Investigação dos casos de doenças febris exantemáticas com IgM reagente contra o sarampo na ausência de transmissão documentada do vírus do sarampo, Estado de São Paulo, 2000-2004

Introdução: Revisar os casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no estado de São Paulo, Brasil, durante os cinco anos seguidos a interrupção da transmissão do vírus do sarampo. Métodos: Nós revisamos 463 casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no estado de São Paulo, Brasil, de 2000 a 2004. Indivíduos vacinados contra o sarampo 56 dias antes da coleta de amostra foram considerados expostos à vacina. Soros da fase aguda e de convalescença foram testados para a evidência de infecção de sarampo, rubéola, parvovírus B19 e herpes vírus 6. Na ausência de soroconversão para imunoglobulina G contra o sarampo, casos com IgM reagente contra o sarampo foram considerados falsos positivos em pessoas com evidência de outras infecções virais. Resultados: Entre as 463 pessoas com doenças febris exantemáticas que testaram positivo para anticorpos IgM contra o sarampo durante o período, 297 (64 por cento) pessoas foram classificadas como expostas à vacina. Entre os 166 casos não expostos à vacina, 109 (66 por cento) foram considerados falsos positivos baseado na ausência de soroconversão, dos quais 21 (13 por cento) tiveram evidência de infecção por vírus da rubéola, 49 (30 por cento) parvovírus B19 e 28 (17 por cento) infecção por herpes vírus humano 6. Conclusões: Após a interrupção da transmissão do vírus do sarampo é necessária exaustiva investigação dos casos com IgM reagente contra o sarampo, especialmente dos casos não expostos à vacina. Testes laboratoriais para etiologias das doenças febris exantemáticas ajudam na interpretação destes casosIntroduction: To review measles IgM-positive cases of febrile rash illnesses in the state of São Paulo, Brazil, over the five-year period following interruption of measles virus transmission. Methods: We reviewed 463 measles IgM-positive cases of febrile rash illness in the state of São Paulo, from 2000 to 2004. Individuals vaccinated against measles ≤ 56 days prior to specimen collection were considered to be exposed to the vaccine. Serum from the acute and convalescent phases was tested for evidence of measles, rubella, parvovirus B19 and human herpes virus-6 infection. In the absence of seroconversion to measles immunoglobulin-G, measles IgM-positive cases were considered false positives in individuals with evidence of other viral infections. Results: Among the 463 individuals with febrile rash illness who tested positive for measles IgM antibodies during the period, 297 (64 per cent) were classified as exposed to the vaccine. Among the 166 cases that were not exposed to the vaccine, 109 (66 per cent) were considered false positives based on the absence of seroconversion, among which 21 (13 per cent) had evidence of rubella virus infection, 49 (30 per cent) parvovirus B19 and 28 (17 per cent) human herpes virus-6 infection. Conclusions: Following the interruption of measles virus transmission, thorough investigation of measles IgM-positive cases is required, especially among cases not exposed to the vaccine. Laboratory testing for etiologies of febrile rash illness aids interpretation of these case

SARS-CoV-2 reinfection: report of two cases in Southeast Brazil

From February 26, 2020 to March 11, 2021, coronavirus disease 2019 (COVID-19) pandemic resulted in 11,439,558 cases and 277,102 deaths in Brazil. Among them, 2,195,130 cases and 63,965 deaths occurred in Sao Paulo State, Southeast Brazil. The recent emergence and rise of new variants of SARS-CoV-2 is of concern because of their higher transmissibility and possible association with more severe disease. Cases of SARS-CoV-2 reinfections have been described since December 2020 in Brazil. This report describes two cases of COVID-19 reinfection, that occurred five and six months after the first infection, during the second wave of the pandemic in Sao Paulo State. Both patients presented mild symptoms in the two COVID-19 episodes and different lineages of SARS-CoV-2 were identified: B.1.1.33 and B.1.1.28 lineages in case 1 and B1.1.128 and P. 2 lineages in case 2

Evaluation of the impact of the anti Haemophilus influenzae type b (Hib) vaccine program in the state of São Paulo and the city of São Paulo, ten years after vaccine introduction

Objetivos: Avaliar o impacto global, direto, indireto e a tendência da duração de proteção da vacinação contra o Haemophilus influenzae tipo b (Hib), no estado de São Paulo (ESP) e no município de São Paulo (MSP), na população de 0 - 59 meses, comparando os períodos pré-vacinal (1996 - 1998) e pós-vacinal (2001 - 2009). Métodos: estudo com componente descritivo e de cunho analítico, retrospectivo. A população de estudo incluiu os menores de cinco anos residentes no ESP e no MSP. Adotou-se como definição de caso confirmado o menor de cinco anos identificado como positivo para o Hib em cultura e/ou contraimunoeletroforese e/ou látex e/ou RT-PCR, em amostra de LCR e sangue, e/ou vínculo epidemiológico. Os dados foram obtidos a partir do SINAN, SIGH-Web Instituto Adolfo Lutz e Fundação IBGE. As variáveis de estudo incluíram as demográficas, clínicas e relativas ao agente, apresentadas em séries temporais e períodos estabelecidos para parametrização e comparabilidade. O parâmetro das avaliações de impacto foi a magnitude da variação da incidência de meningite causada pelo Hib. Para cada estimativa de impacto construiu-se um Intervalo de Confiança (IC) de 95 por cento a partir do cálculo de Risco Relativo (RR). As estimativas do risco relativo (RR) e os respectivos intervalos de 95 por cento de confiança foram analisados utilizando-se o software R. Resultados: nos períodos considerados, foram descritos 1.561 casos confirmados de meningites por Hib no ESP, sendo 27,16 por cento (424/1.561) no MSP, e 80,78 por cento (1.261/1.561) dos casos foram registrados em menores de cinco anos. A maioria dos casos foi confirmada por cultura, com percentual médio de 65 por cento no ESP e 66 por cento no MSP. As taxas médias de incidência de meningites por Hib mais significativas no período pré-vacinal verificaram-se nos menores de um ano (30,56/105- ESP; 32,06/105 - MSP), considerada a faixa etária de maior risco de adoecimento. Após a introdução da vacina contra o Hib em 1999 (menores de dois anos), as taxas de incidência de meningites por Hib declinaram de forma sustentável nos períodos subsequentes analisados. A incidência de meningite por Hib durante o período pós-vacinal variou de 4,02/105- 1,68/105 nos menores de um ano, no ESP e MSP respectivamente e, de forma similar, de 1,43/105 1,01/105 nos menores de cinco anos. Nos menores de 7 - 23 meses (impacto direto), o percentual de redução foi de 95,11 por cento [66,43 - 99,29] no ESP e 95,91 por cento [70,63 - 99,43] no MSP. O impacto global observado nos menores de cinco anos foi 88,19 por cento [26,58 - 98,10] no ESP e 91,06 por cento [33,99 - 98,79] no MSP. Os dados de vigilância mostram que os casos de meningites por Hib continuam ocorrendo, porém em níveis baixos, ao longo de 10 anos após a introdução do esquema de três doses primárias da vacina conjugada específica. Conclusão: a partir deste racional pode-se inferir a utilidade prática e econômica a favor desta modalidade programática adotada no território paulista, com a evidência de redução relativa de meningites por Hib.Objectives: To evaluate global impact, direct and indirect, as well as the tendency of the duration of vaccine protection against Haemophilus influenzae type b (Hib) in the state of São Paulo (ESP) and in the city of São Paulo (MSP), amongst the population between 0-59 months of age during the periods pre-vaccine (1996-1998) and post vaccine (2001-2009). Methods: a retrospective study with a descriptive component and with analytic venue. Studied population included children under five years old, dwelling in ESP and MSP. Criteria adopted as definition of confirmed case was child under five years of age identified as positive for Hib in culture and/or counterimmunelectroforesis and/or latex and/or RT/PCR, in LCR sample and blood. and/or epidemiologic link. Data were obtained from the SINAN, SIGH-Web Instituto Adolfo Lutz and IBGE Foundation. Variables under study included socio-demographic and clinical ones, and those related to the agent; they were presented in temporal series and periods established in order to allow parametric and comparison. Impact evaluation was established upon the variation of incidence magnitude of meningitis caused by Hib. For each impact estimate a Confidence Interval (IC) of 95 per cent from the calculus of Relative Risk (RR). Estimates of relative risk (RR) and the respective intervals of 95 per cent confidence were analyzed employing the R software. Results: During the analyzed periods 1561 confirmed cases of meningitis caused by Hib were described in the state of São Paulo, 27.16 per cent of which (424/1561) in MSP; 80.78 per cent (1261/1561) of the registered cases occurred in children under five years of age. The majority of the cases were confirmed by culture, with an average percentage of 65 per cent in ESP and 66 per cent in MSP. More significant average rates of meningitis per Hib during the pre-vaccine period were registered in children under one year of age (30.56/105- ESP; 32.06/105 - MSP), considered the bracket under higher risk of disease. After the introduction of the vaccine against Hib, in 1999 (for children under two years of age), the rates of meningitis incidence per Hib decreased in sustainable fashion for the subsequent periods analyzed. The incidence of meningitis per Hib during the post vaccine period varied from 4.02/105 - 1.68/105 for children under one year old, in ESP and MSP, respectively and, in similar way, from 1.43/105 to 1.01/105 for those under five years old. For children between 7-23 months old (direct impact), the percentage of reduction was of 95.11 per cent [66.43 - 99.29] in ESP and 95.91 per cent [70.63 - 99.43] in MSP, whereas the global impact observed in children under five years old was 88.19 per cent [26.58 - 98.10] in ESP and 91.06 per cent [33.99 98.79] in MSP. Surveillance data show that cases of meningitis by Hib continue to occur but in low levels along 10 years after the introduction of the three doses primary scheme of administration of the specific conjugated vaccine. Conclusion: from this rationale, it is possible to infer the practical and economic utility favoring this programmatic modality adopted in São Paulo, with the evidence of the relative reduction of meningitis caused by Hib

Mortalidade por doença meningocócica no Município de São Paulo, Brasil: características e preditores

O estudo objetiva descrever a magnitude, as características da mortalidade e da letalidade por doença meningocócica e investigar preditores de óbito por essa causa, no Município de São Paulo, Brasil, de 1986 a 2004. Utilizou-se a regressão logística múltipla não condicional para a investigação dos preditores de óbitos. Foram estudados 10.087 casos de doença meningocócica no município. A taxa anual média de mortalidade foi de 1,0/100 mil habitantes/ano, variando de 0,2 a 1,8; a letalidade foi de 20,5% com grandes diferenças segundo idade, sorogrupo e tipo de hospital. Os preditores de óbito por doença meningocócica foram idade, especialmente as faixas etárias de um a dois anos e de 40 anos ou mais e o sorogrupo W. Os resultados obtidos podem contribuir para a elaboração de políticas públicas com foco na organização da assistência hospitalar e elaboração de protocolos que promovam a maior efetividade do tratamento e a aplicação de estratégias de vacinação que diminuam a incidência nos grupos de maior risco para óbito por doença meningocócica

Epidemiological characteristics of influenza-like illness outbreaks in long-term care facilities of the state of São Paulo, Brazil

Long-term care facilities for older adults present a high risk of outbreaks since they concentrate often more frail and vulnerable individuals. OBJECTIVE: To describe the epidemiological characteristics of influenza-like illness outbreaks and cases among older people in long-term care facilities in the state of São Paulo, Brazil. METODS: The analysis was performed through an exploratory and descriptive approach, with records from the outbreak module of the National System of Notifiable Diseases between January 2020 and June 2021. RESULTS: Outbreaks of influenza-like illness in this department represented 24.93% of all notifications. The highest concentration was seen in the state capital and metropolitan area. A total of 1 018 confirmed outbreaks were observed, involving 6 110 cases and 1 240 deaths among older people. Of these cases, 71.67% were confirmed for coronavirus disease 19 (COVID-19), 12.77% for the influenza virus, and 15.56% for other respiratory viruses. The percentages regarding death outcomes were similar, with a 20.29% lethality of influenza-like illness. Within the studied group, the older adults were the most affected. A statistical difference was observed between cases and deaths. CONCLUSIONS: Owing to the current scenario and the known vulnerabilities of these facilities, there is an urgent need for joint and articulated action by various administrative levels in order to minimize the devastating effects of influenza-like illness outbreaks (especially of COVID- 19) in older adults at long-term care homes. The strengthening of information systems and their interoperability are considered of utmost importance in order to improve the quality of information on outbreaks, which is essential during a pandemic.</p

Risk factors for death from Influenza A(H1N1)pdm09, State of São Paulo, Brazil, 2009.

This case-control study aimed to assess the risk factors for death from influenza A(H1N1)pdm09 in patients with laboratory confirmation, who had severe acute respiratory illness-SARI and were hospitalized between June 28th and August 29th 2009, in the metropolitan regions of São Paulo and Campinas, Brazil. Medical charts of all the 193 patients who died (cases) and the 386 randomly selected patients who recovered (controls) were investigated in 177 hospitals. Household interviews were conducted with those who had survived and the closest relative of those who had died. 73.6% of cases and 38.1% of controls were at risk of developing influenza-related complications. The 18-to-59-year age group (OR = 2.31, 95%CI: 1.31-4.10 (reference up to 18 years of age)), presence of risk conditions for severity of influenza (OR = 1.99, 95%CI: 1.11-3.57, if one or OR = 6.05, 95%CI: 2.76-13.28, if more than one), obesity (OR = 2.73, 95%CI: 1.28-5.83), immunosuppression (OR = 3.43, 95%CI: 1.28-9.19), and search for previous care associated with the hospitalization (OR = 3.35, 95%CI: 1.75-6.40) were risk factors for death. Antiviral treatment performed within 72 hours of the onset of symptoms (OR = 0.17, 95%CI: 0.08-0.37, if within 48hours, and OR = 0.30, 95%CI: 0.11-0.81, if between 48 and 72 hours) was protective against death. The identification of high-risk patients and early treatment are important factors for reducing morbi-mortality from influenza

Severe influenza A(H1N1)pdm09 in pregnant women and neonatal outcomes, State of Sao Paulo, Brazil, 2009

<div><p>To investigate the factors associated with death and describe the gestational outcomes in pregnant women with influenza A(H1N1)pdm09, we conducted a case-control study (deaths and recovered) in hospitalized pregnant women with laboratory-confirmed influenza A(H1N1)pdm09 with severe acute respiratory illness (SARI) in the state of São Paulo from June 9 to December 1, 2009. All cases were evaluated, and four controls that were matched by the epidemiological week of hospitalization of the case were randomly selected for each case. Cases and controls were selected from the National Disease Notification System-SINAN Influenza-web. The hospital records from 126 hospitals were evaluated, and home interviews were conducted using standardized forms. A total of 48 cases and 185 controls were investigated. Having had a previous health visit to a healthcare provider for an influenza episode before hospital admission was a risk factor for death (adjusted OR (<i>OR</i>_<i>adj</i><i>)</i> of 7.93, 95% CI 2.19–28.69). Although not significant in the multiple analysis (<i>OR</i>_<i>adj</i> of 2.13, 95% CI 0.91–5.00), the 3^rd trimester deserves attention, with an OR = 2.22, 95% CI 1.13–4.37 in the univariate analysis. Antiviral treatment was a protective factor when administered within 48 hours of symptom onset (<i>OR</i>_<i>adj</i> = 0.16, 95% CI 0.05–0.50) and from 48 to 72 hours (<i>OR</i>_<i>adj</i> = 0.09, 95% CI 0.01–0.87). There was a higher proportion of fetal deaths and preterm births among cases (p = 0.001) and live births with low weight (p = 0.019), compared to control subjects who gave birth during hospitalization. After discharge, control subjects had a favorable neonatal outcome. Early antiviral treatment during the presence of a flu-like illness is an important factor in reducing mortality from influenza in pregnant women and unfavorable neonatal outcomes. It is important to monitor pregnant women, particularly in the 3^rd trimester of gestation, with influenza illness for diagnosis and early treatment.</p></div

Distribution of pregnancy outcomes of pregnant women hospitalized with influenza A(H1N1)pdm09 associated with severe acute respiratory illness who died (cases) or recovered (controls), State of São Paulo, 2009.

<p>Distribution of pregnancy outcomes of pregnant women hospitalized with influenza A(H1N1)pdm09 associated with severe acute respiratory illness who died (cases) or recovered (controls), State of São Paulo, 2009.</p

Risk factors for death among pregnant women hospitalized with influenza A(H1N1)pdm09, State of Sao Paulo, 2009.

<p>Risk factors for death among pregnant women hospitalized with influenza A(H1N1)pdm09, State of Sao Paulo, 2009.</p