RESUMEN
BACKGROUND: Rotavirus (RV) vaccine, Rotarix, was introduced into the Brazil national immunization program in 2006. To estimate population-level vaccine effect, we conducted a time-trend analysis on all-cause gastroenteritis (GE)-related death certificate-reported deaths (DCRDs), hospital deaths (HDs) and hospitalizations trends in <5-year-olds before and after RV vaccine introduction. METHODS: National level all-cause GE-related death certificate [Mortality Information System] and admission (Hospital Information System) data were aggregated and analyzed. Negative-binomial regression models (adjusting for age, year and region) compared DCRDs, HDs and hospitalization trends in <5-year-olds between baseline (2001-2005) and postvaccine introduction periods (Mortality Information System: 2007-2009 and Hospital Information System: 2007-2010). Negative-binomial regression models were fitted to data for each outcome before 2006, and the predicted annual frequencies of each outcome were plotted against corresponding observed annual frequencies. RESULTS: During the postvaccine introduction period, there was an overall age-independent GE-related DCRDs reduction (20.9%, P = 0.04) observed in children <5 years of age; a reduction was also seen in infants <1 year of age (20.8%, P = 0.003). Age-independent GE-related HDs and hospitalizations reductions (57.1%, P < 0.0001 and 26.6%, P < 0.0001, respectively) were observed in <5-year-olds; HDs reductions were also observed for each age group (<1-year-olds: 55.0%, P < 0.0001 and 1- to <5-year-olds: 59.5%, P < 0.0001). Observed annual frequencies of GE-related DCRDs, HDs and hospitalizations were lower than the predicted value in each age group in all years after 2006. CONCLUSIONS: GE-related DCRDs, HDs and hospitalizations were significantly reduced in <1 and in 1- to <5-year-old Brazilian children after Rotarix introduction, which provides additional evidence of the direct and indirect population-level effect of RV vaccination on GE-related mortality and morbidity in children.
Asunto(s)
Gastroenteritis/epidemiología , Gastroenteritis/mortalidad , Hospitalización , Vacunas contra Rotavirus/administración & dosificación , Brasil/epidemiología , Preescolar , Femenino , Gastroenteritis/prevención & control , Humanos , Programas de Inmunización , Incidencia , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
OBJECTIVES: Rotavirus vaccination was introduced in Brazil in March 2006, targeting an annual birth cohort of approximately 3.5 million. We analyzed trends in all-cause gastroenteritis-related deaths in children <5 years of age during the pre- and post-vaccination periods. METHODS: Data from the National Immunization Program and the Mortality Information System were used to calculate vaccine coverage and mortality rates related to gastroenteritis in children <1 year and 1-4 years of age, using population estimates from the census as the denominator. Relative reductions in mortality rates were calculated for 2007 and 2008, using the 2004-2005 mean as baseline before vaccine introduction. RESULTS: Coverage of two doses of human rotavirus vaccine was 39% in 2006, increasing to 72% in 2007 and 77% in 2008. During 2004-2005, the gastroenteritis mortality rate in children <1 year of age was 56.9 per 100 000, decreasing by 30% (95% confidence interval (CI) 19-41) in 2007 and by 39% (95% CI 29-49) in 2008. In children 1-4 years of age, the mortality rate was 4.5 per 100 000 during 2004-2005, decreasing by 29% (95% CI 10-49) in 2007 and by 33% (95% CI 15-52) in 2008. CONCLUSIONS: The decreased rates of childhood gastroenteritis-related deaths in Brazil following rotavirus vaccine introduction, particularly among children <1 year of age, suggest the potential benefit of vaccination.
Asunto(s)
Gastroenteritis/mortalidad , Infecciones por Rotavirus/mortalidad , Vacunas contra Rotavirus/administración & dosificación , Vacunación , Brasil/epidemiología , Preescolar , Gastroenteritis/prevención & control , Humanos , Lactante , Recién Nacido , Infecciones por Rotavirus/prevención & controlRESUMEN
Rotavirus vaccination was introduced in Brazil in March 2006. We describe trends in hospitalizations from all-cause gastroenteritis in children younger than 5 years during pre- and postvaccination periods using hospital discharge data from Brazil Hospital Information System (SIH-SUS). A reduction in gastroenteritis hospitalizations of 26% and 48% in 2006 and in 2007, respectively, was observed among children younger than 1 year compared with prevaccination period (1998-2005). The largest reduction rates among children younger than 1 year were noted in the South and Southeast regions, approximately 56% in 2007, where vaccine coverage was the highest.
Asunto(s)
Gastroenteritis/epidemiología , Gastroenteritis/patología , Hospitalización/tendencias , Vacunas contra Rotavirus/administración & dosificación , Vacunas contra Rotavirus/inmunología , Brasil/epidemiología , Preescolar , Geografía , Humanos , Lactante , Recién NacidoRESUMEN
O objetivo deste trabalho e descrever o perfil social e economico do psicologo do Distrito Federal, a nivel de graduacao e pos-graduacao, bem como as provaveis condicoes determinantese consequentes dessa formacao. Foi construido um instrumento padronizado de coleta de dados, com base em um questionario respondido por 355 psicologos atuantes no Distrito Federal, no dia das eleicoes obrigatorias para o Conselho de classe. Sao descritos dados referentes a formacao profissional e discutidas algumas das relacoes encontradas entre os dados da graduacao e as informacoes concernentes aos rendimentos e a atuacao profissionais.