natal. Indivíduos previamente vacinados e portadores de doenças crônicas ou agudas foram excluídos. Foi obtido consentimento escrito de todos os participantes ou responsáveis. Para detecçäo qualitativa de IgG sérica anti-rubéola utilizou-se método Elisa-indireto. Resultados: As soroprevalências médias por idade de 999 amostras foram 2 a 5 anos=59 por cento (136/231); 6 a 9 anos=53 porcento (109/204); 10 a 19 anos=56 por cento (243/432); e 20 a 39 anos=80 por cento (106/132). A idade média de 187 gestantes e puérperas foi de 23 anos (10-39) com soroprevalência de 76 por cento (142/187), 62 por cento no grupo de 15-19 anos e 83 por cento no grupo de 26-39 anos. Uma maior soroprevalência esteve associada à maior idade materna (p<0,001), a história de aborto e espotâneo (p=0,03) e a 2 ou mais filhos (p=0,01). Conclusöes: A elevada soroprevalência em pré-escolares revela a intensa transmissäo do vírus nas creches. A alta uscetibilidade nos adolescentes (45 por cento), entre os quais a gravidez é freqüênte, enfatiza a necessidade de se introduzir a vacina precocemente e manter elevada cobertura nos jovens, visando erradicar a rubéola congênita. Igualmente, a vacinaçäo rotineira das puérperas nesse grupo etário é particularmente benéfica.

Prevalência de Haemophilus influenzae resistentes a ampicilina, cefaclor, cefotaxime, cloranfenicol e cotrimoxazol isolados de laboratórios na cidade de Säo Paulo / Prevalence of Haemophilus influenzae resistant to ampicillin, cefaclor, cefotaxime, chloramphenicol and cotrimoxazol isolated from laboratories in the city of Säo Paulo, Brazil

Objetivo: Determinar a resistência à ampicilina e outros antimicrobianos de amostras de H. influenzae isoladas de diferentes materiais clínicos. Métodos; As amostras de H. influenzae foram identificadas por cultura com fatores V e X e prova do ácido amino-levulínico. A produçäo de ß-lactamase (ßLac) foi detectada pela nitrocefina. A sensibilidade aos antimicrobianos foi testada por difusäo do disco e diluiçäo em meio sólido. O sorotipo b foi testado por coaglutinaçäo. Resultados: De 245 H. influenzae identificados, 155 foram testados para o sorotipo b e 28 por cento (43/155) mostraram-se positivos...

Oportunidades perdidas de vacinaçäo / Missed opportunities for immunization

Para identificar e analisar as causas de oportunidades perdidas de vacinaçäo (OPV) no Hospital Infantil Albert Sabin, de Fortaleza (HIAS), foram entrevistadas as acompanhantes de 119 crianças menores de 2 anos que freqüentavam os serviços do hospital. Trinta e sete crianças estavam com o esquema de vacinas em atraso sem contra-indicaçäo de vacinaçäo, ou seja, uma taxa de OPV de 31 por cento (37/119). Noventa por cento delas possuíam o Cartäo de Vacina, mas em apenas 40 por cento dos casos este foi solicitado por um profissional. De 43 crianças internadas, 58 por cento estavam com vacinas atrasadas e sem qualquer contra-indicaçäo. Entre as acompanhantes em idade fértil, a taxa de OPV para o toxóide tetânico (menos de 3 doses) foi de 54 por cento (37/68). Quanto aos 22 profissionais de saúde entrevistados, 86 por cento mostraram um bom conhecimento do calendário vacinal e apenas 23 por cento conheciam 3 contra-indicaçöes de vacinaçäo pelos critérios da OMS. As causas mais importantes de OPV observadas no HIAS foram a negligência na verificaçäo da situaçäo vacinal e as falsas contra-indicaçöes.