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ABSTRACT Objective To characterize the use of private services in infant vaccination and assess vaccination coverage according to the service used. Methods : This was a national vaccination survey conducted in 2020 that estimated the use of private vaccination services and vaccination coverage among infants residing in state capitals and 12 inland municipalities. Results : Of the 37,801 participants, 25.1% (95%CI 23.2;27.2) used private services at least once, with higher proportions in capitals, larger cities and in the South and Southeast regions. Socioeconomic and demographic differences were identified among families, based on the service used. The coverage for the set of vaccines administered up to 24 months was 60.3% (95%CI 58.6;62.0) in the public service and 59.5% (95%CI 55.9;63.0) in private services, and up-to-date vaccines, 10.3% (95%CI 9.1;11.6) and 9.4% (95%CI 7.4;11.8), respectively. Conclusion The use of private services was frequent, with low coverage for the set of vaccines, regardless of the type of service used, especially for up-to-date vaccines.

ABSTRACT Objective To estimate vaccination coverage, identify barriers and hesitancy to vaccinating children up to 24 months, born between 2017-2018, living in the urban area of Rio Branco, Acre, Brazil. Methods Population survey carried out from 2020 to 2021, which assessed sociodemographic characteristics and vaccination status among children. Results Among 451 included children, vaccination coverage was below 80%. Meningococcal C vaccine had the lowest coverage for administered doses (76.3%; 95%CI 70.5;81.3) and doses on time (27.4%; 95%CI 23.1;32.1). The statements “vaccines cause serious adverse reactions” (26.4%; 95%CI 18.1;36.8) and “you don’t need vaccination for diseases that no longer exist” (22%; 95%CI 15.7;29.8) were the most frequent regarding vaccination hesitancy. Lack of vaccines was the main barrier to care (86.6%; 95%CI 71.8;94.3). Conclusion Vaccination coverage in children born in 2017-2018 was below the target recommended for the full schedule of administered doses, both valid and timely administered.

ABSTRACT Objective To analyze full vaccination coverage in live births in 2017 and 2018 in the capitals of the Midwest region of Brazil, according to social strata. Methods Population-based household survey with cluster sampling. Full coverage in children at 12 and 24 months of age and sociodemographic factors were analyzed. Results 5,715 children were analyzed. Full coverage at 12 months of age was 67.9% (95%CI 65.4;70.4), while at 24 months it was 48.2% (95%CI 45.3;51.1). Pneumococcal vaccine had the highest vaccination coverage (91.3%), while the second dose of rotavirus vaccine had the lowest (74.2%). In Campo Grande, no vaccine reached coverage above 90%, with BCG (82.9%) and hepatitis B (82.1%) standing out. Campo Grande and Brasília had the worst vaccination coverage in the high social stratum (24 months of age). Conclusion Vaccination coverage in the Midwest was below 80%, falling short of the recommended target and associated with socioeconomic factors.

ABSTRACT Objective To estimate vaccination coverage and analyze sociodemographic factors associated with non-vaccination in children born in 2017 and 2018 in the state capitals of Northeast Brazil. Methods A household survey using cluster sampling was conducted from 2020-2022 to estimate vaccination coverage and hesitancy. Factors associated with non-vaccination were analyzed using logistic regression to calculate Odds Ratios (OR) and their Confidence Intervals (95%CI). Results Natal was the capital with the lowest vaccination coverage, below 75.0% for most immunizers. Teresina had rates equal to or greater than 90.0% for all vaccines. Among those interviewed, 99.1% (95%CI 98.9;99.3) believe that vaccines are important for health; 95.4% (95%CI 95.0;95.8) trust immunobiologicals and 79.6% (95%CI% 78.8;80.3) are not afraid of reactions. Belonging to the highest socioeconomic stratum (adjusted OR: 1.34 – 95%CI 1.20;1.50) was as a factor associated with non-vaccination. Conclusion Low coverage highlights the need for a better understanding of regional specificities and social inequalities.

ABSTRACT Objective To estimate vaccination coverage in children born between 2017-2018, living in urban areas of state capitals, the Federal District and 12 inland municipalities in Brazil, and to identify associated factors. Methods This was a household survey conducted between 2020-2022, among children up to 24 months old. Vaccination coverage was estimated according to family, maternal and child characteristics. Results Among the 37,801 children in the sample, complete coverage (doses administered) was 60.1% (95%CI 58.6;61.6) and 6.1% (95%CI 5.4;7.0) had not received any vaccines. Coverage was lower among children of mothers with lower level of education (OR = 0.70; 95%CI 0.54;0.90) and in those who experienced delays in receiving any vaccine by 6 months old (OR = 0.28; 95%CI 0.24;0.32). Conclusion Vaccination coverage is below the expected levels. Effective communication strategies are needed to reinforce the importance of routine vaccination, prevent delays and abandonment of the vaccination schedule, in order to recover the high coverage levels achieved in past decades.

Introdução: A principal estratégia para a prevenção das formas graves de tuberculose é a vacinação com a BCG o mais precocemente possível nos recém-nascidos. Objetivo: Analisar a tendência temporal das coberturas vacinais (CV) da BCG em Campinas, de 2010 a 2022, com dados Sistema de Informação do Programa Nacional de Imunização (SI-PNI) e compará-las com dados do Inquérito de Cobertura Vacinal de Campinas de crianças nascidas em 2017 e 2018. Estas CVs foram analisadas segundo variáveis socioeconômicas e características da mãe e da criança imunizada, a fim de identificar grupos menos aderentes à vacinação. Método: Estudo ecológico de série temporal das CVs anuais obtidas no SI-PNI. As CVs obtidas no Inquérito de Campinas (n = 1775) de 2017 e 2018 foram comparadas com as do SI-PNI. Foram estudadas as variáveis do Inquérito associadas ao acesso à vacina, entre elas: estratos socioeconômicos, vacinação em serviço público ou privado, dados da mãe (idade, raça/cor referida, escolaridade e estado civil) e da criança (frequência em creches e ordem de nascimento). A comparação das CVs (SI-PNI e Inquérito) e das proporções obtidas das variáveis (vacinados - não vacinados) foi realizada por meio do teste qui-quadrado de Pearson e considerando-se significância se p ≥ 0,05. Resultados: A tendência temporal da CV da BCG esteve acima da meta de 90% em Campinas até 2017, entretanto, de 2018 a 2021, ficou abaixo do esperado, invertendo a tendência em 2022. Ao analisar os dados do Inquérito nota-se que a CV da BCG de 91,04% foi menor que as registradas no SI-PNI (101,51%) em 2017-18. Crianças em creches apresentaram maiores CV da BCG (93,4%) que as não frequentadoras (87,1%) (p = 0,05). As demais variáveis relacionadas à mãe e à criança não mostraram associação com o status vacinal. As CV da BCG nos estratos A (mais ricos), B, C e D (mais pobres) foram respectivamente, 88,35%, 88,64%, 93,45% e 92,47%. Conclusão: Reforça-se a necessidade de estratégias para manutenção da CV da BCG no primeiro mês de vida, particularmente nas classes mais ricas. Nota-se ainda discordância entre as CV registradas no SI-PNI e no Inquérito. A creche mostra-se um local estratégico para o monitoramento das CV em crianças.

ABSTRACT Objective To analyze vaccination coverage according to social strata in children up to 24 months old, living in the municipality of Londrina (PR), Brazil. Methods This was a population-based survey conducted between 2021 and 2022, in which vaccination coverage and sociodemographic aspects of mothers and families were evaluated using Pearson’s chi-square test. Results In a sample of 456 children, complete vaccination coverage varied according to social strata, being 36.0% (95%CI 26.8;57.8); in stratum A; 59.5% (95%CI 26.1;86); in stratum B; 66.2% (95%CI 51.7;78.1); in stratum C; and 70.0% (95%CI 56.1;81.0) in stratum D. Conclusion The analysis of vaccination coverage indicated that social stratum A is at highest risk for vaccine-preventable diseases.

ABSTRACT Objective To estimate hepatitis A vaccination coverage in 24-month-old children and identify factors associated with non-vaccination. Methods This was a survey involving a sample stratified by socioeconomic strata in capital cities (2020-2022), with coverage estimates and 95% confidence intervals (95%CI), the factor analysis was performed using the prevalence ratio (PR) by means of Poisson regression. Results Among 31,001 children, hepatitis A coverage was 88.1% (95%CI 86.8;89.2). Regarding socioeconomic strata (A/B), the variable immigrant parents/guardians was associated with non-vaccination (PR = 1.91; 95%CI 1.09;3.37); in strata C/D, children of Asian race/skin color (PR = 4.69; 95%CI 2.30;9.57), fourth-born child or later (PR = 1.68; 95%CI 1.06;2 .66), not attending daycare/nursery (PR = 1.67; 95%CI 1.24;2.24) and mother with paid work (PR = 1.42; 95%CI 1.16;1.74) were associated with non-vaccination. Conclusion Hepatitis A coverage was below the target (95%), suggesting that specificities of social strata should be taken into consideration.

ABSTRACT Objective To analyze the reliability of records held on the National Immunization Program Information System (SI-PNI) in a subsample of children included in the national vaccination coverage survey in Brazilian state capitals and Federal District in 2020. Methods This was a study of agreement between data recorded on vaccination cards (doses and dates) and on the SI-PNI for 4050 children with full coverage at 24 months. Results Data on 3587 children were held on the SI-PNI, with losses of 11% (95%CI: 10;12). Total agreement between doses and dates in the two sources was 86% (95%CI: 86;87), however taking each dose and vaccine individually, variation was greater, with 32% of data in only one source. Conclusion Part of the information was not recorded, but the discrepancy can be considered small. Nonetheless, underrecording of doses and children can compromise vaccination coverage estimates, altering the numerator and denominator data.

ABSTRACT Objective To evaluate vaccination coverage and delay in vaccine dose administration in infants in six municipalities in the Southern region of Brazil. Methodology National Vaccination Coverage Survey 2020, with infants born alive in 2017 and 2018, carried out from September 2020 to March 2022. Coverage of doses administered, doses administered on time and delay in dose administration were evaluated. Results For 4681 infants analyzed, coverage for vaccines recommended up to 24 months was 68.0% (95%CI 63.9;71.8%) for doses administered and 3.9% (95%CI 2.7%;5.7%) for doses administered on time. Delay time for the majority of late vaccinations was ≤ 3 months. For some boosters, 25% of vaccine administration was delayed by ≥ 6 months. Conclusion In addition to tracking vaccine defaulters, strategies are needed to encourage compliance with the vaccination schedule at the recommended ages.

ABSTRACT Objective To describe vaccination coverage and hesitation for the basic children’s schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. Methods Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. Results Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. Conclusion Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities.

ABSTRACT Objective To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Methods Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. Results 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. Conclusion There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil.

Despite the introduction of the pneumococcal vaccine, Streptococcus pneumoniae remains a cause of invasive diseases in Brazil. This study provides the distribution of serotypes and antimicrobial susceptibility patterns for pneumococcal isolates before and during the years of the COVID-19 pandemic in two age groups, S. pneumoniae from the pre-COVID-19 (January 2016 to January 2020) and COVID-19 (February 2020 to May 2022) periods. Antimicrobial resistance was evaluated by disk diffusion and minimum inhibitory concentration. The year 2020 was marked by a 44.6% reduction in isolates received and was followed by an upward trend from 2021 onwards, which became evident in 2022. No differences were observed in serotypes distribution between the studied periods. The COVID-19 period was marked by the high prevalence of serotypes 19A, 3, and 6C in both age groups. Serotypes 19A and 6C were related to non-antimicrobial susceptibility. We observed a reduction in S. pneumoniae, without changes in serotypes distribution and epidemiological capsular switch during the COVID-19 period. We observed elevated resistance rates, mainly to penicillin and ceftriaxone for non-meningitis cases in children under 5 years of age.

ABSTRACT Objective: The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. Methods: A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. Results: Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. Conclusion: There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.

Objective: To evaluate the behavior of VCR and VCH, per municipality and per vaccines offered at the NVC, to identify priority areas for intervention. Methods: Descriptive study of a time series, using secondary data and accompanied by a narrative review of the literature evaluating VCR and VCH. Vaccines offered to children under one year and to those aged one year in the pre-pandemic period of COVID-19 (2015 to 2019) were selected and compared to those offered during the pandemic period (2020 and 2021). Results and discussions: The decrease in VCR and VCH is a process that precedes the COVID-19 pandemic but was intensified during this period. In 2021, the VCR was around 70% for most vaccines. This phenomenon encompasses the entire country; however, it is more intense in the states/municipalities located in the north and northeast regions, suggesting greater difficulty in accessing health services. Conclusions: Low and heterogeneous VCR requires the adoption of practices that were previously implemented, establishing partnerships with governmental and non-governmental institutions, with adequate communication, active search for non-compliance and non-adherence to the regular vaccination program, adopting intra- and extramural vaccination strategies, to reverse the current situation and reduce the risk of recurrence of diseases that have been already controlled and eliminated.

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.

Summary: Background: The Brazilian state of Paraná 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 neighbourhood 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 was 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 seroprevalence 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.

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. By maintaining the minimum stock of vaccines under a given production rate, we evaluate the dose interval 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 vaccinate the second dose as soon as possible, while for high first-dose efficacy, the best strategy of time 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 best 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.

Universal immunization against hepatitis B has contributed to reducing incidence of the disease, but older individuals remain susceptible to acquiring the hepatitis B virus worldwide. Thus, this study aimed to investigate the epidemiology of HBV infection in individuals aged 50 years and over in central Brazil and to evaluate the immunogenicity of the monovalent vaccine against hepatitis B in this age group using two vaccine regimens. Method: Initially, a cross-sectional and analytical study was carried out to investigate the epidemiology of hepatitis B. Then, individuals without proof of vaccination for hepatitis B were recruited for a phase IV randomized and controlled clinical trial using two vaccine regimens: Intervention Regimen (IR) (three doses of 40 μg at months 0, 1 and 6) vs. Comparison Regimen (CR) (three doses of 20 μg at months 0, 1 and 6). Results: The overall prevalence of exposure to HBV was 16.6% (95% CI: 14.0%–9.5%). In the clinical trial, statistical differences in protective titers were observed (p = 0.007; IR 96% vs. CR 86%) and the geometric mean of anti-HBs titers was higher in individuals who received the IR (518.2 mIU/mL vs. 260.2 mIU/mL). In addition, the proportion of high responders was higher among those who received the IR (65.3%). Conclusion: reinforced doses should be used in individuals aged 50 years or older to overcome the lower efficacy of the vaccine against hepatitis B.

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

ABSTRACT 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.

Characterization of meningococci isolated from the pharynx is essential towards understanding the dynamics of meningococcal carriage and disease. Meningococcal isolates, collected from adolescents resident in Salvador, Brazil during 2014, were characterized by multilocus sequence typing, genotyping or whole-genome sequencing. Most were nongroupable (61.0%), followed by genogroups B (11.9%) and Y (8.5%). We identified 34 different sequence types (STs), eight were new STs, distributed among 14 clonal complexes (cc), cc1136 represented 20.3% of the nongroupable isolates. The porA and fetA genotypes included P1.18,25-37 (11.9%), P1.18-1,3 (10.2%); F5-5 (23.7%), F4-66 (16.9%) and F1-7 (13.6%). The porB class 3 protein and the fHbp subfamily A (variants 2 and 3) genotypes were found in 93.0 and 71.0% of the isolates, respectively. NHBA was present in all isolates, and while most lacked NadA (94.9%), we detected the hyperinvasive lineages B:P1.19,15:F5-1:ST-639 (cc32); C:P1.22,14-6:F3-9:ST-3780 (cc103) and W:P1.5,2:F1-1:ST-11 (cc11). This is the first report on the genetic diversity and vaccine antigen prevalence among N. meningitidis carriage isolates in the Northeast of Brazil. This study highlights the need for ongoing characterization of meningococcal isolates following the introduction of vaccines and for determining public health intervention strategies.

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

OBJETIVO: Avaliar a imunogenicidade e segurança da vacina contra hepatite B, após o aumento na concentração do antígeno HBsAg para 25 μg, em comparação à vacina de referência. MÉTODOS: Ensaio com alocação aleatória e mascaramento simples, comparando a VrHB-IB (Instituto Butantan) com a vacina de referência (Engerix B®, Glaxo Smith Kline). Os voluntários, entre 31 e 40 anos de idade (n=419), foram alocados aleatoriamente ao grupo experimental (n=216) ou ao grupo controle (n=203), e receberam três doses de vacina. A primeira dose foi administrada no momento do recrutamento, a segunda e terceira 30 e 180 dias depois respectivamente, entre 2004 e 2005. Amostras de sangue foram colhidas para análise sorológica antes da randomização, e após a segunda e terceira doses. Foi realizada a vigilância ativa de eventos adversos durante os cinco primeiros dias após a vacinação. As diferenças foram avaliadas pelos testes do qui-quadrado e exato de Fisher, com nível de significância de 5%. RESULTADOS: Não se observaram eventos adversos graves. A soroporteção foi confirmada em 98,6% (213/216) dos voluntários do grupo experimental, em comparação a 95,6% (194/203) do grupo controle. Os títulos geométricos médios foram de 12.557 e 11.673, respectivamente. CONCLUSÕES: A vacina brasileira foi considerada equivalente à vacina de referência e seu uso recomendado para adultos.OBJETIVO: Evaluar la inmunogenicidad y seguridad de la vacuna contra hepatitis B, posterior al aumento en la concentración del antígeno HBsAg para 25mg, en comparación a la vacuna de referencia. MÉTODOS: Ensayo con distribución aleatoria y enmascaramiento simple, comparando la VrHB-IB (Instituto Butantan) con la vacuna de referencia (Engerix BÒ, Glaxo Smith Kline). Los voluntarios, entre 31 y 40 años de edad (n=419), fueron distribuidos aleatoriamente en el grupo experimental (n=216) o en el grupo control (n=203), y recibieron tres dosis de la vacuna. La primera dosis fue administrada en el momento del reclutamiento, la segunda y tercera 30 y 180 días después respectivamente, entre 2004 y 2005. Muestras de sangre fueron colectadas para análisis sexológico antes de la aleatorización, y posterior a la segunda y tercera dosis. Fue realizada la vigilancia activa de eventos adversos durante los cinco primero días posterior a la vacunación. Las diferencias fueron evaluadas por las pruebas de chi-cuadrado y exacto de Fisher, con nivel de significancia de 5%. RESULTADOS: No se observaron eventos adversos graves. La seroprotección fue confirmada en 98,6% (213/216) de los voluntarios del grupo experimental, en comparación a 95,6% (194/203) del grupo control. Los títulos geométricos promedios fueron de 12.557 y 11.673, respectivamente. CONCLUSIONES: La vacuna brasilera fue considerada equivalente a la vacuna de referencia y su uso recomendado para adultos.OBJECTIVE: To evaluate the immunogenicity and safety of a novel hepatitis B vaccine, after increasing antigen concentration to 25 μg, in comparison to the reference vaccine. METHODS: Single-blinded randomized trial comparing VrHB-IB (Instituto Butantan) and the reference vaccine (Engerix B®, Glaxo Smith Kline). Volunteers aged 31 to 40 years were randomized to either experimental (n=216) or control (n=203) groups, and were given three doses of vaccine. The first dose was administered upon recruitment, and the second and third doses 30 and 180 days later, respectively, between 2004 and 2005. Blood samples were collected for analysis before randomization and after the second and third doses. Active search for adverse effects was perforned in the first five days after vaccination. Differences were evaluated using chi-square and Fisher's exact tests, with a 5% significance level. RESULTS: No severe adverse effects were observed. Seroprotection was confirmed in 98.6% (213/216) of volunteers in the experimental group and 95.6% (194/203) of those in the control group. Geometric mean titers were 12,557 and 11,673, respectively. CONCLUSIONS: The Brazilian vaccine was considered to be equivalent to the reference vaccine and its use is recommended for adults.

OBJETIVO: Analisar a eficácia e segurança de vacina recombinante contra hepatite B em recém-nascidos. MÉTODOS: O estudo foi conduzido em hospital geral do município de Guarulhos, SP, entre 2002 e 2005. A vacina recombinante contra hepatite B do Instituto Butantan (VrHB-IB) foi analisada em dois ensaios clínicos. Em ambos os ensaios, os recém-nascidos foram alocados aleatoriamente ao grupo experimental ou controle (vacina de referência). Os recém-nascidos receberam três doses das vacinas, uma em até 24 h após o nascimento e as subseqüentes 30 e 180 dias após. No primeiro ensaio 538 recém-nascidos completaram o protocolo e no segundo ensaio, 486. Considerou-se critério de equivalência a diferença na soroproteção inferior a 5%. RESULTADOS: A soroproteção no primeiro ensaio (anti HBs > 10mUI/ml) foi de 92,5% (247/267) no grupo experimental, comparada a 98,5% (267/271) no grupo controle (p = 0,001). Com este resultado, a VrHB-IB não atingiu o critério de equivalência estabelecido. Após o aumento da concentração de antígeno na vacina para 25¼g, a soroproteção no segundo ensaio foi de 100% no grupo experimental e 99,2% no grupo controle. Nenhum evento adverso grave foi registrado. CONCLUSÕES: A vacina VrHB-IB modificada foi considerada equivalente à vacina de referência e seu uso recomendado à vacinação de recém-nascidos.OBJETIVO: Analizar la eficiencia y seguridad de vacuna recombinante contra hepatitis B en recién-nacidos. MÉTODOS: El estudio fue conducido en hospital general del municipio de Guarulhos, Sureste de Brasil, entre 2002 y 2005. La vacuna recombinante contra hepatitis B del Instituto Butantan (VrHB-IB) fue analizada en dos ensayos clínicos. En ambos ensayos, los recién-nacidos fueron distribuidos aleatoriamente en el grupo experimental o control (vacuna de referencia). Los recién-nacidos recibieron tres dosis de las vacunas, una en máximo 24 h posterior al nacimiento y las subsecuentes 30 y 180 días posteriores. En el primer ensayo 538 recién-nacidos completaron el protocolo y en el segundo ensayo, 486. Se consideró criterio de equivalencia la diferencia en la seroprotección inferior a 5%. RESULTADOS: La seroprotección en el primer ensayo (anti HBs ³ 10mUI/mL) fue de 92,5% (247/267) en el grupo experimental, comparada con 98,5% (267/271) en el grupo control (p=0,001). Con este resultado, la VrHB-IB no alcanzó el criterio de equivalencia establecido. Posterior al aumento de la concentración del antígeno en la vacuna a 25mg, la seroprotección en el segundo ensayo fue de 100% en el grupo experimental y 99,2% en el grupo control. Ningún evento adverso grave fue registrado. CONCLUSIONES: La vacuna VrHB-IB modificada fue considerada equivalente a la vacuna de referencia y su uso recomendado en la vacunación de recién-nacidos.OBJECTIVE: To analyze the efficacy and safety of a recombinant Hepatitis B vaccine in newborns. METHODS: The study was carried out in a general hospital in the city of Guarulhos, Southeastern Brazil, between 2002 and 2005. The recombinant Hepatitis B vaccine from Instituto Butantan (VrHB-IB) was tested in two clinical trials. In both trials, newborns were randomly allocated to the experimental or control (reference vaccine) groups. Newborns were given three doses of vaccine, one up to 24 hours after birth and the other two 30 and 180 days later. In the first trial, 538 newborns completed the immunization protocol, and 486 in the second. Vaccines were considered equivalent when seroprotection difference was below 5%. RESULTS: Seroprotection in the first trial (anti-HBs > 10mUI/ml) was 92.5% (247/267) in the experimental group, compared to 98.5% (267/271) in the control (p = 0.001). With this result, VrHB-IB did not fulfill the pre-established criterion for equivalence. After increasing the concentration of antigen in the vaccine to 25¼g, seroprotection reached 100% in the experimental group and 99.2% in the control. No severe adverse effects were recorded. CONCLUSIONS: The reformulated VrHB-IB is considered equivalent to the reference vaccine, and its use is recommended in newborns.

Para assegurar a eficácia das vacinas utilizadas no Programa de Imunização é fundamental a manutenção da rede de frio. Este estudo tem o objetivo de avaliar o conhecimento e a prática adotados na conservação das vacinas nas unidades públicas do município de São Paulo. Foram enviados formulários a 390 salas com atividades de rotina e 80 foram selecionadas para uma entrevista com um profissional e observação do refrigerador. Um indicador foi construído para sintetizar os resultados, mediante a atribuição de pontos a itens comuns dos instrumentos utilizados, estabelecendo-se a classificação arbitrária de conhecimento/cumprimento SUFICIENTE, REGULAR e INSUFICIENTE. Sessenta por cento das unidades responderam o formulário, 80 salas foram visitadas e 90 refrigeradores foram observados. Resultados SUFICIENTES foram obtidos por 66% das observações, 55% das entrevistas e 53% dos formulários. O treinamento em sala de vacina influenciou positivamente a maior pontuação das observações. A concordância entre os instrumentos foi baixa, proporcionando a reflexão sobre a maneira como as informações da conservação de vacinas são transmitidas e a necessidade da supervisão sistemática para correção das falhas detectadas.The cold chain is essential to assure the efficacy of the vaccines used in immunization programs. This study aimed to assess the knowledge and the practice adopted in vaccine storage in public units of the city of São Paulo. Forms were sent to 390 health units with custom activities, and 80 were selected for a visit and an interview with a health worker and for observation of the refrigerator. An indicator was built to summarize results, and scores were given to common items of the tools utilized, establishing an arbitrary classification of SUFFICIENT, REGULAR and INSUFFICIENT knowledge/accomplishment. Sixty percent of the units answered the form, all the selected units were visited, and 90 refrigerators were observed. SUFFICIENT results were achieved by 66% observations, 55% interviews, and 53% formularies. Training in vaccine units influenced positively higher scores in observations. Agreement among tools was low, leading to considerations on the way in which vaccines storage guidelines are conveyed, along with the need for systematic supervision to correct the faults detected.

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.

Estudou-se a tendência da mortalidade por homicídios segundo sexo e idade na cidade de São Paulo entre 1979 e 1994, utilizando modelos de ajuste de tendência temporal selecionados com base na significância de beta e valor de R², e análise de resíduos pela técnica de box and whisker plot. A mortalidade por homicídios em São Paulo passou de 12,2 óbitos por 100.000 hab. em 1979 para 34,2 em 1994, apresentando crescimento linear de 1,17 ao ano. O mesmo comportamento é observado em ambos os sexos, embora as taxas para os homens sejam cerca de 14 vezes maiores, denotando a deterioração das condições de vida urbana. Tanto os menores de dez anos como os maiores de 60 anos apresentam taxas constantes no período em valores relativamente baixos. O grupo de 10 a 19 anos apresenta crescimento das taxas segundo o modelo multiplicativo (incrementos 132,55). Os adultos jovens de 20 a 39 anos apresentam taxas crescentes durante todo o período, segundo o modelo linear, enquanto os adultos de 40 a 59 anos apresentam crescimento segundo o modelo recíproco. Observa-se, assim, que cada grupo de idade e sexo apresenta tendência temporal peculiar no período considerado.To study homicide trends by gender and age, 1979-1994, Sao Paulo, Brazil, cubic polynomials were used to determine the best model for adjusting to time trends in homicide mortality rates by age and gender in the city of Sao Paulo, Brazil, 1979-1994. The model best adjusted to each group was selected considering the regression coefficient (beta), R² value, residual analysis, and model's simplicity. The results show linear growth for total rates and rates by gender due to behavior of rates in the 20-29 and 30-39 year age groups. The reciprocal model adjusted best to rates for the 40-49 and 50-59 year age groups, while rates for adolescents followed the multiplicative model. There was no significant relationship between homicide rates and time for the remaining groups (under 10 and over 59 years). Rates for males were considerably higher in all age groups. The remarkably steady growth in homicide rates among adolescents and young adults is consistent with trends observed in other urban areas in developing and developed countries and denotes deteriorating living conditions and increased poverty.

Análise das correlações entre taxas de homicídio por sexo para adolescentes (10-19 a) e adultos jovens (20 a 39 a) em São Paulo, 1995, e áreas definidas segundo indicador socioeconômico. Os 96 distritos da cidade de São Paulo foram agrupados em 5 clusters de acordo com o índice socioeconômico construído através da soma de postos atribuídos às variáveis: renda média mensal dos chefes de famílias, taxa de analfabetos (>5 anos), número médio de cômodos por domicílio e tamanho médio das famílias. Os clusters foram formados pela análise hierárquica por proximidade de vizinhança baseada no cálculo da distância euclidiana para contagens (Programa SPSS). As taxas de homicídio segundo idade e sexo foram calculadas para cada cluster. A correlação de Spearman e o valor de R² foram calculados para cada grupo de idade e sexo. As taxas de homicídios são altas tanto para homens quanto para mulheres, entretanto, o risco é de 12 a 19 vezes maior para os homens, conforme a faixa etária. Há forte correlação negativa entre as taxas de homicídio e o índice socioeconômico (r = -0,81) em todos os grupos analisados. Parte importante das diferenças entre as taxas pode ser atribuída às condições socioeconômicas das áreas de residência (R² = 0,65). Os grupos mais afetados foram os homens de 20 a 29 anos, residentes nas áreas intermediárias ou periféricas da cidade Comparados ao anel central os RR são: 1,7 no anel intermediário interno; 1,9 no anel intermediário externo; 2,8 no anel periférico interno e 4 no anel periférico externo.Analysis of the correlation between homicide rates by gender for adolescents (10-19 years) and young adults (20 to 39 years) in São Paulo, 1995, and areas defined according to a socioeconomic indicator. The 96 districts of the city of São Paulo were grouped into 5 clusters according to a socioeconomic index constructed by adding up classifications given to variables: average monthly income of head of family, illiteracy rate (for those over 5 years of age), average number of rooms per household, and average size of families. Clusters were formed by the hierarchy analysis technique based on neighborhood proximity (similarity), by calculating the square of the Euclidean distance for counts, (SPSS Program). Homicide rates according to age and gender were calculated for each cluster. The Spearman correlation and the R² value were calculated for each age and gender group. Homicide rates are high for both men and women, although the risk is 12 to 19 times greater for men, according to age groups. There is a strong negative correlation between homicide rates and the socioeconomic index (r = -0.81) for all groups analyzed. An important part of the differences between rates may be attributed to the socioeconomic conditions of residence areas (R² = 0,65). Men between 20 and 29 years of age living in intermediate or peripheral areas of the city were the most affected group. RRs in relation to the central ring are: 1.7 in the internal intermediate ring; 1.9 in the external intermediate ring; 2.8 in the internal peripheral ring, and 4 in the external peripheral ring.

A cross-sectional study on the prevalence of schistosomiasis mansoni in three sites of the "Baixada Ocidental Maranhense" was carried out in 1993 in: Alegre (in the municipality of São Bento), Aliança (in Cururupu) and Coroatá II (in the municipality of São João Batista). Results were compared to those of another study performed at the same sites and in similar conditions, in 1987. The entire population of the three sites, with few exceptions, was submitted to fecal tests using the Kato-Katz method and immediate intradermal tests for schistosomiasis in both studies. Subjects with positive results in one of these tests were clinically evaluated by a physical examination. In 1993, the total of 827 subjects were submitted to fecal examination and 826 to intradermal test. Schistosoma mansoni eggs were found in the feces of 154 (18.6%) subjects, while 478 (57.9%) subjects presented a positive intradermal test. Stool examination was carried out in 367 subjects in Alegre with a positivity rate of 14.9%; the intradermal test, performed in 366 subjects, was positive in 47.5% of the cases. In Aliança, 277 subjects had their feces examined and were submitted to an intradermal test, with a positivity rate of 34.4% and 70.7%, respectively. Finally in Coroatá II, 183 inhabitants submitted to fecal and intradermal tests had positivity rates of 2.2% and 59.0%, respectively. When the present data were compared to those obtained in the survey performed in 1987, a significant decrease in the prevalence of infection by S. mansoni was observed in Alegre and Coroatá II, and a prevalence increase in Aliança.Esquistossomose mansoni na Baixada Ocidental Maranhense, Estado do Maranhão, Brasil: estudos transversais realizados em 1987 e 1993 Realizou-se, em 1993, estudo transversal acerca da ocorrência de esquistossomose mansoni em três localidades da Baixada Ocidental Maranhense: Alegre (município de São Bento), Aliança (município de Cururupu) e Coroatá II (município de São João Batista). Os resultados foram cotejados aos de outro estudo, efetuado nas mesmas localidades e em condições semelhantes, em 1987. Em ambos os estudos, salvo poucas exceções, toda a população das três localidades foi submetida a exame parasitológico de fezes, pelo método de Kato-Katz e a intradermorreação para esquistossomose. Os indivíduos que apresentaram resultado positivo em algum desses exames foram avaliados clinicamente, por meio de exame físico. Em 1993, ao todo, 827 pessoas foram submetidas a exame de fezes e 826 a intradermorreação. Nas fezes de 154 (18,6%) encontraram-se ovos de Schistosoma mansoni e 478 (57,9%) apresentaram reação intradérmica positiva. Em Alegre o exame parasitológico de fezes foi realizado em 367 indivíduos, com índice de positividade de 14,9% e a intradermorreação, efetuada em 366 indivíduos, foi positiva em 47,5% dos casos. Em Aliança, 277 indivíduos foram examinados por exame de fezes e intradermorreação apresentando taxas de positividade de, respectivamente, 34,4% e 70,7%. Finalmente, em Coroatá II 183 moradores submetidos a exame de fezes e intradermorreação revelaram índices de positividade de 2,2% e 59,0%, respectivamente. Quando estes dados foram cotejados aos obtidos em inquérito efetuado em 1987 observou-se queda significativa da prevalência de infecção por S. mansoni nas localidades de Alegre e Coroatá II e aumento da prevalência em Aliança.

OBJETIVO: Avaliar aspectos epidemiológicos, clínicos e terapêuticos de idosos com doenças cardiovasculares (DCV), no Brasil. MÉTODOS: Idosos com DCV, atendidos em 36 serviços de Cardiologia e Geriatria do Brasil, foram investigados através de questionário aplicado aos que tinham consulta marcada para o período analisado (um mês). RESULTADOS: Estudados 2196 idosos de 65 a 96 anos, sendo 60% mulheres e analisados os fatores de risco: sedentarismo (74%), pressão arterial (PA) elevada (53%), LDL colesterol aumentado (33%), colesterol total aumentado (30%), obesidade (30%), HDL-colesterol diminuído (15%), diabetes (13%) e tabagismo (6%). Observou-se maior prevalência nas mulheres, com três ou mais fatores de risco. O principal motivo de consulta foi a PA elevada (48%). Teste ergométrico e cinecoronariografia, foram mais solicitados para os homens. Os diagnósticos mais comuns foram hipertensão arterial sistêmica (HAS) (67%) e insuficiência coronária (ICo) (29%). Os medicamentos mais utilizados foram diuréticos (42%). CONCLUSÃO: Foi observada alta prevalência de fatores de risco (93%), principalmente nas mulheres; sedentarismo, como fator de risco mais freqüente, aumentando de prevalência com a idade; HAS, como principal motivo de consulta e diagnóstico; menor investigação e diagnóstico de ICo em mulheres; diuréticos, como os fármacos mais freqüentemente prescritos; insuficiência cardíaca como principal doença associada a internação (31%) e atendimento de emergência (10%).

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.

Estudou-se coorte constituída de uma amostra probabilística (N=468) de crianças menores de 5 anos, residentes em 5 áreas do Município de São Paulo, SP (Brasil), acompanhada durante 1 ano, por meio de entrevistas mensais. A pesquisa foi desenvolvida no período de março de 1986 a maio de 1987. Entre as características sociais e econômicas das famílias das crianças estudadas, estão: a) mediana da renda familiar "per capita" de um salário-mínimo da época; b) 29,3% das crianças tinham pais migrantes com tempo médio de fixação no Município de São Paulo de 18,6 anos; c) 40% das famílias utilizavam exclusivamente serviços de saúde públicos ou filantrópicos. Das crianças estudadas, 87,3% eram eutróficas; 94% haviam recebido todas as doses de vacina preconizadas pelo Programa Nacional de Imunizações; 90,6% nunca haviam sido internadas em conseqüência de infecção respiratória aguda (IRA). Durante a investigação foram identificados 554 episódios de IRA, com uma duração média de 6,8 dias, e uma incidência de 11,08 episódios por 100 crianças/mês. O grupo etário mais atingido foi o dos menores de 1 ano. Em 36,1% dos casos de IRA identificados, verificaram-se eventos semelhantes no mesmo domicílio, sendo que em 53% desses episódios o caso-índice foi uma criança menor de 6 anos. Quanto ao tipo de atendimento, em 45,7% dos episódios as crianças foram tratadas pelas próprias mães, 6,9% recorreram a farmacêuticos, 46,7% foram atendidas em diferentes tipos de ambulatórios e somente 4 casos (0,7%) necessitaram tratamento hospitalar, com um deles evoluindo para óbito. As medidas terapêuticas mais utilizadas entre os casos que demandaram assistência médica foram a antibioticoterapia e os expectorantes. Alguns fatores socioeconômicos e antecedentes pessoais, tais como condições habitacionais, aglomeração intradomiciliar assim como antecedentes de doenças respiratórias, mostraram-se associados à incidência mais elevada de IRA.

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.

Analisa-se o comportamento epidemiológico das meningites por S. pneumoniae no Município de São Paulo, Brasil, no período 1960-1977. Os dados foram coletados diretamente do prontuário dos pacientes e a confirmação da meningite por S. pneumoniae se fez pela bacterioscopia e/ou pela cultura do líquor. No período 1960-1977 foram confirmados 1.965 casos com um coeficiente médio de 1,9 por cem mil habitantes. As crianças menores de 5 anos contribuíram com 52% dos casos dos quais 38,5% eram menores de um ano. Os coeficientes médios por cem mil habitantes, para os menores de um ano, foram 37,1 e 30,1 para 1960-1969 e 1970-1977, respectivamente. A incidência por cem mil habitantes na zona periférica do município, na primeira década (2,3) foi o dobro daquela da zona central (1,1). Os coeficientes padronizados segundo idade foram 1,6, 1,5 e 2,0 para as zonas central, intermediária e periférica, respectiva-mente. No período seguinte estes valores foram 1,4, 1,5 e 2,0. A letalidade média no período foi de 44%, inversamente proporcional ao número de leucócitos no líquor de entrada. A letalidade entre os menores de um ano foi de 60%.The epidemiology of meningitis caused by S. pneumoniae in the city of S. Paulo, Brazil, during the period 1960-77 is analysed. Data were obtained directly from the patients' records and registered on a pre-coded form. Cases of S. pneumoniae meningitis were confirmed by gram stain and/or culture of the cerebrospinal fluid (CSF). During the period 1960-77, there was confirmation of 1,965 cases of S. pneumoniae meningitis, giving an average rate of 1.9 per 100,000 inhabitants. Children of less than 5 years of age accounted for 52% of cases and 39% were less than 1 year old. The average rates for children below 1 year of age were 37 and 30 per 100,000 inhabitants, respectively, for the periods 1960-69 and 1970-77. The rate of incidence for the peripherial zone - 2,2 per 100,000 inhabitants - was pratically double the rate for the central area - 1.2 per 100,000 inhabitants - in the 1960's. The age standardized rates were 1.6, 1.5 and 2.0 for central, intermediate, and peripherial zones, respectivelly. In the 1970's these rates were 1.4, 1.5 and 2.0. The average case fatality rate for the period was 47% which was inversely proportional to the number of CSF leucocytes at first examination. For children less than year old, the case fatality rate was 60% for the same period.

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.

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.

Resumo Com o processo de desinstitucionalização psiquiátrica, as famílias passaram a ser as principais provedoras de cuidados aos pacientes. Essa mudança marcou uma alteração no modo como a família vinha participando do cuidado ao doente mental, mas as dificuldades enfrentadas no desempenho do papel de cuidador têm contribuído para transformações na sua vida. Esta pesquisa objetivou observar quais mudanças ocorrem nos âmbitos social, familiar e sexual de cuidadores de crianças e adolescentes com transtornos mentais atendidos em Centro de Atenção Psicossocial Infantojuvenil (CAPSi). Participaram da pesquisa 64 cuidadores de crianças e adolescentes com transtornos mentais que frequentam um CAPSi. Os dados foram coletados por meio de questionário semiestruturado e analisados com base no programa estatístico Statistical Package for the Social Sciences. Os resultados demonstram que ser cuidador de criança ou adolescente com transtorno mental impacta a vida nos contextos social, conjugal e sexual, observando que 85,9% dos cuidadores abandonaram o emprego para cuidar de criança ou adolescente; somente 34,4% têm momentos de lazer; 81,3% tiveram mudanças na sua vida conjugal, sendo a maioria (98,1%) para pior; e 31,3% não possuem relações sexuais. Concluindo-se esta análise, percebe-se que essa população merece maior atenção das políticas públicas e da sociedade, e os resultados deste estudo poderão influir na adequação dos serviços de saúde mental, uma vez que a saúde de criança ou adolescente depende da saúde do cuidador.

Estudou-se a tendência da mortalidade por homicídios segundo sexo e idade na cidade de São Paulo entre 1979 e 1994, utilizando modelos de ajuste de tendência temporal selecionados com base na significância de beta e valor de R², e análise de resíduos pela técnica de box and whisker plot. A mortalidade por homicídios em São Paulo passou de 12,2 óbitos por 100.000 hab. em 1979 para 34,2 em 1994, apresentando crescimento linear de 1,17 ao ano. O mesmo comportamento é observado em ambos os sexos, embora as taxas para os homens sejam cerca de 14 vezes maiores, denotando a deterioração das condições de vida urbana. Tanto os menores de dez anos como os maiores de 60 anos apresentam taxas constantes no período em valores relativamente baixos. O grupo de 10 a 19 anos apresenta crescimento das taxas segundo o modelo multiplicativo (incrementos 132,55). Os adultos jovens de 20 a 39 anos apresentam taxas crescentes durante todo o período, segundo o modelo linear, enquanto os adultos de 40 a 59 anos apresentam crescimento segundo o modelo recíproco. Observa-se, assim, que cada grupo de idade e sexo apresenta tendência temporal peculiar no período considerado.

Estudou-se a tendência da mortalidade por homicídios segundo sexo e idade na cidade de São Paulo entre 1979 e 1994, utilizando modelos de ajuste de tendência temporal selecionados com base na significância de beta e valor de R², e análise de resíduos pela técnica de box and whisker plot. A mortalidade por homicídios em São Paulo passou de 12,2 óbitos por 100.000 hab. em 1979 para 34,2 em 1994, apresentando crescimento linear de 1,17 ao ano. O mesmo comportamento é observado em ambos os sexos, embora as taxas para os homens sejam cerca de 14 vezes maiores, denotando a deterioração das condições de vida urbana. Tanto os menores de dez anos como os maiores de 60 anos apresentam taxas constantes no período em valores relativamente baixos. O grupo de 10 a 19 anos apresenta crescimento das taxas segundo o modelo multiplicativo (incrementos 132,55). Os adultos jovens de 20 a 39 anos apresentam taxas crescentes durante todo o período, segundo o modelo linear, enquanto os adultos de 40 a 59 anos apresentam crescimento segundo o modelo recíproco. Observa-se, assim, que cada grupo de idade e sexo apresenta tendência temporal peculiar no período considerado.

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.