Resumo em Espanhol:

En junio de 1996, en el Estado de Oaxaca, México, se expusieron larvas de mosquito de la especie Aedes aegypti (Linneo) a los preparásitos infectivos del nemátodo Romanomermis culicivorax, Ross y Smith, en condiciones de laboratorio y de campo. Para los experimentos de laboratorio se utilizaron larvas en estadio I-IV, colectadas en reservorios naturales. Los experimentos se realizaron por triplicado, con 100 larvas de cada estadio larvario por experimento, y se probaron tres dosis de aplicación: 5:1, 10:1 y 15:1 (5, 10 ó 15 preparásitos por larva de mosquito). Para los estudios de campo se tomaron 13 criaderos naturales de A. aegypti con larvas en estadio I-IV y se aplicó una dosis de 15:1 por cada criadero. De acuerdo con los resultados obtenidos en los experimentos de laboratorio, se observó un aumento de la infestación media de las larvas a medida que aumentaba la dosis de aplicación desde 5:1 hasta 15:1. Para la dosis de 10:1, la tasa de parasitismo alcanzó valores de 100, 100, 85 y 74% en las larvas en estadio I, II, III y IV, respectivamente, y, para la dosis de 15:1, valores de 100, 100, 90 y 79%, respectivamente. Los resultados de las pruebas de campo con la aplicación de una dosis de 15:1 en los 13 reservorios naturales proporcionaron elevadas tasas de parasitismo, con valores entre 80-98%, lo que demostró la susceptibilidad de esta especie de mosquito al parasitismo por R. culicivorax en el Estado de Oaxaca, México.

Resumo em Inglês:

In June 1996 in the state of Oaxaca, Mexico, larvae of the mosquito species Aedes aegypti were exposed to infective preparasites of the nematode Romanomermis culicivorax, Ross and Smith, in the laboratory and in the field. For the laboratory experiments larvae in instars I-IV were used; they had been collected in natural reservoirs. The laboratory experiments were carried out in triplicate, with 100 larvae of each larval stage per experiment. Three preparasite application dosage ratios were tested: 5, 10, or 15 preparasites per mosquito larva. For the field studies 13 A. aegypti outdoor breeding sites were used, with larvae in instars I-IV and a 15:1 preparasite dosage ratio. With the laboratory experiments, an increase was observed in the average infestation of the larvae as the preparasite application ratio was increased from 5:1 to 15:1. With a 10:1 ratio, the rates of parasitism were 100%, 100%, 85%, and 74% in the larvae in instars I, II, III, and IV, respectively; for the 15:1 preparasite ratio, parasitism rates were 100%, 100%, 90%, and 79%, respectively. The field tests with the 15:1 preparasite dosage ratio in the 13 outdoor reservoirs produced parasitism rates of 80% to 98%, thus demonstrating the susceptibility of this species of mosquito to parasitism by R. culicivorax in Oaxaca, Mexico.

Resumo em Espanhol:

En el mundo, los rotavirus son responsables de más 125 millones de casos de gastroenteritis infantil y de cerca de 1 millón de muertes al año, especialmente en los países en desarrollo. En comparación con otras medidas de control, la vacunación cuenta con mayores probabilidades de tener un impacto significativo en la incidencia de la enfermedad por rotavirus. La máxima incidencia de la diarrea por rotavirus ocurre entre los 6 y los 24 meses de edad. Sin embargo, en los países en desarrollo no son raros los casos en menores de 6 meses. Los serotipos G1 a G4 son responsables de la mayoría de los casos, pero hay datos que indican que en Brasil el tipo G5 está adquiriendo mayor importancia epidemiológica. Durante la infección natural por rotavirus se inducen respuestas inmunitarias tanto homotípicas como heterotípicas y la respuesta inmunitaria en la superficie de la mucosa intestinal constituye probablemente el factor que mejor predice la inmunidad clínica. Con el objetivo principal de proteger a los niños frente a la diarrea con deshidratación potencialmente mortal, se han probado varios abordajes en el desarrollo de vacunas contra los rotavirus. En los Estados Unidos de América (EUA) se aprobó y comercializó una vacuna antirrotavirus tetravalente recombinante de virus humanos y de Macaca mulatta (RRV-TV), pero posteriormente se retiró del mercado. En varios estudios se ha observado que la eficacia de la vacuna RRV-TV es mayor en los países desarrollados que en los países en desarrollo. En dos países de América Latina (Brasil y Perú) se han realizado estudios de campo con preparaciones de RRV-TV que contenían 4 X 10(4) unidades formadoras de placa (UFP) y se registraron tasas de eficacia protectora frente a todas las diarreas por rotavirus que oscilaron entre 18 y 35%. En otro estudio realizado en Venezuela con mayores dosis de RRV-TV (4 X 10(5) UFP/dosis), se obtuvo una tasa de eficacia de 48% frente a todas las diarreas por rotavirus y de 88% frente a las diarreas graves. Parece ser que la lactancia materna no interfiere con la eficacia de la RRV-TV si se administran tres dosis de la vacuna. Del mismo modo, la posible interferencia de la vacuna oral contra la poliomielitis con la vacuna contra los rotavirus puede ser contrarrestada si se administran tres dosis de esta última o se utilizan formulaciones con títulos elevados. Sin embargo, los enterovirus silvestres pueden conducir al fracaso de la vacunación primaria contra los rotavirus en los países en desarrollo. Estudios realizados en Perú con la vacuna RRV-TV han mostrado una tendencia a la obtención de mayores tasas de eficacia de la vacuna frente a los epidosios diarreicos causados únicamente por rotavirus ("puros"). Los análisis económicos realizados en los EE.UU. indican que una vacuna que cuesta menos de 9 dólares estadounidenses por dosis podría proporcionar ahorros netos en los costes médicos. Sin embargo, hasta la fecha no se han realizado estudios de coste-beneficio en los países en desarrollo. En el futuro, es posible que algunos países de América Latina adapten sus instalaciones de producción de vacunas antipoliomielíticas a la preparación de vacunas contra los rotavirus para uso humano. Un año después de que la RRV-TV fuera aprobada en los EE.UU. para la vacunación de lactantes, la ocurrencia de casos de intususcepción como reacción adversa a la vacuna condujo a su retirada del mercado. En este artículo se analizan las implicaciones de esta medida, en especial en América Latina, entre ellas la necesidad de investigar vacunas alternativas contra los rotavirus, particulamente mediante la realización de ensayos clínicos paralelos en los países desarrollados y en desarrollo.

Resumo em Inglês:

Worldwide, rotaviruses account for more than 125 million cases of infantile gastroenteritis and nearly 1 million deaths per year, mainly in developing countries. Rather than other control measures, vaccination is most likely to have a major impact on rotavirus disease incidence. The peak incidence of rotavirus diarrhea occurs between 6 and 24 months of age. In developing countries, however, cases are not uncommon among children younger than 6 months. G serotypes 1 to 4 are responsible for most disease, but there are indications that in Brazil that G type 5 is of emerging epidemiological importance. Both homotypic and heterotypic responses are elicited during natural rotavirus infection, and the immunological response at the intestinal mucosal surface is probably the more consistent predictor of clinical immunity. With the primary objective of protecting children against life-threatening dehydrating diarrhea, many approaches to rotavirus vaccine development have been attempted. One vaccine, the tetravalent rhesus-human reassortant rotavirus vaccine (RRV-TV), was given licensing approval in the United States of America, introduced to the market, and later withdrawn. A number of studies have found better efficacy of RRV-TV in developed countries than in developing ones. Field trials with a 4 X 10(4) plaque-forming units (PFU) preparation of RRV-TV have been carried out in two countries in Latin America, Brazil and Peru. Those trials yielded protective efficacy rates against all rotavirus diarrhea ranging from 18% to 35%. Data from a large catchment trial in Venezuela with a higher RRV-TV dose, of 4 X 10(5) PFU/dose, indicated an efficacy rate of 48% against all rotavirus diarrhea and 88% against severe rotavirus diarrhea. It appears that breast-feeding does not compromise the efficacy of RRV-TV if three doses of the vaccine are administered. Similarly, possible interference of oral poliovirus vaccine with the "take" of the rotavirus vaccine can be overcome by giving three doses of the rotavirus vaccine or by using a higher-titer formulation of it. Wild enteroviruses, however, may cause primary rotavirus vaccine failure in developing countries. Studies in Peru with RRV-TV have shown a trend towards higher vaccine efficacy rates against "pure" (rotavirus-only) diarrheal episodes. Economic analyses made in the United States indicate that a vaccine that costs less than US$ 9 per dose would lead to a net savings in medical costs. To date, however, cost-benefit studies have not been done in developing countries. In the future, it is possible that some Latin American countries might adapt their polio production facilities to the preparation of rotavirus vaccines for human use. A year after RRV-TV was licensed for vaccination of infants in the United States, the occurrence of intussusception as an adverse event led to the vaccine's withdrawal from the market. The implications of that action, particularly for Latin America, will be addressed in this article, including the need to explore alternative rotavirus candidate vaccines, particularly through the conduct of parallel clinical trials in both developed and developing countries.

Resumo em Português:

A vacinação constitui uma importante medida para a prevenção de doenças e a avaliação de sua eficiência é fundamental para garantir o sucesso dos programas de imunização. O presente estudo descreve os resultados de um inquérito domiciliar para estimar a cobertura vacinal da coorte nascida em 1996 nos municípios de São Paulo, Osasco, Francisco Morato e Guarulhos, Estado de São Paulo, Brasil. O Município de São Paulo foi dividido em cinco estratos, de acordo com as condições de vida. O estudo seguiu a metodologia preconizada pela Organização Pan-Americana da Saúde para a realização de inquéritos de cobertura vacinal. A proporção de crianças com esquema de vacinação completo no momento da entrevista, considerando-se a informação oral e de caderneta, esteve acima de 90% para todos os municípios, exceto Francisco Morato (município com piores condições de vida). Para os estratos no Município de São Paulo, encontramos as piores coberturas nos dois extremos. Quando se consideram apenas as doses aplicadas no 1° ano de vida, as coberturas não atingiram valores seguros. O uso de serviços privados de vacinação foi diretamente proporcional às condições de vida. A diferença entre as coberturas calculadas a partir dos dados de produção e as calculadas a partir de doses administrativas determinadas pelo inquérito é inversamente proporcional às condições de vida nos municípios. Os resultados sugerem que inquéritos de cobertura vacinal como o descrito no presente artigo deveriam ser realizados também em outros municípios. Além disso, é importante treinar os funcionários das salas de vacinação para que preencham adequadamente os dados de vacinação, intensificar a divulgação do calendário oficial de imunização aos profissionais de saúde e facilitar o acesso da população aos serviços de saúde.

Resumo em Inglês:

Immunization is an important disease prevention measure, and evaluating the effectiveness of immunization programs is crucial to ensuring their success. This study describes the results of a household survey in four cities in the state of São Paulo, Brazil: Francisco Morato, Guarulhos, Osasco, and São Paulo. The survey was done in order to estimate immunization coverage for the cohort of children born in 1996. The city of São Paulo was divided into five strata, according to socioeconomic and living conditions. The survey followed the methodology that the Pan American Health Organization recommends for immunization coverage surveys. The proportion of children who had received a complete set of the recommended vaccinations at the time of the interview, taking into account both oral reports and information recorded on the children's immunization cards, was above 90% for all the cities except Francisco Morato, which had the worst living conditions. In the city of São Paulo, the worst coverage was found in the lowest and highest strata. When only the doses received during the first year of life were considered, the coverage was not adequate to produce herd immunity. The use of private vaccination services was higher in the areas with better living conditions. The difference between the coverage calculated based on data from health services and the coverage calculated based on the survey was inversely proportional to living conditions. Our results suggest that surveys similar to the one described here should be carried out in other cities. Employees who provide vaccination services should be trained to correctly record vaccination data. In addition, it is important to make health professionals aware of the official immunization calendar, and to facilitate the public's access to health services.

Resumo em Espanhol:

Mediante electroforesis en gel con pulsos eléctricos (EGPE), se analizaron las Salmonella enteritidis aisladas entre 1987 y 1996 en casos de gastroenteritis de cuatro países caribeños: Barbados, Saint Kitts y Nevis, Santa Lucía y Trinidad y Tabago. También se determinó la resistencia de los aislados a 12 antibióticos. La digestión del ADN con la endonucleasa de restricción XbaI reveló 13 patrones distintos de EGPE entre los 129 aislados de S. enteritidis analizados; los más prevalentes fueron el grupo 1 (88 de 129; 68,2%) y el grupo 2 (26 de 129; 20,2%). Estos patrones se correlacionaron con el origen geográfico de los aislados. Así, de los 28 aislados de Barbados, 20 (71,4%) pertenecían al grupo 2, y de los 93 aislados de Trinidad y Tabago, 78 (83,9%) pertenecían al grupo 1. La digestión del genoma de S. enteritidis con la endonucleasa de restricción SpeI no fue tan discriminativa como la digestión con XbaI. En general, 67 de los 129 aislados (51,9%) mostraron resistencia a uno o más de los 12 antibióticos probados. La prevalencia de resistencia fue de 51% en los aislados de Trinidad y Tabago, de 50% en los de Barbados, de 28,6% en los de Santa Lucía y de 100% en el único aislado de la isla de Saint Kitts. La mayor resistencia correspondió a la triple sulfamida (sulfamerazina, sulfadiazina y sulfametazina: 59 de 129; 45,7%), seguida de la nitrofurantoína (10 de 129; 7,8%), la ampicilina (7 de 129; 5,4%) y la carbamicina (5 de 129; 3,9%).

Resumo em Inglês:

Using pulsed-field gel electrophoresis (PFGE), between 1987 and 1996 we analyzed Salmonella enteritidis isolates from gastroenteritis cases in four Caribbean countries: Barbados, Saint Kitts and Nevis, Saint Lucia, and Trinidad and Tobago. We also determined the resistance of the isolates to 12 antimicrobial agents. Of the 129 isolates of S. enteritidis available for testing, DNA digested by XbaI revealed 13 distinctive PFGE patterns. The most prevalent XbaI PFGE patterns were group 1 (88 of 129 isolates, 68.2%) and group 2 (26 of 129, 20.2%). The patterns found among S. enteritidis isolates correlated with the geographical origin of the isolates. Of the 28 isolates from Barbados, 20 of them (71.4%) belonged to XbaI PFGE group 2, and of the 93 isolates from Trinidad and Tobago, 78 of them (83.9%) belonged to group 1. SpeI digestion of S. enteritidis genome was not as discriminatory as XbaI. Overall, of the 129 isolates, 67 of them (51.9%) exhibited resistance to one or more of the 12 antimicrobial agents that we tested. The prevalence of resistance was 53.8% for the S. enteritidis isolates tested from Trinidad and Tobago, 50.0% for those from Barbados, 28.6% for those from Saint Lucia, and 100.0% for one isolate from the island of Saint Kitts. Resistance was highest to triple sulfur (59 of 129 isolates, 45.7%), followed by furadantoin (10 of 129, 7.8%), ampicillin (7 of 129, 5.4%), and carbamycin (5 of 129, 3.9%).

Resumo em Espanhol:

Es bastante frecuente que en estudios epidemiológicos, durante el proceso de análisis de datos, una o más variables continuas sean cambiadas de escala. El objetivo de este trabajo consistió en evaluar las consecuencias de la categorización de variables en el análisis de datos. Se estudian tres situaciones bajo diferentes escenarios de análisis estadístico en modelos de regresión. Los resultados muestran que la dicotomización de variables continuas puede modificar sustancialmente las relaciones entre variables dependientes e independientes. Así por ejemplo, en estudios epidemiológicos en los que se pretende evaluar el efecto de una exposición sobre una respuesta, la magnitud o la dirección de dicho efecto pueden estar sesgadas como consecuencia de la dicotomización de alguna variable. Se recomienda, por lo tanto, evitar, en la medida de lo posible, la categorización de variables en el análisis.

Resumo em Inglês:

Frequently during the process of data analysis in epidemiological studies, the scale of one or more continuous variables is changed. The objective of this paper was to assess the consequences of categorizing variables during data analysis. We studied three situations with different scenarios for statistical analysis with regression models. The results show that dichotomizing continuous variables can substantially modify the relationships between dependent and independent variables. Thus, for example, in epidemiological studies trying to evaluate the effect of an exposure on a response, the magnitude and/or the direction of this effect can be biased by dichotomizing a variable. We therefore recommend avoiding, as much as possible, the categorization of variables when doing analyses.

Resumo em Inglês:

This report analyzes the current situation of malaria programs in the Americas from the perspective of the Global Malaria Control Strategy, which was adopted in Amsterdam in 1992. After describing the current situation with the disease in the Americas, the report analyzes the principal epidemiological changes and the resistance to antimalarials, as well as the major problems and limitations of the disease control programs, and possible solutions. The report also discusses the activities carried out within the context of the Roll Back Malaria (RBM) initiative, which was adopted in 1998 by the World Health Organization. The fundamental components of that RBM effort are structured interventions, the integration of resources, an antimalarials policy, a strong referral system for diagnosis and treatment, resource networks, and programs to control malaria transmission.