Epidemiological Profile of Children Infected with Bordetella pertussis at Varela Santiago Children’s Hospital: a Retrospective Study

Abstract Background: Pertussis, also called whooping cough, is an acute infectious disease of high transmissibility transmitted through aerosol particles released during the catarrhal phase and paroxysmal cough. Since the 1990s its incidence has increased and atypical clinical forms have been identified, mainly in newborns and adults. We hypothesized that there is a relationship between the high incidence of pertussis infection in children up to 6 months of age and genetic changes in the circulating strains of B. pertussis leading to inefficacy of diphtheria, tetanus, and pertussis vaccine (DTP). Methods: Data were obtained from the medical records of hospitalized patients at the Varela Santiago Children’s Hospital in Brazil from January 1, 2013 to December 31, 2013. Results: A total of 33 cases of pertussis hospitalizations were found, where 75.7% (25/33) of the patients were 6 months of age or younger (6 patients were 30 days old or younger while 19 ranged in age from 31 days to 6 months). Of these, 54.5% (14/25) were in exclusive breastfed children. Only 18.2% (6/33) of the patients had the appropriate administration of DTP doses according to their age. Signs and symptoms were: cough 100%, cyanosis 63.6%, fever 48.5% and inspiratory winch 33.3%. Azithromycin was used as monotherapy in 90% (30/33) of the cases and the mean time of hospitalization was 9.48 days ranging from 6 to 30 days. No patient died. Conclusion: We identified a high prevalence (75.7%) of B. pertussis infection in children up to 6 months of age. This is likely explained by the low vaccination rate (18.2%) and the low percentage of exclusive breastfeeding of the studied population. The low rate of vaccination is unexpected, given that there has been greater access to vaccination in recent decades in Brazil. In addition, the cases evolved with an atypical clinical presentation, since the classic symptoms of the catarrhal stage were absent or had a such short duration that such symptoms were no longer present at the time of hospitalization. Our study does not exclude the possibility that genetic changes are occurring in the circulating strains of B. pertussis and that DTP seems to have less efficacy on these new strains, but future studies will be needed to specifically test this hypothesis. Disclosures All authors: No reported disclosures

d-Dimer elevation and adverse outcomes

d-Dimer is a biomarker of fibrin formation and degradation. While a d-dimer within normal limits is used to rule out the diagnosis of deep venous thrombosis and pulmonary embolism among patients with a low clinical probability of venous thromboembolism (VTE), the prognostic association of an elevated d-dimer with adverse outcomes has received far less emphasis. An elevated d-dimer is independently associated with an increased risk for incident VTE, recurrent VTE, and mortality. An elevated d-dimer is an independent correlate of increased mortality and subsequent VTE across a broad variety of disease states. Therefore, medically ill subjects in whom the d-dimer is elevated constitute a high risk subgroup in which the prospective evaluation of the efficacy and safety of antithrombotic therapy is warranted

Perinatal Case Fatality Rate Related to Congenital Zika Syndrome in Brazil: a Cross-Sectional Study

Abstract Background: Many studies have demonstrated a causal link between Zika virus (ZIKV) infection, microcephaly (MCP), and other congenital abnormalities (CA). This study aimed to determine perinatal case fatality rate in cases of Congenital Zika Syndrome (CZS) in the Rio Grande do Norte State (RN), a Brazilian Northeast State highly impacted by the Zika virus outbreak. Methods: A cross-sectional study was conducted using data obtained through the State Health Department (SHD) for cases of MCP and CA in Rio Grande do Norte from April 2015 to February 5, 2016. Definition of perinatal period: commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth. Results: During the study period, there were 486 cases of MCP and others CA notified in RN, of which 142 were confirmed and 108 remain under investigation. The remaining 236 cases have been ruled out by presenting normal examinations or due to presenting microcephaly by noninfectious causes. Of the total confirmed cases, 26.7% (38/142) died after birth or during pregnancy. 15.78% (06/38) of confirmed deaths had ZIKV infection during pregnancy and 2.63% (01/38) had a positive TORCH blood test. The six cases related to ZIKV were confirmed by RT–PCR and/or IgM/IgG antibodies against ZIKV. The remaining cases of deaths remain either under investigation or have been ruled out. Conclusion: This study highlights a high rate of perinatal lethality (15.78%) in cases of CZS. Despite the growing number of CZS cases, the real incidence and prevalence might be higher due to the underreporting and lack of resources for confirmatory diagnostic tests (laboratory and imaging). Due to the high rate of lethality and the ongoing uncontrolled ZIKV outbreak, this study predicts an increase in the infant mortality rate in Brazil and highlights the need for developing public health programs to control the ZIKV outbreak. Disclosures All authors: No reported disclosures

Congenital Neurological Disorders in Children with Microcephaly Related to Exanthematous Diseases During Pregnancy: A Cohort Study

Abstract Background: An increase in the prevalence of microcephaly (MCP) was seen in Rio Grande do Norte State (RN) since September 2015. This Brazilian northeast state was highly impacted by a Zika (ZIKV) outbreak in the last 2 years. The highest rate of MCP was in November 2015 with 20.1 cases per 1,000 live births, compared with 1.8 cases/year in the previous years. Our study aimed to evaluate the neurological disorders in children with microcephaly whose mothers had exanthematous disease (ED) during the pregnancy. Methods: We evaluated children up to 17 months old followed at a children rehabilitation center in RN. Cohort enrollment occurred with children born between January 2015 and May 2016. We interviewed their mothers about the occurrence of ED during their pregnancy. Results: Of the 37 cases of MCP (25 male, 12 girls), 10 mothers did not know how to describe The presence of ED during pregnancy. Of the 24 cases of MCP with maternal ED, 9 patients were classified as having severe spasticity (Ashworth score 3 and 4), 4 patients were classified as mild (Ashworth score 1e 2) and 11 had no spasticity. Eleven patients had seizure disorders and 5 reported irritability. Conclusion: According to this data, there is a high prevalence of neurological complications in children with MCP related to ED. These patients need close follow-up care and intensive medical interventions. Longer follow-up will provide data regarding these chronic neurological complications and how best to intervene. Disclosures All authors: No reported disclosures