Marilu Mendes Moscardini Rocha

Letalidade na epidemiologia da doença meningocócica: estudo na região de Campinas, SP, 1993 a 1998

OBJETIVO: Analisar a tendencia da letalidade e da incidencia da doenca meningococica no periodo de 1993 a 1998 na regiao de Campinas, SP, abrangendo cinco municipios de seu entorno (1,2 milhoes de habitantes). METODOS: Foi realizado estudo longitudinal retrospectivo de todos os casos notificados (375) da doenca meningococica pela vigilância epidemiologica regional. Por meio de analise de regressao logistica foram identificados os fatores associados ao aumento da letalidade dessa doenca. RESULTADOS: Os anos de 1996 e de 1997 apresentaram maiores coeficientes de letalidade (23,8%), coincidindo com picos de incidencia do sorogrupo B, altos percentuais de meningococcemia e menor investigacao etiologica. Observou-se padrao sazonal e predominio da circulacao da Neisseria meningitidis das cepas B:4:P1.15 e C:2b:P1.3. Os fatores relacionados com o aumento da letalidade pela analise de regressao logistica foram: presenca de meningococcemia, com ou sem meningite (odds ratio ajustado (ORaj) 13,88 e intervalo de confianca de 95% (IC) 4,68-42,13); idade acima de 30 anos (ORaj 6,42; IC 2,32-17,80); idade inferior a 1 ano (ORaj 2,95; IC 1,55-5,63); e sorogrupo B (ORaj 2,33; IC 1,14- 4,79). CONCLUSOES: A septicemia, a idade e o sorogrupo mostraram-se variaveis preditoras de morte. Em alguns anos os coeficientes de letalidade apresentaram-se altos, indicando a necessidade de investigacao da qualidade e da agilidade da assistencia a saude na prevencao dos obitos. O percentual de identificacao etiologica dos casos dificultou conclusoes mais precisas sobre o comportamento epidemiologico das cepas.OBJECTIVE To analyze the trends of the meningococcal disease cumulative incidence and case-fatality rate in the region of Campinas, Brazil, an area that encircles five cities and 1.2 million inhabitants, from 1993 to 1998. METHODS A longitudinal retrospective study of all case records (375) obtained from the regional epidemiological surveillance system was carried out. A logistic regression analysis allowed identifying the risk factors related to fatal outcomes of meningococcal disease. RESULTS The highest fatality rates (23.8%) were seen in the period of 1996 and 1997, coinciding with the incidence peaks of serogroup B Neisseria and a high percentage of septicemia cases. Also at the same period there was registered a poor etiological investigation of the cases. A seasonal pattern and the predomination of strains B:4:P1.15 and C:2b:P1.3 were observed. In the logistic regression analysis, the risk factors related to fatality were: septicemia with or without meningitis (adjusted odds ratio [OR(aj)] = 13.88 and 95% confidence interval [CI] = 4.68 - 42.13); age over 30 years (OR(aj) = 6.42; CI = 2.32 - 17.80); age under 1 year (OR(aj) = 2.95; CI = 1.55 - 5.63); and serogroup B (OR(aj) = 2.33; CI = 1.14 - 4.79). CONCLUSIONS Septicemia, age and serogroup were predictive variables related to a fatal outcome. In 1996 and 1997, case-fatality rates were high, indicating the need to further assessment of the quality of the services delivered and their readiness to take preventive action. The lack of etiological identification in many cases precluded more accurate inferences about the epidemiological behavior of Neisseria meningitidis in the region.

Molecular epidemiology of a nosocomial outbreak due to Enterobacter cloacae and Enterobacter agglomerans in Campinas, São Paulo, Brazil

A total of 73 isolates (57 Enterobacter cloacae and 16 Enterobacter agglomerans), recovered during an outbreak of bacteremia in the Campinas area, São Paulo, Brazil, were studied. Of these isolates, 61 were from parenteral nutrition solutions, 9 from blood cultures, 2 from a sealed bottle of parenteral nutrition solution, and one was of unknown origin. Of the 57 E. cloacae isolates, 54 were biotype 26, two were biotype 66 and one was non-typable. Of 39 E. cloacae isolates submitted to ribotyping, 87.2% showed the same banding pattern after cleavage with EcoRI and BamHI. No important differences were observed in the antimicrobial susceptibility patterns among E. cloacae isolates exhibiting the same biotype, serotype and ribotype. All E. agglomerans isolates, irrespective of their origin, showed same patterns when cleaved with EcoRI and BamHI. The results of this investigation suggest an intrinsic contamination of parenteral nutrition solutions and incriminate these products as a vehicle of infection in this outbreak.

Situação da febre maculosa na Região Administrativa de Campinas, São Paulo, Brasil

Brazilian spotted fever was detected for the first time in the State of S o Paulo in 1929. However, there is no systematic reporting of the disease in the State. In 1985, three cases of the disease occurred in the municipality of Pedreira, located in the Campinas Region, belonging to the 5th Administrative Region, in the Northeast part of the State, including 88 municipalities. An investigation was conducted at the time, but the lack of case registry limited its scope. The present study was undertaken with the aim of recovering the history of the disease in the Region. Data recovered from several public health services for 1985-2000 were used to analyze incidence patterns. It was observed that the transmission area expanded and the number of suspected cases increased, especially after 1996, when mandatory reporting was established. Deaths due to spotted fever were observed in most of the years under study. The study concluded that spotted fever incidence is increasing in the Campinas Region. Complementary bio-ecological studies are currently under way to better understand the epidemiology of this disease, recognized worldwide as an emerging public health problem.

Phenotypical and genotypical characterization of Bordetella pertussis strains isolated in São Paulo, Brazil, 1988-2002

Whooping cough or pertussis was a major cause of childhood morbidity and mortality in the world until the introduction of a whole-cell vaccine in the 1940s. However, since the early 1980s whooping cough cases have increased in many countries, becoming an important problem of public health. This increase may be due to accuracy of laboratory diagnosis and reporting of the disease, a decline in immunity over time, demographic changes, and adaptation of the bacterial population to vaccine-induced immunity. The purpose of this study was to analyze phenotypically and genotypically a collection of 67 Bordetella pertussis isolates recovered during the period 1988-2002 in São Paulo State, Brazil to determine their characteristics and relatedness. All isolates were submitted to susceptibility testing to erythromycin, serotyping, and 56 isolates were analyzed by Pulsed Field Gel Electrophoresis (PFGE). All isolates were susceptible to erythromycin and the majority of them belonged to serotype 1,3. The 56 isolates were classified into 11 PFGE profiles according to the differences in banding patterns. Although more than 60% of the isolates were recovered from patients aged less than three months, almost 15% of them were isolated from adolescents/adults evidencing the increase in the incidence of pertussis among this age group.

Critério diagnóstico da doença meningocócica na Região Metropolitana de Campinas, São Paulo, Brasil

The aim of this article is to evaluate confirmatory criteria: culture, latex agglutination, counter immunoelectrophoresis, microscopic examination, and clinical/epidemiological criteria for cases of meningococcal disease reported in Greater Metropolitan Campinas, São Paulo State, Brazil, from 1993 to 2002 (568 cases). The following variables were also studied: clinical features, gender, age, city, hospital, case fatality, seasonality, and Neisseria meningitidis serogroup. Culture as a confirmatory criterion was the dependent variable in univariate analysis. The mean proportion of confirmatory criterion by culture was 68.7%. Clinical features of meningococcal disease -- meningitis without septicemia (OR = 2.87; CI: 1.89-4.38) and septicemia without meningitis (OR = 0.26; CI: 0.17-0.45) -- were associated with confirmation by culture. Case fatality rates were different among all diagnostic criteria. More attention should be given to etiological diagnostic confirmation in more severe cases. Diagnostic methods such as PCR may improve etiological confirmation of meningococcal disease in cases with negative cultures.