Lucia Ferro Bricks

Utilização de medicamentos por crianças atendidas em creches

In order to study the pattern of the use of medicines by children, 1,382 children seen at 15 of the 16 day-care centers of Pinheiros, S. Paulo city (SP) (Brasil), were followed-up for 2 months. Of these, 37% received 1,409 drugs. Average drug use was 50.9 medicines/100 children/month and the number of medicines used by each child ranged from 0 to 13. Younger children (0-2 years) received more medicines and more frequently than older children; over 80% of the younger children received one or more medicines, and more than 20% received 5 or more medicines vs. less than 45% and 5%, respectively, in the group of children aged 2-7 years. The medications most frequently employed were anti-infective, respiratory medicines and antipyretics used by, respectively. 20.1%, 19.0% and 14.0% of the children studied (usually for respiratory problems). Physicians prescribed 93% of medicines, but there were many inappropriate therapies for benign conditions, such as bronchitis and common colds. Antibiotic measure was observed (66%) including an excessive number of cloramphenicol prescriptions. Also, there were many prescriptions of doubtful value (decongestants, expectorants, vitamin and mineral supplements) and usage of as yet un approved medications for children (diclofenac, benzidamin, iodides).

Judicious use of medication in children

OBJECTIVE: to perform a bibliographic review on criterion-based use of drugs by children. SOURCES OF DATA: articles were searched through Medline database using the terms: acute respiratory diseases, asthma, antibiotics, treatment and children. SUMMARY OF THE FINDINGS: there is an excessive use of drugs to treat acute respiratory diseases and asthma. Drugs with unproved action are frequently prescribed. CONCLUSIONS: considering the toxicity of many drugs used in children and the emergency of bacterial strains resistant to antibiotics, it is essential to develop new methods of diagnosing bacterial infections, as well as to educate both physicians and the general public on the judicious use of drugs.

Impact of pneumococcal conjugate vaccine on the prevention of invasive pneumococcal diseases

OBJECTIVES To evaluate the impact of heptavalent pneumococcal conjugate vaccine in invasive pneumococcal diseases in the United States, and to analyze the potential impact of this vaccine in Brazil. SOURCES OF DATA MEDLINE, LILACS, Cochrane Database Reviews, as well as the websites of the Centers for Disease Control and Prevention (CDC), Brazilian Ministry of Health and Centro de Vigilância Epidemiológica do Estado de São Paulo from January 2000 to January 2006. Articles retrieved with the keywords Streptococcus pneumoniae, pneumococcal diseases, conjugate vaccine, antimicrobial resistance and meningitis were reviewed. SUMMARY OF THE FINDINGS The introduction of heptavalent pneumococcal conjugate vaccine caused a dramatic reduction in the incidence of invasive pneumococcal diseases in American children, reduced antibiotic use and the number of medical visits due to otitis media and pneumonia by children. The incidence of invasive pneumococcal diseases caused by resistant strains declined in immunized children, adults and elderly individuals. In Brazil, the mortality rate of pneumococcal meningitis is very high and the resistance to antibiotics has increased over the last 5 years. CONCLUSIONS Heptavalent pneumococcal conjugate vaccine can benefit not only children, but the entire community and should be included in the Brazilian routine immunization schedule.

Carriage Rate and Effects of Vaccination after Outbreaks of Serogroup C Meningococcal Disease, Brazil, 2010

Polysaccharide vaccine did not affect carriage nor interrupt transmission of an epidemic strain.

Varicella vaccines and measles, mumps, rubella, and varicella vaccine.

OBJECTIVES To present an up-to-date review of studies investigating the efficacy, adverse events and vaccination regimens of the varicella vaccine and the new presentation combined with the vaccine for measles, mumps and rubella. SOURCES OF DATA Bibliographic review of the MEDLINE and LILACS databases covering the period 1999 to 2006. SUMMARY OF THE FINDINGS The varicella vaccine protects 70 to 90% of immunized children against any form of varicella zoster infection, but the efficacy against severe forms is higher (95 to 98%). This is a well-tolerated vaccine that causes few reactions. Since the vaccine was licensed, there have been three confirmed cases of transmission of the vaccine virus by domestic contacts to previously healthy people, who went on to develop mild disease. Despite evidence that the protection offered by this vaccine can wane over a number of years, it is not yet possible to state that a second dose is warranted, bearing in mind exposure to wild virus. After universal vaccination the chances of natural stimulation should drop and it is very probable that booster doses will become necessary. A measles, mumps, rubella, and varicella vaccine has recently been licensed that combines vaccines for measles, mumps, rubella and varicella in a single product with high rates of seroconversion. CONCLUSIONS The Brazilian Society of Pediatrics recommends the varicella vaccine for children from 1 year on. We hope that the measles, mumps, rubella, and varicella vaccine will soon be available in Brazil, since combined vaccines facilitate wider vaccination coverage.

Varicella zoster in children attending day care centers

OBJECTIVE To describe morbidity associated to varicella in children attending day care centers. METHODS Descriptive study carried out through inquiries with parents of 664 children who acquired varicella after admission to day care centers in Taubaté (population: 244,165, census of 2004), a prosperous city in the State of São Paulo. RESULTS The median age was 36 months (range 6 to 80 months); 8.4% of the children had varicella before 1 year of age. The main symptoms were: exanthema (100.0%), fever (85.4%) anorexia (39.6%), and headache (15.3%). 517 children (77.9%) had at least 1 medical visit, and 80.6% received at least 1 medication; 73 (11.0%) received nonsteroidal antiinflammatory drugs, and 52 (7.8%) received antibiotics. Complications occurred in 38 children (5.7%; 95% confidence interval: 3% - 8%); 8 (1.2%) were hospitalized, and 5 (0.7%) had sequelae. Complications and hospitalizations rates were 3 times more frequent in children with less than 1 year of age than in older children. More than half of the children and of the working parents were absent from their regular activities for more than a week. CONCLUSIONS Varicella was associated with significant morbidity, affected younger children, was complicated in more than 5%, and left sequelae in 0.7% of children. More than 10% of the children received nonsteroidal antiinflammatory drugs, highlighting the need to warn the population about the risks of these drugs. Although varicella vaccination is not recommended for children younger than 12 months, vaccination of the children older than a year could avoid by herd immunity the transmission to babies. Brazilian public health authorities should be alerted to this issue and offer varicella vaccine to children attending day care centers.

Colonização de orofaringe por Streptococcus pneumoniae em crianças de creches municipais de Taubaté-SP: correlação entre os principais sorotipos e a vacina pneumocócica conjugada heptavalente

OBJECTIVE: Streptococcus pneumoniae usually colonizes the oropharynx of healthy people. Oropharyngeal carriage is related to the invasion of adjacent structures and to the development of invasive disease. A descriptive cross-sectional study was performed aiming at verifying the prevalence of oropharyngeal colonization by S. pneumoniae in children attending day care centers in the city of Taubate - SP; verifying the frequency of S. pneumoniae serotypes in isolated strains; and relating the most frequent serotypes to the composition of the conjugated heptavalent pneumococcal vaccine currently in use. METHODS: from June 29 to December 15 1998, samples of oropharyngeal material were collected from 987 children, ranging from 8 to 71 months old, enrolled in day care centers in Taubate - SP. The identification of S. pneumoniae was based on the observation of the colonies that presented partial hemolysis in agar-blood and agar-blood with gentamycin plates and on the observation of inhibited growth around the optochin disc. Serotyping was performed by the Quellung reaction, using specific antiserum, provided by the Centers for Disease Control and Prevention (Atlanta, GA/USA), and the Danish nomenclature system. RESULTS: as a result, S. pneumoniae was isolated from the oropharynx in 209 out of 987 children (colonization rate of 21.2%). Twenty eight serotypes were identified. The seven most frequent serotypes were: 6A/6B (21.5%), 19F (14.8%), 18C (7.4%), 23F (7.4%), 9V (6.7%), 14 (5.2%), 10A (4.4%). Except for serotype 10A, all the other six are included in the vaccine. The only vaccine serotype which was not found was serotype 4. CONCLUSION: agreement of 63% between the oropharynx colonizer serotypes and the serotypes present in the vaccine was found.

Universal use of inactivated polio vaccine

OBJECTIVES To present an update on the status of poliomyelitis worldwide, number of cases per year, regions most affected by the disease, vaccines currently available, their risks and benefits, monovalent vaccine use, risks of disseminating a mutant virus in the community, progress that has been made in terms of worldwide eradication and the World Health Organizations (WHO) proposals in this transition period between global eradication and the post-eradication period. SOURCES OF DATA Data for the period from 1955 to 2005 were searched in MEDLINE, LILACS, The Web, Doctors Guide, WHO website and the Pan American Health Organization (PAHO) website and text book. SUMMARY OF THE FINDINGS In 1988, the WHO established the goal of eradicating the disease and interrupting transmission of the wild virus globally. Since then, there has been a dramatic decline of the disease, although in 2005 there were still some countries considered endemic and others where polio returned on account of imported viruses. The vaccines used worldwide are the classical tOPV and IPV, and in this eradication process, the use of mOPV vaccines has been encouraged in places where only one type of poliovirus circulates. In addition to spreading the virus in the community, the OPV vaccines may, however, cause paralyses by reversal of the neurovirulence process. CONCLUSIONS For a world free of poliomyelitis disease, it would be necessary to interrupt circulation of the virus, which will only be possible if the OPV virus were to be discontinued, in accordance with the WHO proposals for this transition period and the post-eradication period.

Prevention of respiratory syncytial virus infections

Respiratory syncytial virus is the most important cause of viral lower respiratory illness in infants and children worldwide. By the age of 2 years, nearly every child has become infected with respiratory syncytial virus and re-infections are common throughout life. Most infections are mild and can be managed at home, but this virus causes serious diseases in preterm children, especially those with bronchopulmonary dysplasia. Respiratory syncytial virus has also been recognized as an important pathogen in people with immunossupressive and other underlying medical problems and institutionalizated elderly, causing thousands of hospitalizations and deaths every year. The burden of these infections makes the development of vaccines for respiratory syncytial virus highly desirable, but the insuccess of a respiratory syncytial virus formalin-inactivated vaccine hampered the progress in this field. To date, there is no vaccine available for preventing respiratory syncytial virus infections, however, in the last years, there has been much progress in the understanding of immunology and immunopathologic mechanisms of respiratory syncytial virus diseases, which has allowed the development of new strategies for passive and active prophylaxis. In this article, the author presents a review about novel approaches to the prevention of respiratory syncytial virus infections, such as: passive immunization with human polyclonal intravenous immune globulin and humanized monoclonal antibodies (both already licensed for use in premature infants and children with bronchopulmonary dysplasia), and many different vaccines that are potential candidates for active immunization against respiratory syncytial virus.

Controversial drugs in otorhinolaryngology

OBJECTIVES: To present a review on the most important groups of drugs used to treat otorhinolaryngological disorders. METHOD: Review of the literature about treatment of pediatric upper respiratory infections and allergy, using MEDLINE and LILACS data. RESULTS AND COMMENTS: Pediatric otorhinolaryngological disorders are extremely frequent and most of the time acute. They are one of the major reasons for pediatric visits. The therapeutical management of these conditions in many cases accounts for an over use of drugs, specially antibiotics, antipyretic and drugs of doubtful value, such as decongestants and expectorants. Judicious use, correct indication, and side effects of these drugs must be better known by physicians who deal with the childs health.