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Las presentes recomendaciones se emiten en función de la mejor evidencia disponible, con un enfoque individual de prevención de la influenza y sus complicaciones, en comparación con las recomendaciones que se efectúan desde el punto de vista de la salud pública (que toman en consideración variables adicionales como prioridades en salud, asignación de presupues- tos, logística, entre otros) que no forman parte del enfoque de este documento

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Introducción. Durante 2020 y 2021, la circulación de los virus influenza se mantuvo por debajo de lo esperado en todo el mundo. En Argentina, en el año 2022 observamos una circulación ininterrumpida de influenza todo el año. Nuestros objetivos fueron describir los patrones de circulación y las características clínicas de niños internados con influenza. Población y métodos. Estudio retrospectivo, analítico, observacional. Se incluyeron todos los niños internados en un centro pediátrico con detección del virus influenza durante los años 2019-2022. Resultados. Se internaron 138 pacientes en 4 años; en 2019 se observó una tasa del 4,5/1000 egresos hospitalarios mientras que en 2022, fue del 15,1/1000. En 2020 y 2021 no hubo casos. En el 2019 la mayoría de los casos ocurrieron en invierno, la causa de la internación fue la infección respiratoria aguda baja (IRAB) en el 79 % y se detectó influenza A en el 92 % de los casos. En el 2022, la mayoría de los casos ocurrieron en primavera, el 62 % presentó IRAB y en el 56 % se detectó influenza A. Ambos períodos tuvieron similares frecuencias de vacunación y de comorbilidades. Conclusiones. En el 2022 se registraron más internaciones por influenza, lo que podría corresponder a que se realizaron métodos diagnósticos moleculares, que son más sensibles, y se observó un cambio en la estacionalidad con más casos en primavera. En 2019 predominó influenza A en infecciones del tracto respiratorio inferior, mientras que en el 2022 influenza A y B fueron similares, y hubo más formas extrapulmonares.

Introduction. During 2020 and 2021, the circulation of influenza virus remained below expectations worldwide. In Argentina, in 2022, we observed an uninterrupted circulation of influenza all year round. Our objectives were to describe the circulation patterns and clinical characteristics of hospitalized children with influenza. Population and methods. Retrospective, analytical, observational study. All children with influenza virus admitted to a children's hospital during the 2019­2022 period were included. Results. A total of 138 patients were admitted over 4 years; in 2019, the rate of hospital discharges was 4.5/1000, compared to 15.1/1000 in 2022. No cases were recorded in 2020 and 2021. In 2019, most cases were observed in the winter; in 79%, the cause was acute lower respiratory tract infection (ALRTI); influenza A was detected in 92%. In 2022, most cases occurred in the spring; 62% developed ALRTI; and influenza A was detected in 56%. Similar rates of vaccination and comorbidities were observed in both periods. Conclusions. In 2022, more hospitalizations due to influenza were recorded, which may have correlated with the use of more sensitive molecular diagnostic testing and a change in seasonality, with more cases observed in the spring. In 2019, influenza A predominated in lower respiratory tract infections, while in 2022, cases of influenza A and B were similar, with more extra-pulmonary forms.

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Resumo O objetivo do artigo é identificar os efeitos econômicos da pandemia de gripe espanhola que atingiu São Paulo no final de 1918, analisando fontes primárias originais. A contribuição para a historiografia econômica é o entendimento dos impactos de curto prazo para a economia paulista dessa pandemia, geralmente preteridos pela literatura econômica devido aos efeitos da Primeira Guerra Mundial. Os resultados indicam que vários setores da economia de São Paulo foram afetados no lado da oferta e da demanda em função do aumento de mortalidade em decorrência da pandemia, principalmente no último trimestre de 1918. As implicações foram visíveis no investimento privado, com a queda do registro de empresas e empréstimos bancários, na diminuição física e de valor da produção industrial de produtos não essenciais e no aumento dos essenciais em um contexto de crise de saúde pública. No entanto, a recuperação também foi rápida, o que explica, em parte, a pouca atenção dada pela historiografia econômica para identificar os efeitos da gripe espanhola sobre a economia.

Abstract The aim of the paper is to identify the economic effects of the influenza pandemic that hit São Paulo in 1918, analyzing original primary sources. The contribution to economic historiography is the understanding of the short-term effects on the economy of São Paulo of the great pandemic of 1918, generally ignored by the economic literature over the effects of WWI. The results indicate that several sectors of São Paulo's economy were affected in supply and demand by the effects of the increase in mortality, mainly in the last quarter of 1918. The effects were visible in private investment, with the drop in business registration, bank loans, the physical and value decrease in the industrial production of non-essential products and the increase of essential products in a context of public health crisis. However, the recovery was also quick, which explains, in part, why economic historiography pays little attention to identify the effects of the influenza on the economy.

Resumen El objetivo del artículo es identificar los efectos económicos de la pandemia de gripe en São Paulo a finales de 1918, analizando fuentes primarias originales. La contribución a la historiografía económica es la comprensión de los efectos de corto plazo sobre la economía paulista de la gran pandemia de finales de 1918, en general ignorados por la literatura económica debido a los efectos de la Primera Guerra Mundial. Los resultados indican que varios sectores de la economía paulista se vieron afectados, por el lado de la oferta y la demanda, por los efectos del aumento de la mortalidad debido a la pandemia, principalmente en el último trimestre de 1918. Los efectos fueron visibles en la inversión privada, con la caída en el registro de empresas, los préstamos bancarios, la disminución física y de valor de la producción industrial de productos no esenciales y el aumento de productos esenciales en un contexto de crisis de salud pública. Sin embargo, la recuperación también fue rápida, lo que explica en parte la poca atención prestada por historiografía económica para identificar los efectos de la gripe española en la economía.

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Frequent outbreaks of avian influenza H9N2 virus in Pakistan revealed that this subtype has become endemic in the poultry industry and, besides economic losses, poses a threat to public health. The present study describes the molecular characterization and pathological alterations in naturally infected broiler chickens with the current H9N2 field strain and their phylogenomic dynamics. In this study, tissue samples (trachea, lung, kidney and intestine) from 100 commercial chicken flocks were collected from July 2018 to August 2019. Samples were subjected to molecular detection, phylogeny and subsequent pathological examination. The complete length of the HA gene was successfully amplified in five samples. Nucleotide sequencing revealed positive samples placed in a clade belonging to the B2 sub-lineage of the G1 genotype and categorized as LPAIV based on the amino acid sequence of the HA gene at the cleavage site (PAKSSR/G). Genetic analysis of the haemagglutinin (HA) gene revealed nt: 80.5%-99.5%; aa: 83.8%-98.9% homology to H9N2 strains reported previously from Pakistan, neighbouring countries, and (A/Quail/Hong Kong/G1/97). Gross lesions include a slight airsacculitis, mild hemorrhages, diffuse congestion and purulent exudate in tracheal mucosa, fibrinonecrotic cast in the trachea lumen and mild pulmonary congestion. Histopathological alterations include sloughing of epithelial cells and infiltration of inflammatory cells in the trachea, mononuclear cells (MNCs) infiltration, pulmonary congestion and exudate in the lumen of parabronchi, peritubular congestion in the kidneys with degeneration of tubular epithelial cells and degenerative changes in the intestinal villi epithelial cells and goblet cell hyperplasia. Immunohistochemistry analysis confirmed the presence of AIVH9N2 antigen in the trachea, lungs, kidney and intestine. Electron microscopy revealed ultrastructural changes in the trachea, including degenerated cilia, mitochondrial swelling and enlarged endoplasmic reticulum. Based on all essential analysis, the present study revealed the distribution of the H9N2 virus of G1 genotype in Punjab, Pakistan, with mild to moderate pathogenicity.

Surtos frequentes do vírus da gripe aviária H9N2 no Paquistão revelaram que esse subtipo se tornou endêmico na avicultura e, além das perdas econômicas, representa uma ameaça à saúde pública. O presente estudo descreve a caracterização molecular e as alterações patológicas em frangos de corte naturalmente infectados com a atual cepa H9N2 e sua dinâmica filogenômica. Neste estudo, amostras de tecidos (traqueia, pulmões, rim e intestino) de 100 lotes comerciais de frangos foram coletadas de julho de 2018 a agosto de 2019. As amostras foram submetidas à detecção molecular, filogenia e posterior exame patológico. O comprimento completo do gene HA foi amplificado com sucesso em cinco amostras. O sequenciamento de nucleotídeos revelou amostras positivas colocadas em um clado pertencente à sublinhagem B2 do genótipo G1 e categorizado como LPAIV com base na sequência de aminoácidos do gene da hemaglutinina (HA) no local de clivagem (PAKSSR/G). A análise genética do gene da HA revelou: nt = 80,5%-99,5%; aa = 83,8%-98,9% de homologia com cepas de H9N2 relatadas anteriormente no Paquistão e em países vizinhos (A/Quail/Hong Kong/G1/97). As lesões macroscópicas incluíram aerossaculite leve, hemorragias leves, congestão difusa e exsudato purulento na mucosa traqueal, cilindro fibrinonecrótico no lúmen da traqueia e congestão pulmonar leve. As alterações histopatológicas incluíram descamação de células epiteliais, infiltração de células inflamatórias na traqueia, infiltração de células mononucleares (MNCs), congestão pulmonar e exsudato no lúmen dos parabrônquios, congestão peritubular nos rins com degeneração das células epiteliais tubulares, alterações degenerativas nas células epiteliais das vilosidades intestinais e hiperplasia de células caliciformes. A análise imunoistoquímica confirmou a presença do antígeno AIVH9N2 na traqueia, nos pulmões, no rim e no intestino. A microscopia eletrônica revelou alterações ultraestruturais na traqueia, incluindo cílios degenerados, inchaço mitocondrial e retículo endoplasmático aumentado. Com base em todas as análises, o presente estudo revelou a distribuição do vírus H9N2 do genótipo G1 em Punjab, Paquistão, com patogenicidade de leve a moderada.

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Abstract: The influenza-like illness (ILI) sentinel surveillance operates in Brazil to identify respiratory viruses of public health relevance circulating in the country and was first implemented in 2000. Recently, the COVID-19 pandemic reinforced the importance of early detection of the circulation of new viruses in Brazil. Therefore, an analysis of the design of the ILI sentinel surveillance is timely. To this end, we simulated a sentinel surveillance network, identifying the municipalities that would be part of the network according to the criteria defined in the design of the ILI sentinel surveillance and, based on data from tested cases of severe acute respiratory illness (SARI) from 2014 to 2019, we drew samples for each sentinel municipality per epidemiological week. The draw was performed 1,000 times, obtaining the median and 95% quantile interval (95%QI) of virus positivity by Federative Unit and epidemiological week. According to the ILI sentinel surveillance design criteria, sentinel units would be in 64 municipalities, distributed mainly in capitals and their metropolitan areas, recommending 690 weekly samples. The design showed good sensitivity (91.65% considering the 95%QI) for qualitatively detecting respiratory viruses, even those with low circulation. However, there was important uncertainty in the quantitative estimate of positivity, reaching at least 20% in 11.34% of estimates. The results presented here aim to assist in evaluating and updating the ILI sentinel surveillance design. Strategies to reduce uncertainty in positivity estimates need to be evaluated, as does the need for greater spatial coverage.

Resumen: La vigilancia centinela de la enfermedad tipo infuenza (ETI) funciona en Brasil para identificar los virus respiratorios de importancia para la salud pública que circulan en el país y comenzó a ser implementada en 2000. Recientemente, la pandemia de COVID-19 ha reforzado la importancia de la detección temprana de la circulación de nuevos virus en el territorio brasileño. Así, se hace oportuno un análisis del diseño de la vigilancia centinela de la ETI. Para ello, simulamos una red centinela identificando los municipios que formarían parte de la red según los criterios definidos en el diseño de la vigilancia centinela de la ETI y, a partir de los datos de casos testados de infección respiratoria aguda grave (IRAG) de 2014 a 2019, se extrajeron muestras para cada municipio centinela por semana epidemiológica. El sorteo se repitió 1.000 veces y se obtuvo la mediana y el intervalo cuantílico del 95% (IC95%) de la positividad por virus, por Unidad Federativa y semana epidemiológica. Según los criterios del diseño de la vigilancia centinela de la ETI, unidades centinelas estarían en 64 municipios, distribuidas principalmente en capitales y zonas metropolitanas de las capitales, preconizando 690 muestras semanales. El diseño presentó una buena sensibilidad (total de 91,65% considerando el IC95%) para la detección cualitativa de los virus respiratorios, incluso los de baja circulación. Sin embargo, hubo una importante incertidumbre en la estimación cuantitativa de la positividad, alcanzando al menos el 20% en el 11,34% de las estimaciones. Los resultados presentados aquí tienen como objetivo ayudar en la evaluación y actualización del diseño de la red centinela. Es necesario evaluar las estrategias para reducir la incertidumbre en las estimaciones de positividad, al igual que la necesidad de una mayor cobertura espacial.

Resumo: A vigilância sentinela de síndrome gripal atua no Brasil identificando os vírus respiratórios de importância para a saúde pública circulantes no país, e começou a ser implementada em 2000. Recentemente, a pandemia de COVID-19 reforçou a importância da detecção precoce de novos vírus em circulação no território brasileiro. Assim, se faz oportuna uma análise do desenho da vigilância sentinela de síndrome gripal. Para tal, simulamos uma rede sentinela, identificando os municípios que fariam parte da rede segundo os critérios definidos no desenho da vigilância sentinela de síndrome gripal, e, a partir dos dados de casos testados de síndrome respiratória aguda grave (SRAG) de 2014 a 2019, sorteamos amostras para cada município sentinela por semana epidemiológica. O sorteio foi repetido mil vezes, obtendo-se a mediana e intervalo quantílico de 95% (IQ95%) da positividade para cada vírus por Unidade Federativa e semana epidemiológica. Segundo os critérios do desenho da vigilância sentinela de síndrome gripal, unidades sentinelas estariam em 64 municípios, distribuídas principalmente em capitais e suas zonas metropolitanas, o que preconizou 690 amostras semanais. O desenho apresentou boa sensibilidade (total de 91,65%, considerando o IQ95%) para a detecção qualitativa dos vírus respiratórios, mesmo os de baixa circulação. Porém, houve importante incerteza na estimativa quantitativa de positividade, chegando a, pelo menos, 20% em 11,34% das estimativas. Os resultados aqui apresentados visam auxiliar a avaliação e a atualização do desenho da rede sentinela. Estratégias para reduzir a incerteza nas estimativas de positividade precisam ser avaliadas, assim como a necessidade de maior cobertura espacial.

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Resumo O artigo analisa as reações dos católicos vinculados às associações leigas na cidade do Salvador, no período da gripe espanhola (1918) e da varíola (1919). Os jornais foram as principais fontes utilizadas para a identificação das festas e dos ritos, tanto dos praticados para pedir a intercessão dos santos quanto daqueles que foram suspensos em função da necessidade de isolamento social. Apesar de ambas as doenças serem transmissíveis e do curto espaço de tempo entre as duas epidemias, a análise das fontes evidenciou diferentes reações dos fiéis quanto às medidas de proteção e busca da cura.

Abstract This article analyzes the reactions of Catholics linked to lay associations in the city of Salvador, in the period of the Spanish flu (1918) and smallpox (1919). Newspapers were the main sources used to identify the festivals and rites, both those practiced to ask for the intercession of the saints, and those that were suspended due to the need for social isolation. In spite of both diseases being transmissible and the short interval between the two epidemics, the analysis of the sources showed different reactions from the faithful regarding the measures of protection and the search for a cure.

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INTRODUCCIÓN: En Chile, los virus respiratorios son una causa frecuente de neumonía adquirida en la comunidad (NAC), con admisión a unidades de paciente crítico en adultos. Los agentes etiológicos asociados son influenza A y B, virus respiratorio sincicial (VRS) y Hantavirus, sumándose el SARS-CoV-2 desde 2020. OBJETIVO: Identificar variables clínicas y de laboratorio asociadas a mortalidad a 30 días en NAC virales graves en un centro del sur de Chile. Metodología: Estudio observacional, se agruparon dos cohortes de pacientes con NAC grave según criterio IDSA/ATS (años 2013-2018, "No COVID-19") y año 2020 ("COVID-19"). Se recolectaron datos sociodemográficos, clínica, laboratorio y mortalidad a 30 días. Se utilizaron pruebas de Chi-cuadrado y Prueba t- student, para variables categóricas y continuas respectivamente. La mortalidad se evaluó mediante regresión logística binaria, con resultados reportados como Odd ratios (ORs). RESULTADOS: La mortalidad a 30 días fue: Hanta virus 54.5%, H1N1 36,8%, 30,4% otras influenza, 25% VRS y 23,6% para COVID-19. Sin diferencia significativa entre el tipo de virus (COVID-19 o NO COVID-19). La mortalidad se asoció con edad > 65 años (OR: 4,6; p 65 años, inmunosupresión, cianosis y uremia al ingreso se asociaron con mayor mortalidad a 30 días en los ingresos por NAC viral grave.

INTRODUCTION: Severe community-acquired pneumonia (CAP) due to respiratory viruses is highly prevalent in Chile. Common etiologies include Influenza A and B, respiratory syncytial virus (RSV), Hantavirus, and SARS-CoV-2 since 2020. OBJECTIVE: To identify clinical and laboratory features associated with 20-day mortality in severe viral CAP in a high complexity health care center in southern Chile. METHODS: The observational study included two cohorts of patients with severe CAP according to IDSA/ATS criteria: the years 2013-2018 (No COVID-19) and the year 2020 (COVID-19). Sociodemographic, clinical, laboratory, and 30-day mortality data were collected. We used Chi-square and Student's T for categorical and continuous variables. We used a binary logistic regression model for mortality analysis, reporting the results as Odd ratios (ORs). RESULTS: Mortality at 30 days was: Hantavirus 54.4%, Influenza H1N1 36.8%, other influenza 30.4%, RSV 25%, and COVID-19 23.6%. We found no significant difference regarding type of virus (COVID-19 or NO COVID-19). Mortality was associated with older age (OR: 4.6; p-value < 0.01), immunosuppression (OR: 5.8; p-value 0.01), and cyanosis (OR: 3.8, p-value 0.02). Conclusion: COVID-19 was not associated with an increased risk of 30-day mortality compared to other common respiratory viruses in our study. Older age, immunosuppression, and cyanosis were associated with higher risk among patients with severe viral CAP.

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No presente artigo, tecemos reflexões e apresentamos conceitos que têm orientado uma pesquisa nos registros de arquivos sobre a febre amarela e a gripe espanhola, nos acervos da Fundação Oswaldo Cruz, da Biblioteca Nacional e do Arquivo Nacional. A pesquisa é centrada na busca dos rastros e das ruínas desses eventos epidêmicos, mediante o método da montagem e com a perspectiva do limiar. Buscamos, por meio dessas materialidades, criar intervalos, experimentar e tecer brechas que prefiguram outros possíveis. Defendemos que, ao manejar, por meio da fabulação crítica, as formas como uma epidemia se faz aparecer, habilitamos a elaboração de uma imaginação política capaz de conferir ao futuro outras possibilidades e outros agenciamentos que não sejam a catástrofe e a melancolia

In this article we reflect on the presented concepts that have guided research in the archival records of Yellow Fever and Spanish Flu in the collections of the Fundação Oswaldo Cruz (Oswaldo Cruz Foundation), the Biblioteca Nacional (National Library), and the Arquivo Nacional (National Archive). The research is centered on the search for the traces and ruins of those epidemic events, through the method of montage and from the perspective of the threshold. We seek, by means of these materialities, to create intervals, to experiment, and to weave gaps that prefigure other possibilities. We argue that, by coping with, through critical fabulation, the ways in which an epidemic makes itself appear, we enable the elaboration of a political imagination capable of giving the future other possibilities and arrangements that are not the catastrophe and the melancholy

En el presente artículo hacemos reflexiones y presentamos conceptos que han guiado una investigación sobre los registros archivísticos de la fiebre amarilla y la gripe española en los acervos de la Fundação Oswaldo Cruz (Fundación Oswaldo Cruz), de la Biblioteca Nacional (Biblioteca Nacional y del Arquivo Nacional (Archivo Nacional). La investigación se centra en la búsqueda de los rastros y las ruinas de esos eventos epidémicos, mediante el método del montaje y la perspectiva del umbral. Buscamos, por medio de estas materialidades, crear intervalos, experimentar y tejer brechas que prefiguren otras posibilidades. Argumentamos que manejando, a través de la fabulación crítica, las formas en que se hace aparecer una epidemia, posibilitamos la elaboración de una imaginación política que dé al futuro otras posibilidades y disposiciones que no sean la catástrofe y la melancolía

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RESUMEN Introducción : La influenza es una causa importante de morbilidad y mortalidad en pacientes con enfermedades cardiovasculares (ECV). El objetivo de esta revisión sistemática actualizada y metaanálisis fue evaluar los efectos de la vacunación contra la influenza (VI) sobre la mortalidad y morbilidad en pacientes adultos con ECV. Métodos : Se realizó una revisión sistemática y un metaanálisis (PubMed, Cochrane Library, International Clinical Trials Registry Platform, y búsqueda manual en presentaciones en congresos de la especialidad), de ensayos clínicos aleatorizados publicados hasta abril de 2022 que investigaron si la VI reduce la mortalidad por todas las causas en pacientes adultos con ECV, incluyendo insuficiencia cardíaca (IC) y enfermedad de las arterias coronarias (EAC), en comparación con pacientes que no fueron vacunados. Resultados : Se analizaron un total de seis ensayos clínicos, que incluyeron 9316 pacientes. Cinco ensayos incluyeron pacientes con EAC, y uno con IC. El seguimiento medio fue de 16 ± 9,7 meses. La VI se asoció con una reducción de la mortalidad en comparación con el control, cociente de riesgos (RR) 0,67, intervalo de confianza del 95% (IC95%) 0,47-0,95; p = 0,03; I2 = 53%; y con una reducción de la mortalidad cardiovascular en comparación con el control, RR 0,64, IC95% 0,44-0,94; p = 0,02; I2 = 54%. El uso de la VI se asoció con una reducción no estadísticamente significativa de infarto de miocardio en comparación con el control, RR 0,82, IC95% 0,60-1,12; p = 0,57; I2 = 0%. Conclusión : En este metaanálisis de seis ensayos controlados aleatorizados, la VI se asoció con una reducción del riesgo relativo del 33% y del 36% de la mortalidad por todas las causas y cardiovascular, respectivamente, en pacientes con ECV. Intentamos promover un consenso con respecto a los beneficios persistentes de la vacuna contra la influenza en pacientes con ECV, incluyendo dos nuevos ensayos clínicos en EAC e IC, donde se confirma la asociación de la vacunación con la reducción de riesgo en sujetos con ECV.

ABSTRACT Background : Influenza is a major cause of morbidity and mortality in patients with cardiovascular disease (CVD). The aim of this updated systematic review and meta-analysis was to evaluate the effect of influenza vaccination (IV) on morbidity and morbidity in adult patients with CVD. Methods : We conducted a systematic review and meta-analysis (PubMed, Cochrane Library, International Clinical Trials Registry Platform, and manual search of conference presentations) of randomized clinical trials published up to April 2022 analyzing whether IV reduced all-cause mortality in adult patients with CVD, including heart failure (HF) and coronary artery disease (CAD), compared with patients who were not vaccinated. Results : A total of six clinical trials comprising 9316 patients were analyzed. Five trials included CAD patients, and one trial included HF patients. Mean follow-up was 16 ± 9.7 months. Influenza vaccine was associated with a reduction of mortality compared to controls: relative risk (RR) 0.67 (95% CI, 0.47-0.95), p = 0.03; I2 = 53%, and with reduction of cardiovascular mortality compared to controls: RR 0.64 (95% CI, 0.44-0.94), p = 0.02; I2 = 54%. There was a non-statistically significant reduction in myocardial infarction compared to control: RR 0.82 (95% CI, 0.60-1.12), p = 0.57; I2 = 0%. Conclusion : In this meta-analysis of six randomized controlled clinical trials, IV was associated with a 33% and 36% relative risk reduction of all-cause mortality and cardiovascular mortality, respectively, in patients with CVD. We sought to promote consensus about the persistent benefits of influenza vaccination in patients with CVD by including two new clinical trials in CAD and HF, confirming the association of vaccination with risk reduction in subjects with CVD.

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Resumo O artigo analisa a epidemia de gripe de 1918 em Diamantina, no interior de Minas Gerais. A partir de fontes bibliográficas e documentais, discute como o ramal ferroviário da Estrada de Ferro Vitória a Minas, inaugurado em 1914, contribuiu para a chegada da doença à cidade que, até então, era representada no discurso de suas elites como isolada e salubre. Aborda as imbricadas relações entre a expansão dos sistemas de transportes pelo interior do Brasil, o meio ambiente, o conhecimento científico e os processos saúde/doença.

Abstract The article analyzes the influenza epidemic in 1918 in Diamantina, a town in the Brazilian state of Minas Gerais. Bibliographic and documental sources are used to investigate the influence of the Vitória-Minas railroad (Estrada de Ferro Vitória a Minas), opened in 1914, on the arrival of the disease in the town, which had until then been represented in the discourse of its elites as insalubrious and isolated. The interrelations between the spread of transportation systems across Brazil, the environment, scientific knowledge, and health-disease processes are discussed.

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Abstract Placebo use in clinical trials, whenever a proven effective treatment exists, is one of the most debated topics in contemporary research ethics. This article addresses the ethical framework for placebo use in clinical trials assessing vaccine efficacy in pregnant women. Vaccine trial participants are healthy at the outset and some must be infected during the study to demonstrate the product's efficacy, meaning that placebo-treated participants are under risk of serious and irreversible harm. If effective vaccines exist, such risk precludes placebo use. This interdiction should be extended to any clinical trial of vaccine efficacy in pregnant women, because a demonstration of clinical efficacy in nonpregnant individuals and comparable immunogenic responses in pregnant women are predictors of efficacy in pregnancy as well. Moreover, product effectiveness in real-world use scenarios can be ascertained by observational studies conducted after its inclusion in vaccination campaigns.

Resumen El uso de placebo en ensayos clínicos es uno de los principales temas debatidos sobre la ética en investigación contemporánea cuando existe un tratamiento eficaz probado. Este artículo aborda la ética en el uso de placebo en ensayos clínicos sobre la eficacia de vacuna en mujeres embarazadas. Las participantes en los ensayos de vacunas estaban sanas al inicio del estudio, y algunas fueron vacunadas durante el estudio para demostrar la eficacia del producto. Las participantes tratadas con placebo corren el riesgo de sufrir daños graves e irreversibles. Si existen vacunas efectivas, este riesgo impide el uso de placebo. Este impedimento debe extenderse a cualquier ensayo clínico de eficacia de vacuna en embarazadas, pues la eficacia clínica demostrada en mujeres no embarazadas y las respuestas inmunogénicas comparables con las embarazadas son predictores de eficacia en el embarazo. Además, la efectividad del producto se constata en estudios observacionales realizados tras las campañas de vacunación.

Resumo O uso de placebo em ensaios clínicos, quando um tratamento comprovadamente eficaz existe, é um dos principais tópicos debatidos na ética em pesquisa contemporânea. Este artigo aborda o quadro ético para o uso de placebo em ensaios clínicos que avaliam a eficácia de vacina em gestantes. Participantes em ensaios de vacina são saudáveis no início e alguns devem ser inoculados durante o estudo para demonstrar a eficácia do produto. Ou seja, participantes tratados com placebo estão sob risco de danos graves e irreversíveis. Se existirem vacinas eficazes, esse risco impede o uso de placebo. Essa interdição deve ser estendida a qualquer ensaio clínico de eficácia de vacina em gestantes, pois a demonstração de eficácia clínica em não gestantes e as respostas imunogênicas comparáveis em gestantes também são preditoras de eficácia na gravidez. Ademais, a eficácia do produto em cenários reais de uso pode ser verificada por estudos observacionais realizados após sua inclusão em campanhas de vacinação.

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The large amount of data generated during the COVID-19 pandemic requires advanced tools for the long-term prediction of risk factors associated with COVID-19 mortality with higher accuracy. Machine learning (ML) methods directly address this topic and are essential tools to guide public health interventions. Here, we used ML to investigate the importance of demographic and clinical variables on COVID-19 mortality. We also analyzed how comorbidity networks are structured according to age groups. We conducted a retrospective study of COVID-19 mortality with hospitalized patients from Londrina, Parana, Brazil, registered in the database for severe acute respiratory infections (SIVEP-Gripe), from January 2021 to February 2022. We tested four ML models to predict the COVID-19 outcome: Logistic Regression, Support Vector Machine, Random Forest, and XGBoost. We also constructed a comorbidity network to investigate the impact of co-occurring comorbidities on COVID-19 mortality. Our study comprised 8358 hospitalized patients, of whom 2792 (33.40%) died. The XGBoost model achieved excellent performance (ROC-AUC = 0.90). Both permutation method and SHAP values highlighted the importance of age, ventilatory support status, and intensive care unit admission as key features in predicting COVID-19 outcomes. The comorbidity networks for old deceased patients are denser than those for young patients. In addition, the co-occurrence of heart disease and diabetes may be the most important combination to predict COVID-19 mortality, regardless of age and sex. This work presents a valuable combination of machine learning and comorbidity network analysis to predict COVID-19 outcomes. Reliable evidence on this topic is crucial for guiding the post-pandemic response and assisting in COVID-19 care planning and provision.

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BACKGROUND: Indigenous peoples are vulnerable to pandemics, including to the coronavirus disease (COVID)-19, since it causes high mortality and specially, the loss of elderly Indigenous individuals. METHODS: The epidemiological data of severe acute respiratory syndrome (SARS) by SARS-CoV-2 infection or other etiologic agents (OEA) among Brazilian Indigenous peoples during the first year of COVID-19 pandemic was obtained from a Brazilian Ministry of Health open-access database to perform an observational study. Considering only Indigenous individuals diagnosed with SARS by COVID-19, the epidemiology data were also evaluated as risk of death. The type of sample collection for virus screening, demographic profile, clinical symptoms, comorbidities, and clinical evolution were evaluated. The primary outcome was considered the death in the Brazilian Indigenous individuals and the secondary outcome, the characteristics of Brazilian Indigenous infected by SARS-CoV-2 or OEA, as the need for intensive care unit admission or the need for mechanical ventilation support. The statistical analysis was done using Logistic Regression Model. Alpha of 0.05. FINDINGS: A total of 3,122 cases of Indigenous individuals with SARS in Brazil were reported during the first year of the COVID-19 pandemic. Of these, 1,994 were diagnosed with COVID-19 and 730/1,816 (40.2%) of them died. The death rate among individuals with SARS-CoV-2 was three-fold increased when compared to the group of individuals with OEA. Several symptoms (myalgia, loss of smell, and sore throat) and comorbidities (cardiopathy, systemic arterial hypertension, and diabetes mellitus) were more prevalent in the COVID-19 group when compared to Indigenous individuals with OEA. Similar profile was observed considering the risk of death among the Indigenous individuals with COVID-19 who presented several symptoms (oxygen saturation <95%, dyspnea, and respiratory distress) and comorbidities (renal disorders, cardiopathy, and diabetes mellitus). The multivariate analysis was significant in differentiating between the COVID-19-positive and non-COVID-19 patients [X2 (7)=65.187; P-value<0.001]. Among the patients' features, the following contributed in relation to the diagnosis of COVID-19: age [≥43 years-old [y.o.]; OR=1.984 (95%CI=1.480-2.658)]; loss of smell [OR=2.373 (95%CI=1.461-3.854)]; presence of previous respiratory disorders [OR=0.487; 95%CI=0.287-0.824)]; and fever [OR=1.445 (95%CI=1.082-1.929)]. Also, the multivariate analysis was able to predict the risk of death [X2 (9)=293.694; P-value<0.001]. Among the patients' features, the following contributed in relation to the risk of death: male gender [OR=1.507 (95%CI=1.010-2.250)]; age [≥60 y.o.; OR=3.377 (95%CI=2.292-4.974)]; the need for ventilatory support [invasive mechanical ventilation; OR=24.050 (95%CI=12.584-45.962) and non-invasive mechanical ventilation; OR=2.249 (95%CI=1.378-3.671)]; dyspnea [OR=2.053 (95%CI=1.196-3.522)]; oxygen saturation <95% [OR=1.691 (95%CI=1.050-2.723)]; myalgia [OR=0.423 (95%CI=0.191-0.937)]; and the presence of kidney disorders [OR=3.135 (95%CI=1.144-8.539)]. INTERPRETATION: The Brazilian Indigenous peoples are in a vulnerable situation during the COVID-19 pandemic and presented an increased risk of death due to COVID-19. Several factors were associated with enhanced risk of death, as male sex, older age (≥60 y.o.), and need for ventilatory support; also, other factors might help to differentiate SARS by COVID-19 or by OEA, as older age (≥43 y.o.), loss of smell, and fever. FUNDING: Fundação de Amparo à Pesquisa do Estado de São Paulo (Foundation for Research Support of the State of São Paulo; #2021/05810-7).

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ABSTRACT Objective. To describe the editorial processing time of published COVID-19 research articles and compare this with a similar topic, human influenza, and analyze the number of publications, withdrawals, and retractions. Methods. A descriptive-analytical study using PubMed on research articles with the MeSH terms human influenza and COVID-19. Time to acceptance (from submission to acceptance) and time to publication (from acceptance to publication) were compared. Retractions and withdrawals were reviewed both qualitatively and quantitatively. Results. There were 31 319 research articles on COVID-19 and 4 287 on human influenza published during 2020. The median time to acceptance for COVID-19 was lower than that for human influenza (8 vs. 92 days). The median time to publication for COVID-19 articles was shorter than those on human influenza (12 vs. 16 days); 47.0% of COVID-19 research articles were accepted within the first week of submission, and 19.5% within one day. There were 82 retractions and withdrawals for COVID-19 articles, 1 for human influenza, and 5 for articles that contain both terms; these were mainly related to ethical misconduct, and 27 (31.0%) were published by the same group of authors in one highest-quartile journal. Conclusions. The conundrum between fast publishing and adequate standards is shown in this analysis of COVID-19 research articles. The speed of acceptance for COVID-19 manuscripts was 11.5 times faster than for human influenza. The high number of acceptances within a day or week of submission and the number of retractions and withdrawals of COVID-19 papers might be a warning sign about the possible lack of a quality control process in scientific publishing and the peer review process.

RESUMEN Objetivo. Describir el tiempo de procesamiento editorial de los artículos de investigación sobre la COVID-19 publicados, compararlo con un tema similar, la gripe humana, y analizar el número de publicaciones realizadas, el de artículos retirados y el de retractaciones. Métodos. Usando PubMed, se llevó a cabo un estudio descriptivo y analítico sobre artículos de investigación con los términos en inglés correspondientes a "gripe humana" y "COVID-19" en el MeSH. Se compararon el tiempo de aceptación (desde la presentación hasta la aceptación) y el tiempo de publicación (desde la aceptación hasta la publicación). Se examinaron las publicaciones retiradas y las retractaciones de manera cualitativa y cuantitativa. Resultados. Hubo 31 319 artículos de investigación sobre la COVID-19 y 4 287 sobre la gripe humana publicados en el año 2020. La mediana del tiempo de aceptación de los artículos sobre la COVID-19 fue inferior que la mediana de la gripe humana (8 días en contraste con 92 días). La mediana del tiempo de publicación de los artículos sobre la COVID-19 fue menor que la de los artículos sobre la gripe humana (12 días en contraste con 16 días). El 47,0 % de los artículos de investigación sobre la COVID-19 se aceptaron en la primera semana de presentación, y el 19,5 %, en un día. Hubo 82 retractaciones y retiradas de artículos sobre la COVID-19, una sobre la gripe humana y 5 de artículos que contenían ambos términos; estas retractaciones y retiradas estuvieron relacionadas principalmente con faltas de conducta ética. Además, hubo 27 artículos (31,0 %) publicados por el mismo grupo de autores en una revista de cuartil más alto. Conclusiones. El dilema entre la publicación rápida y unas normas adecuadas se muestra en este análisis de artículos de investigación sobre la COVID-19. La velocidad de aceptación de los manuscritos sobre la COVID-19 fue 11,5 veces mayor que la velocidad de aceptación de los artículos sobre la gripe humana. El alto número de aceptaciones en un día o una semana desde la presentación y el número de retractaciones y retiradas de artículos sobre la COVID-19 podría ser un signo de advertencia acerca de la posible falta de un proceso de control de calidad en las publicaciones científicas y especialmente en el proceso de arbitraje.

RESUMO Objetivo. Descrever o tempo de processamento editorial dos artigos de pesquisa publicados sobre COVID-19, compará-lo com o de artigos sobre um tema semelhante (gripe humana) e analisar o número de publicações, suspensões e retratações. Métodos. Estudo descritivo-analítico. Foi realizada uma busca no PubMed usando os descritores MeSH "human influenza" e "COVID-19". O tempo até a aceitação (da submissão à aceitação) e o tempo até a publicação (da aceitação à publicação) foram comparados. Retratações e suspensões foram analisadas qualitativa e quantitativamente. Resultados. Foram publicados 31 319 artigos de pesquisa sobre a COVID-19 e 4 287 sobre a gripe humana em 2020. O tempo médio de aceitação de artigos sobre COVID-19 foi menor que o de artigos sobre gripe humana (8 versus 92 dias). O tempo médio até publicação dos artigos sobre COVID-19 foi menor que o de artigos sobre gripe humana (12 versus 16 dias); 47,0% dos artigos sobre COVID-19 foram aceitos na primeira semana após a submissão, e 19,5%, dentro de um dia. Houve 82 retratações e suspensões de artigos sobre COVID-19, 1 sobre gripe humana, e 5 de artigos que continham ambos os termos, principalmente relacionadas a má conduta ética; 27 (31,0%) desses artigos foram publicados pelo mesmo grupo de autores, em uma revista do mais alto quartil. Conclusões. O dilema entre publicar rapidamente e manter padrões adequados fica claro nesta análise de artigos sobre COVID-19. Manuscritos sobre COVID-19 foram aceitos 11,5 vezes mais rapidamente do que artigos sobre gripe humana. O alto número de aceitações em um dia ou semana após a submissão e o número de retratações e suspensões de artigos sobre COVID-19 alertam sobre uma possível falta de controle de qualidade na publicação científica e no processo de revisão por pares.

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Introducción: Constantin von Economo reportó en 1917 múltiples casos de manifestaciones neurológicas secundarias a la pandemia de la gripe española, clasificándolos en tres grandes grupos: forma somnolienta-oftalmopléjica, mutismo y la hipercinética, con secuelas similares a la enfermedad de Parkinson. Objetivo: presentar un caso de reciente aparición de patología rara en Cali, Colombia con manejo adecuado en unidad de cuidados intensivos (UCI). Presentación del caso: paciente de 9 años con disminución de la fuerza en extremidades, disartria y somnolencia, que inició deterioro neurológico progresivo requiriendo manejo en UCI. El equipo multidisciplinario diagnosticó encefalitis letárgica e iniciaron manejo con plasmaféresis e inmunosupresión con mejoría significativa. Discusión y conclusiones: como la prevalencia es escasa, el diagnóstico exige un alto índice de sospecha como la ocurrencia de un cuadro infeccioso previo al inicio de los síntomas, ya que se considera una reacción autoinmune cruzada contra antígenos de la sustancia nigra. En algunos casos hay alteraciones en los estudios imagenológicos o en citoquímico de líquido cefalorraquídeo. El manejo con pulsos de metilprednisolona y filtración de plasma con plasmaféresis brinda mejoría significativa con disminución de las secuelas a futuro.

Introduction: In 1917, Constantin von Economo reported multiple cases of neurological manifestations secondary to the Spanish flu pandemic. He classified them into three main clinical forms: somnolent-ophthalmoplegic, mutism and hyperkinetic, causing sequelae resembling Parkinson ́s disease. Objective: to present a case of a recent appearance rare disease entity, in Cali Colombia, receiving appropriate management in the Intensive Care Unit (ICU). Case presentation: 9-year-old patient presenting with limb muscle weakness, dysarthria and somnolence, evidencing progressive neurological deterioration requiring admission to the ICU for management. A diagnosis of encephalitis lethargica (EL) was made by the attending multidisciplinary team and management with plasmapheresis and immunosuppression was started, obtaining significant improvement. Discussion and conclusions: as the prevalence is low, the diagnosis requires a high level of suspicion in cases presenting with infectious conditions prior to the development of symptoms, since it is considered an autoimmune cross-reaction against substantia nigra antigens. Alterations in brain imaging or in cerebrospinal fluid cytometry may be found in some cases. Management with methylprednisolone pulse therapy and filtration plasmapheresis provides significant improvement with a decrease in future sequelae.

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Influenza is a severe, vaccine-preventable disease. Vaccination programs across Latin American countries show contrasting coverage rates, from 29% in Paraguay to 89% in Brazil. This study explores how national influenza vaccination programs in the chosen South American countries address vaccine confidence and convenience, as well as complacency toward the disease. Barriers and facilitators to influenza vaccination programs in their relation to vaccine hesitancy were observed by documentary analysis and interviews with 38 national immunization program officers in high- (Brazil and Chile) and low-performing (Paraguay, Peru, and Uruguay) countries. Influenza vaccination policies, financing, purchasing, coordination, and accessibility are considered good or acceptable. National communication strategies focus on vaccine availability during campaigns. In Chile, Paraguay, and Uruguay, anti-vaccine propaganda was mentioned as a problem. Programming and implementation face human resource shortages across most countries. Statistical information, health information systems, and nominal risk-group records are available, with limitations in Peru and Paraguay. Health promotion, supervision, monitoring, and evaluation are perceived as opportunities to address confidence and complacency. Influenza vaccination programs identify and act on most barriers and facilitators affecting influenza vaccine hesitancy via supply-side strategies which mostly address vaccine convenience. Confidence and complacency are insufficiently addressed, except for Uruguay. Programs have the opportunity to develop integral supply and demand-side approaches.

La gripe es una enfermedad grave, prevenible mediante vacunas con sus correspondientes programas en países latinoamericanos, informando sobre tasas contrastadas de cobertura, desde el 29% en Paraguay al 89% en Brasil. Este artículo investiga cómo los programas nacionales contra la gripe en países seleccionados de Suramérica abordan la confianza en la vacuna y su conveniencia, así como también la complacencia hacia la enfermedad. Las barreras y facilitadores del programa de vacunación de la gripe, en su relación con la vacilación hacia la vacuna, se observaron mediante análisis documental y entrevistas a 38 a cargo de los programas nacionales de inmunización en países con alto (Brasil y Chile) y bajo desempeño (Paraguay, Perú y Uruguay). Políticas de vacunación contra la gripe, financiamiento, compras coordinación y accesibilidad fueron consideradas como buenas o aceptables. Las estrategias nacionales de comunicación se centran en la disponibilidad de la vacuna durante las campañas. En Chile, Paraguay y Uruguay la propaganda antivacunas fue mencionada como un problema. La planificación e implementación enfrentan escasez de recursos humanos en la mayoría de países a través de la mayoría de países. Los sistemas de información en salud, estadísticas y registros nominales por grupos de riesgo se encuentran disponibles con limitaciones en Perú y Paraguay. La promoción de la salud, supervisión, monitoreo y evaluación son percibidos como oportunidades para abordar la confianza y complacencia. Los programas de vacunación contra la gripe actúan principalmente sobre las barreras y facilitadores que afectan la vacilación a vacunarse mediante estrategias del lado de la demanda, las cuales en su mayor parte van dirigidas a contrarestar la conveniencia. La confianza y complacencia son insuficientemente abordadas en todos los países, excepto en Uruguay. Los programas tienen la oportunidad de desarrollar estrategias que aborden tanto el lado de la oferta como de la demanda.

A influenza é uma doença grave, imunoprevenível, para a qual os programas de vacinação nos países latino-americanos apresentam taxas de cobertura contrastantes, desde 29% no Paraguai até 89% no Brasil. O artigo explora de que maneira os programas nacionais de influenza em países selecionados da América do Sul lidam com a confiança e a conveniência da vacina, assim como, a acomodação em relação à doença. As barreiras e facilitadores dos programas de vacinação contra influenza foram observados em relação à hesitação vacinal, através de análise documental e entrevistas com 38 autoridades de programas nacionais de imunização em países com desempenho alto (Brasil e Chile) e baixo (Paraguai, Peru e Uruguai). As políticas de vacinação contra influenza, financiamento da compra de vacinas, coordenação e acessibilidade são consideradas boas ou aceitáveis. As estratégias nacionais de comunicação estão concentradas na disponibilidade durante campanhas. No Chile, Paraguai e Uruguay, a propaganda antivacina foi mencionada enquanto problema. A programação e a implementação enfrentam escassez de recursos humanos na maioria dos países. Dados estatísticos, sistemas de informação em saúde e registros nominais de grupos de risco estão disponíveis, com limitações no Peru e no Paraguai. A promoção da saúde, supervisão, monitoramento e avaliação foram percebidas como oportunidades para tratar da confiança e da acomodação. Os programas de vacinação contra influenza identificam e agem sobre a maioria das barreiras e facilitadores que afetam a hesitação vacinal através de estratégias do lado da oferta, tratando principalmente da conveniência da vacina. A confiança e a acomodação não são tratadas de maneira suficiente, com exceção notável do Uruguai. Os programas têm a oportunidade de desenvolver abordagens que integram os lados da oferta e da procura.

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BACKGROUND: Knowledge about COVID-19 in pregnancy is limited, and evidence on the impact of the infection during pregnancy and postpartum is still emerging. AIM: To analyze maternal morbidity and mortality due to severe acute respiratory infections (SARI), including COVID-19, in Brazil. METHODS: National surveillance data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) was used to describe currently and recently pregnant women aged 10-49 years hospitalized for SARI from January through November, 2020. SARI cases were grouped into: COVID-19; influenza or other detected agent SARI; and SARI of unknown etiology. Characteristics, symptoms and outcomes were presented by SARI type and region. Binomial proportion and 95% confidence intervals (95% CI) for outcomes were obtained using the Clopper-Pearson method. RESULTS: Of 945,460 SARI cases in the SIVEP-Gripe, we selected 11,074 women aged 10-49 who were pregnant (7964) or recently pregnant (3110). COVID-19 was confirmed in 49.4% cases; 1.7% had influenza or another etiological agent; and 48.9% had SARI of unknown etiology. The pardo race/ethnic group accounted for 50% of SARI cases. Hypertension/Other cardiovascular diseases, chronic respiratory diseases, diabetes, and obesity were the most common comorbidities. A total of 362 women with COVID-19 (6.6%; 95%CI 6.0-7.3) died. Mortality was 4.7% (2.2-8.8) among influenza patients, and 3.3% (2.9-3.8) among those with SARI of unknown etiology. The South-East, Northeast and North regions recorded the highest frequencies of mortality among COVID-19 patients. CONCLUSION: Mortality among pregnant and recently pregnant women with SARIs was elevated among those with COVID-19, particularly in regions where maternal mortality is already high.

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Resumen El desarrollo de la pandemia de la covid-19 ha motivado un renovado interés por la gripe de 1918-1919 para buscar elementos que facilitaran la comprensión de la experiencia presente, pero también como oportunidad para reevaluar la grave crisis sanitaria del siglo XX a la luz de lo que estamos viviendo. En este contexto y con ese objetivo se inserta esta reflexión histórica sobre estos dos fenómenos pandémicos, que muestra los paralelismos existentes y la necesidad de una toma de conciencia de que nuestro modelo de sociedad está en crisis y se requiere una transformación profunda.

Abstract The rise of the covid-19 pandemic has led to renewed interest in the 1918-1919 influenza in search of aspects that might help us understand the current situation, but also as an opportunity to re-evaluate the serious twentieth-century health crisis in light of what we are experiencing now. In this context and with that goal, this historical reflection shows the parallels that exist and the need for a realization that our model of society is undergoing a crisis and requires profound transformation.

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OBJECTIVE: To identify factors associated with the risk of death in adolescent and adult inpatients with laboratory-positive (reverse-transcription polymerase chain reaction) influenza in Mexico during consecutive influenza seasons (2018-2020). METHODS: A retrospective cohort study used national surveillance system data, enrolling 3.422 individuals. The association between various risk factors and 30-day in-hospital lethality were evaluated through risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: The lethality rate was 18.1%. Flu vaccination history (RR=0.56, 95% CI 0.42-0.78), early antiviral drug administration (≤2 days from symptom onset [reference ≥5 days], RR=0.68, 95% CI 0.58-0.81), and a history of asthma (RR=0.66, 95% CI 0.47-0.95) showed protective effects against influenza-attributable death. Mechanical ventilator support produced the highest increase in death risk (RR=3.31, 95% CI 2.89-3.79). Male sex, older age, AH1N1 subtype, and other chronic diseases were also associated with fatal in-hospital influenza-related outcomes. CONCLUSIONS: Our findings highlight the major relevance of promoting immunization in high-risk individuals, together with ensuring early and effective antiviral management in suspected influenza cases.

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