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The recent licensure of two different serogroup B recombinant protein meningococcal vaccines in Brazil emphasizes the importance of a better knowledge of the real burden of serogroup B meningococcal (MenB) disease to establish evidence-based vaccination policies. We performed an observational, descriptive study, from 2001 to 2015, analyzing the incidence and case fatality rates (CFR) of MenB disease in Brazil, according to age group and region. In the absence of any vaccine use targeting MenB disease, a significant decline of 90% in the overall incidence rates of MenB disease was observed (from 0.55 cases/100,000 habitants in 2001 to 0.05 in 2015), with declines found in all age groups during the study period. The highest incidence rates were consistently observed in infants and children 1–4 year of age, whereas adults ≥ 60 years experienced the highest CFR (33.9%). The proportion of cases with serogroup identified increased from 37.1% in 2001 to 51.5% in 2015. Despite an improvement in recent years, the quality of diagnosis is highly heterogeneous in the diverse regions, presenting important deficiencies that still prevent the possibility of a robust and reliable analysis of the burden of the meningococcal disease in Brazil. Based on the findings of this study and taking in account the unlikely indirect effect associated with the use of the new recombinant serogroup B protein vaccines, infants < 1 year is the age group to be prioritized when considering the implementation of routine immunization programmes with MenB vaccines.

The SARS-CoV-2 pandemic is a major concern all over the world and, as vaccines became available at the end of 2020, optimal vaccination strategies were subjected to intense investigation. Considering their critical role in reducing disease burden, the increasing demand outpacing production, and that most currently approved vaccines follow a two-dose regimen, the cost-effectiveness of delaying the second dose to increment the coverage of the population receiving the first dose is often debated. Finding the best solution is complex due to the trade-off between vaccinating more people with lower level of protection and guaranteeing higher protection to a fewer number of individuals.Here we present a novel extended age-structured SEIR mathematical model that includes a two-dose vaccination schedule with a between-doses delay modelled through delay differential equations and linear optimization of vaccination rates. Simulations for each time window and for different types of vaccines and production rates were run to find the optimal time window between doses, that is, the one that minimizes the number of deaths.We found that the best strategy depends on an interplay between the vaccine production rate and the relative efficacy of the first dose. In the scenario of low first-dose efficacy, it is always better to apply the second dose as soon as possible, while for high first-dose efficacy, the optimal window depends on the production rate and also on second-dose efficacy provided by each type of vaccine. We also found that the rate of spread of the infection does not affect significantly the thresholds of the optimal window, but is an important factor in the absolute number of total deaths. These conclusions point to the need to carefully take into account both vaccine characteristics and roll-out speed to optimize the outcome of vaccination strategies.

Background: The Brazilian state of Parana conducted a mass vaccination campaign against dengue with the tetravalent attenuated vaccine CYD-TDV. The campaign targeted thirty endemic municipalities. The objective of this study was to assess the effectiveness of CYD-TDV in preventing symptomatic virologically confirmed dengue cases according to specific age groups in five of the municipalities. Methods: A case-control study was carried out in the five most populous municipalities targeted by the vaccination, with a vaccine uptake of 25%. Symptomatic dengue cases were identified by the municipal health departments. The age groups targeted were 15–18 and 19–27 in four municipalities and 9–14 and 28–44 in one municipality. All cases were confirmed by real time reverse transcription quantitative polymerase chain reaction (RT-qPCR). For each case, two controls were selected: a neighborhood control and a workplace or school/college control, matched by age group. A conditional logistic regression model was used to determine the odds ratio for vaccination and the vaccine effectiveness. Findings: Study participants included 618 RT-qPCR-confirmed dengue cases and 1,236 matched controls (with a non-reactive dengue IgM serologic test). Vaccine effectiveness against dengue due to any serotype was 11·1% (95% CI: –19·0%; 33·6%). Effectiveness against DENV-1 was 33·3% (95% CI: -5·0%; 57·6%) and against DENV-2 was -56·7% (95% CI: -142·2%; -5·0%). No DENV-3 were detected. The vaccine was significantly effective in the prevention of DENV-4 cases (VE = 93·3%; 95% CI: 47·7%; 99·2%). Interpretation: CYD-TDV was effective in the prevention of symptomatic cases due to DENV-4, but not due to any serotype. The low dengue sero-prevalence in the target population could possibly be related to these results. Funding: This study was supported through a grant to the Sabin Vaccine Institute from Sanofi-Pasteur. Sanofi-Pasteur had no role in the study design, protocol development, data collection, analysis, or publication of results. Declaration of Interest: EJA Luna and JC Moraes have received consultancy fees and travel sponsorship from Sanofi-Pasteur. D Garrett, F. Crosewski, I Riediger, F Fantinato and K Ribeiro declare no conflict of interest. Ethical Approval: The Santa Casa de Sao Paulo Research Ethics Committee (Resolution no. 1817892, on November 11, 2016) and Pan American Health Organization Ethics Review Committee – PAHOERC (Resolution PAHO 2016-11-0056) approved the study protocol.

Objectives: To evaluate the effectiveness of Topical Oxygen Jet Therapy (TOJT) in the treatment of surgical wounds in adult patients who has clinical signs of infection for over 30 days; and to identify the pathogens causing complicated skin and soft tissue infections. Method: Parallel, randomized clinical trials randomly divided into “Control Group” (CG) and “Treatment Group” (TG), which were followed up for 10 consecutive days. Venous antibiotics and dressings were used in both groups. In addition, TOJT were used on the wounds in the TG. The outcome criteria were based on clinical indicators: Pressure Ulcer Scale for Healing (PUSH) and Visual Analog Scale Pain (VAS). The paired t-test or Wilcoxon, chi-squared or Fisher’s exact test, and Student’s t-test or Mann–Whitney tests were used with a significance level of 5%. Results: 73 inpatients were included and followed up: 39 in TG and 34, CG. There were no significant differences in socio-demographic variables or of initial laboratory tests, except for blood glucose that was higher in TG than in CG (p = 0.044). Ten days into treatment, both the area of PUSH wounds (p < 0.001) and the pain scale (p = 0.029) were significantly reduced in TG. Staphylococcus aureus was the most prevalent pathogen (40%) with no significant difference between the two groups. Discussion: Although the follow-up time was of only ten days, a significant improvement was observed in TG. As a limitation of the study, the small sample size precluded the comparison of S. aureus infections between the two groups. Conclusion: TOJT accelerated the healing process, reduced pain and contributed to an improvement in the clinical status of the wounds when compared to CG. These findings demonstrate the effectiveness and relevance of the employed technique. It can be easily incorporated as a routine procedure in hospitals without extra investment.

Streszczenie Wprowadzenie W marcu 2010 r. wprowadzono do stosowania w Brazylii 10-walentną skoniugowaną szczepionke przeciwko pneumokokom ( pneumococcal conjugate vaccine ; PCV10). Podstawą dopuszczenia jej do obrotu bylo wykazanie, ze w zakresie wskaźnikow immunologicznych dotyczących skuteczności w zapobieganiu zakazeniom pneumokokowym nie byla ona gorsza od szczepionki 7-walentnej. Schemat dawkowania PCV10 obejmuje podanie trzech podstawowych dawek w wieku 2, 4 i 6 miesiecy oraz dawki przypominającej w wieku 12 miesiecy. W czasie wprowadzania szczepionki na rynek zaproponowano szczepienie pojedynczą dawką wszystkich dzieci w wieku 12–23 miesiecy, nieobjetych podstawowym cyklem szczepien. Analizowano skutecznośc szczepionki PCV10 w profilaktyce inwazyjnych chorob pneumokokowych u dzieci w Brazylii. Metody Od 1 marca 2010 r. do 31 grudnia 2012 r. w 10 stanach w Brazylii u dzieci w wieku kwalifikującym do podania co najmniej jednej dawki PCV10 prowadzono badania przesiewowe w kierunku inwazyjnych chorob pneumokokowych, określanych jako wyhodowanie Streptococcus pneumoniae z krwi, plynu mozgowo-rdzeniowego lub innego miejsca, ktore w warunkach fizjologicznych nie jest skolonizowane przez bakterie. U dzieci wykonywano badania laboratoryjne oraz prowadzono obserwacje szpitalną. Jednym z celow badania bylo utworzenie w kazdym przypadku odpowiedniej grupy kontrolnej, obejmującej 4 dzieci odpowiadających pod wzgledem wieku i miejsca zamieszkania. Do analizy wykorzystano warunkową regresje logistyczną, a skutecznośc PCV10 obliczono jako (1 – skorygowany sparowany iloraz szans) × 100% zarowno do typu szczepionki, jak i odpowiednich serotypow bakterii zawartych w szczepionce (to znaczy w tej samej grupie serologicznej co serotyp szczepionki). Wyniki W 316 przypadkach chorob inwazyjnych (mediana wieku 13,2 miesiąca, zakres 2,6–53,1) i u 1219 dzieci w grupie kontrolnej (13,3 miesiąca, 2,6–53,1) skorygowana skutecznośc dostosowanego do wieku schematu szczepienia PCV10 wyniosla 83,8% (95% CI: 65,9–92,3) przeciwko serotypom zawartym w szczepionce i 77,9% (41,0–91,7) przeciwko serotypom związanym ze szczepionką. Skutecznośc przeciwko określonym serotypom wykazano wobec dwoch najczestszych serotypow zawartych w szczepionce – 14 (87,7%, 60,8–96,1) i 6B (82,8%, 23,8–96,1) oraz serotypowi 19A (82,2%, 10,7–96,4), związanemu z serotypem szczepionki 19F. Pojedyncza dawka szczepienia u dzieci w wieku 12–23 miesiecy, nieobjetych podstawowym cyklem szczepien, skutecznie zapobiegala chorobom wywolanym przez rodzaje bakterii zawarte w szczepionce (68,0%, 17,6–87,6). Nie wykazano skuteczności przeciwko serotypom pneumokokow niezawartych w szczepionce, zarowno po odpowiednim do wieku podstawowym cyklu szczepien, jak i po pojedynczym szczepieniu. Interpretacja Szczepionka PCV10 podawana w Brazylii w ramach rutynowego programu szczepien ochronnych zapobiega chorobom inwazyjnym wywolywanym przez serotypy pneumokokow zawarte w szczepionce. Podanie PCV10 moze wywolac tez ochrone krzyzową przeciwko niektorym serotypom związanym ze szczepionką.

In 2010, introduction of the meningococcal C conjugate vaccine in Brazil for children2 years provided an immediate reduction in the incidence rates of disease among the age groups targeted for the vaccine, but no early impact was observed in unvaccinated age groups. Knowledge about meningococcal carriage is crucial for improving our understanding of the disease epidemiology and for designing effective vaccination programs. Taking in account the very limited published data currently available describing meningococcal carriage in Brazil, we performed a study to evaluate the prevalence of Neisseria meningitidis carriage among adolescent students.A cross-sectional study was conducted in 2012 to assess the prevalence of meningococcal carriage among a representative sample of 1208 students 11-19 years of age in Campinas, Brazil. Genotypic and phenotypic characterization of isolated carriage strains and the effect of potential risk factors for carriage were also analyzed.The overall carriage prevalence was 9.9% (95% confidence interval, 8.3-11.8%), with dominance of serogroup C (1.32%), followed by serogroups B (0.99%), E (0.74%), Y (0.49%) and W (0.25%). A lower level of education of the parents was independently associated with a higher risk of carriage. A high diversity of genotypes was found among carriage strains.The evidence gathered during this study provides estimates of carriage prevalence in Brazilian adolescents, showing an unusually high dominance of serogroup C. These results have important implications in future strategies to optimize the impact of the current meningococcal C vaccination program in Brazil.

Proponer y poner a prueba un modelo para analizar el nivel de riesgo de reintroducción y transmisión del virus del sarampión que existe en los municipios durante el período posterior a la eliminación en la Región de las Américas.Se realizó un estudio ecológico y analítico empleando datos sobre la epidemia de sarampión que afectó al noreste del Brasil del 2013 al 2015. Las variables para el análisis se seleccionaron después de efectuar un amplio examen de las publicaciones científicas sobre el riesgo de importación de casos de sarampión. Se llevó a cabo un análisis con una sola variable considerando la presencia o ausencia de los casos de sarampión confirmados en 184 municipios del estado de Ceará (Brasil) para evaluar la asociación entre la variable dependiente y 23 variables independientes, que se agruparon en cuatro categorías: 1) características de los municipios; 2) indicadores de calidad de los programas de vacunación y la vigilancia epidemiológica; 3) estructura de organización de la respuesta de salud pública, y 4) indicadores del impacto seleccionados. Se consideró significativo un valor deEl modelo tenía una sensibilidad de 95% en el caso de la concordancia entre los municipios clasificados dentro de las categorías de “riesgo alto” y “riesgo muy alto” y los que tuvieron una epidemia entre el 2013 y el 2015 en Ceará. De los 38 municipios que tuvieron una epidemia, 76% (29/38) se clasificaron dentro de las categorías de “riesgo alto” y “riesgo muy alto”; 146 municipios no notificaron casos (Dado el riesgo inminente de reintroducción de la circulación del sarampión durante el período posterior a la eliminación en la Región de las Américas, este modelo puede ser útil para reconocer las zonas en las que existe un mayor riesgo de reintroducción y transmisión continua del sarampión. El conocimiento de las zonas vulnerables podría desembocar en actividades de vigilancia y seguimiento apropiadas para evitar la transmisión sostenida.Elaborar e testar um modelo para analisar o risco de reintrodução e transmissão do vírus do sarampo ao nível municipal no período pós-eliminação nas Américas.Um estudo analítico-ecológico foi realizado com base nos dados da epidemia de sarampo ocorrida em 2013–2015 no nordeste do Brasil. As variáveis para análise foram selecionadas após extensa revisão da literatura científica sobre o risco de importação de casos de sarampo. Uma análise univariada considerando a presença ou a ausência de casos confirmados de sarampo em 184 municípios no Estado do Ceará foi conduzida para avaliar a associação entre a variável dependente e 23 variáveis independentes divididas em quatro grupos: 1) características dos municípios, 2) indicadores de qualidade dos programas de vacinação e da vigilância epidemiológica, 3) estrutura organizacional para resposta em saúde pública e 4) indicadores de impacto selecionados. Um nível de significância de 5% foi definido. Todas as variáveis comA sensibilidade do modelo foi de 95% para concordância entre os municípios categorizados como “risco alto” e “risco muito alto” e os que registraram a ocorrência de epidemia entre 2013 e 2015 no Ceará. Dos 38 municípios onde ocorreu uma epidemia, 76% (29/38) apresentaram “risco alto” e “risco muito alto” de reintrodução e transmissão do vírus do sarampo e 146 municípios não notificaram casos (Diante do risco iminente de reintrodução da circulação do vírus do sarampo no período pós-eliminação nas Américas, este modelo pode servir para identificar as áreas de maior risco de reintrodução e transmissão contínua do vírus do sarampo. Conhecer as áreas vulneráveis incentiva a adoção de procedimentos adequados de vigilância e monitoramento a fim de prevenir a transmissão sustentada.

Polysaccharide vaccine did not affect carriage nor interrupt transmission of an epidemic strain., During 2010, outbreaks of serogroup C meningococcal (MenC) disease occurred in 2 oil refineries in São Paulo State, Brazil, leading to mass vaccination of employees at 1 refinery with a meningococcal polysaccharide A/C vaccine. A cross-sectional study was conducted to assess the prevalence of meningococci carriage among workers at both refineries and to investigate the effect of vaccination on and the risk factors for pharyngeal carriage of meningococci. Among the vaccinated and nonvaccinated workers, rates of overall meningococci carriage (21.4% and 21.6%, respectively) and of MenC carriage (6.3% and 4.9%, respectively) were similar. However, a MenC strain belonging to the sequence type103 complex predominated and was responsible for the increased incidence of meningococcal disease in Brazil. A low education level was associated with higher risk of meningococci carriage. Polysaccharide vaccination did not affect carriage or interrupt transmission of the epidemic strain. These findings will help inform future vaccination strategies.

The Global Meningococcal Initiative (GMI) is an international group of scientists and clinicians with expertise in meningococcal disease (MD). It promotes MD prevention through education and research. Given geographic differences in disease epidemiology, prevention strategies (e.g., vaccination) should be country-specific to ensure local needs are met. However, regional policies/recommendations and standardized disease diagnostic criteria should be implemented to improve surveillance and control strategies, and allow for more robust data comparisons. Consequently, the GMI convened a meeting with Latin American representatives to discuss the burden of MD and vaccination practices/policies, and consider if the global GMI recommendations could be tailored. The group determined that as robust, uniform epidemiologic data are required to make informed health-policy decisions, it would be useful to first summarize the regional situation herein (including disease surveillance, case definitions, epidemiology, vaccination and outbreak control strategies) and then determine a consensus-based meningococcal case definition for use throughout the region.

OBJETIVO: Avaliar a função sexual de mulheres após a menopausa com diagnóstico de síndrome metabólica. MÉTODOS: Estudo caso-controle, incluindo 195 mulheres após o período da menopausa (amenorreia ≥1 ano, FSH ≥30 mUI/mL e idade entre 43 a 69 anos), atendidas no Departamento de Obstetrícia e Ginecologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo e nas Unidades Básicas de Saúde do Programa de Saúde da Família da cidade de São Paulo. Foram coletados dados clínicos e avaliados o índice de massa corpórea e a circunferência abdominal. Na análise bioquímica foram solicitadas dosagens de colesterol total, HDL e LDL colesterol, triglicerídeos e glicemia de jejum. Foram consideradas com síndrome metabólica as mulheres que apresentaram três ou mais critérios diagnósticos: circunferência abdominal maior do que 88 cm; triglicerídeos ≥150 mg/dL; HDL colesterol 88 cm and triglycerides ≥150 mg/dL; cholesterol HDL

Introduction In March, 2006, oral rotavirus vaccine was added to Brazil's infant immunization schedule with recommended upper age limits for initiating (by age 14 weeks) and completing (by age 24 weeks) the two-dose series to minimize age-specific risk of intussusception following rotavirus vaccination. Several years after introduction, estimated coverage with rotavirus vaccine (83%) was lower compared to coverage for other recommended childhood immunizations (≥94%). Methods We analyzed data from Brazil's national immunization program on uptake of oral rotavirus vaccine by geographic region and compared administrative coverage estimates for first and second doses of oral rotavirus vaccine (Rota1 and Rota2) with first and second doses of diphtheria-tetanus-pertussis-Haemophilus influenzae type b vaccine (DTP-Hib1 and DTP-Hib2). For 27 Brazilian cities, we compared differences between estimated rotavirus and DTP-Hib coverage in 2010 with delayed receipt of DTP-Hib vaccine among a cohort of children surveyed before rotavirus introduction. Results In 2010, infant vaccination coverage was 99.0% for DTP-Hib1 versus 95.2% for Rota1 (3.8% difference), and 98.4% for DTP-Hib2 versus 83.0% for Rota2 (15.4% difference), with substantial regional variation. Differences between DTP-Hib and rotavirus vaccination coverage in Brazilian cities correlated with delay in DTP-Hib vaccination among children surveyed. Age restrictions for initiating and completing the rotavirus vaccination series likely contributed to lower coverage with rotavirus vaccine in Brazil. Conclusion To maximize benefits of rotavirus vaccination, strategies are needed to improve timeliness of routine immunizations; monitoring rotavirus vaccine uptake and intussusception risk is needed to guide further recommendations for rotavirus vaccination.

Neisseria meningitidis is a commensal bacterium of the human nasopharynx. In rare cases, it penetrates the mucosa, entering the blood stream and causing various forms of disease. Meningococcal conjugate vaccines can prevent invasive disease not only by direct effect in vaccinated individuals but also by herd protection, preventing acquisition of carriage, which interrupts transmission and leads to protection of unvaccinated persons. In 2010 in Salvador, Brazil, an outbreak of group C meningococcal disease led to a mass meningococcal serogroup C conjugate vaccination drive, targeting those

BACKGROUND Meningococcal C conjugate (MenC) vaccine was introduced as part of the Brazilian National Immunisation Program in 2010 for children < 1 year of age. OBJECTIVES The study objective was to evaluate the impact of this vaccination strategy. METHODS An observational, mixed ecological and analytical study was conducted, based on time series panel data from surveillance records (2001-2013). FINDINGS A total of 37,538 of meningococcal disease cases were recorded during the study period. Of these, 19,997 were attributed to serogroup C. A decrease in meningococcal disease serogroup C (MDC) incidence among children aged < 1 year [65.2%; 95% confidence interval (CI): 20.5-84.7%] and 1-4 years (46.9%; 95%CI: 14.6-79.1%) were found in the three years following vaccination introduction. Vaccination impact on the reduction of MDC incidence varied from 83.7% (95%CI: 51.1-100.0%) in the Midwest region to 56.7% (95%CI: 37.4-76.0%) in the Northeast region. MAIN CONCLUSIONS Vaccination against MDC in Brazil had a positive impact on the population of children aged < 1 year, across all regions, and on the 1-4 year-old cohort. Nevertheless, in our view there is scope for improving the vaccination strategy adopted in Brazil.

Introduction: Psychiatric disorders in childhood and adolescence are extremely prevalent, affecting approximately 1 in 10 Brazilian children. Child mental health affects all areas of development and impacts the physical and mental health of the family and in school performance, with its obvious consequences in adulthood. Objective: The objective was to evaluate the perception of quality of life of children and adolescents with mental disorders caregiver's. Methodology: There were participating 64 caregivers of children and adolescents with mental disorders who attend one capside at a city of Paraiba backlands. Data from samples were obtained through a socio demographic questionnaire and the quality of life questionnaire WHOQOL Bref. Data were analyzed using the statistical program Statistical Package for Social Sciences (SPSS). Results: The results showed that sixty (93.8%) caregivers were women, 27 (42.2%) completed high school, 40 (62.5%) were housewives, 31 (48.4%) were married , 46 (71.9%) were Catholic, 55 (85.9%) were mothers of children and adolescents and the overall score for quality of life WHOQOLBref ranged from 12.5 to 62.5 (mean = 43.9 ; SD = 12.0) and that the lowest average was found in the psychological domain (m = 40.1). Conclusion: At the end of it, the results of this study may influence on the availability of social support networks, on the creation of socio-sanitary laws, on the structure and adequacy of mental health services, since the health of children and adolescents depends on the caregiver health.

Introduction: Pertussis is an acute disease of the respiratory tract, has global distribution and occurs endemically with epidemic cycles every 2-5 years. It can occur at any time of year and at any stage of life, but mainly affects children under six months. It is observed the resurgence of the disease in Brazil even in places with high proportion of vaccine coverage. Objective: The research aimed to identify the epidemiological profile of pertussis in period from 2008 to 2014 in the municipalities linked to 6th Regional Management of Health from Paraiba. Method: The study is characterized as descriptive epidemiological from secondary data by a quantitative approach, it was used for data collection the database of 6 th GRS and SINAN. Results: The results show suspected cases reported in seven municipalities, higher incidence of female, white color and less than a year old, all cases in children under six months, with severe symptoms of the disease with a significant incidence of hospitalization in this age group. Conclusion: Pertussis is still present in the region, it is necessary to maintain high vaccination coverage, the survey suggests that the laboratory test be respected because more than half of the suspected cases did not perform and improve the quality of information from the appropriate filling of the plug notification.

Summary Objectives In emerging countries, pneumonia is a leading cause of hospitalization and death, particularly among the youngest and oldest. This retrospective study aimed to quantify the incidence of hospitalization due to all-cause pneumonia (HDTP) and in-hospital case fatality rates (CFRs) in all age groups, in five administrative regions of Brazil. Methods The International Classification of Diseases Tenth Revision coding for pneumonia (J12–J18) and an interactive web-based database of individuals covered by the Unified Health System in Brazil who were hospitalized from 2003 to 2007, were used to identify cases. In-hospital CFRs were the percentage of hospitalized cases that died. Results The overall HDTP incidence per 100 000 people of all ages decreased from 451 in 2003 to 388 in 2007. When categorized by age group, the HDTP incidence was lowest for those aged 5–49 years, and highest in children aged ≤4 years and adults aged ≥50 years. The in-hospital CFR increased from 2.89% in 2003 to 4.02% in 2007. Regional differences in HDTP incidence rates and in-hospital CFR were observed from 2003 to 2007. Conclusions As expected, the highest HDTP rates were observed in the very young and the elderly. Regional differences in hospitalization incidence rates and in-hospital CFRs were observed.

Household contacts are important sources of Bordetella pertussis in infants. A total of 353 household contacts of 97 index cases were evaluated for pertussis by culture and polymerase chain reaction. Twenty eight contacts were positive (8.0%). The presence of symptoms did not influence the rate of diagnosed bacteriologic pertussis in communicants. We conclude that contacts with an index case can be positive for B. pertussis independently of the presence of symptoms.

Background: Brazil implemented routine immunization with the human rotavirus vaccine, Rotarix, in 2006 and vaccination coverage reached 81% in 2008 in Sao Paulo. Our aim was to assess the impact of immunization on the incidence of severe rotavirus acute gastroenteritis (AGE). Methods: We performed a 5-year (2004-2008) prospective surveillance at a sentinel hospital in Sao Paulo, with routine testing for rotavirus in all children less than 5 years of age hospitalized with AGE. Genotypes of positive samples were determined by reverse transcription polymerase chain reaction. Results: During the study, 655 children hospitalized with AGE were enrolled; of whom 169 (25.8%) were positive for rotavirus. In the post-vaccine period, a 59% reduction in the number of hospitalizations of rotavirus AGE and a 42.2% (95% confidence interval [CI], 18.6%-59.0%; P = 0.001) reduction in the proportion of rotavirus-positive results among children younger than 5 years were observed, with the greatest decline among infants (69.2%; 95% CI, 24.7%-87.4%; P = 0.004). Furthermore, the number of all-cause hospitalizations for AGE was reduced by 29% among children aged

No Brasil, os Dias Nacionais de Vacinação (DNV) são realizados duas vezes ao ano para manter a eliminação da poliomielite e prover a vacinação de rotina para crianças menores de cinco anos. Poucos estudos examinam fatores associados à participação das crianças brasileiras nos Dias Nacionais de Vacinação ou a contribuição desses dias de vacinação para a cobertura com as vacinas recomendadas. MÉTODOS: Inquérito domiciliar com amostragem por conglomerados realizado nas 26 capitais e no Distrito Federal. Foram estudadas as datas de aplicação das vacinas, verificando-se a participação das crianças entre 19 e 35 meses de idade no DNV mais recente, ou o motivo alegado para não fazê-lo. Os dados obtidos foram cotejados com dados administrativos. RESULTADOS: Das 17.749 crianças incluídas no inquérito, 16.213 (91%) participaram no último DNV. Crianças que receberam vacinas no setor privado tiveram menor participação (84%) no DNV. Em 13 capitais, as estimativas de cobertura baseadas no número de doses aplicadas foram superiores às do inquérito. Entre as crianças que não participaram no último DNV, os principais motivos de não participação foram decisão dos pais, orientação médica, a criança estar doente e fatores associados com a organização do DNV. No total, 15% das crianças incluídas receberam pelo menos uma dose de vacina além da vacina oral contra poliomielite no último DNV, incluindo vacinas contra febre amarela, hepatite B, tríplice viral (sarampo-rubéola-caxumba) e difteria-tétano-pertussis-Haemophilus influenzae tipo b. CONCLUSÕES: Nas capitais brasileiras, os dias nacionais de vacinação continuam tendo altos níveis de participação da população e oferecem oportunidades para recuperação da cobertura vacinal. Os motivos para não comparecer aos DNV evidenciam a necessidade de se estudar estratégias diferenciadas de comunicação para incorporação destas crianças. In Brazil, National Immunization Days (NIDs) are held twice a year to maintain the elimination of poliomyelitis and to provide routine immunization for children younger than five years of age. Few studies have examined factors associated with participation in National Immunization Days among Brazilian children, or the contribution of immunization days to the coverage of recommended vaccines. METHODS: We conducted a household cluster survey in 26 state capitals and the Federal District among children aged 19 to 35 months. Vaccination histories, including dates of vaccination, participation in the most recent NID or reasons for non-participation were obtained. Survey estimates were compared with official estimates based on doses administered. RESULTS: Among the 17,749 children surveyed, 16,213 (91%) participated in the most recent NID. Children who received vaccination in the private sector had the lowest participation (84%) in NIDs. In 13 capitals, official coverage estimates were higher than those from the survey. The main reasons given for non-participation the most recent NID included parent's decision not to participate, doctor's advice, child's illness, and factors associated with the organization of the NID. Overall, 15% of the children surveyed had received at least one immunization in addition to oral polio vaccine in the most recent NID, including yellow fever, hepatitis B, measles-mumps-rubella (MMR) and combined diphtheria-tetanus-pertussis-Haemophilus influenzae type b vaccines. CONCLUSIONS: In Brazilian capitals, National Immunization Days continue to enjoy high levels of acceptance by the population and offer opportunities to complete recommended immunization schedules. Reasons for non-participation suggest the need for different communication strategies to reach parents who do not bring their children for vaccination on NIDs.

We conducted a multi-stage household cluster survey to calculate hepatitis B vaccine coverage among children 18–30 months of age in 27 Brazilian cities. Hepatitis B vaccine is administered at birth, 1 month and 6 months of age by Brazil's national immunization program. Among 17,749 children surveyed, 40.2% received a birth dose within one day of birth, 94.8% received at least one dose of hepatitis B vaccine, and 86.7% completed the three-dose series by 12 months of age. Increased coverage with the birth dose and administration of hepatitis B in combination with diphtheria–tetanus–pertussis– Haemophilus influenzae type b antigens could improve protection against hepatitis B.

Este estudo analisa o comportamento epidemiológico da doença meningocócica na cidade de São Paulo, Brasil, ao longo do século XX. Utilizando dados de prontuários, atestados de óbito e do sistema de vigilância epidemiológica os autores descrevem a tendência secular da doença, sua variação sazonal, a distribuição espacial e por idade e sexo. A tendência secular mostra incidência constante nos períodos endêmicos, interrompida pela presença de epidemias. As quatro epidemias registradas durante o século XX ocorreram em momentos de graves perturbações sociais e foram produzidas pelos sorogrupos A, A e C, e B e C. A variação sazonal com exacerbação no outono/inverno mantém-se constante durante todo o século. A distribuição espacial acompanha os deslocamentos da população pobre no espaço urbano. A distribuição por idade e sexo mantém-se inalterada em todos os períodos endêmicos, mostrando maior risco entre os menores de um ano e decréscimos acentuados à proporção que aumenta a idade. Os períodos epidêmicos, com exceção do último, mostram alteração significante na distribuição etária, com aumento do risco entre jovens e adultos jovens, e ocorrência de casos em todas as faixas etárias. This study analyzes the epidemiological behavior of meningococcal disease in the city of São Paulo, Brazil, over the course of the 20th century. Applying data from patient records, death certificates, and epidemiological surveillance, the authors describe trends in the disease throughout the century, seasonal variations, and incidence distribution by area, age, and gender. The temporal trends show constant incidence during endemic periods, interrupted by epidemic events. Four epidemic events during the last century occurred in circumstances of serious social disturbances and were caused by serogroups A (the first two), A and C, and B and C, respectively. Seasonal variations involved aggravation during autumn and winter throughout the entire century. Geographic distribution followed the displacement of the poor population in the urban territory. Age and gender distribution remained unaltered during all the endemic periods, showing an increased risk associated with younger age. The epidemic periods (except for the last) showed major alterations in age and gender distribution, with an increased risk among young people and youth adults and occurrence in all age brackets.

Despite almost universal use of measles vaccines in recent decades, epidemics of the disease continue to occur. Understanding the role of primary vaccine failure (failure to seroconvert after vaccination) and secondary vaccine failures (waning immunity after seroconversion) in measles epidemics is important for the evaluation of measles control programs in developing countries. After a measles epidemic in São Paulo, Brazil, 159 cases previously confirmed by detection of specific immunoglobulin M (IgM) antibodies were tested for IgG avidity, and a secondary immune response, defined by an IgG avidity index of at least 30%, was established in 30 of 159 (18.9%) patients. Among the 159 patients, 107 (67.3%) had not been vaccinated and 52 (32.7%) had received one or more doses of measles vaccine. Of the 107 unvaccinated patients, 104 (97.2%) showed a primary immune response, defined as an IgG avidity index of less than 30%. Among the 52 patients with documented vaccination, 25 (48.1%) showed a primary immune response and 27 (51.9%) showed a secondary immune response, thereby constituting a secondary vaccine failure. Primary vaccine failure was observed in 13 of 13 patients vaccinated prior to 1 year of age and in 43.5 and 12.5%, respectively, of patients receiving one or two doses after their first birthdays. These results provide evidence that measurement of IgG avidity can be used to distinguish between primary and secondary vaccine failures in vaccinated patients with measles; the method can also be a useful tool for the evaluation of measles control programs.

OBJECTIVE To characterize patients of primary health care services according to demographic and socioeconomic aspects, habits and lifestyle, health condition, and demand for health services and medicines. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services), a cross-sectional study carried out between 2014 and 2015. Interviews were conducted with patients over the age of 17 years, with a standardized questionnaire, in primary health care services of a representative sample of cities, stratified by regions of Brazil. The analysis was performed for complex samples and weighted according to the population size of each region. RESULTS A total of 8,676 patients were interviewed, being 75.8% women, most of them aged from 18 to 39 years; 24.2% men, most of them aged from 40 to 59 years; 53.7% with elementary school; 50.5% reported to be of mixed race ethnicity, 39.7%, white, and 7.8%, black. Half of patients were classified as class C and 24.8% received the Bolsa Familia benefit. Only 9.8% had health insurance, with higher proportion in the South and lower in the North and Midwest. The proportion of men who consumed alcohol was higher than among women, as well as smokers. The self-assessment of health showed that 57% believed it to be very good or good, with lower proportion in the Northeast. The prevalence of chronic diseases/conditions, such as hypertension (38.6%), dyslipidemia (22.7%), arthritis/rheumatism (19.4%), depression (18.5%), diabetes (13.6%), and others are higher in these patients them among the general population. Medicines were predominantly sought in the health care service or in pharmacies of the Brazilian Unified Health System. CONCLUSIONS It was possible to characterize the profile of patients of Primary Health Care, but the originality of the research and its national scope hinders the comparison of results with official data or other articles. RESUMO OBJETIVO Caracterizar os usuários dos serviços de atenção primária à Saúde segundo aspectos demográficos, socioeconômicos, hábitos e estilo de vida, condições de saúde referidas e demanda aos serviços de saúde e medicamentos. MÉTODOS Foram utilizados dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, um estudo transversal, exploratório, de natureza avaliativa, realizado entre 2014 e 2015. As entrevistas foram realizadas com usuários maiores de 17 anos, com questionário padronizado, em serviços de atenção primária de amostra representativa de municípios, estratificada pelas regiões do Brasil. A análise realizada foi para amostras complexas e ponderada de acordo com o tamanho da população de cada região. RESULTADOS No total foram entrevistados 8.676 usuários, sendo 75,8% mulheres, a maioria de 18 a 39 anos de idade; 24,2% homens, e entre estes, a maioria de 40 a 59 anos; 53,7% com ensino fundamental; 50,5% se autodeclararam pardo, 39,7% branco e 7,8% preto. Metade dos usuários foi classificada como classe C e 24,8% recebia bolsa-família. Apenas 9,8% possuía plano de saúde, com maior proporção no Sul e menor no Norte e no Centro-Oeste. A proporção de homens que consumia bebida alcóolica foi maior que entre mulheres, assim como os fumantes. A autoavaliação de saúde mostrou que 57% acreditavam ser muito boa ou boa, com menor proporção no Nordeste. As prevalências de doenças/condições crônicas como hipertensão (38,6%), dislipidemia (22,7%), artrites/reumatismo (19,4%), depressão (18,5%), diabetes (13,6%) e outras são maiores nesses usuários que na população geral. Os medicamentos eram predominantemente procurados no próprio serviço ou em farmácias do Sistema Único de Saúde. CONCLUSÕES Foi possível caracterizar o perfil dos usuários da Atenção Básica, mas o ineditismo da pesquisa e sua abrangência nacional dificulta a comparação dos resultados com dados oficiais ou de outros artigos.

BackgroundSince 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. The authors examined coverage with routine infant immunisations from a survey of Brazilian children according to socioeconomic stratum of residence census tract.MethodsThe authors conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the federal district. The authors calculated coverage with recommended vaccinations among children until 18 months of age, according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination.ResultsAmong 17 295 children with immunisation cards, 14 538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunised by 18 months of age versus 81.2%–86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (pConclusionsEvidence from Brazilian capitals shows success in achieving high immunisation coverage among poorer children. Strategies are needed to reach children in wealthier areas.

The prevalence of rubella antibodies was evaluated through a ramdom Seroepidemiological survey in 1400 blood samples of 2-14 year old children and in 329 samples of umbilical cord serum. Rubella IgG antibodies were detected by ELISA, and the sera were collected in 1987, five years before the mass vaccination campaign with measles-mumps-rubella vaccine carried out in the city of São Paulo in 1992. A significant increase in prevalence of rubella infection was observed after 6 years of age, and 77% of the individuals aged from 15 to 19 years had detectable rubella antibodies. However, the seroprevalence rose to 90.5% (171/189) in cord serum samples from children whose mothers were 20 to 29 years old, and reached 95.6% in newborns of mothers who were 30 to 34 years old, indicating that a large number of women are infected during childbearing years. This study confirms that rubella infection represents an important Public Health problem in São Paulo city. The data on the seroprevalence of rubella antibodies before the mass vaccination campaign reflects the baseline immunological status of this population before any intervention and should be used to design an adequate vaccination strategy and to assess the Seroepidemiological impact of this intervention.

Background. Few population-based studies of infectious etiologies of fever-rash illnesses have been conducted. This study reports on enhanced febrile-rash illness surveillance in Campinas, Brazil, a setting of low measles and rubella virus transmission. Methods. Cases of febrile-rash illnesses in individuals aged ,40 years that occurred during the period 1 May 2003–30 May 2004 were reported. Blood samples were collected for laboratory diagnostic confirmation, which included testing for adenovirus, dengue virus, Epstein-Barr virus (EBV), enterovirus, human herpes virus 6 (HHV6), measles virus, parvovirus-B19, Rickettsia rickettsii, rubella virus, and group A streptococci (GAS) infections. Notification rates were compared with the prestudy period. Results. A total of 1248 cases were notified, of which 519 (42%) had laboratory diagnosis. Of these, HHV-6 (312 cases), EBV (66 cases), parvovirus (30 cases), rubella virus (30 cases), and GAS (30 cases) were the most frequent causes of infection. Only 10 rubella cases met the rubella clinical case definition currently in use. Notification rates were higher during the study than in the prestudy period (181 vs 52.3 cases per 100,000 population aged ,40 years). Conclusions. Stimulating a passive surveillance system enhanced its sensitivity and resulted in additional rubella cases detected. In settings with rubella elimination goals, rubella testing may be considered for all cases of febrile-rash illness, regardless of suspected clinical diagnosis.

O presente artigo revisita inicialmente alguns dos elementos conceituais e operacionais sobre pesquisa avaliativa, em consonância com uma concepção ampliada de qualidade, reunindo saberes e campos de ação no âmbito das práticas de Saúde Pública. Em seguida, buscamos viabilizar o desenho de um modelo teórico tendo em vista a proposta de implementação das ações de vigilância da saúde, como na definição de uma imagem-objetivo da organização e integração das políticas e práticas de saúde sob uma lógica hierarquizada e regionalizada. Por fim, refletimos sobre os devires e desafios em torno da importância da teoria no campo da avaliação em saúde, produzindo saberes e abordagens para construção de modelos lógicos que relevem a complexidade dos objetos de intervenção e sua natureza de prática social transformadora. Initially this article revises some of the conceptual and operational elements on evaluative research by gathering knowledge and action fields on public health practices. Such concepts are taken according to a wider conception of quality. Then, the article intends to arrange a theoretical model design considering the proposition for implementation of health surveillance actionsAn image-objective definition of organization and integration of health polices and practices based on hierarchic and local logic also take place. Finally, becomings and challenges around the theory in the health evaluation field turn to be the aim of our reflection in order to enable the production of knowledge and approaches to construct logic models which reveals the complexity of interventionist objects as well as its transforming nature of social practices.

OBEJETIVO: Analisar a representatividade da amostra e a precisao das estimativas obtidas com o uso da metodologia por conglomerados (30 por 7) proposta pela Organizacao Mundial da Saude mediante sua aplicacao em inqueritos de cobertura vacinal realizados em Diadema e Sao Caetano do Sul, Estado de Sao Paulo, Brasil, em 2000. METODO:A representatividade das amostras foi avaliada atraves da comparacao entre os setores censitarios sorteados para os inqueritos e os demais setores nos dois municipios em termos de caracteristicas sociodemograficas (estrutura etaria da populacao, escolaridade, proporcao de familias chefiadas por mulheres, renda mensal do chefe de familia e condicoes de saneamento). A precisao das estimativas de cobertura pelas vacinas do esquema basico de vacinacao (BCG; difteria, coqueluche e tetano, ou DPT; poliomielite; hepatite B; sarampo; e sarampo, caxumba e rubeola, ou triplice viral) foi analisada atraves das medidas de efeito do desenho e amplitude dos intervalos de confianca. A precisao foi considerada como satisfatoria quando o efeito do desenho foi inferior a 2,0 e a amplitude dos intervalos de confianca foi inferior a 10%. RESULTADOS: Em ambos os municipios, a comparacao entre os setores sorteados e nao sorteados mostrou distribuicoes semelhantes para as variaveis socioeconomicas e demograficas. Quanto a precisao das estimativas, tanto em Diadema quanto em Sao Caetano do Sul o efeito do desenho foi inferior a 2,0 para todas as vacinas. Em Diadema, os intervalos de confianca foram inferiores a 10% para todas as vacinas, com excecao da triplice viral. Em Sao Caetano do Sul, como as criancas incluidas no inquerito representaram 89% da amostra prevista, a amplitude dos intervalos de confianca foi um pouco maior do que 10% para a vacina contra a poliomielite (10,3%), para a vacina contra o virus da hepatite B (11,8%), para a vacina contra o sarampo (10,4%), para a triplice viral (12,9%) e para o esquema completo (11,2%). CONCLUSAO: O metodo de inquerito de cobertura vacinal proposto pela Organizacao Mundial da Saude e capaz de fornecer dados representativos da populacao, desde que os procedimentos metodologicos de selecao da amostra sejam rigorosamente seguidos no campo.

INTRODUÇÃO: O declínio da morbi-mortalidade pelas gastroenterites é, em boa parte, responsável pela queda da mortalidade infantil e da mortalidade por doenças infecciosas nos países do terceiro mundo. Esse agravo ainda se destaca, nesses países, como importante problema de saúde pública, especialmente, entre os menores de 5 anos. OBJETIVOS: Descrever aspectos do comportamento das gastroenterites entre crianças menores de 5 anos, residentes em 5 bairros do Município de São Paulo. MATERIAL E MÉTODO: Estudou-se uma amostra probabilística (N = 468) de crianças menores de 5 anos, residentes em 5 áreas do Município de São Paulo, SP (Brasil), acompanhada durante um ano, por meio de entrevistas mensais. RESULTADOS: Durante o acompanhamento foram identificados 139 episódios de diarréia, com uma duração média de 5,5 dias, 10% dos casos prolongaram-se por 15 dias ou mais. Em 20% dos episódios havia ao menos outra pessoa na família com diarréia. A incidência foi de 2,78 casos por 100 crianças/mês, sendo mais elevada nos menores de 2 anos. Em 46,1% dos episódios de gastroenterite as crianças não demandaram assistência médica tendo sido tratadas pelas próprias mães, ou não receberam qualquer tratamento; em 51,8% dos episódios o atendimento foi feito em serviços de assistência primária à saúde e somente 2,1% dos casos necessitaram tratamento hospitalar. Nenhuma criança evoluiu para óbito. Entre as medidas terapêuticas mais utilizadas estão a reidratação oral (25,2%) e a antibioticoterapia associada à reidratação oral (11,5%); em somente 2 casos foi feita reidratação endovenosa. Alguns fatores socioeconômicos e antecedentes pessoais mostraram-se associados à ocorrência de diarréias, entre eles, as condições da habitação, saneamento básico e renda familiar "per capita" e história pregressa de diarréias freqüentes. DISCUSSÃO: Os resultados obtidos parecem refletir a tendência de diminuição da morbi-mortalidade por diarréias no Município de São Paulo, durante a década de 80, período em que houve acentuada queda nas internações hospitalares por essa causa. Tal tendência deve ser acompanhada atentamente, pois influenciará modificações nas características da demanda de assistência à saúde infantil. INTRODUCTION: The decrease morbi-mortality gastroenteritis in is related to the factor responsible largely for the fall in infant mortality and mortality from communicable diseases in developing countries. Nevertheless, diarrhea is still a considerable public health problem in these countries, especially among children under 5 years old. OBJECTIVES: To describe some aspects of the of gastroenteritis epidemiology among children up to 5 years old, resident in areas of S. Paulo county. MATERIAL AND METHOD: A probabilistic sample of children up to 5 years old was studied (n=468). The epidemiological survey was undertaken in five areas S. Paulo county (Brazil) from March 1986 to May 1987. Data were obtained through household interviews once a month over a year. RESULTS: During the follow-up 139 diarrhea episodes were registered, with a mean duration of 5.5 days. Twenty percent of the diarrhea events were followed by at least one other case in the household. The incidence of gastroenteritis was 2.78 episodes per 100 children/month. The highest incidence affected the children of up to 2 years of age. In 46.1% of the gastroenteritis episodes medical assistance was not sought, the children were treated by their mothers or not at all; 51.8% of the diarrhea events were attended to by the primary health care service, and only 2.1% were attended to by a hospital. No child died as a consequence of diarrhea. Of the therapeutical interventions used the most frequent were oral rehydration (25.2%) and oral rehydration with antibiotics (11.5%). Various socio-economic and personal background factors such as living conditions, water supply, sewarage, coverage; family income per capita and prior history of frequent gastroenteritis were associated with a higher incidence of gastroenteritis. DISCUSSION: The results seen to reflect the tendency of morbi-mortality by gastroenteritis to decrease in S. Paulo county during the 1980's when hospital treatment of diarrhea presented a considerable reduction. This tendency must be observed closely, because it will influence the changes to be mode in the kind of demand for medical care.

Rubella is a viral infection which causes a mild disease. Teratogenic effects do however occur in 20-50% of children born to women during the first trimester of pregnancy. The goal of rubella vaccination should therefore be to prevent the adverse effects of congenital rubella syndrome caused by intrauterine rubella infection. A major vaccination strategy against measles-mumps-rubella was introduced in 1992 in the state of Sao Paulo Brazil based upon mathematical models and comprised of a pulse vaccination covering all children aged 1-10 years followed by the inclusion of the vaccine in the routine calendar at 15 months of age. This paper reports the evaluation of the efficacy of this mixed vaccination strategy. A rubella seroprevalence survey was conducted on 4953 children aged 1-15 years immediately and one year after the campaign showing the average rubella seroprevalence to have increased from 0.40 to 0.97 over the period. There was a commensurately dramatic drop in the reported number of congenital rubella syndrome cases.

A controlled trial was performed with the purpose of investigating which factors could be considered of significant risk for the development of basal cell carcinoma. A total of 259 cases of basal cell carcinoma diagnosed from July 1991 to July 1992 were compared with 518 controls matched for age and sex. All subjects in both groups were white. Protocol data were submitted to statistical analysis by the chi-square test and by multiple conditional logistic regression analysis and the following conclusions were reached: 1) light skin color (types I and II of the Fitzpatrick classification), odds ratio of 2.8; outdoor work under constant sunlight, odds ratio of 5.0; the presence of actinic lesions due to exposure to the sun, odds ratio of 4.9, are risk factors perse. 2) Type III skin in the Fitzpatrick classification only represents a risk factor when the patient reports a history of intense sunburns, but not in the absence of such a history. 3) Sunburns per se do not represent a risk factor althorig the point made in item 2 of these conclusions is valid. 4) Other suspected risk factors whose significance was not confirmed by multiple conditioned logistic regression analysis were: residence in rural areas, light eyes and blond hair color, extent of the awareness of the "sun x skin cancer" relationship, familial occurrence of skin cancer, excessive exposure to the sun, and freckles appearing in childhood.Realizou-se estudo controlado para investigar quais os fatores de risco, para o desenvolvimento do carcinoma basocelular, são significantes. Foram utilizados 259 casos de carcinoma basocelular (diagnosticados entre julho de 1991 e julho de 1992) e 518 controles, pareados segundo sexo e idade. Submetidos os dados constantes do protocolo à análise estatística (Qui-quadrado e Regressão Logística Múltipla Condicional), foi possível obter as seguintes conclusões na população estudada: 1 - Representam fatores de risco, por si só: - as peles claras de tipo l e II de Fitzpatrick; - a atividade profissional desenvolvida sob exposição constante à luz solar (atividade agropecuária); - a presença de alterações cutâneas decorrentes da exposição crônica à radiação solar. 2 - A pele do tipo III, na classificação de Fitzpatrick, representa fator de risco somente quando há história anterior de queimaduras solares intensas; já em ausência destas queimaduras anteriores, a pele do tipo III passa para o grupo de não-risco. 3 - Os fatores de risco assinalados puderam ser incluídos na equação logarítimica que expressa o Modelo Logístico de Probabilidade de Doença: 1,6041.x1 + 1,5938.x2 + 1,0208.x3 onde x1 é a atividade agropecuária, x2 são as alterações actínicas de pele e x3 o tipo de pele. 4 - Queimaduras solares não representam fator de risco, embora seja válida a ressalva feita no item 2, destas conclusões. 5 - Os outros fatores suspeitos de risco e não confirmados pela Análise de Regressão Logística Múltipla Condicional foram: residência em área rural, olhos e cabelos claros, nível de informação sobre a relação sol X câncer de pele, história familiar de câncer de pele, exposição solar intensa e aparecimento de efélides na infância.