Soroconversão vacinal da hepatite B em crianças no primeiro ano de vida e sua relação com a soropositividade das mães em uma comunidade de São José dos Campos

PURPOSE: To detect seroconversion of hepatitis B vaccine and antibody waning 3 years after vaccination in children immunized according to the World Health Organization schedule and its relationship to the mother's serostatus during pregnancy. METHODS: A serological study was carried out in São José dos Campos. Blood samples from pregnant women were taken for hepatitis B marker serology. To evaluate seroconversion in infants born to these women, serology was performed 1 month after they were vaccinated with recombinant vaccine. Another group of children was evaluated 3 years after being immunized. RESULTS: Among 224 pregnant women, 0.9% were positive for hepatitis B surface antigen, 8.0% for antibodies to the surface antigen, and 4.5% for antibodies to the virus core. Seroconversion among 174 infants was as follows: absent in 18 children (10.35%), low level in 15 (8.62%), intermediate level in 26 (14.94%), and a high level (good response) in 115 (66.09%). Antibody positivity after 3 years was as follows: absent in 8 children (7.92%), low level in 51 (50.5%), intermediate level in 20 (19.8%), and high level in 22 (21.78%). Considering the age that the vaccine was administered, a significant proportion of non-seroconverters was found among children who had received the complete 3-dose schedule before 9 months (P = 0.023). Another factor that significantly contributed to the lack of seroconversion was the presence of any serological marker for hepatitis B during pregnancy (P = 0.044). CONCLUSIONS: Data gathered in this work show that the immunization schedule for hepatitis B in low or moderate prevalence areas should be revised in order to optimize seroconversion.OBJETIVO: Determinar a soroconversão vacinal da hepatite B em crianças no primeiro ano de vida e sua relação com a soropositividade das mães e avaliar a concentração de anticorpos 3 anos após a vacinação. MÉTODOS: Estudo sorológico, realizado na cidade de São José dos Campos com amostras de sangue coletadas de gestantes para testar marcadores de Hepatite B. Para avaliar a soroconversão em crianças nascidas dessas mulheres, realizou-se sorologia mês após a última dose de vacina. Em outro grupo de crianças, imunizadas há 3 anos, foi feita a mesma sorologia. RESULTADOS: Entre 224 gestantes, 0,9% foram positivas para o antígeno de superfície, 8,0% para anticorpos contra este antígeno e 4,5% para anticorpos contra o "core" viral. A soroconversão de 174 crianças, um mês após a última dose da vacina, foi ausente em 18 crianças (10,35%), baixa em 15 (8,62%), intermediária em 26 (14,94%), e houve boa resposta em 115 (66.09%). A soropositividade de 101 crianças vacinadas há 3 anos, foi ausente em 8 (7,92%), baixa em 51 (50,5%), intermediária em 20 (19,8%), e alta concentração de anticorpos em 22 (21,78%). Considerando a idade da vacinação, encontrou-se uma proporção significante de crianças soronegativas entre vacinadas antes dos 9 meses (p=0,023). Contribuiu significativamente para a baixa soroconversão a positividade de qualquer marcador sorológico durante a gravidez (p=0,044). CONCLUSÃO: Os dados reunidos neste trabalho mostram que o calendário vacinal para a Hepatite B em regiões de baixa ou moderada prevalência poderia ser revisado para otimizar a soroconversão

Desempenho de testes sorológicos para o diagnóstico de infecção por HTLV em população de alto-risco de São Paulo, Brasil

Testing problems in diagnosing human T-lymphotropic virus (HTLV) infection, mostly HTLV-II, have been documented in HIV/AIDS patients. Since December 1998, the Immunology Department of Instituto Adolfo Lutz (IAL) offers HTLV-I/II serology to Public Health Units that attend HTLV high-risk individuals. Two thousand, three hundred and twelve serum samples: 1,393 from AIDS Reference Centers (Group I), and 919 from HTLV out-patient clinics (Group II) were sent to IAL for HTLV-I/II antibodies detection. The majority of them were screened by two enzyme immunoassays (EIAs), and confirmed by Western Blot (WB 2.4, Genelabs). Seven different EIA kits were employed during the period, and according to WB results, the best performance was obtained by EIAs that contain HTLV-I and HTLV-II viral lysates and rgp21 as antigens. Neither 1st and 2nd, nor 3rd generation EIA kits were 100% sensitive in detecting truly HTLV-I/II reactive samples. HTLV-I and HTLV-II prevalence rates of 3.3% and 2.5% were detected in Group I, and of 9.6% and 3.6% in Group II, respectively. High percentages of HTLV-seroindeterminate WB sera were detected in both Groups. The algorithm testing to be employed in HTLV high-risk population from São Paulo, Brazil, needs the use of two EIA kits of different formats and compounds as screening, and because of high seroindeterminate WB, may be another confirmatory assay.Problemas nos testes diagnósticos de infecção pelos vírus linfotrópicos de células T humanas (HTLV), principalmente HTLV-II, têm sido observados em pacientes com HIV/Aids. Desde Dezembro de 1998, a Seção de Imunologia do Instituto Adolfo Lutz (IAL) oferece a sorologia para HTLV-I/II para Serviços de Saúde Pública que atendem populações consideradas de risco para esta infecção. Duas mil trezentas e doze amostras de soro: 1.393 de Centros de Referência em Aids (Grupo I) e 919 de Clínicas de Especialidade em HTLV (Grupo II) foram encaminhadas para o IAL para a pesquisa de anticorpos anti-HTLV-I/II. A maioria delas foram testadas por dois ensaios imunoenzimáticos (EIAs) e confirmadas por Western Blot (WB 2.4, Genelabs). Sete kits diferentes de EIAs foram empregados durante o período e de acordo com os resultados do WB a melhor performance foi obtida com os EIAs que continham lisado viral dos HTLV-I e -II e a rgp21 como antígenos. Nenhum kit de EIA de 1ª, 2ª ou 3ª geração foi 100% sensível para detectar todas as amostras verdadeiramente HTLV-I/II reagentes. A prevalência de HTLV-I e HTLV-II, respectivamente, foi de 3,3% e 2,5% no Grupo I e de 9,6% e 3,6% no Grupo II. Em ambos os Grupos, foram detectadas altas percentagens de soros com padrão indeterminado no WB. O algoritmo de testes sorológicos para ser usado em população de alto risco para HTLV de São Paulo, Brasil, necessita de dois kits EIAs de princípios e composição diferentes para a triagem sorológica e, pelo elevado número de WB indeterminado, talvez de um outro teste confirmatório

Relationship among epidemiological parameters of six childhood infections in a non-immunized Brazilian community

Epidemiological parameters, such as age-dependent force of infection and average age at infection () were estimated for rubella, varicella, rotavirus A, respiratory syncytial virus, hepatitis A and parvovirus B19 infections for a non-immunized Brazilian community, using the same sera samples. The for the aforementioned diseases were 8.45 years (yr) [95% CI: (7.23, 9.48) yr], 3.90 yr [95% CI: (3.51, 4.28) yr], 1.03 yr [95% CI: (0.96, 1.09) yr], 1.58 yr [95% CI: (1.39, 1.79) yr], 7.17 yr [95% CI: (6.48, 7.80) yr] and 7.43 yr [95% CI: (5.68, 9.59) yr], respectively. The differences between average ages could be explained by factors such as differences in the effectiveness of the protection conferred to newborns by maternally derived antibodies, competition between virus species and age-dependent host susceptibility. Our seroprevalence data may illustrate a case of the above-mentioned mechanisms working together within the same populatio

Hepatitis B (HBV), Hepatitis C (HCV) and Hepatitis Delta (HDV) Viruses in the Colombian Population—How Is the Epidemiological Situation?

Background: Viral hepatitis B, C and delta still remain a serious problem worldwide. In Colombia, data from 1980s described that HBV and HDV infection are important causes of hepatitis, but little is known about HCV infection. The aim of this study was to determine the currently frequency of HBV, HCV and HDV in four different Colombian regions. Methodology/Principal Findings: This study was conducted in 697 habitants from 4 Colombian departments: Amazonas, Choco, Magdalena and San Andres Islands. Epidemiological data were obtained from an interview applied to each individual aiming to evaluate risk factors related to HBV, HCV or HDV infections. All samples were tested for HBsAg, anti-HBc, anti-HBs and anti-HCV markers. Samples that were positive to HBsAg and/or anti-HBc were tested to anti-HDV. Concerning the geographical origin of the samples, the three HBV markers showed a statistically significant difference: HBsAg (p = 0.033) and anti-HBc (p < 0.001) were more frequent in Amazonas and Magdalena departments. Isolated anti-HBs (a marker of previous vaccination) frequencies were: Choco (53.26%), Amazonas (32.88%), Magdalena (17.0%) and San Andres (15.33%) p < 0.001. Prevalence of anti-HBc increased with age; HBsAg varied from 1.97 to 8.39% (p = 0.033). Amazonas department showed the highest frequency for anti-HCV marker (5.68%), while the lowest frequency was found in San Andres Island (0.66%). Anti-HDV was found in 9 (5.20%) out of 173 anti-HBc and/or HBsAg positive samples, 8 of them from the Amazonas region and 1 from them Magdalena department. Conclusions/Significance: In conclusion, HBV, HCV and HDV infections are detected throughout Colombia in frequency levels that would place some areas as hyperendemic for HBV, especially those found in Amazonas and Magdalena departments. Novel strategies to increase HBV immunization in the rural population and to strengthen HCV surveillance are reinforced by these results.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo - FAPESP[2007/53457-7]Fundacao de Amparo a Pesquisa do Estado de Sao Paulo - FAPESP[2008/50461-6]CNPqSao Paulo, SP, BrazilPontificia Universidad Javeriana, Bogota, Colombi

O que está subjacente à escolha do estudante pela profissão médica?

PURPOSE: To determine the reasons for choosing the medical profession by interviewing freshmen medical students from the Faculty of Medicine, University of São Paulo and investigating their socio-economic and psychological profiles, as well as to determine whether there are gender differences. METHOD: One hundred and sixty three freshmen medical students answered a questionnaire regarding their socio-economical profile. Of those, 30 female and 30 male students underwent a face-to-face interview regarding the career choice, the Thematic Apperception Test (TAT) and the 16 Personality Factor Questionnaire (16 PF). The results were analyzed qualitatively and by Mann-Whitney, chi2, Fisher's Exact, and r p coefficient tests. RESULTS: Most students were middle class, catholic, and had physicians in their families. Students of both genders had made an: early choice of the medical career and a persistence in taking exams many times, even after being discouraged. They also showed an awareness of the difficulties and limitations in developing their careers. The study revealed a strong valuation of the humanistic aspects of medicine; openness to new experiences; a deep personal identification with the choice of profession; a critical need for fulfillment in their careers; and conscious and unconscious desires to help people and be recognized for their usefulness, without being narcissistic. Female students were more sensitive (POBJETIVO: Determinar as razões da escolha da profissão médica em um grupo de alunos do primeiro ano de medicina da Faculdade de Medicina da Universidade de São Paulo, investigando o perfil sócio-econômico e psicológico, e as diferenças com relação ao gênero dos alunos. MÉTODO: Cento e sessenta e três alunos responderam a um questionário para avaliar seu perfil sócio-econômico. Destes, 30 mulheres e 30 homens submeteram-se a uma entrevista face a face sobre a escolha da profissão, ao Teste de Apercepção Temática (TAT) e ao teste 16 PF. Os resultados foram analisados qualitativamente e pelos testes de Mann-Whitney, chi2, Fisher's Exact e coeficiente r p. RESULTADOS: A maioria dos estudantes pertence à classe média, são católicos e possuem médicos na família. Estudantes de ambos os gêneros haviam escolhido precocemente a profissão e mostraram persistência para prestar o vestibular, mesmo quando desencorajados por terceiros. O estudo revelou consciência das dificuldades e limitações da carreira médica, bem como grande valorização dos aspectos humanísticos da medicina e espírito aberto a novas experiências. Verificou-se que a profissão ocupa um papel central em suas identidades, a relevância dada à satisfação profissional, o desejo consciente e inconsciente de ajudar os semelhantes e de serem reconhecidos por isso, sem a busca exclusiva de uma gratificação narcísica. As alunas apresentaram maior Brandura (

A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture

OBJECTIVES:This study sought to verify the effects of acupuncture as an adjuvant treatment for the control of asthma.METHODS:This was a randomized, controlled, crossover trial conducted at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A total of 74 patients with mild/moderate, persistent asthma were randomized into two therapeutic groups: Group A - 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham weekly acupuncture sessions, followed by a 3-week washout period and 10 real weekly acupuncture sessions. Patients used short- and long-acting β-2 agonists and inhaled corticosteroids when necessary. Prior to treatment and after each period of 10 treatment sessions, the patients were evaluated for spirometry, induced sputum cell count, exhaled nitric oxide (NO) and with the Short Form 36 (SF-36) and Questionnaire on Quality of Life-Asthma (QQLA) questionnaires. Daily peak flow and symptom diaries were registered. The level of significance adopted was 5% (α=0.05).RESULTS:In Group B, after real acupuncture, there was a decrease in eosinophils (p=0.035) and neutrophils (p=0.047), an increase in macrophages (p=0.001) and an improvement in peak flow (p=0.01). After sham acupuncture treatment, patients experienced less coughing (p=0.037), wheezing (p=0.013) and dyspnea (p=0.014); similarly, after real acupuncture, patients reported less coughing (p=0.040), wheezing (p=0.012), dyspnea (

Sequencing of E2 and NS5A regions of HCV genotype 3a in Brazilian patients with chronic hepatitis

Hepatitis C virus (HCV) is a major cause of liver disease throughout the world. The NS5A and E2 proteins of HCV genotype 1 were reported to inhibit the double-stranded (ds) RNA-dependent protein kinase (PKR), which is involved in the cellular antiviral response induced by interferon (IFN). The response to IFN therapy is quite different between genotypes, with response rates among patients infected with types 2 and 3 that are two-three-fold higher than in patients infected with type 1. Interestingly, a significant percentage of HCV genotype 3-infected patients do not respond to treatment at all. The aim of this paper was to analyse the sequences of fragments of the E2 and NS5A regions from 33 outpatients infected with genotype 3a, including patients that have responded (SVR) or not responded (NR) to treatment. HCV RNA was extracted and amplified with specific primers for the NS5A and E2 regions and the PCR products were then sequenced. The sequences obtained covered amino acids (aa) 636-708 in E2 and in NS5A [including the IFN sensitivity determining region (ISDR), PKR-binding domain and extended V3 region)]. In the E2 and NS5A regions, we did observe aa changes among patients, but these changes were not statistically significant between the SVR and NR groups. In conclusion, our results suggest that the ISDR domain is not predictive of treatment success in patients infected with HCV genotype 3a.FAPESPAlves de Queiroz Family Fund for Researc

Modelling the test, trace and quarantine strategy to control the COVID-19 epidemic in the state of São Paulo, Brazil.

Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society. In this paper we modelled and simulated a test-trace-and-quarantine strategy to control the COVID-19 outbreak in the State of São Paulo, Brasil. The State of São Paulo failed to adopt an effective social distancing strategy, reaching at most 59% in late March and started to relax the measures in late June, dropping to 41% in 08 August. Therefore, São Paulo relies heavily on a massive testing strategy in the attempt to control the epidemic. Two alternative strategies combined with economic evaluations were simulated. One strategy included indiscriminately testing the entire population of the State, reaching more than 40 million people at a maximum cost of 2.25 billion USD, that would reduce the total number of cases by the end of 2020 by 90%. The second strategy investigated testing only symptomatic cases and their immediate contacts - this strategy reached a maximum cost of 150 million USD but also reduced the number of cases by 90%. The conclusion is that if the State of São Paulo had decided to adopt the simulated strategy on April the 1st, it would have been possible to reduce the total number of cases by 90% at a cost of 2.25 billion US dollars for the indiscriminate strategy but at a much smaller cost of 125 million US dollars for the selective testing of symptomatic cases and their contacts

Medical adverse events in elderly hospitalized patients: A prospective study

OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates. METHODS: This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e. g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score II). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events. RESULTS: The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events, the patients with medical adverse events had a significantly longer hospital stay (21.41 +/- 15.08 days versus 10.91 +/- 7.21 days) and a higher mortality rate (39 deaths [41.5%] versus 17 deaths [22.1%]). Mortality was significantly predicted by the Simplified Acute Physiology Score II score (odds ratio [OR] = 1.13, confidence interval [CI] 95%, 1.07 to 1.20), the Katz score (OR = 1.47, CI 95%, 1.18 to 1.83), and medical adverse events (OR = 3.59, CI 95%, 1.55 to 8.30). CONCLUSION: Medical adverse events should be monitored in every elderly hospitalized patient because there is no risk profile for susceptible patients, and the consequences of adverse events are serious, sometimes leading to longer hospital stays or even death