Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases

Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Main body of the abstract: Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. Conclusion: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV

International nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

Vaccines Under Development: Group B Streptococcus, Herpes-zoster, Hiv, Malaria And Dengue

Objectives: To review the current state of development of streptococcus B, herpes-zoster, HIV, malaria and dengue vaccines. These vaccines were selected both because of imminent commercial release and because of specific problems with their development. Sources of data: A review of the literature was performed by means of a MEDLINE search, on the period 1996 to 2006, for the epidemiology and immunology of these diseases, analyzing both the greatest obstacles to creating a vaccine and the current state of research, with emphasis on studies in the most advanced stages. Summary of the findings: Each of the five diseases chosen presents specific problems for vaccine development. Nevertheless, in the majority of cases these have been or are in sight of being resolved, allowing for the prediction that a safe and effective vaccine - or vaccines - will be available in the near future. Conclusions: Despite the problems faced in developing these vaccines, advances in molecular biology and immunology have made it possible to overcome most obstacles, opening up the prospects for new vaccines. Copyright © 2006 by Sociedade Brasileira de Pediatria.82SUPPL. 1S115S124Gibbs, R.S., Schrag, S., Schuchat, A., Perinatal infections due to group B streptococci (2004) Obstet Gynecol, 104, pp. 1062-1076Vaciloto, E., Richtmann, R., Costa, H.P.F., Kusano, E.J.U., Almeida, M.F.B., Amaro, E.R., A survey of the incidence of neonatal sepsis by group B streptococcus during a decade in a Brazilian maternity hospital (2002) Braz J Infect Dis, 6, pp. 55-62Schuchat, A., Group B streptococcus (1999) Lancet, 353, pp. 51-56Schrag, S., Gorwitz, R., Fultz-Butts, K., Schuchat, A., Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC (2002) MMWR Recomm Rep, 51, pp. 1-22(2002) Active Bacterial Core Surveillance (ABCs) Report, Emerging Infections Program Network, Group B Streptococcus, , http://www.cdc.gov/ncidod/dbmd/abcs/survreports/gbs02.pdf, Access: 04/03/2006Lin, F.Y., Weisman, L.E., Azimi, P.H., Philips III, J.B., Clark, P., Regan, J., Level of maternal IgG anti-group B streptococcus type III antibody correlated with protection of neonates against early-onset disease caused by this pathogen (2004) J Infect Dis, 190, pp. 928-934Baker, C.J., Kasper, D.L., Correlation of maternal antibody deficiency with susceptibility to neonatal group B streptococcal infection (1976) N Engl J Med, 294, pp. 753-756Baker, C.J., Kasper, D.L., Group B streptococcal vaccines (1985) Rev Infect Dis, 7, pp. 458-467Baker, C.J., Rench, M.A., Edwards, M.S., Carpenter, R.J., Hays, B.M., Kasper, D.L., Immunization of pregnant women with a polysaccharide vaccine of group B streptococcus (1988) N Engl J Med, 319, pp. 1180-1185Zaleznik, D.F., Rench, M.A., Hillier, S., Krohn, M.A., Platt, R., Lee, M.L., Invasive disease due to group B streptococcus in pregnant women and neonates from diverse population groups (2000) Clin Infect Dis, 30, pp. 276-281Kasper, D.L., Paoletti, L.C., Wessels, M.R., Guttormsen, H.K., Carey, V.J., Jennings, H.J., Immune response to type III group B streptococcal polysaccharide-tetanus toxoid conjugate vaccine (1996) J Clin Invest, 98, pp. 2308-2314Baker, C.J., Paoletti, L.C., Wessels, M.R., Guttormsen, H.K., Rench, M.A., Hickman, M.E., Safety and immunogenicity of capsular polysaccharide-tetanus toxoid conjugate vaccines for group B streptococcal types Ia and Ib (1999) J Infect Dis, 179, pp. 142-150Baker, C.J., Paoletti, L.C., Rench, M.A., Guttormsen, H.K., Edwards, M.S., Kasper, D.L., Immune response of healthy women to 2 different group B streptococcal type V capsular polysaccharide-protein conjugate vaccines (2004) J Infect Dis, 189, pp. 1103-1112Heath, P.T., Feldman, R.G., Vaccination against group B streptococcus (2005) Expert Rev Vaccines, 4, pp. 207-218Poland, G.A., The growing paradigm of preventing disease: Vaccines to prevent herpes zoster and pertussis in adults (2005) Ann Intern Med, 143, pp. 539-541Donahue, J.G., Choo, P.W., Manson, J.E., Platt, R., The incidence of herpes zoster (1995) Arch Intern Med, 155, pp. 1605-1609Helgason, S., Petursson, G., Gudmundsson, S., Sigurdsson, J.A., Prevalence of postherpetic neuralgia after a first episode of herpes zoster: Prospective study with long term follow up (2000) BMJ, 321, pp. 794-796Di Luzio Paparatti, U., Arpinelli, F., Visona, G., Herpes zoster and its complication in Italy: An observational survey (1999) J Infect, 38, pp. 116-120Chidiac, C., Bruxelle, J., Daures, J.P., Hoang-Xuan, T., Morel, P., Leplege, A., Characteristics of patients with herpes zoster on presentation to practitioners in France (2001) Clin Infect Dis, 33, pp. 62-69Hodson, A.H., Epidemiology of shingles (1991) J R Soc Med, 84, p. 184Mounsey, A.L., Matthew, L.G., Slawson, D.C., Herpes zoster and postherpetic neuralgia: Prevention and management (2005) Am Fam Physician, 72, pp. 1075-1080Thomas, S.L., Wheeler, J.G., Hall, A.J., Contacts with varicella or with children and protection against herpes zoster in adults: A case-control study (2002) Lancet, 360, pp. 678-682Wood, M.J., Kay, R., Dworkin, R.H., Soong, S.J., Whitley, R.J., Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: A meta-analysis of placebo-controlled trials (1996) Clin Infect Dis, 22, pp. 341-347Tyring, S.K., Beutner, K.R., Tucker, B.A., Anderson, W.C., Crooks, R.J., Antiviral therapy for herpes zoster: Randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older (2000) Arch Fam Med, 9, pp. 863-869Jackson, J.L., Gibbons, R., Meyer, G., Inouye, L., The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis (1997) Arch Intern Med, 157, pp. 909-912Oxman, M.N., Levin, M.J., Johnson, G.R., Schmader, K.E., Straus, S.E., Gelb, L.D., A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults (2005) N Engl J Med, 352, pp. 2271-2284Campion, E.W., The oldest old (1994) N Engl J Med, 330, pp. 1819-1820Chaturvedi, U.C., Shrivastava, R., Nagar, R., Dengue vaccines: Problems and prospects (2005) Indian J Med Res, 121, pp. 639-652Damonte, E.B., Pujol, C.A., Coto, C.E., Prospects for the therapy and prevention of dengue virus infections (2004) Adv Virus Res, 63, pp. 239-285Schlagenhauf, P., Malaria: From prehistory to present (2004) Infect Dis Clin North Am, 18, pp. 189-205Greenwood, B., Malaria vaccines. Evaluation and implementation (2005) Acta Trop, 95, pp. 298-304Breman, J.G., Alilio, M.S., Mills, A., Conquering the intolerable burden of malaria: What's new, what's needed: A summary (2004) Am J Trop Med Hyg, 71, pp. 1-15Moorthy, V.S., Good, M.F., Hill, A.V., Malaria vaccine developments (2004) Lancet, 363, pp. 150-156Good, M.F., Stanisic, D., Xu, H., Elliott, S., Wykes, M., The immunological challenge to developing a vaccine to the blood stages of malaria parasites (2004) Immunol Rev, 201, pp. 254-267Engwerda, C.R., Good, M.F., Interactions between malaria parasites and the host immune system (2005) Curr Opin Immunol, 17, pp. 381-387Good, M.F., Xu, H., Wykes, M., Engwerda, C.R., Development and regulation of cell-mediated immune responses to the blood stages of malaria: Implications for vaccine research (2005) Annu Rev Immunol, 23, pp. 69-99Good, M.F., Vaccine-induced immunity to malaria parasites and the need for novel strategies (2005) Trends Parasitol, 21, pp. 29-34Webster, D., Hill, A.V., Progress with new malaria vaccines (2003) Bull World Health Organ, 81, pp. 902-909Greenwood, B.M., Bojang, K., Whitty, C.J., Targett, G.A., Malaria (2005) Lancet, 365, pp. 1487-1498Heppner Jr., D.G., Kester, K.E., Ockenhouse, C.F., Tornieporth, N., Ofori, O., Lyon, J.A., Towards an RTS, S-based, multi-stage, multi-antigen vaccine against falciparum malaria: Progress at the Walter Reed Army Institute of Research (2005) Vaccine, 23, pp. 2243-2250Ballou, W.R., Arevalo-Herrera, M., Carucci, D., Richie, T.L., Corradin, G., Diggs, C., Update on the clinical development of candidate malaria vaccines (2004) Am J Trop Med Hyg, 71, pp. 239-247Hill, A.V., Pre-erythrocytic malaria vaccines: Towards greater efficacy (2006) Nat Rev Immunol, 6, pp. 21-32Vernick, K.D., Waters, A.P., Genomics and malaria control (2004) N Engl J Med, 351, pp. 1901-190

Healthcare-associated Infections Among Neonates In Brazil

OBJECTIVE: To describe the epidemiology of healthcare-associated infections (HAIs) among neonates. DESIGN: Prospective surveillance of HAIs was conducted during 2 years. Infections beginning within 48 hours of birth were defined as HAIs of maternal origin. Death occurring during an active episode of HAI was considered related to HAI. SETTING: Seven neonatal units located in three Brazilian cities. PATIENTS: All admitted neonates were included and observed until discharge. RESULTS: Twenty-two percent of 4,878 neonates had at least one HAI. The overall incidence density was 24.9 per 1,000 patient-days, and 28.1% of all HAIs were maternally acquired. HAI rates ranged from 12.3% in the group with a birth weight (BW) of more than 2,500 g to 51.9% in the group with a BW of 1,000 g or less. The main HAIs were bloodstream infection (BSI) and pneumonia. Coagulase-negative staphylococci, Enterobacter species, Staphylococcus aureus, and Klebsiella pneumoniae were the main pathogens. Forty percent of all deaths were related to HAI. Central venous catheter (CVC)-associated BSIs per 1,000 CVC-days ranged from 17.3 (BW, 1,501 to 2,500 g; device utilization [DU], 0.11) to 34.9 (BW, ≤ 1,000 g; DU, 34.92). Ventilator-associated pneumonia per 1,000 ventilator-days ranged from 7.0 (BW, ≤ 1,000 g; DU, 0.34) to 9.2 (BW, 1,001 to 1,500 g; DU, 0.14). CONCLUSIONS: The high proportion of HAIs of maternal origin highlights perinatal care issues in Brazil and the need to improve the diagnosis of neonatal HAIs. The very low BW group and device-associated infections should be priorities for prevention strategies in this population.259772777Donowitz, L.G., Nosocomial infection in neonatal intensive care units (1989) Am J Infect Control, 17, pp. 250-257Ford-Jones, E.L., Mindorff, C.M., Langley, J.M., Epidemiologic study of 4,684 hospital-acquired infections in pediatric patients (1989) Pediatr Infect Dis J, 8, pp. 668-675Daschner, F., Analysis of bacterial infections in a neonatal intensive care unit (1983) J Hosp Infect, 4, pp. 90-91Hoogkamp-Korstanje, J.A., Cats, B., Senders, R.C., Van Ertbruggen, I., Analysis of bacterial infections in a neonatal intensive care unit (1982) J Hosp Infect, 3, pp. 275-284Raymond, J., Aujard, Y., Group, E.S., Nosocomial infections in pediatric patients: A European, multicenter prospective study (2000) Infect Control Hosp Epidemiol, 20, pp. 260-263Sohn, A.H., Garrett, D.O., Sinkowitz-Cochran, R.L., Prevalence of nosocomial infections in neonatal intensive care unit patients: Results from the first national point-prevalence survey (2001) J Pediatr, 139, pp. 821-827Gaynes, R.P., Horan, T.C., Surveillance of nosocomial infections (1999) Hospital Epidemiology and Infection Control, pp. 1285-1317. , Mayhall G, ed. Baltimore: Williams & WilkinsGarner, J.S., Jarvis, W.R., Emori, T.G., Horan, T.C., Hughes, J.M., CDC definitions for nosocomial infections, 1988 (1988) Am J Infect Control, 16, pp. 128-140Gaynes, R.R., Edwards, J.R., Jarvis, W.R., Culver, D.H., Toison, J.S., Martone, W.J., Nosocomial infections among neonates in high-risk nurseries in the United States (1996) Pediatrics, 98 (3 PART 1), pp. 357-361Horan, T.C., Emori, T.G., Definitions of key terms used in the NNIS System (1997) Am J Infect Control, 25, pp. 112-116Pessoa-Silva, C.L., Meurer Moreira, B., Camara Almeida, V., Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit: Risk factors for infection and colonization (2003) J Hosp Infect, 53, pp. 198-206Hemming, V.G., Overall Jr., J.C., Britt, M.R., Nosocomial infections in a newborn intensive-care unit: Results of forty-one months of surveillance (1976) N Engl J Med, 294, pp. 1310-1316Josephson, A., Karanfil, L., Alonso, H., Watson, A., Blight, J., Risk-specific nosocomial infection rates (1991) Am J Med, 91 (SUPPL. 3B), pp. 131S-137SMaguire, G.C., Nordin, J., Myers, M.G., Koontz, F.P., Hierholzer, W., Nassif, E., Infections acquired by young infants (1981) Am J Dis Child, 135, pp. 693-698Moro, M.L., De Toni, A., Stolfi, I., Carrieri, M.P., Braga, M., Zunin, C., Risk factors for nosocomial sepsis in newborn intensive and intermediate care units (1996) Eur J Pediatr, 155, pp. 315-322Kawagoe, J.Y., Segre, C.A., Pereira, C.R., Cardoso, M.F., Suva, C.V., Fukushima, J.T., Risk factors for nosocomial infections in critically ill newborns: A 5-year prospective cohort study (2001) Am J Infect Control, 29, pp. 109-114Ho, J.J., Late onset infection in very low birth weight infants in Malaysian level 3 neonatal nurseries (2001) Pediatr Infect Dis J, 20, pp. 557-560Ehrenkranz, R.A., Younes, N., Lemons, J.A., Longitudinal growth of hospitalized very low birth weight infants (1999) Pediatrics, 104, pp. 280-289Pessoa-Silva, C.L., Miyasaki, C.H., De Almeida, M.F., Kopelman, B.I., Raggio, R.L., Wey, S.B., Neonatal late-onset bloodstream infection: Attributable mortality, excess of length of stay and risk factors (2001) Eur J Epidemiol, 17, pp. 715-720Townsend, T.R., Wenzel, R.P., Nosocomial bloodstream infections in a newborn intensive care unit: A case-matched control study of morbidity, mortality and risk (1981) Am J Epidemiol, 114, pp. 73-80National Nosocomial Infections Surveillance (NNIS) System report: Data summary from January 1992-June 2001, issued August 2001 (2001) Am J Infect Control, 29, pp. 404-421Pearson, M.L., Guideline for prevention of intravascular device-related infections (1996) Infect Control Hosp Epidemiol, 17, pp. 438-473Guidelines for prevention of nosocomial pneumonia (1997) MMWR, 46 (RR-1), pp. 1-79Stoll, B.J., The global impact of neonatal infection (1997) Clin Perinatol, 24, pp. 1-21Hugonnet, S., Sax, H., Eggimann, P., Chevrolet, J.-C., Pittet, D., Nosocomial bloodstream infection and clinical sepsis (2004) Emerg Infect Dis, 10, pp. 76-8

High rate of non-albicans candidemia in Brazilian tertiary care hospitals

In order to evaluate the epidemiology of candidemia in Brazil, we performed a prospective multicenter study conducted in six general hospitals from Sao Paulo and Rio de Janeiro. We enrolled a total of 145 candidemic patients (85 males) with a median age of 32 years. Non-albicans species accounted for 63% of all episodes and the species most frequently causing candidemia were C. albicans (37%), C. parapsilosis (25%), C. tropicalis (24%), C. rugosa (5%), and C. glabrata (4%). Systemic azoles were used before the onset of candidemia in only six patients. There were no differences in the coexisting exposures or underlying diseases associated with the species most frequently causing candidemia. The overall crude mortality rate was 50%. Nosocomial candidemias in our tertiary hospitals are caused predominantly by non-albicans species, which are rarely fluconazole resistant. This predominance of non-albicans species could not be related to the previous use of azoles. (C) 1999 Elsevier Science Inc.34428128