The close proximity of the United States to the Mexican border poses a concern for communicable diseases because of the high flow of population movement. The purpose of this retrospective, quantitative study was to identify risks associated with respiratory diseases using an analysis of archived data from the Severe Acute Respiratory Illness (SARI) surveillance program. Based on the epidemiologic triangle theory, demographic and etiologic factors were analyzed to examine any associations with SARI in this population. Between 2010 and 2012, 798 subjects enrolled in this program, with 336 (42.1%) testing positive for respiratory pathogens. Chi square analysis determined that age (X2 (4, N = 786) = 255.361, p < 0.001), clinic location (X2 (3, N = 780) = 290.841, p < 0.001), and race/ethnicity (X2 (4, N = 762) = 1456.701, p < 0.001) showed significant associations with SARI in the population. The logistic regression model showed that the youngest age group (0-4) had the highest risk of developing SARI compared to other age groups (5-24 OR = 0.521, 95% CI [0.311-0.871]; 25-49 OR = 0.377, 95% CI [0.224-0.636]; 50-64 OR = 0.211, 95% CI [0.118-0.376]; >65 OR = 0.225, 95% CI [0.143-0.356]. African Americans were also at higher risk of developing SARI compared to Hispanic Americans (OR = 3.997, 95% CI [1.272-12.558]. This study promotes positive social change by informing efforts to increase vaccination and health literacy, improve the accessibility and availability of preventive health care in low socioeconomic communities, and promote healthy lifestyles among at-risk groups. These steps will improve the overall health of the communities along the U.S.-Mexico border region.

Made available in DSpace on 2015-12-06T23:46:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2013 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução: O resfriado comum a uma das sindromes infecciosas mais frequentes na infancia, sendo causado por um grupo numeroso de virus, podendo vir acompanhado de complicacoes e uma significativa morbidade. Constitui uma das principais causas de consultas em servicos de atendimento primario a Saúde e um dos principais motivos para o uso indevido de antibioticos.! OBJETIVOS. Descrever a ocorrencia, etiologia, evolucao clinica, uso de antibioticos e absenteismo no trabalho dos responsaveis dos casos de resfriados comuns dentre as criancas atendidas em um servico de atencao primaria a Saúde na cidade de São Paulo. METODOS. No periodo de mar/2008 a fev/2009, foi selecionada uma amostra de casos de criancas menores de 12 anos com diagnostico de resfriado comun com inicio ate cinco dias, as quais foram acompanhadas ate a resolucao completa do quadro. Foram excluidos casos com suspeita de infeccoes bacterianas secundarias, cardiopatias congenitas, doencas pulmonares cronicas, imunodefiCiências e historico de prematuridade. Os dados clinicos foram anotados em formularios padronizados e as amostras de lavado de nasofaringe (uma por caso) foram submetidas a uma ou mais tecnicas laboratoriais (imunofluorescencia direta, reacao da polimerase em cadeia e reacao da polimerase em cadeia em tempo real) para a deteccao de rinovirus (HRV), virus sincicial respiratorio (RSV), parainfluenza 1, 2 e 3 (PIV1-3), adenovirus (AdV), metapneumovirus (hMPV), bocavirus (HBoV), influenza A e B (IFVA e IFVB), coronavirus (HCoV) e enterovirus (HEV). RESULTADOS. Os resfriados representaram 29,0% de todas as consultas medicas (955/3282). Foi obtida uma amostra de 134 casos, com media de idade de 3,6 anos (med 2,6 a). Em 73,8% (99/134) dos casos foi detectado pelo menos um virus, tendo sido o HRV (41,0%) e o IFVA (17,2%) os mais frequentes. O tempo medio de duracao dos sintomas foi de 8,8 dias, nao tendo havido diferencas nas medias de duracao dos sintomas associados aos diferentes virus. A coriza (91,8%) e a tosse (90,3%) foram as manifestacoes mais frequentes, sendo que o quadro associado aos diferentes virus foi semelhante, exceto pelos casos com HRV que apresentaram menos febre (p=0,025) e com IFVB que apresentaram menos tosse (p=0,001). As coinfeccoes ocorreram em 30,3% dos casos (30/99) e nao apresentaram diferencas com relacao as manifestacoes clinicas, ocorrencia de complicacoes e media de duracao dos sintomas quando comparadas aos casos com monoinfeccoes, O indice de complicacoes foi de 11,9%, porem, os antibioticos foram prescritos em 39,6% dos casos, tendo sido a maior parte das prescricoes consideradas indevidas. Foi verificada uma media de 1,5 consultas e 1,0 dia de absenteismo por caso de resfriado. CONCLUSAO. Apesar de considerados patologias benignas, os resfriados foram responsaveis por um alto indice de uso indevido de antibioticos, consultas medicas e dias de absenteismo no trabalho. A ampliacao das faixas etarias para as vacinas disponiveis no sistema publico de Saúde, a disponibilizacao de testes diagnosticos rapidos para os virus respiratorios e o estimulo a educacao medica continuada poderiam contribuir para melhorar o cenario atual possibilitando uma profilaxia mais ampla, o diagnostico rapido e o uso racional de antibioticos / INTRODUCTION. The common cold are caused by a large group of viruses and is one of the most frequent infectious syndromes in childhood which can be followed by complications and a significant morbidity. They are a major cause of consultations in primary care services and a major reason for the misuse of antibiotics. OBJECTIVES. To describe the occurence, etiology, clinical course, complications, use of antibiotics, number of consultations and days of work absenteeism of parents in cases of common colds in children attending an outpatient primary health care service in São Paulo city. METHODS. From mar/2008 to Feb/2009, we selected a sample of cases of children under 12 years diagnosed with common colds starting up to five days, which were followed until resolution of symptoms. We excluded cases with suspected secondary bacterial infections, congenital heart disease, chronic lung diseases, immunodeficiencies and history of prematurity. Clinical data were recorded on a standardized form and samples of nasopharyngeal wash (one for each case) were subjected to one or more laboratory techniques (direct immunofluorescence, polymerase chain reaction and real time polymerase chain reaction) for detection of rhinovirus (HRV), respiratory syncytial virus (RSV), parainfluenza virus 1, 2 and 3 (PIV1-3), adenovirus (AdV), metapneumovirus (hMPV) Bocavirus (HBoV), influenza A and B (IFVA and IFVB ), coronavirus (HCoV) and enterovirus (HEV). RESULTS. Colds accounted for 29.0% of all medical consultations (955/3282). We obtained a sample of 134 cases of common cold cases, with a mean age of 3.6 years (med 2.6). At least one virus was detected in 73.8% (99/134) of cases and HRV (41.0%) and IFVA (17.2%) were the most frequent viral agents. The mean time of symptoms was 8.8 days, with no differences among different types of viruses. Coriza (91.8%) and cough (90.3%) were the most frequent symptoms, and the clinical characteristics among different types of viruses were similar, except for the fact that cases with HRV had less fever (p = 0.025) and with IFVB had less cough (p = 0.001). The coinfections occurred in 30.3% of cases (30/99) and were not different with respect to clinical manifestations, rate of complications and duration of symptoms when compared to cases with monoinfections. The complication rate was 11.9%, however, antibiotics were prescribed in 39,6% of cases, with most prescriptions considered improper. The average of doctos visits and lost work days was 1.5 visits and 1.0 days of absenteeism per case of common cold. CONCLUSION. Although considered benign diseases, common colds were responsible for a high rate of antibiotics misuse, doctor visits and days of work absenteeism. A wider coverage for all ages with vaccines available in the Brazilian public health system, the availability of rapid diagnostic tests for respiratory viruses and the continuous medical education could improve the current scenario and promote a broader prevention, rapid diagnosis and rational use of antibiotics. / BV UNIFESP: Teses e dissertações

Orientador: Fátima Pereira de Souza / Banca: José Luiz Proença Módena / Banca: Maria Elisabete Jorge Amaral / Resumo: As infecções do trato respiratório estão associadas com mortalidade significativa no mundo inteiro e afetam principalmente crianças menores de cinco anos de idade. A maioria das infecções respiratórias é causada por agentes virais como: Vírus Sincicial Respiratório (RSV), Influenzavírus tipo A e B (FLUA e FLUB), Parainfluenza tipo 1, 2 and 3 (PIV-1, PIV-2 e PIV-3), Rhinovirus (HRV) e Metapneumovirus Humano (hMPV). O conhecimento da epidemiologia e prevalência desses vírus é importante para que metodologias terapêuticas possam ser aplicadas apropriadamente e saber como esses vírus estão circulando. O objetivo deste trabalho foi investigar a incidência de 8 tipos de vírus respiratórios em 279 amostras de aspirado nasofaríngeo obtidas de Julho/2004 a Setembro de 2005 de 120 crianças (73 do sexo masculino e 47 do sexo feminino) com idade entre 0 a 6 anos com sintomas de infecção respiratória aguda. A análise foi realizada pela técnica de RT-PCR e seqüenciamento direto. Nossos resultados mostraram que 27,2% (76/279) das amostras foram positivas para pelo um dos vírus respiratórios, sendo 84,2% (64/76) de Picornavírus, 76,3% (58/76) de Rhinovírus e 7,9% de Enterovírus (6/76), 7,9% (6/76) de RSV, 1,3% (1/76) de hMPV, 2,6% (2/76) de FLUA, 2,6% (2/76) de PIV-1 e 1,3% (1/76) de PIV-2. As infecções repetidas acometeram 29% (22/76) das crianças com infecção respiratória. A maioria das re-infecções, 82% (18/22), foram pelo gênero Rhinovírus. Os sintomas mais freqüentes foram coriza diagnosticada em 89,5% dos casos (68/76) seguido de tosse em 67,1% (51/76). Os Rhinovírus foram detectados em todo o período de estudo, com picos de infecção nos meses de inverno e outono, porém não houve associação significativa entre a presença viral e a sazonalidade. Neste estudo houve prevalência de infecção e re-infecção por Rhinovírus. Portanto, este estudo... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Respiratory tract infections are associated with significant mortality worldwide and affect mostly children under five years of age. Most respiratory infections are caused by viral agents such as: Respiratory Syncytial Virus (RSV), the viruses of Influenza type A and B (FLUA and FLUB), Parainfluenza type 1, 2 and 3 (PIV-1, PIV-2 and PIV-3), Rhinovirus (HRV) and Human Metapneumovirus (hMPV). Knowledge of the epidemiology and prevalence of these viruses is important for therapeutic methods can be applied as appropriate and to know how these viruses are circulating. The aim of this work was to investigate the incidence of 8 types of respiratory viruses in 279 samples of nasopharyngeal aspirated obtained from July/2004 to September/2005 of 120 children (73 male and 47 female) with age between 0 to 6 years with symptoms of acute respiratory infection. The analysis was performed by RT-PCR and direct sequencing. Our results showed that 27,2% (76/279) of samples were positive at least for a type of the respiratory viruses, with 84,2% (64/76) of Picornaviruses, with 76,3% (58/76) of Rhinovírus e 7,9% of Enterovírus (6/76), 7,9% (6/76) of RSV, 1,3% (1/76) of hMPV, 2,6% (2/76) of FLUA, 2,6% (2/76) of PIV-1 and 1,3% (1/76) of PIV-2. The recurrent infections affect 29% (22/76) of children with respiratory infection. Most re-infections, 82% (18/22), were by Rhinovírus genus. The most frequent symptoms were runny nose diagnosed in 89.5% (68/76) followed by cough in 67.1% (51/76). Rhinovírus were detected throughout the study period, with peaks of infection during the winter and autumn, but there was no significant association between viral presence and seasonality. In this study there was prevalence of infection and re-infection by Rhinovírus. Therefore, this study provided better understanding of the circulation of respiratory viruses in a population of day care in the region... (Complete abstract click electronic access below) / Mestre

Abstract The purpose of this study was to develop sensitive and specific laboratory diagnostic methods for the demonstration of pneumococcal surface antigens or pneumococcus-specific antibodies in clinical samples. The work took account of epidemiological aspects of both pneumococcal disease and nasopharyngeal carriage of pneumococcus. We first compared the sensitivity of pneumococcal culture and antigen detection methods in nasopharyngeal samples in a developing country setting and then investigated the possibility of improving the sensitivity of the antigen detection by introducing an enrichment step in the procedure. — Further investigations were designed to determine the validity of pneumolysin-specific immune complex bound antibody assay as a tool for diagnosing pneumococcal ALRI in a developing country setting. Finally, we developed an enzyme immunoassay for the detection of pneumococcal capsular polysaccharide antigens, using type-specific antibodies produced in-house in rabbits through immunisation with an in-house-produced pneumococcal whole cell vaccine. The method was tested in nasopharyngeal and middle ear fluid samples. The first results indicated that antigen detection might be more sensitive than culture in demonstrating pneumococci in URT, particularly in children with prior antimicrobial therapy. Antigen detection is a feasible method for studies on pneumococci in developing countries. For type-specific demonstration of S. pneumoniae, detection of pneumococcal antigen after an enrichment step proved a sensitive method that can be applied for epidemiologic study purposes, e.g., in vaccine trials, in areas without ready access to a good microbiology laboratory. Determination of IC-bound pneumolysin IgG antibodies appears to be a useful method for species-specific diagnosis of pneumococcal infections. The results indicating pneumococcal aetiology in ALRI patients in this study compare well with the best results obtained by the use of lung aspirates. Increasing the number of serial samples improves the sensitivity of the assay, but even two samples provide more positive findings than other methods currently in routine use. Criteria of positivity need to be confirmed in subsequent larger studies with both healthy controls and patients with confirmed pneumococcal disease. It is also important to control the findings in patients with pneumonia of non-pneumococcal origin. The novel enzyme immunoassay was shown to work well with enrichment culture samples, with an almost 100% sensitivity compared with the culture. Middle ear fluid samples were too diluted for the enzyme immunoassay method used, and only 74% sensitivity compared with culture was achieved. Provided that adequate samples can be obtained, the method will be a useful complement to the current laboratory methods used to diagnose pneumococcal disease. With the existence of a broad spectrum of microbiological and immunological methods, it is imperative to seek international consensus for standard methods to demonstrate pneumococcus. Otherwise it is very difficult to compare results from different clinical studies. A WHO Working Group recently proposed a standard method for detecting upper respiratory carriage of pneumococcus, but a lot of work remains to be done in other areas of research on pneumococcal infections.

Made available in DSpace on 2014-06-11T19:27:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-05Bitstream added on 2014-06-13T19:55:51Z : No. of bitstreams: 1 bonfim_cm_me_sjrp.pdf: 483201 bytes, checksum: ee7e5d0928d4f0c7dcb6b57d4216ed16 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / As infecções do trato respiratório estão associadas com mortalidade significativa no mundo inteiro e afetam principalmente crianças menores de cinco anos de idade. A maioria das infecções respiratórias é causada por agentes virais como: Vírus Sincicial Respiratório (RSV), Influenzavírus tipo A e B (FLUA e FLUB), Parainfluenza tipo 1, 2 and 3 (PIV-1, PIV-2 e PIV-3), Rhinovirus (HRV) e Metapneumovirus Humano (hMPV). O conhecimento da epidemiologia e prevalência desses vírus é importante para que metodologias terapêuticas possam ser aplicadas apropriadamente e saber como esses vírus estão circulando. O objetivo deste trabalho foi investigar a incidência de 8 tipos de vírus respiratórios em 279 amostras de aspirado nasofaríngeo obtidas de Julho/2004 a Setembro de 2005 de 120 crianças (73 do sexo masculino e 47 do sexo feminino) com idade entre 0 a 6 anos com sintomas de infecção respiratória aguda. A análise foi realizada pela técnica de RT-PCR e seqüenciamento direto. Nossos resultados mostraram que 27,2% (76/279) das amostras foram positivas para pelo um dos vírus respiratórios, sendo 84,2% (64/76) de Picornavírus, 76,3% (58/76) de Rhinovírus e 7,9% de Enterovírus (6/76), 7,9% (6/76) de RSV, 1,3% (1/76) de hMPV, 2,6% (2/76) de FLUA, 2,6% (2/76) de PIV-1 e 1,3% (1/76) de PIV-2. As infecções repetidas acometeram 29% (22/76) das crianças com infecção respiratória. A maioria das re-infecções, 82% (18/22), foram pelo gênero Rhinovírus. Os sintomas mais freqüentes foram coriza diagnosticada em 89,5% dos casos (68/76) seguido de tosse em 67,1% (51/76). Os Rhinovírus foram detectados em todo o período de estudo, com picos de infecção nos meses de inverno e outono, porém não houve associação significativa entre a presença viral e a sazonalidade. Neste estudo houve prevalência de infecção e re-infecção por Rhinovírus. Portanto, este estudo... / Respiratory tract infections are associated with significant mortality worldwide and affect mostly children under five years of age. Most respiratory infections are caused by viral agents such as: Respiratory Syncytial Virus (RSV), the viruses of Influenza type A and B (FLUA and FLUB), Parainfluenza type 1, 2 and 3 (PIV-1, PIV-2 and PIV-3), Rhinovirus (HRV) and Human Metapneumovirus (hMPV). Knowledge of the epidemiology and prevalence of these viruses is important for therapeutic methods can be applied as appropriate and to know how these viruses are circulating. The aim of this work was to investigate the incidence of 8 types of respiratory viruses in 279 samples of nasopharyngeal aspirated obtained from July/2004 to September/2005 of 120 children (73 male and 47 female) with age between 0 to 6 years with symptoms of acute respiratory infection. The analysis was performed by RT-PCR and direct sequencing. Our results showed that 27,2% (76/279) of samples were positive at least for a type of the respiratory viruses, with 84,2% (64/76) of Picornaviruses, with 76,3% (58/76) of Rhinovírus e 7,9% of Enterovírus (6/76), 7,9% (6/76) of RSV, 1,3% (1/76) of hMPV, 2,6% (2/76) of FLUA, 2,6% (2/76) of PIV-1 and 1,3% (1/76) of PIV-2. The recurrent infections affect 29% (22/76) of children with respiratory infection. Most re-infections, 82% (18/22), were by Rhinovírus genus. The most frequent symptoms were runny nose diagnosed in 89.5% (68/76) followed by cough in 67.1% (51/76). Rhinovírus were detected throughout the study period, with peaks of infection during the winter and autumn, but there was no significant association between viral presence and seasonality. In this study there was prevalence of infection and re-infection by Rhinovírus. Therefore, this study provided better understanding of the circulation of respiratory viruses in a population of day care in the region... (Complete abstract click electronic access below)

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