Surveillance of influenza A H1N1 2009 among school children during 2009 and 2010 in São Paulo, Brazil

INTRODUCTION: Influenza A H1N1 2009 is associated with a high morbidity rate among children around the world, including Brazil. This survey was conducted on samples of symptomatic children (< 12 years) to investigate the influenza virus as the etiological agent of respiratory infections in a day care school in a health facility during the first and second pandemic wave of H1N1 (2009-2010) in São Paulo, Brazil. METHODS: Influenza infections were determined by real-time PCR in 34% (47/137) of children with a median age of 5 years (8 months - 12 years), from June to October 2009 and in 16% (14/85) of those with median age of 6 years (1-12 years), from March to November 2010. RESULTS: In general, most positive cases (64%) occurred in children aged 5-12 years, this age group was significantly the most affected (39.8%, p = 0.001, OR = 8.3, CI 95% 1.9-36.9). Wheezing was reported by 31% (19/61) and dyspnea by 23% (14/61) of the studied patients. An outbreak of influenza H1N1 with an attack rate of 35.7% among children (median age 6 years) was documented in April 2010, before the vaccination campaign against the pandemic virus was extended for children up to 5 years in Brazil. CONCLUSIONS: Therefore, the study reinforces the recommendation to immunize school children to reduce the incidence of the disease.

Prevalence of influenza and adherence to the anti-flu vaccination among elderly

INTRODUCTION: The flu, a condition that can affect the elderly by increasing the risk of serious complications can be prevented through vaccination. Estimate the prevalence of signs and symptoms suggestive of influenza in a group of elderly either vaccinated or unvaccinated against influenza was the objective this study. METHODS: This is a cross-sectional study performed in a Brazilian City. A structured questionnaire was employed to identify the presence of signs and symptoms of influenza in individuals aged 60 years or over. For analysis of associations between variables the prevalence ratio (PR) and its 95% confidence interval (95% CI) were used. RESULTS: One hundred ninety-six participants were interviewed, of whom 57.7% were female. The average age was 69.7 years. About 25% of the vaccinated and 20% of the unvaccinated in 2009, and 25% of the vaccinated and 22.5% of the unvaccinated in 2010 reported having the flu. Among the vaccinated and unvaccinated in 2009 and 2010, there was no verified association between vaccination and influenza (PR=1.24; [95% CI: 0.63-2.43] and PR=1.11; [95% CI: 0.59-2.09], respectively). CONCLUSIONS: This study suggests that, among the elderly selected, the vaccination coverage for influenza is below the ideal, even with projection of the best indices for 2011 (~ 84%). The data on vaccination and disease protection needs further research; however, the results point to the need for measures to better clarify to this population about the disease, its complications and the benefits of vaccination, in addition to combatting the stigma related to low adherence.

The characteristics, clinical manifestations and outcomes of pandemic influenza A (H1N1) 2009 in the elderly

IntroductionThe objetctive of this study was to evaluate the 2009 Pandemic Influenza A (H1N1) in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients.MethodsThis was an observational, retrospective study. Data were collected from the National Notifiable Diseases (SINAN), from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors.ResultsWe included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis.ConclusionsAlthough relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality.

Pandemic influenza A (H1N1) 2009: epidemiological analysis of cases in a tropical/semi-arid region of Brazil

IntroductionThe year 2009 marked the beginning of a pandemic caused by a new variant of influenza A (H1N1). After spreading through North America, the pandemic influenza virus (H1N1) 2009 spread rapidly throughout the world. The aim of this study was to describe the clinical and epidemiological characteristics of cases of pandemic influenza in a tropical/semi-arid region of Brazil.MethodsA retrospective study analyzed all suspected cases of pandemic influenza (H1N1) 2009 reported in the Ceará State through the National Information System for Notifiable Diseases during the pandemic period between 28 April, 2009 and November 25, 2010.ResultsA total of 616 suspected cases were notified, 58 (9.4%) in the containment phase and 558 (90.6%) in the mitigation phase. Most cases were of affected young people resident in the City of Fortaleza, the largest urban center in the State of Ceará. The most frequent symptoms presented by the cases with confirmed infection were fever, cough, myalgia, arthralgia, and nasal congestion. Mortality rate was 0.0009/1,000 inhabitants and lethality was 5.6%. Deaths were observed only in the mitigation phase. Mortality rates were similar for both sexes but were higher in the age group under 5 years.ConclusionsThe study suggests that the influenza A (H1N1) pandemic in this tropical/semi-arid region had a lower magnitude when compared to states in the Southern and Southeastern regions of Brazil.

Spontaneous reporting of adverse events following pandemic influenza A (H1N1) immunization in a reference center in the State of Sao Paulo, Brazil

Introduction This paper describes adverse events (AEs) temporally associated to the pandemic influenza A (H1N1) vaccine observed in a reference center in São Paulo, Brazil, during a 2010 mass vaccination campaign. Methods A retrospective study involving persons who sought medical care for AEs following influenza vaccination. Data were retrieved from medical records, vaccine AE notification forms, and a computerized system for immunobiological registration. Results Sixty-six vaccinees sought medical care for AEs after immunization. The most frequent AEs were fever, headache, myalgia, and pain at the injection site. No serious AEs were reported. Conclusions Few vaccinees spontaneously reported AEs to influenza A (H1N1) vaccine at this center.

Influenza infection and Kawasaki disease

INTRODUCTION: The objective of this study was to investigate the possible link between influenza (Flu) infection and Kawasaki disease (KD). METHODS: We examined the medical records of 1,053 KD cases and 4,669 influenza infection cases hospitalized at our institute from January 1, 2011 to December 31, 2013. Cases of KD with concomitant influenza infection formed the KD + Flu group. Each KD + Flu case was matched with 2 KD cases and 2 influenza infection cases, and these cases were assigned to the KD group and Flu group, respectively. The differences in the principal clinical manifestations, course of disease, incomplete KD rate, intravenous immunoglobulin (IVIG) resistance rate, and echocardiographic detection results between the KD + Flu group and KD group were compared. The fever durations and laboratory test results of these three groups were compared. RESULTS: 1) The seasonal variations of the KD + Flu group, KD group and Flu group were similar. 2) The morbidity rate of incomplete KD was higher in the KD + Flu group compared with the KD group. 3) Patients in the KD + Flu group exhibited a longer time to KD diagnosis compared with patients in the KD group. 4) The KD + Flu group exhibited the longest fever duration among the three groups. 5) The CRP and ESR values in the KD + Flu group were higher those in the Flu or KD groups. CONCLUSIONS: Concomitant influenza infection affects the clinical manifestations of KD and can impact the laboratory test results and the diagnosis and treatment of the disease. However, it remains unclear whether influenza contributes to KD etiology.

Acute disseminated encephalomyelitis following inactivated influenza vaccination in the Brazilian Amazon: a case report

AbstractHere, we describe a case of acute disseminated encephalomyelitis (ADEM) that occurred during a plausible risk interval following inactivated influenza vaccination in a previously healthy 27-year-old man from Manaus, Brazil. He was treated with intravenous methylprednisolone and immunoglobulin. One-month follow-up revealed resolution of the brain lesions, but not of the spinal cord lesions. No recurrence or progression of the main neurological symptoms was observed. After two years of monitoring, the patient continues to experience weak lower limbs and urinary retention. Thus, we recommend that ADEM should be considered in a patient presenting with neurological symptoms after influenza vaccination.

Comparative study of lymphocytes from individuals that were vaccinated and unvaccinated against the pandemic 2009-2011 H1N1 influenza virus in Southern Brazil

ABSTRACTINTRODUCTION:While no single factor is sufficient to guarantee the success of influenza vaccine programs, knowledge of the levels of immunity in local populations is critical. Here, we analyzed influenza immunity in a population from Southern Brazil, a region with weather conditions that are distinct from those in the rest of country, where influenza infections are endemic, and where greater than 50% of the population is vaccinated annually.METHODS:Peripheral blood mononuclear cells were isolated from 40 individuals. Of these, 20 had received the H1N1 vaccine, while the remaining 20 were unvaccinated against the disease. Cells were stimulated in vitro with the trivalent post-pandemic influenza vaccine or with conserved major histocompatibility complex I (MHC I) peptides derived from hemagglutinin and neuraminidase. Cell viability was then analyzed by [3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide)]-based colorimetric assay (MTT), and culture supernatants were assayed for helper T type 1 (Th1) and Th2-specific cytokine levels.RESULTS:Peripheral blood lymphocytes from vaccinated, but not unvaccinated, individuals exhibited significant proliferation in vitro in the presence of a cognate influenza antigen. After culturing with vaccine antigens, cells from vaccinated individuals produced similar levels of interleukin (IL)-10 and interferon (IFN)-γ, while those from unvaccinated individuals produced higher levels of IFN-γ than of IL-10.CONCLUSIONS:Our data indicate that peripheral blood lymphocytes from vaccinated individuals are stimulated upon encountering a cognate antigen, but did not support the hypothesis that cross-reactive responses related to previous infections can ameliorate the immune response. Moreover, monitoring IL-10 production in vaccinated individuals could comprise a valuable tool for predicting disease evolution.

Folha, talo e bulbo de alho (Allium sativum): Alguns efeitos farmacológicos "In Vivo"

Alguns efeitos farmacológicos da folha, talo e bulbo do alho foram investigados. Os extratos foram preparados por triturarão em solução etanólica 50%. Após evaporação a concentração final foi ajustada para 100 mg sólidos/ml. A dose utilizada foi de 1 g sólidos/kg por via oral. Vários efeitos (discretos) foram observados em comundongos, tais como diarréia, ptose e piloereção. Em ratos observou-se efeito hipoglicêmico do bulbo, efeitos analgésicos e hiperalgésicos dos três extratos e em ratos com hipertensão espontânea (mas não em ratos normotensos) um pronuciado efeito antihipertensivo de longa duração.

Efeitos do extrato bruto do Asparagus plumosus sobre a pressão arterial e freqüência cardíaca em cães atropinizados

O extrato bruto do Asparagus plumosus foi aplicado em cães e verificou-se significativo efeito hipotensor e bradicárdico, em cães atropinizados, estas mesmas respostas não foram significativas sugerindo uma possível atividade parassimpaticomimética.

Efeitos antihipertensor e diurético de alguns alimentos de origem vegetal

Nove extratos de plantas amplamente utilizadas como alimento tem sido investigados sobre seus efeitos diurético e antihipertensor em ratos. Os efeitos diuréticos foram moderados. Três extratos (oliveira, alho e manjericão) diminuiram a pressão arterial durante várias horas. O agrião mostrou um efeito hipertensor. Conclui-se que alimentos de origem vegetal podem produzir efeitos importantes sobre a pressão arterial em ratos.

Efeitos da profundidade de semeadura e posição da semente na germinação e formação da haste das mudas de cedrorana (Cedrelinga catenaeformis DUCKE)

Foram estudados os efeitos da profundidade de semeadura e da posição da semente no ato do semeio sobre a porcentagem de germinação, índice de velocidade de emergência e formação de haste das mudas de cedrorana (Cedrelinga catenaeformis Ducke). Foram analisadas duas profundidades de semeadura e três posições de semeio das sementes. O tratamento de 2 cm de profundidade e na posição natural de queda das sementes sobre um plano proporcionou melhores resultados para abreviar, uniformizar, aumentar a germinação e formar mudas com a haste reta.

Teores de rotenona em Clones de Timbó (Derris Spp. Fabaceae) de diferentes regiões da Amazônia e os seus efeitos na emergência de Imagos em Musca Domestica L

A análise dos teores de rotenona, em clones de três espécies de timbó, permitiram a classificação destas plantas de acordo com as suas eficiências no controle de larvas de Musca domestica. Os resultados evidenciaram correlações significativas entre os teores de rotenona apresentados pelos clones de Derris urucu e de Derris nicou, com relação a capacidade de controle das larvas. As plantas com os maiores teores de rotenona foram as mais eficientes. O conteúdo de rotenona, os efeitos dos clones das espécies de Derris nas moscas, além dos locais de origem das plantas, mostraram que deve ter ocorrido entre estes timbós, a existência de isolamento populacional, durante a época do pleistoceno na Amazônia. Em Derris sp., que apresentou menor teor de rotenona, sendo ineficiente no controle das larvas, estas diferenças não foram assinaladas.

Efeitos do tamanho da semente e do recipiente no crescimento de mudas de Camu-camu (Myrciaria dubia)

O camu-camu (Myrciaria dubia (H. B. K.) McVaugh, Myrtaceae) é uma fruteira silvestre dos rios e lagos da Amazônia que está sendo domesticada para cultivo cm solos de terra firme. O seu potencial econômico reside no seu alto teor de ácido ascórbico, que pode ser de até 2950 mg/100g de polpa. O objetivo do presente trabalho foi avaliar o desenvolvimento das mudas de camu-camu provenientes de sementes de diferentes tamanhos, produzidas em diferentes volumes de substrato. O delineamento experimental foi de blocos casualizados, em esquema fatorial de 3x4, com quatro repetições. Os fatores foram tamanho da semente (pequena, média e grande, pesando 19, 37 e 67 g/100 sementes, respectivamente) e tamanhos do recipiente (sacos plásticos pretos de 12x23, 16x28, 19x21 e 20,5x33 cm, com 750, 1500, 1750 e 3500 g, respectivamente). As mudas provenientes de sementes grandes c médias tiveram melhor desenvolvimento (altura de 53 e 46 cm, respectivamente) e as mudas cultivadas em sacos de 19x21 cm mostraram uma tendência de maior desenvolvimento (altura de 49 cm), inclusive durante todo o período de cinco meses. Portanto, mudas de camu-camu com 30 cm de altura (pronto para o campo) podem ser obtidas em 60 a 70 dias após o transplante das plântulas provenientes de sementes grandes e médios e usando sacos de mudas com 19x21 cm.

Efeitos da ocupação urbana sobre a macrofauna de invertebrados aquáticos de um Igarapé da cidade de Manaus/AM - Amazônia Central

A qualidade da água e a fauna composta pelos macroinvertebrados aquáticos do Igarapé do Mindú, o qual tem suas nascentes em áreas florestadas e atravessa a cidade de Manaus (Amazonas, Brasil), foram estudadas de 1993 a 1995. Desmatamentos e ocupação das áreas ao longo do igarapé, juntamente com a poluição orgânica doméstica causaram drásticas alterações nas características físico-químicas das águas e na composição da fauna aquática. Assim, temperatura da água, condutividade elétrica, pH e sedimentos em suspensão aumentaram significativamente, enquanto que os valores de oxigênio dissolvido na água diminuíram. Esses fatores de alterações, associados com a redução natural da velocidade de corrente d'água e aumento da radiação solar, resultaram em eutrofização e mudança marcante da fauna bentônica.