Lessons From The Epidemiological Surveillance Program, During The Influenza A (h1n1) Virus Epidemic, In A Reference University Hospital Of Southeastern Brazil [lições Aprendidas Pelo Programa De Vigilância Epidemiológica, Durante A Epidemia Pelo Vírus Da Influenza A (h1n1), Em Um Hospital Universitário Na Região Sudeste Do Brasil]

Introduction: The case definition of influenza-like illness (ILI) is a powerful epidemiological tool during influenza epidemics. Methods: A prospective cohort study was conducted to evaluate the impact of two definitions used as epidemiological tools, in adults and children, during the influenza A H1N1 epidemic. Patients were included if they had upper respiratory samples tested for influenza by real-time reverse transcriptase polymerase chain reaction during two periods, using the ILI definition (coughing + temperature ≥ 38°C) in period 1, and the definition of severe acute respiratory infection (ARS) (coughing + temperature ≥ 38°C and dyspnoea) in period 2. Results: The study included 366 adults and 147 children, covering 243 cases of ILI and 270 cases of ARS. Laboratory confirmed cases of influenza were higher in adults (50%) than in children (21.6%) (p < 0.0001) and influenza infection was more prevalent in the ILI definition (53%) than ARS (24.4%) (p < 0.0001). Adults reported more chills and myalgia than children (p = 0.0001). Oseltamivir was administered in 58% and 46% of adults and children with influenza A H1N1, respectively. The influenza A H1N1 case fatality rate was 7% in adults and 8.3% in children. The mean time from onset of illness until antiviral administration was 4 days. Conclusions: The modification of ILI to ARS definition resulted in less accuracy in influenza diagnosis and did not improve the appropriate time and use of antiviral medication.444405411Dawood, F.S., Jain, S., Finelli, L., Shaw, M.W., Lindstrom, S., Emergence of a novel swineorigin influenza A (H1N1) virus in humans (2009) N Engl J Med, 360, pp. 2605-2615. , Novel swine-origin influenza A (H1N1) virus investigation team, et alPeiris, J.S., Poon, L.L., Guan, Y., Emergence of a novel swine-origin influenza A virus (S-OIV) H1N1 virus in humans (2009) J Clin Virol, 45, pp. 169-173Antigenic and genetic characteristics of swine-origin 2009 A (H1N1) influenza viruses circulating in humans (2009) Science, 325, pp. 197-201. , WHO Collaborating Center for Influenza, Centers for Disease Control and Prevention, et alSmith, G.J.D., Vijaykrishna, D., Bahl, J., Lycett, S.J., Worobey, M., Pybus, O.G., Origins and evolutionary genomics of the 2009 swine-origin H1N1 influenza A epidemic (2009) Nature, 450, pp. 1122-1126Oliveira, W.K., Penna, G., Kuchenbecker, R., Santos, H., Araujo, W., (2009) Pandemic H1N1 Influenza in Brazil: Analysis of the First 34,506 Notified Cases of Influenza-like Illness with Severe Acute Respiratory Infection (SARI), , http://www.eurosurveillance.org/viewarticle.aspx?articleid=19362/, Surveillance Team for the pandemic influenza A(H1N1) 2009 in the Ministry of Health, et al, Euro Surveill, Available fromBerts, R.F., Flu virus (1995) Principles and Practice of Infectious Diseases, pp. 1546-1567. , In: Mandell GL, Bennett JE, Dolin R, editors, 4th ed. New York: Churchill LivingstoneBoivin, G., Hardy, I., Tellier, G., Maziade, J., Predicting flu infections during epidemics with the use of a clinical definition (2000) Clin Infect Dis, 31, pp. 1166-1169Monto, A.S., Gravenstein, S., Elliott, M., Colopy, M., Schweinle, J., Clinical signs and symptoms predicting influenza infection (2000) Arch Int Med, 160, pp. 3243-3247Ong, A.K., Chen, M.I., Lin, L., Tan, A.S., Nwe, N.W., Barkham, T., A comparative analysis of new influenza A (H1N1) cases (2009) PlosONE, 4, pp. e8453. , Improving the clinical diagnosis of influenzaChan, M.C., Chan, R.W., Yu, W.C., Ho, C.C., Yuen, K.M., Fong, J.H., Tropism and innate host responses of the 2009 pandemic H1N1 influenza virus in ex vivo and in vitro cultures of human conjunctiva and respiratory tract (2010) Am J Pathol, 176, pp. 1828-1840O'Riordan, S., Barton, M., Yau, Y., Read, S.E., Allen, U., Tran, D., Risk factors and outcomes among children admitted to hospital with pandemic H1N1 influenza (2010) CMAJ, 182, pp. 39-44Babcock, H.M., Merz, L.R., Fraser, V.J., Is influenza an influenza-like illness? Clinical presentation of influenza in hospitalized patients (2006) Infect Control Hosp Epidemiol, 27, pp. 266-270Kelly, H., Birch, C., The causes and diagnosis of influenza-like illness (2004) Aust Family Physician, 33, pp. 305-309Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection (2010) N Engl J Med, 362, pp. 1708-1719. , Writing Committee of the WHO consultation on Clinical Aspects of Pandemic (H1N1) 2009 InfluenzaPresanis, A.M., de Angelis, D., Hagy, A., Reed, C., Riley, S., The severity of pandemic H1N1 influenza in the United States from April to July 2009: A Bayesian analysis (2009) PLoS Med, 6, pp. e1000207. , New York City Swine Flu Investigation TeamDonaldson, L.J., Rutter, P.D., Ellis, B.M., Greaves, F.E., Mytton, O.T., Pebody, R.G., Mortality from pandemic A/H1N1 2009 influenza in England: Public health surveillance study (2009) BMJ, 339, pp. b5213(2010), http://portal.salud.gov.mx/contenidos/noticias/influenza/estadisticas.html/, Secretaria de Salud Mexico. Estadísticas [Internet]. Assessed in October, [cited 2011 Feb 15]. Available fromEchavarría, M., Querci, M., Marcone, D., Videla, C., Martinez, A., Bonvehi, P., Pandemic (H1N1) 2009 cases, Buenos Aires, Argentina (2010) Emerg Infect Dis, 16, pp. 311-313Uyeki, T., Diagnostic testing for 2009 pandemic influenza A (H1N1) virus infection in hospitalized patients (2009) N Engl J Med, 361, pp. e114Blyth, C.C., Iredell, J.R., Dwyer, D.E., Rapid-test sensitivity for novel swine-origin influenza A (H1N1) virus in humans (2009) N Engl J Med, 361, p. 25Lee, N., Chan, P.K., Hui, D.S., Rainer, T.H., Wong, E., Choi, K.W., Viral loads and duration of viral shedding in adult patients hospitalized with influenza (2009) J Infect Dis, 200, pp. 492-500Chang, Y.S., van Hal, S.J., Spencer, P.M., Gosbell, I.B., Collett, P.W., Comparison of adult patients hospitalized with pandemic (H1N1) 2009 influenza and seasonal influenza during the "PROJECT" phase of the pandemic response (2010) Med J Aust, 192, pp. 90-93Shieh, W., Blau, D.M., Denison, A.M., Deleon-Carnes, M., Adem, P., Bhatnagar, J., 2009 pandemic influenza A (H1N1): Pathology and pathogenesis of 100 fatal cases in the United States (2010) Am J Pathol, 177, pp. 166-17

[aids Patients' Compliance With Antiretroviral Treatment: Notified Difficulties And Measures For Improvement At A Teaching Hospital].

This study aimed at identifying the incidence of drug intake errors and the main therapy-related difficulties among AIDS patients as well as at proposing measures to increase patients' adherence to treatment. Sixty-one patients with AIDS assisted by the University Hospital of São Paulo State University at Campinas were interviewed. The most frequent errors concerned the combinations of drugs and the length of fasting. The difficulties reported were adverse effects and the variety of drugs. Based on these data, the authors proposed the use of an illustrated guide for drug-related information. It is hoped that individualized guidance can contribute to minimize errors concerning adherence to therapy.950-

Intradermal Hepatitis B Vaccination In Patients With Advanced Chronic Renal Failure: Immunogenicity And Follow-up.

Patients undergoing dialysis usually have a poor response to conventional hepatitis B vaccination. To observe the effects of intradermal hepatitis B (HB) vaccination in a 13-month prospective study of adult patients with end-stage renal failure. The patients were with or without previous hepatitis B vaccination, but all had antibody titres <10 mUI/mL. Patients were allotted to two groups: previous hepatitis B virus vaccination and no previous hepatitis B virus vaccination or anti-HBs titres <10 mUI/mL. Patients in both groups received 16 i.d. injections of 0.1 mL of hepatitis B virus vaccine over an eight-week period. Patients had antibody titres assessed before vaccination, 1 month after and every 3 months for a year. Antibody titres >/=10 mUI/mL were considered protective. Seventy patients completed the protocol. Protective titres were elicited in 82% of each group. Age, time under dialysis, diabetes, smoking and body-mass index were not associated with seroconversion. Persistent protective titres >12 months occurred in 27 (58.7%). Adverse events were trivial. Intradermal hepatitis B virus vaccination is an alternative in end-stage renal failure.25849-5

Clusters Of Brazilian Spotted Fever In São Paulo State, Southeastern Brazil. A Review Of Official Reports And The Scientific Literature

[No abstract available]15SUPPL. 2202204Angerami, R.N., Resende, M.R., Feltrin, A.F.C., Brazilian spotted fever: a case series from an endemic area in Southeastern Brazil. Epidemiological aspects (2006) Ann N Y Acad Sci, 1078, pp. 170-172Sexton, D.J., Muniz, M., Corey, G.R., Brazilian spotted fever in Espirito Santo, Brazil: description of a focus of infection in a new endemic region (1993) Am J Trop Med Hyg, 49, pp. 222-226Galvão, M.A.M., Dumler, S., Mafra, C.L., Fatal spotted fever Rickettsiosis, Minas Gerais, Brazil (2003) Emerg Infect Dis, 9, pp. 1402-1405Jones, T.F., Craig, A.S., Paddock, C.D., Family cluster of Rocky Mountain spotted fever (1999) Clin Infect Dis, 28, pp. 853-859Oteo, J.A., Portillo, A., Santibáñez, S., Blanco, J.R., Pérez-Martinez, L., Ibarra, V., Cluster of cases of Rickettsia felis infection from Southern Europe (Spain) diagnosed by PCR (2006) J Clin Microbiol, 44, pp. 2669-267

Life cycle of female ticks of Amblyomma cooperi Nuttal & Warburton, 1908 (Acari: Ixodidae) under laboratory conditions Ciclo biológico de fêmeas do carrapato Amblyomma cooperi Nuttal & Warburton, 1908 (Acari:Ixodidae) sob condições de laboratório

The biological cycle of female ticks of Amblyomma cooperi was studied under controlled conditions. The study has begun with two engorged females collected in a naturally infested wild capybara. The larvae originated from the oviposition of these two females were used for collecting young adults through artificial infestations in rabbits. The female parasitic and free living phases were evaluated using artificial infestation of ticks in a capybara. The average body weight of females was 958.2± 175.6mg, the average pre-egg laying period was 8.5± 1.4 days, the reproductive efficiency index was 59.5± 4.2 and the nutritional efficiency index was 77.3± 4.8. The incubation and eclosion periods were 41.9 and 5.9 days, respectively, and the rate of eclosion was 64%. These figures were obtained under high relative humidity conditions which were necessary for the success of the egg incubation process of this species. The preliminary data obtained with the artificial infestation in rabbits raises the possibility of this and other domestic species be used as an epidemiologic link between the domestic and the wild environment with the potential exposure of human populations to A. cooperi and to the maculosa fever agent.<br>O ciclo biológico de Amblyomma cooperi foi estudado sob condições de laboratório. O estudo iniciou-se com duas fêmeas ingurgitadas coletadas de uma capivara selvagem naturalmente infestada. As larvas provenientes da postura foram utilizadas para obtenção de adultos, por meio de infestação artificial em coelhos. As fases parasitária e de vida livre das fêmeas foram avaliadas utilizando-se infestação artificial em capivara. A média de peso corporal foi de 958,2± 175,6mg, a média do período de pré-postura de 8,5± 1,4 dias e dos índices de eficiência reprodutiva e nutricional de 59,5± 4,2 e 77,3± 4,6, respectivamente. Os períodos de incubação e eclosão foram de 41,9 e 5,9 dias, respectivamente. A taxa de eclosão foi de 64%. Estes dados foram obtidos sob alta umidade relativa, necessária para o sucesso da incubação dos ovos dessa espécie. Os dados preliminares obtidos com a infestação artificial em coelhos levanta a possibilidade dessa e de outras espécies domésticas serem possíveis elos epidemiológicos entre o ambiente doméstico e o silvestre, com potencial risco de exposição humana a A. cooperi e ao agente etiológico da febre maculosa